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PubMed1984

An evaluation of the referral and rehabilitation process among the minority handicapped.

This study examines factors believed to be predictive of the referral and rehabilitation process in this country. Using the Fiscal Year 1978 data from the Rehabilitation Services Administration, the study examines two general hypotheses found in the literature: (1) that minority status is likely to be a key determinant in the referral and rehabilitation process, and (2) that selected socio-demographic factors along with social supports and disability condition are likely to reveal direct influences on the referral and rehabilitation process. Multiple regression was used for the analysis. The analysis of the study revealed that the independent variables, for the most part, had either a direct or indirect effect on the outcome of referral and rehabilitation. More specifically, the results suggest that bias exist in the referral and rehabilitation process.

Adult↗

PubMed1997

Rehabilitation efforts before and after tightening eligibility for disability benefits in Norway.

This paper reports the use of vocational rehabilitation among applicants for disability benefits in Norway before and after the eligibility criteria were tightened in 1991. The data sources were documents of 668 applicants from 1990 and 1993 in two countries. Vocational rehabilitation is the preferred benefit in the National Insurance Act, and was a core issue in the restriction reform. Nevertheless, rehabilitation was tried by only 14% of the applicants in 1990, and by no more than 19% in 1993. Eight per cent of the applicants were referred to an employment officer before determination in 1990, and 14% in 1993. In order to study different pathways from work to applying for disability benefits, six types of 'social security careers' were constructed. The commonest comprised sick pay only, the second led through unemployment, and the third included rehabilitation. Rehabilitation may also be offered to applicants who are refused disability benefits. This was the alternative determination for 4% of the refused cases in 1990, a proportion that increased to 12% after the reform. The main reason for the relatively infrequent use of rehabilitation is probably the continuous downgrading over many years of resources and institutions for this task.

Adult↗

PubMed2000

Patient and spouse perceptions of stroke and its rehabilitation.

The object of the study was to determine, in stroke patients and their spouses, changes in their perceptions of stroke, information received about it, its management, and its rehabilitation. There were assessments on acute admission, on admission to and discharge from rehabilitation, and six and twelve months after discharge. Participants were 60 twelve month stroke survivors who had undergone an inpatient rehabilitation programme, and 46 spouses. Their perceptions of stroke, of medical information received, of the management of stroke, and of rehabilitation were assessed in a structured interview. Stroke was predominantly perceived by participants in terms of physiological causes and disabling consequences. Its causes were poorly understood, as was the role of doctors and hospitals for people with strokes. The role of rehabilitation was better understood. Many participants felt they were told little about the illness during care. Stroke patients and their spouses adapt with varying success to their changed circumstances. This adaptation will benefit from better communication between medical staff and families in the acute and rehabilitation settings.

Aged↗

PubMed2003

Factors that influence the use of rehabilitation services in an urban Ugandan hospital.

The aim of the present study was to determine factors that motivate or deter injured individuals from using outpatient rehabilitation services at an urban Ugandan hospital. A qualitative study design was employed to obtain information about injured individuals' experiences with rehabilitation therapy services after they were discharged from a hospital setting. Key informant interviews were conducted with 13 Ugandan individuals who were currently attending an outpatient physiotherapy clinic at Mulago Hospital in the city of Kampala. Nine rehabilitation therapists from Mulago Hospital were interviewed in a focus-group format to identify factors that prevent individuals from attending therapy. Study participants identified a number of fears and misconceptions about the rehabilitation services being offered. Many individuals reported the cost and availability of transport as a major barrier. Interview respondents believed that by attending physiotherapy they were rejecting the use of a local healer and were benefiting from medically trained experts. Rehabilitation therapists reported responses similar to interview respondents. Individuals who are currently accessing rehabilitation services at Mulago Hospital are motivated and committed to their recovery process. These individuals reported a number of improvements since starting therapy. However, more research is required to better understand how local methods of healing influence health-seeking behaviours.

Adult↗

PubMedDate not supplied

The status of burn rehabilitation services in the United States: results of a national survey.

A survey to determine the status of burn rehabilitation services in the United States was developed and sent to 186 burn treatment facilities. The facilities were divided into four groups based upon number of admissions per year (0 to 80, 81 to 120, 121 to 200, and 200+). Completed surveys were received from 114 facilities. Results indicated that burn facilities of different sizes were consistent with respect to the severity of burn injuries treated, the length of hospitalization for acute injuries, and the duration of physician follow-up after discharge. Burn facilities with more admissions were more likely to report (1) organized outpatient burn rehabilitation programs, (2) available specialized burn rehabilitation personnel, (3) regular interdisciplinary inpatient staffing conferences and outpatient clinics, and (4) structured educational activities for staff and Full-time equivalent burn rehabilitation personnel were equally represented across facilities of different sizes. The overall results suggest that there have been substantial improvements in the comprehensiveness of burn rehabilitation care since a previous survey in 1983. Minimum guidelines for burn rehabilitation are suggested based upon the relative consistency between burn facilities indicated by the survey results.

