Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BACKGROUND

Primary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.

METHODS

A retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.

RESULTS

The findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30-49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.

CONCLUSION

This study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

[Current status of requirements in the design of healthcare facilities to ensure accessibility for patients with disabilities]

BACKGROUND AND OBJECTIVE

People with disabilities are one of the groups that usually frequent healthcare centers, so it is essential to attend to their specific needs, especially from the point of view of universal accessibility, safety and healthcare quality. The aim of the study is to summarize the available evidence on the needs of groups of patients with some type of disability in access, navigation and stay during the reception of healthcare in various health centers and to identify successful solutions.

MATERIALS AND METHODS

A scoping review had been designed, based on a literature review without time limit in three databases (PubMed, WOS, and Embase).

RESULTS

Of the 2562 articles identified, 11 were included. Recommendations for improvement in the design of healthcare services focused on the following aspects: improving access to primary care centers; navigation, signage, and orientation in the hospital environment; elevator design; hospital room bathroom design; meeting the needs of wheelchair users; importance of the participation of the patient with a disability; involvement of stakeholders in the design process; and the need for appropriate policies to ensure accessibility to buildings.

CONCLUSIONS

The promotion of artistic programs in healthcare settings and the participation of people with disabilities in the design process of healthcare settings could provide beneficial solutions. More studies are needed, given the scarcity of evidence found, to ensure that care for this group is based on criteria of patient safety, universal accessibility, healthcare quality and humanization.

Health-Related Quality of Life in Patients with Inherited Ataxia in Ireland

Inherited cerebellar ataxias (CA) are heterogeneous progressive neurological conditions associated with significant functional limitations. This study aimed to assess the implications of inherited CA on patients' self-reported quality of life (QoL) and impairments in work and activities. 129 individuals with ataxia responded to a survey focused on QoL. Health-related QoL was measured using the RAND 36-Item Short Form Survey. An adaptation of the validated Work Productivity and Activity Impairment questionnaire was used to assess the effect of health on work productivity and ability to perform activities over the past week. Nine percent of respondents were currently employed. Individuals with inherited ataxia experienced significant activity impairment, and 75% required professional or informal care. Health-related quality of life (HRQoL) was significantly worse in all areas for the individuals with inherited ataxia compared with Irish population normative values. Participants with Friedreich's ataxia (n = 56) demonstrated worse physical functioning then those with undetermined ataxia (n = 55). Female gender, younger age at symptom onset, current employment, retirement due to age or ataxia, and living in a long-term care facility were associated with higher sub-scores in different domains of HRQoL, while disease duration correlated with worse physical functioning sub-scores. This study is the first cross-sectional study on HRQoL in patients with inherited ataxia in Ireland. It highlights high rates of unemployment, difficulty with daily activities and physical functioning limitations, which is worse than comparative international studies. Given the limited therapeutic options currently available, optimising HRQoL is an important aspect of managing ataxia.

Is there a sexual difference in the relationship between sociodemographic information and the unmet dental care needs of disabled adults? An analysis from a national survey on persons with disabilities

BACKGROUND

Health status and health care utilization in people with disabilities are more likely to be poorer than those without disabilities. Previous studies showed that there were gaps in health-related conditions by sociodemographic information and gender but the association between these factors was not explained. This study aims to analyze the relationship between sociodemographic information and the unmet dental care needs of people with disabilities and explore the effect of sex within this relationship.

METHODS

The 2014 national survey on persons with disabilities was used, which separated unmet healthcare needs into medical and dental services. Unweighted samples included 6,824 people with disabilities in total and 6,555 (96.1% of the total, weighted as 6,583) people aged 20 years or older were selected as the study population. Frequency and chi-square tests were conducted to determine differences in the prevalence of unmet dental needs based on socioeconomic information, chronic diseases, and behavioral factors after applying weights. Logistic regressions were performed using an adjusted model with sociodemographic information, chronic diseases, and behavioral variables. All analyses were performed using IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA).

RESULTS

Analysis of the sociodemographic factors related to unmet dental care revealed that they were higher in women and the elderly. In the fully adjusted logistic model, most of the sociodemographic information was significantly associated with unmet dental needs. The lowest group was 4.18 times more likely to have unmet dental care needs than the richest group, and females and middle-school graduates were almost twice as likely to experience unmet dental care needs than males and university graduates. Considering the interaction effect of age on unmet dental needs depending on sex differences, the odds ratio decreased for females with every annual increase in both models. Compared with the younger group, the older group showed a lower risk of having unmet dental needs, especially in females.

