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PubMed2002

[Fitness for work after vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVE: The evaluation of a vocational rehabilitation programme initiated by the State Social Security Institute in Iceland (SSSI) in 1999 with the aim of reducing disability. MATERIAL AND METHODS: New disability claimants who had been unable to work because of illness for a few months at least were referred by SSSI physicians to a multidisciplinary team for assessment of rehabilitation potentials and an advice on the appropriate type of rehabilitation. The study group included all the 109 individuals who were referred to the team in the year 2000. Data on marital status, number of children and level of education was compared with information about the Icelandic population obtained in a national survey. The outcome of the rehabilitation was assessed in a telephone survey, carried out by the Social Science Research Institute, University of Iceland, 1-2 years after the assessment and by information obtained from the disability register at SSSI. The effectiveness of the rehabilitation programme was evaluated by comparing the study group with a comparable group that had started to receive rehabilitation pension before the SSSI could offer vocational rehabilitation. Their progress was assessed a year and half after they had contacted the SSSI, the same length of time as the study group had been in the in the rehabilitation programme. RESULTS: In the study group there were about twice as many women as men. The mean age was 35 years (range 18-57 years). The main medical reasons for referral to the team were musculosceletal and psychiatric disorders. Those evaluated were more likely to be unmarried or divorced, had more children and a lower educational level than the general Icelandic population. After evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. In all, 46 individuals received other treatment or education. Almost three quarters (72%) of the participants in the telephone survey said that their fitness for work had increased after rehabilitation, but only 47% had returned to work. At the time of the reserach, 23% were students and it is likely that a part of them will return to work when their studies are completed. Between one and two years after the evaluation by the multidisciplinary team 44 out of 109 (40.4%) in the study group received disability pension and a equal number received no social insurance benefits at all. In the comparison group 97 out of 119 (81.5%) received disability pension and 21 (17.7%) received no social insurance benefits at all. CONCLUSIONS: This study shows that vocational rehabilitation organized by the SSSI is effective and can prevent disability. The results of this study are similar to the results of two Swedish studies on the same topic.

English Abstract↗
PubMed1994

[Cost/benefit relations: evaluation of inpatient and ambulatory rehabilitation].

Three different forms of rehabilitation in patients after myocardial infarction are discussed on the basis of cost-effectiveness: 1) outpatient rehabilitation as performed in North America and other developed countries, 2) inpatient rehabilitation in Germany, and 3) outpatient rehabilitation in Germany. Parameters compared are mortality, coronary risk factor profile, and return to work. A metaanalysis of international studies on outpatient rehabilitation demonstrated a significant reduction of total and cardiovascular mortality. Similar data are not available for inpatient rehabilitation in Germany. However, data of 6 years of outpatient rehabilitation as performed in the "Heidelberg Study" demonstrate a continuous significant improvement in coronary risk factor profile and cardiopulmonary fitness. On the other hand, 4 weeks of inpatient rehabilitation exhibited only short-term and no long-lasting effects (4 years) on coronary risk factor profile. The economic benefit can be based on return to work, which is only marginally affected by rehabilitation in the USA, where more than 80% of the patients are back to work 6 months after myocardial infarction. In Germany, about 5 months after myocardial infarction 50% of the patients are retired, despite 4-6 weeks inpatient rehabilitation; i.e., the patients which are back to work can be assumed to be less than 50%. The costs of 8 weeks outpatient rehabilitation in North America has been calculated to be 804 DM per patient, 4 weeks of inpatient rehabilitation amounts to about 5320-5600 DM, and 1 year ambulatory treatment in the "Heidelberg Study" accounts for 2270 DM per patient. It can be concluded: outpatient rehabilitation as performed in North America has been shown to significantly reduce total and cardiovascular mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMedDate not supplied

The 1989 CARF nursing standards: guidelines for implementation. Commission of Accreditation of Rehabilitation Facilities.

Since its earliest days, the Commission on Accreditation of Rehabilitation Facilities (CARF) has shown its commitment to maintaining its standards to reflect the current practice of rehabilitation. At a task force convened in 1988, a group of experts in rehabilitation was charged with the revision of the standards that addressed comprehensive inpatient rehabilitation. This task force included rehabilitation nurses who could identify and address the elements of rehabilitation nursing that are essential to any comprehensive inpatient rehabilitation setting. Recognizing that there are implications for rehabilitation nursing throughout the standards, it was felt that the standards that are specific to the practice of rehabilitation nursing should be expanded to address the quality and quantity of rehabilitation nursing in the inpatient setting, as well as the integration of the specialty of rehabilitation nursing into a truly comprehensive rehabilitation program. The outcome of this endeavor is the revision of the standards for rehabilitation nursing, which can be found in the 1989 Standards Manual for Organizations Serving People with Disabilities. The actual nursing standards, found in section III A of the manual, are reprinted here with permission of CARF.

