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PubMedDate not supplied

Relationship between type of health insurance and time to inpatient rehabilitation placement for surgical subspecialty patients.

A significant proportion of patients on a neurosurgical service require inpatient rehabilitation placement after discharge. The relationship between the type of health insurance of the patient at the time of admission and the time to placement of patients has not previously been addressed. We prospectively studied all patients on the adult neurosurgical service at our hospital to determine whether the type of health insurance carried by patients is related to the time necessary to arrange acceptance into inpatient rehabilitation facilities. Ninety-one patients (51 men, 40 women; mean age, 56 years) admitted to the neurosurgery service during a 6-month period required inpatient rehabilitation placement after discharge. The time in days between the request for placement into a rehabilitation facility and the acceptance of the patient was examined. The mean time for placement of patients with and without health insurance at the time of admission was 0.8 days and 2.1 days, respectively (overall mean, 1.1 days) (P < .002). No statistically significant associations were found between age, sex, or race of the patient and the time to placement. In addition, there was no difference in the time to placement between those patients admitted as a result of trauma and those patients admitted for reasons other than trauma. These results indicate that among patients on a neurosurgical service, patients with private health insurance are accepted into inpatient rehabilitation approximately 1 day sooner than patients without private health insurance. Patients without private health insurance are delayed in their transfer to inpatient rehabilitation facilities and more aggressive inpatient rehabilitation. How this finding translates into an increase in cost of care or a decrease in patient outcomes is unknown.

Adolescent↗
PubMed2000

The effectiveness of community-based rehabilitation for stroke patients who remain at home: a pilot randomized trial.

OBJECTIVE: To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London. DESIGN: Randomized controlled trial. SETTING: Patients' homes in South London. SUBJECTS: Stroke patients not admitted to hospital after a stroke. INTERVENTION: Rehabilitation at home by rehabilitation team for up to three months or usual care. MAIN OUTCOME MEASURES: The primary outcome measure was the Barthel score. Secondary measures included the Motricity Index, Rivermead ADL, Hospital Anxiety and Depression score and Nottingham Health Profile. RESULTS: Forty-three patients who remained at home were randomized to rehabilitation team (23) or 'usual' care (20). The mean number of physiotherapy sessions was three (range 1-14) for the rehabilitation team group and two for the usual care group. Patients (with a deficit) in the rehabilitation arm of the trial were more likely to receive occupational, physical and speech therapy than those in the control arm (p = 0.03, 0.01 and 0.008, respectively). For those patients actually receiving therapy, there was no evidence that the amount received differed between the groups. However, the number of patients in each of these comparisons was very small. The outcome for patients in the rehabilitation team arm of the trial was nonsignificantly higher (0.05 < p < 0.2) than for those in the control arm for the areas of Nottingham Health Profile, anxiety, depression, caregiver strain and the proportion of patients living at home. Based on the data observed here, a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33% difference between intervention and control groups in these outcomes. CONCLUSION: Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinically effective would require trials of adequate size.

Aged↗
PubMed2006

The effect of rehabilitation service use on coping patterns over time among older adults with age-related vision loss.

OBJECTIVE: To enhance our understanding of coping and rehabilitation in the context of adaptation to disability by examining how coping may change over a two-year time period, and how different vision rehabilitation services may affect coping over time. DESIGN: Longitudinal two-wave study (baseline and two-year follow-up). SETTING: Vision rehabilitation agency. SUBJECTS: Older adults with visual impairment. METHOD: In-person interviews using structured assessments of functional vision loss and functional disability, rehabilitation service use and coping strategies. RESULTS: Ninety-five people participated in both study waves. Findings showed change in patterns of coping over the two-year period of the study, as participants adjusted to living with age-related vision loss. Although instrumental coping was the only coping mode with evidence for average change (a decrease), affective and escape/distraction strategies showed individual variation in change over time. Rehabilitation use explained variance in coping at time 2 over and above impairment status and coping at time 1. Those who used a greater number of assistive aids between time points were likely to report more instrumental coping at time 2, and those who used counselling between time points were likely to report more affective coping at the two-year follow-up. Finally, those who used more optical aids were likely to report more escape/distraction coping at time 2, whereas those who saw a low vision specialist tended to report less of this type of coping over time. CONCLUSIONS: Findings suggest that rehabilitation interventions can affect coping patterns over time, and that direction and magnitude of such an effect may depend on the type of rehabilitation received.

