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PubMed2005

Measuring rehabilitation research capacity: report from the AAPM&R Research Advisory Committee.

There is considerable concern regarding the paucity of individuals pursuing biomedical research in general and rehabilitation research in particular. The Research Advisory Committee (RAC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) accepted the task to explore the barriers to biomedical research careers for physicians and rehabilitation scientists and, in particular, those factors pertaining to successfully conducting rehabilitation research. Concurrently, the Foundation for PM&R was also exploring the related issue of building capacity for rehabilitation research and planning a Rehabilitation Research Summit to address this issue for the spring of 2005. The goals of the Research Summit included the identification of barriers to rehabilitation research and development of an active agenda to enhance research capacity. As such, AAPM&R and the Foundation for PM&R worked through the RAC survey to provide some key information that would help the summit leaders achieve their goals. This report presents portions of the survey related to research capacity and outlines the methodology of the data collection and analysis within the context of the capacity taxonomy framework as presented at the Research Summit, "Building Research Capacity," held in the spring of 2005. This survey report provides quantitative information about researchers and academicians, their research environment, as well as their barriers and incentives for conducting rehabilitation research. Observations here provide a platform for future work in understanding the adequacy of the rehabilitation research enterprise, its appropriateness, and ability to meet societal needs for those with disabilities.

Academies and Institutes↗
PubMed2006

Factors contributing to patient satisfaction with medical rehabilitation in German hospitals.

The objective of this study was to quantify overall patient satisfaction, through the identification of the particular aspects of patient satisfaction that were most likely to cause patients to recommend the rehabilitation hospital to others. The research entailed analysing secondary data from a quality improvement programme for medical rehabilitation, conducted from 1997 until 2004, in seven rehabilitation hospitals in Germany. Overall patient satisfaction and several potential predictors were examined in relation to 120,825 patients who had received inpatient medical rehabilitation. Recommending the rehabilitation hospital to others is a measure of overall patient satisfaction with the rehabilitation. Logistic regression was used to identify the factors that predicted patient satisfaction or dissatisfaction at discharge from the rehabilitation hospital. Overall satisfaction was mainly determined by the general atmosphere in the hospital, successful rehabilitation and the medical care. The general atmosphere was strongly associated with admission procedures, accommodation, catering, service, organisation and nursing care. In conclusion, the results suggest that in order to increase the rate of recommendation, rehabilitation hospitals should aim for not only high quality in medical care, but also the creation of a pleasant atmosphere.

Female↗
PubMed2005

Acute coronary syndromes: cardiac rehabilitation programmes and quality of life.

AIMS: This paper reports a study examining the quality of life of clients following hospital admission with acute coronary syndrome in Hong Kong and their use of cardiac rehabilitation. BACKGROUND: Coronary heart disease is a major source of mortality and morbidity in Hong Kong. Western studies have suggested that participation in cardiac rehabilitation improves the quality of life of clients with coronary heart disease yet the use of cardiac rehabilitation has been reported to be low. Better understanding is needed of the psychosocial status of these clients in Hong Kong and their use of cardiac rehabilitation services. METHODS: A prospective, pretest-post-test study was carried out, with data collected over a period of 6 months with convenience sample of 182 participants. Baseline data were obtained within one week after hospital admission for individuals experiencing ACS. The second phase of data collection commenced at 6 months after hospital discharge. Total period of data collection took over 12 months between 2002 and 2003. The Chinese version of the SF-36 was used to assess quality of life, and demographic data and the extent to which clients participated in the cardiac rehabilitation programme were assessed. RESULTS: Only 25% of the participants attended at least one session of the cardiac rehabilitation programme. Significant improvement occurred in all clients' perceived quality of life 6 months following initial hospital admission. No significant group differences in perceived quality of life were found according to whether or not clients used the cardiac rehabilitation services. CONCLUSION: Improvement in perceived health-related quality of life was evident over a 6-month period. Yet our findings suggested that participation in the cardiac rehabilitation programme did not have any apparent effects in subjects' perceived quality of life. Further studies using both generic and disease-specific health-related quality of life instruments, as well as the inclusion of control group, are recommended. Continual improvement in cardiac rehabilitation programmes, and consideration of alternative modes of delivery other than the traditional attendance at hospital outpatient services, are also recommended.

Aged↗
PubMed2005

Exploration of patients' needs for information on arrival at a geriatric and rehabilitation unit.

