Rehabilitation Care Research Articles

Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers.

The latest research on socioeconomic status (SES) and stroke continues to demonstrate that individuals with low SES are at a higher risk of stroke, receive lower-quality care, and experience poorer outcomes. Despite growing evidence on the impact of SES on stroke, gaps remain in understanding the underlying mechanisms and the influence of SES in different contexts, particularly in low- and middle-income countries. This narrative review builds upon our previous reviews from 2006 to 2015, focusing on studies published since 2015 to update on the influence of SES on stroke. Reports from nationwide or population-based observational studies in the past decade have confirmed that these inequalities persist globally and have provided new evidence on their mechanisms. In high-income countries, inadequate control of cardiovascular risk factors (hypertension, diabetes, obesity, and dyslipidemia) among lower socioeconomic groups has been found to explain much of the inequality in stroke risk. Exposure to particulate air pollution (both environmental and indoor from solid fuel cooking) synergizes with cardiovascular risk factors, especially hypertension, as major causes in low- and middle-income countries. Lower SES is persistently associated with disparities in care and increased poststroke disability and mortality. Lower SES also exacerbates other causes of health inequality among women, ethnic minorities, and migrants. Addressing stroke inequalities requires an interdisciplinary approach. Targeting cardiovascular risk factors, providing equitable quality of acute and rehabilitative stroke care, enacting legislative measures, and implementing societal changes remain leading global priorities.

Development of a complex intervention to prevent complications in patients recovering at home after transcatheter aortic valve replacement by optimizing home-based cardiac rehabilitation processes: a Delphi study

ObjectivesThis study aimed to systematically develop a nurse-led complex intervention to enhance the quality of and adherence to home-based cardiac rehabilitation (HBCR) care for patients who have undergone transcatheter aortic valve replacement (TAVR). The intervention integrated stakeholder perspectives, expert insights, empirical evidence, and theoretical frameworks.MethodsWe initially searched for initial cardiac rehabilitation strategies based on the “Behavior Change Wheel” model and literature review. The Delphi method was used in three rounds of consultations. The guidelines for the Conducting and Reporting of Delphi studies were also followed. The Delphi panel consisted of 15 experts in rehabilitation medicine, clinical medicine, cardiovascular nursing, behavioral science, community nursing, geriatric nursing, and nursing management from various provinces and cities in China. Panelists were asked to rate the effectiveness of HBCR strategies on a 5-point Likert scale.ResultsA questionnaire was sent to the members of the expert panel via email. The consensus from 15 experts led to the development of a framework in round 3. The response rates for the three rounds were 88.23, 100.00, and 100.00%, respectively. The expert authority coefficients for all rounds were 0.95. The Kendall coefficients obtained in the three rounds were 0.09, 0.78, and 0.87, respectively.ConclusionA set of strategies was developed for a comprehensive HBCR program for patients with TAVR, which can provide practical methods for relevant government departments, healthcare professionals, and patients’ families. Future research should investigate the experiences of stakeholders and assess the cost-effectiveness of implementing these strategies.

Research on Sports Injury Rehabilitation Detection Based on IoT Models for Digital Health Care.

Physical therapists specializing in sports rehabilitation detection help injured athletes recover from their wounds and avoid further harm. Sports rehabilitators treat not just commonplace sports injuries but also work-related musculoskeletal injuries, discomfort, and disorders. Sensor-equipped Internet of Things (IoT) monitors the real-time location of medical equipment such as scooters, cardioverters, nebulizer treatments, oxygenation pumps, or other monitor gear. Analysis of medicine deployment across sites is possible in real time. Health care delivery based on digital technology to improve access, affordability, and sustainability of medical treatment is known as digital health care. The challenging characteristics of such sports injury rehabilitation for digital health care are playing position, game strategies, and cybersecurity. Hence, in this research, health care IoT-enabled body area networks (HIoT-BAN) have been designed to improve sports injury rehabilitation detection for digital health care. The health care sector may benefit significantly from IoT adoption since it allows for enhanced patient safety; health care investment management includes controlling the hospital's pharmaceutical stock and monitoring the heat and humidity levels. Digital health describes a group of programmers made to aid health care delivery, whether by assisting with clinical decision-making or streamlining back-end operations in health care institutions. A HIoT-BAN effectively predicts the rise in sports injury rehabilitation detection with faster digital health care based on IoT. The research concludes that the HIoT-BAN effectively indicates sports injury rehabilitation detection for digital health care. The experimental analysis of HIoT-BAN outperforms the IoT method in terms of performance, accuracy, prediction ratio, and mean square error rate.