Adaptation, Psychological↗
PubMed2004

Defining oral rehabilitation.

"Oral rehabilitation" is a phrase that is used to encompass several levels of oral therapy. Usually, dentists think of an oral rehabilitation as meaning restoration of all of the teeth in a given mouth. However, when only the defective teeth in any mouth are restored, that too could be defined as an oral rehabilitation. The advent of esthetic dentistry has encouraged oral rehabilitation for esthetic reasons only. This article suggests that such oral rehabilitations should be preceded by thorough informed consent and education about other, more conservative, therapies. Patients should have full knowledge that such rehabilitations are not required, and that they may require frequent re-treatment at significant cost. Qualified specialists or experienced general dentists are capable of treating all levels of oral rehabilitation, and completion of courses at specific commercial institutes is not necessary.

Dental Restoration, Permanent↗
PubMed2002

Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: an overview and cost analysis.

BACKGROUND: Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services. OBJECTIVE: To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke. METHODS: A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care. RESULTS: Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350] ($US11 390)] compared with standard care. CONCLUSIONS: A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.

Aged↗
PubMed1998

Vocational rehabilitation and future sick-leave.

The aim of the present pretest-posttest study was to examine and compare the impact of vocational rehabilitation on future sick-leave for employed and unemployed people, respectively, on long-term sick-leave. The study is based on 416 registered long-term sick-leave cases that were initiated during 1992-94 in the city of Stockholm, and that became objects for vocational rehabilitation. The hypotheses were (1) that the number of sick-days and levels of benefit for both employed and unemployed would be less after rehabilitation than before and (2) that rehabilitation would affect employed people more than unemployed people. The hypotheses are supported in that both employed and unemployed have less sick-days and lower levels of benefits after vocational rehabilitation than before and that unemployed people have more sick-days and higher levels of benefits than employed people after rehabilitation. However, since unemployed people also have more sick-days before rehabilitation, the proportional decrease is about the same. Another finding was that men, especially among the unemployed improved more than women.

Adult↗
PubMed1983

Rehabilitation of the neurologically disabled patient: principles, practice, and scientific basis.

Rehabilitation is a therapeutic program specifically directed toward restoring the optimum level of function available to patients with severe permanent disabilities. It complements standard care, which focuses on curing the primary pathology. Preventive rehabilitation is designed to minimize the complications of inactivity that tend to develop during a protracted curative process (contractures, pressure sores, muscle atrophy, cardiopulmonary deconditioning, cognitive dulling). Comprehensive rehabilitation focuses on the restoration of function. It encompasses physical reconditioning, teaching new ways to accomplish the basic tasks of locomotion, object handling, personal care, relationships with family and society, employment, and recreation. The rehabilitation program is largely designed and provided by a team of allied health professionals, each an expert in one area of function. Reverting to a less dominant role, the physician provides leadership by defining the stress (activity) tolerance of the patient's pathology, coordinates the team, and manages intercurrent problems that arise. Comprehensive rehabilitation is an in-hospital program. Less intense elements can be provided in a skilled nursing facility, out-patient clinic, or the patient's home. The details of the rehabilitation process vary with the nature of the patient's primary pathology. These have been illustrated in this review of the programs for two very diverse situations. Spinal cord injury introduces varying levels of physical incapacitation. Conversely, brain injury primarily creates a cognitive and behavioral deficit. Both are complex problems requiring comprehensive rehabilitation if the impairment is severe.

Brain Injuries↗
PubMed2002

1: Rehabilitation and older people.

