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PubMed2000

Post-stroke rehabilitation. A review of the guidelines for patient management.

A comprehensive, intense rehabilitation program is key to successful convalescence for patients who have experienced stroke. A guideline on post-stroke rehabilitation published by the Agency for Healthcare Research and Quality provides clinicians with detailed recommendations for managing patients who have sustained a brain attack. Rehabilitation should begin following diagnosis and after any life-threatening issues have been effectively managed. The key steps include patient management during the acute phase, screening for rehabilitation and choice of setting, managing rehabilitation, and facilitating the patient's transition back into the community. The timeliness of rehabilitation interventions and the intensity of rehabilitation services are important factors in maximizing a patient's functional outcome at hospital discharge and on follow-up.

Aged↗
PubMed2000

[Economic limits in rehabilitation].

At the end of the 90s, the German government imposed strict budget restrictions--to an extent previously unknown--on German rehabilitation medicine, arguing that this was necessary for economic reasons. In particular, these restrictions have led to considerable and permanent cuts in the area for which the pension insurance system is responsible. The consequence of this has been that in 1998--for the first time in the history of the rehabilitation system--expenditure on medical rehabilitation was distributed approximately equally between the pension and health insurance systems. A factor which contradicts the restrictions imposed by law is that an increase in the need for rehabilitation among those in gainful employment--due to demographic factors--can also be observed at the macro-economic level. This increase will peak in 2015 as will the increased demand for rehabilitation due to a change in the curative paradigm--for example due to sharp rates of growth in surgery which is performed. An internal contradiction to a restrictive health policy in rehabilitation medicine arises from the increasing number of evidence-based instances of proof of the effectiveness of rehabilitation, which also indicate economic benefits.

Budgets↗
PubMed2002

Rehabilitative nursing: a core nursing function across all settings.

Nurses are challenged to meet the changing health care needs of the Australian population as they live longer and experience increasing levels of disability. This paper reports on part of the findings of a recent study of rehabilitation nurses and suggests that the findings are relevant to all nurses as they attempt to meet this challenge. Thirty-four registered nurses working in rehabilitation settings in three states of Australia participated in the study. In-depth interviews and focus group discussions were used to collect data and validate interpretations. From the seven domains of practice identified in the findings, this paper discusses only one, the rehabilitative approach. This domain begins to capture the how and why of rehabilitation nursing practice, rather than the what. The rehabilitative approach is about the way the nurses conceptualise and think about their practice and the people they interact with. It is greater than the cliché of holistic care. Given that rehabilitation is a process that the patient undergoes and is not setting specific, the findings of this study offer direction to all nurses in supporting the rehabilitation of their patients. The study, the first of its kind in Australia, provides valuable guidance for the designers of undergraduate and postgraduate nursing programs in Australia.

Adult↗
PubMed2003

Features of occupational rehabilitation systems in Australia: a map through the maze.

This review contributes to the limited literature on systems of occupational rehabilitation in Australia. Occupational rehabilitation is defined and features of occupational rehabilitation systems within the workers' compensation framework are described. Common features include: (a) the trend to workplace management, (b) preferred rehabilitation program settings and (c) widespread acceptance of some identified principles of occupational rehabilitation. Other features such as roles of stakeholders and participants, relationship of rehabilitation providers and employers, and the services provided have a number of variations in the Australian systems. Similarities and differences between features of Australian and North American systems are noted. Implications for occupational rehabilitation providers are discussed, and recommendations for practice and future research are made.

Australia↗
PubMed2004

Work resumption or not after rehabilitation? A descriptive study from six social insurance offices.

The objective of this study was to describe measures and outcomes of vocational rehabilitation at six local national insurance offices in the same county in Sweden. Data were collected from mainframe registers and other records at each office. There were great differences in sickness allowance, incapacity rate, selected rehabilitation measures and resuming work. The percentage of sick-listed people who received any rehabilitation measure differed from 1.2 to 8.7%. The gender distribution for the study population was 36% men and 64% women and the predominant diagnosis was musculoskeletal pain conditions, which was followed by psychiatric disorders. Outcomes varied from office B, which reported 58% fully fit after completed planned rehabilitation, to office C, which reported only 24% fully fit. The clear differences in outcome between the offices indicate that various rehabilitation measures differ in effectiveness. The rehabilitation measure 'investigation of working ability' was not linked to any great proportion of people resuming work, but showed a greater correspondence to full disability pension. There were also large differences in social and demographic factors in the different municipalities. The effect of these on the rehabilitation process requires further investigation.