Students’ perspectives and expectations on the planning phase of elective postings in phase III of the MBBS program

Background: The National Medical Council (NMC) in its new Curriculum Based Medical Education (CBME) has mandated four weeks of elective postings for phase III part II MBBS students of 2019 batch. Each student will undergo two weeks of training in block-1 subjects including pathology, microbiology, virology, biochemistry, genetics, molecular biology, immunology, infection control, research, community outreach experience and others. Block-2 electives include psychiatry, neonatology, dermatology, rehabilitation and palliative care, hematology, oncology and others. Since the 2019 batch of students were the first batch of students who have undergone electives postings, this study was conducted to understand their perspectives and expectations about the planning phase of the elective postings, so that appropriate changes could be made in the future to make the learning experience more fruitful. Methods: This was a questionnaire-based study done among 198 phase III, part II MBBS students in various Government and self-financing medical colleges across South-India (mainly Tamilnadu). The google form questionnaire was shared to the students through social media platforms. Results: Among the study participants 25% were from Government medical colleges and the 75% are from self-financing medical colleges. Majority of the students chose the block-2 elective subject based on their interest whereas only half of the students chose their elective subject in block-1 based on interest. A significantly higher number of students in private medical colleges were given information about the expected learning experience in each elective posting before choosing one in block-1. A significantly higher number of students in block-1 were given a schedule and logbook when compared to block-2. All the students were given a logbook in Government medical colleges in both block-1 and block-2 postings. Conclusion: Providing a proper learning environment and appropriate planning by the stakeholders for elective postings, as recommended by the NMC will motivate the students to perform better academically and will guide them to choose their specialization based on their interests and the needs of the country.

Access to rehabilitation services for families of children with disabilities in Ghana

Background: Early rehabilitation interventions can significantly mitigate the effects of disabilities in children as they grow older. However, families of children with disabilities (CWDs) in resource-deprived settings face limited opportunities to access rehabilitation services for their children resulting in largely unmet rehabilitation needs.Aim: This study assessed knowledge of families of CWDs on rehabilitation services and accessibility to services for their children.Setting: The study was carried out in the selected districts in the Upper West Region, Ghana.Methods: Families that knew about rehabilitation services and acknowledged their child’s need for one were the subjects of this cross-sectional, quantitative study, using a researcher-administered questionnaire. STATA software was utilised for analysis.Results: Over half of the participants, 113 (54.85%), attempted to access rehabilitation services for their children, but only 31 (27.18%) were successful. The barriers to access included financial problems (n = 197 [95.63%]), shyness (n = 167 [81.07%]), transportation issues (n = 155 [75.24%]), community discouragement (n = 145 [70.39%]) and the attitudes of healthcare providers (n = 145 [70.39%]). Among those who accessed rehabilitation services, over half reported dissatisfaction with travel distance and associated costs (n = 18 [58.06%]), as well as travel time and wait time for services (n = 15 [48.39%]). Participants with no formal education (adjusted odds ratio [AOR] = 0.22; 95% confidence interval [CI]: 0.07, 0.59) and those who agreed that negative attitudes from health personnel were a barrier to access (AOR = 0.08, 95% CI: 0.00–1.01) were less likely to access rehabilitation services for their children.Conclusion: The low access to rehabilitation services suggests that many CWDs may miss relevant rehabilitation services that could improve their health outcomes and functioning. Policy interventions are required to facilitate families’ access to rehabilitation services for their children.Contribution: This study contributes to the literature on rehabilitation care in Ghana and provides a foundation for further research in rehabilitation care in the Upper West Region, as it is the first of its kind conducted in the region.