CONCLUSIONS

The factor most closely related to the unmet dental care needs of disabled people was socioeconomic problems. Its influence also differed by sex and age. Therefore, economic support measures and sexual differences are needed for long-term policy consideration to reduce the unmet dental care needs of disabled people.

Delivering Rehabilitation Care Around the World: Voices From the Field

OBJECTIVES

To identify the challenges and common issues that the rehabilitation health workforce experienced in delivering services in different practice settings across the world. These experiences could suggest approaches to improving rehabilitation care to people in need.

DESIGN

A semi-structured interview protocol centering on 3 broad research questions was conducted to collect data. The data were analyzed to identify common themes across the cohort interviewed.

SETTING

Interviews were conducted using Zoom. Interviewees not able to access Zoom provided written responses to the questions.

PARTICIPANTS

Participants included 30 key rehabilitation opinion leaders from different disciplines from 24 countries, across world regions and income levels (N=30).

INTERVENTIONS

NA.

MAIN OUTCOME MEASURES

Although rehabilitation care deficiencies differ in severity, participants reported that the demand for services consistently outstrips available care, regardless of world region or income level. Access and social barriers, particularly in rural areas and remote regions, are common challenges for those delivering and receiving rehabilitation care.

RESULTS

Individual voices from the field reported both challenges and hopeful changes in making rehabilitation services available and accessible.

CONCLUSIONS

The descriptive approach undertaken has allowed individual voices, rarely included in studies, to be highlighted as meaningful data. Although the research findings are not generalizable beyond the convenience cohort included without further analysis and validation in specific local practice contexts, the authentic voices that spoke out on these issues demonstrated common themes of frustration with the current state of rehabilitation services delivery but also hopefulness that more solutions are on the horizon.

Investigation and influencing factors of the behavioral intention of nurses voluntarily participating in the care of older adults with disabilities

Objectives

This study aimed to analyze nurses' intention and influencing factors to participate in voluntary care services for older adults with disabilities, and build a structural equation model to clarify the influence of behavioral attitude, subjective norms, and perceived behavioral control on the behavioral intention, to lay the foundation for establishing voluntary care teams for older adults with disabilities.

Methods

This cross-sectional study was conducted in 30 hospitals of different levels from August to November 2020. Participants were selected by convenience sampling. A self-designed questionnaire was used to survey nurses to investigate their intention to participate in voluntary care services for older adults with disabilities, including four dimensions: behavioral intention (three items), behavioral attitude (seven items), subjective norms (eight items), and perceived behavioral control (eight items), a total of 26 items. Logistic regression was used to analyze the influence of general information on behavioral intention. Smart PLS 3.0 software was used to build the structural equation model, and the influence of behavioral attitude, subjective norms, and perceived behavioral control on behavioral intention was analyzed.

Results

A total of 1,998 nurses were enrolled, 1,191 (59.6%) were willing to participate in volunteer care for older adults with disabilities, and the willingness of nurses to participate in volunteer care for older adults with disabilities was above the medium level. The scores of behavioral attitude, subjective norm, perceived behavioral control, and behavioral intention dimension were 26.31 ± 5.94, 30.93 ± 6.62, 27.58 ± 6.70, and 10.78 ± 2.50, respectively. Logistic regression analysis showed that the nurses who had urban household registration, held a management positions in the department, received free help from other volunteers, and was rewarded by hospitals or organizations for voluntary activities were more willing to participate (P < 0.05). The partial least squares analysis showed that behavioral attitudes (β = 0.456, P < 0.001), subjective norms (β = 0.167, P < 0.01), and perceived behavioral control (β = 0.123, P < 0.01) had a significant positive impact on behavioral intention. The more positive the attitude, the more support, the fewer the obstacles, and the greater the intention of the nurses to participate.

Conclusion

Mobilizing nurses to volunteer care for older adults with disabilities is feasible in the future. Therefore, policymakers and leaders need to improve relevant laws and regulations to ensure the safety of volunteers, reduce the external hindrance factors of volunteer activities, pay attention to the cultivation of nursing staff values, identify the internal needs of nursing staff and improve incentive measures, to improve the willingness of nursing staff to participate and transform it into practical action.

Effects of comorbidity on post-acute outcomes in acquired brain injury: ABI-RESTaRT 1991-2020

BACKGROUND

Current understanding of comorbidities associated with acquired brain injury (ABI) and the effects on post-acute ABI outcomes is poor.

