Rehabilitation Medicine

Objective: To evaluate the efficacy of Qigong in rehabili tation for patients with burnout. Design: Prospective, randomized controlled trial. Subjects: Eighty-two patients (68 women and 14 men, mean age 44.3 (standard deviation 9.1) years) diagnosed with burnout. Methods: Basic care was offered to both the intervention and the control group. Patients in the intervention group received basic care and, in addition, performed Qigong twice a week for 12 weeks. Psychological variables, health-related quality of life, perceived relaxation and physical measurements were assessed at baseline and after the intervention period. Results: No significant difference in treatment efficacy between the groups was found by either intention-to-treat or per-protocol analyses. Both groups improved significantly over time, with reduced levels of burnout, fatigue, anxiety and depression, and increased dynamic balance and physical capacity. Conclusion: In this study, a Qigong intervention twice a week for 12 weeks had no additional effect beyond basic care for patients with burnout.

To compare the effects of group-based and individual-based motor skill training on motor performance in children with developmental coordination disorder. Design: Randomized controlled pilot intervention study. Subjects/patients: Twenty-three children (4 girls) with developmental coordination disorder (mean age (standard deviation (SD)) 8 years (1 year and 2 months)). Methods: Twelve children were randomly assigned to undergo a motor training programme once a week for 8 consecutive weeks in a group setting, and 11 children received the same training on an individual basis during the same period. Each child was also instructed to perform home exercises on a daily basis. The Movement Assessment Battery for Children (MABC) was used to assess motor ability. Home exercise compliance and parental satisfaction with the programmes were also evaluated. Results: A significant reduction in the MABC total impairment score was found following both group-based (mean-4.4 (SD 5.0), p = 0.003) and individual-based training (mean-5.2 (SD 5.1), p = 0.016). However, the change in total impairment score did not differ significantly between the 2 groups (p = 0.379). There was similarly no significant between-group difference in home exercise compliance (p = 0.288) and parental satisfaction (p = 0.379). Conclusion: Group-based training produced similar gains in motor performance to individual-based training. Groupbased training may be the preferred treatment option due to the associated cost savings.

as a special issue and supplement of the Journal of Rehabilitation Medicine. Gutenbrunner, Ward, and Chamberlain's (2007) supplement was written with the intent of stating the position of physical and rehabilitation medicine (PRM) in Europe. It defines the specialty, its work, the competencies of its practitioners and its relationships to other medical disciplines and allied health professionals. It also aims to ensure that PRM is seen as a European specialty, where high quality practitioners working within excellent standards of care can practice in accord with evidence-based medicine, as well as within the context of their different national practices. In doing so, the supplement describes training and skills of PRM specialists. It also provides the underlying principles of specialized rehabilitation, which will allow policymakers, health planners, medical and paramedical colleagues to identify how PRM works and how it can assist the process of allowing people with disabilities to participate fully in society.

Assistive technology is often recommended with the aim of increasing user independence and reducing the burden on informal caregivers. However, until now, there has been no tool to measure the outcomes of this process for caregivers. To describe the development of the Caregiver Assistive Technology Outcome Measure (CATOM), a tool developed to measure the impact of assistive technology interventions on the burden experienced by informal caregivers, and to undertake preliminary evaluation of its psychometric properties. Based on an existing conceptual framework, existing measures were reviewed to identify potential items in a preliminary version of the measure. Cognitive interviewing was used to identify items needing clarification. A revised CATOM and manual were then reviewed by clinicians. After revising some items based on the interview findings, the measure was piloted as part of an intervention study examining the impact of assistive technology on the users' informal caregiv...