Adolescent↗
PubMed2005

[Indication guidelines for medical rehabilitation in the context of disease management programmes].

In current and upcoming disease management programmes in Germany, the provision of medical services is strongly oriented on ICD diagnoses and on services traditionally provided by the statutory health insurance. Multidisciplinary services, such as medical rehabilitation, mostly covered by other payers (e.g. pension funds) are not taken into account. On the other hand, many chronically-ill patients have complex and multifocal health complaints that are best addressed by multidisciplinary interventions. Considering this inherent deficit, in 2002 the German Society of Rehabilitation Sciences has initiated the research project "Indication Guidelines" aimed at developing indication criteria for rehabilitation in the context of disease management programmes. The concept presented in this paper relies on three basic requirements: 1. Impaired participation (according to ICF) caused by multifocal deficits leads to the definition of goals for rehabilitation, taking into account clinical and legal aspects as well as the patients preferences. 2. Multifocal health problems are best addressed by a multidisciplinary rehabilitation programme as it is currently provided by the German pension funds. 3. Scientific evidence has to demonstrate that these programmes are very likely to be effective (positive rehabilitation prognosis, evidence-based rehabilitation). Further requirements include adequate instruction of patients, as well as intensive and prolonged after-care. Both could be very well integrated into comprehensive disease management programmes.

Disease Management↗
PubMed2005

[The Rehabilitation Guideline Program of the BfA].

UNLABELLED: Since 1998, the German Federal Pension Insurance for Salaried Employees (BfA) has funded several research projects aimed at developing clinical practice guidelines for medical rehabilitation. Using a standardized protocol, therapeutic processes for individual disorders were evaluated as to whether they were evidence-based. The projects covered about half of all rehabilitation cases handled by the BfA. Effective therapeutic procedures were identified in a systematic literature review. Clusters of therapies--so called evidence-based therapeutic modules (ETM)--were formed, outlining the frame of an ideal rehabilitation. A target/actual comparison was carried out to determine the need to develop rehabilitation guidelines. Routine data of the Classification of Therapeutic Performances derived from discharge letters were compared with the ETM, allowing comparison of the actual provision of treatment with the scientifically-defined target. The variance in therapies between the ETM on one hand, and among rehabilitation centers on the other hand, made the necessity for the development of rehabilitation clinical practice guidelines clear. The ETM were finalized after a written survey including all professions and a subsequent multi-professional expert workshop. The guidelines are now integrated into the BfA's quality assurance system. The process of implementation is accompanied by research teams. CONCLUSION: By developing clinical practice guidelines specific to rehabilitation, the pension insurance is the only sector of the German health system in which quality evaluation is carried out on the basis of clinical practice guidelines. This will improve the treatment of chronically ill patients on a scientific and quality-assured basis.

Evidence-Based Medicine↗
PubMed2005

Incidence and risk factors of medical complications during inpatient stroke rehabilitation.

BACKGROUND: Knowing the types and frequency of medical complications of stroke patients during inpatient rehabilitation, together with the ability to identify high-risk patients, would be extremely helpful for providing the best possible physiologic environment for their recovery. METHODS: A retrospective study was conducted. Charts of 346 stroke patients who were consecutively admitted or transferred for inpatient rehabilitation in a tertiary care hospital from October 1997 to September 1998 were reviewed. Demographic and stroke characteristics, preexisting neuromedical conditions, neurological deficits, disability level, medical complications occurring during inpatient rehabilitation, and complications that required transfer off the rehabilitation ward were recorded for each patient. Univariate and stepwise multiple logistic regression analyses were performed to determine the factors that were significantly associated with the occurrence of any medical complication. RESULTS: Forty-four percent of patients experienced 1 or more complications. The most common complications were musculoskeletal pain (15.0%), urinary tract infection (13.6%), depression (9.3%), upper gastrointestinal tract bleeding (4.9%), and pneumonia (4.9%). Ten patients were transferred to the acute care ward during admission because of severe medical complications. Among them, 5 had a recurrent stroke, 3 had pneumonia, 1 had ventriculoperitoneal shunt obstruction, and 1 had organic psychosis. The occurrence of any of the medical complications was significantly associated with the following factors which were presented at admission or transfer to the rehabilitation ward: being female, having no voluntary movement of the affected hand, being more functionally dependent, and having to undergo Foley catheter insertion. CONCLUSIONS: Medical complications were common among stroke patients undergoing inpatient rehabilitation. Prevention and proper management are also very important in the rehabilitation ward.

