Interventions to enhance recovery in healthy workers; a scoping review. Physical rehabilitation interventions for adult patients with critical illness across the continuum of recovery: an overview of systematic reviews protocol Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. Effectiveness of a peer-support community in addiction recovery: participation as intervention. The development of the Be Active & Relax “Vitality in Practice” (VIP) project and design of an RCT to reduce the need for recovery in office employees Enhanced outpatient treatment for co-occurring disorders: main outcomes. My Disaster Recovery: a pilot randomized controlled trial of an Internet intervention Enhanced Recovery After Surgery Versus Conventional Perioperative Care in Rectal Surgery Adding contingency management intervention to vocational rehabilitation: outcomes for dually diagnosed veterans. Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial. Feasibility of enhanced recovery programme in various patient groups Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial. Enhancing Postoperative Recovery of Cardiac Surgery Patients Spinal Cord Injury Rehabilitation Evidence: Methods of the SCIRE Systematic Review. A randomized controlled trial of the effectiveness of the illness management and recovery program. Restoring depleted resources: Efficacy and mechanisms of change of an internet-based unguided recovery training for better sleep and psychological detachment from work.
Background Faster recovery from work may help to prevent work-related ill health . Aims To provide a preliminary assessment of the range and nature of interventions that aim to improve recovery from cognitive and physical work . Methods A scoping review to examine the range and nature of the evidence , to identify gaps in the evidence base and to provide input for systematic review s. We search ed for workplace intervention studies that aim ed at enhancing recovery . We used an iterative method common in qualitative research to obtain an overview of study elements , including intervention content , design , theory , measurements , effects and cost-effectiveness . Results We found 28 studies evaluating seven types of interventions mostly using a r and omized controlled study design . For person-directed interventions , we found relaxation techniques , training of recovery experiences , promotion of physical activity and stress management . For work-directed interventions , there were participatory changes , work-break schedules and task variation . Most interventions were based on the conservation of re sources and affect-regulation theories , none were based on the effort-recovery theory . The  need for recovery ( NfR ) and the recovery experiences question naires ( REQ ) were used most often . Study authors reported a beneficial effect of the intervention in 14 of 26 published studies . None of the studies that used the NfR scale found a beneficial effect , whereas studies that used the REQ showed beneficial effects . Three studies indicated that interventions were not cost-effective . Conclusions Feasible and possibly effective interventions are available for improving recovery from cognitive and physical workload . Systematic review s are needed to determine their effectiveness Background Patients admitted to the intensive care unit with critical illness often experience significant physical impairments , which typically persist for many years following resolution of the original illness . Physical rehabilitation interventions that enhance restoration of physical function have been evaluated across the continuum of recovery following critical illness including within the intensive care unit , following discharge to the ward and beyond hospital discharge . Multiple systematic review s have been published appraising the exp and ing evidence investigating these physical rehabilitation interventions , although there appears to be variability in review methodology and quality . We aim to conduct an overview of existing systematic review s of physical rehabilitation interventions for adult intensive care patients across the continuum of recovery . Methods / design This protocol has been developed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol ( PRISMA -P ) guidelines . We will search the Cochrane Systematic Review Data base , Data base of Abstract s of Review s of Effectiveness , Cochrane Central Register of Controlled Trials , MEDLINE , Excerpta Medica Data base and Cumulative Index to Nursing and Allied Health Literature data bases . We will include systematic review s of r and omised controlled trials of adult patients , admitted to the intensive care unit and who have received physical rehabilitation interventions at any time point during their recovery . Data extraction will include systematic review aims and rationale , study types , population s , interventions , comparators , outcomes and quality appraisal method . Primary outcomes of interest will focus on findings reflecting recovery of physical function . Quality of reporting and method ological quality will be appraised using the PRISMA checklist and the Assessment of Multiple Systematic Review s tool . Discussion We anticipate the findings from this novel overview of systematic review s will contribute to the synthesis and interpretation of existing evidence regarding physical rehabilitation interventions and physical recovery in post-critical illness patients across the continuum of recovery . Systematic review registration PROSPERO CRD42015001068 The purpose of this study was to determine the efficacy of a peer-led illness self-management intervention called Wellness Recovery Action Planning ( WRAP ) by comparing it with usual care . The primary outcome was reduction of psychiatric symptoms , with secondary outcomes of increased hopefulness , and enhanced quality of life ( QOL ) .  