Objective: The primary aim of this study was to compare the motor performance of physically well-recovered men with traumatic brain injury with that of healthy men. Design: Cross-sectional study in a national rehabilitation centre. Methods: Static and dynamic balance, agility and rhythm co-ordination of men with traumatic brain injury (n /34) and healthy controls (n /36) were assessed. Between-group differences in dynamic balance and agility were analysed by analysis of covariance and differences in static balance and rhythm co-ordination by logistic regression analysis. Cut-off points for clinical screening were determined by receiver operating characteristics analyses. Results: Men with traumatic brain injury had impaired balance and agility compared with healthy men and in a rhythm co-ordination test they had difficulties in starting and sustaining simultaneous rhythmical movements of hands and feet. In receiver operating characteristics analyses a running figure-of-eight test (agility), tandem walking forwards (dynamic balance) and rhythm co-ordination test with fast tempo were found the most sensitive and specific for distinguishing between men with traumatic brain injury and the healthy men. Conclusions: The impairments in motor performance of physically well-recovered patients with traumatic brain injury were obvious. The results of this study extend the knowledge of problems in motor performance among patients with traumatic brain injury and provide further information for clinical rehabilitation. (MMSE; normal /24/30), which is a widely used method for assessing cognitive status in adults, testing orientation, attention, immediate and short-term recall, language, and ability to follow simple verbal and written commands (12); and they were able (iv ) to maintain initial test positions; (v ) to perform a 2 km Walk Test developed at UKK Institute (13); and (vi ) to run a short distance. In addition, for the subjects with TBI, more than one year should have passed since the J

To assess the effectiveness of an interdisciplinary ambulatory rehabilitation programme for persons with spina bifida in an Australian community cohort. Fifty-four participants randomized to a treatment group (n = 27) for a high-intensity rehabilitation programme (with cognitive behavioural therapy) or a control group (n = 27) comprising usual care. Outcome measures include: Disability: Urogenital Distress Inventory (UDI6), Incontinence Impact Questionnaire-7 (IIQ7), American Urological Association Symptom Index (AUA), Wexner-Faecal Incontinence Score (WFIS), Neurological Disability Scale (NDS); Participation: Depression, Anxiety Stress Scale (DASS), McGill Quality of Life (MQOL), Brief COPE Scale, Genera-lized Self-efficacy Scale (GSE). Assessments were made at baseline and 3-months post-intervention. Adjusted for baseline disease and demographic covariates, the intervention group improved significantly at 3-month follow-up for primary and secondary outcomes, with moderate to large...

Objective: To explore the long-term outcomes of CONECSI (COping with NEuropathiC Spinal cord Injury pain), a multidisciplinary cognitive behavioural treatment programme in persons with spinal cord injury.Design: Long-term follow-up pre-post-intervention design.Subjects: A total of 29 subjects with a spinal cord injury and chronic neuropathic pain from 4 Dutch rehabilitation centres.Methods: Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire). Secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Random coefficient analysis was used for the analyses of measurements before (t1), immediate post-intervention (t2), and 6 (t3), 9 (t4), and 12 (t5) months follow-up.Results: The analyses showed significant improvements on pain intensity (t1–t2 and t1–t5) and pain-related disability (t1–t2, t1–t4, and t1–t5), anxiety a...

Proper assessment of disabilities is essential for rehabilitation of patients with Duchenne muscular dystrophy. The aim of this study was to identify and quantify the disabilities in children with Duchenne muscular dystrophy and correlate them with impairment. Thirty-one patients with Duchenne muscular dystrophy of age four years and above were studied. The motor functions were evaluated using total motor score, upper and lower extremity function grades and timed function tests. Disability was quanti ed with Barthel index. The mean scores of motor scales were: total motor score ¡52 § 7.8, total functional grade ¡4.4 § 1.9 and timed function score ¡12.5 § 5.8. Barthel index scores ranged from 45-95 with a mean of 70.8 § 12.7. Motor scales correlated with each other and with Barthel index. Thirty children had disabilities in multiple spheres of life, which were signi cantly in uenced by the motor power. Barthel index was useful in identifying and quantifying speci c areas of disabilities in these children. Evaluation of disabilities using speci c measures may be crucial for planning comprehensive management.

To develop and test the ability of a screening instrument to identify subgroups among primary healthcare patients with musculoskeletal pain. The Pain Belief Screening Instrument covers pain intensity, disability, self-efficacy, fear avoidance and catastrophizing. Design: Cross-sectional, correlational and comparative study. Subjects: Patients in primary healthcare (n 1 = 215; n 2 = 93) with a pain duration of 4 weeks or more were included. Methods: Items for the Pain Belief Screening Instrument were derived from principal component analyses of: the Self-efficacy Scale, the Tampa Scale of Kinesiophobia and the Catastrophizing subscale in the Coping Strategies Questionnaire. Cluster solutions of scores on the screening instrument and the original instruments were cross-tabulated. The reliability of items in the Pain Belief Screening Instrument was examined. Results: The screening instrument identified 2 groups: highor low-risk profile for pain-related disability. Validity was inbetween moderate and substantial (κ = 0.61, p < 0.001). The reliability of each item in the Pain Belief Screening Instrument in relation to the corresponding item in the original instruments was moderate to high (r s 0.50-0.80, p < 0.01). Conclusion: The screening instrument fairly well replicated subgroups identified by the original instruments. The reliability of items in the screening instrument was acceptable. Further testing of predictive validity for a primary healthcare population is needed.