Older people make up the majority of participants in general rehabilitation programs. Stroke and hip fracture are the major diagnostic groups. Most older people with significant disability of recent onset have the potential to benefit from rehabilitation. Assessing an older person's premorbid functional and cognitive status, which are strong determinants of rehabilitation outcome, is an important component of management. The major goals of rehabilitation for older people are mobility and self-care without the assistance of another person. Evidence suggests that rehabilitation for older people involving a coordinated multidisciplinary team of health professionals (including nurses and doctors) is effective. Contemporary rehabilitation practice is not confined to traditional inpatient rehabilitation units; it also occurs in the community and other non-hospital settings, and involves general practitioners.

Activities of Daily Living↗
PubMed1998

[Occupational rehabilitation of former drug addicts--experiences of the Isney Stephanuswerk].

Rehabilitees who have completed substance withdrawal treatment are among the special target groups for vocational rehabilitation measures. It in particular is at the transition from the primarily medically focussed phase of substance withdrawal treatment into the phase of vocational rehabilitation that this population has to cope with substantial adjustment problems, with the consequence of frequent, and occasionally massive, relapse into substance abuse, and hence not only temporary interruption of the vocational rehabilitation measure. From the long years of experience in working with this population at the Stephanuswerk Isny rehabilitation centre, an absolute need has emerged to offer particularly intensive social-educational and psychological follow-along supports during the phase of vocational rehabilitation. In response to these insights, cause-oriented action strategies have been devised seeking to prevent relapse among ex-dependent rehabilitees and/or assist them in their efforts to cope, in order to avoid drop-outs from the vocational rehabilitation programme, with all the adverse consequences this would imply. These action strategies inter alia included drafting a catalogue of criteria applicable before client admission to the programme, as well as a catalogue of relapse-prevention measures during vocational rehabilitation. The core element of relapse prevention had been creating a prevention-focussed self-help group project, which, in terms of structure and concept, turned out a crucial stabilizing factor for relapse prevention or coping in rehabilitees at risk.

Adult↗
PubMed1998

[Introduction of the Bavarian Scientific Rehabilitation Group].

As a part of the Rehabilitation Research Programme of both the Ministry for Education, Science, Research and Technology and the German Pension Insurance, the Rehabilitation Research Network of Bavaria has begun its work after having completed a planning phase of three years. Under the heading entitled "Patients in Rehabilitation" physical, psychological and social consequences of chronic diseases are addressed from a bio-psycho-social point of view. The network contains ten research projects which are located in different university institutions and rehabilitation clinics all over Bavaria. These projects can be assigned to three thematic clusters: diagnostical and predictor studies; evaluation of treatments; interface problems in rehabilitation. The interventions to be evaluated are aimed at strengthening patients' coping abilities. Wherever feasable, randomized controlled studies are performed. Both economical and gender-specific effects are investigated. A central facility for coordination and methodological consultation was implemented at the University of Würzburg. The network has the objective of both improving the quality of rehabilitation research and education and increasing the resources of institutions doing rehabilitation research in Bavaria.

Forecasting↗
PubMed1995

Cost-effective rehabilitation: Part 2--Approaches to patient management problems.

Part one of this two-part series discussed general principles of cost-effective rehabilitation: Patients in rehabilitation programs should be working toward achievement of real-world functional goals. Goals should be realistic, and reachable in a reasonable amount of time. Rehabilitation services should be provided at the lowest safe and effective level of care appropriate to the patient's needs. Patients should be participating to their full potential in an active therapy program. Therapy intended to maintain a patient's current condition should be carried out by nonprofessionals who have had training sessions with rehabilitation professionals as needed. Discharge planning begins on the day of admission to the inpatient or outpatient rehabilitation program. This second of the two-part series will focus on individual patient management issues. It discusses circumstances in which the principles of cost-effective rehabilitation may need to be modified. It also discusses approaches to remedy patient management problems that may lead to excessive or ineffective utilization of rehabilitation services.

Case Management↗
PubMed1999

The relation between admission balance and functional outcomes following stroke rehabilitation: a medical center based study.

