Introduction: Post-COVID syndrome (PCS) can lead to severe restrictions in the ability to work and participate in society and can lead to the development of depressive symptoms. The aim of this study was to investigate how many PCS patients suffer from clinically relevant depressive symptoms and to what extent PCS rehabilitation can modulate psychological symptoms as well as limitations in functional health. Methods: Prospective multicenter cohort study PoCoRe (N = 1,028). Assessment of depressiveness (PHQ-9, PHQ-2), fatigue (FSMC) and functional health and disability (WHO-DAS2.0). Frequency analyses, mean comparisons. Results: At the start of rehabilitation, 71.4% (n = 734) fulfilled the core symptoms of depressive disorders in general in the PHQ-2. In the screening-positive patients, the PHQ-9 total score was on average M = 23.74 (standard deviation = 4.43). As expected the depressive symptom burden was reduced more in depressed PCS patients (d = 0.50) than in nondepressed PCS patients (d = 0.32). Fatigue symptoms did not change. Functional health (WHO-DAS) improved above all in coping with everyday life (d = 0.71, or 1.04), and in the nondepressed patients also in mobility (d = 0.27). In the sociomedical assessment, 24.7% of the total samples were assessed as having an impaired capacity for the reference occupation and 19.5% as having an impaired capacity for the general labor market. Depressive patients had the worse sociomedical outcome. Conclusion: Depressiveness is common and can be well influenced by PCS rehabilitation. Fatigue is less easily influenced, which indicates that they are independent symptoms. Patients with persistent depression and fatigue have a poorer sociomedical prognosis.

BACKGROUND:The importance of dysfunctional coping strategies in the chronification of pain is well documented. The avoidance endurance model (AEM) has proven to be well-suited which, according to initial clinical experiences, is also well-suited to depicting dysfunctional illness behavior in post-COVID syndrome (PCS, COVID coronavirus disease). The aim of this study is to demonstrate which patterns occur and how frequently in PCS patients and whether they change in the context of multimodal rehabilitation. METHOD:As part of the PoCoRe multicenter study, N = 481 PCS rehabilitation patients were examined with respect to illness behavior according to the AEM at the start and end of rehabilitation. Frequency analyses, χ2-tests and Sankey diagrams were used. RESULTS:At the start of rehabilitation around 81.8% of PCS patients exhibited dysfunctional illness behavior, of which 57.7% were dysfunctional endurers (distress endurance response), in 24.1% fear avoidance was present, in 10.0% eustress endurance and in 8.2% an adaptive response. Over the course of rehabilitation the behavioral patterns shifted by 8.8% towards adaptive response and by 12.7% to eustress endurance, which mainly comes from the former distress endurance types (-6.7%). Fear avoidance decreased by approx. 4.8%. Within the individual AEM reaction patterns, dysfunctional patterns can change in favor of functional patterns as well as functional patterns in favor of dysfunctional patterns. CONCLUSION:The clear predominance of dysfunctional patterns in this highly chronified sample suggests that the avoidance endurance concept is also relevant in the chronification of fatigue in PCS. In contrast to chronic pain patients, however, the endurance patterns clearly predominate here. There was a clear shift towards the functional pattern during rehabilitation, which speaks in favor of modifiability; however, around 10-15% of patients developed in an unfavorable direction, which should be taken into account in treatment planning and investigated further.