Burn Units↗

PubMedDate not supplied

Rehabilitation engineering education at the University of Virginia.

The graduate rehabilitation engineering program of study at the University of Virginia is the first program of its type in the United States. The first students were admitted to the program in the fall of 1979. The program is designed to train students with engineering and clinical science backgrounds in the field of rehabilitation engineering. Emphasis is placed on practical training through internship activities at the University of Virginia Rehabilitation Engineering Center and Medical School Department of Orthopedics and Rehabilitation. Field experience is received at the Woodrow Wilson Rehabilitation Center and the University of Virginia Children's Rehabilitation Center.

Biomedical Engineering↗

PubMed1997

Improving health care outcomes through geriatric rehabilitation. Conference summary.

The Boston Working Group on Improving Health Care Outcomes Through Geriatric Rehabilitation was structured around four major themes: (1) defining disability or disablement; (2) the patient's experience of the processes and outcomes of care; (3) the role and value of clinical practice guidelines; and (4) the need for casemix and severity or risk adjustment procedures and measures. These discussions produced opening statements of policy or empiric issues and recommendations about the best means of demonstrating the benefits of geriatric rehabilitation and, in particular, how to measure, ensure, and improve the quality of rehabilitation services, especially for the elderly. This article summarizes the reports from the work groups and identifies some common themes. Critical points include: (1) the need to define and describe geriatric rehabilitation better for nonexperts in the health field and for patients and consumers in general; (2) the need for more research to link rehabilitation processes with measurable and clinically important outcomes; (3) the breadth and depth of domains of processes and outcomes of care that ideally could and should be measured; and (4) the need to reach many audiences with a clear message about the importance of geriatric rehabilitation in ensuring high quality of care and good health status and functional outcomes for all elderly patients.

Aged↗

PubMedDate not supplied

Tri-State Regional Pulmonary Rehabilitation Survey. Program characteristics and practices.

PURPOSE: This report summarizes the pulmonary rehabilitation characteristics found in the 1991 survey of programs in the Pennsylvania, New Jersey, and Delaware region. METHODS: A listing of 111 potential Tri-state regional programs with pulmonary rehabilitation was compiled. A 34-item questionnaire was developed. Using multiple mailings and phone-call follow-up, 59 programs of 100 the active programs in the region returned the questionnaires. Programs that were providing services to patients with pulmonary disease were compared to those focusing on patients with cardiac and/or pulmonary disease. RESULTS: A third of all programs (31%) used combined cardiopulmonary services. Pulmonary-only programs averaged 1.7 hours per day, and cardiopulmonary programs averaged 1.1 hours per day (P < .01). Both types of programs averaged 2.4 days per week. Average duration of pulmonary-only programs was 8.7 weeks, and duration of cardiopulmonary programs was 10.6 weeks (P < .05). Most programs (85%) required referral from the patients' primary physician. Many programs (64%) reported that local physicians other than the program's medical director referred a majority of the patients. Almost all programs (92%) performed exercise testing before initiating pulmonary rehabilitation. Post-rehabilitation discharge planning seemed to be based in many programs on performance measures taken during the final rehabilitation sessions or from a final 6- or 12-minute walk. Educational sessions were provided by 95% of the programs. Maintenance sessions were not offered by 39% of the programs. Seventy-three percent of the pulmonary-only programs and 44% of the cardiopulmonary programs offered support groups (P < .05). The pulmonary-only program coordinator's specialty was mostly respiratory therapy (70%), whereas in cardiopulmonary programs, coordinators tended to be nurses (39%) or from other nonrespiratory specialties (28%). No respiratory staff were used by 38% of the cardiopulmonary programs. CONCLUSIONS: The type of rehabilitation program, either pulmonary-only or cardiopulmonary, appears to influence many program characteristics (e.g., hours per day, weeks in duration, coordinator's specialty, and staffing).

Analysis of Variance↗

PubMedDate not supplied

Patient preferences for cardiac rehabilitation and desired program elements.

