Rehabilitation Care Research Articles

Risk Factors for Musculoskeletal Health: A Review of the Literature and Clinical Application.

Musculoskeletal disorders (MSKD) are currently the leading contributor to disability worldwide. Unlike other prevalent and disabling healthcare conditions such as CVD, risk factors associated with MSKD are not commonly discussed or integrated into current medical practice, rehabilitation practice or wellness programs. The primary purpose of this review is to describe the known risk factors most closely associated with MSKD. The secondary purpose is to propose a clinical model to manage MSK health aimed at maximizing the healthy pursuit of a physically active and healthy lifestyle. In this review the most common MSKD risk factors, with a focus on those that can be easily screened in clinical practice are presented. The importance of understanding the magnitude and number of risk factors present as well as the multidimensional nature of MSKD risk is discussed. A total of 11 MSKD risk factors were identified. Most of the risk factors are modifiable, and the evidence associated with modifiability for the most prominent risk factors is reviewed.Researchers have found that often patients are discharged from care with several known MSKD risk factors. In such instances, local pain and dysfunction are managed well, but expanding our rehabilitation care to include comprehensive risk factor management would ultimately benefit the patient and reduce healthcare costs. The most common MSKD risk factors are discussed and a clinical framework to individualize intervention is proposed. Addressing key risk factors within rehabilitation may be an important step to reduce the enormous and growing burden these disorders are having on society. 5.

Outpatient Rehabilitation Utilization After Major Limb Loss in Adults Receiving Care in the Military Health System From 2001 to 2017

ObjectiveTo investigate exposures associated with outpatient rehabilitation encounters among Military Health System (MHS) beneficiaries with major limb loss. DesignRetrospective, cohort study. SettingAmerican military treatment facilities and civilian health care facilities that accept TRICARE benefits. ParticipantsAdult MHS beneficiaries with major limb amputation(s) acquired between January 2001 and September 2017 (N=5161). InterventionsNot applicable. Main Outcome MeasuresThis exploratory analysis investigated associations between outpatient rehabilitation care and demographic and amputation characteristics in MHS beneficiaries with major limb loss. ResultsMost beneficiaries were aged 55-64 (36%), male (73%) and retirees/dependents (60%) with enlisted sponsor rank (88%) and single limb loss (89%). The active/reserve beneficiaries were younger, majority male, and more likely to be diagnosed with incident behavioral health conditions. Unadjusted negative binomial regression models revealed increased rates of outpatient rehabilitation encounters in active-duty service members (ADSMs) than in retirees/dependents (rate ratio, 10.02; 95% confidence interval, 9.30-10.80). The rate ratios for sex, sponsor rank, limb(s) lost, incident behavioral health condition, incident traumatic brain injury, incident posttraumatic stress disorder, and outpatient care setting were attenuated after stratification by beneficiary category. Enlisted ADSMs had increased rates of outpatient rehabilitation encounter days compared with officers, whereas retirees/dependents with enlisted sponsors had decreased than those with officer sponsors. ADSMs who accessed outpatient care in direct and private care settings demonstrated high rates of outpatient rehabilitation encounters compared with those who only sought care from private care settings (rate ratio, 4.60; 95% confidence interval, 2.95-6.81). ConclusionsThis study suggests that MHS beneficiaries with major limb loss use outpatient rehabilitation services differently, based on active/reserve duty or retiree/dependent status. This study is the first of its kind to quantify outpatient rehabilitation utilization for military beneficiaries with all-cause major limb loss and may inform MHS policymakers on the rehabilitation needs for combat- and noncombat-related amputee populations.