Purpose The most common symptoms of PCS are persistent fatigue and cognitive impairment, which significantly affect participation in work and daily life. There is increasing evidence for the effectiveness of rehabilitative treatment approaches. Nevertheless, voices are being raised, especially in the social media, that negatively evaluate rehabilitation for PCS. The aim of this study was to objectify the subjective success of treatment and the satisfaction of inpatients with PCS with the rehabilitation. Methods As part of a prospective multicentre cohort study (n=1028), the subjective treatment success and patient satisfaction (ZUF-8) at the end of PCS rehabilitation were examined (PCS rehabilitation indications: Dual rehabilitation, psychosomatics, neurology and pneumology). Frequency analyses, mean value comparisons, correlation analyses and regression models were used. Results The subjective success of treatment was rated as good to very good across all PCS rehabilitation indications. Approximately 62% of PCS patients experienced improvement in physical symptoms, about 58% improvement in mental well-being. The general State of health and performance improved in 62% and 47% of patients, respectively. If all categories of treatment success are considered together, at least one area improved in 87.5%. Around 90% of PCS patients would recommend rehabilitation to others or return for treatment. Comparable results also showed that the treatment met the patients' needs. The vast majority of PCS patients (around 90%) would recommend the rehabilitation programme to others or return for treatement. Global patient satisfaction correlated to r=-0.727 (p<0.001) with the subjectively experienced psychological relief, but not with the 6-minute walking test (6MWT) as a somatic surrogate parameter. Regression analyses showed that only improvement in depression had a significant influence on patient satisfaction and subjective treatment success, but not improvement in walking distance or the socio-medical assessment (general labour market performance). Conclusion PCS rehabilitants were satisfied with the therapy programme across all indications examined and experienced successful treatment. The vast majority of PCS rehabilitants found a multimodal rehabilitation program to be helpful.

Bei der Chronifizierung von Schmerz ist die Bedeutung dysfunktionaler Copingstrategien gut belegt. Bewährt hat sich hier das Avoidance-Endurance-Modell (AEM), das sich nach ersten klinischen Erfahrungen auch beim Post-COVID-Syndrom (PCS; COVID „coronavirus disease“) gut eignet, um dysfunktionales Krankheitsverhalten abzubilden. Ziel der vorliegenden Studie ist es nachzuweisen, welche Muster bei Patienten mit PCS wie häufig vorkommen und ob sie sich im Rahmen einer multimodalen Rehabilitation (Reha) verändern. Im Rahmen der Multicenterstudie PoCoRe wurden N = 481 PCS-Rehabilitanden hinsichtlich des Krankheitsverhaltens nach dem AEM zu Reha-Beginn und -Ende untersucht. Häufigkeitsanalysen, Chi2-Test und Sankey-Diagramm kamen zur Anwendung. Zu Reha-Beginn wiesen etwa 81,8

OBJECTIVES:In patients with somatic illness and additional mental disorder, not only motor or sensory functions may be impaired, but also psychological capacities. These become more and more important for work ability in our modern working world. There are presently no data about the type and distribution of psychological capacity impairments in patients with comorbid somatic and mental disorders. These data are however important for estimation of diagnostic and therapy requirements. METHODS:402 orthopedic, cardiological, and neurological patients with additional mental disorders were investigated with a structured clinical assessment for mental disorders (MINI) and psychological capacity impairments (Mini-ICF-APP). RESULTS:In all three somatic indications at least half of the comorbid patients had any clinically relevant psychological capacity impairment. Neurological patients (67%) and orthopedic patients (72%) were more often affected than cardiological patients (50.5%). Orthopedic patients are slightly more impaired in self-care; neurological and orthopedic patients are more impaired in mobility; and cardiological patients are less impaired in assertiveness. CONCLUSION:In comparison of all three somatic patient groups with mental disorders the number of psychological capacity impairments is similar. In contrast to patients with mental disorders only (i. e. those without somatic comorbidity), the psychological impairment quality in comorbid patients may be influenced by the somatic illness. The data from this study are important in order to estimate diagnostic and therapeutic needs, such as capacity training or compensation of psychological capacity impairments.

