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At least 1,063 records · Page 59Linked to original sources
PubMed2004

Post-stroke follow-up in a rehabilitation center outpatient clinic.

BACKGROUND: Follow-up examinations in a rehabilitation center clinic after stroke are essential for coordinating post-acute services and monitoring patient progress. Of first-stroke patients discharged from our rehabilitation ward to the community 92% are invited for ambulatory check-up once every 6 months. OBJECTIVES: To review patient complaints at follow-up and the recommendations issued by the attending physical medicine and rehabilitation specialist at the outpatient clinic. METHODS: We extracted relevant data from the records and assessed the relationship between functional status on admission and discharge (measured by FIM), length of stay, and number of complaints. Patients were divided according to the side of neurologic damage, etiology, whether the stroke was a first or recurrent event, and main clinical syndrome (neglect or aphasia). RESULTS: Patients' complaints included: decreased hand function (in 40%), general functional deterioration (20%), difficulty walking (11%), speech dysfunction (10%), various pains (especially in plegic shoulder) (8%), urine control (2%), sexual dysfunction (3%), swallowing difficulties (2%), and cognitive disturbances (2%). Patients received the following recommendations: physiotherapy (for 52.5%), occupational therapy (37.5%), speech therapy (12.5%), different bracing techniques (22.5%), pain clinic treatment (12.5%), changing medication prescriptions (7.5%), psychological treatment (10%), sexual rehabilitation (5%), vocational counseling (2.5%), counseling by social workers (2.5%), and repeat neuropsychological diagnosis (2.5%). A reverse correlation was found between the number of complaints and FIM at admission (P = 0.0001) and discharge (P = 0.0003), and between LOS and FIM at admission (P = 0.0001) and discharge (P = 0.004). A direct correlation was found between the number of complaints and LOS (P = 0.029). No relation was found between age, type of stroke, first and recurrent event, and clinical syndromes and patient complaints in the outpatient rehabilitation. Community rehabilitation services met 58% of all recommendations in 62% of patients, mainly physiotherapy and occupational therapy, with 34% of patients waiting for implementation of the recommendations and 4% not available for follow-up. CONCLUSIONS: Follow-up examinations should be an integral part of post-stroke rehabilitation. Rehabilitation treatment in the community must be strengthened.

Aged↗
PubMedDate not supplied

[Deficiencies in rehabilitation measures in the course of early chronic polyarthritis].

It was the objective of this descriptive cohort study with prospective and retrospective data collection to examine whether measures of rehabilitation medicine and of vocational rehabilitation are too rare during the course of early rheumatoid arthritis (RA). Seventy three gainfully employed consecutive outpatients with early RA at the first examination (time one -T1) (> or = 5 ARA 1958 criteria, disease duration < or = 12 months) were reexamined at time two (T2) after a mean follow-up of 6 years (S.D. +/- 2 yrs.). Of the 73 patients 27 persons received a social security pension at T2 because of work disability (WD) due to RA. This group was analysed separately from the 34 patients who were still working at T2. Even though the 27 patients with WD had severe disease (functional capacity, ESR, radiological erosions) at T2, only 17 (63%) had participated in inpatient rehabilitation programmes. Despite frequent strenuous job-related physical requirements in 44-70% of the patients with WD measures of vocational rehabilitation had been taken in only 26%: vocational retraining in 4%, adaptation of the workplace because of RA in 8%, reduced working-time in 22%. No patient had changed the job. At least one of these measures of vocational rehabilitation had been taken in only 7 of 34 of the persons working at T2 (21%). Of these 34 patients 21-39% reported continued difficulties with different physical requirements of their jobs. In the early phase of RA significant shortcomings regarding the measures of rehabilitation medicine and vocational rehabilitation could be demonstrated. The early initiation of rehabilitation programmes aims at an improvement of the patient's physical abilities and an adjustment of the job requirements.

Adolescent↗
PubMed1997

[Considerations for the continuing development of vocational rehabilitation from the viewpoint of the Federal Institute for Employment].