Objective: To evaluate the safety and effect of a home training program on muscle function in 7 patients with sporadic inclusion body myositis. Design: The patients performed exercise 5 days a week over a 12-week period. Methods: Safety was assessed by clinical examination, repeated muscle biopsies and serum levels of creatine kinase.

Objectives: To summarise and critically evaluate the evidence from randomised clinical trials (RCTs) of t'ai chi as a treatment for patients with osteoarthritis (OA). Design: Eleven databases were searched from their inception to July 2010. RCTs testing t'ai chi against any type of controls in human patients with OA localised in any joints that assessed any type of clinical outcome measures were considered. Two reviewers independently performed the selection of the studies, data abstraction and validations. The risk of bias was assessed using Cochrane criteria. Results: Nine RCTs met the inclusion criteria, and most of them had significant methodological weaknesses. Six RCTs tested the effects of t'ai chi compared with that of an attention-control programme, a waiting list and routine care or self-help programmes in patients with OA in the knee. The meta-analysis suggested that t'ai chi has favourable effects on pain (n¼256; standard mean difference (SMD), À0.79; 95% CI À1.19 to À0.39; p¼0.0001; I 2 ¼55%), physical function (n¼256; SMD, À0.86; 95% CI À1.20 to À0.52; p<0.00001; I 2 ¼38%) and joint stiffness (n¼256; SMD, À0.53; 95% CI À0.99 to À0.08; p¼0.02; I 2 ¼67%). Conclusion: The results are encouraging and suggest that t'ai chi may be effective in controlling pain and improving physical function in patients with OA in the knee. However, owing to the small number of RCTs with a low risk of bias, the evidence that t'ai chi is effective in patients with OA is limited.

Objective: To explore the dose equivalence ratio and treatment costs for abobotulinumtoxinA and incobotulinumtoxinA for patients with focal dystonias. Design: Patient chart review. Subjects/Patients: Adult patients with blepharospasm (n = 19), cervical dystonia (n = 122), hemifacial spasm (n = 91) or segmental/generalized dystonia (n = 19) at a neurology outpatient clinic. Methods: Patients were switched from established abobo-tulinumtoxinA therapy to incobotulinumtoxinA at a ~4:1 unit ratio. Dose requirements, injection intervals, treatment efficacy, and adverse events were evaluated for a period of ≥ 1 year. Results: Patients were switched from abobotulinumtoxinA to incobotulinumtoxinA with a mean dose ratio of 4.07 (standard deviation (SD) 0.50). After switching, incobotulinum-toxinA dose requirements remained stable; the mean (SD) dose ratio at the end of the review period (52-219 weeks after switching) was 3.89 (SD 0.58). Injection intervals also remained stable after switching. Adverse events were injection site pain (n = 45) and bruising (n = 4). Five patients (2.0%) discontinued incobotulinumtoxinA treatment: 4 stopped receiving injections, and 1 reverted to abobotulinumtoxinA. Switching to incobotulinumtoxinA reduced the mean toxin expenditure to 76.7% of the cost of abobotulinumtoxinA. Conclusion: For patients with conditions commonly treated in dystonia clinics, switching from abobotulinumtoxinA to incobotulinumtoxinA, given at equivalent doses (~4:1 unit ratio) at similar intervals, was effective, well tolerated and achieved cost savings.

