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PubMed1997

[Extensive rehabilitation needed in epilepsy. Different models for varying needs].

Many people with epilepsy experience the need for more information concerning their condition and some people require, at times, greater access to rehabilitation services than has previously been available. Information and support may also be required by the family, friends and work colleagues of the patient. Research indicates that rehabilitation needs, for the patient, can arise in relation to poor self-esteem, overprotection as a child, low expectations, reduced cognitive abilities and stigma perceived or experienced in the family, in society, and at work. Successful rehabilitation is individualistic and should therefore be based on an assessment of the individual's needs. Only on the basis of this can realistic goals be identified. In the cases where intensive multidisciplinary rehabilitation is required a thorough medical assessment will also be needed in order to formulate realistic goals. Achievement of these goals may involve input from psychological, neuropsychological, pedagogical, social, employment and family orientated perspectives. Specialists in these areas must be included within, or co-ordinated by, the epilepsy team or rehabilitation service. In Sweden hospital based epilepsy-teams have added psycho-social rehabilitation aspects in their responsibilities and other rehabilitation services have recently begun to focus on the needs of people with epilepsy. This has led to a range of different rehabilitation models being available. The need to develop improved epilepsy rehabilitation services was identified in the 1970s and has recently received short-term funding support to develop new services and build up expertise. It is hoped that in the future these services will continue to find support at both the county and national levels.

Epilepsy↗
PubMed1997

Knowledge acquisition and decision-making: spinal cord injured individuals perceptions of caring during rehabilitation.

Nurses and other healthcare providers have little research to guide them on specific interventions and attitudes which expedite the attainment of rehabilitation outcomes by spinal cord injured (SCI) individuals and their successful return to the community (Fuhrer, 1994; Whiteneck, 1994). Acquisition of knowledge is required during rehabilitation to learn self-care and decision-making which is essential to long term survival following SCI. However, skills that patients and families are able to accomplish in rehabilitation are often not able to be translated into the home environment (White & Holloway, 1990). The process of learning self-care and decision-making needs to be more clearly elucidated, so more effective interventions can be designed which can improve problem-solving and lead to enhanced well-being and quality of life. The purpose of this qualitative study was to describe the meaning, process and consequences of caring during rehabilitation from the perspective of the SCI individual. This paper will report on the findings from one research question: How is the process of a developing caring relationship perceived by SCI individuals during rehabilitation? The theoretical foundation of caring for this study was synthesized from philosophical, ethical, feminist, and nursing literature. A purposive sample of adults with traumatic SCI were interviewed at least once during their initial rehabilitation stay. Twenty interviews were conducted with fifteen participants at various times during their rehabilitation stay over a six month period. The core category of "getting back together" or reintegration of self, which was the major work of rehabilitation, was accomplished with nurses and therapists who were perceived as caring. The process of a developing caring relationship was conceptualized, from participants' descriptions in three phases: learning the other, learning what I need to know, and letting me find out. During each phase reciprocal behaviors occurred between the patient and the caregiver resulting in intermediate outcomes, which facilitated movement to the next phase. Consequences of these caring relationships were: well-being, self-care, autonomy, independence, and hope. Caring by rehabilitation professionals was perceived by SCI individuals as central to recovery and to a positive attitude toward disability.

Adult↗
PubMed1997

[Cardiac rehabilitation in children. Interdisciplinary approach].

The concept of rehabilitation has been defined by the authors as a supervised process of progressive exercise training to improve aerobic fitness. Cardiac rehabilitation in children should be dedicated to patients with repaired complex congenital heart diseases who have residual functional and psychological problems. The basic objectives for rehabilitation are defined: to improve exercise efficiency, aerobic capacity and quality of life, to reduce the incidence of sudden death, to enable young patients to take part safely and effectively in athletics. The guidelines for organising a cardiac rehabilitation programme are specified. First of all the need of protected environments, functional evaluation before starting the programme, the description of the rehabilitation session and staff needed. Equally important is the psychosocial aspect. It is difficult to quantify, in a scientific manner, the effectiveness of psychosocial intervention, but it helps the children to integrate into social life thus enhancing their quality of life. The results of a census of 110 world-wide centres offering regular cardiac rehabilitation programmes are presented. Italy currently has only two centres suitable for pediatric cardiac rehabilitation: they treat a small number of patients. Personal experience, with 20 patients, agrees with that of Galioto, about an increase in exercise capacity of these patients after rehabilitation programme, with an increased cardiac output at rest and at peak of exercise, an increased O2 uptake and an increased duration of exercise testing. The usefulness of cardiac rehabilitation programmes, the need of interdisciplinary approach and increasing the case series are stressed.