The law on enhancing growth and employment (Wachstums- und Beschäftigungsförderungsgesetz-WFG) of September 25, 1996 has entailed fundamental changes in the law governing vocational rehabilitation under the employment promotion act (Arbeitsförderungsgesetz-AFG). While a legal entitlement existed so far, vocational rehabilitation benefits, as of January 1, 1997, on principle are granted as discretionary benefits. In the employment promotion reform bill (Arbeitsförderungs-Reformgesetz-AFRG) awaiting passage in 1997, the former legal entitlement is reestablished in those cases where special vocational rehabilitation benefits and services are needed due to the type or severity of disability, or for safeguarding rehabilitation success. The WFG is to bring about a 500 million DM reduction in vocational rehabilitation spending by the federal employment service Bundesanstalt für Arbeit (BA). This targetted economy also is adhered to notwithstanding the said major expansion of legal entitlement. Already before passage of the WFG, the BA's governing board had set up a working group to look into the issue of developing vocational rehabilitation further. Subjects dealt with had included cooperation among rehabilitation agencies; participant structure in vocational retraining centre programmes; programmes offered; quality assurance; and cost structures in retraining centres. In the wake of the working group's deliberations, the board passed revised provisions for programme participation in vocational retraining centres, and decided on December 18, 1996 that, as of April 1, 1998 a new settlement procedure should be introduced with the vocational rehabilitation facilities, with specific programme-related prices on the basis of agreed quality standards.

Cost Control↗
PubMedDate not supplied

Critical care elements in a rehabilitation nursing course.

This article describes a specialized rehabilitation education program, based on adult learning theory, that was developed to promote retention of rehabilitation nurses at MetroHealth Center for Rehabilitation in Cleveland. The curriculum encompasses the skills required to care for rehabilitation patients needing both advanced rehabilitation nursing and critical care nursing. Critical care and rehabilitation nurses collaborated in the presentation of topics and were guided by the course coordinators. Learners were chosen based on experience in rehabilitation, with priority given to those certified in rehabilitation nursing. A variety of evaluation methods elicited positive responses. A 6-month postcourse survey also was completed to assess the long-term effects of the course.

Critical Care↗
PubMedDate not supplied

Analysis of the roles and responsibilities of rehabilitation nursing staff.

This article describes a study whose purpose was to identify the roles and the responsibilities of rehabilitation nursing staff members, specifically the registered nurses and the nurse extenders, or rehabilitation technicians. The members of the nursing staff kept work diaries, listing each work activity and the time spent on that activity. Results of the study indicated that the majority of the registered nurses' time was focused on either direct or indirect patient care. The majority of the rehabilitation technicians' time was focused on direct patient care; however, rehabilitation technicians on the evening shifts spent significantly more time in indirect patient care and unit maintenance than did their day-shift counterparts. Data analysis indicated that 33% of evening-shift rehabilitation technicians' time and 36% of day-shift rehabilitation technicians' time was unaccounted for in the work diaries. As a result of this study, the authors recommend a review of the job description for rehabilitation technicians. Furthermore, the results identify a need for staff development education for rehabilitation technicians so that they can expand their roles and responsibilities.

Humans↗
PubMedDate not supplied

A model of practice to address cultural competence in rehabilitation nursing.

A position statement developed by the Association of Rehabilitation Nurses (ARN), Appropriate Inclusion of Rehabilitation Nurses Wherever Rehabilitation is Provided, stated that nurses are an essential part of a client's rehabilitation because they provide holistic care and "attend to the full range of human experiences and responses to health and illness" (Association of Rehabilitation Nurses, 1996, p.1). Rehabilitation nurses must become strongly aware of the role that culture plays in this process. This article presents a conceptual model of practice with which to address cultural competence in rehabilitation nursing. The model's constructs of cultural awareness, cultural knowledge, cultural encounters, cultural skill, and cultural desire are discussed. Examples from the field of rehabilitation nursing are presented in the discussion of these constructs.

Clinical Competence↗
PubMed2002

Rehabilitation approaches to stroke.

