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At least 1,531 records · Page 85Linked to original sources
PubMed2003

Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients.

BACKGROUND AND PURPOSE: The greater mortality and residual physical impairments among black stroke patients may be attributable to differential utilization of rehabilitation services. This report examines, within an equal-access healthcare system, racial differences in time to initiation of stroke rehabilitation services and in the trajectory of physical function recovery. METHODS: This study was a secondary analysis of data from an inception cohort of 1073 stroke patients hospitalized between April 1995 and March 1997 and followed up for up to 1 year. Inpatient data came from medical record reviews; follow-up data came from telephone interviews at 1, 6, and 12 months after stroke. The study included consecutive acute ischemic or intracerebral hemorrhagic stroke patients from 9 VA medical centers. The main outcome measures were time to initiation of inpatient rehabilitation services and ability to perform activities of daily living. RESULTS: There were no racial differences in receipt of inpatient rehabilitation services (blacks, 76%; whites, 70%) or in the proportion of patients referred within 3 days of admission (blacks, 43.5%; whites, 42.0%). Among patients who experienced delay in initiation of rehabilitation, only low-income blacks experienced worse functional recovery over 12 months. CONCLUSIONS: Low-income black stroke patients who experience delay in initiation of inpatient rehabilitation have a worse trajectory of functional recovery in the first year after stroke. Poverty-associated factors in the postdischarge setting may explain this phenomenon.

Activities of Daily Living↗
PubMed2005

Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: executive summary.

BACKGROUND: A panel of experts developed stroke rehabilitation guidelines for the Veterans Health Administration and Department of Defense Medical Systems. METHODS: Starting from previously established guidelines, the panel evaluated published literature through 2002, using criteria developed by the US Preventive Services Task Force. Recommendations were based on evidence from randomized clinical trials, uncontrolled studies, or consensus expert opinion if definitive data were lacking. RESULTS: Recommendations with Level I evidence include the delivery of poststroke care in a multidisciplinary rehabilitation setting or stroke unit, early patient assessment via the NIH Stroke Scale, early initiation of rehabilitation therapies, swallow screening testing for dysphagia, an active secondary stroke prevention program, and proactive prevention of venous thrombi. Standardized assessment tools should be used to develop a comprehensive treatment plan appropriate to each patient's deficits and needs. Medical therapy for depression or emotional lability is strongly recommended. A speech and language pathologist should evaluate communication and related cognitive disorders and provide treatment when indicated. The patient, caregiver, and family are essential members of the rehabilitation team and should be involved in all phases of the rehabilitation process. These recommendations are available in their entirety at http://stroke.ahajournals.org/cgi/content/full/36/9/e100. Evidence tables for each of the recommendations are also in the full document. CONCLUSIONS: These recommendations should be equally applicable to stroke patients receiving rehabilitation in all medical system settings and are not based on clinical problems or resources unique to the Federal Medical System.

Adult↗
PubMed2005

A survey of goal-setting methods used in rehabilitation.

OBJECTIVES: This survey provides a description of the goal-setting methods that are currently being used in community and inpatient rehabilitation centers across the United Kingdom. Given current policy, emphasis was placed on finding out how much patient involvement in the goal-setting process exists, concentrating on how such involvement may be facilitated. DESIGN: A postal survey design was used to access a large sample size over a broad geographical area. The questionnaire was piloted at a British Society for Rehabilitation Medicine (BSRM) meeting; subsequently, some response categories were expanded. The questionnaire was approved by the BSRM Research and Clinical Standards committee. Questionnaires were coded to track responses from individuals. The received data were anonymized and analyzed using a statistics package for social science (SPSS) database. Subjects. Members of the BSRM were selected for this survey because this represents one of the most comprehensive listings of rehabilitation services in the United Kingdom. RESULTS: The survey had a 60% response rate. A problem-orientated approach to goal setting was most commonly reported, with rehabilitation teams defining, formulating, and evaluating the goals. Patients were supplied with limited information about goal setting during their rehabilitation admission, although 60% of respondents reported giving patients a copy of their goals. Thirty percent of respondents used goals as a measure of rehabilitation effectiveness. Standardized goal-setting measures were not commonly used. CONCLUSION: These data demonstrate that individual disciplines tend to discuss potential goals with their patients during treatment sessions and then formulate goals on the basis of the discussion. There is scope to develop and refine the approach to goal setting so the patients have more opportunities to engage in the goal-setting process.

Case Management↗
PubMedDate not supplied

Cardiac rehabilitation: goals, interventions and action plans.

