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This article describes a pilot project in specialized vocational rehabilitation program at Reykjalundur Rehabilitation Center in Iceland. It gives a brief historical overview of the development of the program, describes the theoretical frame used and the way the program is designed. Finally, it discusses the results of the program and ways to improve the program.
Results of rehabilitation of physically disabled people for employment on the open labour market over the period 1975-1985 are presented. Out of 680 eligible clients, 53% were successfully placed. When corrected for uncontrollable withdrawals and uncontrollable dismissals the success rate rises to 77% (363 of 471 clients). The drop-out rate of 16% for preventable reasons and a partially preventable wastage of 31% are highlighted for potential action and improvement. The main reasons for admission were trauma (motor vehicle accidents, assaults and industrial injuries), poliomyelitis and congenital abnormalities in a ratio of 4:3:1. These groups accounted for 82% of all admissions. The problem of adequate evaluation and screening to predict outcome reliably is discussed and the use of a modified version of the International Classification of Impairments, Disabilities and Handicaps of the World Health Organisation is advocated. Of those clients who were successfully placed, 75-80% remained in employment for more than 1 year and 55-60% for more than 2 years. On the whole, the rehabilitation process appears to lead to successful re-integration into the working community for most of the physically disabled persons admitted to the Centre.
Neurological neurosurgical early rehabilitation (NNER) is a new important therapeutic link within the spectrum of neurorehabilitation. This concept was formulated by expert opinion of the German Task Force on NNER to define both the structural and process quality of rehabilitation in patients who sustained brain damage with sensory motor, cognitive, and neurobehavioural impairment. NNER is focused on improving higher nervous functions, preventing or treating secondary and tertiary complications and thus to recuse disabilities. This concept is based on interdisciplinary teamwork and needs multidisciplinary cooperation with all specialists involved. The progress of recovery can be measured with the aid of the Coma Remission Scale.
OBJECTIVE: To assess what effect organizational, funding, and system changes in the health care environment may have on rehabilitation research. DESIGN: National survey. SETTING: Academic and clinical research programs. PARTICIPANTS: A total of 138 physicians participated in the survey. INTERVENTION: Mailed instrument requesting information on demographics, research activities, and indicators of change. MAIN OUTCOME MEASURES: Percentage of respondents reporting specific perceptions on (1) how academic and research programs are affected by organizational changes, (2) availability of research funds, and (3) the overall impact that health care changes have on research; between-group comparisons on survey responses. RESULTS: Usable responses were obtained from 138 physicians (response rate, 42.5%). Responding physicians reported workplace changes that included organizational restructuring (32.6%), affiliation with managed care plans (24%), and staff decreases (45.9%). Over half (54.8%) indicated that facility changes had detracted from their abilities to conduct research. A third (34.8%) reported declines in numbers of inpatient beds, and 89.6% reported decreased length of stay (LOS). Decreased LOS was cited as detracting from ongoing research by 36.6% and as discouraging new research by 33.3% of respondents. Although not reflected in measures of scholarly productivity, 53.6% reported having less time to devote to scholarship and 48.5% reported decreased professional activities. Over two thirds (67.4%) of responding physicians indicated that health care system changes had a negative impact on current research, and 54.5% indicated that such changes made it less likely that they would pursue new research. CONCLUSION: Changes in the health care system have had a dampening effect on rehabilitation physicians' research pursuits.
The article discusses the structural requirements on inpatient institutions for oncological rehabilitation and expresses the position of the German Cancer Society's Section for Rehabilitation, Aftercare and Social Medicine (ARNS). Standards are formulated concerning spatial conditions, technical equipment, personnel (number, professions, qualification) and networking conditions with regard to all cancer diagnoses. These standards are also discussed with regard to various specific cancer diagnoses such as, for example, breast cancer, gastrointestinal tumours, lung tumours and brain tumours, as well as with regard to patients in specific treatment measures such as bone marrow and stem cell transplantation.
In 1998, the German Federal Ministry of Education and Research (BMBF) and the German pension insurance scheme established a funding programme for research in rehabilitation. This initiative led to the establishment of eight regional research networks in which numerous research projects were sponsored for eight years (1998-2005). Within the framework of this funding programme, various self-assessment instruments were developed, adapted or improved in order to measure patient-reported outcomes and predictors. In sum, the analyses meet high psychometric standards. In this paper, a comprehensive review is given in five important assessment fields of rehabilitation research in Germany: Health-related quality of life (generic, disease-specific, children and adolescents, preference-based), evaluation of specific therapy and education programmes, motivation, screening for vocational problems and screening for comorbid mental disorders. The instruments are critically discussed, and perspectives for further research are pointed out.
