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At least 127 records · Page 7Linked to original sources
PubMed1995

Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies.

BACKGROUND AND PURPOSE: The risk of falls is very high among stroke patients, and falling is a major complication in stroke rehabilitation. This study aimed to investigate the incidence, characteristics, and consequences of falls in an inpatient stroke rehabilitation setting. METHODS: One hundred sixty-one patients consecutively admitted to a geriatric stroke rehabilitation unit were studied. Falls that occurred during their rehabilitation stay were prospectively registered and analyzed. RESULTS: Sixty-two of the patients (39%) suffered falls. The total number of falls was 153, which corresponds to an incidence rate of 159 falls per 10,000 patient-days. Most falls occurred during transfers or from sitting in a wheelchair or on some other kind of furniture. Seventeen falls (11%) were classified as the result of extrinsic mechanisms, 49 (32%) were intrinsic falls, 39 (25%) occurred in a nonbipedal position (while sitting or lying), and 48 falls (31%) remained unclassified. No injury was observed in 109 of 153 incidents (71%), whereas 6 falls (4%) involved fractures or other serious injury. CONCLUSIONS: Since falls are so frequent, they must be considered a significant problem in stroke rehabilitation. Fall prevention strategies should therefore be developed and included in rehabilitation programs.

Accidental Falls↗
PubMedDate not supplied

[Psychosomatic rehabilitation. Self-image, rehabilitative concepts, psychotherapeutic approaches, need vs. demand issues].

To provide optimal medical care for patients with psychosomatic disorders, rehabilitation and acute medicine should be viewed as separate but related parts of one overall health care concept. Psychosomatic rehabilitation now plays a major role in the care of chronically ill patients beyond the framework of traditional medical psychotherapy. The self image and rehabilitative concepts of this field are strongly influenced by two cornerstones of psychotherapy: psychodynamics and behavioral science. In the past the main factors used to define requirements for inpatient care were the capacity of existing facilities and the degree of their utilization; what was and still is lacking is an expert assessment of real demand. By offering programs for a broad spectrum of chronic disorders, the field of psychosomatic rehabilitation has achieved impressive therapeutic results at moderate cost; this assertion is substantiated by numerous analyses of the health care system. However, the high quality standard in the field of psychosomatic rehabilitation is currently endangered by politically motivated economic measures and the accompanying reduction of therapy time. If this counterproductive trend is not halted, the inevitable outcome will be suboptimal--in particular for chronically ill patients. In conclusion, possibilities are outlined for improved networking among professionals in psychosomatic rehabilitation.

Ambulatory Care Facilities↗
PubMed2003

Individual status at the start of rehabilitation: Implications for vocational rehabilitation programs.

UNLABELLED: This research investigated the situation of 143 unemployed sick leavers at the start of vocational rehabilitation in Sweden. It is argued in this paper that in order to gain a meaningful picture of the vocational rehabilitation process it is necessary to know and understand something of individual differences and status at the onset. In doing so, assessment was carried out of the possible influence of one contextual factor and five individual factors on health, duration of sick leave and unemployment. Findings suggest that individual differences exist in health status, length of sick leave and unemployment, at the upstart of vocational rehabilitating. Locus of control was found to exert important influence on the differences between the individuals in the study sample, with persons of external locus of control having a less favourable point of departure at the start of vocational rehabilitation compared to other groups. It is therefore assumed that these persons will be in greater need of support during the vocational rehabilitation process. The level of unemployment within a geographical area was also found to influence the length of sick leave. CONCLUSIONS: Our suggestion is for rehabilitation programs to be developed and selected to match the special needs and differences whether they are of individual or of social nature.

Adolescent↗
PubMedDate not supplied

Answering the rehabilitation needs of leprosy-affected persons in integrated setting through primary health care services and community-based rehabilitation.

This article aims to discuss the strategies for answering the rehabilitation needs of persons with leprosy-related disabilities in integrated settings through primary health care (PHC) services and community-based rehabilitation (CBR). While the provision of rehabilitation services through the PHC system remains problematic in most developing countries, the article concludes that CBR programmes have the potential for rehabilitation of leprosy-affected persons in integrated settings. However, the limited coverage of CBR programmes may pose an obstacle to such an approach. The author suggests the use of existing specific rehabilitation infrastructures meant only for leprosy-affected persons for initiating, sustaining and extending the CBR coverage to the surrounding communities. At the same time, the author asks for support and strengthening of organizations of leprosy-affected persons, promoting their active involvement in all rehabilitation processes.