BACKGROUND: Data evaluating the efficacy of traditional cardiac rehabilitation programs to meet patient needs are limited. The authors studied patient-perceived preferences in cardiac rehabilitation programs and desired program elements to evaluate differences by gender or age. METHODS: The authors surveyed 199 patients (136 men, 60.0 +/- 11.6 years; 63 women, 63.7 +/- 12.7 years; P = 0.045) discharged from a tertiary referral hospital with acute myocardial infarction. Participants completed a standardized questionnaire regarding enrollment in rehabilitation and preferences for six program types on a 10-point scale (1 = little or no agreement, 10 = strongly agree). RESULTS: In this study, 54.3% of subjects enrolled in cardiac rehabilitation. Older patients (> or = 65 years) were more likely to enroll in home-based programs compared with younger patients (< 65 years) (11.8% versus 1.4%, P = 0.02). Younger patients preferred a short-term rehabilitation facility more than older patients (7.4 +/- 3.5 versus 5.1 +/- 4.1 units on the 10-point scale, P = 0.001), and rated the following more favorably than older patients: local health club programs (6.2 +/- 3.7 versus 4.5 +/- 4.0, P = 0.01), long-term programs (6.5 +/- 3.8 versus 4.9 +/- 4.2, P = 0.02), and comprehensive programs (6.6 +/- 3.7 versus 4.9 +/- 2.2, P = 0.02). Younger patients rated the following program elements more favorably compared with older patients: stress management (7.0 +/- 3.5 versus 5.7 +/- 4.1, P = 0.04), vocational counseling (5.1 +/- 3.9 versus 1.9 +/- 2.4, P = 0.001), and smoking cessation (4.9 +/- 4.4 versus 2.7 +/- 3.4, P = 0.001). CONCLUSIONS: Program preferences differed significantly by age, but not gender. Older patients enrolled in home-based programs over clinic-based programs. Younger patients rated stress management, vocational counseling, and smoking cessation more favorably than older patients. Strategies to enhance patient participation in cardiac rehabilitation should incorporate patient age and preferences for program types and elements.

Aged↗

PubMedDate not supplied

The use of video capture virtual reality in burn rehabilitation: the possibilities.

We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.

Burns↗

PubMed2006

Applying evidence standards to rehabilitation research.

OBJECTIVE: To describe evidence grading methods employed in the systematic reviews in this special series of articles. To provide an overview of results of these reviews to critique the quality of rehabilitation research. To identify issues in the application of evidence grading methods to rehabilitation. DESIGN: Conceptual review of evidence-based practice and evidence grading methods. English-language research studies on rehabilitation of persons with spinal cord injury, traumatic brain injury, and burn for the 5-yr period of 1999-2004 were reviewed using methods of the American Academy of Neurology supplemented by Cochrane criteria and summarized. RESULTS: Rehabilitation has a shortage of high-level studies. The number of level 1 treatment studies was quite limited (five in spinal cord injury, 15 in traumatic brain injury, 12 in burn rehabilitation), as was the number of level 2 studies (26, 4, and 2, respectively). Despite the large number of correlational studies published, the number of high-level (1 or 2) diagnostic and prognostic studies was surprisingly limited (34, 11, and 5, respectively). The rate of production of high-level studies is rapidly increasing. Problems were encountered in applying standard evidence criteria to complex issues encountered in some studies, suggesting limitations and issues in evidence grading methodology. CONCLUSIONS: Rehabilitation needs more high-level studies. Some improvements in research methodology are relatively affordable (e.g., improved blinding), whereas others are expensive (e.g., large randomized controlled trials). Lower-level investigations reporting promising results need to be followed by more definitive, higher-level trials.

Brain Injuries↗

PubMed2006

Day-of-injury computerized tomography, rehabilitation status, and development of cerebral atrophy in persons with traumatic brain injury.

OBJECTIVE: To compare day-of-injury (DOI) computerized tomography (CT) findings with acute injury severity markers, disability at acute hospital admission and discharge from inpatient rehabilitation, injury severity markers, and degree of postacute cerebral atrophy on magnetic resonance imaging (MRI). DESIGN: Retrospective chart review of 240 consecutive traumatic brain injury (TBI) admissions (mean age 31.7 +/- 15.8 yrs) with moderate-to-severe initial brain injury. All DOI CT abnormalities were qualitatively rated. Disability was assessed using the Disability Rating Scale (DRS) and the FIM measure. In a representative subset, cerebral atrophy was determined by the ventricle-to-brain ratio (VBR) method and quantified from MRI scans 25 or more days postinjury. RESULTS: CT classification resulted in nonsignificant differences in DRS and FIM ratings at the time of discharge from the rehabilitation unit, except in brainstem injury subjects who had significantly higher DRS and lower FIM scores at rehabilitation discharge. At 25 or more days postinjury, presence of any DOI CT abnormality was associated with larger VBR. Increased VBR, as an index of cerebral atrophy, was associated with worse rehabilitation discharge DRS and FIM ratings. CONCLUSIONS: Other than brainstem injury, DOI CT findings relate poorly to rehabilitation outcome. Presence of DOI CT abnormalities were associated with the development of cerebral atrophy, which was associated with poorer rehabilitation discharge DRS and FIM scores.