A total of 519 adults with severe and persistent mental illness were recruited from outpatient community mental health setting s in 6 Ohio communities and r and omly assigned to the 8-week intervention or a wait-list control condition . Outcomes were assessed at end of treatment and at 6-month follow-up using an intent-to-treat mixed-effects r and om regression analysis . Compared to controls , at immediate postintervention and at 6-month follow-up , WRAP participants reported : ( 1 ) significantly greater reduction over time in Brief Symptom Inventory Global Symptom Severity and Positive Symptom Total , ( 2 ) significantly greater improvement over time in hopefulness as assessed by the Hope Scale total score and subscale for goal directed hopefulness , and ( 3 ) enhanced improvement over time in QOL as assessed by the World Health Organization Quality of Life-BREF environment subscale . These results indicate that peer-delivered mental illness self-management training reduces psychiatric symptoms , enhances participants ' hopefulness , and improves their QOL over time . This confirms the importance of peer-led wellness management interventions , such as WRAP , as part of a group of evidence -based recovery-oriented services The main purpose of the study was to determine whether a peer-support community programme would reduce relapse rates among clients recovering from substance addictions and homelessness and result in increased perceived community affiliation , supportive behaviours , self-determination and quality of life . Mixed methods were utilized including semi-structured interviews , participant observation and a pretest/post-test to evaluate changes on the  quality of life rating  , the  Medical Outcomes Study -Social Support Survey  , and the Volitional Question naire . Data from the prior year 's permanent supportive housing programme were used for comparison of relapse rates . Significant reduction of risk of relapse was found in clients who participated in the programme . Significant differences were found on three subscales of the Medical Outcomes Study -Social Support Survey . Improvement that did not reach statistical significance was seen on the quality of life rating . Qualitative evidence supported improvements in perceived community affiliation and supportive behaviours . Evidence suggests that a peer-supported community programme focused on self-determination can have a significant positive impact on recovery from substance addictions and homelessness . Limitations include a small sample size and lack of a r and omized control group Background There is strong evidence to suggest that multiple work-related health problems are preceded by a higher need for recovery . Physical activity and relaxation are helpful in decreasing the need for recovery . This article aims to describe ( 1 ) the development and ( 2 ) the design of the evaluation of a daily physical activity and relaxation intervention to reduce the need for recovery in office employees . Methods / Design The study population will consist of employees of a Dutch financial service provider . The intervention was systematic ally developed , based on parts of the Intervention Mapping ( IM ) protocol . Assessment of employees needs was done by combining results of face-to-face interviews , a question naire and focus group interviews . A set of theoretical methods and practical strategies were selected which result ed in an intervention program consisting of Group Motivational Interviewing ( GMI ) supported by a social media platform , and environmental modifications . The Be Active & Relax program will be evaluated in a modified 2 X 2 factorial design . The environmental modifications will be pre-stratified and GMI will be r and omised on department level . The program will be evaluated , using 4 arms : ( 1 ) GMI and environmental modifications ; ( 2 ) environmental modifications ; ( 3 ) GMI ; ( 4 ) no intervention ( control group ) . Question naire data on the primary outcome ( need for recovery ) and secondary outcomes ( daily physical activity , sedentary behaviour , relaxation/detachment , work- and health-related factors ) will be gathered at baseline ( T0 ) , at 6 months ( T1 ) , and at 12 months ( T2 ) follow-up . In addition , an economic and a process evaluation will be performed . Discussion Reducing the need for recovery is hypothesized to be beneficial for employees , employers and society . It is assumed that there will be a reduction in need for recovery after 6 months and 12 months in the intervention group , compared to the control group . Results are expected in 2013.Trial registration Netherl and s Trial Register ( NTR ) : This study , which was conducted in an outpatient substance abuse treatment program , r and omly assigned clients with mental health symptoms to either a control group , which received basic program services , or an experimental group , which was configured as a modified therapeutic community ( TC ) track , with the addition of modified TC features and three specific elements-psychoeducational seminar , trauma-informed addictions treatment , and case management . The experimental group had significantly better outcomes as compared with the control group on measures of psychiatric severity and on the key measure of housing stability ; no difference was observed for substance use , crime , and employment . The findings must be qualified because ( a ) only 3 of 34 representative measures ( < 10 % ) showed significant differential treatment effects and ( b ) analysis revealed partial implementation of the enhancements . The study provides modest support for the effectiveness , on specific outcomes , of outpatient substance abuse treatment programs that add modified TC features and targeted interventions to strengthen their capacity to treat co-occurring disorders Abstract This pilot study tested the efficacy of the My Disaster Recovery ( MDR ) website to decrease negative affect and increase coping self-efficacy .  Fifty-six survivors of Hurricane Ike were recruited from a larger study being conducted at the University of Texas Medical Branch at the first anniversary of the storm . Restricted r and omization was used to assign participants to the MDR website , an information-only website , or a usual care condition . Group × time interactions indicated that MDR reduced participant worry more than the other conditions . A similar trend was also identified for depression . Both websites were accessed a small to moderate amount and participants reported mixed satisfaction for both websites . Although the effect sizes for worry and depression were in the moderate to large range , small sample size and timing of the intervention qualify the findings . These preliminary findings encourage further evaluation of MDR with a larger , demographically diverse sample and indicate that the MDR website might be helpful in reducing worry and depression BACKGROUND : Enhanced recovery after surgery programs have been developed to improve recovery , shorten hospital stays , and reduce morbidity . OBJECTIVE : The aim of the current study was to examine the effects of the enhanced recovery program on the outcome of rectal surgery . DESIGN : A cohort of patients who underwent open rectal surgery after an enhanced recovery program was compared with a historic case-matched control group receiving conventional perioperative care . Patients were matched for type of surgery , disease , comorbidity , and demographic characteristics . Data regarding fast-track targets , length of hospital stay , mortality , complications , relaparotomies , and readmissions were collected . RESULTS : Forty-one patients in the enhanced recovery group were compared with 82 case-matched patients receiving conventional care .  The length of hospital stay ( median : 8 days vs 12 days , P < .005 ) was reduced in the enhanced recovery after surgery group . There were no significant differences in epidural use , mortality , morbidity , and readmission rates between groups . LIMITATIONS : This study performed an intention-to-treat analysis for the multimodal enhanced recovery program in rectal surgery . Specific elements of the program were not analyzed separately . The study used nonr and omly assigned historic controls for comparison . CONCLUSION : Enhanced recovery after surgery programs help to reduce the length of hospital stay after rectal surgery In this r and om-assignment trial , we evaluated the efficacy of using a contingency management ( CM ) intervention to enhance job acquisition and tenure among participants of a vocational rehabilitation ( VR ) program .  The CM intervention offered participants cash incentives up to $ 1,170 for completing tasks related to sobriety and job search and maintenance . Participants were 100 veterans with comorbid psychiatric disorders and substance dependence who were r and omly assigned either to VR only or VR + CM . Relative to participants in the VR-only group , those in the VR + CM group showed more intense job search es and transitioned to competitive employment faster and at higher rates . No significant difference was found in job tenure , though this may be due to the limited follow-up period . Abstinence rates were significantly better in the VR + CM group during the first 16 weeks of follow-up but not significantly different in subsequent follow-ups . No relationship was found between relapse and employment . These results suggest that rehabilitation outcomes may be enhanced by adding CM to current programming or by restructuring traditional work-for-pay contingencies to include direct financial rewards for achievement of clinical goals PURPOSE To compare coping effectiveness training ( CET ) with supportive group therapy ( SGT ) for  anxiety , depression , and adjustment to injury in an acute spinal cord injury/dysfunction ( SCI/D ) rehabilitation population .  CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups ( Kennedy , Duff , Evans , & Beedie , 2003 ; King & Kennedy , 1999 ) . The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition , SGT . RESEARCH METHOD Participants ( N = 40 ) entering a hospital-based program were assigned to treatment condition using block r and omization . Question naire mood measures were completed at program admission , program discharge , and 3-month postdischarge follow-up . Adjustment to disability was assessed at follow-up only . Analyses of variance tested for group differences in anxiety , depression , and adjustment to injury . RESULTS Both groups reported reductions in mood symptoms with no differences between treatment conditions . However , similar reductions were obtained after fewer sessions of CET .  