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PubMed1977

[Sociopsychological and sociological aspects of rehabilitation (author's transl)].

The concept of a social rehabilitation theory should not focus exclusively upon the one-dimensional aspect of restoring the ability to work, but also embrace the behaviour of the individual in all areas of life. The term rehabilitation as used in a modern highly industrialised society has to take into account the social change which has undergone the term "disease", and should respect scientific findings relating to nature and sociology. This would motivate the social environment of the rehabilitee to cooperative understanding and reduce the manifold conflict situations which the chronically ill encounter in the time following rehabilitation. A therapeutic approach towards social rehabilitation could be constitued by improved preparation of the rehabilitee for the post-rehabilitation time--i.e. therapeutic talks and group therapy designed to develop and stabilise behaviour patterns allowing for new and/or different work assignement, also on the premise of reduced possibilities of role functioning.--The diversified psycho-social problems call for increased psychotherapeutic and sociotherapeutic assistance during rehabilitation.

Behavior↗
PubMed1998

[Patient satisfaction after inpatient rehabilitation: different results at different follow-up times?].

UNLABELLED: Different Results at Different Times of Questioning? In 1994 a quality assurance programme for the German medical rehabilitation system was introduced by the national association of pension funds. One of its five parts focussed on patients' satisfaction and health effects. Both domains were to be assessed by postal questionnaires. The first section of the instrument enquired about patients' perceptions and evaluations of both rehabilitation structures and processes. It is well known that satisfaction surveys tend to underestimate the true level of criticism due to social desirability bias. This is especially problematic in the context of quality assurance programmes where criticism can be seen as one driving force of improvement. The magnitude of the bias depends on many factors. In this study we tested the influence of different time intervals between discharge from rehabilitation clinic and first postal contact. DESIGN: We conducted an experimentally varied satisfaction survey among four groups of rehabilitands. If necessary, the first postal questionnaire was followed by two reminders. SETTING: One Bavarian pension fund for blue collar workers. PATIENTS: 520 rehabilitands were recruited from various rehabilitation clinics specialized in muskuloskeletal disorders. About 70% suffered from nonspecific back pain. They were randomly allocated to one of the following time intervals between discharge and postal questionnaire: one, four, eight and twelve weeks. INSTRUMENTS AND TARGET VARIABLES: All patients received an identical questionnaire with 67 items and several subscales. We compared the extent of dissatisfaction between the four groups. RESULTS: The response rate (after two reminders) showed a linear decrease from 97% (postal questionnaire after one week) to 83% (12 weeks). The extent of dissatisfaction did not change systematically though there was a (statistically nonsignificant) tendency towards higher levels of criticism at week twelve. CONCLUSIONS: An experimental variation of time intervals between discharge from rehabilitation and first postal contact does not seem to influence the extent of reported dissatisfaction though it clearly influences the response rate: The later the sending out the lower the response rate. Taking into account additional administrative and organisational aspects of the programme we propose to send out satisfaction questionnaires between 8 and 10 weeks after rehabilitation.

Adult↗
PubMed2001

A history of cancer rehabilitation.

More than 8 million people in the United States have a history of cancer and more than 1 million new cancers are diagnosed each year. The 5-year survival rates for most tumors continue to improve due to earlier detection and treatment strategies. With increased cancer survival rates, there is a greater need for physiatrists (physicians trained in physical medicine and rehabilitation) to coordinate rehabilitation services and prepare a comprehensive plan for treatment and follow-up. Rehabilitation for patients with cancer should be no different from rehabilitation for other diagnostic conditions. The ultimate goal should be the achievement of the highest functional status possible within the limits of the disease and the patient's choices. Physiatrists have training that enables them to assess functional disability, biomechanics, quality of life, and human development, as well as the knowledge to prescribe appropriate medications, modalities, and orthotic, prosthetic, and assistive devices. An examination of the history of cancer rehabilitation will steer us toward future success for our patients. It is important that past lessons direct us away from pitfalls, and that patients receive the rehabilitation services to which they are entitled.

History, 20th Century↗
PubMed1992

Neurological rehabilitation.