Cardiac rehabilitation services are now well established in the UK. There is a growing evidence base for cardiac rehabilitation interventions but, despite this, there remains much variation in service models and delivery. The 'National Service Framework for Coronary Heart Disease' sets out goals for cardiac rehabilitation interventions based on lifestyle change; however, many people do not have access to cardiac rehabilitation towards menu-driven approaches, which may suit individual need more than a standardized approach. Nurses play a crucial role in the delivery of cardiac rehabilitation services and hold the necessary skills and expertise so to do. Future challenges to cardiac rehabilitation include developing increasingly patient-focused services across the boundaries of primary, secondary and social care, and increasing patient and public involvement in services.

Coronary Disease↗
PubMed1997

Preparedness for medical rehabilitation of casualties in disaster situations.

Natural and man-made disasters produce large numbers of severely and multiply injured casualties, many of whom survive with severe impairments that require comprehensive and protracted rehabilitation (brain and spinal cord damage, peripheral nerve injuries, amputations). In a disaster situation, even adequately developed rehabilitation services are unable to provide care to the large number of casualties, without advance planning and preparation. Such planning has to consider expansion of available rehabilitation institutions and conversion of other facilities into settings for rehabilitation, and integrating all into a rehabilitation referral system consisting of levels of care. It should further consider strengthening community service for the provision of continuity of rehabilitation care and the preparation of guidelines for adequate management of various categories of disablements at various levels. The paper offers guidance to those in disaster-prone areas, or in anticipation of a disaster, who might wish to undertake the planning, as well as to those who need to organize available services or to set up new ones, once the disaster has occurred.

Disaster Planning↗
PubMed2002

[Cardiac rehabilitation in the Ile-de-France region. Current organization and suggestions for reorganization].

The Ile-de-France Regional Hospital Agency wished to complete the Regional Health Organisation Plan for Cardiology from 1999-2004 with a specific report on cardiac rehabilitation. A working group was set up and, after 8 meetings, its conclusions were submitted. They were adopted after presentation to the regional technical committee for cardiology. The requirements for cardiac rehabilitation were defined according to acknowledged indications in the medical literature: about 18,000 patients per year are candidates for cardiac rehabilitation in the Ile de France region. The existing equipment (1999-2000) was reviewed: 435 hospital beds allowing treatment of 5,780 patients per year; 45 day hospital places (only 20 of which were operational in 2000), in addition to a large fee for act activity allowing a total ambulatory management of a further 1,265 patients per year. The following proposals were made: more uniform distribution of hospital beds in the region; develop ambulatory rehabilitation especially on a day hospital basis; create a third possibility of rehabilitation associating home exercise rehabilitation and a program of education, prevention, reinsertion, psychotherapy within a network of extra-hospital care.

Cardiac Rehabilitation↗
PubMed1975

[Some considerations on the rehabilitation of the elderly (author's transl)].

This paper presents the conditions, possibilities and success rates in the rehabilitation of the elderly. Comparisons are made between two large groups of elderly people with chronic diseases. It is shown that 34% of the chronically ill, so-called "nursing home cases", could be rehabilitated after an average stay of 510 days in a rehabilitation centre. Old age is no hindrance to perseverance in medical rehabilitation. The methodical approaches in medical rehabilitation of the aged are described. Finally, suggestions are made as to how physicians in hospitals could be convinced of the promising prospects of rehabilitating elderly, chronically ill people.

Age Factors↗
PubMed1992

[Basic considerations in the rehabilitation of foreign workers].

Rehabilitation involves executive duties, the patient must actively cooperate with the rehabilitation team, and both sides must set clear goals. In the case of rehabilitation of foreigners, it is difficult to set goals because of language and cultural differences. The rehabilitation clinic in Bellikon hospitalizes so many foreigners that it decided to comply with their demands by choosing a specific personnel. In fact, with the purpose of improving the basis for communication, the clinic employs therapists and nursing staff that come from other countries and cultures, offering them further vocational training, too. Not only should misunderstandings and feelings of frustration be avoided as far as possible, but interactive therapy should become the foundation stone for a successful treatment and rehabilitation. The conference on rehabilitation that was organized by the SAR in autumn 1991 made up a part of these efforts.

Cultural Characteristics↗
PubMed2005

[Rehabilitation system in Lithuania (past, present, and future)].

The article presents the data on development of rehabilitation system in Lithuania. Three main periods are considered in the development: the first period--employment of some procedures of physical therapy, the second--development of multiprofile rehabilitation, and the third--development of comprehensive rehabilitation system. Main directions of development of medical rehabilitation (in multiprofile hospitals, in sanatoria, in home setting) are discussed. Rethinking rehabilitation is considered in accordance with the data discussed at the 20th World Congress of Rehabilitation International, 2004, Oslo.

History, 20th Century↗
PubMed2005

When considering vocational rehabilitation: describing and comparing the Swedish and American systems and professions.