This prospective study evaluated the clinical use of the Fugl-Meyer Balance Scale (FMBS) on stroke patients during hospitalization and assessed the relationship between balance score at admission to the rehabilitation program and functional outcome at discharge. One hundred and sixty-three stroke patients admitted to the in-patient rehabilitation department of a university-based medical center between January 1 and December 31, 1997 were recruited for this investigation. Functional ability was evaluated with the Functional Independence Measure (FIM) instrument, and balance was measured using the 7-item Fugl-Meyer Balance Scale. These measures were assessed both at admission to and discharge from the inpatient rehabilitation program. Pearson correlation and multiple regression analyses were used to determine the relationship between balance and functional ability scores at admission and rehabilitation outcomes at discharge, including length of stay, functional gain, and efficiency. The results demonstrated that the balance score at admission accounted for 6% of the variation in length of stay, once demographic influences were controlled. The FIM efficiency score could possibly be predicted by the balance ability at admission, which accounted for 3% of the variance. However, the balance score could not provide predictive information about the FIM gain beyond that already provided by the FIM score at admission, which accounted for 4% of the variance with demographic factors controlled. Overall, balance ability at admission, assessed by the Fugl-Meyer Balance Scale, had no or at least only little, contribution to account for the variance in rehabilitation outcomes. These findings suggest that the use of Fugl-Meyer Balance Scale at admission to stroke inpatient rehabilitation seemed not to enhance the ability to predict rehabilitation outcomes.

Adult↗
PubMed1999

[Validation of procedures of rehabilitation after cerebrovascular accident].

There are several methodological difficulties in the assessment of the effectiveness of rehabilitation in stroke patients. Obviously, double-blind studies are not possible, and only single-blind procedures can used. It is difficult to control for non specific effects, such as spontaneous recovery, patient's and therapist's motivation, social environment. It is necessary to assess the effect non only at the level of impairments, but also on disability and handicap. However, there are now accumulating data in the literature suggesting that stroke rehabilitation has a significant, although mild, effectiveness. Patients treated in specialized stroke rehabilitation units obtain a better outcome, in terms of independence in daily-life activities, than those treated in general wards. They also have shorter hospitalisation durations and are more frequently able to return home. Treatment effectiveness is related to intensity and duration of rehabilitation, and also to stroke severity. Patients with moderate impairments seem to benefit more from treatment than patients with mild or severe deficits. However, significant improvements can still be obtained in very severe cases, and even late (up to two years) post stroke. Similarly, rehabilitation of cognitive deficits (aphasia and unilateral neglect) has also been found efficient in most studies, even if the beneficial effect is relatively small. Aphasic patients treated by speech therapists improve more than patients treated by non specialized therapists or by family members who received a short training. One limitation of neglect rehabilitation is the inconsistent generalisation of treatment effects to daily-life situations. These data are encouraging but further research is needed to find out what precisely works, and how, in the "black box" of rehabilitation.

Functional Laterality↗
PubMed1999

[Empirical determination of the need for rehabilitation].

In Germany, members of social insurance (e.g., pension) schemes have to apply for medical rehabilitation. Usually, the applications are the expression of a subjective demand. If the applications are granted this leads to the actual supply of medical rehabilitation services. Formerly, long waiting lists were common. These have been replaced by a new balance between demand (amount of applications), "offer" (capacity of rehabilitation clinics) and the amount of granted applications. In addition to these notions, the article develops the concept of need for rehabilitation services based on sociomedical indications. Consequently, the need for medical rehabilitation can--to a certain degree--be objectified. The concept of need should not be mixed up with that of demand: not every member of a social insurance scheme who objectively is in need of medical rehabilitation realizes the need, not everybody who realizes a need will apply for rehabilitation, and not all applications will be granted. The article gives an overview of different ways of needs assessment.

Germany↗
PubMed1999

[Subjective health, need for rehabilitation and utilization in a West-East comparison--results of a survey of insured clients of the federal insurance office for employees and the Saxony federal insurance office].