Community Networks↗
PubMed1998

A model for diagnostics in neurological rehabilitation: an answer to 'the biopsychosocial disease consequence model in rehabilitation' of Talo et al.

In 1996, Talo et al. published their comprehensive version of a bio-psycho-social disease consequence model in rehabilitation, which deals with 'model development in the Finnish "Work hardening" programme for chronic pain'. The explanations given here serve to check the theoretical background of this model for certain basic assumptions as well as for the possibility to transfer it to other fields of rehabilitation. This is done from the viewpoint of neurological rehabilitation. The starting point is the consideration that the conceptions underlying the ICIDH are not suitable to serve as a mainstay of a model for diagnostics in rehabilitation because they do not reflect essential characteristics of the diagnostic process which is the basis for intervention. A model for diagnostics in neurological rehabilitation is contrasted to that of Talo et al. Regarding the theoretical background this model has different characteristics compared to that developed by the Finnish authors. It is guided by the process of gaining cognition in two different ways: (1) On the assumption that the diagnostic process reflects the same principles basically valid for theory-development in science, the basis of the model are conceptions for description and explanation of a patient's current condition. (2) Due to a holistic idea of disablement these conceptions are related to the individual's bio-psychosocial existence. As it relates to the model developed by Talo et al. this one represents a type of 'meta-level'. With regard to the long-term objective the main interest associated with the alternative model refers to its implications concerning the conception of the rehabilitation process as a prerequisite for internal quality management.

Chronic Disease↗
PubMed2004

Full-time integrated treatment program, a new system for stroke rehabilitation in Japan: comparison with conventional rehabilitation.

OBJECTIVE: To validate the effectiveness of the Full-time Integrated Treatment (FIT) program that is characterized by rehabilitation 7 days/wk, encouragement of daytime activity, and enhanced communication between staff in stroke rehabilitation. DESIGN: Since our facility changed from the conventional rehabilitation system of 5 days of treatment to the FIT program in December 2000, we compared the conventional rehabilitation program with the FIT program at our hospital. The conventional treatment group and the FIT group consisted of 48 and 58 first-stroke hemiplegics, respectively. RESULTS: The motor subscore of the FIM instrument at admission and at discharge was 64.3 and 77.0 in the conventional group and 60.6 and 80.9 in the FIT group, respectively. The length of stay and efficiency of the FIM instrument were 80.0 days and 0.16 in the conventional group and 69.8 days and 0.30 in the FIT group, respectively. These differences between groups were statistically significant, with the exception of admission FIM data. CONCLUSIONS: Because the FIT program attained a higher discharge FIM level with a shorter length of stay, the FIT program was concluded to be an efficient and effective method of stroke rehabilitation.

Activities of Daily Living↗
PubMed1998

Stroke rehabilitation outcome variation in Veterans Affairs rehabilitation units: accounting for case-mix.

OBJECTIVE: To assess variation in stroke outcomes and create a case-mix adjustment model for stroke rehabilitation in Veterans Affairs Medical Centers. DESIGN: Observational SETTING AND PATIENTS: Within Veteran's Health Administration hospitals, there are 63 acute rehabilitation bedservice units that care for approximately 2,000 stroke patients annually. MAIN OUTCOME MEASURES: Functional gain in FIM points, length of stay (LOS), LOS efficiency (FIM gain/LOS). RESULTS: Significant variation in average patient functional gain, LOS, and LOS efficiency was observed among the 37 highest-volume rehabilitation units. Using analysis of covariance, a model was developed that adjusted functional gain and LOS (logged LOS) unit means using 10 potential covariates identified in a literature review and in pilot studies. Four and six covariates, respectively, were retained in the final models for FIM gain and LOS. The R2 for FIM gain and LOS accounted for by rehabilitation unit alone increased from .07 to .31 (FIM gain) and from .13 to .34 (logLOS) with the addition of the significant covariates to each model. CONCLUSIONS: As much as 24% of the variation in two important stroke rehabilitation outcomes is attributable to largely immutable patient and system characteristics (eg, patient function on admission, age, days since stroke onset, year of discharge, marital status, and referral source). Hence, controlling for case-mix is critical for accurate comparison of unit outcomes. Further, the variation in LOS efficiency between VA rehabilitation units suggests a large potential for cost and resource utilization savings system-wide.