Shared Medical Appointments to Improve Equitable Access to Rehabilitative Care for Long COVID

Long COVID is an infection-associated chronic condition that can cause a wide variety of symptoms and long-term functional impairments. Although investigation into curative treatment is ongoing, current standard management of long COVID relies heavily on rehabilitative care by physical, occupational, and speech therapists. Unfortunately, many persons with long COVID encounter financial barriers to receiving rehabilitative care, especially because some state Medicaid programs and safety net health insurance plans do not cover one-on-one rehabilitation visits. Shared medical appointments are group visits that can deliver multidisciplinary care, and they are widely reimbursed by health insurance plans. Shared medical appointments also offer the added benefit of peer support and camaraderie, and they are an efficient method for clinicians to deliver care to many patients at once. Shared Medical appointments can serve as an innovative method of delivering rehabilitative care for persons with long COVID who cannot access individual appointments with a physical, occupational, and/or speech therapist. The purpose of this clinical perspective is to present the rationale, development, and organization and content of a six-session curriculum of shared medical appointments, which was created to deliver rehabilitation principles for long COVID management. The curriculum covers physical activity, daily living activities, and thinking and speaking. It includes identification of functional concerns and goals, instruction in rehabilitative strategies and tools, and troubleshooting challenges that are encountered as patients implement strategies. The content in this clinical perspective is intended to be easily adapted and delivered by other clinicians to facilitate more equitable access to long COVID rehabilitative care.

The effect of menstrual cycle phase-based rehabilitation for females following anterior cruciate ligament reconstruction: A randomised controlled trial

Research reports that follicular phase-based resistance training, where females predominantly perform resistance training in the first half of their menstrual cycle (MC), appears to result in better responses than regular training. The objective of this study was to compare the effects of MC phase-based rehabilitation (MCPBR) versus usual care (UC), following anterior cruciate ligament reconstruction (ACLR). Forty-three females participated in a 12-week intervention commencing six weeks post-ACLR. The primary outcome was knee extension strength limb symmetry index (LSI), and the secondary outcome was self-reported function (measured using the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Questionnaire, and Knee Self Efficacy Scale), measured at baseline and endpoint. Participants were randomly assigned to MCPBR (n = 21) or UC (n = 22). Participants’ MCs were monitored using calendar tracking, basal body temperature tracking, and urinary ovulation testing. Thirty-six females provided data for the final analysis. The M (SD) knee extension LSI for participants following MCPBR was 81.2% (13.2%), compared to 73.5% (21.8%) for those following UC (p = 0.17). The M (SD) one repetition maximum knee extension of the injured leg was 38.8 kg (14.1 kg) following MCPBR and 30.4 kg (11.7 kg) following UC (p = 0.06). Self-reported function was similar between groups. The findings of this study show that MCPBR and UC result in similar knee extension LSI and function and therefore do not support the recommendation of MCPBR for ACL rehabilitation in a New Zealand context. Future research should investigate females’ experience of MCPBR following ACLR.

Health care costs and service utilization in the first year following moderate to severe traumatic injury.

