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PubMed2005

[Findings on the effectiveness of rehabilitation].

The German Federal Ministry of Education and Research (BMBF) and the German Pension Insurance scheme established a funding programme for research in rehabilitation. This review presents the findings of 38 available evaluation studies analyzing the effects of medical rehabilitation in Germany in different indications. With a total of 10 studies, the effectiveness of rehabilitation in chronic low back pain was evaluated most frequently. The other research projects analyzed the effects of rehabilitation in psychosomatic diseases (9 studies), cardiac diseases (9), cancer (4), neurological diseases (3), bowel diseases (1) and rehabilitation of children and juveniles (2). According to the results at hand, medical rehabilitation significantly improves the patients' state of health at the end of the rehab measure. Effectiveness is maintained in numerous patients also in the medium or fairly long-term. Hence, rehabilitation accomplishes a prerequisite for further gainful employment. Most of the patients treated have been suffering from chronic illness for many years and have developed psychological complaints besides their serious somatic symptoms and impairments. Here, rehabilitation takes on a fundamental assignment in the care of chronically ill patients. The projects carried out under the promotional focus highlight concrete perspectives for evidence based enhancement of medical rehabilitation. This, amongst others, also holds true for the positive experience with treatment modules within specific vocational training and with patient education. Some of the insights gained are already being realized. As a current task of development, the findings point to further improving the sustainability of rehabilitation's positive impact particularly in chronic low back pain. Pertinent conceptual approaches can be derived from the projects presented.

Back Pain↗
PubMed2004

Use of outcomes information in acute inpatient rehabilitation.

OBJECTIVE: To describe the ways in which rehabilitation outcomes information is used in the acute inpatient rehabilitation industry and the industry's views on the topic of public disclosure of rehabilitation outcomes information. DESIGN: A mixed-methods approach, featuring data from 39 informational telephone interviews with rehabilitation industry stakeholders followed by a survey of 95 randomly sampled acute inpatient rehabilitation provider organizations. RESULTS: Both the informational interviews and survey findings revealed that there is currently little stakeholder demand for functional outcomes information. Outcomes information is primarily used within provider organizations to track the effectiveness of rehabilitation services. There is general consensus among rehabilitation provider organizations in favor of public disclosure of outcomes information. CONCLUSIONS: Outcomes information is not routinely shared with rehabilitation stakeholders (i.e., payers and consumers). Rehabilitation providers and industry stakeholders generally express favorable attitudes toward public disclosure of outcomes information. Stakeholders' perceptions of current barriers and facilitators of outcomes information provide insight into the steps that can be taken toward greater transparency in the rehabilitation industry.

Activities of Daily Living↗
PubMed2025

Rehabilomics Strategies Enabled by Cloud-Based Rehabilitation: Scoping Review.

BACKGROUND: Rehabilomics, or the integration of rehabilitation with genomics, proteomics, metabolomics, and other "-omics" fields, aims to promote personalized approaches to rehabilitation care. Cloud-based rehabilitation offers streamlined patient data management and sharing and could potentially play a significant role in advancing rehabilomics research. This study explored the current status and potential benefits of implementing rehabilomics strategies through cloud-based rehabilitation. OBJECTIVE: This scoping review aimed to investigate the implementation of rehabilomics strategies through cloud-based rehabilitation and summarize the current state of knowledge within the research domain. This analysis aims to understand the impact of cloud platforms on the field of rehabilomics and provide insights into future research directions. METHODS: In this scoping review, we systematically searched major academic databases, including CINAHL, Embase, Google Scholar, PubMed, MEDLINE, ScienceDirect, Scopus, and Web of Science to identify relevant studies and apply predefined inclusion criteria to select appropriate studies. Subsequently, we analyzed 28 selected papers to identify trends and insights regarding cloud-based rehabilitation and rehabilomics within this study's landscape. RESULTS: This study reports the various applications and outcomes of implementing rehabilomics strategies through cloud-based rehabilitation. In particular, a comprehensive analysis was conducted on 28 studies, including 16 (57%) focused on personalized rehabilitation and 12 (43%) on data security and privacy. The distribution of articles among the 28 studies based on specific keywords included 3 (11%) on the cloud, 4 (14%) on platforms, 4 (14%) on hospitals and rehabilitation centers, 5 (18%) on telehealth, 5 (18%) on home and community, and 7 (25%) on disease and disability. Cloud platforms offer new possibilities for data sharing and collaboration in rehabilomics research, underpinning a patient-centered approach and enhancing the development of personalized therapeutic strategies. CONCLUSIONS: This scoping review highlights the potential significance of cloud-based rehabilomics strategies in the field of rehabilitation. The use of cloud platforms is expected to strengthen patient-centered data management and collaboration, contributing to the advancement of innovative strategies and therapeutic developments in rehabilomics.