OBJECTIVE

To describe the prevalence, severity and patterns of comorbidity for the pre-injury, acute and post-acute phases, and to examine the effects of post-acute comorbidities on functional independence and length of stay (LOS) at discharge from post-acute care.

METHODS

Retrospective whole-population cohort study of n = 1,011 individuals with traumatic (TBI) or non-traumatic brain injury (NTBI), or eligible neurologic conditions admitted to a post-acute neurorehabilitation and disability support service in Western Australia (WA) between 1991 and 2020. Comorbidities were ascertained from internal electronic medical records and linked hospital and emergency department data from the WA Data Linkage System. We measured comorbidities across 14 body systems using the Cumulative Illness Rating Scale (CIRS) and Elixhauser Comorbidity Index (ECI), and functional independence with the UK Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). We used multilevel mixed-effect regression models to determine the effects of comorbidity on post-acute outcomes.

RESULTS

NTBI was the most common diagnosis (54%), followed by TBI (34%) and neurologic conditions (10%). Pre-injury comorbidities were present in over half the cohort. Comorbidity prevalence increased significantly from 57% to 84% (∆+27%) and severity (mean ECI score) increased significantly from 2.1 to 13.8 (∆+11.7) between pre-injury and the acute phase and remained elevated at admission to post-acute services (82%, mean ECI score 7.3). Psychiatric comorbidity was the most prevalent (56%) and was associated with significantly poorer functional outcomes at discharge and an increase in LOS of 6.5 months. Genitourinary, musculoskeletal, eye, ear nose and throat, and renal comorbidities also had significant effects on post-acute outcomes.

CONCLUSIONS

ABI has a long-term impact on multiple body systems. Identification and management of comorbidities is critical to maximize functional outcomes and reduce the cost of post-acute care.

Are consumers satisfied with the use of prosthetic sports feet and the provision process? A mixed-methods study

BACKGROUND

Special feet connected to a prosthesis, prosthetic sports feet, enable athletes with a lower limb amputation to run. The selection of a prosthetic sports feet is usually based on body weight and preferred sports performance. The selection of a prosthetic sport feet is also based on clinicians who likely have limited experience due to a small number of athletes with a lower limb amputation.

HYPOTHESIS

Athletes with a lower limb amputation are not satisfied with the use and service associated with prosthetic sports feet due to a lack of prosthetic sports feet provision guidelines, poorer function of prosthetic sports feet compared to the anatomical foot and ankle, and limited experience of clinicians.

EVALUATION OF HYPOTHESIS

A mixed-methods study in 16 athletes with a lower limb amputation using a prosthetic sport foot from Össur or Otto Bock, included semi-structured interviews and quantitative analysis. Three dimensions of prosthetic sports feet were investigated: 1) use, 2) provision process, and 3) cosmetics. Qualitative data were analyzed to identify factors influencing consumer satisfaction. Quantitative data were analyzed to investigate satisfaction and perceived relative importance of the dimensions.

RESULTS

Participants were satisfied with the prosthetic sports feet use. However, they were not satisfied with the process prior to provision. The prosthetic sport feet use was perceived as the most important dimension. Sports performance was the critical element in the prosthetic sports feet use and was influenced by stability, confidence and fear, safety, focus, energy return, and comfort. Cosmetics were unimportant. Motivation to purchase the prosthetic sports feet was the key element for the prosthetic sports foot acquisition. Satisfaction about the process prior to provision was negatively influenced by poor support of professionals during rehabilitation, the complexity and duration of the purchase process, and lack of information and accessibility of prosthetic sports feet.

CONCLUSION

The most important dimension of the prosthetic sports feet was its use, which was directly influenced by performance. To further increase the satisfaction with prosthetic sports feet, clinicians should establish how to meet the desired sports performance level of athletes with a lower limb amputation. Improving the process prior to the provision process may increase satisfaction. We suggest increasing the support of professionals during rehabilitation and training through cooperation between involved services, organizing prosthetic sports feet try-out sessions, and increase the accessibility of the prosthetic sports feet. In this way, individuals with a lower limb amputation may become and stay more physically active and participate in sports.

The need scoping and prioritization of the medical team to integrate new technologies for inpatient rehabilitation services

BACKGROUND/PURPOSE

To explore unmet needs for inpatient rehabilitation services and assess the relative preference of new technology versus current practice by a structured decision-making model.