AIM: The aim of this study was to gather information about patients' needs prior to transferring from an acute care facility to a rehabilitation setting that could assist patients to engage actively in rehabilitation activities upon entering the unit. BACKGROUND: The provision of information is an important aspect of health care as it assists patients to become informed and actively participate in this care. Improved recovery has been associated with patients' adherence to care regimes. METHOD: Semi-structured interviews were undertaken with a convenient sample of nine patients shortly after admission/transfer to a rehabilitation unit and with four of these patients after discharge. The intent was to learn what information patients receive prior to admission to the rehabilitation unit, whether this information is useful and whether different information would be more useful to facilitate patients' engagement in the activities central to rehabilitation treatment. RESULTS: Interviews revealed that, generally, patients received very little information about what to expect on admission to the rehabilitation unit and patients' engagement was more dependent on perceptions about rehabilitation. Thematic analysis identified that, in general, rehabilitation was perceived as 'a ticket out' and 'a good thing'. In relation to provision of information of participants identified that 'doesn't matter that I don't know'; 'information is not always meaningful' and 'I will adjust in my own time'. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to recognize that patients are often compliant with decisions made while they are inpatients of the current health care system. Even though patients may 'actively participate' in rehabilitation processes it is often still as a passive recipient of health care.

Activities of Daily Living↗
PubMed2006

New roles in rehabilitation--the implications for nurses and other professionals.

RATIONALE, AIMS AND OBJECTIVES: The development of rehabilitation and intermediate care services, and roles therein, is part of current UK health policy to meet the demands of the ever-growing older population. One new role is the rehabilitation assistant (RA). This is a generic support worker trained at a basic level in nursing, physiotherapy, occupational therapy and social work who works under the supervision of the referring professionals, to deliver integrated rehabilitation programmes. RAs were introduced in one region in the north-west of England to increase the rehabilitation activity for patients. An empirical qualitative study was recently undertaken to evaluate the impact of the RAs from the perspectives of patients and associated nurses, therapists, managers and the RAs. METHODS: Fifty-five semi-structured interviews were used to collect data, which was then inductively analysed into categories and then themes. The categories included variations in role, benefits of role, acceptance and integration of role, difficulties with role, training and retention. This paper focuses on the benefits and difficulties of the role. RESULTS: It was found that patients, professionals and the RAs expressed great satisfaction with the new role. However, barriers to effective rehabilitation were reported owing to ward routines and organizational systems that interrupted and caused inconsistencies with the rehabilitation care programmes for patients. CONCLUSIONS: If it is agreed that the majority of patients (unless end stage terminally ill, unwilling or unable) could benefit from some degree of rehabilitation, then there is an issue around how such skills could be widely implemented. This paper discusses the barriers to effective rehabilitation, the benefits and drawbacks of looking at new ways of working and the need for a unified approach by all care workers in rehabilitative care.

Attitude of Health Personnel↗
PubMed1994

Stroke inpatient rehabilitation: a comparison across age groups.

OBJECTIVE: To examine and compare the inpatient stroke rehabilitation experience of older adults (> or = 75 years) with that of young adults (< 65 years) and young-old adults (65-74 years). DESIGN: Cross-sectional descriptive study. SETTING: A large university-affiliated free-standing rehabilitation hospital. PARTICIPANTS: 260 adults who were admitted to inpatient stroke rehabilitation with a primary diagnosis of recent (< 120 days) stroke (ICD9 430-436). VARIABLES: Demographic data, diagnosis, time between stroke onset and rehabilitation admission, discharge disposition, and functional status on admission and discharge were obtained from the patient's medical record. Treatment intensity and type, length of stay, and primary payment source data were obtained from the patient's billing record. Three-month mortality data were available from the hospital's routine follow-up survey. MAIN RESULTS: Compared with the younger adults (< 65 yrs and 65-75 years), the older adults (> or = 75 years) were admitted to rehabilitation earlier and with comparable cognitive but poorer motor function. Rehabilitation treatment intensity (per day) and type were similar across age groups, but the older adults (> or = 75 years) had significantly shorter rehabilitation stays. Three-month survival was comparable across age groups, but the older adults (> or = 75 years) had poorer motor function at discharge and were more often discharged to a nursing home or required a paid caregiver. CONCLUSIONS: Age-associated factors may influence inpatient stroke rehabilitation referral, treatment, and outcome, particularly for patients over age 75. The cumulative effects of frailty and co-morbid disease upon stroke disability and treatment are possible explanations for the findings. The study provides evidence of a need for further investigation of stroke rehabilitation strategies for adults over 75 years old.