Loss of balance and falling are serious risk factors for patients with osteoporosis. Falls often result in fractures that require medical attention and may even be fatal. In addition to pharmacological therapy, there is clinical evidence to support the importance of exercise to prevent falls and improve balance. The effect of a 1-year complex balance-training programme, combining exercises to improve postural balance with aerobic elements, was studied in female patients with established osteoporosis. The women in the exercise group improved their postural control and balance, increased their aerobic capacity, and had fewer falls than those who did not undertake the exercise programme. Objective: To investigate the effect of a 12-month complex balance-training programme on static and dynamic postural balance, aerobic capacity and frequency of falls in women with established osteoporosis. Design: Randomized controlled trial in which the intervention group was assigned a 12-month exercise programme (3 times a week for 30 min) and the control group had no intervention. Subjects: A total of 100 osteoporotic women with at least one previous fracture. Methods: Performance-based Timed Up and Go (TUG), Berg Balance Scale (BBS) and stabilometric platform tests were used to evaluate balance. Aerobic capacity was measured by bicycle ergometry. Frequency of falls was assessed using a falls diary. Results: After 1 year, there was a statistically significant difference between the improvement achieved in the intervention and control groups on the performance-based TUG, BBS and stabilometric platform tests (p < 0.05). Mean metabolic equivalent (MET) value decreased in the intervention group, from 4.91 to 3.82 (a significant difference from the change achieved in the control group; p = 0.05). Relative risk of falls was 0.534 at 1 year (p = 0.17). Conclusion: The 12-month balance-training programme significantly improved postural balance and increased aerobic capacity in women with established osteoporosis.

Objective: IMPACT-S is the screener part of the ICF Measure of Participation and ACTivities questionnaire. IMPACT-S consists of 33 items in 9 scales, reflecting the 9 activity and participation chapters of the International Classification of Functioning, Disability and Health (ICF). The reliability and validity of IMPACT-S as an independent brief measure of activities and participation was examined. Design: Repeated administration of a postal questionnaire.

Journal of Rehabilitation Medicine Appendix SI. Data extracted from included studies First author Year Reference Country Study design Setting Patient characteristics settings Intervention Control Follow-up time Withdrawal/Drop-outs Results: Function post-mTBI symptoms Psychological function Cognitive function Results: Activities and participation ADL and participation Return to work Use of healthcare services Results: Quality of life Life satisfaction Health status Risk of bias Method of measurement Blinding Handling of missing data Comments

Objective: To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive ICF Core Set and a Brief ICF Core Set for rheumatoid arthritis. Methods: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF, and based on these preliminary studies, relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds.

To study the effectiveness of a 12-month exercise therapy on kinesiophobia and physical activity in patients with spondylolisthesis after lumbar spine fusion. Randomized controlled trial. Patients (n = 98) with spondylolisthesis who had undergone lumbar spine fusion. All patients (mean age 59 years) had received lumbar spine fusion surgery and identical postoperative instructions. Three months postoperatively, they were randomized into an exercise group (n = 48) or usual care group (n = 50). The exercise group received 12-month progressive home-based training with regular booster sessions, and the usual care group a single session of physiotherapy instruction. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK) and physical activity by the International Physical Activity Questionnaire (IPAQ) preoperatively, 3 months after lumbar spine fusion, and at the end of the 12-month intervention. Before the intervention, the median (first quartile; third quartile) of TSK w...

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.

Objective: To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of the Comprehensive ICF Core Set and the Brief ICF Core Set for stroke. Methods: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds.

Objective: To report on the results of the consensus process to develop the first version of both a Comprehensive ICF Core Set and a Brief ICF Core Set for breast cancer. Methods: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was realized. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies, relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds.

BACKGROUND Military personnel have an elevated risk of sustaining mild traumatic brain injuries (mTBI) and postconcussion symptoms (PCS). Smartphone apps that provide psychoeducation may assist those with mTBI or PCS to overcome unique barriers that military personnel experience with stigma and access to health care resources. OBJECTIVE This study aims to (1) use the Mobile Application Rating Scale (MARS) to evaluate smartphone apps purporting to provide psychoeducation for those who have sustained an mTBI or a PCS; (2) explore the relevance, utility, and effectiveness of these apps in facilitating symptom management and overall recovery from mTBI and PCS among military personnel; and (3) discuss considerations pertinent to health care professionals and patients with mTBI when considering the use of mobile health (mHealth), including apps for mTBI psychoeducation. METHODS A five-step systematic search for smartphone apps for military members with mTBI or PCS was conducted on January...