Cloud Computing↗
PubMed2003

Stroke rehabilitation services in New Zealand.

AIMS: To obtain an overall picture of the organisation of stroke rehabilitation services throughout New Zealand and to see if this is consistent with recommendations in evidence-based guidelines. METHODS: A questionnaire was sent to all hospitals in New Zealand. This included questions about access to organised stroke rehabilitation, guidelines for the management of common problems after stroke, and the use of audit. RESULTS: All 48 hospitals surveyed responded, with 37 providing inpatient stroke rehabilitation services. Only one hospital (serving 9% of the population) provided a dedicated, inpatient stroke rehabilitation facility. In the other 36 hospitals, stroke rehabilitation was performed in assessment, treatment and rehabilitation units (25 hospitals, 84%) or general medical wards (8 hospitals, 7%). Only 57% of the population had access to hospitals with a nominated lead clinician for stroke rehabilitation services. Thirty per cent were served by hospitals without a multidisciplinary therapy team expert in stroke care. Guidelines for the management of common problems following stroke were used in most hospitals. Only 8 hospitals (28%) had audited their stroke rehabilitation services. CONCLUSIONS: The organisation and type of rehabilitation services available for people with stroke are not consistent with best practice or accepted guidelines. The development of an organised approach to stroke rehabilitation services in New Zealand must be seen as a priority.

Age Factors↗
PubMed1955

Industry's contribution in the field of rehabilitation.

TWO MAIN GROUPS OF PEOPLE ARE CONCERNED IN REHABILITATION IN INDUSTRY: the permanently disabled and those temporarily put out of action by reason of accident or illness. The first group has been dealt with by legislation and by creating rehabilitation centres and training centres. The rehabilitation of the temporarily disabled has on the whole not been developed to the same extent.The speed of recovery after an illness, and especially after an accident, is very much related to efficient initial treatment and after-care. If the treatment takes place in hospital, the discharge from hospital, often due to lack of beds, takes place in a critical phase when the after-care should be supervised. Team-work between hospitals, physiotherapists, and industries at this period can do useful work in rehabilitating the temporarily disabled.The most important problem to industry is the rehabilitation of minor injuries and illnesses, because they are so common. At the Vauxhall Motors Ltd factory, with over 12 000 employees, rehabilitation has been carried out since 1945 in a special retraining shop which accommodates 60 patients. In six years some 2300 patients have passed through this shop. Although priority has been given to works' casualties, over 50% of the cases have been non-occupational injuries or illnesses. About 25% of the patients were fracture cases, and of these 90% were able to return to their pre-disability jobs within six weeks.Although rest and prolonged immobilization may be necessary in the treatment of injuries, movements, especially repetitive movements, may be very useful in preventing joint stiffness, and improving muscle tone and blood circulation. Carried out under careful medical supervision, they will not counteract the rapid healing of bone and soft-tissue lesions. Substitution of engineering techniques for the conventional handicraft methods of occupational therapy is one of the most important developments in the field of rehabilitation. Spindle drilling-machines, sometimes with a special grip, and bench work, sometimes with leg operations, have been most useful in creating suitable movements for patients in the retraining shop.The success of this method of rehabilitation can be shown from the fact that the average period of absence for a septic finger has been reduced from 22.5 to 1.86 days.This experience of the rehabilitation of the temporarily disabled comes from a large industry. For smaller industries where such a scheme would not be practicable, the problem might be solved by establishing group industrial rehabilitation centres, attached to up-to-date and well-staffed hospitals.