This article describes the state of the science in stroke rehabilitation dealing with three main topics: (1) General approach to stroke rehabilitation (stroke services and stroke units), (2) Neurophysiological and pharmacological interventions (facilitation of brain repair mechanisms) and (3) Experimental approaches (neuronal transplantation). Stroke rehabilitation is an active process beginning during acute hospitalisation, progressing to a systematic program of rehabilitation services and continuing after the individual returns to the community. There is world-wide consensus that stroke patients should be treated at specialised stroke unit with specially trained medical and nursing staff, co-ordinated multidisciplinary rehabilitation and education programs for patients and their families. Stroke Unit has been shown to be associated with a long-term reduction of death and of the combined poor outcomes of death and dependency, independent of patients age, sex, or variations in stroke unit organisations. No study has clearly shown to what extent the beneficial effect is due to specific rehabilitation strategies. New imaging studies in stroke patients indicate altered post stroke activation patterns, which suggest some functional reorganisation. Reorganisation may be the principle process responsible for recovery after stroke. It is assumed that different post ischaemic interventions like physiotherapy, occupational therapy, speech therapy, electrical stimulation, etc. facilitates such changes. Scientific evidence demonstrating the values of specific rehabilitation interventions after stroke is limited. Comparisons between different methods in current use have so far mostly failed to show that any particular physiotherapy, occupational therapy, speech therapy or stroke rehabilitation strategy is superior to another. Clinical data are strongly in favour of early mobilisation and training. Pharmacological interventions in animals revealed that norepinephrine, amphetamine and other alpha-adrenergic stimulating drugs can enhance motor performance after unilateral ablation of the sensory motor cortex. The clinical data in humans are rather contradictory. Neural grafting and neurogenesis are new potential modes of stroke therapy. Neural grafting enhanced functional outcome and reduced thalamic atrophy in rats only when combined with housing in enriched environments. Recent studies have shown that stem cells can differentiate to neurons in the adult human dentate gyrus in vivo.

Activities of Daily Living↗
PubMed1992

[Screening for determination of workers in need of rehabilitation].

Blue collar workers whose fitness is at risk may receive in-patient rehabilitation therapy in the Federal Republic of Germany, provided they apply for it to their annuity insurance company. Only 50% of the workers who retire early (before the age of 60) and are in need of medical rehabilitation make such an application within the five-year period before retirement. It is against this background that we are developing and testing a screening procedure which includes all insured workers and recommends a rehabilitation therapy to those at risk. The screening procedure involves two steps: a questionnaire which is then followed by a medical examination. In an experiment with 600 workers who are insured with the LVA Württemberg (the relevant insurer) we tested: whether the screening is accepted by the insured and their family doctors, to what extent the insurer's appointed doctors ratify the family doctor's report and give approval for rehabilitation therapy, whether the questionnaire is suitable for the preselection of insured at risk, and whether the screening detects insured at risk who do not apply for rehabilitation therapy. Participation at the screening was 68% and speaks well for the acceptance of the procedure. The family doctors recommended rehabilitation therapy in 43% of all cases whereas the insurer's appointed doctors recommended such a therapy only in 25%. This discrepancy arose in 2/3 of the cases due to the fact that the insurer's appointed doctors refused renewed rehabilitation therapy during the mandatory three-year waiting period or considered out-patient rehabilitative treatment sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Disability Evaluation↗
PubMed2005

[Routine report on the medical rehabilitation of patients with musculoskeletal diseases].

The commission "Rehabilitation" of the German Society of Rheumatology compiled a data set for a routine report of the rehabilitation system for muskuloskeletal diseases. More than 250 rehabilitation hospitals offer inpatient rehabilitation for patients with musculoskeletal diseases. The prevalence of inpatient rehabilitation decreased due to new legislative rules in 1997, increased again thereafter but has not reached the former level. The prevalence of inpatient rehabilitation during the preceding year in patients with inflammatory rheumatic diseases treated by rheumatologists amounts to 12% with higher figures in men than in women and lower figures in the area of the former German Democratic Republic. The prevalence of outpatient rehabilitation increased during the last few years but, currently, does not exceed 5% of the entire rehabilitation procedures.

Ambulatory Care↗
PubMed1993

Current perceptions of rehabilitation professionals towards mild traumatic brain injury.

There has been long-standing controversy in the medical literature and increasing interest within the rehabilitation field in mild traumatic brain injury and postconcussion syndrome. The Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine conducted an opinion survey to analyze the perceptions of rehabilitation professionals towards patient's with these problems. The survey initially compared response patterns of rehabilitation personnel to two earlier identical surveys made with a group of neurosurgeons and a group of neuropsychologists. As a group, rehabilitation professionals tend to have perceptions of mild traumatic brain injury that are similar to those of neuropsychologists. The survey also included a group of questions developed to analyze specific issues among rehabilitation professionals related to symptomatology, persistence, and treatment. The most salient findings concluded that rehabilitation providers: (1) want a grading system associated with the term to designate injury severity, symptom severity, and level of functional impairment; (2) most frequently use neuropsychologists in assessment and treatment of these patients; (3) report cognitive deficits as the most common symptom, followed by irritability and somatic complaints; (4) when medications are used, most frequently use antidepressants; (5) typically follow these patients anywhere from six to 18 months postinjury; and (6) report that most patients make a complete functional recovery, though there is a substantial proportion (about 25%) who do not. Implications drawn from the survey include that there is a need to better define the term and its associated features and that there is a substantial group of patients who remain at least partially functionally disabled and present a major challenge to the rehabilitation community.