Activities of Daily Living↗
PubMed1997

Geriatric rehabilitation: state of the art.

OBJECTIVES: To provide a clinically useful conceptual framework for the evaluation and treatment of disability in older persons, to review the rehabilitation of common conditions affecting function in older persons, and to discuss the effects of the ongoing changes in the healthcare system on geriatric rehabilitation. METHODS: MedLine search and review of relevant texts for information on (1) geriatric disability and its treatment, (2) recent high quality research, guidelines, and review articles relevant to the rehabilitation of conditions commonly causing geriatric disability, (3) effects of recent changes in the healthcare system on geriatric rehabilitation. RESULTS: Several pertinent models for geriatric disability were identified. These are explicated, along with information on the epidemiology of geriatric disability and its causes and relevant clinical applications. Rehabilitation is reviewed for musculoskeletal disorders, stroke and peripheral vascular disease, amputation, cardiopulmonary disorders, hip fracture, and deconditioning. Changes in the healthcare system appear to be affecting geriatric rehabilitation, especially the advent of managed care; relevant articles and opinions are reviewed, along with strategies to accommodate these changes. CONCLUSIONS: Our understanding of the causes of disability in the older population has improved significantly over the last decade. There has also been noteworthy progress in our knowledge about the effects of selected rehabilitation interventions, especially exercise-related interventions. However, the cost-effectiveness of many rehabilitative interventions remains unclear, particularly for differing patient groups across the continuum of care. More research will be needed to evaluate the effects of managed care on rehabilitation outcomes in older persons.

Aged↗
PubMed2005

Factors affecting outpatient rehabilitation outcomes in elders.

PURPOSE: To identify factors affecting outpatient rehabilitation outcomes in elders. DESIGN: A retrospective cohort design was used to explore factors affecting outpatient rehabilitation outcomes in elders. METHODS: Analyses of health records from a nurse-managed comprehensive outpatient rehabilitation facility were conducted. Data pertinent to the study were abstracted from 201 health records, including scores from three standard instruments: the Functional Independence Measure, the Mini-Mental State Examination, and the Geriatric Depression Scale, to construct study variables. Multivariate and stepwise regression analyses were performed. FINDINGS: Cognitive impairment was associated with lower admission and discharge function, but not with rehabilitation outcomes (functional gain, rehabilitation efficiency, days of service, and discharge location). Age > or = 80 years, admission function, and the interaction of age > or = 80 years and admission function affected functional gain and rehabilitation efficiency. Older age, being Black, and having more medical comorbidities were associated with days of service. None of these factors contributed to discharge location. CONCLUSIONS: Cognitive impairment was not associated with outpatient rehabilitation outcomes. Rather, age > or = 80 years and function when admitted affected functional gain and rehabilitation efficiency in elders who participated in outpatient rehabilitation services.

Activities of Daily Living↗
PubMed2000

Home or hospital for stroke rehabilitation? results of a randomized controlled trial : I: health outcomes at 6 months.

BACKGROUND AND PURPOSE: We wished to examine the effectiveness of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke. METHODS: This was a randomized, controlled trial comparing early hospital discharge and home-based rehabilitation with usual inpatient rehabilitation and follow-up care. The trial was carried out in 2 affiliated teaching hospitals in Adelaide, South Australia. Participants were 86 patients with acute stroke (mean age, 75 years) who were admitted to hospital and required rehabilitation. Forty-two patients received early hospital discharge and home-based rehabilitation (median duration, 5 weeks), and 44 patients continued with conventional rehabilitation care after randomization. The primary end point was self-reported general health status (SF-36) at 6 months after randomization. A variety of secondary outcome measures were also assessed. RESULTS: Overall, clinical outcomes for patients did not differ significantly between the groups at 6 months after randomization, but the total duration of hospital stay in the experimental group was significantly reduced (15 versus 30 days; P<0.001). Caregivers among the home-based rehabilitation group had significantly lower mental health SF-36 scores (mean difference, 7 points). CONCLUSIONS: A policy of early hospital discharge and home-based rehabilitation for patients with stroke can reduce the use of hospital rehabilitation beds without compromising clinical patient outcomes. However, there is a potential risk of poorer mental health on the part of caregivers. The choice of this management strategy may therefore depend on convenience and costs but also on further evaluations of the impact of stroke on caregivers.

Aged↗
PubMed2006

Measuring outcomes of vision rehabilitation with the Veterans Affairs Low Vision Visual Functioning Questionnaire.