Adult↗
PubMed2006

Time to rehabilitation admission and associated outcomes for patients with traumatic brain injury.

OBJECTIVE: To examine the association between time from injury to rehabilitation admission and outcomes for patients with traumatic brain injuries (TBIs). DESIGN: Retrospective chart review. SETTING: One hundred-bed inpatient rehabilitation facility with a 20-bed brain injury unit. PARTICIPANTS: Patients with TBIs discharged from initial inpatient rehabilitation between 2003 and 2004 (N=158). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcomes examined were functional independence at discharge (motor, cognitive, total FIM scores), rehabilitation length of stay (LOS), and rehabilitation cost. RESULTS: Significant linear trends were observed for time to admission and motor FIM scores, total FIM scores, rehabilitation LOS, and cost. All linear regression models contained time to admission as a significant predictor of rehabilitation outcomes. Over half of the variability in outcomes was explained by predictors including time to admission and case-mix group or individual FIM scores with the exception of discharge motor FIM score, for which only 45% of the variability was explained. CONCLUSIONS: Patients who progress to rehabilitation earlier do better functionally and have lower costs and shorter LOSs. Furthermore, the time to rehabilitation admission is easily calculated and could be used by rehabilitation providers in adjunct with admission FIM scores to estimate resource utilization.

Adolescent↗
PubMed1995

The ownership difference in relative performance of rehabilitation specialty hospitals.

Despite the rapid growth in the number of rehabilitation specialty hospitals in recent years, there is little knowledge of the performance of these facilities. The recent growth in the number of for-profit rehabilitation providers and increasing competition among for-profit and not-for-profit rehabilitation hospitals have raised questions about differences in performance. This study analyzed differences in financial and operational performance between for-profit rehabilitation specialty hospitals and not-for-profit rehabilitation specialty hospitals for fiscal years ending in 1989 through 1992. Because rehabilitation hospitals are exempted from Medicare's Prospective Payment System, but subject to cost limits established under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), this study controlled for the influence of TEFRA by grouping hospitals into "new" and "existing" categories. The findings show significantly higher net revenue and profits in existing for-profit rehabilitation hospitals. In addition, existing for-profit rehabilitation facilities served a larger percentage of Medicare patients and had fewer employees than existing not-for-profit facilities. It was concluded that existing for-profit rehabilitation hospitals maximized their charges to increase their revenues. These findings have important policy implications for reimbursement alternatives under consideration for inpatient rehabilitation programs.

Financial Management, Hospital↗
PubMed1999

Comparison between men and women admitted to an inpatient rehabilitation unit after cardiac surgery.

OBJECTIVE: To determine whether there are differences in several factors between men and women who undergo inpatient post-cardiac surgery rehabilitation. DESIGN: A retrospective chart review. Information was collected on a variety of factors: age; previous myocardial infarction; number of days from surgery to admission to rehabilitation; postsurgery, prerehabilitation complications; length of stay on the rehabilitation unit; living arrangements before surgery; disposition; and postdischarge recommendations. SETTING: Community hospital rehabilitation unit associated with a university hospital. PATIENTS: One hundred thirty-eight patients (54 men, 84 women) admitted to an inpatient rehabilitation unit after cardiac surgery. RESULTS: There was a significant relationship between sex and preadmission living arrangements; 56% of women lived alone versus 26% of men (p < .01). There was a statistically significant difference in length of stay on the rehabilitation unit (p < .02). Men stayed longer, with a median stay of 16 days (95% confidence interval, 15 to 20) versus 15 days for women (95% confidence interval, 14 to 15). Ninety-three percent of men were discharged from rehabilitation at 30 days versus 98% of women. No relationship was noted between men and women in age, previous myocardial infarction, number of days from surgery to rehabilitation admission, length of stay on the rehabilitation unit, postsurgery-prerehabilitation complications, complications on the rehabilitation unit, presurgery living arrangements, disposition, and postdischarge therapy recommendations. CONCLUSION: Men and women showed comparable courses after cardiac surgery. Before surgery, women lived alone more frequently than men.

