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van der Veen R, van der Burgt S, Königs M, Oosterlaan J, Peerdeman S. Team functioning in Neurorehabilitation: a mixed methods study. J Interprof Care 2024; 38:621-631. [PMID: 38470835 DOI: 10.1080/13561820.2024.2325694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
The objective of this study was to enhance understanding of team functioning in a neurorehabilitation team by identifying the factors that impede and facilitate effective interprofessional team collaboration. We focused on team identification, psychological safety, and team learning, and conducted the research at a neurorehabilitation center treating young patients with severe acquired brain injury in the Netherlands. A mixed-methods approach was employed, integrating quantitative data from questionnaires (N = 40) with qualitative insights from a focus group (n = 6) and in-depth interviews (n = 5) to provide a comprehensive perspective on team dynamics. Findings revealed strong team identification among participants, denoting a shared sense of belonging and commitment. However, limited psychological safety was observed, which negatively affected constructive conflict and team learning. Qualitative analysis further identified deficiencies in shared mental models, especially in shared decision-making and integrated care. These results highlight the crucial role of psychological safety in team learning and the development of shared mental models in neurorehabilitation settings. Although specific to neurorehabilitation, the insights gained may be applicable to enhancing team collaboration in various healthcare environments. The study forms a basis for future research to investigate the impact of improvements in team functioning on patient outcomes in similar settings.
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Affiliation(s)
- Ruud van der Veen
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Stéphanie van der Burgt
- Teaching and Learning Center (TLC), Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Quality of Care Group, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marsh Königs
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia Peerdeman
- Teaching and Learning Center (TLC), Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Quality of Care Group, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Neurosurgery, De Boelelaan, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Richter C, Golla A, Bieber A, Saal S, Mau W, Kimmel A, Breuninger K. [Experts' uncertainties in decisions on the indication for rehabilitation as part of the assessment of long-term care needs: Results of semi-structured interview]. DAS GESUNDHEITSWESEN 2024; 86:192-199. [PMID: 38128572 DOI: 10.1055/a-2144-5901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE As part of assessment of long-term care needs, Medical Services of the compulsory German Health Insurance have to decide whether medical rehabilitation is indicated. The aim of this study was to identify uncertainties and associated factors while deciding whether rehabilitation was indicated in this standardized review process. METHOD Semi-structured interviews were conducted with a total of twelve nursing experts and six physician experts from six different Medical Services. In the interviews of the two professional groups, thinking aloud and problem-centered methods were used. They were subjected to a cognitive pretest prior to data collection. All interviews were conducted over telephone in May 2021, digitally recorded and transcribed thereafter. They were analyzed based on the method of structuring qualitative content analysis using the MAXQDA software. RESULTS Uncertainties in decision-making can arise both from case-related characteristics and case-independent contextual factors. Nursing experts associated uncertainties in assessing the criteria of rehabilitation indication primarily with certain diseases (especially dementia or mental illnesses), multimorbidity, an unclear illness and ambulatory care situation, as well as a negative rehabilitation-related attitude of the persons being assessed. The physician experts, who based their decisions on available documentation in the case files, described uncertainties, particularly due to insufficient information relevant to the decision (e. g., on diagnostics, course of disease and treatment, weighting of existing limitations) in the nursing experts' assessments. Across all criteria, the experts' own professional or private rehabilitation experience and their understanding of the role of rehabilitation before and during the need for long-term care, as well as aspects of communication practice and the professional exchange between the nursing and the physician experts also influenced the overall decision-making process. CONCLUSION The identification of uncertainties in experts' decision-making process and associated factors enables the development of strategies to strengthen specifically the certainty of experts' decision-making and thus may contribute to the promotion of a needs-based rehabilitation access via long-term care assessment.
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Affiliation(s)
- Cynthia Richter
- Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - André Golla
- Institut für Rehabilitationsmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Susanne Saal
- Fachbereich Gesundheit und Pflege, Ernst-Abbe-Hochschule Jena, Jena, Germany
| | - Wilfried Mau
- Institut für Rehabilitationsmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Andrea Kimmel
- Stabsstelle Evaluation Pflege, Medizinischer Dienst Bund, Essen, Germany
| | - Katrin Breuninger
- Team Rehabilitation/Heilmittel/Prävention, Medizinischer Dienst Bund, Essen, Germany
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Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Home Versus Hospital Rehabilitation of Older Adults Following Hip Fracture Yields Similar Patient-Reported Outcome Measures. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241230293. [PMID: 38491840 PMCID: PMC10943717 DOI: 10.1177/00469580241230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/18/2024]
Abstract
The increase in hip fractures (HF) due to aging of the population and the rise in attractiveness of services provided at home following the COVID-19 pandemic, emphasize the need to compare outcomes of home versus hospital HF rehabilitation. To date, studies comparing the 2 services have focused primarily on clinical outcomes rather than patient-reported outcomes (PROs). This longitudinal observational study evaluated PROs of older adults with HF in the 2 settings. The SF36 questionnaire was used to measure PROs 3 times after surgery. The first PRO was retrospective and reflected pre-fracture health status. Descriptive statistics and mixed-effect logistic regression were used. Of 86 patients participating in the study, 41 had home rehabilitation and 45 had hospital rehabilitation. In both groups, the mental and physical scores plummeted 2 weeks after the HF, compared to pre-fracture status. The difference in improvement from pre-fracture status to recovery in both groups, were not significantly (P < .05) different, except for the pain domain. PROs of home versus hospital rehabilitation were similar, suggesting that rehabilitation at home can be as effective as hospital rehabilitation for suitable patients. This knowledge can improve quality of care in an aging global population.
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Affiliation(s)
- Hanna S. Schroeder
- Hebrew University of Jerusalem, Jerusalem, Israel
- Israeli Ministry of Health, Israel
| | - Avi Israeli
- Israeli Ministry of Health, Israel
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Omer Or
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Ora Paltiel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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Skumsnes R, Thygesen H, Groven KS. Facilitators and barriers to communication in rehabilitation services across healthcare levels: a qualitative case study in a Norwegian context. BMC Health Serv Res 2023; 23:1353. [PMID: 38049788 PMCID: PMC10696812 DOI: 10.1186/s12913-023-10222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND People with problems in functioning following severe injury or illness often need multiple and combined interventions in their rehabilitation processes. In these processes, communication and collaboration between the involved healthcare professionals are essential. Despite efforts in research and policy, communication across hospital and primary healthcare services and within the primary healthcare settings remains challenging. In one region of Norway, a new intermunicipal rehabilitation team has been established to supplement the traditional services and context-bound research is needed to gain insight into the complexity of the new communication structures that are developing. The aim of this study was to explore facilitators and barriers to communication to inform further improvement of the services. METHODS A qualitative case study design was used to explore the exchange of patient information in the rehabilitation processes of four patients. Data collection included participant observations in communication situations and an exploration of the electronic patient records of these four patients. Reflexive thematic analysis was used to analyse the empirical data. RESULTS The complex rehabilitation processes explored involved a large number of actors across healthcare organisational levels. Lacking a common culture for rehabilitation, poor access to written information and unclear responsibility for sharing information across organisational boundaries seemed to represent barriers to interprofessional communication. Joint meetings, the use of common rehabilitation tools and language and establishing informal communication channels served to facilitate communication. CONCLUSION The intermunicipal team collaborating across different organisational levels added complexity to communication structures, but also facilitated interprofessional communication by promoting formal and informal ways of exchanging information. However, the intricate organisational divisions of healthcare provision in the Norwegian context represent boundaries which can be difficult to overcome. Therefore, cross-organisational coordination services should be developed.
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Affiliation(s)
- Randi Skumsnes
- Centre for Diaconia and Professional Practice, VID Specialized University, Oslo, Norway.
- Department of Innovation and Research, City of Stavanger, Stavanger, Norway.
| | - Hilde Thygesen
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Department of Rehabilitation Sciences and Health Technolgy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Karen Synne Groven
- Department of Rehabilitation Sciences and Health Technolgy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Kelly E, Spina E, Liantonio J. Comparative Analysis of Palliative Care Needs Identified in Inpatient Rehabilitation and Skilled Nursing Facilities by Multidisciplinary Team Members. Arch Phys Med Rehabil 2023; 104:2027-2034. [PMID: 37331422 DOI: 10.1016/j.apmr.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Assess access to, need for, and beliefs surrounding specialized palliative care (PC). DESIGN Observational, comparative analysis needs assessment survey. SETTING Four inpatient rehabilitation facilities (IRFs) or skilled nursing facilities with long-term care (SNFs/LTC) that provide subacute rehabilitation within 1 tertiary care system. PARTICIPANTS Allied health professionals, physicians, nursing, case managers, social workers, spiritual care (n=198). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Frequency of patient needs, attitudes about current systems, individual beliefs, and barriers to PC. Confidence in management, communicating, and navigating primary PC competencies among clinical pathway employees. RESULTS Of 198 respondents, 37% said PC was available at their facility. Those in IRF reported higher frequencies of grief/unmet spiritual needs of patients compared with SNF/LTC (P≤.001). Conversely, SNF/LTC reported higher frequencies of agitation, poor appetite, and end-of-life care (P≤.003). Respondents in SNF/LTC felt more confident managing end-of-life care, explaining what hospice and PC are and appropriateness for referral to each, discussing advance directives, determining appropriate decision-makers, and navigating ethical decisions than in IRFs (P≤.007). SNF/LTC participants reported higher effectiveness of their current system involving PC and ease of hospice transition compared with IRFs (P≤.008). A majority agreed that PC does not take away patient hope, could prevent recurrent hospitalizations, improve symptom management, communication, and patient and family satisfaction. The most common reported barriers to PC consultation were (1) attitudes and beliefs of staff or patients and families, (2) system issues with access, cost, or prognosis communication, and (3) lack of understanding of PC role. CONCLUSIONS A gap exists in PC access in IRF and SNF/LTC despite patient needs and staff beliefs. Future studies should focus on identifying which patients should be referred to PC in the post-acute setting and what outcomes can be used as a guide to meet the needs of this growing area of practice.