This study examines the feasibility of classifying rehabilitation patients according to relative cost and proposes an option for a casemix classification and payment system for rehabilitation services in Victoria. The classification system proposed has 16 mutually exclusive groups based on patient diagnosis, change in functional status, admission functional status and age, using patient length of stay as a proxy for cost. Data relating to five hospitals were collected over three months during 1994, resulting in 483 inpatient episodes from a variety of impairment groups. The data were analysed using an analysis of variance model (PC Group), with the resulting model accounting for 30 per cent of the variance in length of stay. The study also considers the implications of incentives to contain cost and concludes by suggesting that such a payment system would be feasible to implement following further research to validate and refine the system.
PRIMARY OBJECTIVE: To report the outcome of 232 clients undertaking Rehab UKs Vocational Rehabilitation Programme, over three consecutive years, in three centres across the UK. METHODS AND PROCEDURES: Data regarding demographic characteristics of participants, type and severity of acquired brain injury were collected on admission to the programme. The duration of the vocational programme and occupational status on discharge is also reported. INTERVENTIONS: A description of the vocational programme is given including selection and admission criteria, main components of the programme, monitoring and evaluation frameworks. RESULTS: Forty-one per cent of participants were discharged into paid competitive employment, with a further 16% gaining voluntary work and 15% taking up mainstream training or education. The remaining 28% were referred to other services or withdrew from the programme. CONCLUSIONS: Vocational rehabilitation offering educational and experiential learning opportunities is effective in enabling participants with severe acquired brain injuries to return to paid employment.
PURPOSE: To describe the methods used for the development and implementation of the Rehabilitation Activities Profile for Children (Children's RAP), an instrument to structure information for team conferences. METHODS: Our strategy consisted of nine steps: (1) survey in clinical practice; (2) literature search; (3) formation of a national study group; (4) development of specifications and a national draft; (5) development of local drafts; (6) integration of local drafts; (7) consultation of users and experts; (8) national conference; and (9) assessment of user experience. RESULTS: The final version of the Children's RAP consists of three sections: (1) basic information about the child and its proxies; (2) present situation and needs of the child and its proxies; and (3) conclusions of the team conference. User satisfaction ranged from adequate to good. The Children's RAP is currently used in 53% of the Dutch pediatric rehabilitation centres. CONCLUSION: The methods used guarantee an optimal involvement of users, experts and literature. With these methods it was possible to develop an instrument which is widely accepted and implemented in clinical practice.
The growth and survival of children was studied after rehabilitation for malnutrition at the Nutrition Rehabilitation Centre (NRC) of St Mary's Hospital on average 1.5 year after discharge. The findings are intended partly to provide descriptive information on later progress in the community of these children and also to identify specific risk factors. Of 50 children eligible for follow-up, 39 (78 per cent) could be traced. Overall mortality was 36 per cent, 28 per cent were found to be underweight, and 36 per cent were in good condition with satisfactory catch up in weight. Mortality was determined by age, duration of stay in hospital and centre, and nutritional status. Most literature on the subject implies that the long-term effectiveness of the NRC is affected by limiting factors at home and in the centre itself. Our data suggest that the poor results are mainly due to improper use of the NRC. The NRC was called in too early by the hospital and children were discharged too soon from the NRC. As evidenced by the frequent presence of infectious symptoms, the severity of nutritional status, inadequate weight gain, and short duration of stay in the hospital and the NRC.
OBJECTIVE: To investigate differences between African American and white respondents in willingness to enroll in a rehabilitation research registry for future research and to determine if reasons for consenting and refusing to enroll differ by ethnicity. DESIGN: Inpatient recruitment results from 739 African American and white respondents in which patients were admitted to a rehabilitation hospital with a diagnosis of stroke or traumatic brain injury. RESULTS: A similar proportion of African American and white respondents (both patients and surrogates) consented to enroll in the registry (72% of all African American respondents vs. 68% of all white respondents). African Americans and whites provided similar reasons for consenting and refusing to enroll. Demographic variables associated with consent were: higher education, younger age, and facility. The odds of consenting to enroll in the registry were 5 times as high for those who thought they had a great deal to gain from enrollment compared with those who thought they had less to gain and were nearly 2 times as high for those who reported little concern about privacy compared with those who were more concerned about privacy. CONCLUSIONS: Ethnicity was not found to be a predictor of willingness to enroll in a study registry. A greater belief of gain and less concern over privacy were associated with willingness to enroll, even after controlling for age, education, facility, and ethnic group.