Symptoms of depression increased in both groups following hospital discharge . CONCLUSIONS Clinical and research implication s , including innovative interventions during the period after discharge , are discussed Introduction An accelerated multi-modal rehabilitation programme may improve the recuperation and reduce the complication rate in patients undergoing colorectal surgery . The aim of this study was to see whether fast-track recovery is feasible in various patient groups . Patients and methods Data on all patients operated for intestinal pathology from July 2006–April 2008 were prospect ively collected for this prospect i ve study . All included patients entered a multi-modal rehabilitation programme .  Peri- and postoperative complications and readmissions , pathology reports and operation characteristics were recorded prospect ively . Results Three hundred and forty-eight patients underwent colorectal surgery .  No difference in readmission rate was found between various patient groups . The only significant differences after multivariate regression analysis were in re-operation rate and length of stay in favour of the elective surgery group . Conclusions Fast-track modalities can be introduced with a low complication rate in all patient groups . Length of stay in elderly patients averages 10 days , implying that this group can not be considered as “ fast track ” , although the same protocol can also be applied in this group . Better organization of the aftercare might however considerably change the length of stay of elderly patients , since postoperative complications do not differ between old and young patients The aim of this r and omized clinical trial was to compare patients treated using a multimodal approach [ enhanced recovery after surgery ( ERAS ) ]  , with a special focus on counselling , to patients treated in a st and ard conventional care pathway , who underwent elective colorectal resection BACKGROUND Mental health policy in many countries is oriented around recovery , but the evidence base for service-level recovery-promotion interventions is lacking . METHODS We did a cluster , r and omised , controlled trial in two National Health Service Trusts in Engl and .  REFOCUS is a 1-year team-level intervention targeting staff behaviour to increase focus on values , preferences , strengths , and goals of patients with psychosis , and staff-patient relationships , through coaching and partnership . Between April , 2011 , and May , 2012 , community-based adult mental health teams were r and omly allocated to provide usual treatment plus REFOCUS or usual treatment alone ( control ) . Baseline and 1-year follow-up outcomes were assessed in r and omly selected patients . The primary outcome was recovery and was assessed with the Question naire about Processes of Recovery ( QPR ) . We also calculated overall service costs . We used multiple imputation to estimate missing data , and the imputation model captured clustering at the team level . Analysis was by intention to treat . This trial is registered , number IS RCT N02507940 . FINDINGS 14 teams were included in the REFOCUS group and 13 in the control group . Outcomes were assessed in 403 patients ( 88 % of the target sample ) at baseline and in 297 at 1 year . Mean QPR total scores did not differ between the two groups ( REFOCUS group 40·6 [ SD 10·1 ] vs control 40·0 [ 10·2 ] , adjusted difference 0·68 , 95 % CI -1·7 to 3·1 , p=0·58 ) . High team participation was associated with higher staff-rated scores for recovery-promotion behaviour change ( adjusted difference -0·4 , 95 % CI -0·7 to -0·2 , p=0·001 ) and patient-rated QPR interpersonal scores ( -1·6 , -2·7 to -0·5 , p=0·005 ) at follow-up than low participation . Patients treated in the REFOCUS group incurred £ 1062 ( 95 % CI -1103 to 3017 ) lower adjusted costs than those in the control group . INTERPRETATION Although the primary endpoint was negative , supporting recovery might , from the staff perspective , improve functioning and reduce needs . Implementation of REFOCUS could increase staff recovery-promotion behaviours and improve patient-rated recovery . FUNDING National Institute for Health Research The purpose of this trial was to determine the effectiveness of advanced practice nursing support on cardiac surgery patients ’ during the first 5 weeks following hospital discharge . Patients ( N = 200 ) were r and omly allocated to two groups : ( a ) an intervention group who received telephone calls from an advanced practice nurse ( APN ) familiar with their clinical condition and care needs , twice during the first week following discharge then weekly thereafter for 4 weeks , and ( b ) a usual care group . Measures of health-related quality of life ( HRQL ) , symptom distress , satisfaction with recovery care , and unexpected health care contacts were obtained at 5 weeks following discharge . There were no significant group differences in HRQL , unexpected contacts with the health care system , or symptom