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Affiliation(s)
- Erin Kelly
- Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Elizabeth Spina
- Division of Palliative Care, Rochester Regional Health, Rochester, NY
| | - John Liantonio
- Department of Family Medicine, Division of Palliative Care, Thomas Jefferson University Hospital, Philadelphia, PA
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Lindelöf N, Nilsson I, Littbrand H, Gustafson Y, Olofsson B, Fjellman-Wiklund A. A focus groups study of staff team experiences of providing interdisciplinary rehabilitation for people with dementia and their caregivers-a co-creative journey. BMC Geriatr 2023; 23:572. [PMID: 37723442 PMCID: PMC10507912 DOI: 10.1186/s12877-023-04269-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The World Health Organization claims that rehabilitation is important to meet the needs of persons with dementia. Rehabilitation programmes, however, are not routinely available. Person-centred, multidimensional, and interdisciplinary rehabilitation can increase the opportunities for older adults with dementia and their informal primary caregivers to continue to live an active life and participate in society. To our knowledge, staff team experiences of such rehabilitation programmes, involving older adults with dementia and their informal caregivers has not been previously explored. METHODS The aim of this qualitative focus group study was to explore the experiences of a comprehensive staff team providing person-centred multidimensional, interdisciplinary rehabilitation to community-dwelling older adults with dementia, including education and support for informal primary caregivers. The 13 staff team members comprised 10 professions who, during a 16-week intervention period, provided individualised interventions while involving the rehabilitation participants. After the rehabilitation period the staff team members were divided in two focus groups who met on three occasions each (in total six focus groups) and discussed their experiences. The Grounded Theory method was used for data collection and analysis. RESULTS The analysis resulted in four categories: Achieving involvement in rehabilitation is challenging, Considering various realities by acting as a link, Offering time and continuity create added value, and Creating a holistic view through knowledge exchange, and the core category: Refining a co-creative process towards making a difference. The core category resembles the collaboration that the staff had within their teams, which included participants with dementia and caregivers, and with the goal that the intervention should make a difference for the participants. This was conducted with flexibility in a collaborative and creative process. CONCLUSIONS The staff team perceived that by working in comprehensive teams they could provide individualised rehabilitation in creative collaboration with the participants through interaction, knowledge exchange, time and continuity, coordination and flexibility, and a holistic view. Challenges to overcome were the involvement of the person with dementia in goal setting and the mediating role of the staff team members. The staff pointed out that by refinement they could achieve well-functioning, competence-enhancing and timesaving teamwork.
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Affiliation(s)
- Nina Lindelöf
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, SE-90187, Sweden.
| | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Occupational therapy, Umeå University, Umeå, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Håkan Littbrand
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Berdal G, Sand-Svartrud AL, Linge AD, Aasvold AM, Tennebø K, Eppeland SG, Hagland AS, Ohldieck-Fredheim G, Valaas HL, Bø I, Klokkeide Å, Sexton J, Azimi M, Dager TN, Kjeken I. Bridging gaps across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases: Results from a stepped-wedge cluster randomized controlled trial. Clin Rehabil 2023:2692155231153341. [PMID: 36862585 PMCID: PMC10387727 DOI: 10.1177/02692155231153341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. DESIGN A pragmatic stepped-wedge cluster randomized trial. SETTING Eight rehabilitation centers in secondary healthcare, Norway. PARTICIPANTS A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). INTERVENTIONS A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients' needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. MAIN MEASURES Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients' goal attainment measured by the Patient Specific Functional Scale (0-10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. RESULTS No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: -0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. CONCLUSION The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group.
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Affiliation(s)
- Gunnhild Berdal
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Anne-Lene Sand-Svartrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Anita Dyb Linge
- 574813Muritunet Rehabilitation Centre, Valldal, Ålesund, Norway
| | | | - Kjetil Tennebø
- 158956Valnesfjord Health Sports Centre, Valnesfjord, Norway
| | - Siv G Eppeland
- Department of Physiotherapy, Sørlandet Hospital, Arendal, Norway
| | | | | | | | - Ingvild Bø
- Department of Rehabilitation, Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Åse Klokkeide
- Rehabilitering Vest Rehabilitation Centre, Haugesund, Norway
| | - Joseph Sexton
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Maryam Azimi
- REMEDY Patient Advisory Board, Diakonhjemmet Hospital, Oslo, Norway
| | - Turid N Dager
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), 11316Diakonhjemmet Hospital, Oslo, Norway
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Lee SB, Oh YT, Yang SW, Kim JB. Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities. SENSORS (BASEL, SWITZERLAND) 2023; 23:2761. [PMID: 36904962 PMCID: PMC10006891 DOI: 10.3390/s23052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Patients discharged from hospitals after an inpatient course of medical treatment for any ailment or traumatic injury that results in disabling conditions and are rendered mobility impaired require ongoing systematic sports and exercise programs to maintain healthy lifestyles. Under such circumstances, a rehabilitation exercise and sports center, accessible throughout local communities, is critical for promoting beneficial living and community participation for these individuals with disabilities. An innovative data-driven system equipped with state-of-the-art smart and digital equipment, set up in architecturally barrier-free infrastructures, is essential for these individuals to promote health maintenance and overcome secondary medical complications following an acute inpatient hospitalization or suboptimal rehabilitation. A federally funded collaborative research and development (R&D) program proposes to build a multi-ministerial data-driven system of exercise programs using a smart digital living lab as a platform to provide pilot services in physical education and counseling with exercise and sports programs for this patient population. We describe the social and critical aspects of rehabilitating such a population of patients by presenting a full study protocol. A modified sub-dataset of the previously generated 280-item full dataset is applied using a data-collecting system-"The Elephant"-as an example of how data acquisition will be achieved to assess the effects of lifestyle rehabilitative exercise programs for people with disabilities.
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Affiliation(s)
- Seung Bok Lee
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
| | - Yim Taek Oh
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Frontier Research Institute for Convergence Sports Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Seung Wan Yang
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
| | - Jong Bae Kim
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju 26493, Republic of Korea
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9
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Lee SB, Oh YT, Yang SW, Kim JB. Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities. SENSORS 2023; 23:2761. [DOI: https:/doi.org/10.3390/s23052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
Patients discharged from hospitals after an inpatient course of medical treatment for any ailment or traumatic injury that results in disabling conditions and are rendered mobility impaired require ongoing systematic sports and exercise programs to maintain healthy lifestyles. Under such circumstances, a rehabilitation exercise and sports center, accessible throughout local communities, is critical for promoting beneficial living and community participation for these individuals with disabilities. An innovative data-driven system equipped with state-of-the-art smart and digital equipment, set up in architecturally barrier-free infrastructures, is essential for these individuals to promote health maintenance and overcome secondary medical complications following an acute inpatient hospitalization or suboptimal rehabilitation. A federally funded collaborative research and development (R&D) program proposes to build a multi-ministerial data-driven system of exercise programs using a smart digital living lab as a platform to provide pilot services in physical education and counseling with exercise and sports programs for this patient population. We describe the social and critical aspects of rehabilitating such a population of patients by presenting a full study protocol. A modified sub-dataset of the previously generated 280-item full dataset is applied using a data-collecting system—“The Elephant”—as an example of how data acquisition will be achieved to assess the effects of lifestyle rehabilitative exercise programs for people with disabilities.
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Affiliation(s)
- Seung Bok Lee
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
| | - Yim Taek Oh
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Frontier Research Institute for Convergence Sports Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Seung Wan Yang
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
| | - Jong Bae Kim
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju 26493, Republic of Korea
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10
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Bonn MM, Dickey JP, Moran B, McGuire S, Graham L. Completing an interdisciplinary outpatient intervention improves patient rehabilitation goals following a mild traumatic brain injury. Physiother Theory Pract 2023; 39:310-316. [PMID: 35001810 DOI: 10.1080/09593985.2021.2022046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Individualized and interdisciplinary rehabilitation programs are recommended following a mild traumatic brain injury (mTBI), but often have long waitlists. Accordingly, innovative evidence-based programs are needed. OBJECTIVES The first objective of this study was to determine the number and types of rehabilitation goals chosen by individuals completing an interdisciplinary outpatient rehabilitation intervention (BrainEx90) for persisting symptoms following an mTBI. The second objective was to investigate whether completing BrainEx90 or choosing specific types of goals influenced performance and satisfaction ratings of these goals. METHODS 217 individuals (44.4 ± 13.5 years old) with persisting symptoms following an mTBI completed BrainEx90, a 16-session interdisciplinary group outpatient rehabilitation intervention at Parkwood Institute between November 2013 and September 2019. Performance and satisfaction ratings of self-identified goals before and after BrainEx90 were assessed using the Canadian Occupational Performance Measure, and changes in ratings were analyzed using a linear mixed effects model. RESULTS 1008 goals were identified and categorized as: productivity (45%); leisure (37%); and self-care (18%). Satisfaction ratings were significantly higher for all goal types following BrainEx90. Satisfaction with self-care goals improved significantly more than leisure [t(151) = 3.24, p < .01] and productivity [t(144) = 2.97, p < .01] goals. Performance ratings were also significantly greater following BrainEx90 [2.4, 95% CI [2.27, 2.53], p < .01)]. CONCLUSION Performance and satisfaction of self-identified rehabilitation goals significantly improved following BrainEx90. Satisfaction with self-care goals demonstrated the greatest improvements, yet the most identified goal type was productivity.