Abstract Background: In patients with somatic illness and additional psychomental health problem, not only motor or sensory functions may be impaired, but also psychological skills which become more and more important for work ability in our modern working world. There are presently no data about the type and distribution of capacity impairments in patients with comorbid somatic and psychomental health problems. These data are however important for estimation of diagnostic and therapy requirements. This research thus investigates capacity impairment in patients who suffer from mixed somatic and mental health problems. Research questions are: (1) How many of patients with comorbid somatic and mental disorders suffer from clinically relevant capacity impairments according to Mini-ICF-APP? and (2) Do patients with different somatic diseaeses have different capacity impairments? Methods: 402 patients with comorbid mental and somatic health problems (out of 1016 screened patients) were in depth investigated in a clinical interview for mental disorders (MINI) and capacity limitations (Mini-ICF-APP). Results: At least half of the patients had any clinically relevant capacity impairment. Neurology patients (67%) and orthopedic patients (72%) were more often affected than cardiology patients (50.5%). Orthopedic patients are slightly more impaired in self-care, neurology and orthopedic patients are more impaired in mobility, and cardiology patients are less impaired in assertiveness.Conclusion: In comparison to patients with chronic mental health problems the number of capacity impairments is similar. The data from this study are important in order to estimate diagnostic and therapeutic needs in respect to capacity training or compensation of capacity impairments.

Background In Patients suffering from post-COVID syndrome, in addition to physical limitations, cognitive limitations, fatigue, dyspnea as well as depression and anxiety disorders may also be present. Up to now (as of May 2022), approx. 514 million people worldwide have been infected with SARS-CoV-2, in Germany this affects approx. 25 million. In Germany, 2.5 million people could potentially be affected by post-COVID syndrome. Post-COVID is thus a highly relevant public health issue. So far, there is no specific causal therapy for the post-COVID syndrome, but with multimodal symptom-oriented rehabilitation, the course can be favourably influenced. However, there is no study yet that focuses on patients in different rehabilitation indications and compares the focal symptomatology and coping strategies as well as the patients' benefit per indication. Methods/design As first objective, pulmonal, cardiac, neurological, cognitive or/and psychological functional impairments in rehabilitation patients after COVID-19 disease will be described. The second objective is the differentiated review of the specific rehabilitation measures, in the short term and in the longer term for the purpose of future prognoses and optimisation of therapeutic interventions. This prospective, non-randomised, controlled longitudinal study, plus multi-group comparisons will take place in seven rehabilitation clinics of different specialisations: cardiological rehab, pneumological rehab, neurological rehab, psychosomatic rehab. Within 12 months, 1000 cases across all participating centres will be included. Somatic and psychological testing will be conducted at three measurement points: Admission (t0), discharge (t1), 6-montas Catamnesis (t2). The patients receive the usual care according to the respective rehabilitation priorities, adapted to the special challenges of post-COVID symptoms. Patients of the post-COVID outpatient clinic without rehabilitation will be used as a control group. Discussion This study will precisely assess the extent to which subclinical neurological or/and psychological impairments are present in post-COVID-19 rehabilitation and the results will help, developing, providing and evaluating appropriate treatment concepts. This may also have relevant implications for the improvement of physical ability and quality of life in post-COVID-19 patients and increase the probability of return to work. Trial registration Z-2022-1749-8, registered 03. February 2022, https://studienanmeldung.zks-regensburg.de

Background: In patients with somatic illness and additional psychomental health problem, not only motor or sensory functions may be impaired, but also psychological skills which become more and more important for work ability in our modern working world. There are presently no data about the type and distribution of capacity impairments in patients with comorbid somatic and psychomental health problems. These data are however important for estimation of diagnostic and therapy requirements. This research thus investigates capacity impairment in patients who suffer from mixed somatic and mental health problems. Research questions are: (1) How many of patients with comorbid somatic and mental disorders suffer from clinically relevant capacity impairments according to Mini-ICF-APP? and (2) Do patients with different somatic diseaeses have different capacity impairments ? Methods: 402 patients with comorbid mental and somatic health problems (out of 1016 screened patients) were in depth investigated in a clinical interview for mental disorders (MINI) and capacity limitations (Mini-ICF-APP). Results: At least half of the patients had any clinically relevant capacity impairment. Neurology patients (67%) and orthopedic patients (72%) were more often affected than cardiology patients (50.5%). Orthopedic patients are slightly more impaired in self-care, neurology and orthopedic patients are more impaired in mobility, and cardiology patients are less impaired in assertiveness. Conclusion: In comparison to patients with chronic mental health problems the number of capacity impairments is similar. The data from this study are important in order to estimate diagnostic and therapeutic needs in respect to capacity training or compensation of capacity impairments.