METHODS

The clinical needs for in-patient rehabilitation care were explored by an in-depth interview with the aid of a service blueprint in 2 affiliated hospitals of a university. A questionnaire was constructed according to the analytic hierarchical process (AHP) model to make pairwise comparison between the clinical needs for prioritization. The preference between traditional practice and new technology to fulfill the criteria was compared.

RESULTS

Seven categories of unmet needs were summarized through focus group interviews to construct a questionnaire for the analytic hierarchical process. The results showed that assessment and recording ranked first as important applications, followed by clinical alerts, implementation of rehabilitation, patient/family education, team communication, schedule management and finally, the localization of patients/workers. The subjects from different professional disciplines had different rankings of preference weight, reflecting the individualized needs related to their practice. In addition, the subjects placed a higher preference on new technology than on current practice in all the categories.

CONCLUSION

The preference global weights on the needs to integrate new technologies into rehabilitation services aims to improve efficiency, safety and outcome. Further studies are needed to explore the needs from the perspective of the patients.

Health Care Professionals and the Employment-Related Needs of Cancer Survivors

Introduction Individuals diagnosed with cancer look to health care professionals as primary sources of information. This positions staff in oncology settings in an ideal role to inform patients, who continue workforce participation in increasing numbers, about resources that might help them to handle work-related issues related to their oncological symptoms. This article reports on findings from a survey of staff that provide nonmedical services to cancer patients in two Houston area hospital systems. The impetus for this survey was two-fold: the trend in recent years for increasing numbers of cancer survivors to stay in the workforce after or even during treatment, and low levels of awareness that these employees are eligible for protection under the Americans with Disabilities Act of 1990 and its 2008 amendments (ADA Amendments Act of 2008, Pub. L. 110-325, 122 Stat. 3553, 2008; Americans with Disabilities Act, 42 U.S.C. § 12111-17, 2006). The survey assesses perceptions of the effects of cancer on patients' employment status, levels of knowledge about supports to address these employment-related needs, and respondents' preferred modes for information receipt. The latter topic serves the purpose of tailoring training activities to the respondents' informational needs and learning preferences. Methods Data were collected via an online survey administered in two Houston-area hospital systems. This article reports on the findings from 86 respondents. Results Tenure as measured by years in oncology is related positively to level of knowledge about disability-related benefits, legislation and programs (r = .32, P < .01). Respondents with more years in their profession worked with patients whom they reported had a higher number of cancer side effects that "created work difficulties for patients" (r = .24, P < .05). The number of side effects was in turn positively associated with negative effects of the diagnosis at work (r = .27, P < .05). A higher score of negative effects of the cancer diagnosis at work in turn correlated with unwanted consequences of disclosing the cancer at work (r = .36, P < .01). No statistically significant correlations were observed among the variables measuring respondents' reported knowledge of disability-related benefits, laws and programs, their perception of patients' level of understanding of these topics, and reports of patients' receipt of reasonable accommodation. Conclusions Health care professionals who treat cancer patients could benefit from training resources about how survivors might address their employment-related needs, including how to convey that knowledge to their patients. Mentoring programs might also have positive outcomes, since respondents with greater tenure in oncology-related settings reported higher levels of knowledge about disability-related topics.

Housing accessibility and its associations with participation among older adults living with long-standing spinal cord injury

OBJECTIVES

To describe the housing situation and aspects of participation among older adults living with long-standing spinal cord injury (SCI) with attention to SCI severity, and to examine whether and how objective housing accessibility (based on objectively measurable criteria) is associated with aspects of participation.

DESIGN

Cross-sectional study utilizing the assessment tools Impact on Participation and Autonomy (IPA) and Housing Enabler (HE). Adjusting for demographic, social and injury related data, associations between objective housing accessibility and aspects of participation were analyzed by means of ordinal regression models.

SETTING

Home and community settings.

PARTICIPANTS

Older adults (≥ 50 years) (N = 123), with a traumatic or non-traumatic SCI for at least 10 years. To make comparisons within the sample, three groups of SCI severity were formed using the American Spinal Injury Association (ASIA) Impairment Scale.

RESULTS

Housing adaptations and environmental barriers were common and differed between SCI severity groups; those with AIS D injuries had fewer adaptations and more environmental barriers indoors. A majority of the participants in the total sample perceived their participation as good or very good in most of the IPA activities studied. Accessibility indoors was significantly associated with autonomy indoors (P = 0.009), family role (P = 0.002) and participation problems (P = 0.004); more accessibility problems were associated with less participation and more participation problems.