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Affiliation(s)
- Marquise M Bonn
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - James P Dickey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Becky Moran
- Regional Acquired Brain Injury Outpatient Program, Parkwood Institute, London, ON, Canada
| | - Shannon McGuire
- Regional Acquired Brain Injury Outpatient Program, Parkwood Institute, London, ON, Canada
| | - Laura Graham
- Lawson Health Research Institute, London, ON, Canada.,School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
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Rashid M, Harish SP, Mathew J, Kalidas A, Raja K. Comprehensive rehabilitation outcome measurement scale (CROMS): development and preliminary validation of an interdisciplinary measure for rehabilitation outcomes. Health Qual Life Outcomes 2022; 20:160. [PMID: 36456958 PMCID: PMC9714173 DOI: 10.1186/s12955-022-02048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 09/15/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Comprehensive and interdisciplinary measurement of rehabilitation outcome is an essential part of the assessment and prognosis of a patient. Thus, this requires substantial contributions from the patient, their family and the rehabilitation professional working with them. Moreover, the measurement tool should be comprehensive and must consider the cultural compatibility, cost efficiency and contextual factors of the region. METHODS The Comprehensive Rehabilitation Outcome Measurement Scale (CROMS) was developed through consensus and followed the Delphi process incorporating inputs from various rehabilitation professionals. The domains and items were finalized using Principal Component Analysis (PCA). The tool was validated in two native languages and back-translated considering the semantic equivalence of the scale. Intra-class correlation coefficient was performed to determine the agreement between the therapist and patient-reported scales. RESULTS The final CROMS carries 32 comprehensive items that can be completed by the person with disability and the professional team. CROMS compares well to similar items on FIM (l ICC of 0.93) and has good internal consistency with a Cronbach's Alpha of 0.92 for both patient and therapist reported measures. CONCLUSIONS The 32 item CROMS is a tool that can potentially be used to evaluate the functional independence of various patient populations, predominantly patients with neurological disabilities.
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Affiliation(s)
| | | | - Jerin Mathew
- grid.29980.3a0000 0004 1936 7830University of Otago, Dunedin, New Zealand
| | | | - Kavitha Raja
- JSS College of Physiotherapy, Mysuru, 570004 India
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Mediating effect of job embeddedness between relational coordination and employees’ well-being: A reflective-formative approach. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Maurer-Karattup P, Neumann O, Danneil W, Thöne-Otto AIT. Leitlinienbasierte Standards zur Struktur- und Prozessqualität neuropsychologischer Diagnostik und Therapie. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2022. [DOI: 10.1024/1016-264x/a000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Zusammenfassung: Die vorliegende Arbeit untersucht die aktuelle wissenschaftliche Evidenz zur Diagnostik und Therapie neuropsychologischer Störungen nach Hirnschädigung, wie sie bis 2020 in Leitlinien publiziert wurde. Deren Umsetzung ist nur möglich, wenn die institutionellen Rahmenbedingungen dies erlauben. Unter Einbezug der klinischen Erfahrung wurden daher auf Basis der Leitlinien Standards für eine wissenschaftlich fundierte neuropsychologische Diagnostik und Therapie erarbeitet. Es entstanden Best-Practice-Empfehlungen zu Struktur- und Prozessqualität, insbesondere zu Intensität und Häufigkeit der Interventionen. Diese werden für die wichtigsten neuropsychologischen Funktionsbereiche vorgestellt. Sowohl die Deutsche Gesellschaft für Neuropsychologie e. V. (GNP) als auch die Deutsche Gesellschaft für Neurologie e. V. (DGN) unterstützen diese Empfehlungen. Sie richten sich an Neuropsycholog_innen sowie an Einrichtungsleitende und Sozialversicherungsträger und definieren die Rahmenbedingungen für eine auf den individuellen Fall angepasste leitliniengerechte neuropsychologische Behandlung.
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Affiliation(s)
| | | | - Wolfgang Danneil
- Waldklinik Jesteburg & Neuropsychologische Praxis Nordheide, Jesteburg, Deutschland
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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Thøgersen CMS, Glintborg C, Hansen TGB, Trettvik J. Psychotherapeutic Intervention for Adults With Acquired Brain Injury: A Case Study Using BackUp. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:771416. [PMID: 36188993 PMCID: PMC9397759 DOI: 10.3389/fresc.2022.771416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022]
Abstract
A moderate-to-severe acquired brain injury (ABI) can have tremendous lifelong consequences for ABI-survivors and their families. Despite rehabilitation practice since the 1980s aspiring to a dynamic, coherent and holistic approach, the psychological dimension still seems to be a challenge and research has revealed persisting psychosocial impairments after ABI. Therefore, we developed BackUp©, a manual based short term psychological intervention for adults with ABI. This study explores the effect of the intervention though a small feasibility study, employing a single case design. One client received the intervention. Self-report measures were collected, and a semi structured interview was conducted. While results from pre, post and follow-up measures do not show clear positive results, the interview reveals positive experiences and the participant reported achieving his therapy goal. This case study provides support for a psychological intervention to support the psychological rehabilitation after an ABI.
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Leet A, Dennis S, Muller J, Walsh S, Bowen-Salter H, Kernot J. Demonstrating the processes and outcomes of a rural Community Mental Health Rehabilitation Service: A realist evaluation. PLoS One 2021; 16:e0260250. [PMID: 34813607 PMCID: PMC8610260 DOI: 10.1371/journal.pone.0260250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND As part of significant mental health reform, the Community Mental Health Rehabilitation Service (CMHRS) was implemented in rural South Australia. The CMHRS is a 10-bed mental health residential program offering rehabilitative mental health support to rural residents. AIM To analyse the CMHRS service delivery model and its impact on recovery outcomes for consumers. METHODS A mixed method, realist evaluation approach was utilised. A purposive sample of CMHRS staff (n = 6) and consumers (n = 8) were recruited. Consumer recovery was measured using the RAS-DS (on admission and discharge). Participants' perspectives of the service were gained via one staff focus group (n = 6) and individual semi-structured interviews (consumers n = 6; staff n = 2). Pre-post RAS-DS scores were analysed using paired t-tests/Wilcoxon paired-signed rank test, with qualitative data analysed thematically. RESULTS Significant positive increases in RAS-DS total scores were observed at discharge, supported by the qualitative themes of (re)building relationships and social connections and recovering health and wellbeing. Contextual factors (e.g. staffing) and program mechanisms (e.g. scheduling) impacting on service implementation were identified. CONCLUSION Maintaining a rehabilitation recovery-focused approach, balanced with an appropriately trained multi-disciplinary team, are vital for maximising positive consumer outcomes. SIGNIFICANCE This realist evaluation identifies critical factors impacting rural mental health rehabilitation service delivery.
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Affiliation(s)
- A. Leet
- Barossa Hills Fleurieu Local Health Network/ Rural and Remote Mental Health Service, Angaston, Australia
| | - S. Dennis
- Flinders and Upper North Local Health Network/ Whyalla Integrated Mental Health Service, Whyalla, Australia
| | - J. Muller
- Department of Rural Health, Allied Health and Human Performance/ University of South Australia, Adelaide, Australia
| | - S. Walsh
- Department of Rural Health, Allied Health and Human Performance/ University of South Australia, Adelaide, Australia
| | - H. Bowen-Salter
- International Centre for Allied Health Evidence, Allied Health and Human Performance/University of South Australia, Adelaide, Australia
| | - J. Kernot
- Occupational Therapy Program, Allied Health and Human Performance/ University of South Australia, Adelaide, Australia
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Mohammadi E, Hassandoost F, Mozhdehipanah H. Evaluation of the "partnership care model" on quality of life and activity of daily living in stroke patients: A randomized clinical trial. Jpn J Nurs Sci 2021; 19:e12448. [PMID: 34448546 DOI: 10.1111/jjns.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stroke is a widespread chronic disease which remains a serious problem for public health and is the cause of major disability and death in adults. Despite valuable efforts, these patients still need new care programs for recovery and rehabilitation. AIM The aim of this study is to determine the effect of the partnership care model (PCM) on quality of life (QOL) and activities of daily living (ADL) in stroke participants. METHOD The study is a randomized clinical trial carried out in an educational and therapeutic center in 2019. Sixty-seven participants (allocated randomly in intervention and control groups) with cerebrovascular accident who had hospitalization histories were selected. Data collection instruments were the Stroke-Specific QOL scale and Lawton questionnaires. The care plan was developed and implemented for the intervention group after evaluating and recording basic information including demographic variables, care needs, and problems identified in the first PCM-based stage. Ethics approval was obtained from the University / Regional Research Ethics Committee (IR.NIMAD.REC.1397.236). RESULTS The results show that the mean scores of the QOL significantly increased after the intervention in the intervention group (before = 130.80; 3 months = 172.19; 6 months = 205.29) compared to the control group (before = 150; 3 months = 144.86; 6 months = 160.66). Also, the mean scores of the ADL significantly increased after the intervention in the intervention group (before = 1.96; 3 months = 3.64; 6 months = 4.87) compared to the control group (p < .05). The effect size is equal to 0.501 and 0.245 for QOL and ADL, respectively. CONCLUSION The findings show that the care program based on a PCM recovered the QOL and ADL of stroke participants more than other interventions.
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Affiliation(s)
- Eesa Mohammadi
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Fateme Hassandoost
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Hossein Mozhdehipanah
- Clinical Research Development Unit, Bouali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
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Skempes D, Kiekens C, Malmivaara A, Michail X, Bickenbach J, Stucki G. Supporting government policies to embed and expand rehabilitation in health systems in Europe: A framework for action. Health Policy 2021; 126:158-172. [PMID: 34281701 DOI: 10.1016/j.healthpol.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus urgently needed to support rehabilitation policy development and expand access to rehabilitation care to meet population needs effectively. This paper describes a framework to guide policy action for rehabilitation in Europe. The framework was developed in collaboration with the European Academy of Rehabilitation Medicine based on a focused literature review and expert consultations. A review in PubMed and grey literature sources identified 458 references and resulted in 135 relevant documents published between 2006 and 2019. Thematic analysis of extracted information helped summarize the findings and develop the draft policy action framework. This was circulated to a wider group of experts and discussed in three workshops in 2018-2019. The framework was revised according to their feedback. The proposed framework contains 48 options for policy action organized in six domains and twelve subdomains that address several areas of health programming. The proposed framework provides a structure to understand the policy terrain related to rehabilitation in Europe and the measures required for translating aspirational political pronouncements into targeted programmatic action and tangible health and social outcomes.