Humans↗
PubMed2004

Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation.

STUDY DESIGN: Retrospective descriptive study. OBJECTIVES: (1). To obtain an overall appraisal of patients with epidural metastatic spinal cord compression (SCC) admitted to nine Dutch spinal cord units (SCUs) between 01-01-1990 and 01-01-2000. (2). To identify factors that predict survival >1 year after in-patient rehabilitation of patients with epidural metastatic SCC. SETTING: Dutch SCUs. Rehabilitation Center Amsterdam, Amsterdam. Rehabilitation Center Heliomare, Wijk aan Zee. Rehabilitation Center De Hoogstraat, Utrecht. Rehabilitation Center Rijndam, Rotterdam. Rehabilitation Center Sophia Stichting, Den Haag. Rehabilitation Center Beatrixoord, Haren. Rehabilitation Center Het Roessingh, Enschede. Rehabilitation Center Sint Maartenskliniek, Nijmegen. Rehabilitation Center SRL Hoensbroeck, Hoensbroek. METHODS: (1). Clinical records were reviewed and demographic, clinical and functional data were collected according to a protocol. The date of admittance to the SCU, rehabilitation goals, date of discharge and date of death were recorded. (2). The odds ratio (OR) was calculated for all determinants on admittance to the SCU in order to find indicators that predict survival >1 year after discharge from the SCU. An OR >or=2 was considered to be clinically significant. RESULTS: In total, 131 patients with epidural metastatic SCC were admitted. In all, 117 clinical records were retrieved and 97 clinical records provided complete data. The average age on admittance was 58 years. Among the patients 53% were male. The average Barthel score on admittance was 7.2/20 points. The average length of stay in the SCU was 104 days (3-336). Overall, 66% of the patients were discharged. The average Barthel score on discharge was 12.0 points. The average survival after discharge was 808 (0-3669) days. During their stay on the SCU, seven patients died. At 1 year after discharge, 52% of the patients were still alive. These patients suffered less complications, had been admitted less often to a hospital during rehabilitation, had made better functional progress and had been discharged home more often. A survival >1 year after discharge is related to ASIA D (OR 4.3), MRC 4 and 5 (OR 5.4), tumour in remission (OR 3.8) and independence or partial independence on the Barthel items: dressing (OR 4.3) and making transfers (OR 5.0). CONCLUSIONS: Patients with epidural metastatic SCC may benefit from in-patient rehabilitation.

Adult↗
PubMed2002

Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke.

During the 1990s most western European and Organization of Economic Cooperation and Development (OECD) countries experienced financial difficulties and were forced to cut back on or restrain health care expenditures. Home rehabilitation has received attention in recent years because of its potential for cost containment. Often forgotten, however, is the redistribution of costs from one caregiver to another. The aim of this study was to analyse whether a redistribution of costs occurs between health care providers (the County councils) and social welfare providers (the municipalities) in a comparison of home-based rehabilitation and hospital-based rehabilitation after stroke. The study population included 123 patients, 53 in the home-based rehabilitation group and 68 in the hospital-based rehabilitation group. The patients were followed up at 6 and 12 months after onset of stroke. Resource use over a 12-month period included acute hospital care, in-hospital rehabilitation, home rehabilitation and use of home-help service as well as nursing home living. The hospital-based rehabilitation group had significantly fewer hospitalization days after a decision was made about rehabilitation at the acute care ward and consequently the cost for the acute care period was significantly lower. The cost for the rehabilitation period was significantly lower in the home-based rehabilitation group. However, the cost for home help service was significantly higher in the home-based rehabilitation group. The total costs for the care episode did not differ between the two groups. The main finding of this study is that there seems to occur a redistribution of costs between health care providers and social welfare providers in home rehabilitation after stroke in a group of patients with mixed degree of impairment.

Activities of Daily Living↗
PubMedDate not supplied

[Evaluation of outpatient rehabilitation: goals, conceptual framework and study design of a health and pension insurance joint research project].