Fatigue ist eines der häufigsten Symptome bei Patienten mit Multipler Sklerose (MS) 1 2. Fatigue kann das Symptom sein, das die berufliche Leistungsfähigkeit am gravierendsten beeinträchtigt 3 4. Der Großteil der MS-Patienten ist im erwerbsfähigen Alter. Für die sozialmedizinische Leistungsbeurteilung ist besonders problematisch, dass es sich bei der Fatigue um ein subjektives Phänomen handelt, dass nicht objektiv messbar ist.

BACKGROUND:Studies analyzing risk factors of weaning failure in neurological and neurosurgical early rehabilitation (NNER) patients are rare.AIM:The aim of this study was to identify clinical factors influencing the weaning of NNER patients.DESIGN:An observational, retrospective data analysis of a German multicenter study was performed.SETTING:German neurological early rehabilitation centers.POPULATION:Inpatient ventilated NNER patients (N.=192) were enrolled in the study.METHODS:Demographical data, main diagnosis, medical devices, special medical care and assessment instruments of functional abilities, consciousness and independence in activities of daily living were accrued and compared between patients with and without successful weaning. The prognostic power of factors associated with weaning success/failure was analyzed using binary logistic regression.RESULTS:In total, 75% of the patients were successfully weaned. Colonization with multi-drug resistant bacteria and the need for dialysis were independent predictors of weaning failure. Successfully weaned patients had a shorter length of stay, better functional outcome, and lower mortality than non-successfully weaned patients.CONCLUSIONS:Successfully weaned patients differ from patients with weaning failure in several clinical variables. All these variables are associated with the morbidity of the patient, indicating that the weaning process is strongly influenced by disease burden.CLINICAL REHABILITATION IMPACT:Functional abilities, level of consciousness, independence in activities of daily living, colonization with multi-drug resistant bacteria, need for dialysis and disease duration might help to predict the weaning process of NNER.

In this paper, we present a deep learning framework "Rehab-Net" for effectively classifying three upper limb movements of the human arm, involving extension, flexion, and rotation of the forearm, which, over the time, could provide a measure of rehabilitation progress. The proposed framework, Rehab-Net is formulated with a personalized, light weight and low-complex, customized convolutional neural network (CNN) model, using two-layers of CNN, interleaved with pooling layers, followed by a fully connected layer that classifies the three movements from tri-axial acceleration input data collected from the wrist. The proposed Rehab-Net framework was validated on sensor data collected in two situations: 1) semi-naturalistic environment involving an archetypal activity of "making-tea" with four stroke survivors and 2) natural environment, where ten stroke survivors were free to perform any desired arm movement for the duration of 120 min. We achieved an overall accuracy of 97.89% on semi-naturalistic data and 88.87% on naturalistic data which exceeded state-of-the-art learning algorithms namely, linear discriminant analysis, support vector machines, and k-means clustering with an average accuracy of 48.89%, 44.14%, and 27.64%. Subsequently, a computational complexity analysis of the proposed model has been discussed with an eye toward hardware implementation. The clinical significance of this study is to accurately monitor the clinical progress of the rehabilitated subjects under the ambulatory settings.

In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation.

We present a novel architecture for arm movement classification based on kinematic properties (joint angle and position), computed from MARG sensors, using a quaternion-based gradient-descent method and a 2-link model of the upper limb. The design based on Coordinate Rotation Digital Computer framework was validated on stroke survivors and healthy subjects performing three elementary arm movements (reach and retrieve, lift arm, rotate arm), involved in 'making-a-cup-of-tea', an archetypal daily activity, achieved an overall accuracy of 78% and 85% respectively. The design coded in System Verilog, was synthesized using STMicroelectronics 130 nm technology, occupies 340K NAND2 equivalent area and consumes 292 nW @ 150 Hz, besides being functionally verified up to 25 MHz making it suitable for real-time high speed operations. The orientation, arm position and the joint angle, are computed on-the-fly, with the classification performed at the end of movement duration.