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Affiliation(s)
- Dimitrios Skempes
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (Bologna), Italy; Physical and Rehabilitation Medicine, University Hospitals Leuven - Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare and Orton Orthopedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Xanthi Michail
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland.
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Sondell A, Lampinen J, Conradsson M, Littbrand H, Englund U, Nilsson I, Lindelöf N. Experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program. BMC Geriatr 2021; 21:341. [PMID: 34078266 PMCID: PMC8173830 DOI: 10.1186/s12877-021-02282-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is great need for development of feasible rehabilitation for older people with dementia. Increased understanding of this population's experiences of rehabilitation participation is therefore important. The aim of this study was to explore the experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program. METHODS Sixteen older people with dementia were interviewed about their experiences of participation in a person-centred multidimensional interdisciplinary rehabilitation program. The program comprised assessments by a comprehensive team of rehabilitation professionals followed by a rehabilitation period of 16 weeks, including interventions based on individualized rehabilitation goals conducted with the support of the rehabilitation team. The rehabilitation was performed in the participants' homes, in the community and at an outpatient clinic, including exercise with social interaction in small groups offered twice a week to all participants. The interviews were conducted at the end of the rehabilitation period and analysed with qualitative content analysis. RESULTS The analysis resulted in one overarching theme: Empowered through participation and togetherness and four sub-themes: Being strengthened through challenges; Gaining insights, motives, and raising concerns about the future; Being seen makes participation worthwhile; and Feelings of togetherness in prosperity and adversity. The participants increased their self-esteem by daring and coping in the rehabilitation. The insights about themselves and their condition motivated them to continue with their prioritized activities, but also raised concerns about how the future would play out. Collaboration in the group and being seen and acknowledged by staff strengthened their own motivation and self-efficacy. CONCLUSION According to community-dwelling older people with dementia, a person-centred multidimensional interdisciplinary rehabilitation program was experienced as viable and beneficial. The participants seemed empowered through the rehabilitation and expressed mostly positive experiences and perceived improvements. Providers of interdisciplinary rehabilitation programs for this group should consider aspects raised by the participants e.g. the positive experience of being challenged in both exercise and daily activities; the importance of being seen and feeling secure; the benefits and challenges of collaboration with others in the same situation; and the generation of new perspectives of current and future situation.
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Affiliation(s)
- Anna Sondell
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden. .,Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
| | - Josefine Lampinen
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Mia Conradsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Håkan Littbrand
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Undis Englund
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Nina Lindelöf
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden
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Izumi SI, Li Z, Sato A. Quantifying face-to-face communication among multidisciplinary medical professions in a convalescent rehabilitation ward by using a name tag-type information communication device: A pilot study. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tschuggnall M, Grote V, Pirchl M, Holzner B, Rumpold G, Fischer MJ. Machine learning approaches to predict rehabilitation success based on clinical and patient-reported outcome measures. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Sormunen E, Ylisassi H, Mäenpää-Moilanen E, Remes J, Martimo KP. Co-operation in the prevention of work disability due to musculoskeletal disorders: A cross-sectional study among occupational health professionals in Finland. Work 2020; 67:697-708. [DOI: 10.3233/wor-203319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Occupational health service (OHS) providers and their client organizations are obligated to collaborate in promoting health and work ability. Little is known how this multiprofessional co-operation is implemented in relation to the prevention of musculoskeletal disorders (MSD). OBJECTIVE: The aim of this study was to investigate the working practices of co-operation among OHS professionals, and between the OHSs and workplaces. METHODS: In 2015 a web-based questionnaire was sent to 3900 OHS professionals in Finland. A total of 589 responded: 106 physicians, 322 nurses, 134 physiotherapists and 27 psychologists. RESULTS: The co-operation within OHS personnel was regarded to strengthen the processes to promote work ability of workers with MSD. Despite the positive expectations of co-operation, there is a problem of having enough time to put good ideas into practice. Four main possibilities to develop co-operation were identified: creating proactive working models with defined roles; increasing awareness of importance of early intervention models; implementing the principles of good OH practice; and adopting the knowledge of the latest information to promote work ability. CONCLUSIONS: Despite its recognized importance, co-operation both with OHS colleagues and with the workplaces was not always optimal. There is a need for defined roles and common proactive working models between each stakeholder for more effective co-operation.
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Affiliation(s)
- Erja Sormunen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | - Jouko Remes
- Finnish Institute of Occupational Health, Helsinki, Finland
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Ambrosino P, Iannuzzi GL, Formisano R, Spedicato GA, D'Abrosca V, Di Gioia L, Di Minno MND, Pappone N. Exergaming as an Additional Tool in Rehabilitation of Young Patients with Rheumatoid Arthritis: A Pilot Randomized Controlled Trial. Games Health J 2020; 9:368-375. [DOI: 10.1089/g4h.2019.0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Luisa Di Gioia
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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A Rehabilitation Framework for Children Living With HIV in South Africa: Reaching Consensus for a Resource-Poor Community. J Assoc Nurses AIDS Care 2020; 31:228-240. [PMID: 31764208 DOI: 10.1097/jnc.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although rehabilitation frameworks for adults living with HIV are developing steadily, interventions to ensure the integration of rehabilitation into the routine care of children living with HIV-related disabilities lags. We sought to explore perceptions of, and gain expert consensus on, a rehabilitation framework for children living with HIV. Experts in HIV pediatric care in South Africa engaged in a Delphi survey, based on findings from a context-specific rehabilitation framework for adults. Consensus was determined by an a priori threshold of 80% agreement and an interquartile range of 1 or lower on criteria to be included as essential or useful in the framework. Experts agreed that enhancing access to patient-centered care through decentralization and training of health care and community care workers in the use of disability screening tools at each point of care needed to be included in the framework. Strengthening multiprofessional team collaboration was also seen as fundamental.
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Petersen L, Birkelund R, Schiøttz-Christensen B. Challenges to cross-sectoral care experienced by professionals working with patients living with low back pain: a qualitative interview study. BMC Health Serv Res 2020; 20:164. [PMID: 32131819 PMCID: PMC7057631 DOI: 10.1186/s12913-020-4988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While interdisciplinary, cross-sectoral collaboration promotes the effectiveness of rehabilitation programmes for persons with low back pain, challenges remain for this process. Few studies have explored challenges to cross-sectoral care as experienced by all the involved professionals across sectors during a course of treatment. The aim of this study was to explore challenges to cross-sectoral care as experienced by professionals involved in the course of treatment for patients with low back pain. METHOD This semi-structured, qualitative interview study included 28 health care professionals and 8 social workers who interacted with patients with low back pain. A systematic text condensation method was used to analyse data. Nvivo was used to structure and thematise the interview data. RESULTS Professionals expressed challenges in relation to a lack of collaboration, knowledge sharing and acknowledgement of one other and they appeared to differ in their approach to patients with pain or patients with limited function. Additional challenges included time constraints, availability and subjective approaches to managing guidelines for low back pain. A lack of a common information technology (IT) registration system and limited knowledge of the work of other professions disrupted knowledge sharing among sectors. DISCUSSION The different approach to patients with pain or patients with limited function challenged mutual understanding and collaboration among professionals. The lack of mutual understanding and knowledge of each other's work appeared to create an environment of disrespect and distrust among professionals that generated feelings of a lack of acknowledgement from other health care professionals. CONCLUSION To provide cross-sectoral care, we must ensure that professionals work together towards transparent and informed transitions from one sector to the next. This study contributes to the existing literature by presenting challenges to cross-sectoral care that are experienced by the diverse groups of professionals involved in a course of treatment for patients with low back pain.
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Affiliation(s)
- Lisbeth Petersen
- Medical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark
| | - Regner Birkelund
- Health Services Research Unit, Lillebaelt Hospital, The Department of Regional health Research, University of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Berit Schiøttz-Christensen
- Medical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, The Department of Regional health Research, University of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark
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Pishkhani MK, Dalvandi A, Ebadi A, Hosseini MA. Adherence to a Rehabilitation Regimen in Stroke Patients: A Concept Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:139-145. [PMID: 32195160 PMCID: PMC7055185 DOI: 10.4103/ijnmr.ijnmr_170_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/07/2019] [Accepted: 12/23/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adherence to rehabilitation regimens is a major issue in the treatment of stroke. Despite the agreement on the importance of adherence, there is still no clear definition of this concept in rehabilitation. The aim of this study was the concept analysis of the concept of adherence to rehabilitation regimens in stroke patients. MATERIALS AND METHODS This qualitative concept analysis was performed using Walker and Avant's method. English and Persian articles were searched using keywords such as "adherence", "compliance", "rehabilitation", "stroke", and other related keywords among articles published from 1997 to 2018 in PubMed, Scopus, Web of Science, Google Scholar, Iranmedex, Magiran, and Scientific Information Database (SID). Related textbooks were also searched and all articles containing definitions, attributes, antecedents, and consequences of the concept were included in the study. RESULTS The attributes of the concept included complex, multidimensional, and dynamic behavior in the treatment process, personal experience, and adaptive behavior in patients, changeable, situational, voluntary, and collaborative behavior, and active communication between the patient and the healthcare provider. Common antecedents of the concept of adherence to the rehabilitation regimen were classified into patient-related and environmental-related categories and the consequences were classified into the three categories of patient-related, healthcare professional-related, and healthcare system-related. CONCLUSIONS This concept analysis can be useful in eliminating any ambiguity of the concept of adherence to rehabilitation regimens. It helps clarify the vague concepts used in nursing rehabilitation instead of adherence. The results of this study can be helpful for researchers for further studies in this context.