distress . The provision of APN support via telephone followup after cardiac surgery is feasible . However , further r and omized trials of single and multicomponent APN interventions are needed to prove effectiveness The Spinal Cord Injury Rehabilitation Evidence ( SCIRE ) is a synthesis of the research evidence underlying rehabilitation interventions to improve the health of people living with SCI . SCIRE covers a comprehensive set of topics and in this issue we present six papers relevant to SCI rehabilitation clinicians ( SCI inpatient rehabilitation practice s , gait strategies , upper extremity reconstructive surgery , spasticity treatments , cardiovascular health and bone health ) . The SCIRE used a systematic and well-defined protocol to assess and synthesize the evidence . Each article was scored for its method ological quality using either the Physiotherapy Evidence Data base ( PEDro ) Score for r and omized controlled trials or the Downs and Black Tool for other types of studies . Following the individual study assessment , conclusions were drawn about the accumulated studies for each topic of interest based on the levels of evidence , quality of studies and concurring evidence . The SCIRE project was design ed for health professionals to inform them of best practice OBJECTIVE This study evaluated the effectiveness of the Illness Management and Recovery program implemented in a group format . METHODS A total of 210 persons with a severe mental illness receiving treatment at rehabilitation centers in the community in Israel were r and omly assigned to either the Illness Management and Recovery program or treatment as usual . The  Illness Management and Recovery Scale ( client and clinician versions ) and measures of coping and social support were administered to participants before and after the intervention . RESULTS Participants in the Illness Management and Recovery program showed significant improvement in knowledge about their illness and progress toward their personal goals compared with those receiving treatment as usual .  Clinician ratings also indicated significant improvement in overall outcome for clients in the Illness Management and Recovery program compared with those who received treatment as usual . Significant improvement in coping was found in both groups , and no change in social support was found for either group . CONCLUSIONS The Illness Management and Recovery program was effective in increasing clients ' knowledge of their illness and helping them make progress toward personal goals OBJECTIVE This r and omized controlled trial evaluated the efficacy of an Internet-based intervention , which aim ed to improve recovery from work-related strain in teachers with sleeping problems and work-related rumination . In addition , mechanisms of change were also investigated . METHODS A sample of 128 teachers with elevated symptoms of insomnia ( Insomnia Severity Index [ ISI ] ≥ 15 ) and work-related rumination ( Cognitive Irritation Scale ≥ 15 ) was assigned to either an Internet-based recovery training ( intervention condition [ IC ] ) or to a waitlist control condition ( CC ) . The IC consisted of 6 Internet-based sessions that aim ed to promote healthy restorative behavior . Self-report data were assessed at baseline and again after 8 weeks . Additionally , a sleep diary was used starting 1 week before baseline and ending 1 week after post assessment . The primary outcome was insomnia severity . Secondary outcomes included perseverative cognitions ( i.e. , work-related rumination and worrying ) , a range of recovery measures and depression . An extended 6-month follow-up was assessed in the IC only . A serial multiple mediator analysis was carried out to investigate mechanisms of change . RESULTS IC participants displayed a significantly greater reduction in insomnia severity ( d = 1.37 , 95 % confidence interval : 0.99 - 1.77 ) than did participants of the CC . The IC was also superior with regard to changes in all investigated secondary outcomes . Effects were maintained until a naturalistic 6-month follow-up . Effects on insomnia severity were mediated by both a reduction in perseverative cognitions and sleep effort . Additionally , a greater increase in number of recovery activities per week was found to be associated with lower perseverative cognitions that in turn led to a greater reduction in insomnia severity . CONCLUSIONS This study provides evidence for the efficacy of an unguided , Internet-based occupational recovery training and provided first evidence for a number of assumed mechanisms of change
The majority of this literature derives from the study of patients undergoing colorectal surgery , but increasingly enhanced recovery is spreading to other surgical specialties .
The combination of reduced length of hospital stay ( a surrogate for morbidity ) with no increase in readmissions to hospital suggests that morbidity is reduced with enhanced recovery .
Inconsistency in morbidity reporting limits the value of pooling data between studies , but within study comparisons in general support this conclusion .
Patients adhering to an  enhanced recovery programme  return to normal function faster than those following traditional care pathways .
PURPOSE OF REVIEW The aim of this review is to summarize important publications in  enhanced recovery during 2010 - 2011 and to highlight key themes .