In Germany the statutory health and pension insurance schemes are the main providers of medical rehabilitation, the majority of rehabilitation measures being given in an inpatient setting. Over the last few years, the health and pension insurance schemes have strengthened the extension of outpatient rehabilitation, and have funded a comprehensive evaluation study in this context. In this evaluation study outpatient rehabilitation in centres with different conceptual backgrounds is compared with inpatient rehabilitation in rehab clinics, indications considered being cardiology and orthopaedics. Overall, 14 rehab centres and more than 2000 patients were included in the project. The patients were interviewed and medically examined before and after the measure. A follow-up was done after six and twelve months. In addition to the rehabilitants themselves, the rehab centre physicians as well as the office-practice physicians were interviewed about the outcome of the rehab measure. One year after rehabilitation, data were collected from the relevant health and pension insurance funds concerning the benefits the patients had received. Due to the study's non-experimental design, validity of the results is confined to rehabilitants participating on an outpatient basis and who had been found medically suited for this type of rehabilitation, were capable of travelling to the rehab centre on their own within less than 45 minutes and had voluntarily opted for the outpatient setting. The findings of the study show that outpatient rehabilitants' motivation and expectations differ from those found in inpatient rehabilitation. The health economics analysis performed is restricted to the costs involved in the rehabilitation measure as such as well as the health-related benefits provided to the rehabilitants in the twelve-month study period. The issue of whether increasing outpatient rehab measures will lead to decreasing costs in the rehab system as a whole had not been considered in the framework of this project.

Ambulatory Care↗
PubMed2004

How can a work rehabilitation process be improved?--a qualitative study from the perspective of social insurance officers.

PURPOSE: The aim of this study is to describe social insurance officers' experiences of a work rehabilitation process at a rehabilitation centre in the northern parts of Sweden. In Sweden the social insurance company has a key role to coordinate all efforts concerning work rehabilitation planning between all rehabilitation actors. METHOD: Ten social insurance officers at the social insurance company in a city in northern Sweden were interviewed using a narrative approach about their experiences of work rehabilitation processes in general. The interviews were analysed by qualitative content analysis with a focus on their experiences of goals, content and results of a work rehabilitation process. RESULTS: The social insurance officers' experiences of how a work rehabilitation process could be improved were described in six categories; (1) Early identification of problems, needs and interventions (2) clear goal formulations, (3) a focus on psychosocial factors (4) a greater variety of possible interventions, (5) activating employers to a higher extent in work rehabilitation and (6) a closer cooperation and information exchange with other rehabilitation actors. CONCLUSIONS: It is possible to improve a work rehabilitation process by focusing on early identification of problems, needs and interventions, with a variety of interventions to choose between and with clear goal formulations and recognizing psychosocial factors in the process. To activate employers to a higher extent in work rehabilitation and to make the information exchange between rehabilitation actors more frequent may also improve work rehabilitation processes.

Adult↗
PubMed2001

Factors associated with successful vocational rehabilitation in a Swedish rural area.

The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three time-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.

Adult↗
PubMed2006

Predicting cardiac rehabilitation enrollment: the role of automatic physician referral.

BACKGROUND: Despite the established benefits of cardiac rehabilitation, evidence suggests referral to, and subsequent enrollment in, cardiac rehabilitation following a coronary event remains low (10-25%). The aim of this study was to identify predictors of attendance to cardiac rehabilitation intake and subsequent enrollment in rehabilitation after coronary artery bypass graft surgery within the framework of an automatic referral system. DESIGN AND METHODS: We conducted a historic prospective study of patients who underwent coronary artery bypass graft surgery between 1 April 1996 and 31 March 2000 and lived within the geographic referral area of a multi-disciplinary cardiac rehabilitation center in central-south Ontario, Canada. Coronary artery bypass graft surgery patients are automatically referred to cardiac rehabilitation at the time of hospital discharge. Consecutive health records of eligible patients were reviewed for medical history, cardiac risk factor profiles, and evidence of cardiac rehabilitation intake attendance and enrolment. RESULTS: A total of 3536 patients met eligibility criteria. Patients were predominantly male (79.1%), approximately 64 years of age, living with a spouse or a partner, English-speaking, retired and had multiple cardiac risk factors. Of eligible patients, 2121 (60.0%) attended the cardiac rehabilitation intake appointment. Of patients who attended cardiac rehabilitation intake 1463 (69%) enrolled in at least one cardiac rehabilitation service, based on their risk factor profile. Selected cardiac rehabilitation services were exercise training (n=1287; 88%), nutrition counseling (n=571; 39.0%), nursing care (n=546; 37.3%), and psychological intervention (n=223; 15.2%). CONCLUSIONS: An institutionalized, physician-endorsed system of automatic referral to cardiac rehabilitation resulted in higher rates of cardiac rehabilitation intake and enrollment following coronary artery bypass graft surgery than previously reported and should be adopted for all cardiac populations.