Most of the previous studies on costs following trauma have focused solely on in-hospital costs and costs associated with the acute treatment and early rehabilitation. As a result, post-hospital costs are often neglected in the estimation of total costs. We aimed to describe service utilization and total costs for health care services, rehabilitation services, and social support in the periods 0-6 months and 7-12 months after moderate-to-severe traumatic injury. Further, we explored costs and their associations with sociodemographic, clinical and injury-related variables. Data were obtained from a prospective, 12 months follow-up study of patients in all ages with moderate-to-severe traumatic injury determined by a New Injury Severity Score (NISS) > 9, admitted directly or within 72h to the trauma referral centres in year 2020. Data on utilization of health care and rehabilitation services from the Norwegian Patient Register (NPR), the Municipal patient and user register (KPR), and the Norwegian Control and Payment of Health Reimbursements Database (KUHR) were used. A total of 601 patients were included, 24% with moderate and 76% with severe injuries. The overall mean total health care cost per patient in the first year after traumatic injury was 846,877 (SD 1,042,649) Norwegian Kroner (NOK). The mean total cost of rehabilitation per patient was 251,487 (SD 317,050) NOK. Most costs were attributable to secondary care in the first six months post-injury. Severely injured patients had a higher health care utilization and average cost compared to those with moderate injury. Injury severity factors were the most prominent cost drivers, and number of injuries, severe head, spine, and extremity injuries were significantly associated with higher costs during the first year following trauma. The findings give a holistic insight into health care utilization and costs for patients across all ages with complex needs following trauma and can contribute to the planning and provision of services for this patient group.

A Combined Comprehensive Palliative and Rehabilitative Care Plan for a Child With Cerebral Palsy

A Combined Comprehensive Palliative and Rehabilitative Care Plan for a Child With Cerebral Palsy

Hospital-Acquired Pressure Ulcers and Long-Term Motor Score Recovery in Patients With Acute Cervical Spinal Cord Injury

Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair). To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI. Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024. PUs acquired during surgical or first rehabilitative SCI care. The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression. The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01). In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.

Brief Outpatient Rehabilitation Program for Post-COVID-19 Condition: A Randomized Clinical Trial.

Post-COVID-19 condition (PCC) is emerging as a common and debilitating condition with few treatment options. To assess the effectiveness of a brief outpatient rehabilitation program based on a cognitive and behavioral approach for patients with PCC. Patients with mild to moderate PCC were randomized 1:1 to an established transdiagnostic rehabilitation program or care as usual at a single referral center recruiting from the region of the South-Eastern Norway Regional Health Authority. Participants were followed up after treatment completion and 12 months after enrollment using participant-reported outcome measures. Data were collected from February 22, 2022, until April 15, 2024. Intention-to-treat analysis was performed. The program consisted of 2 to 8 outpatient encounters with approximately 2 to 6 weeks between each encounter. The intervention was theoretically grounded in the cognitive activation theory of stress, and physicians and physiotherapists were trained in cognitive and behavioral approaches with targeted negative stimuli and response outcome expectancies being particularly important. Participant-reported physical function assessed by the Short-Form Health Survey 36 Physical Function Subscale (SF-36-PFS) served as the primary outcome. Secondary outcome measures were the remaining subscales of the SF-36, return to work self-efficacy and symptom scores on fatigue, postexertional malaise, breathlessness, cognitive difficulties, sleep problems, anxiety and depression symptoms, and smell and taste abnormalities. Safety measures included primary health care contacts; hospital admissions; initiation of pharmacologic and/or nonpharmacologic therapy; occurrence of novel disease, illness, or other health problems; worsening of selected key symptoms; working abilities; and thoughts of suicide. A total of 473 patients with mild to moderate PCC were assessed for eligibility (n = 364 physician referred; n = 109 self-referred); 314 were included (225 females [72%]; mean [SD] age, 43 [12] years) and 231 completed the primary end point evaluation. The SF-36-PFS scores improved statistically and clinically significantly in the intervention group (score difference between groups, 9.2; 95% CI, 4.3-14.2; P < .001; Cohen d = 0.43; intention-to-treat analysis). The effect was sustained over time. Most secondary and safety measures favored the intervention. In this randomized clinical trial, a brief outpatient rehabilitation program with a cognitive and behavioral approach in patients with PCC was effective and safe. This trial adds to the evidence supporting such interventions in routine clinical care. Future research should investigate which elements of this approach are the most effective and identify subgroups for which the current treatment is most relevant. ClinicalTrials.gov Identifier: NCT05196451.