Increasingly, neurologists are participating in the rehabilitation of disorders of the nervous system. Compelling reasons why neurologists, especially those with academic interests, should become involved in rehabilitation include the opportunity to observe patients in the recovery phases of their illnesses and to study issues relating to functional recovery, exposure to patients (such as those with spinal cord injury) who are often not seen by neurologists in the acute phase, and the opportunity to help establish a scientific base for rehabilitation medicine. Many areas of investigation can contribute to the scientific basis of neurological rehabilitation. Among the most promising are regeneration in the central (CNS) and peripheral nervous systems, adaptive mechanisms following CNS injury, computational neuroscience, neuromuscular physiology of chronic denervating conditions (e.g., the post-polio syndrome), and outcome studies of both physical and pharmacological therapeutic modalities. While there may be financial advantages to involvement in neurological rehabilitation, these are probably overestimated and interest in this field would continue to grow without them. There is a need for enhanced training in this subspecialty, including the development of dual certification programs in neurology and rehabilitation medicine.

Certification↗
PubMed2005

Impact of osteoarthritis on the rehabilitation of patients following a stroke.

OBJECTIVE: To determine if functional gain for patients following stroke rehabilitation is adversely affected by osteoarthritis (OA). METHODS: A retrospective cohort analysis was conducted using data collected between 1994 and 2001 from a large national registry of US rehabilitation inpatients. Outcome variables were functional status (the Functional Independence Measure [FIM Instrument]) at discharge and followup, FIM gain during and after rehabilitation, length of stay, and discharge setting. The primary predictor variable was the presence of OA. Covariates were age, sex, race, other comorbidities, type of stroke, length of stay, and time to followup. Analysis was by multivariable regression. RESULTS: Data from 3,094 patients with OA and 44,943 patients without OA admitted following a stroke to inpatient rehabilitation facilities were analyzed. In unadjusted analyses, OA was associated with significantly higher FIM ratings than patients without OA at admission (mean +/- SD 65.7 +/- 19.2 versus 63.1 +/- 20.5; P < 0.001) and discharge (mean +/- SD 89.2 +/- 21.8 versus 87.7 +/- 23.0; P < 0.001), but with lower FIM ratings at followup (mean +/- SD 97.7 +/- 24.7 versus 99.7 +/- 24.9; P < 0.001). In multivariate analyses, adjusting for potential confounders, OA was associated with a 1.62-day increase in length of stay (95% confidence interval [95% CI] 1.15, 2.08) and a 1.37 smaller improvement in FIM scores between admission and followup (95% CI 0.62, 2.12). This smaller increase in FIM instrument score was caused by less improvement in FIM after discharge. CONCLUSION: OA impairs recovery from stroke. This is compensated for by longer length of stay for inpatient medical rehabilitation. Reimbursement systems may need to consider the impact of OA as a comorbid condition in patients receiving stroke rehabilitation.

Aged↗
PubMedDate not supplied

Education for rehabilitation nursing.

An increasing shortage of rehabilitation nurses is anticipated in the coming decade. This article describes one potential answer to the nursing shortage through a course in rehabilitation nursing for senior baccalaureate students. The unique features of the course included the use of holistic learning experiences that integrate theory and practice. Clinical experiences in critical care units, in intensive rehabilitation settings, and in a variety of outpatient facilities, as well as travels with rehabilitation nurse consultants in the field, provided students with rich perspectives on the scope of rehabilitation nursing practice. Replication of this successful course in other settings has the potential to enhance the recruitment of new graduates into the field of rehabilitation nursing.

Education, Nursing, Baccalaureate↗
PubMedDate not supplied

Patient transfer to rehabilitation: just another move?

Although relocation stress syndrome (RSS) is not a diagnosis that is unique to rehabilitation patients, it is important for nurses practicing in rehabilitation environments to be knowledgeable about this phenomenon. Rehabilitation patients are at high risk for RSS. Nursing care planning should incorporate interventions that aim to prevent or reduce RSS. While various relocations are inherent in the rehabilitation process, emphasis should be placed on predictability of care and on patients and families having as much control over decision making as possible. The authors describe how appropriate assessment and management of RSS can facilitate smoother transitions throughout the rehabilitation process and permit a stronger focus on rehabilitation therapies and on patient and family teaching.

Continuity of Patient Care↗
PubMedDate not supplied

Rehabilitation nursing in home care.

A randomized sample of 83 members of the Association of Rehabilitation Nurses' (ARN's) Home Health Special Interest Group (SIG) responded to a survey in 1998 and 1999 to determine the role intensity of rehabilitation nurses in home care. An instrument was developed that was based on role descriptions formulated by ARN. Significant differences in the roles were reported for caregiver, case manager, counselor, family-client educator, advocate, administrator, student/staff educator, and researcher. Rewards of home nursing included one-to-one interaction with clients, teaching opportunities, promotion of function, nurse autonomy, and seeing rehabilitation results. Difficulties included poor interdisciplinary coordination, budget restrictions, lack of understanding of rehabilitation nursing, and inadequate home aides. Differences between inpatient and home rehabilitation nursing included less equipment and resources and increased levels of responsibility in the home. Barriers for the transition to home rehabilitation nursing included interdisciplinary team communication, reimbursement standards and documentation, time management, autonomous nursing roles, and separation from help or emergency services.