To determine the psychometric properties of the Neck Bournemouth Questionnaire in patients with chronic neck pain, using Rasch analysis. A sample of 161 subjects with chronic neck pain was assessed with the Neck Bournemouth Questionnaire. Before performing Rasch analysis, we examined the structure of the scale with factor analysis. The goodness-of-fit of the data to the model, thresholds ordering, unidimensionality, local independence of the items, differential item functioning, person separation index, and mean person&#39;s location were assessed. Both exploratory and confirmatory factor analyses supported the presence of 2 factors. Only Factor 1 needed a modification (item 7 removal) in order to achieve the fit to the Rasch model (χ2 = 10.65, df 8, p = 0.22). The person separation index was 0.80 and the mean location of persons 0.48 (standard deviation (SD) 1.02). Factor 2 (items 4 and 5) fitted the model without modifications (χ2 = 3.86, df 4, p = 0.42). Its person separation ind...

Objective: carbon-composite knee-ankle-foot orthoses (KAFOs) on energy cost of walking in patients with former polio who normally wear a conventional leather/metal KAFO or plastic/metal KAFO. Design: Participants: 55 years). Intervention: -Outcome measures: isfaction. Results: ---Conclusion: In patients with former polio, carbon-composite --J Rehabil Med 39 Fig. 2. Averaged data over all subjects for the gait parameters that are associated with the reduction in net EC (energy cost) of walking: (upper) Sagittal knee angle during mid-stance; (middle) Forward excursion of the centre of pressure; (lower) Sagittal ankle moment during terminal stance. Data are shown for the old KAFO (dashed lines) and new KAFO (solid lines). Arrows represent the direction of improvement.

The Stroke Rehabilitation Assessment of Movement (STREAM) instrument is used to measure motor and mobility problems in patients who have experienced a stroke. The purposes of the study were to examine the interrater reliability, concurrent and convergent validity of the STREAM instrument in stroke patients. Fifty-four stroke patients participated in the study. For the purpose of interrater reliability, the STREAM instrument was administered by two raters on each patient within a 2-day period. Validity was assessed by comparing the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; scores on the STREAM instrument with those obtained from the other well-established measures. Weighted kappa statistics for inter-rater agreement on scores for individual items ranged from 0.55 to 0.94. The intraclass correlation coefficient for the total score was 0.96 indicating very high inter-rater reliability. The intraclass correlation coefficients were also very high in each of the subscales. The total STREAM score was moderately to highly associated with the score of the Barthel Index and Fugl-Meyer motor assessment scale, rho = 0.67, and 0.95, respectively. The STREAM subscale scores were closely associated with scores of the other well-validated measures. Our results demonstrate that consistent and valid information can be obtained from the STREAM instrument and support its use in the value of the STREAM evaluation of motor and mobility recovery in persons who have experienced a stroke.

The Bobath concept, also known as neurodevelopmental treatment, is a widely used approach in the rehabilitation of hemiparetic subjects in many countries. Despite 50 years of clinical use its effectiveness is questionable. This paper aims to examine whether there is evidence to accept neurodevelopmental treatment as an effective approach. A systematic literature search was undertaken. Fifteen trials have been selected and classified according to a 5-level hierarchic scale of evidence for clinical interventions. Results show no evidence proving the effectiveness of neurodevelopmental treatment or supporting neurodevelopmental treatment as the optimal type of treatment, but neither do methodological limitations allow for conclusions of non-efficacy. Methodological aspects of selected studies are discussed and requirements for further research are suggested.

Report about the Maui-Molokai Adult Drug Court, which I created and which achieved over 12 years an 84% success rate for graduates, measured by whether a graduate committed another felony crime.  The program has  many innovative features, not utilized by other drug courts.  So far as I know, this is the only article that describes evolution of a drug court.