A Novel Behavioral Intervention to Enhance Physical Activity for Older Veterans in a Skilled Nursing Facility.

Physical activity levels during skilled nursing facility (SNF) rehabilitation fall far below what is needed for successful community living and to prevent adverse events. This feasibility study's purpose was to evaluate the feasibility, acceptability, and preliminary effectiveness of an intervention designed to improve physical activity in patients admitted to SNFs for short-term rehabilitation. High-Intensity Rehabilitation plus Mobility combined a high-intensity (i.e.,high weight, low repetition), progressive (increasing in difficulty over time), and functional resistance rehabilitation intervention with a behavioral economics-based physical activity program. The behavioral economics component included five mobility sessions/week with structured goal setting, gamification, and loss aversion (the idea that people are more likely to change a behavior in response to a potential loss over a potential gain). SNF physical therapists, occupational therapists, and a mobility coach implemented the High-Intensity Rehabilitation plus Mobility protocol with older Veterans (n = 18) from a single SNF. Participants demonstrated high adherence to the mobility protocol and were highly satisfied with their rehabilitation. Treatment fidelity scores for clinicians were ≥95%. We did not observe a hypothesized 40% improvement in step counts or time spent upright. However, High-Intensity Rehabilitation plus Mobility participants made clinically important improvements in short physical performance battery scores and gait speed from admission to discharge that were qualitatively similar to or slightly higher than historical cohorts from the same SNF that had received usual care or high-intensity rehabilitation alone. These results suggest a structured physical activity program can be feasibly combined with high-intensity rehabilitation for SNF residents following a hospital stay.

Effects of core training based on respiratory therapy on elderly stable COPD patients in the rehabilitation hospital: a study protocol for a randomised controlled trial

IntroductionElderly stable chronic obstructive pulmonary disease (COPD) patients frequently experience walking dysfunction. Research indicates that balance training holds promise for enhancing walking stability in these individuals, whereas respiratory therapy (RT)...

Perspectives of Key Stakeholders on Integrating Wearable Sensor Technology into Rehabilitation Care: A Mixed-Methods Analysis.

Rehabilitation is facing a critical practice gap: Patients seek out rehabilitation services to improve their activity in daily life, yet recent work demonstrates that rehabilitation may be having a limited impact on improving this outcome due to lack of objective data on patients' activity in daily life. Remote monitoring using wearable sensor technology is a promising solution to this address this gap. The purpose of this study was to understand patient and clinician awareness of the practice gap and preferences for integrating wearable sensor technology into rehabilitation care. This study used a mixed-methods approach consisting of surveys and 1:1 interviews with clinicians (physical and occupational therapists or assistants) employed at an outpatient rehabilitation clinic within an academic medical center and patients seeking care at this clinic. Data were analyzed using descriptive statistics and thematic analysis. Data saturation was reached from recruiting nineteen clinicians and ten patients. Both clinicians and patients recognized the importance of measuring activity outside the clinic and viewed wearable sensor technology as an objective measurement tool. Most clinicians (63%) preferred continuous (vs. intermittent) monitoring within a care episode and most patients (60%) were willing to sync their sensor data as often as instructed by their provider. To maximize integration into clinical workflows, clinicians voiced a preference for availability of sensor data in the electronic health record. Clinicians and patients value the use of wearable sensor technology to improve measurement of activity outside the clinic environment and expressed preferences for how this technology could best be integrated into routine rehabilitation care.

Interventions for the management of long covid (post-covid condition): living systematic review

ObjectiveTo compare the effectiveness of interventions for the management of long covid (post-covid condition).DesignLiving systematic review.Data sourcesMedline, Embase, CINAHL, PsycInfo, Allied and Complementary Medicine Database, and Cochrane Central Register of...