Home Care Services↗
PubMedDate not supplied

Predictors of disorientation among brain injury and stroke patients during rehabilitation.

Predictors of temporal disorientation among brain injury and stroke patients undergoing rehabilitation were explored in this descriptive study. Cognitive orientation is a construct of consciousness, and the Parallel Distributed Processing model provided a framework for conceptualizing consciousness in this study. Data were collected by a retrospective chart review of a convenience sample of stroke and brain injury patients admitted to an acute rehabilitation hospital over 4 months. The dependent variable in the study was the Temporal Orientation Test used as a daily measure in the study hospital. A total of 167 patients were admitted during the time frame, and of those, 114 patients met the study criteria and were included in the data analysis. The independent variables were defined as age, gender, years of education, number of comorbidities, patient diagnosis, orientation status on admission, and use of narcotic/sedative medications. A logistical regression was performed using SPSS Release 11.01. Only one of the six variables--orientation status on admission-reliably predicted the onset of disorientation during the rehabilitation stay with an odds ratio of 0.217, p < .001. This indicates that the risk of becoming disoriented after a period of orientation during the rehabilitation stay increased by 78% among patients who are disoriented on admission to rehabilitation, compared with those who are oriented on admission. These findings confirm that temporal orientation is unstable during the period of rehabilitation following a brain injury or stroke.

Analgesics, Opioid↗
PubMed2004

Pulmonary rehabilitation: analysis of a clinical service.

BACKGROUND AND PURPOSE: There is significant research supporting the role of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD). However, less is known about real-life clinical rehabilitation services. Data were analysed from a clinical pulmonary rehabilitation service provided in the UK, consisting of seven weeks' twice-weekly training and education. METHOD: A retrospective study. Baseline measures consisted of activity of daily living, mood state, spirometry, exercise tolerance using the Incremental Shuttle Walk Test (ISWT) and health status using the St George's Hospital Respiratory Questionnaire (SGRQ). Responders to pulmonary rehabilitation were defined as those with a mean reduction of four points on the SGRQ and a mean increase of 48 metres on the ISWT. RESULTS: One hundred and eight patients entered the programme and 91 completed it. All outcomes showed statistically and clinically significant change after the rehabilitation programme. Responder analysis showed that 37% of patients achieved benefits for both the SGRQ and the ISWT. Twenty-eight per cent of patients were non-responders for both; 17% benefited for the SGRO only and 14% improved their exercise tolerance. Patients with restrictive disease (n = 11) showed large mean ISWT score of 98.2 m (Standard deviation (SD) 69.4 m) (p < 0.01), as did patients with moderate COPD (n = 30), who scored a mean ISWT change of 77.3 m (SD 92.0 m) (p < 0.01) and a SGRQ score of -7.6 (SD 13.7) (p < 0.01), and those with mild COPD (n = 12), who scored a mean ISWT change of 62.5 m (SD 87.4 m) (p < 0.01) and a mean SGRQ change of -3. 7 (SD 8.1) (p < 0.01). Patients with severe COPD (n = 23) showed a smaller mean change in ISWT of 32.6 m (SD 79.4 m) and in SGRQ of -2.8 (SD 7.1). However, analysis of variance (ANOVA) showed no statistical differences between the groups (p = 0.13). CONCLUSIONS: Clinical pulmonary rehabilitation programmes are effective for most patients. However for patients with more severe impairment, maximal gains may be harder, or take longer, to achieve. Patients with restrictive disease appear to do well, although future trials will be needed to test this supposition.

Aged↗
PubMed1982

A psychiatric rehabilitation treatment program: can i recognize one if i see one?

Over the last several decades there has been a tremendous growth in the number of community-based settings that indicate that they provide rehabilitation programming to persons with severe psychiatric disabilities. Questions can be raised, however, as to the extent to which these settings are actually providing programs that are rehabilitative in nature. Ten essential ingredients of rehabilitation programming are presented for use in discriminating between programs that are rehabilitation oriented and programs which are rehabilitation in name only. The articulation of these ten essential ingredients can serve as a guide for the continued development of community-based settings which attempt to provide comprehensive rehabilitation programming.