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Affiliation(s)
- Maryam Khoshbakht Pishkhani
- Department of Nursing, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- School of Nursing and Midwifery, Islamic Azad University of Tehran, Central Branch, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Hosseini
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Petersen L, Birkelund R, Schiøttz-Christensen B. Experiences and challenges to cross-sectoral care reported by patients with low back pain. A qualitative interview study. BMC Health Serv Res 2020; 20:96. [PMID: 32028943 PMCID: PMC7006064 DOI: 10.1186/s12913-020-4952-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background Cross-sectoral care comprises interdisciplinary and coordinated efforts for patients with complex care needs involving various competencies and professions across the primary health care sector, hospital sector, and municipal services. Cross-sectoral care can increase the effectiveness of rehabilitation programmes, but the treatment courses often lack coherence. Establishing successful treatment pathways requires a better understanding of the health care challenges faced by patients with low back pain. The aim of this study was to explore how patients with low back pain experience cross-sectoral care. Method A qualitative interview study including 25 patients with low back pain. Patients were recruited in connection with their appointment at the Spine Centre of Southern Denmark. Recruitment stopped when the interviews no longer added new knowledge to the subject. The data were analysed using a systematic text condensation approach. Results Patients with low back pain experienced cross-sectoral care to be fragmented, with episodes lacking collaboration, information, and acknowledgement of their problem. They desired recognition of having a serious back problem and of being more than the diagnosis itself. Patients found it hard to keep track of their course of treatment due to a perceived lack of organisational support and collaboration between professionals. The patients called for more information about the treatment plan and the reasons for further referral in order to better understand and manage their treatment. Conclusion Patients’ experiences indicate a need for a stronger person-centred approach in cross-sectoral care, in which the individual’s experiences of living with low back pain are taken into account.
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Affiliation(s)
- Lisbeth Petersen
- Medical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, Østre Hougvej 55, 5500, Middelfart, Denmark
| | - Regner Birkelund
- Health Services Research Unit, Lillebaelt Hospital, The Department of Regional Health Research, University of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Berit Schiøttz-Christensen
- Medical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, Østre Hougvej 55, 5500, Middelfart, Denmark. .,The Department of Regional Health Research, University of Southern Denmark, Østre Hougvej 55, 5500, Middelfart, Denmark.
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Tederko P, Mycielski J, Angerova Y, Denes Z, Grabljevec K, Ilieva E, Ilieva A, Moslavac S, Popa D, Takac P, Krasuski M, Tarnacka B. Role of diversity in assembling of rehabilitation teams in Central Europe. Eur J Phys Rehabil Med 2020; 56:131-141. [PMID: 31939266 DOI: 10.23736/s1973-9087.20.05904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multiprofessional teamwork in physical and rehabilitation medicine (PRM) allows achieving patient-centered goals in accordance with the assumptions of the bio-psycho-social model of functioning. Team composition and methods of collaboration depend of the specificity of goals to be achieved, as well local contextual factors. International comparative studies on rehabilitation teamwork are lacking, despite data on how teams differ between countries are crucial for the process of harmonization of PRM practice across Europe. AIM To compare models of collaboration within rehabilitation teams in Central Europe. DESIGN A cross-sectional explorative study. SETTING The data were collected in Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Slovakia between February and June 2018. POPULATION PRM physicians. METHODS An anonymous questionnaire inquiring of rehabilitation teamwork details was spread through national PRM societies, and other organizations associating PRM physicians. An ordered logit regression was applied to analyze the results. RESULTS Responses were obtained from 455 respondents. Significant differences between the studied countries in the composition of rehabilitation teams and frequencies of team meetings were detected. In the analyzed population of PRM physicians, we found positive associations between the chance of participation in team meetings and working in a hospital, the amount of time devoted to PRM practice, and older age. The chance for patients and caregivers to participate in rehabilitation team meetings was correlated with PRM physician's hospital practice, activity as a PRM teacher, older age and devoting more time to PRM practice. Country specificities of rehabilitation team content were analyzed with regards to local economic, legal, and historical backgrounds, and availability of human resources. Underrepresentation of key professionals (e.g. occupational therapists, orthotists/prosthetists), inadequate distribution of professionals in healthcare and as well as outdated educational systems in some countries may affect the efficacy of the comprehensive care in rehabilitation. CONCLUSIONS Central European countries differ in rehabilitation teamwork with regard to the contribution of professionals, meeting frequencies, and participation of patients and caregivers. Well-designed studies on teamwork models delineating ways to improve teamwork efficacy are in demand. CLINICAL REHABILITATION IMPACT Between-country diversity of rehabilitation team content should be considered while planning activities aimed at European harmonization of PRM practice.
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Affiliation(s)
- Piotr Tederko
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland - .,Polish Rehabilitation Society, Warsaw, Poland -
| | - Jerzy Mycielski
- Department of Econometrics and Statistics, Faculty of Economics, University of Warsaw, Warsaw, Poland
| | - Yvona Angerova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, and General Teaching Hospital, Prague, Czech Republic
| | - Zoltan Denes
- National Institute for Medical Rehabilitation, Budapest, Hungary
| | | | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Aleksandra Ilieva
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Sasa Moslavac
- Spinal Unit, Special Hospital for Medical Rehabilitation, Varazdinske Toplice, Croatia
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix Spa, Oradea, Romania
| | - Peter Takac
- Department of Physiatry, Balneology and Medical Rehabilitation, Faculty of Medicine, P. J. Safarik University and L. Pasteur University Hospital, Kosice, Slovak Republic
| | - Marek Krasuski
- Polish Rehabilitation Society, Warsaw, Poland.,Private Practitioner, Warszaw, Poland
| | - Beata Tarnacka
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Polish Rehabilitation Society, Warsaw, Poland
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Barclay L, Lalor A, Migliorini C, Robins L. A comparative examination of models of service delivery intended to support community integration in the immediate period following inpatient rehabilitation for spinal cord injury. Spinal Cord 2019; 58:528-536. [DOI: 10.1038/s41393-019-0394-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 11/09/2022]
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Sears JM, Edmonds AT, Fulton-Kehoe D. Tracking Opioid Prescribing Metrics in Washington State (2012-2017): Differences by County-Level Urban-Rural and Economic Distress Classifications. J Rural Health 2019; 36:152-166. [PMID: 31583779 DOI: 10.1111/jrh.12400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/04/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE High-risk opioid prescribing is a critical driver of prescription opioid-related morbidity and mortality. This study explored opioid prescribing patterns across urban-rural and economic distress classifications. Secondarily, this study explored the urban-rural distribution of relevant health services, economic factors, and population characteristics. METHODS County-level opioid prescribing metrics were based on quarterly Washington State Prescription Monitoring Program data (2012-2017). Counties were classified using the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties, and Washington State unemployment-based distressed areas. County-level measures from Area Health Resources Files were used to describe the urban-rural continuum. FINDINGS Persistent economic distress was associated with higher-risk opioid prescribing. The large central metropolitan category had lower-risk opioid prescribing metrics than the other 5 urban-rural categories, which were similar to each other and not ordered by degree of rurality. High-risk prescribing declined over time, without notable trend divergence by either urban-rural or economic distress classifications. CONCLUSIONS The most striking urban-rural differences in opioid prescribing metrics were between large central metropolitan and all other categories; thus, we recommend caution when collapsing urban-rural categories for analysis. Further research is needed regarding geographic and economic patterning of opioid prescribing practices, as well as the dissemination of guidelines and best practices across the urban-rural continuum. Finally, the multiple intertwined burdens faced by rural communities-higher-risk prescribing practices, higher opioid morbidity and mortality rates, and fewer resources for primary care, mental health care, alternative pain treatment, and opioid use disorder treatment-must be addressed as an urgent public health priority.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, University of Washington, Seattle, Washington.,Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington.,Institute for Work & Health, Toronto, Ontario, Canada
| | - Amy T Edmonds
- Department of Health Services, University of Washington, Seattle, Washington
| | - Deborah Fulton-Kehoe
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington
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Naicker AS, Htwe O, Tannor AY, De Groote W, Yuliawiratman BS, Naicker MS. Facilitators and Barriers to the Rehabilitation Workforce Capacity Building in Low- to Middle-Income Countries. Phys Med Rehabil Clin N Am 2019; 30:867-877. [PMID: 31563176 DOI: 10.1016/j.pmr.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
An increase in population and chronic conditions leading to disability require increasing emphasis on rehabilitation and health intervention. Poorer countries do not usually have the rehabilitation workforce needed to promote societal inclusion and participation. The roles of the rehabilitation workforce were often not clearly defined, leading to task shifting among rehabilitation professionals. Barriers to capacity building were poor availability of human resources and insufficient training program/supports for their professional development. Facilitators were local government support and international non-governmental organizations collaboration. Recommendations for capacity building effort are for collaboration with the developed nations to encourage funding, training, education, and sharing of resources.
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Affiliation(s)
- Amaramalar Selvi Naicker
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia.
| | - Ohnmar Htwe
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Abena Yeboaa Tannor
- Department of Family Medicine, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, PO EBox 1934, Kumasi, Ghana
| | - Wouter De Groote
- Department of Rehabilitation Medicine, St Jozef, Bornem, Belgium
| | - Brenda Saria Yuliawiratman
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Manimalar Selvi Naicker
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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Rehabilitation for People Living with Dementia: A Scoping Review of Processes and Outcomes. J Aging Res 2019; 2019:4141050. [PMID: 31275651 PMCID: PMC6589218 DOI: 10.1155/2019/4141050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives The aim of this scoping review was to map intervention studies of rehabilitation for people living with dementia regarding processes and outcomes, with a particular focus on whether the intervention is person-centred, home-based, or organised adopting a multidisciplinary approach and measures outcomes relating to everyday functioning and well-being. Methods A systematic search of electronic databases was conducted in PubMed, CINAHL, PsycINFO, Embase, and Cochrane. Studies from 2005 to November 2018 were collected and screened for relevance and quality. Randomised control trials and prospective cohort trials reporting a statistically significant effect on one or more outcome measures were included. Included studies were mapped according to selected processes and outcome measures. Results Twenty-six intervention studies were included and mapped. Nineteen of the interventions were person-centred, nine were home-based, and 14 reported a multidisciplinary approach. Twelve of the interventions had activities of daily living as an outcome measure, and 14 had quality of life as an outcome measure. Conclusion Person-centredness appears in most rehabilitation interventions for people living with dementia. Other processes and outcomes are heterogeneously described in the research literature. Rehabilitation programmes can be home-based or take place at a centre. Although not exclusive, the organisation of rehabilitation can be multidisciplinary. Fewer than half of the intervention studies measure the impact on activities of daily living and quality of life. Future guidelines must take into account the weak evidence regarding these aspects.