Adult↗
PubMed2004

[Rehabilitation of patients after lower limb amputation as a basic element of adaptation to normal life].

Amputations of bottom limbs are serious problem. Loss of leg causes always heavy psychical injury, it makes life more difficult, as well as moving and self-service. The change of appearance and shape of body demands adaptations of patient and his neighbourhood. Every amputation is not only heavy physical injury but also violent and long-lasting psycho-emotional and social stress. Most of patients are afraid of unknown, so it's necessary to decrease their fear, they expect our help in solving their social and domestic problems. The aim of investigations is to show the process of adapting to normal life of people after amputation of bottom limb on example of their rehabilitation. The following investigative methods were used: steered observation, interview, Polish version of questionnaire RNL (reintegration to normal living) in small modification and inquiry. Investigations were conducted in two hospital wards and the rehabilitation centre. The group consisted of 82 patients--59 men (72% of group) and 23 women (28%). The numerous group (43%) were people between 50-69 years old. Only a few patients after amputation go to special out-patients' department. The main reason of it is the lack of rehabilitation centre in the neighbourhood. 1/5 of the group regularly uses rehabilitation at expert, however most patients over 70s do not use any rehabilitation. Frequent form of activity at studied people is morning exercises and easy exercises of stump. Lack of physical activity is typical for 1/3 of group. Physically active are only 12 patients (15%). Near half of the group uses artificial limbs, but 1/5 of group does not want to have it. Most of them is over 70 years old. Results of investigation show the need of opening the larger quantity of rehabilitation centres to make the rehabilitation more common and accessible. Essential meaning has also bigger motivation of patients to physical activity as well as using artificial limbs, which do facilitate functioning in everyday life and improve the mood of patients after amputation.

Activities of Daily Living↗
PubMed2005

Nosocomial infections in the rehabilitation department.

AIM: The patients of a Rehabilitation Department are at high risk of nosocomial infections because they generally have a long term hospitalisation and more and more frequently immune-compromised subjects, like old patients or with chronic illness, are admitted to rehabilitation programs. However, to evaluate the real infectious risk of a Rehabilitation Unit, it is important to consider also that a high number of patients are transferred from other hospitals after a specific therapy of the acute phase of their medical or surgical pathology and so many nosocomial microrganisms previously acquired may spread to a Rehabilitation Unit. METHODS: From January to December 2003 we have performed a screening of the bacteruria among the patients at admittance to the Rehabilitation Unit of S. Orsola Fatebenefratelli Hospital of Brescia (Italy). RESULTS: A significant bacteruria (>100000 cfu/mL) in 28.9% of 114 patients coming from home and in 41.9% of 179 patients transferred from other hospitals without antibacterial treatment has been documented. CONCLUSIONS: These findings confirm the presence of an high number of patients colonized or infected by nosocomial bacteria previously acquired in hospital and underline the need, in addition to specific skill, of wide infectious knowledge among the medical staff of a Rehabilitation Unit. A specific approach to the infectious problem in the Rehabilitation Department in order to reduce the risk of nosocomial infections may be suggested.

Aged↗
PubMed1991

Cardiac rehabilitation programs.