Cardiac Care Facilities↗
PubMed2006

Risk factors and characteristics of falls during inpatient rehabilitation of elderly patients.

The present study investigated the incidence, characteristics, and risk factors predictive of falls in different patient populations hospitalized in a geriatric rehabilitation hospital. Overall 84 fallers and 84 control patients were enrolled in this study. The patients were analyzed into three subgroups: patients hospitalized for stroke rehabilitation, hip surgery rehabilitation, and other rehabilitation patients. All patients were evaluated for their predisposing and situational risk factors for the fall. Each group of fallers was analyzed in relation to the control group. Every group was also analyzed in relation to the other groups. Risk-taking activity and using wheelchairs were common risk factor among patients hospitalized for stroke rehabilitation or hip surgery rehabilitation. Vertigo and anti-hypertensive drugs intake were significant predictors of falling among all fallers in the hospital. Among Stroke patients' vertigo was a significant predictor of falling. Anti-depressant drug intake was the only weakly significant predictor of falling among deconditioned patients. Patient's falls in a geriatric rehabilitation setting tend to demonstrate patterns that may be used to focus prevention strategies. We found that risk factors for falls differ between different groups of rehabilitation patients, and that the selection of type of patients may affect which combination of risk factors is identified.

Accidental Falls↗
PubMed2000

Important qualities in physiatrists: perceptions of rehabilitation team members and patients.

OBJECTIVE: To determine the personal qualities important in physiatrists as described by patients and rehabilitation team members. DESIGN: An oral survey. SETTING: Adult rehabilitation service at a teaching rehabilitation institution affiliated with an academic medical center. PARTICIPANTS: Convenience sample of 171 people including inpatients, rehabilitation nurses, occupational and physical therapists, and resident and full-time attending physicians. INTERVENTIONS: Two questions to elicit the personal qualities that were considered important in a physical medicine and rehabilitation physician. MAIN OUTCOME MEASURES: Subjects' responses grouped as personal qualities (personality), working qualities (professionalism), competence, caring, and collegiality. RESULTS: Caring and competence qualities were the most important to patients. Collegiality and caring were valued most by the rehabilitation staff. Personal qualities and competence were of relatively greater importance to the physiatrists. CONCLUSIONS: There was significant variability in the relative. value assigned to each of the five groups of traits among the respondents. Knowledge of the desires and expectations of the people involved in the rehabilitation process may benefit rehabilitation patients, physicians, and staff.

Adult↗
PubMed2003

Outcomes of rehabilitation services for nursing home residents.

OBJECTIVE: To examine survival and community discharge outcomes related to rehabilitation services among patients admitted to nursing homes before the implementation of the Balanced Budget Amendment of 1997. DESIGN: Retrospective cohort. SETTING: A total of 945 Medicaid-certified nursing homes in Ohio. PARTICIPANTS: A total of 11,150 patients admitted for the first time to a nursing home from 1994 to 1996. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Community discharge and survival rates among patients who did or did not receive rehabilitation services, using multivariable techniques to adjust for patients' propensity to receive rehabilitation and for other potential confounders. In secondary analyses, we also examined dose-response effects and analyzed the effects of rehabilitation when patients were divided into 5 diagnostic groups (stroke, hip fracture, congestive heart failure, chronic lung disease, other). RESULTS: Rehabilitation was provided to 58% of the patients and was associated with higher community discharge rates (relative risk=1.48; 95% confidence interval [CI], 1.40-1.57) and a lower hazard of death (hazard ratio=.81; 95% CI,.75-.88). Dose-response effects were observed for both outcomes (P<.001) among patients receiving rehabilitation. Rehabilitation was associated with improved community discharge rates in each of the 5 diagnostic groups. CONCLUSIONS: New reimbursement policies that discourage the provision of rehabilitation services may have adverse effects on patients, their families, and societal costs of care.