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Hustoft M, Biringer E, Gjesdal S, Moen VP, Aβmus J, Hetlevik Ø. The effect of team collaboration and continuity of care on health and disability among rehabilitation patients: a longitudinal survey-based study from western Norway. Qual Life Res 2019; 28:2773-2785. [PMID: 31144204 PMCID: PMC6761089 DOI: 10.1007/s11136-019-02216-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate how changes in patient-rated health and disability from baseline to after rehabilitation were associated with communication and relationships in rehabilitation teams and patient-rated continuity of care. METHODS Linear models were used to assess the associations between relational coordination [RC] and Nijmegen Continuity Questionnaire-Norwegian version [NCQ-N] with changes in the World Health Association Disability Assessment Schedule 2.0 [WHODAS 2.0] and EuroQol EQ-VAS [EQ-VAS]. To express change in WHODAS 2.0 and EQ-VAS, the model was adjusted for WHODAS 2.0 and EQ-VAS baseline scores. Analyses for possible slopes for the various diagnosis groups were performed. RESULTS A sample of 701 patients were included in the patient cohort, followed from before rehabilitation to 1 year after a rehabilitation stay involving treatment by 15 different interprofessional teams. The analyses revealed associations between continuity of care and changes in patient-rated health, measured with EQ-VAS (all p values < 0.01). RC communication was associated with more improvement in functioning in neoplasms patient group, compared to improvement of health among included patient groups. The results revealed no associations between NCQ-N and WHODAS 2.0 global score, or between RC in the rehabilitation teams treating the patients and changes in WHODAS 2.0 global score. CONCLUSION The current results revealed that better personal, team and cross-boundary continuity of rehabilitation care was associated with better patient health after rehabilitation at 1-year follow-up. Measures of patient experiences with different types of continuity of care may provide a promising indicator of the quality of rehabilitation care.
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Affiliation(s)
- Merethe Hustoft
- Centre for Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway.
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Eva Biringer
- Section of Research and Innovation, Helse Fonna Local Health Authority, Haugesund/Stord, Norway
| | - Sturla Gjesdal
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Vegard Pihl Moen
- Centre for Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Jörg Aβmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
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Dellafiore F, Caruso R, Conte G, Grugnetti AM, Bellani S, Arrigoni C. Individual-level determinants of interprofessional team collaboration in healthcare. J Interprof Care 2019; 33:762-767. [PMID: 31006297 DOI: 10.1080/13561820.2019.1594732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interprofessional team collaboration (ITC) is pivotal for the safety and the quality of healthcare settings, being associated with higher staff and patient satisfaction. However, individual-level determinants (i.e. socio-demographic and working satisfaction) remain currently largely unexplored. This study aimed to describe the overall ITC (i.e. partnership, cooperation, coordination), identifying the individual-level determinants of each ITC domain. This study had a multicentre approach, using cross-sectional data collection. ITC was assessed using the Interprofessional Team Collaboration Scale II, Italian version (I-AITCS II). The determinants of ITC were investigated through multivariable linear regression models. The study results showed significant associations between the same ITC domains, as well as the important role of work satisfaction in determining cooperation and coordination. Physicians reported more inadequate partnership levels than other healthcare professionals. This study provides insights for future research and gives a useful description of the determinants of ITC for multi-stakeholder healthcare organizations.
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Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Simona Bellani
- Orthopedics and traumatology Unit, ASST Monza, Monza, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
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Van de Winckel A, Ottiger B, Bohlhalter S, Nyffeler T, Vanbellingen T. Comprehensive ADL Outcome Measurement after Stroke: Rasch Validation of the Lucerne ICF-Based Multidisciplinary Observation Scale (LIMOS). Arch Phys Med Rehabil 2019; 100:2314-2323. [PMID: 30928303 DOI: 10.1016/j.apmr.2019.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/02/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To establish Rasch validation of the Lucerne International Classification of Functioning, Disability and Health (ICF)-based Multidisciplinary Observation Scale (LIMOS) in stroke. LIMOS measures the level of assistance in daily life activities related to motor function, communication, cognition, and domestic life. Rasch Measurement Theory (RMT) transforms an ordinal scale into an interval scale and thus the Rasch-based LIMOS scale captures a more accurate improvement of functional outcomes via Rasch-transformed scores. DESIGN Cross-sectional study design. SETTING Neurorehabilitation center, Luzerne, Switzerland. PARTICIPANTS We recruited participants with stroke (N=407; age=63.2±16.0y; n=157 women) through consecutive sampling. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were assessed with LIMOS at admission and discharge of rehabilitation. We used RMT to evaluate overall model fit, response dependency, floor and ceiling effect, reliability, and differential item functioning (DIF) for sex, age, type, and time of stroke on the 4 LIMOS subscales using the Rasch Unidimensional Measurement Model (RUMM) 2030 program. RESULTS The Rasch-based LIMOS subscales fit the Rasch model after reducing and rescoring items: motor (from 20 to 18 items), communication (5 items), cognition (from 15 to 13 items), and domestic life (5 items). There was no floor or ceiling effect. Some artificial DIF was identified. Scoring at discharge was dependent on the scoring responses at admission, which means that without applying a correction factor to the discharge scores, there was an underestimation of change in scores between admission and discharge, ranging from 0.24 to 0.97 logits (10.79%-49.24%) on the different subscales. CONCLUSIONS The Rasch-based LIMOS scale is recommended to measure functional outcome in people with acute or chronic stages of ischemic or hemorrhagic stroke.
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota.
| | | | | | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Bailey JC, Kurklinsky S, Sletten CD, Osborne MD. The Effectiveness of an Intensive Interdisciplinary Pain Rehabilitation Program in the Treatment of Post-Laminectomy Syndrome in Patients Who Have Failed Spinal Cord Stimulation. PAIN MEDICINE 2019; 19:385-392. [PMID: 28402524 DOI: 10.1093/pm/pnx060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction Post-laminectomy syndrome (PLS) patients who have previously undergone spinal cord stimulation and failed to have significant improvement create a unique challenge for ongoing pain management. We hypothesize that, following successful completion of intensive, interdisciplinary pain rehabilitation (IPR), this patient population can achieve a significant reduction in pain, improvement in mood, functional levels, and self-efficacy. Materials and methods A retrospective chart review was conducted comparing the following for patients prior to enrollment in the IPR program and upon completion: numeric rating scale (NRS) pain scores; functional status via the six-minute walk test; mood via the Center for Epidemiologic Studies Depression Scale (CES-D), Multidimensional Pain Inventory (MPI) Life control scores and MPI Interference, and the Pain Catastrophizing Scale (PCS); and self-efficacy via the Pain Self-Efficacy Questionnaire (PSEQ). Results Forty-three patients met inclusion criteria, with 17 males and 26 females and a mean age of 64 years. Patients demonstrated a statistically significant increase in six-minute walk test distance of 104 m, a decrease in average NRS pain score of 1.4 points, an increase in average MPI life control by 8.3 points, a decrease average MPI interference by 5.3 points, an increase in average Short Form-36 by 6.5 points, an increase in average PCS by 4.4 points, and an increase in average PSEQ score of 18.1. Their average mood via CES-D improved by 4.2 points. Conclusions Intensive, interdisciplinary pain rehabilitation provides an effective therapeutic modality for patients with post-laminectomy syndrome who have failed spinal cord stimulation by decreasing pain levels and by increasing functional status and self-efficacy.
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Affiliation(s)
- Joshua C Bailey
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Michael D Osborne
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Scrivener K, Pocovi N, Jones T, Dean B, Gallagher S, Henrisson W, Thorburn M, Dean C. Observations of Activity Levels in a Purpose-Built, Inpatient, Rehabilitation Facility. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:26-38. [DOI: 10.1177/1937586718823519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Effective rehabilitation should include high levels of physical activity. The impact of the environmental design on activity levels has had minimal consideration. Purpose: This study investigates activity levels of inpatients undergoing rehabilitation in a new rehabilitation facility with innovative design and multidisciplinary care, comparing weekday and weekend activity levels, as well as changes over a 12-month period. Method: An observational study reporting participants’ location, people present, body position, and activity type on 2 weekdays and 1 weekend day using behavior mapping techniques. Fifteen participants were observed in a mixed rehabilitation unit with neurological, orthopedic, and other health conditions. Results: Results were calculated as the proportion of observations participants spent in each location, position, and performing activities (physical, cognitive, social), and time spent alone and inactive. On average, participants were engaged in activity for 86% (standard deviation [ SD] = 9) of the day, with physical activity accounting for 51% ( SD = 11), cognitive activity 28% ( SD = 10), and social activity 42% ( SD = 16). There was more physical activity (mean difference [ MD] 8% absolute, confidence interval [CI] = [4, 12], p < .01) and less social activity ( MD −6% absolute, CI [−11, −1], p = .02) on weekdays compared to weekends. Overall, participants were alone and inactive for 12% ( SD = 9) of the day. Participants observed in 2016 displayed similar results to those observed in 2015. Conclusion: High levels of activity were achieved in this facility that underwent environmental redesign, construction of new facilities, and implementation of evidence-based strategies.