Attitude of Health Personnel↗
PubMed1994

Rehabilitation after injury and the need for coordination.

The outcome of treatment after injury can be measured using the general terms of mortality and morbidity. Mortality is an all-or-none phenomenon, but morbidity is a graded response to injury and its medical treatment, varying from complete return to normality at one end of the scale to total dependence on other people requiring residence in an institution at the other end. The words disability (the individual's response) and handicap (society's reaction) specify the morbidity. Rehabilitation affects these two outcomes of disability and handicap and is a complex process involving the patient, carers and a team of specialists. The rehabilitation team is comprised of professionals each with specialist skills who aim to rehabilitate the individual as far as possible back to his former health and independence. All aspects of an individual's life are treated, including the physical, functional, psychological and social. The team operates in a number of ways according to the setting and treatment approaches used. The rehabilitation process should remain consistent throughout and focus on the patient's strengths and deficits. The key to effective rehabilitation is good organization with a comprehensive team approach working towards common goals and aims. Whether the patient is located in an acute hospital, rehabilitation unit, nursing home or in his own house, rehabilitation must be continuous. It is a mistake to believe that the rehabilitation process can only exist in a special centre; it must start in the acute hospital and be maintained even when at home, although its intensity may vary at different stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed2005

The relationship between mean flow velocity and functional and neurologic parameters of ischemic stroke patients undergoing rehabilitation.

OBJECTIVE: To investigate the correlation between mean flow velocity (MFV) as measured by transcranial Doppler ultrasonography (TCD) and functional and neurologic impairment during inpatient rehabilitation after acute stroke. DESIGN: Prospective study comparing results of rehabilitation in patients with different TCD findings. SETTING: Acute neurologic rehabilitation department. PARTICIPANTS: Twenty-four consecutive patients admitted to a rehabilitation center with a diagnosis of a first ischemic stroke in the middle cerebral artery (MCA) territory. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Impairment as measured with the National Institutes of Health Stroke Scale (NIHSS) and disability as assessed with the FIM instrument. RESULTS: Normative or high blood-flow velocity in the MCA of the damaged hemisphere was associated on admission with higher FIM and lower NIHSS scores during 2 months of hospitalization. Absent or low flow velocity correlated with much worse functional and neurologic outcome, especially after 1 and 2 months of inpatient rehabilitation. Statistical correlation was found between MFV in the MCA of the damaged hemisphere, measured by admission TCD, and FIM score on admission and 1 month later. NIHSS scores during hospitalization also correlated with MFV in the MCA of the damaged hemisphere on admission and after 1 month. MFV in the MCA of the undamaged hemisphere 1 month after admission correlated negatively with FIM scores during inpatient rehabilitation. CONCLUSIONS: Our data showed a correlation between blood-flow velocity in the MCA of both hemispheres and the parameters of functional and neurologic status at different stages of acute inpatient rehabilitation after first ischemic stroke in MCA territory. Cerebral blood flow as measured by TCD can be an additional tool for monitoring the rehabilitation process after stroke.

Adult↗
PubMed2005

Effect of rehabilitation site on functional recovery after hip fracture.

OBJECTIVE: To evaluate whether FIM instrument motor outcomes differ between hip fracture survivors undergoing rehabilitation in inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs). DESIGN: Inception cohort with follow-up to 12 weeks after hospital discharge. SETTING: University-affiliated tertiary care hospital, IRFs, and SNFs. PARTICIPANTS: All hip fracture patients prospectively admitted between March 1, 2002, and June 30, 2003, were eligible if they were 60 years or older and had surgical stabilization of the fracture. INTERVENTIONS: Posthip fracture rehabilitation delivered at either IRFs or SNFs. MAIN OUTCOME MEASURE: FIM motor score obtained postoperatively and at 2 and 12 weeks posthospital discharge. RESULTS: IRF patients stayed an average of 12.8 days, whereas SNF patients averaged 36.2 days. Rehabilitation participation scores were obtained during therapy sessions and did not differ between groups. A repeated-measures analysis of covariance found a significant group by time interaction (F 2,68 =23.75, P <.001), which indicates that patients in an IRF had significantly higher FIM motor scores than those in an SNF across time. Logistic regression showed that IRF subjects were more likely to reach 95% of their prefracture FIM motor by week 12 than were SNF patients. A significantly higher percentage of IRF patients were discharged home after rehabilitation compared with SNF patients. CONCLUSIONS: IRF patients had superior 12-week functional outcomes, as measured by the FIM motor score, compared with those treated in an SNF. The improved outcomes occurred during a significantly shorter rehabilitation length of stay and remained even when statistically controlling for baseline differences between groups. These data suggest that hip fracture survivors should not be excluded from receiving inpatient rehabilitation services. Randomized clinical trials are needed to understand more fully differences between rehabilitation treatment settings.