CONCLUSION

This study indicates that optimizing the housing environment for older adults with SCI can potentially increase their participation and make them more autonomous. Further studies based on longitudinal data are needed to determine the causality of the associations identified.

Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century

BACKGROUND

People with disabilities face challenges accessing basic rehabilitation health care. In 2006, the United Nations Convention on the Rights of Persons with Disabilities (CRPD) outlined the global necessity to meet the rehabilitation needs of people with disabilities, but this goal is often challenged by the undersupply and inequitable distribution of rehabilitation workers. While the aggregate study and monitoring of the physical rehabilitation workforce has been mostly ignored by researchers or policy-makers, this paper aims to present the 'challenges and opportunities' for guiding further long-term research and policies on developing the relatively neglected, highly heterogeneous physical rehabilitation workforce.

METHODS

The challenges were identified through a two-phased investigation. Phase 1: critical review of the rehabilitation workforce literature, organized by the availability, accessibility, acceptability and quality (AAAQ) framework. Phase 2: integrate reviewed data into a SWOT framework to identify the strengths and opportunities to be maximized and the weaknesses and threats to be overcome.

RESULTS

The critical review and SWOT analysis have identified the following global situation: (i) needs-based shortages and lack of access to rehabilitation workers, particularly in lower income countries and in rural/remote areas; (ii) deficiencies in the data sources and monitoring structures; and (iii) few exemplary innovations, of both national and international scope, that may help reduce supply-side shortages in underserved areas.

DISCUSSION

Based on the results, we have prioritized the following 'Six Rehab-Workforce Challenges': (1) monitoring supply requirements: accounting for rehabilitation needs and demand; (2) supply data sources: the need for structural improvements; (3) ensuring the study of a whole rehabilitation workforce (i.e. not focused on single professions), including across service levels; (4) staffing underserved locations: the rising of education, attractiveness and tele-service; (5) adapt policy options to different contexts (e.g. rural vs urban), even within a country; and (6) develop international solutions, within an interdependent world.

CONCLUSIONS

Concrete examples of feasible local, global and research action toward meeting the Six Rehab-Workforce Challenges are provided. Altogether, these may help advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs.

Auditing Access to Outpatient Rehabilitation Services for Children With Traumatic Brain Injury and Public Insurance in Washington State

OBJECTIVE

To identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services.

DESIGN

Audit study with paired calls, where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury and public or private insurance.

SETTING

Outpatient rehabilitation clinics.

PARTICIPANTS

Sample of rehabilitation clinics (N=287): 195 physical therapy (PT) clinics, 109 occupational therapy (OT) clinics, 102 speech therapy (ST) clinics, and 11 rehabilitation medicine clinics.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Acceptance of public insurance and the number of business days until the next available appointment.

RESULTS

Therapy clinics were more likely to accept private insurance than public insurance (relative risk [RR] for PT clinics, 1.33; 95% confidence interval [CI], 1.22-1.44; RR for OT clinics, 1.40; 95% CI, 1.24-1.57; and RR for ST clinics, 1.42; 95% CI, 1.25-1.62), with no significant difference for rehabilitation medicine clinics (RR, 1.10; 95% CI, 0.90-1.34). The difference in median wait time between clinics that accepted public insurance and those accepting only private insurance was 4 business days for PT clinics and 15 days for ST clinics (P≤.001), but the median wait time was not significantly different for OT clinics or rehabilitation medicine clinics. When adjusting for urban and multidisciplinary clinic statuses, the wait time at clinics accepting public insurance was 59% longer for PT (95% CI, 39%-81%), 18% longer for OT (95% CI, 7%-30%), and 107% longer for ST (95% CI, 87%-130%) than that at clinics accepting only private insurance. Distance to clinics varied by discipline and area within the state.

CONCLUSIONS

Therapy clinics were less likely to accept public insurance than private insurance. Therapy clinics accepting public insurance had longer wait times than did clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care.

Interprofessional Collaboration in Improving Oral Health for Special Populations

People with complex medical, physical, and psychological conditions are among the most underserved groups in receiving dental care and consequently have the most significant oral health disparities of any group. The traditional dental care delivery system is not able to deliver adequate services to these people with "special needs" for a variety of reasons. New systems of care are evolving that better serve the needs of these groups by using interprofessional teams to reach these individuals and integrate oral health services into social, educational, and general health systems.