Aged↗
PubMed2005

Acute inpatient rehabilitation of 55 patients after liver transplantation.

OBJECTIVE: Acute rehabilitation for patients who have had liver transplants is often necessary to restore functional mobility, but no studies, except for case reports, have documented the complications, outcomes, or predictors of success of an acute inpatient rehabilitation program. Our objective was to examine each of these areas related to rehabilitation after liver transplantation. DESIGN: We performed a chart review of 55 patients who received a liver transplant and were treated on our acute rehabilitation service. We examined several factors, including age, reason for transplant, length of acute hospital stay, length of acute inpatient rehabilitation stay, FIMtrade mark scores, albumin levels, medical complications, and discharge disposition. RESULTS: Patients undergoing rehabilitation after liver transplantation required multiple medical interventions, including liver biopsy, ultrasound, blood transfusions, and dialysis. Several patients (15%) were transferred to the acute care hospital for medical problems. Both a low albumin and a long length of stay in the acute care hospital correlated with a longer stay in rehabilitation and less efficient rehabilitation. Longer rehabilitation stays correlated positively with FIM gain (P < 0.001, r = 0.534). Significant improvements in FIM scores (P < 0.001) during acute inpatient rehabilitation were noted in patients who were discharged to home. We also found that age, albumin level, and length of stay in the hospital did not predict discharge disposition. CONCLUSION: Patients who have had liver transplants can achieve significant functional gains in acute rehabilitation. Rehabilitation professionals should be aware of potential complications and factors that may affect the rehabilitation of this patient population.

Activities of Daily Living↗
PubMed1999

[Need for rehabilitation and application behavior].

The need for rehabilitation is not absolute and given quality. Determination of the need for rehabilitation depends on various criteria, e.g., the case history and certain legally standardized medical prerequisites. Both the regulation of rehabilitation expenditures and different types of personal excess coverage may be interpreted as efforts on the part of social policy to introduce additional controls (i.e., alongside the medical prerequisites) of the need for rehabilitation. Since rehabilitation benefits are only granted in case the insured has applied for, the demand for personal excess coverage might cause a certain selection of financially powerful rehabilitees. Recent cost-cutting legislation, which inter alia included strict budgeting of rehabilitation expenditures and increased personal excess coverage, had entailed a considerable decline in the number of applications for rehabilitation in 1996 and 1997. Several pension insurance funds started questioning their insured to examine the general interest in using rehabilitation services. The results show a strong need for rehabilitation in the group of the older insured (aged 40 and over), however, only 35% to 40% of the insured in subjective need for rehabilitation intend to file an application for rehabilitation and an even smaller number of insured actually apply for rehabilitation. Major impediments to applying for rehabilitation mentioned are job uncertainty as well as the increased personal excess coverage under the recent austerity legislation.

Adult↗
PubMed2004

Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture.

OBJECTIVES: This study examines the effects of depression and cognitive impairment in elderly hip fracture patients receiving inpatient rehabilitation. Our goal was to determine whether any association of depression and cognitive impairment with rehabilitation outcome is accounted for by more immediate effects of these variables on rehabilitation participation. METHODS: We measured depression using the Hamilton Rating Scale for Depression (Ham-D), cognition using the Mini Mental State Examination (MMSE), and rehabilitation outcomes using the motor scale of the Functional Independence Measure (motor FIM) in a prospective observational study of 57 elderly rehabilitation hospital patients admitted to a university-affiliated, freestanding rehabilitation hospital with primary diagnosis of hip fracture. We also assessed rehabilitation participation, to determine whether this accounted for (mediated) any relationship of depression and cognitive impairment with rehabilitation outcome. RESULTS: Baseline Ham-D and MMSE scores were correlated with motor FIM efficiency-those with higher depressive symptoms had lower efficiency (r = -0.44, p < 0.001); similarly, those with more cognitive impairment had lower motor FIM efficiency (r = 0.52, p < 0.001). Rehabilitation participation was a mediator of this association: greater depressive symptoms and cognitive impairment predicted poorer rehabilitation participation which, in turn, predicted lower motor FIM efficiency. Ham-D and MMSE scores were predictors of discharge location: subjects with high depressive symptoms and greater cognitive impairment were more likely to go to a nursing home or personal care home upon discharge. CONCLUSIONS: Depression and cognitive impairment are predictive of negative outcomes in elderly patients' rehabilitation from hip fracture. This effect is mediated by rehabilitation participation, and ratings in this area may serve as a potentially useful clinical and research tool for the rehabilitation environment.