Adult↗
PubMed1998

Cardiac rehabilitation in the elderly.

Rehabilitation for patients with heart disease consists of exercise training, behavioral interventions, counseling, and education with the goal of improving physiologic and psychosocial status. The Cardiac Rehabilitation Clinical Practice Guidelines, recently published in the United States, list the most substantial benefits of cardiac rehabilitation as an improvement in exercise tolerance, symptoms, blood lipid levels, and psychosocial well-being, and a reduction in cigarette smoking, stress, and mortality. With the evidence-base on the elderly in the Guidelines derived from 1 non-randomized controlled trial and 7 observational studies, the efficacy and effectiveness of cardiac rehabilitation is based almost exclusively on data generated on young and middle-aged males. We have located an additional 10 randomized and 2 non-randomized controlled trials published since the Guidelines, but only one provided age-specific data. The elderly are the fastest growing segment of the population, and may be more responsive to the effects of cardiac rehabilitation as they often have greater initial disability and less independence than younger patients. While referral of elderly persons to cardiac rehabilitation services appears safe and warranted in the secondary prevention of heart disease, the lack of rigorous scientific evidence has created an important clinical research and clinical policy vacuum which urgently needs to be filled.

Adult↗
PubMed2005

[Structural quality of neurologic rehabilitation clinics].

BACKGROUND: In 2003, criteria for assessing the structural quality of rehabilitation units for inpatient treatment were developed in cooperation with the German statutory pension insurance and health insurance. The aim of this study was to assess this quality using predefined valuation criteria and to test their applicability. METHODS: In the context of the Quality Assurance Programme for Rehabilitation provided by the German statutory health insurance, the structural quality of 18 neurological rehabilitation units was assessed applying the criteria for the first time. RESULTS: On average, the 18 rehabilitation units fulfilled 93.9% of the basic criteria. Despite this high proportion, variability in the degree of realisation in the individual rehabilitation units could be demonstrated. The basic criteria are realistic in respect to the structural requirements, without leveling out the differences between the centres. CONCLUSION: Assessing the structural quality of rehabilitation units on the basis of defined standards allows for a benchmark between units as well as for improvements within the individual units.

Germany↗
PubMed2007

[Applicability, duration, and sociomedical course of rehabilitation of alcohol dependency. Current results and perspectives from the insurers' point of view].

Reducing the paucity of German studies on the rehabilitation of alcohol-dependent patients, this article presents current data of Germany's national Pension Insurance Federal Institution. Numbers of applications, grants and use of rehabilitation, length and duration of treatment, percentage of nonattendance, comorbidity, and sociomedical course after 2 years are discussed. There has been a constant increase in numbers of rehabilitative treatment, especially in the outpatient setting with decreased treatment length, a high rate of comorbidity, and improvements in the sociomedical course and vocational integration. Two years after rehabilitation, 87% of inpatients and 92% of outpatients were recontributing to the pension system continuously or sporadically. Despite the still marked deficits in the provision of rehabilitative treatment for addicted patients, rehabilitation plays an important and established role in this field and shows promising clinical results.

Adult↗
PubMed2006

[Quality control in rehabilitation of patients with visual impairment: evaluation of use and benefits of optic and electronic devices].

BACKGROUND: Not only medical care and prescription of magnifying devices, but also social and professional rehabilitation are part of a complete interdisciplinary low vision service. This study provides quantitative data about the success of rehabilitation and the quality of the Low Vision Department's work. PATIENTS AND METHODS: A sample of 105 visually disabled patients, who had already been provided with magnifying aids and other rehabilitation measures by the Low Vision Department, answered a questionnaire about quality control during a follow-up visit. The survey was carried out between May and October 2004. Patients were asked to rate the different rehabilitation measures and to comment on how frequently they used the different magnifying devices. Furthermore, they were asked to judge to what degree they coped with different life situations when using or not using the low vision aids. RESULTS: The most frequently used aids were magnifiers (61%), glasses for near vision (34%), closed circuit television (20%), and monocular telescopes (20%). Of the 105 patients, 85 (81%) reported on frequent use of the devices, with just 3 patients (3%) reporting that they hardly ever used the aids. Only 2% of the patients could read newspaper text without the use of magnifying aids, while 51% were able to do this using the aids; 46% of the patients reported that they had profited from the social and professional rehabilitation measures. CONCLUSION: Independently from the causal ophthalmologic diagnosis, patients were found to have benefited greatly from the rehabilitation measures provided by the Low Vision Department, enabling them to take part in more activities and participate more fully in social life, thereby greatly improving their quality of life. Frequent use of the low vision aids by the patient was ensured when offered alongside continued professional support.