Aged↗
PubMed2004

[Outpatient rehabilitation as mirrored by the users--findings on the quality of outpatient orthopaedic rehabilitation provided by the Federal Insurance Institute for Employees, BfA].

This article presents the central results of a survey including all persons insured by the BfA (Bundesversicherungsanstalt für Angestellte, German Federal Insurance Institute for Employees) who had participated in outpatient orthopaedic rehabilitation between March and August of 2002. A total of 3838 insured persons were addressed, 69 % replied (n = 2660 questionnaires). The standardized survey included an appraisal of the outpatient rehabilitation measure, the care provided by physicians, psychologists and therapists, the organisation and performance of the rehabilitation measure, as well as of the stressors and general conditions specific to various outpatient measures. The assessment of treatment outcome, physical and psychosocial improvements, and the attainment of therapy goals were of particular importance. Overall, the results show a positive appraisal of outpatient rehabilitation but also indicate the necessity for optimisation--particularly with regard to resting rooms, physician and psychological care, as well as the suitability of the therapy for everyday life. Above all, however, the comparison of the rehabilitation centres shows a great variance in quality of care. Some rehabilitation centres show extraordinary results in many aspects of quality, whereas others reveal systematic deficits of quality.

Ambulatory Care↗
PubMed2004

[Psychosocial rehabilitation at the dawn of the 21st century: II: Therapeutic or rehabilitative modalities and institutional disposition].

The main goal of psychosocial rehabilitation is to compensate the vulnerability underlying psychiatric disorders through intermediate institutions when the persistence and recurrence of these disorders have led to social and professional exclusion. Intermediate institutions refer to services which allow transition between the state of dependence on the hospital to the state of relative autonomy in social community. Psychosocial rehabilitation is a comprehensive approach which link the type of interventions: treatment, rehabilitation and support integrated in multimodal and individualized programs. A study of the out-patients followed by the rehabilitation unit of the psychiatric department in Lausanne has shown that provision of services is divided into 60% for rehabilitation, 20% for treatment and 20% for support independently of the psychiatric disorders. The implementation of these programs necessitates institutional support from psychiatric hospital to outpatient clinics through different types of facilities in order to offer a medical and psychosocial device of rehabilitation into the community.

Combined Modality Therapy↗
PubMed2006

[Demographic features and difficulties in rehabilitation in patients referred to hand rehabilitation unit for phalangeal fractures].

OBJECTIVES: We evaluated demographic and occupational features of patients with phalangeal fractures of the hand, etiologies and types of injuries, and the results of rehabilitation. METHODS: The study included 91 fingers of 62 patients (54 males, 8 females; mean age 28+/-13 years; range 4 to 59 years) who were referred to our hand rehabilitation unit for phalangeal fractures. Demographic features, the cause and localization of injury, the type of surgery, time from surgery to rehabilitation, and the follow-up period were determined. At the end of rehabilitation, range of motion (ROM) of the phalangeal joint and total ROM of the injured fingers were assessed using the Strickland-Glogovac rating system. RESULTS: A great majority of injuries were caused by work accidents, followed by sport injuries and falls occurring in students. Sixty patients (96.8%) were right-handed. The fractures occurred in the dominant hand in 29 patients (46.8%). The majority of patients (n=45) were primary school graduates. The most common mechanism of injury was accidents related to heavy work machinery (n=18). The most commonly injured finger and the phalanx were the third finger (n=25, 27.5%) and the proximal phalanx (n=59, 56.7%), respectively. Only 27 patients (43.6%) had a sufficient follow-up with a mean of 79.7+/-46.6 days (range 30 to 254 days). Following rehabilitation, the mean ROM and the total ROM were 45.0+/-22.9 degrees and 63.3+/-16.1 degrees for the injured joint and the thumb, and 31.3+/-22.5 degrees and 122+/-60.3 degrees for the injured joint and the other fingers, respectively. CONCLUSION: Our data provide important insight into appropriate treatment and rehabilitation of phalangeal fractures, in particular, shortcomings in the treatment and follow-up.