Aged↗
PubMed1992

The status of psychosocial research in the rehabilitation of the cancer patient.

This article has tried to describe the current status of psychosocial research in the rehabilitation of the cancer patient. It attempted to weave together the author's perspective of how decisions early in the history of sponsored research programs, particularly by the National Cancer Institute, combined with a limited knowledge base led to limited growth of the Rehabilitation Program. Thus, the current status of psychosocial cancer rehabilitation can be reasonably attributed to the decision at the National Cancer Institute to encourage the development of cancer rehabilitation services, rather than to aggressively expand the knowledge base. Although, in retrospect, it is possible to criticize these decisions, in fact, they were legitimate choices among a wide range of options. It was also not possible in this article to discuss many topics in psychosocial cancer rehabilitation, particularly differences in psychosocial adjustment as a function of type of cancer. What the study attempted to do was to confront the impression that cancer rehabilitation, in general, and psychosocial cancer rehabilitation, in particular, are ancillary activities that can receive a secondary level of resource allocation and support. The point was made that determining if psychosocial rehabilitation is possible raises as many basic research questions as does understanding how chemotherapy works or how a malignancy develops. All three areas ask legitimate basic research questions on how the body works and how behavior changes. Today, 10 years after the start of the original Rehabilitation Program, psychosocial cancer rehabilitation is an established field of study and an integral part of most major oncology services. Now, as stated, what is needed is an expansion of its knowledge base. Some of the issues that are deserving of support include studies on cosmesis, to what extent voluntary processes can compensate loss in speech and swallowing functions, functional evaluation following alternative surgical procedures, what is the quality of life following long-term survival of cancer, what are the group dynamics following return of a cancer patient to a work site, and so on. Each of these research questions can be guided by the same model developed for cancer control research by Greenwald and Cullen. Other more general approaches include recognizing and promoting the preventative dimension of cancer rehabilitation and developing the art and practice of psychometric assessment of psychosocial aspects of cancer rehabilitation, just to name two such areas. The American Cancer Society also recently sponsored a meeting to review and set new directions for psychosocial rehabilitation research.(ABSTRACT TRUNCATED AT 400 WORDS)

Health Services Needs and Demand↗
PubMed2003

[Inpatient medical rehabilitation in diabetes mellitus in light of evidence based practice guidelines: an evaluation on the basis of BfA routine data].