Activities of Daily Living↗

PubMed2006

Multidisciplinary perceptions of the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care.

AIM: This paper describes the perceptions of nurses, healthcare assistants, doctors and therapists of rehabilitation and the role of nurses and healthcare assistants on an acute older adults ward in a London teaching hospital. BACKGROUND: The role perception, education and training and attitudes towards the older adults have been identified as barriers that have an impact upon the nurses' role within rehabilitation. However, little is known about the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care. DESIGN: Action research study. METHOD: Twenty-four semi-structured interviews were conducted and audio recorded about healthcare professionals' understanding of rehabilitation, the type of skills needed and their perceptions of the role of nurses and healthcare assistants in rehabilitation. The interview transcripts were analysed using the thematic content analysis. RESULTS: The findings suggest that the therapists relied on nurses and healthcare assistants for therapy carry-over. Healthcare assistants were perceived as the professional group who could deliver therapy carry-over. There was an evidence of role hierarchy as healthcare assistants perceived that they were not actively involved in decision-making or discharge planning. CONCLUSION: This paper suggests that healthcare assistants and nurses are viewed as the professional group best placed to deliver therapy carry-over. However, whilst there is an acknowledgement of their role, there remains a reluctance to acknowledge healthcare assistants as a professional group and to involve them within decision-making and discharge planning. RELEVANCE TO CLINICAL PRACTICE: Employers must be seen to advocate, support and implement education and training programs for healthcare assistants. However, whilst nurses and healthcare assistants have an integral role in rehabilitation, there needs to be more research into the how they are supported by therapy professionals.

Aged↗

PubMed2005

Functional outcomes for older adults with cognitive impairment in a comprehensive outpatient rehabilitation facility.

The purpose of the study was to examine functional outcomes of a nurse-managed, community-based Comprehensive Outpatient Rehabilitation Facility (CORF) for frail older adults and to compare the outcomes between two groups: older adults with cognitive impairment and those with intact cognition. A retrospective cohort design using healthcare record abstraction was used for the study. Two hundred and one older adults who were admitted to the CORF from the end of 1997 to early 1999 were included in the study. Data were abstracted from healthcare records, including clinician-generated Mini-Mental State Examination, Geriatric Depression Scale, and Functional Independence Measure scores from the healthcare records and investigator-constructed measures of functional gain, rehabilitation efficiency, days of service, and discharge location. Multivariate regression analyses were performed to compare rehabilitation outcomes between the two groups. Regardless of cognitive status, all subjects improved significantly in their levels of functional dependence through participating in this outpatient rehabilitation program (P<.001). Subjects with cognitive impairment exhibited more functional dependence at baseline and discharge than did their cognitively intact counterparts. Nevertheless, there was no difference between the two groups in functional gain (P=.63), rehabilitation efficiency (P=.66), days of service (P=.83), or discharge location (P=.69). Therefore, despite their greater degree of functional dependence on admission, older adults with cognitive impairment benefited from this CORF without requiring more days of service and should thus be referred for rehabilitation services.

Aged↗

PubMed1995

Role of stroke rehabilitation units in managing severe disability after stroke.

BACKGROUND AND PURPOSE: Stroke unit rehabilitation tends to be directed toward stroke patients with moderately severe disabilities ("the middle group"). Data collected on a stroke rehabilitation unit, however, showed improving outcome over 3 years in patients with a poor prognosis (discharge home: 48% versus 16%, P < .02; discharge Barthel Index score: 9 versus 6, P < .05). The hypothesis that stroke rehabilitation units may improve outcome in severely disabled stroke patients was tested in this study. METHODS: A randomized controlled study was undertaken in 71 patients with a poor prognosis who were treated either on a stroke rehabilitation unit (n = 34) or on general wards (n = 37) to compare outcome between the two groups. Data collected were also compared with those from a methodologically similar study undertaken 3 years ago. RESULTS: Severe stroke patients treated on the stroke rehabilitation unit had a significantly better outcome compared with general wards (mortality: 21% versus 46%, P < .05; discharge home 47% versus 19%, P < .01; median length of hospital stay: 43 versus 59 days, P < .02). The number of stroke unit patients being discharged home had increased significantly from the previous study, with a trend toward improvement in median discharge Barthel Index score. CONCLUSIONS: Stroke rehabilitation units may improve outcome in severe stroke patients. This improvement appears to be due to the development of innovative management strategies that reduce mortality and institutionalization and enable caregivers to support more disabled stroke patients at home.