PURPOSE: To evaluate the sensitivity to change, in patients who undergo vision rehabilitation, of the Veteran Affairs (VA) Low Vision Visual Functioning Questionnaire (LV VFQ-48), which was designed to measure the difficulty visually impaired persons have in performing daily activities and to evaluate vision rehabilitation outcomes. METHODS: Before and after rehabilitation, the VA LV VFQ-48 was administered by telephone interview to subjects from five sites in the VA and private sector. Visual acuity of these subjects ranged from near normal to total blindness. RESULTS: The VA LV VFQ exhibited significant differential item functioning (DIF) for 7 of 48 items (two mobility tasks, four reading tasks, and one distance-vision task). However, the DIF was small relative to baseline changes in item difficulty for all items. Therefore, the data were reanalyzed with the constraint that item difficulties do not change with rehabilitation, which assigns all changes to the person measure. Subjects in the inpatient Blind Rehabilitation Center (BRC) program showed the largest changes in person measures after vision rehabilitation (effect size = 1.9; t-test P < 0.0001). The subjects in the outpatient programs exhibited smaller changes in person measures after rehabilitation (effect size = 0.29; t-test P < 0.01). There was no significant change in person measures for the control group (test-retest before rehabilitation). CONCLUSIONS: In addition to being a valid and reliable measure of visual ability, the VA LV VFQ-48 is a sensitive measure of changes that occur in visual ability as a result of vision rehabilitation. Patients' self-reports of the difficulty they experience performing daily activities measured with this instrument can be used to compute a single number, the person measure that can serve as an outcome measure in clinical studies. The VA LV VFQ-48 can be used to compare programs that offer different levels of intervention and serve patients across the continuum of vision loss.

Activities of Daily Living↗
PubMed1997

Assessing and restoring function in elderly people--more than rehabilitation.

OBJECTIVE: To quantify the medical component of assessing and restoring function in the elderly and to determine if a subset who did not require medical input could be identified. DESIGN: Prospective consecutive sample. SETTING: Inpatient assessment, treatment and rehabilitation unit for the elderly in New Zealand. PATIENTS: Two hundred patients aged 60-98 years. MAIN OUTCOME MEASURES: (1) Proportion of elderly people receiving rehabilitation who also required treatment of medical problems. (2) Characteristics of those not requiring medical input. RESULTS: One hundred and seventy-two (86%) of people required some medical input during their hospital stay for rehabilitation. Forty-nine per cent had medical conditions which had a direct impact on their rehabilitation. Rehabilitation was delayed for a mean 16.8 (13.0-20.6)% of hospital stay when significant medical problems required treatment. People with previously undiagnosed conditions affecting rehabilitation tended to be older. The referral diagnoses most likely to result in an uncomplicated inpatient stay (i.e. rehabilitation only or rehabilitation with treatment of minor medical problems) were postsurgical treatment (55% uncomplicated), stroke (47% uncomplicated) or amputation (55% uncomplicated). However, 45-53% of people with these problems had a major medical component to their stay. People with other referral diagnoses or those admitted from institutions for the elderly were more likely to have a medical component to their stay. CONCLUSION: Restoration of function in the elderly requires a combination of both medical and rehabilitation skills. Reliable predictors of those not requiring medical input could not be found.

Activities of Daily Living↗
PubMed2005

A qualitative study investigating patients' beliefs about cardiac rehabilitation.

BACKGROUND: The opportunity to attend a cardiac rehabilitation course is usually offered to patients who have suffered a myocardial infarction. However, despite referral, many patients fail to attend. OBJECTIVE: To elicit patients' beliefs about the role of the cardiac rehabilitation course following myocardial infarction. DESIGN: Qualitative study using in-depth semi-structured interviews. SETTING: London Teaching Hospital. SUBJECTS: Thirteen patients were interviewed after discharge from hospital following myocardial infarction, but prior to attendance at cardiac rehabilitation. MAIN OUTCOME MEASURES: Patients' beliefs about cardiac rehabilitation that may act as barriers to attendance. RESULTS: Themes identified included: the content of cardiac rehabilitation, perceptions of exercise, benefits of cardiac rehabilitation, explicit barriers to attendance and cardiac knowledge. Whilst some patients viewed cardiac rehabilitation as an important and necessary part of recovery others expressed doubt that it was appropriate for them. Some patients were uncertain of the course content and misunderstood the role of exercise and its perceived effects. Misconceptions with regard to cardiac knowledge were also apparent. The combination of erroneous beliefs about cardiac rehabilitation and cardiac misconceptions seemed to result in doubts regarding attendance. CONCLUSIONS: Prior to course attendance some patients hold erroneous beliefs about the course content, especially the exercise component. Co-existent cardiac misconceptions are also apparent. Further research is needed to clarify the extent to which these beliefs may contribute to the decision not to attend cardiac rehabilitation.