Aged↗
PubMed2005

A rehabilitation program for patients recovering from severe stroke.

OBJECTIVE: The purpose of this study was to describe the outcomes of patients with a severe stroke admitted to a specialized "slow stream" rehabilitation program and to develop a model to predict discharge destination. METHODS: Chart review of 196 consecutive non-ambulatory ("lower-band") stroke patients admitted between 1996-2001, to a specialized in-patient rehabilitation unit designed to accommodate the needs of patients with profound disabilities, and who were considered inappropriate for conventional inpatient rehabilitation programs. Special features of this program included the availability of an independent living unit, therapies tailored to individual tolerance and the opportunity to remain on the unit for an extended period until such time that the patients' rehabilitation potential had been maximized. RESULTS: Patients were admitted to the unit after a median of 49 days following stroke onset. Their median admission and discharge functional independence measure (FIM) scores were 46 and 70, respectively. The improvement in ability to perform self-care tasks was statistically significant (Z= -11.18, p<0.0001). By discharge, 54 patients (28%) were able to ambulate independently (with or without an assistive device), while 142 patients (72%) remained wheelchair dependent. Eighty-five patients (43%) returned to their own home upon rehabilitation discharge, while the remainder were admitted to nursing homes or hospitals closer to the patients' home. Admission FIM score, age, no previous history of stroke and male sex were the variables found to most strongly predict discharge home. CONCLUSIONS: Patients with severe strokes who received individualized care on a highly specialized stroke rehabilitation unit achieved impressive functional outcomes despite a lag of seven weeks post stroke before rehabilitation was initiated. Many patients were no longer wheelchair dependent and almost half returned home. Active rehabilitation should not be limited to "middle-band" stroke patients.

Activities of Daily Living↗
PubMed2002

Mobility status during inpatient rehabilitation: a comparison of patients with stroke and traumatic brain injury.

OBJECTIVES: To compare the mobility status (admission and discharge status, change in status) between patients with stroke and traumatic brain injury (TBI) during inpatient rehabilitation and to determine the relationship between mobility status and outcome variables including length of stay (LOS). DESIGN: Prospective study. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: A total of 210 patients with stroke (n = 136) and TBI (n = 74) consecutively admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical Outcome Variable Scale (COVS), a 13-item scale of mobility status (measured on admission and discharge from inpatient rehabilitation), and rehabilitation LOS. RESULTS: With age and time since injury controlled in the model, the TBI group showed a significantly higher mobility status on admission and discharge over the stroke group, but the change (improvement) in mobility status did not differ. The admission mobility status accounted for 61% and 60% of variability of the discharge mobility status for the stroke and TBI groups, respectively. The admission mobility status accounted for 40% and 50% of the variability in rehabilitation LOS for the stroke and TBI groups, respectively. Either the admission mobility status or the physical therapist's prediction of the discharge status could be used to determine the actual discharge mobility status, although the physical therapist's predictions were more accurate than using a statistical model. CONCLUSIONS: The TBI group showed a higher mobility status at admission and discharge from inpatient rehabilitation than the stroke group; however, the rate of improvement (improvement in mobility status per day) did not differ between groups. Admission mobility status using the COVS was an excellent predictor of discharge mobility status and rehabilitation LOS in stroke and TBI patients.

Activities of Daily Living↗
PubMed2003

Characteristics of effective and efficient rehabilitation programs.