Aged↗
PubMed2002

[Effectiveness of rehabilitation with musculoskeletal diseases].

Multidisciplinary treatment focusing on impairments, activities and participation are an important component within the therapeutic regimen in musculoskeletal conditions. In Germany, for more than 95% of the patients multidisciplinary treatment is provided as inpatient rehabilitation. According to the results of a study from the Netherlands, inpatient rehabilitation is superior to usual care in terms of decreasing disease activity and improving emotional well-being in rheumatoid arthritis. Another randomized, controlled study gives evidence that rehabilitation is more effective as compared to usual care in ankylosing spondylitis. In patients suffering from fibromyalgia, after inpatient rehabilitation, symptoms improve significantly and this is true even one year after discharge. The results of a quality management project financed by the German health insurance and including several thousand patients with musculoskeletal diseases show an improvement in physical and emotional dimensions of health status at discharge and after a six month follow-up. Recent studies comparing inpatient with outpatient rehabilitation in patients with musculoskeletal diseases provide information that both forms are equally effective. Taking into account the high number of inpatient rehabilitation procedures in Germany, more outcomes research is required urgently.

Humans↗
PubMed2004

Cardiopulmonary rehabilitation after treatment for lung cancer.

Lung cancer is the leading cause of cancer-related death in women and men in the United States. As of 1987, lung cancer deaths in women exceeded deaths caused by breast cancer. Despite years of research and improvements in surgical, chemotherapeutic, and radiation treatments, this fact remains unchanged. Equally dismal is that the expected 5-year survival rate for all patients with lung cancer is 15%. Although hidden in this number is improved survival for many patients who have early disease, it still translates into significant morbidity and early mortality for many patients. Although prevention is key, optimizing the care of these patients with lung cancer is also paramount. Cardiopulmonary rehabilitation programs have been shown to be effective in treating patients with chronic heart and lung diseases, among other illnesses, regardless of prerehabilitation functioning. Not only do morbidity and mortality from cancer hinge directly on premorbid functioning, health, and status, but functional status as a measure of baseline health is a reliable prognostic indicator for patients with lung cancer. As a result, including a program of exercise in any treatment regimen for cancer is sensible. However, rehabilitation in patients with lung cancer has not been studied well. Data on rehabilitation in patients with other cancers and illnesses (eg, chronic obstructive pulmonary disease) are clear in the beneficial effects of supervised exercise on quality of life (QOL). To assess the role of cardiopulmonary rehabilitation in patients with lung cancer undergoing treatment, it is necessary to meld studies regarding patients with noncancerous conditions with studies addressing rehabilitation in patients with cancer. This fusion of information demonstrates that rehabilitation results in significant improvements in QOL in patients who participate, regardless of the disease in question. Although QOL may not always have been an obvious endpoint for treating patients with lung cancer, it is apparent from studies of the patients themselves that an improved QOL is far more important than other goals of therapy.

Female↗
PubMed1993

Applying quantitative methods to the prediction of full functional recovery in adult rehabilitation patients.

The purpose of this project was to construct a pilot prognostic index for use in research and clinical practice that would predict functional recovery in adult rehabilitation patients at discharge using clinical characteristics at admission to rehabilitation (independent performance of seven activities of daily living and three basic mobility tasks). We constructed the index from retrospectively collected data on 1,020 adult rehabilitation patients who underwent rehabilitation between 1980 and 1986. Adjusting for patient characteristics, the odds of recovering independent function doubled for each ten-point increase in the 100-point functional status score measured at admission to rehabilitation (odds ratio = 2.1, 95% confidence interval [CI] = 1.9 to 2.4). The odds increased by a factor of 1.9 (95% CI = 1.1 to 3.2) in patients with an impairment considered more functionally reversible and by a factor of 2.1 (95% CI = 1.3 to 3.4) in patients transferred from an acute hospital. The odds of functional recovery decreased in those over 79 years of age, in those who were unemployed before hospitalization, and as the number of comorbid conditions increased. Our findings demonstrate the feasibility of developing quantitative estimates of functional prognosis. Prior to use, the index should be externally validated in different rehabilitation facilities.

Activities of Daily Living↗