Aged↗
PubMed2003

An exploration of the contribution of the community nurse to rehabilitation.

Effective hospital and community rehabilitation services are increasingly recognised as a means of meeting the changing pattern of health and social care need. While the district or community nurse has the potential to play a central part in community rehabilitation provision, this role has received relatively scant attention in the literature. This paper describes research findings on community nurses' perceptions of their role and potential contribution to rehabilitation. As part of a wider, 2-year, qualitative investigation of the role of the nurse in rehabilitation, fieldwork was undertaken with both district and community staff nurses. This comprised focus group discussions and interviews with staff recruited as a consequence of the follow-up of patients' experiencing rehabilitation. The findings indicate that community-based nurses contributed to patient rehabilitation by making assessments, referring on to other members of the multi-professional team, advocating for and liaising with other services, helping people to adapt, teaching and motivating patients and carers, supporting and involving families, and providing technical care. A number of challenges to community-based nursing roles were apparent, including feelings of exclusion, lack of recognition, a lack of time for rehabilitation and paucity of referrals for rehabilitation. Greater clarity and recognition is needed of the community-based nursing contribution to rehabilitation, and there is a need to ensure that community nursing assessments contribute to patients' rehabilitation goals and the promotion of independent living.

Community Health Nursing↗
PubMed2002

A framework for the role of Registered Nurses in the specialty practice of rehabilitation nursing in Australia.

AIM OF THE STUDY: This study sought to explore systematically the role of Registered Nurses working in rehabilitation in Australia. BACKGROUND: Rehabilitation has been identified as an important aspect of health care. However, evidence of a comprehensive investigation of the nurses' role in rehabilitation cannot be found. From Australia, in particular, no research has been published in this area. METHODS: This study used a qualitative approach by engaging 13 nurses in one-to-one interviews and a further 21 in focus group discussions. Thematic analysis was conducted on the interview and focus group data. FINDINGS: Seven domains of practice were identified and are suggested as a framework for the specialty practice of rehabilitation nursing. They capture the 'how' and 'what' of rehabilitation nursing practice. Central to this practice is a rehabilitative approach to patient care, teaching and coaching, and continual assessment. The nurses explained in detail how these aspects of rehabilitation nursing differentiate their practice from that of their acute care colleagues. CONCLUSION: The rehabilitative approach is one of a variety of approaches to nursing care, but should not be seen as the exclusive domain of rehabilitation nurses. Rehabilitation belongs in every nurse's toolkit.

Adult↗
PubMed2001

Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients.

OBJECTIVE: To examine how depressive symptoms, a history of depression, and cognitive functioning contribute to the prediction of rehabilitation efficiency in stroke patients. DESIGN: Consecutive admissions to an acute inpatient rehabilitation program were screened for cognitive functioning and level of depressive symptoms. History of depression was determined by family member interview. Functional status was evaluated at time of admission and discharge. Depressive symptoms, depression history, and cognitive functioning were examined as predictors of length of stay (LOS) and efficiency of utilization of rehabilitation services. SETTING: Acute inpatient rehabilitation hospital. PATIENTS: A total of 348 consecutive stroke admissions to an inpatient program were evaluated for depression and cognitive functioning, of whom 243 patients completed all aspects of the screening. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation progress, measured with the LOS efficiency measure (LOS-EFF) of the FIM instrument, and length of rehabilitation hospital stay. RESULTS: Patients with higher levels of depressive symptoms used rehabilitation services less efficiently than those with lower symptom levels but did not have longer LOSs. History of depression was associated with longer LOS and less efficient use of rehabilitation services. Cognitive impairment did not predict rehabilitation efficiency. CONCLUSIONS: The present study lends further support to the benefits of screening stroke patients at the time of rehabilitation admission for depression and history of depression. Identifying patients who have high levels of depressive symptoms and/or a previous depressive episode will allow more comprehensive assessment and rapid intervention.