Cardiac rehabilitation programs are safe and effective in improving the functional activities of patients with cardiac disease, but they may be hazardous to those patients whose life might be in jeopardy if subjected to exercise. It is clear that not all cardiac patients require supervised rehabilitation programs to return to normal pre-cardiac-event activities. Many patients who have suffered cardiac events recover from the events without much functional debilitation, usually because they were normally active prior to the cardiac event. Patients who have had heart transplants, percutaneous transluminal coronary angioplasty, or heart valve surgery have no unique characteristics that differentiate them from cardiac patients who have had a myocardial infarction or coronary artery bypass graft or who have stable angina in terms of the necessity for participating in supervised rehabilitation programs. Therefore, patients who have had these surgical procedures might be selected for enrollment in cardiac rehabilitation programs on the basis of their physical and psychological conditions. Those patients who benefit from rehabilitation programs usually accomplish their goals within the 12-week sessions of the usual programs. Patients with stable cardiac conditions who are at high risk and have minimal functional capacities (3-5 METs) appear to benefit most, while patients who are of low risk and have functional capacities of 7-9 METs have minimal need for the program. High-risk patients have been described as including those who develop ventricular arrhythmias or marked ischemia with exercise. Low-risk patients have been described as including those who have functional capacities at 3 weeks postoperation of 8 METs or more, which allows them to resume most of their vocational and recreational activities. Patients with intermediate risk and functional capacities benefit from the programs, but they may not require the full 12 weeks of participation. The latter group may safely exit the programs when they attain the goals of the cardiac rehabilitation programs, e.g., the resumption of pre-cardiac-event activities and return to a relatively normal life. Accordingly, heart transplant patients and patients who have undergone percutaneous transluminal coronary angioplasty or heart valve surgery could benefit from prescribed cardiac rehabilitation programs if they have the need as described. The available information implies that many heart transplant, PTCA, or heart valve surgery patients are in excellent functional status after the surgical intervention and require minimal or no supervised exercise programs. However, a significant number of patients may lack confidence in their capabilities and may benefit from earlier exercise testing that would demonstrate to them their functional capabilities.(ABSTRACT TRUNCATED AT 400 WORDS)

Aftercare↗
PubMed1991

[Rehabilitation following myocardial infarct].

Today rehabilitation after myocardial-infarction is a routine measure in most countries, yet its effectiveness is still under discussion. Rehabilitation aims at ameliorating the quality of life and at preventing a cardiovascular reevent, in other words at prolonging life. The latter "hard" endpoints is best amenable to quantification. Only recent meta-analyses of pooled data were able to show that rehabilitation in fact does prolong life. The relative importance of physical exercise in mostly complex rehabilitation programs is even less clear. This analyses implies a benefit, yet the exact proof is still missing. If rehabilitation could be shown to improve quality of life, its application would, of course, be justified even if it did fail to prolong life. Important open questions relate to the optimizing of rehabilitation: duration, frequency, intensity as well as age and sex of responders. Answering these will be a challenge for tomorrow's rehabilitation medicine.

Combined Modality Therapy↗
PubMed1991

Identifying people in need of rehabilitation in rural Zimbabwe.

The Ministry of Health of Zimbabwe has initiated eight Community-based Rehabilitation projects in rural areas. Within each project, a survey was undertaken to identify people with a disability who could benefit from these projects. This article discusses the set-up, outcome and shortcomings of the surveys. The results of the surveys are compared with previous studies on people in need of rehabilitation in Zimbabwe. The surveys led to three major findings: 1. The majority of the people in need of rehabilitation in the rural areas have not been in contact with rehabilitation services before; 2. The results of the surveys differ from previous studies in terms of the numbers of clients in the different diagnostic categories; 3. Community-based rehabilitation deals with a different group of clients compared with hospital-based Rehabilitation. The use of the ICIDH is recommended to standardise future surveys. Implications for the development of rehabilitation services are discussed in the article.

Community Health Services↗
PubMed1990

[Rehabilitation--a challenge for lawmakers and social administration].