OBJECTIVE: To investigate the characteristics of rehabilitation hospitals and units correlated with gains in motor and cognitive function, after adjusting for case severity of the patients admitted and for length of stay (LOS). DESIGN: The Uniform Data System for Medical Rehabilitation (UDSMR) database was first analyzed to develop a method of adjusting for patient case severity on admission. Rehabilitation programs were surveyed to assess characteristics commonly thought to be associated with efficiency and effectiveness. Data on these characteristics were linked to UDSMR data on patient characteristics and functional gain. SETTING: Seventy-seven rehabilitation hospitals across the United States. PARTICIPANTS: A total of 37,692 inpatients from the participating rehabilitation hospitals. INTERVENTION: Comprehensive rehabilitation programs not altered by researcher. MAIN OUTCOME MEASURES: Program effectiveness was estimated by gains in motor and cognitive subscale scores of the FIM trade mark instrument between admission and discharge, adjusted for indicators of caseload severity at admission. Efficiency was estimated by adjusting gains for LOS as well. RESULTS: Primary factors affecting both motor and cognitive gains included admission function (treated curvilinearly), age, certain diagnostic distinctions, onset-admission interval, admission class, and LOS. Correlations between staffing intensity and numerous other program characteristics with functional gain were meager, each accounting for less than 2% of variance. LOS was predicted by a number of factors, notably by the percentage of managed care cases (r=-.20), but not by staffing intensity. CONCLUSIONS: Relationships between rehabilitation practices and functional gains by patients do not appear to be simple or overt. Continued research is needed to identify reliable connections between rehabilitative processes and patient outcomes in practice.

Aged↗
PubMedDate not supplied

[Outpatient and inpatient neurological rehabilitation--a follow-up comparison].

Since the mid-90s outpatient rehabilitation has been developed by public health insurance companies and pension funds. Outpatient rehabilitation is defined as comprehensive multidisciplinary and medically supervised service which in neurological rehabilitation mostly follows inpatient rehabilitation. In the present paper partial results of a larger study (by Schoenle and Leyhe, 2000) are reported with respect to the follow-up of the effects of outpatient versus inpatient rehabilitation 6 month after termination of the treatment. Major results are the endurance of the effects over the observed time interval and the equivalent effectiveness of the two forms of rehabilitation. Distinct effects were observed for the two patient groups (more progress in the body related functional disturbances for inpatients versus cognitively related progress for the outpatients). The results reflect intrinsic features of neurological rehabilitation and the current organizational status of neurological rehabilitation in Germany.

Activities of Daily Living↗
PubMed2000

A randomized controlled trial of rehabilitation at home after stroke in Southwest Stockholm: outcome at six months.

A 6-month follow-up of a single-blind, randomized, controlled trial in Southwest Stockholm was performed in order to evaluate the effect of early supported discharge and continued rehabilitation at home after stroke. Eighty-three stroke patients with moderate neurological impairments, continent, independent in feeding, and mental function within normal limits one week after onset were included in the study. The patients were allocated 1:1 to early supported discharge and continued rehabilitation at home by a specialized team, versus routine rehabilitation. Patient outcomes measured were motor capacity, dysphasia, activities of daily living, social activities, perceived dysfunction, mortality and reported falls. Data on length of stay in hospital; initial and recurrent during 6 months were compared. The 6-month follow-up of 78 patients showed no statistically significant differences in patient outcome. The results of multivariate logistic regression analysis suggest a positive effect of home rehabilitation on activities of daily living. At 3-6 months the frequency of significant improvements was higher in the intervention group. Death or dependency in activities of daily living was 24% in the intervention group compared with 44% in the control group. The mean initial hospitalization was 29 days in routine rehabilitation group versus 14 days in the home rehabilitation group. We conclude that for moderately disabled stroke patients with mental function within normal limits, early supported discharge and continued rehabilitation at home had no less a beneficial effect on patient outcome than routine rehabilitation, reduced initial hospitalization significantly and had no adverse effects on mortality and number of falls.

Activities of Daily Living↗
PubMed2006

Survey of general practitioners' attitudes toward physical medicine and rehabilitation.