Rehabilitation of functionally impaired in Sweden and the United States is compared and contrasted. Found is that there are fundamental differences in strategies. The Swedish system most often uses a medically oriented multidisciplinary team approach. The US system most often uses a single individual, the vocational rehabilitation counselor, to work with functionally impaired in helping them return to work. Emphasized is that a vocational rehabilitation counselor uses a unique array of skills that is not duplicated in Sweden by a single profession. Suggested is that a single person with a range of skills can more economically provide vocational rehabilitation services to those with functional impairments; whether this is practical for Sweden is yet to be determined. In contrasting the two systems it was evident that the US system has been in operation for a much longer time and that the Swedish system is maturing. Noted is that the governments of both countries are feeling pressure regarding funding of vocational rehabilitation. This is affecting the level and quality of services. The authors advocate wider contact between Swedish and US university-level training programs in rehabilitation. Felt is that each system has strengths and knowledge that can be used to benefit the other.

Humans↗
PubMed2005

[Cardiological rehabilitation--a chance of returning to work].

According to the definition of the World Health Organization (WHO) "rehabilitation is a comprehensive and coordinated application of medical, social, educational and occupational measures to adapt a sick person to new life and to assist in gaining the best possible physical fitness". With respect to patients with cardiovascular diseases, the significance of comprehensive cardiologic rehabilitation is particularly emphasized. Return to work is by some authors perceived as a marker of rehabilitation efficiency. At the 8th World Rehabilitation Congress held in Dublin in May 2004, Perk (Sweden) reviewed the literature addressing the issue of returning to work. Over the recent seventy years, 460 publications devoted to this topic have been published. They mainly focus on the proportion of persons who return to work after myocardial infarction, percutaneous angioplasty of coronary arteries or implantation of aortic-coronary stents as well as on factors contributing to this success. It has been revealed that rehabilitation is one of numerous factors. Interestingly, socioeconomic and psychological, but not medical, factors play the major role in assuring return to work. There are also other factors which play a role, such as age < 50 years, education, social support, physical efficiency, disease perception, work satisfaction, absence of clinical symptoms, depression, fear, relations between the management and employees, place of residence (rural or urban area), economic status, sense of disability, waiting time for surgical procedure (period shorter than 3 months increases the frequency of returning to work). The number of studies providing evidence that rehabilitation enhances a chance of returning to work is rather limited. The authors review the state-of-the-art in this area based on the available literature.

Cardiac Rehabilitation↗
PubMed2006

The state of physical medicine and rehabilitation in Iowa: 2000-2005.

BACKGROUND: The purpose of this study was to to describe the practice of physical medicine and rehabilitation within Iowa from 2000-2005 by conducting a survey of the 30 practicing physical medicine and rehabilitation physicians in Iowa. RESULTS: Nine of 15 respondents completed medical school or residency training in midwest states. Physiatrists expressed numerous concerns including poor reimbursement, increasing malpractice costs, and difficulty recruiting physiatrists to Iowa. Iowa is ranked 49th in physical medicine and rehabilitation physicians per capita population. It also ranks 50th in Medicare payments per enrollee, yet is ranked fourth in the nation for percentage of citizens over the age of 65. CONCLUSIONS: Recruitment of physical medicine and rehabilitation physicians should be tailored toward resident physicians completing training programs from midwest states. Retention of Iowa physiatrists, due to Iowa's lack of a physical medicine and rehabilitation residency training program, low Medicare reimbursement, and high percentage of patients over the age of 65, may lead to a "perfect storm" public health crisis for Iowans regarding the availability of future physical medicine and rehabilitation services.

Iowa↗
PubMed1991

Resident interest in physical medicine and rehabilitation fellowships. Results of a survey.

Physiatry, one of the six medical specialties that does not currently offer added or special qualification certification examinations, does not have accredited fellowships in potential subspecialty areas. These issues are currently being debated by the leadership organizations within physical medicine and rehabilitation such as the Association of Academic Physiatrists, the American Academy of Physical Medicine and Rehabilitation, the Physical Medicine and Rehabilitation Residency Review Committee and the American Board of Physical Medicine and Rehabilitation. Recent events, such as the establishment of funding agencies with an interest in medical rehabilitation research training, suggest that physiatric fellowships may become more available. A survey was conducted to determine whether physiatric residents desire postresidency training and, if interested, what type of additional training they would seek. This information could be used in formulating policies regarding the establishment, accreditation and certification of subspecialty fellowships within physical medicine and rehabilitation. Of 968 physiatric residents currently in training, 525 (54%) responded to a 22-question survey assessing resident interest regarding fellowship training, the different subspecialty areas, salary expectations, fellowship duration, preferred amount of time devoted to clinical v research work, mentorship, double boarding, accreditation, certification and a section for general comments. The results of the survey indicate considerable interest in fellowship training, which diminishes as residents approach graduation. Residents favored clinically oriented fellowships of 1-yr duration, which should be accredited and certified. Sports medicine was identified as the area of greatest subspecialty interest.