OBJECTIVE: Multidisciplinary team care is an opportunity to improve the long-term metabolic situation of patients with diabetes mellitus, hence can help reduce the individual and financial burden of diabetes-related complications. The aim of this study is to evaluate the extent to which patients undergoing rehabilitation carried by the German Federal Insurance Institute for Salaried Employees (BfA) were treated in accordance with recent evidence-based clinical practice guidelines on diabetes mellitus. METHODS: We extracted specific treatment recommendations relevant to inpatient rehabilitation from national and international evidence-based guidelines and allocated them to general subjects of diabetes care (e. g. [disease specific] education, physical activity, psychosocial interventions). In the "Classification of Therapeutic Procedures (KTL)", an instrument used to classify therapeutic procedures in rehabilitation, we then identified those procedures that represented the recommendations of the guidelines. The coded procedures were allocated to the general aspects of diabetes care, too. In total, 9 "therapeutic modules" were designed, each containing guideline-recommendations and coded procedures. Using the KTL codes documented as a routine in discharge reports, we were able to describe, analyse and evaluate the procedures performed during rehabilitation. The data set we used contained KTL codes and medical information from 9,456 patients whose rehabilitation was carried by the BfA diagnosed with either diabetes mellitus type 1 or 2, who received an inpatient rehabilitation procedure during the years 2000 and 2001. RESULTS: The number of patients who received at least one procedure out of the particular therapeutic module is as follows (numbers in brackets represent the total number of KTL codes in that therapeutic module): Therapeutic module "Education (3)" - 98.66 %, "Exercise Training (63)" - 92.42 %, "Nutrition Training (14)" - 96.44 %, "Stress (18)" - 35.33 %, "Motivation (15)" - 82.87 %, "Coping Skills (15)" - 27.42 %, "Social Work (26)" - 11.44 %, "Alcohol and Nicotine (24)" - 3.69 %, "Diabetic Complications (81)" - 75.42 %. On average patients received procedures out of 5.2 different therapeutic modules. The results were consistent over subgroups (type 1/type 2 diabetes, men/women) but varied considerably between clinics. The care provided in clinics with higher numbers of diabetic patients is more in line with guideline specifications. DISCUSSION: A substantial number of patients received procedures out of the therapeutic modules "Education", "Exercise Training", "Nutrition Training" and "Motivation". In other therapeutic modules (e. g. "Alcohol and Nicotine") deficits were noted. These deficits as well as the substantial variation between clinics demonstrate the need to develop clinical practice guidelines for rehabilitation of patients with diabetes. In principle, the results of this study have to be interpreted carefully because we did not examine to which extent the documented processes are in accordance with the realities. CONCLUSIONS: Inpatient rehabilitation of diabetic patients carried by the BfA can be characterised as multidisciplinary and in accordance with the recommendations of recent evidence-based guidelines. Certain problematic aspects should be put into focus. A guideline taking into account all rehabilitative aspects, including the preparation for and the care after the rehabilitation process, can be instrumental in reducing deficits in rehabilitative care as well as differences between clinics. To gain wide acceptance, guideline development should be coordinated by a scientific institute and involve members of all groups concerned (e. g. the rehabilitative team, GPs, patients). Within certain limits the "KTL" instrument permits evaluation of process quality in rehabilitation of patients with diabetes mellitus.

Combined Modality Therapy↗
PubMed2006

Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction.

BACKGROUND: Some sociodemographic and psychological variables such as patients' belief about illness are associated with attendance at cardiac rehabilitation. Exploration of patients' beliefs about treatment regarding cardiac rehabilitation has been limited to qualitative studies; their role in relation to attendance at cardiac rehabilitation after acute myocardial infarction (AMI) remains speculative. OBJECTIVES: To develop a valid and reliable measure of patients' beliefs regarding cardiac rehabilitation and to ascertain the relationship between such beliefs and attendance. DESIGN: A prospective questionnaire-based study. SETTING: Coronary care unit of a London teaching hospital. PATIENTS: 130 patients with AMI; 104 (83%) men; mean age 58.4 (standard deviation (SD) 10.7) years. INTERVENTIONS: Patients completed a 26-item questionnaire consisting of statements pertaining to beliefs about cardiac rehabilitation. MAIN OUTCOME MEASURES: Cardiac rehabilitation attendance; beliefs of patients about cardiac rehabilitation. RESULTS: Four subscales pertaining to patients' beliefs about cardiac rehabilitation were produced, accounting for 65.3% of the attendance variance: perceived necessity of cardiac rehabilitation (alpha = 0.71), concerns about exercise (alpha = 0.79), practical barriers (alpha = 0.70) and perceived personal suitability (alpha = 0.74). Patients who attended were more likely to believe that cardiac rehabilitation was necessary and to understand its role compared with non-attenders (17.7 (SD 2.7) v 16.9 (SD 3.0), p = 0.029). Patients who thought cardiac rehabilitation was suitable for a younger, more active person were less likely to attend (5.6 (SD 1.9) v 4.6 (SD 1.7), p = 0.007). Patients who expressed concerns about exercise or who reported practical barriers to attendance were less likely to attend, although these did not reach statistical significance. CONCLUSION: Beliefs about cardiac rehabilitation can be quantified and differ between attenders and non-attenders of cardiac rehabilitation.

Adult↗
PubMed1998

A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm.