This study reports the attitudes of general practitioners towards physical medicine and rehabilitation after participating in a continued medical education course in this field. Given the high prevalence of musculoskeletal disorders and number of disabled persons in the country, along with the role of general practitioners in the primary and long-term management of such patients, basic competency in rehabilitation medicine must be considered in the educational curriculum of medical students. Nevertheless, rehabilitation medicine is not taught in most universities. This study was performed to evaluate the attitude of general practitioners towards physical medicine and rehabilitation as a baseline for developing educational programs in this field. In a simple descriptive study, at the end of a continued medical education program in low back pain management, 217 questionnaires, focusing on the field of physical medicine and rehabilitation, were distributed between participants. One-hundred-and-forty-three questionnaires were analyzed. Statistical analyses were performed with descriptive and Student's t-test. The results showed that of the participants, 69 (48.3%) were female and that they graduated from 24 medical schools. Most respondents (92.2%) believed that musculoskeletal education had not been sufficient in general practitioner training courses. Of the respondents, 56.8% had visited at least one disabled patient during the previous month, while 11% had visited more than 10 in the same period, but 84.3% had not studied disabilities. Musculoskeletal physical examination was the most needed educational field cited by general practitioners. In conclusion, this study clearly documents the inadequacy of basic rehabilitation training in medical schools. The findings reveal the most needed and preferred rehabilitation areas for general practitioners, and these should be considered in the establishment of rehabilitation training programs for Iranian medical students.

Attitude of Health Personnel↗
PubMed2005

Stroke rehabilitation in Switzerland versus the United States: a preliminary comparison.

This article compares the structure and process of rehabilitation for stroke patients at 2 internationally recognized rehabilitation hospitals, Klinik Valens ("Valens") in Switzerland and the William Donald Schaeffer Rehabilitation Hospital at Kernan ("Kernan") in the United States. Although the patient mix, structure, and process of rehabilitation were similar in many regards, there were some important differences. Most notably, on average, patients at the U.S. hospital were discharged from rehabilitation at approximately the same day poststroke that rehabilitation began in Switzerland. Patients remained in an inpatient setting an average of 40 days longer in Switzerland (for the combination of acute care and rehabilitation) and had significantly higher levels of functioning at discharge when compared to their U.S. counterparts. The authors' findings suggest that Europe may offer opportunities for rehabilitation research that would be difficult to duplicate in the United States and highlight policy-relevant questions for future studies aimed at developing efficient managed care systems for stroke survivors.

Activities of Daily Living↗
PubMed1979

Rehabilitating the severely disabled: the foreign experience.

This paper sets forth a model for examining the relationships between fourteen policy and politicoeconomic variables, and the social benefits and costs of rehabilitation. Based on discussions in early 1977 with scholars, ministry officials, trade unionists, and politicians in several northwestern European countries, as well as on documentation relating to the rapid growth of disability expenditures and the factors thought to influence it, some "lessons" are presented for policymakers in the United States and other countries. In general, current trends are seen as depressing the post-service earnings of individual rehabilitants, limiting the stabilizing effects of rehabilitation on labor market turnover, and increasing available time for unpaid work in the home and elsewhere. Unequal intergovernmental cost sharing in the provision of benefits and services, it is argued, seems likely to promote inefficient allocation of scarce rehabilitation resources with negative consequences for goal attainment. The high rates of inflation which prevail in the United States and in many northwestern European countries are causing the immediate costs of providing rehabilitation services to rise and simultaneously increasing the opportunity costs of spending for rehabilitation. The net effect of these cost increases is a reduction in the overall benefit/cost ratio that results from investments in rehabilitation. A number of predictions are made about how the United States will shape its disability and rehabilitation policies in the course of the next twenty years.

Cost-Benefit Analysis↗
PubMed1998

[Saxony-Anhalt/Necklenburg-Vorpommern Scientific Rehabilitation Research Groups].

Interfaces in Medical rehabilitation are the central target of the research collaboration in Sachsen-Anhalt/Mecklenburg-Vorpommern. Six scientific projects and one inter-project initiative aim at questions and problems concerning regional rehabilitation resources, the motivation of applicants and ways of access to rehabilitation, steering mechanisms in the allocation of medical rehabilitation, stages and phases in the rehabilitation system, cost-effectiveness of out-patient rehabilitation and ways and means of adaptation of medical rehabilitation to Job requirements. Research focuses on rehabilitation in persons with chronic back pain, traumatic and vascular CNS injury and coronary infarction.

Forecasting↗
PubMed1999

[How great is the need for ambulatory rehabilitation in the orthopedics field?--Results of a multi-perspective approach].