Adult↗
PubMed1997

Evaluating rehabilitation medicine: effects on survival, function, and home care.

The goal of this study was to measure the clinical impact of rehabilitation on adults diagnosed with a disabling disorder in four major diagnostic groups (nervous, circulatory, musculoskeletal, and injury). To summarize the current knowledge in this area, a meta-analysis of rehabilitation studies was also completed. Specific objectives of the clinical trial were to determine the effects of inpatient rehabilitation on: (1) survival, (2) function, (3) home care, and related variables such as family function and use of health care resources. Patients hospitalized for the first time with a disabling condition (n = 85) were randomly assigned to inpatient rehabilitation (n = 43) or to outpatient follow-up (n = 42) in which the usual medical services were provided but no scheduled rehabilitative therapies were offered. To compare the two groups, analyses of covariance were conducted for functional ability, health care use, survival, health status, personal adjustment and family function. The between subjects factor was inpatient rehabilitation versus the control group. The within subjects factor was time of assessment (index, six months, and 1 year). No significant treatment effect was found at six months or one year for any of the variables under study using analyses of covariance. There were also no differences between groups in their use of nursing homes, length of hospital stay, survival, or in the number of hospital readmissions or clinic visits during the first year after hospital discharge. Rehabilitation did cost significantly more than medical care, primarily due to the cost of inpatient services. Some clinical trials have noted a treatment effect on functional ability but not on mortality, need for skilled care, or mental health status. The current study is consistent with these previous findings except for the lack of impact on physical function. This exception may be due to the fact that prior studies looked only at homogeneous groups, whereas the current study utilized heterogeneous grouping across four major diagnostic categories. Any apparent benefit may not be detectable across disability groups and may require more specialized scrutiny, or even tailored rehabilitative care, to detect a difference. It is recommended that health care systems evaluate the benefits of subacute rehabilitative care and consider outpatient programs that can be provided at home for implementation.

Activities of Daily Living↗
PubMed2006

Cardiac rehabilitation and survival of dialysis patients after coronary bypass.

Patients who are on renal dialysis are at high risk for cardiac death and have a large burden of cardiovascular disease and cardiovascular disease risk factors. Cardiac rehabilitation can promote improved survival of nondialysis patients after coronary artery bypass grafting (CABG) surgery and is covered by Medicare, but no previous studies have investigated whether dialysis patients' survival after CABG may be improved as a function of cardiac rehabilitation. A prospective cohort study was conducted using Medicare claims (1998 to 2002) for CABG and cardiac rehabilitation and patient information from the United States Renal Data System database for 6215 renal patients who initiated hemodialysis and underwent CABG between January 1, 1998, and December 31, 2002, with mortality follow-up to December 31, 2003. Cardiac rehabilitation was defined by Current Procedural Terminology codes for monitored and nonmonitored exercise in Medicare claims data. Dialysis patients who received cardiac rehabilitation after CABG had a 35% reduced risk for all-cause mortality and a 36% reduced risk for cardiac death compared with dialysis patients who did not receive cardiac rehabilitation, independent of sociodemographic and clinical risk factors, including recent hospitalization. Only 10% of patients received cardiac rehabilitation after CABG, compared with an estimated 23.4% of patients in the general population, and lower income patients of all ages as well as women and black patients who were aged 65+ were significantly less likely to receive cardiac rehabilitation services. This observational study suggests a survival benefit of cardiac rehabilitation for dialysis patients after CABG.

Aged↗
PubMedDate not supplied

Rehabilitation service utilization models: changes in the opportunity structure for disabled women.