BACKGROUND AND PURPOSE: This study describes the methodology, patient outcome, and use of hospital and rehabilitation services at 3 months of a population-based randomized controlled trial. The purpose was to evaluate rehabilitation at home after early supported discharge from the Department of Neurology, Huddinge Hospital, for moderately disabled stroke patients in southwest Stockholm. METHODS: The patients were eligible if they were continent, independent in feeding, had mental function within normal limits, and had impaired motor function and/or aphasia 1 week after stroke. Patients were randomized either to early supported discharge with continuity of rehabilitation at home for 3 to 4 months or to routine rehabilitation service in a hospital, day care, and/or outpatient care. The home rehabilitation team consisted of two physical therapists, two occupational therapists, and one speech therapist; one of the therapists was assigned as case manager for the patient. The rehabilitation program at home emphasized a task- and context-oriented approach. The activities were chosen on the basis of the patient's personal interests. Spouses were offered education and individual counseling. A total of 81 patients were followed up for a minimum of 3 months. Patient outcome was assessed by the Frenchay Social Activity Index, Extended Katz Index, Barthel Index, Lindmark Motor Capacity Assessment, Nine-Hole Peg Test, walking speed over 10 m, reported falls, and subjective dysfunction according to the Sickness Impact Profile. Patient use of hospital and home rehabilitation service and patient satisfaction with care were studied. RESULTS: Overall there were no statistical significant differences in outcome. Multivariate logistic regression analysis suggested a systematic positive effect for the home rehabilitation group in social activity, activities of daily living, motor capacity, manual dexterity, and walking. A considerable difference in resource use during such a 3-month period was seen. A 52% reduction in hospitalization was observed: from 29 days in the routine rehabilitation group to 14 days in the home rehabilitation group. Patient satisfaction was in favor of the latter group. CONCLUSIONS: Early supported discharge with continuity of home rehabilitation services for the majority of moderately disabled stroke patients during the first 3-month period after acute stroke is not less beneficial than routine rehabilitation and can be a rehabilitation service of choice if follow-up at 6 and 12 months confirms the suggested effectiveness and considerable reduction in use of health care.

Activities of Daily Living↗
PubMed1990

[The effect of rehabilitation on the prognosis of acute myocardial infarction of the aged].

We examined the effect of rehabilitation on the prognosis of aged patients with a first episode of acute myocardial infarction. The mean age of patients was 77 years old. We divided them into two groups, one group consisted of 53 patients for whom a rehabilitation program was available, another group consisted of 84 patients for whom a rehabilitation program was not available. Of the patients with rehabilitation available, there were 20 who were unable to receive rehabilitation, 15 who were able to participate in only light rehabilitation, 27 who were able to walk and 22 who finished rehabilitation. During 3.5 years of follow-up after initial myocardial infarction, the rates of cardiac death were 51% in the group without rehabilitation and 41% in the group with rehabilitation. For 26 patients who died of cardiac events and who had received rehabilitation, there was a positive correlation (r = 0.53) between the level of rehabilitation reached and the survival in years. The incidence of angina pectoris after myocardial infarction was more frequent in the group with rehabilitation. However the exercise activity level was higher and the prognosis was better in the group with rehabilitation, although statistical significance was not found.

Aged↗
PubMed1999

[Patients' views on ambulatory orthopedic/traumatologic rehabilitation].

Although patients' perspectives play an important role in most area of the health care system, little is known so far about patients' views regarding outpatient rehabilitation. As part of an evaluation study on new model of rehabilitation, we therefore also investigated the patients' views, giving special attention to the commonly suggested advantages of outpatient rehabilitation. In the study, 1013 patients were given a questionnaire, in which patients could evaluate their satisfaction with outpatient rehabilitation and could mark preferences for either inpatient or outpatient rehabilitation. The results confirmed to a large extent the advantages of outpatient rehabilitation. This form of rehabilitation offers the patients a complex therapy close to their residence and can facilitate an early occupational reintegration. Outpatient rehabilitation also offers the possibility to take care of the family and to spend free time with the family. This fact is perceived as one important advantage leading to preference for outpatient rehabilitation. In general, patients were most satisfied with the care given by their therapists or physician, as well as with the treatment. They were less satisfied with the subsequent treatment after rehabilitation. A majority of patients felt left alone after treatment. One of the advantages of outpatient rehabilitation is the possibility of including relatives and the family doctor in the outpatient treatment. However, only few patients agreed, that the family doctor or relatives were sufficiently included in the treatment. Most younger patients prefer the outpatient rehabilitation. One of the reasons given was the possibility of taking care of important jobs at home. The results of our study give evidence for a high demand of patients for outpatient rehabilitation.

Adult↗