In the health and social sectors, many diagnostic and prognostic tests are carried out without a constant watch on (1) what influence the test results have on decisions, and (2) the impact of these decisions on every day clinical work. Consequently, it is not known whether the additional information gained, if any, justifies the expenditure necessary for resources involved in a testing procedure. In fact, the net impact of testing in every day clinical work may be negative. By carrying out a testing procedure, under the before mentioned conditions, resources would be wasted. Since the early 1970's a battery of standardized performance tests have been used at the Vocational Rehabilitation Clinic in Aarhus, Denmark. Originally, the aim of the tests was to identify and give an early discharge to those clients, that were, in any case, shown to be fit for a social pre-term pension. An early discharge of these clients would enable the Clinic to counsel a greater number of clients who were suited to vocational rehabilitation. The test period lasts two weeks, and the average stay in the Clinic amounts to about 3 months. During the years 1981 to 1983, a total of 607 clients were discharged from the Clinic. Out of the 607, 379 had been given the battery of tests. Those tested stayed 16 days longer at the clinic than the rest of the clients. A few clients got an early discharge. The associations between the test results and case closure status were weak. Furthermore, these weak associations occurred in 6 out of 51 tests.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice. METHODS: Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient's chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated. RESULTS: Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia). CONCLUSION: Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.
Pain remains one of the most common, yet most challenging, medical problems in health care today, and it is one of the most common complications that occurs after a stroke. Pain can affect the course of stroke rehabilitation adversely, and it occasionally may be a cause for transfer back to an acute care hospital. The Post-Stroke Rehabilitation Outcomes Project (PSROP) database was used to describe the incidence of pain by body location and trends in the use of different classifications of medications to treat pain. Of the 1,122 participants in the PSROP database, the most common locations of pain in stroke survivors were the head, leg, back, and shoulder. The most frequently prescribed classifications of pain medications were other analgesics (acetaminophen and tramadol), followed by narcotic analgesics, non-steroidal antiinflammatory drugs (NSAIDs), anticonvulsants, and tricyclic antidepressants. After acetaminophen, the most frequently prescribed medications in each classification, respectively, include hydrocodone APAP, cox-2 inhibitors, gabapentin, and amitriptyline. Other frequently prescribed pain medications included sumatriptan (migraine analgesic), cyclobenzaprine (muscle relaxant), and baclofen (antispasticity muscle relaxant). Medications should be chosen based upon the medical condition causing pain, the ability of the stroke survivor to comply with administration of the medication, and the cost of the medication. Appropriate and timely treatments of painful conditions result in maximum function and the ability to lead active lives and maintain an adequate quality of life.
Presented is a computer-based system for interactive assignment control, designed to cope with the increasing requirements in rehabilitation and health care concerning quality assurance, greater flexibility, as well as enhanced effectiveness and efficiency. Thanks to multi-factor control, medical, organizational and economic parameters can be taken into account selectively. In addition, an unbureaucratic approach to determining length of rehabilitation programme participation is described, which has been implemented successfully for the last three years.
The Secretary amends the regulations governing The State Vocational Rehabilitation Services Program (VR program). These amendments are needed to implement changes in the Rehabilitation Act of 1973, as amended (Act). These changes establish evaluation standards and performance indicators for the VR program.
The Secretary amends the regulations governing the State Vocational Rehabilitation Services Program (VR program) by revising the scope of employment outcomes under the VR program. These regulations redefine the term "employment outcome" (as it applies to the VR program) to mean outcomes in which an individual with a disability works in an integrated setting. This action is necessary to reflect the purpose of Title I of the Rehabilitation Act of 1973, as amended (Act), which is to enable individuals with disabilities who participate in the VR program to achieve an employment outcome in an integrated setting.
To obtain empirical data on the impact of changes in the health care system on rehabilitation research, physicians, psychologists, nurses, physical therapists, and occupational therapists involved in such research were surveyed to determine: 1) how the changes had affected their research productivity; 2) whether their scholarly activities (e.g., publications) had been affected; and 3) whether working in an academic vs non-academic institution made a difference. There were 438 usable responses (38% response rate) to the survey, which was sent to members of national organizations. Although the results somewhat supported suggestions that changes in the system had had a dampening effect on research, they were ambiguous, failing to clearly demonstrate a negative impact of managed care. More rigorous study is needed to enable firm conclusions and the formulation of actions to address factors that may influence rehabilitation research.