Objectives: To describe the occurrence of kinesiophobia and to investigate the association between kinesiphobia and pain variables, physical exercise measures and psychological characteristics in patients with musculoskeletal pain. Design: A prospective descriptive study involving 2 selected physiotherapy departments within a primary healthcare setting in the south-west of Sweden. Patients: Included were 140 of 369 (38%) consecutive patients (aged between 18 and 65 years) with musculoskeletal pain. Methods: Questionnaires including background data, pain variables, physical exercise measures and psychological characteristics were sent to the patients prior to their appointment with the physiotherapist. A simple and a multiple logistic regression model were performed to identify associations among the variables where kinesiophobia was defined as the dependent variable. Results: A high degree of kinesiophobia and psychological distress were observed in approximately 50% of the responders. According to the simple logistic regression analysis the factors that seemed to be associated with kinesiophobia were interference, disability, pain severity, pain intensity, life control, affective distress, depressed mood and solicitous response. The multiple logistic regression analysis showed no significant associations. Conclusion: Kinesiophobia is a commonly seen factor among patients with musculoskeletal pain, which ought to be taken into consideration when designing and performing rehabilitation programmes.

Objective: to determine the effectiveness of mobility device interventions in terms of activity and participation for people with mobility limitations. Design: Systematic review. Search of 7 databases during the period 1996 to 2008. Methods: controlled studies and non-controlled follow-up studies were included if they covered both baseline and follow-up data and focused on activity and participation. Study participants had to be aged over 18 years with mobility limitations. Mobility device interventions encompassed crutches, walking frames, rollators, manual wheelchairs and powered wheelchairs (including scooter types). two reviewers independently selected the studies, performed the data extraction, and 4 reviewers assessed the studies' methodological quality. Disagreements were resolved by consensus. Results: eight studies were included: one randomized controlled trial, 4 controlled studies, and 3 follow-up studies that included before and after data. two studies dealt with the effects of powered wheelchair interventions and the other studies with various other types of mobility device. two studies were of high, internal and external methodological quality. interventions were found to be clinically effective in terms of activity and participation in 6 studies. the results did not, however, give a unanimous verdict on the effectiveness of mobility devices in enhancing the activity and participation of mobility impaired people. Conclusion: interventions and outcome measurement methods varied between the studies; consequently, it was not possible to draw any general conclusions about the effectiveness of mobility device interventions. However, evidence was found that mobility devices improve users' activity and participation and increase mobility. A lack of high-quality research hampers conclusions about effectiveness. More original, well-designed research is required.

To provide an update on rehabilitation in Madagascar by using local knowledge to outline the potential barriers and facilitators for implementation of the World Health Organization (WHO) Disability Action Plan (DAP). A 14-day extensive workshop programme (September-October 2014) was held at the University Hospital Antananarivo and Antsirabe, with the Department of Health Madagascar, by rehabilitation staff from Royal Melbourne Hospital, Australia. Attendees were rehabilitation professionals (n=29) from 3 main rehabilitation facilities in Madagascar, who identified various challenges faced in service provision, education and attitudes/approaches to people with disabilities. Their responses and suggested barriers/facilitators were recorded following consensus agreement, using objectives listed in the DAP. The barriers and facilitators outlined by participants in implementing the DAP objectives include: engagement of health professionals and institutions using a multi-sectoral approach...

Objective: To study factors related to quality of life after a hypoxic period due to cardiac arrest. Design: Retrospective cohort study. Subjects: Eighty-eight survivors of out-of-hospital cardiac arrest, admitted to a Dutch academic hospital between 2001 and 2006. Methods: Patients received a set of questionnaires at home. The main outcome measures were physical and mental quality of life (Medical Outcomes Study 36-item Short Form Health Survey; SF-36). Potential determinants were cognitive complaints, emotional problems (depression/anxiety), post-traumatic stress, fatigue, daily functioning and participation in society. Multiple linear regression analyses were performed with physical and mental quality of life as dependent variables. Results: Sixty-three (72%) patients responded. Mean time since cardiac arrest was 36 months (standard deviation (SD) 19) . Backward regression analyses showed that physical quality of life was significantly (p < 0.001, adjusted R 2 = 0.531) related to cognitive complaints (β = -0.378), instrumental daily life activities (β = 0.262), post-traumatic stress (β = -0.246) and fatigue (β = -0.226). Mental quality of life was significantly (p < 0.001, adjusted R 2 = 0.664) explained by anxiety/depression (β = -0.609), fatigue (β = -0.177) and cognitive complaints (β = -0.175). Conclusion: Quality of life is related to cognitive complaints, fatigue, anxiety/depression, post-traumatic stress and difficulties in daily activities in survivors of out-of-hospital cardiac arrest. Rehabilitation programmes for this group should specifically address these topics.