Aged↗
PubMed2000

[Clinical studies in rehabilitation research--problems and solutions from biometrical perspective].

Methodology of clinical studies is highly sophisticated in drug research. But clinical trials are also necessary to demonstrate efficacy and safety of rehabilitation treatment. The call for evidence based medicine has also reached rehabilitation. However, in rehabilitation medicine it is much more difficult to design and conduct clinical trials with a high methodological standard. Among the reasons are: A comparable control group is necessary because spontaneous healing and unspecific measures contribute to therapeutic success, too. But what could "placebo rehabilitation" look like? The masking of therapies (blinded studies) will hardly ever be possible. Therefore, it is more difficult to achieve the same treatment and observation for the treatment and control group. Treatments in rehabilitation take longer to become effective than a drug and maybe the success will disappear after some time. Therefore, long-term trials and follow-ups are necessary. Such studies are expensive, need a strong organisation, and drop-outs are unavoidable. An appropriate outcome variable does not always exist. "Return to work" is an important, reliable and valid variable, but it delivers only one bit of information per patient. As a consequence, smaller progress in rehabilitation can only be demonstrated with large sample sizes. Outcome variables based on time enable studies with reasonable sample sizes. Sometimes it is more difficult to obtain acceptance of randomisation in rehabilitation patients than in acute patients. Some rehabilitation hospitals have only recently begun to take an interest in controlled clinical trials, hence are not so experienced. Nevertheless, controlled clinical trials delivering convincing results are possible in rehabilitation medicine as well. But biometrical consultation is necessary e.g. for study design, study conduction and evaluation. Most important points are the methodology of the study design and its practicability. Especially in these topics rehabilitation physicians and biometrician have to cooperate.

Biometry↗
PubMedDate not supplied

[Outpatient cardiological rehabilitation--acceptance and conditions related to choice of setting].

In view of the increasing demands for more co-operation and integration among health care providers and "uninterrupted" care delivery processes increasing attention is being paid to establishing the determinants of a more flexible form of rehabilitation setting. Interest is focused particularly on determining at what stages and under what conditions specific choices of rehabilitation setting are made. In 1838 patients admitted consecutively to a cardiological rehabilitation clinic, the study investigated how many patients opted for outpatient rehabilitation and what factors influenced the patients' choice of rehabilitation setting. A total of 165 (9 %) of the 1838 patients chose outpatient rehabilitation. Patients who prefer outpatient rehabilitation are mainly male, belong to a higher social class and are younger. Patients who choose inpatient treatment feel more restricted by their illness. This is also revealed in the difference in coping strategies employed. Patients who prefer the inpatient setting show a greater tendency towards rumination than outpatients. It is thus comprehensible that these patients hope to gain a greater distance from their day-to-day problems. The results indicate that patients' willingness to take advantage of outpatient forms of rehabilitation is moderated both by sociodemographic, psychosocial and disease-related variables as well as by context variables. It is embedded in the complex biopsychosocial conditions governing rehabilitation. One consequence for managing the introduction of more flexible modes of rehabilitation could be to avoid dirigistic and unidimensional control parameters. The results indicate that more flexible disease management cannot follow fixed rules, but rather that the planning of individual requirements should be taken into account.

Aged↗
PubMed2002

[Long-term effect of indoor rehabilitation on children and young people with moderate and severe asthma].

In a multi-centre trial the effect of indoor rehabilitation in case of bronchial asthma in childhood and adolescence was evaluated on a prospective basis in comparison to an ambulant group of patients. 195 children and adolescents aged between 8 and 16 suffering from bronchial asthma (grading of severity 3 and 4) were included in the trial. The rehabilitation group (RG) included 149 patients, whereas the out-patient reference group consisted of 46 patients. At the beginning of the trial (in the rehabilitation group about 14 days before rehabilitation started) and 12 months afterwards, the pulmonary function (FEV 1, peak flow and MEF50), asthma-related school day off, participation in school sport, asthma management and quality of life were recorded. 12 months after the indoor rehabilitation, the rehabilitation group had significantly better MEF50-values (P = 0.007) than the ambulant group. The rehabilitation group also had significantly better values (P < 0.01) with regard to the asthma management. Already at the beginning of the study both groups indicated a satisfactory participation in school sport with 3.5 hours a week which could not be increased further. The baseline values for asthma-related school day off and quality of life of the rehabilitation group were worse than those of the ambulant group. 12 months after rehabilitation, however, the values were significantly better (P < 0.01) compared to baseline and almost similar to the levels of the ambulant group. Significantly improvements with regard to MEF50, asthma management, school day off and quality of life could thus be achieved by indoor rehabilitation.