In light of contemporary social legislation, jurisdiction, scientific publications as well as the great numbers of institutions and facilities, the field of rehabilitation has undergone profound, positive changes from the beginnings of social legislation till today. Lawmaker and social administration are equally concerned with the tasks at hand today and in the future. The legislator is responsible for closing legislational gaps and for creating definitional clarity. Inter alia because of the high expectations relative to quality and quantity of social services and benefits, it is not possible in the Federal Republic of Germany to achieve greater simplicity and at the same time greater social equity of rehabilitation law. One of the main problems is to determine what exactly is comprised by "social rehabilitation" as well as its relationships with other areas of rehabilitation, aside from integrating social rehabilitation in its entirety into the catalogue of tasks incumbent on the social insurance sector. The self-government bodies are called on to make even greater use of the rooms for action accorded under the applicable provisions. This includes the competence for undertaking research, which, in particular in the health insurance sector, emanates from art. 217 SGB 5 (Social Code, Book 5). The social protection administrations are called on to define the bases for rehabilitation programme standards relative to the various disability types, in view of safeguarding rehabilitation effectiveness and efficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Disability Evaluation↗
PubMedDate not supplied

[Medical rehabilitation of disability insurance--determination of the status and future perspectives].

The legal prerequisites for medical rehabilitation offered by the pension insurance institutions are described. The definition of position includes the attitude towards applying for rehabilitation and its repercussions on the selection of rehabilitation, specific questions with regard to expert opinion, the indications for general medical rehabilitation measures and the changes within the concept of rehabilitation. Future possibilities are shown. Some examples of rehabilitation measures relating to specific indications are chosen to demonstrate successes and problems in this regard. Finally, the present state of research in rehabilitation and its future development are considered.

Chronic Disease↗
PubMed1977

Effect of vocational rehabilitation on employment and earnings of the disabled: state variations.

Analysis of followup data in linked records of the Social Security Administration and the Rehabilitation Services Administration shows wide variation by State in 1972 employment and earnings of rehabilitants compared with those for other disabled persons whose cases were closed by State vocational rehabilitation agencies in fiscal year 1971. These State differences in the effect of rehahabilitation occur for both men and women. When the States are ranked by the magnitude of the rehabilitation effect, a reasonable consistency is found among the rankings under the various measures of effect. Under the most valid measure used--employment percentage difference between rehabilitated and not-rehabilitated clients--two patterns emerge: (1) The effect of rehabilitation among the States increases proportionally in South-to-North and West-to-East directions and (2) the relative effect favors women in more States than it does men and in more States than under the other measures.

Employment↗
PubMed1984

Early rehabilitation for stroke patients: a new look.

Many investigators have argued that early rehabilitation is important to maximize recovery from stroke and have documented a correlation between better outcomes and earlier admission to rehabilitation. But is this correlation good evidence for causation? In a sample of 94 stroke patients admitted to a comprehensive rehabilitation hospital, shorter onset-admission intervals definitely correlated with functional status outcomes (r = 0.27, p less than or equal to 0.006). However, when functional status upon admission, prior acute care improvement, level of consciousness shortly after the stroke, and other patient characteristics were partialled out, the correlation disappeared (partial r = -0.03, ns). The putative effect of early rehabilitation was attributable to the better health of stroke patients who could be admitted earlier to rehabilitation. Indications were that optimal timing for rehabilitation may differ depending upon side of paralysis. Rather than assuming that earlier is always better, future research and practice should concentrate on grading rehabilitative efforts to the capacities and needs of patients.

Adult↗
PubMed1982

[The problems involved in outcome control of non-industrial vocational rehabilitation measures].

The Social Code prescribes to the institutions financially responsible for rehabilitation to use their budgetary funds in accord with the principles of cost-effective and economical conduct, and to set up cost-benefit analyses in appropriate cases. This, however, presupposes a close and trusting working relationship between the financially responsible institutions and the rehabilitation facilities. It is possible to apply cost-benefit analysis to vocational rehabilitation; however, only those data should be included in the assessment that can in fact be clearly quantified. To ward off the danger of vocational rehabilitation missing labour market demands, improved statistical accessibility is recommended. The financially responsible institutions and the labour administration should draw up an overall statistical survey of rehabilitation--possibly in the form of a "rehabilitation report"--, containing break-downs of labour market statistics for comparison. This would facilitate vocational rehabilitation being accompanied and evaluated by research, the results obtained would be more obvious and clear. Improved prediction as regards employment opportunities of the rehabilitees could result.

Cost-Benefit Analysis↗