Aged↗
PubMed2006

The state of rehabilitation research: art or science?

Rehabilitation research has been criticized as not standing up enough to the rigors of scientific method to be called "science." The field has been portrayed as slow to promote its scientific achievements and to include them under the rubric of evidence-based rehabilitation. Following in the footsteps of psychology, rehabilitation as a broad-based discipline has faced many similar obstacles in achieving scientific status. Controversy exists about what exactly constitutes rehabilitation science versus its art and its respective multidisciplinary domains. The conception of these domains is directly related to current methods available to assess the state of the discipline and its research accomplishments. I used quantitative methods, such as randomized clinical and/or controlled trials (RCTs) and systematic reviews, to assess the status of rehabilitation research. Findings suggest that, as a field, rehabilitation makes significant contributions to science, measurable by the number and quality of RCTs and systematic reviews conducted so far on topics of critical importance for clinical care. In "artful" complement, qualitative approaches can be used as research tools to aid investigators in seeking knowledge beyond that obtained by quantitative methods, assessing many complexities associated with the various contexts of rehabilitation research. Other requirements to develop a common vision of rehabilitation science are also discussed.

Art↗
PubMed1995

Acute and subacute rehabilitation for stroke: a comparison.

Subacute rehabilitation, a recent innovation, is a less intense form of traditional inpatient rehabilitation. This study is a retrospective comparison of stroke treatment in a comprehensive inpatient service (acute rehabilitation) and subacute rehabilitation in a skilled nursing facility. Consecutive records during 1990 and 1991 resulted in 331 patients at the acute level and 97 at the subacute. Analysis of patient characteristics found few major differences between the two populations. Scrutiny of billing records found that acute program patients had twice as much treatment during a stay, twice the daily treatment hours, and twice the average charge per day. Acute rehabilitation patients showed substantially greater gains in functional impairment measures (FIM), but the proportion of patients discharged to the community varied little. Cost-effectiveness analysis found that the charge per successful discharge was more than double for acute rehabilitation. The charge per one point of FIM gain also was substantially higher. Although subacute rehabilitation was found to be more cost-effective than acute, additional research is needed to establish policies regarding rehabilitation services.

Activities of Daily Living↗
PubMed1996

Charges for outpatient rehabilitation: growth and differences in provider types.

OBJECTIVE: This study compares Medicare program charges through time for outpatient rehabilitation services across different types of institutional providers. DESIGN: Observational study of Medicare Part B claims. The analytic methods include a decomposition analysis and analysis of variance via regression. SETTING: Data come from six different institutional providers types: community hospital outpatient departments, rehabilitation hospital outpatient departments, skilled nursing facilities, independent rehabilitation agencies, comprehensive outpatient rehabilitation facilities, and home health agencies. PATIENTS: Five percent random sample of Medicare beneficiaries who used any institutionally based Part B physical, occupational, or speech therapy during the calendar years 1987 to 1990. MAIN OUTCOME MEASURE: Charges for Medicare Part B rehabilitation therapies (physical and occupational therapy, speech pathology). RESULTS: Charges for rehabilitation services grew more than 86% during this period across all provider types. Both the likelihood of using rehabilitation services and the average annual charges per patient grew rapidly. We found large differences in average annual per person charges and in the growth in charges across the six institutional provider types. Analyses that controlled for patient demographic characteristics and diagnoses across five provider types did not explain observed differences. Hospital outpatient departments were consistently the least costly type of institutional provider and independent rehabilitation agencies the most expensive. Diagnostic data were not available for home health agency claims, so these were omitted from the multivariate analysis of annual charges. CONCLUSIONS: The large increases in charges cannot be explained by increases in the Medicare eligible population, aging, or inflation. The level and differential in growth is highest among new provider types and those dominated by proprietary ownership. These observations suggest that therapy services are profitable and that provider incentives may be an important component in overall growth.