Comprehensive assessment and progression of health status during neurorehabilitation in survivors of critical illness: a prospective cohort study

BackgroundCritical illness survivors frequently suffer from long-term impairments, often described as post-intensive care syndrome (PICS). PICS encompasses physical, cognitive, and mental impairments. Additionally, the term intensive care unit (ICU)-acquired weakness (ICUAW) was coined for muscle weakness after critical illness. Research on the progression and outcome of individuals affected by PICS and ICUAW is scant. Thus we aimed to assess the health status and its progression during neurorehabilitation in critically ill patients using comprehensive outcome measures, describe the prevalence of PICS, and evaluate factors associated with rehabilitation outcomes.MethodsPatients with mixed reasons for critical illness who received ≥ 5 days of mechanical ventilation on the ICU and who were admitted to neurorehabilitation, were eligible to be included in this prospective cohort study. A number of outcomes (patient-reported, clinician-reported, and performance) were assessed after discharge from the ICU (V1) and shortly before discharge from inpatient neurorehabilitation (V2). The prevalence of PICS, defined as having at least one impairment in any PICS dimension), was calculated at V1 and V2. Multiple logistic regressions were conducted to identify factors associated with rehabilitation outcome (poor outcome = modified Rankin Scale > 2) and ICUAW at V2 (MRC sum score < 48).ResultsIn total, 250 critical illness survivors (62 ± 14 years, 34% female, median stay on ICU 55 days, median inpatient rehabilitation 65 days) were included. 11 participants (4.4%) died before V2. All outcomes improved significantly during rehabilitation except sensory impairment and pain. PICS was present in 96% at V1 and in 85% at V2, whereby mainly the physical domain (V1: 87%, V2: 66%; ICUAW with MRC sum score < 48) and the cognitive domain (V1:65%, V2:55%; Montreal Cognitive Assessment < 26) were affected. Mental impairment was lower (V1:48%, V2:29%; Hospital Anxiety and Depression Scale > 7), but still affected a considerable number of participants. Accordingly, health-related quality of life was rather low at discharge (0.64 ± 0.28, index value of EQ-5D-5L). MRC sum score at V1, duration of mechanical ventilation, and female gender were significantly associated with a poor rehabilitation outcome. Grip strength in % of reference at V1, age, female gender, and comorbidities were significantly associated with persistent ICUAW at discharge.ConclusionsDespite significant improvements during rehabilitation, survivors after critical illness experience a substantial burden of PICS and ICUAW at discharge from rehabilitation care. Survivors of critical illness require long-term follow-up, supportive structures, and tailored long-term multi-disciplinary therapies even after intensive rehabilitation.Trial registration: German Clinical Trials Register, DRKS00021753. Registered 03 September, 2020. https://drks.de/search/en/trial/DRKS00021753.

Management of Acute Lateral Humeral Condyle Fractures in Children

Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion. With the aim of enhancing the understanding of pediatric LHC fracture management among pediatric healthcare practitioners, we present a literature review combined with our technical recommendations based on our experience. Imaging through AP, lateral, and internal oblique X-rays remains the gold standard for diagnosis, although there is increasing focus on non-irradiating techniques, considering the skeletally immature nature of the patients. Several classification systems aid in fracture assessment, each varying in their simplicity, reproducibility, and inter- and intra-observer correlations. The treatment approaches for LHC fractures include conservative management with immobilization for minimally displaced fractures and surgical intervention for displaced fractures. The surgical options encompass closed and open reductions, using Kirschner wires or cannulated screws for fixation. While both methods show favorable outcomes, recent years have seen a growing interest in expanding the traditional indications for closed approaches. After a period of post-surgical immobilization of the limb, rehabilitation care is recommended to assist in the recovery of the range of motion. During the postoperative period, the most frequent complications are bony overgrowth, malunion, and infection, although with highly variable rates, which typically do not result in functional impairment if managed properly. Regular follow-up and monitoring are essential for optimal recovery and minimizing long-term complications.