Aged↗

PubMed2001

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

BACKGROUND AND PURPOSE: The aims of this study were to examine the frequency, types, and clinical factors associated with medical complications that occur during inpatient rehabilitation and to identify risk factors for complications that require a transfer to an acute care facility. METHODS: A cohort of 1029 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke information, impairment, preexisting medical conditions, and admission laboratory abnormalities were recorded. Medical complications, defined as new or exacerbated medical problems, were documented for each patient. Complications that required transfer off rehabilitation were noted. Univariate and multiple logistic regression analyses were used to determine factors that were associated with risk of medical complications and risk of transfer off rehabilitation. RESULTS: Seventy-five percent of patients experienced >/=1 medical complication during rehabilitation. Significant factors for the development of any medical complication included greater neurological deficit (odds ratio [OR], 4.10; confidence interval [CI], 1.88 to 8.91), hypoalbuminemia (OR, 1.71; 95% CI, 1.15 to 2.52), and history of hypertension (OR, 1.81; 95% CI, 1.27 to 2.59). Nineteen percent of patients had a medical complication that required transfer to an acute care facility. Significant factors for transfers were elevated admission white blood cell counts (OR, 1.92; 95% CI, 1.32 to 2.79), low admission hemoglobin levels (OR, 1.89; 95% CI, 1.32 to 2.68), greater neurological deficit (OR, 2.46; 95% CI, 1.37 to 4.39), and a history of cardiac arrhythmia (OR, 1.79; 95% CI, 1.18 to 2.67). CONCLUSIONS: Medical complications are common among patients undergoing stroke rehabilitation. A significant number of these medical complications may require a transfer to an acute facility.

Accidental Falls↗

PubMed2002

Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke.

BACKGROUND AND PURPOSE: The purpose of this study was to determine if compliance with poststroke rehabilitation guidelines was associated with better functional outcomes. METHODS: An inception cohort of 288 stroke patients in 11 Department of Veteran Affairs Medical Centers hospitalized between January 1998 and March 1999 were followed prospectively for 6 months. Data were abstracted from medical records and telephone interviews. The primary study outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and postacute rehabilitation guideline compliance scores (range 0 to 100) were derived from an algorithm. All outcomes were adjusted for case-mix. RESULTS: Average compliance scores in acute and postacute care settings were 68.2% (SD 14) and 69.5% (SD 14.4), respectively. After case-mix adjustment, level of compliance with postacute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function was not associated with guideline compliance. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. CONCLUSION: Greater levels of adherence to postacute stroke rehabilitation guidelines were associated with improved patient outcomes. Compliance with guidelines may be viewed as a quality-of-care indicator with which to evaluate new organizational and funding changes involving postacute stroke rehabilitation.

Activities of Daily Living↗

PubMed2006

Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial.

OBJECTIVE: To assess the effect of three weeks of rehabilitation in the home setting for younger patients with stroke with the aim of improving activity level. DESIGN: A randomized controlled study with blinded evaluations at discharge, three weeks, three months and one year after discharge. SETTING: Home of the patient or the ordinary day rehabilitation clinic at the university hospital. SUBJECTS: Fifty-eight patients (median age 53 years) consecutively discharged from inpatient rehabilitation with a first occurrence of stroke participated in training directly after discharge. INTERVENTION: Rehabilitation was given for 9 hours/week over three weeks. The home group received individually tailored training, based on the patient's needs and desires, with a focus on activities in their natural context. Support and information were also given. The intervention in the day clinic group was aimed mainly at improved functions. MAIN MEASURES: The main outcome was activity, assessed with the Assessment of Motor and Process Skill (AMPS). The impairment level was also evaluated. Costs were estimated. RESULT: There were no significant differences between the groups on any of the four assessments. However, there seemed to be an earlier improvement on some measures (including AMPS) for the home group. For both groups there was a greater improvement on the activity level than on the impairment level. the costs of the home group were less than half of the costs of the day clinic group. CONCLUSION: With the present results, both rehabilitation programmes could be recommended, however, further studies are needed to define patients who may specifically benefit from the home rehabilitation programme. Costs should be taken into consideration.

Adult↗