Attitude of Health Personnel↗
PubMed1990

[The current status of cardiac rehabilitation in Switzerland].

The aim of this study was to investigate the present situation of institutionalized cardiac rehabilitation in Switzerland. In 1989, there were 21 rehabilitation clinics and 21 ambulatory cardiac rehabilitation programs in Switzerland. All programs include physical activity and risk factor intervention. There is a wide variety of program selection and intensity. The medical care, the physical activity program, the strategy for risk factor intervention, the technical equipment and the emergency concept can be regarded as good in most rehabilitation clinics and in the ambulatory rehabilitation programs. However, a search for quality criteria for further activities in cardiac rehabilitation in Switzerland seems desirable.

Cardiac Rehabilitation↗
PubMed1984

[Rehabilitation of the handicapped caught between content programming and economic justification].

Notwithstanding the wide socio-cultural scope of theoretical social policy, those, at any rate, who are involved in practical social policy making time and again face the task of providing an economic justification for their respective programmes; the field of rehabilitation of the disabled is no exception to this rule. An economic justification of rehabilitation service provision would however imply their flexibility within economic development: content programming continuity and economic justification will clash as the economic situation changes. Maintaining, or honouring, present rehabilitation service programming will jeopardize economic justification, whereas orientation of rehabilitation practice toward economic justifiability would imply the need to abandon redemption of present content programming. This entails a normative dilemma between rehabilitation content programming, or goal-setting, on the one hand, and its economic-functional, theoretical justification as reflecting given economic circumstances on the other. This normative dilemma gives rise to critically re-consider current practice in, and the rank accorded to, economic justification in rehabilitation service provision.

Cost-Benefit Analysis↗
PubMed1983

Cost-benefits of medical rehabilitation: review and critique.

Evidence of the cost-benefits and cost-effectiveness of medical rehabilitation is reviewed. In stroke rehabilitation, favorable evidence was found, but also the contrary. For spinal cord injury, studies of effectiveness and costs have shown the value of specialized rehabilitation centers. For other areas of medical rehabilitation, investigations have given hints regarding cost-effectiveness but little firm evidence. In allied areas--rehabilitative alternatives in long-term care, vocational rehabilitation, and medical care in general--studies were identified that hold valuable lessons for future study of cost-benefits. A concluding critique identifies obstacles to the study of cost-benefits and makes specific suggestions. Improved experimental designs are required to control for selection biases. Alternatives to ongoing practice need to be entertained if cost-benefit study is to be useful.

Cerebrovascular Disorders↗
PubMed1995

[The rehabilitation of the cardiac patient in childhood. Its current status and outlook].

A cognitive survey of the state of the art of cardiac rehabilitation in the pediatric age in Italy has been carried out, involving in the inquiry 22 Centers of Pediatric Cardiology and Cardiac Surgery, and the Italian Societies of Cardiovascular Surgery and Functional Evaluation and Cardiac Rehabilitation, to assess whether this topic has the dimensions of a social problem. The results of this investigation show that there is in Italy an increasing population of post-surgical patients, at least 3,000 per year which, together with about 500 congenital and acquired non-operated patients with heart disease, could benefit by rehabilitation, early or late according to the age. Although considered "important" by most of the inquired cardiologists and cardiac surgeons there are in Italy, up to date, only two Centers suited for pediatric cardiac rehabilitation, which, further, treat only a limited number of patients. Guidelines for functional evaluation and rehabilitative programs are needed to be applied, possibly, in selected rehabilitative Centers for adults.

Adolescent↗
PubMed1994

The rehabilitation team: staff perceptions of the hospital environment, the interdisciplinary team environment, and interprofessional relations.

Although inpatient rehabilitation is an interdisciplinary activity organized around a treatment team, there is a limited understanding of the workings of the interdisciplinary process. To elucidate staff perceptions of key aspects of the rehabilitation treatment process, we surveyed staff (n = 113) from selected inpatient teams. The staff completed social psychological instruments that measure perceptions of the hospital environment (The Ward Atmosphere Scale [WAS]), the team's environment (the Group Environment Scale [GES]), and interprofessional relations (Interprofessional Perception Scale [IPS]). Rehabilitation staff generally endorse the team approach, but express concerns over professional boundaries. Interprofessional difficulties seemed to be independent of team membership or professional training. Compared with published data from other settings, rehabilitation teams resembled task-oriented groups, but showed significant differences across teams in their perceptions of the team and hospital environments. The task-oriented character of rehabilitation teams, team-specific characteristics, and discord in interprofessional relationships may need to be considered in studies of rehabilitation teams effectiveness.

Adult↗