Despite the necessity to expand the outpatient rehabilitation system in Germany the development up to now must be described as quite reluctant. As yet there is a considerable lack of information about the demand for such care in Germany. On the basis of a complex study design insurants, applicants for medical rehabilitation, physicians in a rehabilitation hospital and general practitioners were asked how they estimated the demand for outpatient orthopedic rehabilitation care. Resulting data unanimously show a substantial demand in roughly one third of insurants who desire rehabilitation, clearly exceeding the already realized outpatient care. The investigation also illustrated that physicians often are uncertain as to their decisions and that depending on the respective point of view (insurants or different groups of physicians) there are different preferences as to the kind of rehabilitative care for the benefit of one specific patient. The results stress not only the fact that there is a demand for information of insurants and their referring physicians regarding the new outpatient rehabilitation offer, but also reveal the demand for a development of differential indication criteria for outpatient and inpatient rehabilitation, as well as for definite procedural regulations which should be harmonized among all insurers.

Adult↗
PubMed2003

Virtual rehabilitation--benefits and challenges.

OBJECTIVES: To discuss the advantages and disadvantages of rehabilitation applications of virtual reality. METHODS: VR can be used as an enhancement to conventional therapy for patients with conditions ranging from musculoskeletal problems, to stroke-induced paralysis, to cognitive deficits. This approach is called "VR-augmented rehabilitation." Alternately, VR can replace conventional interventions altogether, in which case the rehabilitation is "VR-based." If the intervention is done at a distance, then it is called "telerehabilitation." Simulation exercises for post-stroke patients have been developed using a "teacher object" approach or a video game approach. Simulations for musculo-skeletal patients use virtual replicas of rehabilitation devices (such as rubber ball, power putty, peg board). Phobia-inducing virtual environments are prescribed for patients with cognitive deficits. RESULTS: VR-augmented rehabilitation has been shown effective for stroke patients in the chronic phase of the disease. VR-based rehabilitation has been improving patients with fear of flying, Vietnam syndrome, fear of heights, and chronic stroke patients. Telerehabilitation interventions using VR have improved musculo-skeletal and post-stroke patients, however less data is available at this time. CONCLUSIONS: Virtual reality presents significant advantages when applied to rehabilitation of patients with varied conditions. These advantages include patient motivation, adaptability and variability based on patient baseline, transparent data storage, online remote data access, economy of scale, reduced medical costs. Challenges in VR use for rehabilitation relate to lack of computer skills on the part of therapists, lack of support infrastructure, expensive equipment (initially), inadequate communication infrastructure (for telerehabilitation in rural areas), and patient safety concerns.

Cognition Disorders↗
PubMed2004

Cardiac rehabilitation services in New Zealand: access and utilisation.

AIM: To identify factors associated with patient referral to, uptake of, and completion of cardiac rehabilitation programmes in New Zealand. METHODS: Information was collected on referrals to cardiac rehabilitation during February 2002. Routinely collected hospitalisation data were obtained for men and women aged over 35 years with specified coronary episodes. The data were merged, and four predictive logistic regression models developed. RESULTS: There were 2001 people either hospitalised or referred to cardiac rehabilitation. Of the 1696 hospitalised, 36% were referred for rehabilitation. After adjusting for ethnicity, women were less likely to be referred: odds ratio (OR)=0.72 [95% confidence interval (CI) 0.57-0.91]. With each 10-year age increase, there was a lower likelihood of referral (OR=0.74; 95%CI 0.67-0.82). Of those people who were referred to inpatient rehabilitation, 83% were referred to an outpatient programme. Lack of access to transport was associated with reduced likelihood of referral (OR=0.44 95%; CI 0.28-0.70) and with attendance (OR=0.54; 95%CI 0.33-0.88). Those who had previously attended a cardiac rehabilitation programme were significantly more likely to attend, and compared to those aged 65 to 74 years, those older or younger were less likely to complete the programme. Some associations with deprivation were found, but none with ethnicity. CONCLUSION: This study demonstrated considerable scope for improvement in referral to, uptake of and completion of cardiac rehabilitation programmes in New Zealand. It highlighted the need to improve referral processes, promotion, provision, delivery and monitoring of cardiac rehabilitation services.

Adolescent↗