ORGANIZATION OF MEDICAL SERVICES FOR TRAUMA PATIENTS: CURRENT REQUIREMENTS AND BEST PRACTICES OF COOPERATION BETWEEN TRAUMATOLOGISTS AND THERAPISTS

Modern requirements for the organization of medical services for traumatological patients reflect the need for effective cooperation between specialists in traumatology and therapy. It is important to note that today there are a large number of unique programs that allow for the collective work of specialists in various fields in order to organize better medical care. This article examines the unique practices of cooperation between these specialties in order to optimize the diagnosis, treatment and rehabilitation of patients with traumatic injuries in age. The work involves not only therapists, traumatologists, but also other specialists in related fields who can assist in the rehabilitation of the patient. The analysis of the state and problems of multidisciplinary treatment of traumatologists includes answers only from the medical staff of regional trauma centers and end-treatment centers treating seriously injured people. Special attention is paid to the coordination of efforts between doctors of various profiles, the exchange of information, the use of innovative methods and technologies. The results of the study will improve the quality of medical care for trauma patients and make a significant contribution to the development of medical practice in general. The critical importance of collaboration between traumatologists and therapists is to ensure a comprehensive approach to the treatment of patients with traumatic conditions. Research in the field of organization of medical services for traumatological patients is important for the development of modern medicine. It provides an opportunity to create new formats and programs of medical care for the rapid rehabilitation of patients. New approaches contribute to improving current medical processes and improving the quality of life of society.

Physical medicine and rehabilitation clerkships in medical school: A valuable and integrated addition to the advanced clerkships.

The medical specialty of physical medicine and rehabilitation (PM&R) focuses on quality of life, function, ability, and interdisciplinary care. PM&R clerkships are uniquely qualified to teach medical students about rehabilitation and the spectrum of postacute care, medical knowledge, and medical decision making related to health care affecting people with disabilities, health care disparities affecting people with disabilities, and the communication and teamwork strategies to provide a patient-centered approach to optimize function and outcomes. PM&R clerkships can be used to fulfill stakeholder and governing body requirements, such as medical knowledge, rehabilitation, critical judgment, health disparities, ethics, communication, teamwork, and patient-centered medical care, in order to maintain accreditation and provide a high-quality education This review provides both a rationale for a medical student clerkship in PM&R and an effective example of such an experience that has been implemented during medical school training.

Elements of a nurse-coordinated post-stroke home care rehabilitation in the Philippines: A cross-sectional study.

Stroke is the leading cause of disability and the second leading cause of death worldwide. In the Philippines, there is a lack of a unified system for the care of community-dwelling patients with stroke. Furthermore, rehabilitation facilities are underutilized, and human resources and financial support policies are lacking. Nurses have become valuable human resources in rehabilitation. Current literature has inconsistent and weak evidence on the effectiveness of home-based post-stroke rehabilitation. This study aimed to determine essential elements that constitute a nurse-coordinated post-stroke home care rehabilitation in the Philippines. A literature review was conducted to generate items for a tool that would elicit important elements of post-stroke home care rehabilitation in terms of structure, process, and outcome domains. Two rounds of the modified e-Delphi technique were conducted with a panel of 10 experts, and the content validity index (CVI) was calculated. Using the developed tool, a cross-sectional survey was conducted among nurses in the Philippines in March 2024. The responses were subjected to principal component analysis. The validated tool contains 55 items with an item level CVI range of 0.9-1.0 and a scale level CVI of 0.99. Online survey responses were received from 326 participants. The first principal component for each domain was analyzed. Structure elements involve an interdisciplinary team that integrates policy and funding for home visits and telehealth services, ensuring culturally responsive home environments. Process elements involve collaborative planning and evidence-based treatment processes coordinated by nurses, prioritizing patient and family engagement. Nurses may perform therapies delegated by rehabilitation specialists. Outcomes elements focus on achieving patient- and family-centered goals, enhancing daily activities, and improving overall quality of life. Given the complexity of community-based rehabilitation, this study determined the essential elements of post-stroke home care rehabilitation. These elements are crucial in providing guidance to policymakers, clinicians, and patients in the delivery of home-based post-stroke care.