Adolescent↗
PubMedDate not supplied

Cardiac rehabilitation service provision in Ireland: the Irish Association of Cardiac Rehabilitation survey.

BACKGROUND: The first national survey of cardiac rehabilitation services was conducted. AIMS: To establish levels of service provision, service formats, and geographic distribution of cardiac rehabilitation services in 1998. METHODS: Public hospitals in the Republic (n=41) and Northern Ireland (n=12) which provide services to cardiac patients were surveyed. RESULTSl Response rate was 81%. Twelve centres (29%) in the Republic and nine (75%) in Northern Ireland provided cardiac rehabilitation. There was wide geographic variability in service provision. Most centres were unable to identify the proportion of eligible patient participation. Most programmes were established for less than five years. All programmes had multidisciplinary teams, multicomponent courses and co-ordinators. Additionally, 44% of hospitals without programmes had plans regarding programme establishment. CONCLUSIONS: The findings highlight the underdeveloped but rapidly expanding nature of cardiac rehabilitation services in Ireland. They provide a baseline from which to address rehabilitation needs and to judge the success of the National Cardiovascular Health Strategy in addressing these needs.

Coronary Disease↗
PubMed2007

Inpatient stroke rehabilitation: a comparative study of admission criteria to stroke rehabilitation units in four European centres.

OBJECTIVE: To explore the clinical and non-clinical factors involved in decision-making concerning admission to European stroke rehabilitation units. DESIGN: Observational study on case-mix at intake combined with questionnaires and semi-structured interviews with the medical consultants of each European stroke rehabilitation unit. PATIENTS AND SETTINGS: Clinical data on 532 first-ever patients after stroke. Medical consultants from 6 European stroke rehabilitation units in 4 European countries (UK, Belgium, Germany and Switzerland). METHODS: Standardized clinical assessments within 2 days after admission. Questionnaires to each medical consultants followed by a qualitative round of semi-structured interviews. RESULTS: Case-mix of patients after stroke was significantly different between European stroke rehabilitation units. Clinical criteria for admission were seldom explicit and were evaluated differently between the European stroke rehabilitation units. In the UK units, diagnosis of stroke was the only criterion for admission. In the Belgian, German and Swiss units, pre-morbid conditions were taken into account in admission decisions. The likelihood of discharge home was considered highly important in the Swiss units. CONCLUSION: Case-mix differences at intake could be linked to different appraisals of clinical and non-clinical factors of patients after stroke. The findings urge us to be more explicit about decision-making processes at admission in order to provide a more comprehensive insight into the interplay between context and process of care.

Belgium↗
PubMed1996

[Rehabilitation as interdisciplinary responsibility--the medical specialty "physical and rehabilitative medicine"].

Physical and rehabilitation medicine is an independent medical subspecialty and is not derived from "physics" but from "physis-nature". Beside the elements of specific movements, it does use physical components such as heat, cold, light, water, and electricity for therapeutic purposes. Physical medicine and rehabilitation has always been a discipline with own methods, issues, and own areas of research and theory. The treatment techniques of this specialty are summarized under the term "physiotherapy". Its methods, which also contain balneology and medical climatology, are using physical and physiological principles of order in the organism. The application of this therapy happens for the training of impaired functions, influence of pathogenetic processes causing pain, and for the activation of the body's regeneration capacities. Physiotherapy is not limited to certain diseases or stages of illness but may prevent, abolish, or weaken malregulation of functional units, especially when used in repetitions. A particular focus of the rehabilitation is to address the still remaining functional reserves of an injured organism in a way that a compensation can be reached as close a possible to the etiological point of the pathogenetic chain of causes. Declared goal of the physiotherapy is the induction and optimization of healing processes. Due to this interdisciplinary approach, physical and rehabilitation medicine is an essential part for almost every medical subspecialty. Because of the increasing importance of this discipline, the specialist for physicial and rehabilitation medicine was introduced in Germany in 1992.

Humans↗