There were substantial changes within the rehabilitation framework due to new laws as well as internal need for more flexibility. In connection with this process, the BfA and the LVA Sachsen initiated a survey among their insured persons, the main points being the need for and use of rehabilitative care. The results of a West/East comparison are presented. A questionnaire was send to approximately 29,000 insured persons, the overall response rate was 43%. White collar workers in the East reported a better state of health compared with those in the West, with the most profound differences found in females. Subjective health status and subjective working capability were highly associated. The proportion of persons who reported a need for rehabilitation amounts to 24% among the insured with the LVA Sachsen (blue collar workers, East) and 12% among the white collar workers in the East. Independent of the state of health there was also an association between work stress and the need for rehabilitation. Persons from the East were less informed about rehabilitative care than persons from the West. Financial and workplace problems were among the major reasons not to apply for a rehabilitation measure even if there is a need. These reasons were mentioned more often in the East. In conclusion, there are substantial differences between West and East concerning the rehabilitative health sector. A prominent role is played by the employment situation.

Adult↗
PubMed1999

[Are there class-specific disadvantages in utilization of medical rehabilitation?].

Many studies prove the fact that the risk for morbidity and mortality is increased in lower social classes. Most chronical diseases also accumulate in lower classes. However, data are missing as to whether this social disadvantage also affects the use of medical rehabilitation, which could supply support in dealing with the consequences of such diseases. On the basis of questionnaire data of 3021 insures of the LVA pension insurance fund for workers, it was examined whether there are class specific differences in the need for medical rehabilitation and in the intention of insures to apply for such a measure and which kind of class specific barriers and attitudes may hinder the application. The results first of all confirm that insured of lower social classes are specially health strained and have a particular demand for rehabilitative offers. The insured, however, quite rarely rate themselves as requiring rehabilitation, whereas there is no significant class specific difference in the intention to apply for rehabilitation. There are significant differences in the attitudes which influence application for medical rehabilitation. Above all, there are economic considerations and job-related fears which hinder lower class insurees to apply for medical rehabilitation. This calls for action regarding implementation of special screenings and counselling.

Adult↗
PubMed1975

A rehabilitation evaluation system which complements the problem-oriented medical record.

The traditional medical history and physical examination format is disease rather than disability oriented. It has been shown to be incomplete for the total evaluation of rehabilitation patients. Direct applications of Weed's Problem-Oriented Medical Record have proven to be formidable and cumbersome due to the complexity and diversity of rehabilitation. Therefore, we have developed the Rehabilitation Evaluation System (RES) to document functional rehabilitation management and progress during inpatient hospitalization and outpatient follow-up. The system identifies 18 key rehabilitation areas, each with an individual and objective four-point scale. Utilization of this system in our department has been invaluable in formulating goals and continually evaluating the on-going rehabilitation process. We used the RES with equal facility on 46 rehabilitation inpatients including stroke, amputation, spinal cord injury, multiple sclerosis, orthopedic-trauma, rheumatoid arthritis and poliomyelitis. The mechanics of the RES are presented in detail with a specific patient-example of hemiplegia. Its complimentary use with the Problem-Oriented Medical Record is discussed. Practical advantages are seen in patient care, medical student and resident education, record keeping and research.

Disability Evaluation↗
PubMed2000

Determinants and outcomes of inpatient versus home based rehabilitation following elective hip and knee replacement.

OBJECTIVE: There are large variations in practice patterns and costs of rehabilitation following total joint replacement (TJR). We evaluated the determinants of rehabilitation setting (home based vs inpatient) after TJR, and its influence on early functional outcomes. METHODS: We studied a retrospective cohort of 146 primary total hip and knee replacements. Ninety-six patients completed a mailed survey consisting of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Medical Outcomes Survey Short Form-36 (SF-36), and a satisfaction questionnaire. RESULTS: The mean age of the cohort was 66 years, 70% were women, and osteoarthritis was the primary diagnosis in 79%. Thirty-nine percent received home based rehabilitation. Determinants of home based rehabilitation included preference for home based rehabilitation, male sex, and knowledge regarding TJR. At a mean followup of 8 months post TJR, there were no significant differences between the inpatient and home based rehabilitation groups with respect to the WOMAC, SF-36, and satisfaction scores. CONCLUSION. These results support continued use of home based rehabilitation.

Aged↗