Adolescent↗
PubMed2004

[Geriatric rehabilitation in Germany: service provision policy and structural aspects from a statutory health insurance perspective].

The so-called shifting of paradigm in medicine has inevitably led to an increasing importance of medical rehabilitation, especially geriatric rehabilitation, within the system of medical care in the Federal Republic of Germany. Nationally valid guidelines for assessing the indication of geriatric rehabilitation and for recommending options for appropriate allocation have been elaborated within the framework of the German statutory health insurance system. In addition, manpower and equipment requirements for ambulatory geriatric rehabilitation facilities have been agreed on. These guidelines include clarifications concerning the following: definition of the geriatric patient; definition of the patient in need of geriatric rehabilitation; demarcation of geriatric rehabilitation from organ-specific rehabilitation; operationalization of assessment procedures and allocation recommendations concerning geriatric rehabilitation; requirements profiles for ambulatory geriatric rehabilitation facilities. Essential prerequisites for successful implementation of these national standards are among others: turning towards the bio-psycho-social model of health and disease advocated by the World Health Organization; overcoming the traditional deficit model of aging and old-age in favour of a resource-oriented approach in service-provision policies; rejecting the one-sided fiscal thinking in the current debate over service-provision policies in geriatric rehabilitation.

Adolescent↗
PubMed2005

[Implementation and evaluation of a further-training measure on detection and diagnostics of mental disorders in medical rehabilitation].

The prevalence of comorbid mental disorders in rehabilitation patients is high. In spite of the biopsychosocial treatment approach in rehabilitation, recognition and treatment rates of comorbid mental disorders during medical rehabilitation are low. Therefore this study evaluates a special further-training measure for rehabilitation staff, intended to inform them about the relevance of comorbid mental disorders in rehabilitation patients, to train them in the use of screening instruments, and to discuss needed changes in rehabilitation processes. 14 further-training courses were carried out with 148 participants of different professions from rehabilitation hospitals. Interest in the training was rated to be high whereas previous knowledge of comorbid mental disorders was relatively low. The participants rated the basic conditions of the training as being good. Overall, the steps discussed to improve psycho-diagnostics in rehabilitation were rated as being important and realistic. Especially early recognition of mental burden, the use of screeners for detection, and the naming of diagnoses of mental disorders in discharge reports were considered as most readily realized. The results underline the importance of further-training for improving psycho-diagnostics in rehabilitation clinics, not only to ensure the biopsychosocial treatment approach in rehabilitation but also in view of reducing costs in the health care system.

Consumer Behavior↗
PubMed2001

Rehabilitation an international perspective: a Zimbabwean experience.

PURPOSE/METHOD: The article discusses rehabilitation practices in Zimbabwe from both a local and international perspective. It considers the nature of formal and informal rehabilitation services in the country, and rehabilitation personnel training. RESULTS: Indigenous disability-related practices dominate the informal rehabilitation sector whereas modern rehabilitation practices characterize the formal rehabilitation sector. Rehabilitation clients make use of both the formal and informal rehabilitation systems. Persons with disabilities in Zimbabwean urban centres have more access to the formal rehabilitation service system than those in the rural areas. CONCLUSIONS: Rural communities may have more habilitation than rehabilitation, and are more accommodating of disability-related differences.

Persons with Disabilities↗
PubMed2000

Integrated institution--community rehabilitation in developed countries: a proposal.

PURPOSE: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. METHODS: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries; presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. RESULTS: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. CONCLUSION: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.

Community Health Services↗