Aged↗
PubMed1997

Review criteria for stroke rehabilitation outcomes.

OBJECTIVES: To develop review criteria from the Agency for Health Care Policy and Research Stroke Rehabilitation Guidelines, to review chart records from three sites of care, and to evaluate the interrater and intrarater reliability for the chart review. DESIGN: A descriptive cross-sectional study using a convenience sample. SETTING: Charts for abstraction were obtained from three sites of care home health care, nursing facilities, and inpatient rehabilitation centers. PARTICIPANTS: Charts were included in the study from the three sites of care if the following conditions were met: (1) the client's first admission to a rehabilitation setting; (2) the client's care was Medicare reimbursed; (3) the client lived in the community prior to the stroke; and (4) the client was receiving skilled rehabilitation services. MEASURES: Review criteria, developed directly from the AHCPR Stroke Rehabilitation guidelines, consisted of 11 global quality criteria representative of comprehensive multidisciplinary rehabilitative care. There were approximately 150 variables, comprised of specific criteria to measure each of the 11 global quality criteria plus comprehensive demographic and client-specific information. RESULTS: Results of this study suggest that differences exist in documentation of care across the three sites of care. There was difficulty in obtaining adequate numbers of home health charts. Intrarater reliability, using Cohen's Kappa, was .78 and interrater reliability was .64. CONCLUSIONS: Based on chart documentation, there is variability in the process of stroke rehabilitation care across nursing facilities, inpatient rehabilitation facilities, and home health. This variability can be reliably assessed by chart review. This study provides the impetus for future research specifically evaluating the associations between documentation of the processes of care and patient outcomes.

Cerebrovascular Disorders↗
PubMed1999

Focus on rehabilitation: teamwork that works.

The end-stage renal disease patient has progressed in the past 25 years from the patient who was chosen by a committee to continue life, to a patient who chooses to live well on dialysis. The Vanderbilt Dialysis Clinic (VDC) has developed a collaborative team approach to enable the patient to more effectively achieve this goal. The emphasis has been placed on the patient's "ability, not disability." The collaborative effort of the staff at the VDC has evolved based on the perspective of a team concept. Each discipline or member of the team has a specific goal but functions in a manner that is interdependent of the other team members. The physician, nurses, dietitians, social workers, technicians, and activities director all play an important role in the concept of rehabilitating the whole person. The key to a successful rehabilitation program is to begin with interested patients and staff to serve as a catalyst for others. The Rehabilitation Program at VDC has been based on the principles of continuous quality improvement (CQI) at the unit. The team used the CQI process to brainstorm ideas to implement the exercise program, to overcome barriers to success, and to recognize opportunities to motivate patients and staff. Physicians, nurses, technicians, and dietitians worked together to develop the screening protocols so that the staff would feel comfortable when assessing the patient for exercise. An exercise physiologist from Vanderbilt's Kim Dayani Human Performance Center participated in evaluating the exercise screening information and worked with individual patients and staff members as the program began. Equipment was acquired in the form of used stationary bicycles, smaller ergometer-style pedals, hand and ankle weights, and therabands. The exercise program was initiated with only 2 to 4 patients per week participating, after which time it was evaluated and modified. VDC discovered that heightened awareness does indeed impact the level of participation in the facility. The Rehabilitation Team implemented the exercise program in October 1996 with 60% patient participation, yet within 6 months, participation decreased to 25%. One year later in conjunction with a Rehabilitation Fair, interest again peaked to a participation level of 60% in the center and 66% with the home dialysis population. While the improvement in participation may have been due to more quantifiable measurement, it is perhaps more reflective of the emphasis placed on the importance of exercise. Motivators such as an Annual Rehabilitation Fair in which all areas of the Life Options Rehabilitation Advisory Council's "5 E's"--encouragement, education, exercise, employment, and evaluation--are emphasized and have been effective in generating renewed interest among staff and patients in improving overall rehabilitation of patients at the VDC. Continuous motivation of patients and staff through ongoing program implementation, evaluation, and modification based on the CQI process is necessary to maintain everyone's level of interest.

Administrative Personnel↗