The focus of this paper is the opportunity structure for rehabilitation and subsequent outcome for disabled women, in comparison with disabled men. From evidence cited in the literature the differential provision of rehabilitation and other supportive services to disabled women suggests variation in outcome, based on two analytic service utilization models of rehabilitation: medical and psychosocial. Aggregate trend data (1972 and 1978) were used in the analysis of adult disabled groups, by gender and selected disabling conditions. There are two striking results from the analysis of these data sets. One indicates that receipt of rehabilitation is greatly influenced by sociodemographic factors, particularly gender and age. A detailed examination of the combination effects of gender and other sociodemographic variables shows that there are subtleties, such as an interaction between race and gender and education and gender, as well as between age and gender, that put uneducated, younger, white women at a disadvantage in their access to rehabilitation resources. The analysis of these sociodemographic factors over two points in time, however, demonstrates what can be considered a diffusion of the distinctions of social inequality, probably due to changes in rehabilitation legislation that redefined eligibility criteria for rehabilitation services and expanded programme goals. The second result of note is that neither form of rehabilitation is associated with a positive outcome, in this case ability to work. In the earlier data set (1972), indications were that neither the medical model of rehabilitation nor the psychosocial model were effective in returning the individual to the work role. This was true for both men and women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Trauma-rehabilitation connections: discharge and admission decisions for children.

Paediatric discharge coordinators and rehabilitation admission coordinators were surveyed about how children are selected for rehabilitation. The following areas are covered: (1) the decision process, and how children are selected for rehabilitation; (2) who is involved in making acute-care discharge and rehabilitation admission decisions; (3) factors that guide selection of children for rehabilitation; and (4) satisfaction with referral practices. Surveys were completed by 30 trauma discharge and rehabilitation admission coordinators, recruited from paediatric trauma units and paediatric/general rehabilitation units nationwide. Most respondents were satisfied with transfers, although some voiced concerns about constraints placed on referrals by insurance. Even when inpatient rehabilitation was clearly needed, 40% said insurance status still affected whether children were admitted. There was little evidence that any uniform criteria are used to make decisions. Half had no training in discharge/admission planning and half did not base decisions on functional assessments. Although guidelines are increasingly used in clinical decision-making, few are available concerning critical decisions about which children receive inpatient rehabilitation following trauma.

Ambulatory Care↗
PubMed1995

Rehabilitation of geriatric patients.

OBJECTIVE: To describe the role of geriatric rehabilitation, the methods of practice, and the mechanisms underlying integrated care in rehabilitation medicine. DESIGN: We reviewed the rehabilitation-related medical literature and outlined an approach to the evaluation of impairment in older patients and subsequent rehabilitation planning. RESULTS: For optimal rehabilitation of geriatric patients, knowledge of general principles of rehabilitation and key areas affecting the elderly population is important. A rehabilitation program will be most successful if a team approach--including a physician, rehabilitation nurse, physical therapist, occupational therapist, psychologist, medical social worker, and recreational therapist--is used. Attention should be paid to special considerations in older patients (such as the presence of comorbid conditions) and potential barriers to care in order to maximize benefit. CONCLUSION: Rehabilitation of elderly patients can assist in preserving functional independence and improving the quality of life. Assessment and management in an individual patient are best performed by a team approach.

Aged↗
PubMedDate not supplied

[A study on the effect that rehabilitation education influence on the knowledge attitude and practice of public health nurse].

The home visiting health nurses are important man-power who can serve various and persistent rehabilitation care to disabled person in community. The Community Based Rehabilitation project (CBR) of national rehabilitation center have been carried out from 1995. As a part of that project national health center performed rehabilitation education program for home visiting health nurses. The purpose of this study is to analysis the effect of this education. In the first stage all of those groups were educated for two weeks in national rehabilitation center. But only two group nurses, one is in a urban and the other in a rural community, have been educated continually in the field through discussing rehabilitation care case study. The data in this study were gathered from three group health nurses and analysed by SAS computer program. The results about knowledge, attitude and practice changes of the three group nurses were as follows. 1. In the pre education state the mean point of all nurses' attitude for rehabilitation was 59, but in the post education state that was 90. The difference between pre and post attitude is very significant (t = -14.1, p < 0.0001). 2. In the pre education state the mean point of all nurses' knowledge for rehabilitation was 45, but in the post education state that was 78. The difference between pre and post knowledge is very significant (t = -12.7, p < 0.0001). 3. In the pre education state the mean point of all nurses' practice for rehabilitation care was 37, but in the post education state that was 62. The difference between pre and post practice is very significant (t = -7.3, p < 0.0001). 4. In practice point, the two group nurses who have been educated continuously were superior to the other (t = -3.9, p < 0.001). 5. All points between the urban and rural nurses were no significant differences (p > 0.1). 6. All changes of the attitude, knowledge and practice did not affected by age (F = 0.58, p > 0.1), professional career (F = 0.61, p > 0.1), educational background (F = 0.97, p > 0.1).

Education, Nursing, Continuing↗