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Affiliation(s)
- Katharine Scrivener
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Natasha Pocovi
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Taryn Jones
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Bridget Dean
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Shaun Gallagher
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Wesley Henrisson
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Michael Thorburn
- Department of Health Professions, Macquarie University, New South Wales, Australia
| | - Catherine Dean
- Department of Health Professions, Macquarie University, New South Wales, Australia
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Küçükdeveci AA, Stibrant Sunnerhagen K, Golyk V, Delarque A, Ivanova G, Zampolini M, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2019; 54:957-970. [DOI: 10.23736/s1973-9087.18.05501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Hustoft M, Biringer E, Gjesdal S, Aβmus J, Hetlevik Ø. Relational coordination in interprofessional teams and its effect on patient-reported benefit and continuity of care: a prospective cohort study from rehabilitation centres in Western Norway. BMC Health Serv Res 2018; 18:719. [PMID: 30223847 PMCID: PMC6142375 DOI: 10.1186/s12913-018-3536-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background Rehabilitation services depend on competent professionals who collaborate effectively. Well-functioning interprofessional teams are expected to positively impact continuity of care. Key factors in continuity of care are communication and collaboration among health care professionals in a team and their patients. This study assessed the associations between team functioning and patient-reported benefits and continuity of care in somatic rehabilitation centres. Methods This prospective cohort study uses survey data from 984 patients and from health care professionals in 15 teams in seven somatic rehabilitation centres in Western Norway. Linear mixed effect models were used to investigate associations between the interprofessional team communication and relationship scores (measured by the Relational Coordination [RC] Survey and patient-reported benefit and personal-, team- and cross-boundary continuity of care. Patient-reported continuity of care was measured using the Norwegian version of the Nijmegen Continuity Questionnaire. Results The mean communication score for healthcare teams was 3.9 (standard deviation [SD] = 0.63, 95% confidence interval [CI] = 3.78, 4.00), and the mean relationship score was 4.1 (SD = 0.56, 95% CI = 3.97, 4.18). Communication scores in rehabilitation teams varied from 3.4–4.3 and relationship scores from 3.6–4.5. Patients treated by teams with higher relationship scores experienced better continuity between health care professionals in the team at the rehabilitation centre (b = 0.36, 95% CI = 0.05, 0.68; p = 0.024). There was a positive association between RC communication in the team the patient was treated by and patient-reported activities of daily living benefit score; all other associations between RC scores and rehabilitation benefit scores were not significant. Conclusion Team function is associated with better patient-reported continuity of care and higher ADL-benefit scores among patients after rehabilitation. These findings indicate that interprofessional teams’ RC scores may predict rehabilitation outcomes, but further studies are needed before RC scores can be used as a quality indicator in somatic rehabilitation. Electronic supplementary material The online version of this article (10.1186/s12913-018-3536-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merethe Hustoft
- Centre for Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway. .,Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Eva Biringer
- Section of Research and Innovation, Helse Fonna Local Health Authority, Haugesund/Stord, Norway
| | - Sturla Gjesdal
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Jörg Aβmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
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Caruso R, Magon A, Dellafiore F, Griffini S, Milani L, Stievano A, Orchard CA. Italian version of the Assessment of Interprofessional Team Collaboration Scale II (I-AITCS II): a multiphase study of validity and reliability amongst healthcare providers. LA MEDICINA DEL LAVORO 2018; 109:316-324. [PMID: 30168504 PMCID: PMC7682163 DOI: 10.23749/mdl.v109i4.7101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022]
Abstract
Objective: To develop and validate an Italian version of the Assessment of Interprofessional Team Collaboration Scale II (I-AITCS II). Methods: A multiphase validation study was conducted. The first phase was the AITCS-II translation from English into Italian to develop the first version of I-AITCS II for practitioners. The second phase was the study of I-AITCS II face and content validity, and the third phase was a cross-sectional data collection to provide evidence of construct validity using the psychometrics testing and the reliability assessment through the internal consistency study. Results: The agreement for the forward-translation among researchers was high. The face and content validity were satisfactory. The underlying constructs of I-AITCS II were partnership, cooperation and coordination. Internal consistency was good for both scale and domains level. There were significant differences related to partnership in the comparison between settings. Conclusions: I-AITCS II showed evidence of validity and reliability. It will be useful to gather data to address programs aimed to enhance interprofessional team collaboration within the Italian healthcare contexts, and it could be used for cross-national researches.
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Affiliation(s)
- Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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Communication and Relational Ties in Inter-Professional Teams in Norwegian Specialized Health Care: A Multicentre Study of Relational Coordination. Int J Integr Care 2018; 18:9. [PMID: 30127693 PMCID: PMC6095090 DOI: 10.5334/ijic.3432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: The delivery of integrated care depends on the quality of communication and relationships among health-care professionals in inter-professional teams. The main aim of this study was to investigate individual and team communication and relational ties of teams in specific care processes within specialized health care. Methods: This cross-sectional multi-centre study used data from six somatic hospitals and six psychiatric units (N = 263 [response rate, 52%], 23 care processes) using a Norwegian version of the Relational Coordination Survey. We employed linear mixed-effect regression models and one-way analyses of variance. Results: The mean (standard deviation) relational coordination total score ranged from 4.5 (0.33) to 2.7 (0.50). The communication and relationship sub-scale scores were significantly higher within similar functional groups than between contrasting functional groups (P < .05). Written clinical procedures were significantly associated with higher communication scores (P < .05). The proportion of women in a team was associated with higher communication and relationship scores (P < .05). Conclusion: The Relational Coordination Survey shows a marked variation in team functions within inter-professional teams in specialized health-care settings. Further research is needed to determine the reasons for these variations.
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Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study. J Head Trauma Rehabil 2018; 33:E38-E48. [PMID: 29385013 DOI: 10.1097/htr.0000000000000370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate a model of community-based case management (CM). SETTING New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP). PARTICIPANTS All clinicians (N = 72) providing CM within 14 BIRP community rehabilitation teams. DESIGN A prospective, multicenter study. MAIN MEASURES A purpose-designed survey. METHODS Participants from the 12 adult and 2 pediatric services (8 located in metropolitan areas, 6 in rural areas) completed a 3-part survey investigating their organizational context, clinical approach, and CM interventions. Between-groups analyses explored differences among individual services, as well as differences based on age (adult vs pediatric) and location (metropolitan vs rural). RESULTS All services provided a direct service model of CM. The underlying principles were uniform across services (more direct than indirect service provision; with more client-related than administrative-related tasks; more holistic than service-led in defining client needs; with decision making equally directed by staff and clients; and undertaking a more comprehensive than minimalist range of tasks). CM interventions included the provision of individual support, family support, advocacy, and community development alongside assessment, monitoring, referral, and liaison tasks. There were little differences in practice based on age or location. CONCLUSION The NSW BIRP has drawn upon the results to produce a model of service for CM.
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Wylie K, McAllister L, Davidson B, Marshall J, Amponsah C, Bampoe JO. Self-help and help-seeking for communication disability in Ghana: implications for the development of communication disability rehabilitation services. Global Health 2017; 13:92. [PMID: 29284504 PMCID: PMC5747098 DOI: 10.1186/s12992-017-0317-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In low and middle-income countries, such as Ghana, communication disability is poorly recognised and rehabilitation services for people with communication disability are limited. As rehabilitation services for communication disability develop, and the profession of speech-language pathology grows, it is important to consider how services can most appropriately respond to the needs and preferences of the community. Understanding the ways in which people currently self-help and seek help for communication disability is central to developing services that build on existing local practices and are relevant to the community. METHODS A qualitative descriptive survey was used to explore likely self-help and help-seeking behaviours for communication disability, in Accra, Ghana. The survey required participants to describe responses to hypothetical scenarios related to communication disability. A mix of theoretical sampling and convenience sampling was used. Qualitative content analysis was used to analyse data and develop categories and subcategories of reported self-help behaviours and sources of help and advice for communication disability. RESULTS One hundred and thirty-six participants completed the survey. Results indicated that community members would be likely to engage in a variety self-help strategies in response to communication disability. These included working directly with a person with a communication disability to attempt to remediate a communication impairment, altering physical and communication environments, changing attitudes or care practices, educating themselves about the communication disability, providing resources, and responding in spiritual ways. Participants indicated that they would seek help for communication disability across a range of sectors - including the Western healthcare, religious, and traditional sectors. CONCLUSIONS Understanding existing community actions to self-help and help-seek may allow emerging communication rehabilitation services, including the profession of speech-language pathology, to build on existing community practices in resource-limited contexts such as Ghana.
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Affiliation(s)
- Karen Wylie
- Korle Bu Teaching Hospital, ENT Department, PO Box 77, Korle Bu, Accra, Ghana
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, PO Box 143, Korle Bu, Accra, Ghana
| | - Lindy McAllister
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
| | - Bronwyn Davidson
- Department of Audiology & Speech Pathology, The University of Melbourne, 550 Swanston Street, Melbourne, VIC 3010 Australia
| | - Julie Marshall
- Health Professions Department, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6GX UK
| | - Clement Amponsah
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, PO Box 143, Korle Bu, Accra, Ghana
| | - Josephine Ohenewa Bampoe
- Department of Audiology, Speech and Language Therapy, School of Biomedical and Allied Health Sciences, University of Ghana, PO Box 143, Korle Bu, Accra, Ghana
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Kanbe K, Sekine C. Long-Term Efficacy of Rehabilitation Following Arthroscopic Synovectomy in Patients With Rheumatoid Arthritis Treated With Biologic Agents. Ann Rehabil Med 2017; 41:998-1004. [PMID: 29354576 PMCID: PMC5773443 DOI: 10.5535/arm.2017.41.6.998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/25/2017] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents. Methods Arthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes. Results The increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89–0.21X). Conclusion Rehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.
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Affiliation(s)
- Katsuaki Kanbe
- Department of Rehabilitation, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.,Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Chiaki Sekine
- Department of Rehabilitation, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.,Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
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Ciapponi A, Lewin S, Herrera CA, Opiyo N, Pantoja T, Paulsen E, Rada G, Wiysonge CS, Bastías G, Dudley L, Flottorp S, Gagnon M, Garcia Marti S, Glenton C, Okwundu CI, Peñaloza B, Suleman F, Oxman AD. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011083. [PMID: 28901005 PMCID: PMC5621087 DOI: 10.1002/14651858.cd011083.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. METHODS We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile phone messaging for patients with long-term illnesses, mobile phone messaging reminders for attendance at healthcare appointments, mobile phone messaging to promote adherence to antiretroviral therapy, women carrying their own case notes in pregnancy, interventions to improve childhood vaccination. Quality and safety systems: decision support with clinical information systems for people living with HIV/AIDS. Complex interventions (cutting across delivery categories and other health system arrangements): emergency obstetric referral interventions. AUTHORS' CONCLUSIONS A wide range of strategies have been evaluated for improving delivery arrangements in low-income countries, using sound systematic review methods in both Cochrane and non-Cochrane reviews. These reviews have assessed a range of outcomes. Most of the available evidence focuses on who provides care, where care is provided and coordination of care. For all the main categories of delivery arrangements, we identified gaps in primary research related to uncertainty about the applicability of the evidence to low-income countries, low- or very low-certainty evidence or a lack of studies.
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Affiliation(s)
- Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Cristian A Herrera
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Tomas Pantoja
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | | | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Gabriel Bastías
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Lilian Dudley
- Stellenbosch UniversityDivision of Community Health, Faculty of Medicine and Health SciencesFransie Van Zyl DriveTygerbergCape TownSouth Africa7505
| | - Signe Flottorp
- Norwegian Institute of Public HealthDepartment for Evidence SynthesisPO Box 4404 NydalenOsloNorway0403
| | - Marie‐Pierre Gagnon
- CHU de Québec ‐ Université Laval Research CentrePopulation Health and Optimal Health Practices Research Unit10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Charles I Okwundu
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Fatima Suleman
- University of KwaZulu‐NatalDiscipline of Pharmaceutical Sciences, School of Health SciencesPrivate Bag X54001DurbanKZNSouth Africa4000
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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Ndosi M, Ferguson R, Backhouse MR, Bearne L, Ainsworth P, Roach A, Dennison E, Cherry L. National variation in the composition of rheumatology multidisciplinary teams: a cross-sectional study. Rheumatol Int 2017; 37:1453-1459. [PMID: 28551723 PMCID: PMC5570775 DOI: 10.1007/s00296-017-3751-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 05/18/2017] [Indexed: 11/27/2022]
Abstract
The objective of this study is to describe the composition of multidisciplinary teams (MDT) working within rheumatology departments across the UK. All rheumatology departments in the United Kingdom (UK) were invited to participate in a national electronic survey between February 2014 and April 2015 as a part of a national audit for the management of rheumatoid and early inflammatory arthritis commissioned by Healthcare Quality Improvement Partnership. Rheumatology departments were asked to report their MDT composition; defined as a rheumatologist (consultant or specialist trainee), specialist nurse, occupational therapist physiotherapist, and podiatrist. The data were collected as Whole Time Equivalent (WTE) of each professional group at each department adjusted to 100,000 population. The data were grouped according to British Society for Rheumatology regions to study regional variations. The survey was completed by 164/167 departments (98% response rate). All departments reported an MDT comprising a rheumatologist (consultant or specialist trainee) and almost all included a specialist nurse but only 28 (17%) of the departments had MDTs comprising all the professional groups. There was a high degree of regional variation in the provision of Allied Health Professionals (physiotherapists, occupational therapists, and podiatrists) in the UK. MDT care is recommended for the management of inflammatory arthritis, but few UK rheumatology departments have a full complement of healthcare professionals within their MDT. There is a high degree of regional variation in the composition and staffing levels of the rheumatology MDT across the UK; the impact of which warrants further investigation.
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Affiliation(s)
- Mwidimi Ndosi
- Department of Nursing and Midwifery, Centre for Health and Clinical Research, University of the West of England, Bristol, UK.
- Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK.
| | - Rachel Ferguson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- Department of Podiatry, Solent NHS Trust, Southampton, UK
| | - Michael R Backhouse
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lindsay Bearne
- Division of Health and Social Care Research, King's College London, London, UK
| | | | - Alan Roach
- British Society for Rheumatology, London, UK
| | | | - Lindsey Cherry
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- Department of Podiatry, Solent NHS Trust, Southampton, UK
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Differences in Multidisciplinary and Interdisciplinary Treatment Programs for Fibromyalgia: A Mapping Review. Pain Res Manag 2017; 2017:7261468. [PMID: 28620267 PMCID: PMC5460453 DOI: 10.1155/2017/7261468] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/19/2017] [Indexed: 01/18/2023]
Abstract
Fibromyalgia is a multifaceted chronic pain syndrome and the integration of different health disciplines is strongly recommended for its care. The interventions based on this principle are very heterogeneous and the difference across their structures has not been extensively studied, leading to incorrect conclusions when their outcomes are pooled. The objective of this mapping review was to summarize the characteristics of these programs, with particular focus on the integration of their components. We performed a search of the literature about treatments for fibromyalgia involving multiple disciplines on PubMed and Scopus. Starting from 560 articles, we included 22 noncontrolled studies, 10 controlled studies, and 17 RCTs evaluating the effects of 38 multidisciplinary or interdisciplinary interventions. The average quality of the studies was low. Their outcomes were usually pain intensity, quality of life, and psychological variables. We created a map of the programs based on the degree of integration of the included disciplines, which ranged from a juxtaposition of few components to a complex harmonization of different perspectives obtained through teamwork strategies. The rehabilitation programs were then thoroughly described with regard to the duration, setting, therapeutic components, and professionals included. The implications for future quantitative reviews are discussed.
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Björnsdóttir SV, Triebel J, Arnljótsdóttir M, Tómasson G, Valdimarsdóttir UA. Long-lasting improvements in health-related quality of life among women with chronic pain, following multidisciplinary rehabilitation. Disabil Rehabil 2017; 40:1764-1772. [DOI: 10.1080/09638288.2017.1312565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sigrún Vala Björnsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
| | - Jan Triebel
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
- Department of Orthopaedic Surgery, Akademiska, University Hospital Uppsala, Sweden
| | | | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Health team for the elderly: a feasibility study for preventive home visits. Prim Health Care Res Dev 2017; 18:242-252. [DOI: 10.1017/s1463423617000019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim was to describe the development, utilization and feasibility of a model of preventive home visits, in an urban and a rural municipality in Norway.
Background
Older people >65 years will rise significantly in coming years. Increased age is associated with risk of disability, illness and need for public health services. Preventive home visits is assumed to help older people to maintain their functional level longer, delaying disease and thus delaying the need for health care.
Method
Descriptive explorative design describing the development, utilization and feasibility of preventive home visits in two different settings. All 77-year-old persons living at home in an urban municipality and all 75 years and older in a rural municipality were invited to participate. A questionnaire including a substantial number of tests concerning; fall, nutrition, polypharmacy and cognitive impairment was used by Health Team Nurses as base for a risk assessment. Pilot studies were conducted to validate the questionnaire including an inter-rater reliability study of the risk assessment tool. A multiprofessional team, Health Team for the Elderly met each week to evaluate risk assessments and make recommendations to be sent to each respective general practitioner. Data were analysed using descriptive and inferential statistics. In total, 167 persons (109 from the urban municipality and 58 from the rural municipality) participated, corresponding to 60% of the approached individuals. The mean time for the visits was 108 minutes (SD 20). Missing data were identified for; Do you feel safe in your municipality (17.5%) and Are you looking forward to ageing (11.4%). In total, 36 persons (21.7%) were identified with increased risk for developing illness. We suggest that a structured model of preventive home visits and collaboration between highly specialized health care professionals are important factors for reliable health promoting risk assessments of elderly home dwellers.
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Coppack RJ, Bilzon JL, Wills AK, McCurdie IM, Partridge L, Nicol AM, Bennett AN. A comparison of multidisciplinary team residential rehabilitation with conventional outpatient care for the treatment of non-arthritic intra-articular hip pain in UK Military personnel - a protocol for a randomised controlled trial. BMC Musculoskelet Disord 2016; 17:459. [PMID: 27821103 PMCID: PMC5100075 DOI: 10.1186/s12891-016-1309-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/26/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Non-arthritic hip disorders are defined as abnormalities of the articulating surfaces of the acetabulum and femur before the onset of osteoarthritis, including intra-articular structures such as the acetabular labrum and chondral surfaces. Abnormal femoroacetabular morphology is commonly seen in young men who constitute much of the UK military population. Residential multidisciplinary team (MDT) rehabilitation for patients with musculoskeletal injuries has a long tradition in the UK military, however, there are no studies presenting empirical data on the efficacy of a residential MDT approach compared with individualised conventional outpatient treatment. With no available data, the sustainability of this care pathway has been questioned. The purpose of this randomised controlled trial is to compare the effects of a residential multidisciplinary intervention, to usual outpatient care, on the clinical outcomes of young active adults undergoing treatment for non-arthritic intra-articular hip pain. METHODS/DESIGN The trial will be conducted at the Defence Medical Rehabilitation Centre, Headley Court, UK. One hundred military male participants with clinical indicators of non-arthritic intra-articular hip pain will be randomly allocated to either: (1) 7-day residential multidisciplinary team intervention, n = 50; (2) 6-week physiotherapist-led outpatient intervention (conventional care), n = 50. Measurements will be taken at baseline, post-treatment (1-week MDT group; 6-weeks physiotherapy group), and 12-weeks. The primary outcome measures are the function in daily living sub-scale of the Copenhagen Hip and Groin Outcome Score (HAGOS), the physical function subscale of the Non-arthritic Hip Score (NAHS), and VAS pain scale. Secondary outcomes include objective measures of physical capacity and general health. An intention-to-treat analysis will be performed using linear and mixed models. DISCUSSION This study will be the first to assess the efficacy of intensive MDT rehabilitation, versus conventional outpatient care, for the management of non-arthritic hip pain. The results from this study will add to the evidence-base and inform clinical practice for the management of intra-articular non-arthritic hip pain and femoroacetabular impingement in young active adults. TRIAL REGISTRATION ISRCTN Reference: ISRCTN 59255714 dated 11-Nov-2015.
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Affiliation(s)
- Russell J. Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Andrew K. Wills
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Ian M. McCurdie
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
| | - Laura Partridge
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
| | - Alastair M. Nicol
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
| | - Alexander N. Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Epsom, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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