Legal provision for the rights of persons who receive rehabilitation assistance

The research is devoted to the problems of legal provision of the rights of persons who receive rehabilitation assistance. The author examines the norms of international and national legislation that enshrine the rights of citizens in the field of healthcare. The works of scholars who have examined the peculiarities of exercising certain patients’ rights are studied. The article describes the legislative acts regulating the rights of a patient in a rehabilitation institution in Ukraine. It is indicated that certain patient rights are enshrined in the Civil Code of Ukraine and the Fundamentals of Healthcare Legislation. Special rights of the patients of rehabilitation institutions are provided for by the Laws of Ukraine “On Rehabilitation in the Healthcare Sector” and “On Rehabilitation of Persons with Disabilities in Ukraine”. The classification of patient's rights into socio-economic, legal, informational, ethical and those related to ensuring the quality of rehabilitation care is proposed. It is indicated that informational rights include the right to information about rights and obligations, diagnosis, functional limitations, nature of treatment, and preservation of medical confidentiality. It is concluded that socio-economic rights consist in the possibility of access to free rehabilitation services at the expense of budgetary funds under the programme of State medical guarantees. It is noted that ethical rights provide for a humane and respectful attitude of medical personnel towards patients. Among the legal rights of the patient is the possibility of judicial and administrative protection of the patient’s rights by applying to law enforcement agencies and courts. The patient has the right to qualified rehabilitation care. Proposals for amendments to the current legislation are made. The necessity to systematise patient rights and provide for them in a separate Law of Ukraine “On Protection of Patients’ Rights” is emphasised.

Implementation Of A Novel And Integrated Community Flexible Endoscopic Evaluation Of Swallowing (FEES) Service Model For Older Persons

Abstract Background FEES is a gold standard Speech & Language Therapy (SLT) led diagnostic instrument that facilitates evidence-based dysphagia care. A novel community-based FEES service for older persons’ services was recently established in Ireland's Mid-West. New pathways, integrated across divisions, were designed and implemented to complement existing dysphagia pathways within Integrated Care Programme for Older Persons (ICPOP), inpatient rehabilitation for older persons and primary care. An integrated pathway was also established with acute services (Otolaryngology). The aim of this abstract is to describe the implementation process for this novel community FEES service. Methods An SLT-led FEES team engaged with a range of community- and acute-based stakeholders across policy and practice: SLTs, Otolaryngologists, management teams, ICPOP teams, Gerontology Consultants, General Practitioners, Infection Prevention and Control (IPC) teams. Normalisation Process Theory (NPT), an empirically tested and theoretically-sound implementation science framework, scaffolded discussion across a range of implementation and consultation activities including co-design workshops and educational presentations and training, using Health Service Executive (HSE) Change Management tools. Results Stakeholders co-developed a shared understanding of current and new pathways to identify and enact implementation strategies at individual, discipline and system-levels. The project involved stakeholder mapping, communication/engagement planning, risk management, resource planning, and large-scale targeted education/training across settings and disciplines. A FEES working group was formed to coordinate, sustain, monitor, and futureproof implementation activities. Conclusion This collaborative project generated interdisciplinary vision and action to enact an innovative dysphagia care pathway for older people in the community. Articulated through an NPT lens, the project provides insights into the collaboration needed to implement truly integrated care and to identify enablers at individual, disciplinary, and organisational levels. Such knowledge is essential for enhancing integrated care and enacting change and innovation in the Irish health service.

“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit

Abstract Background Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation. Methods A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel. Results Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p<0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3). Conclusion Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.

Rehabilitative subacute inpatient care-Optimizing posthospital care for geriatric patients with rehabilitation needs: results of the REKUP study

Geriatric patients in subacute inpatient care (SC) with rehabilitation needs after hospitalization seldom utilize rehabilitative services and are often transitioned to long-term care (LTC), suggesting that their care in SC can be optimized. To evaluate the effectiveness of rehabilitative subacute inpatient care (REKUP) in improving the care of geriatric patients in SC with rehabilitation needs after hospitalization. The study was conducted as anonrandomized intervention trial with an historical control group (CG). The intervention group (IG: n = 49) received REKUP (activating therapeutic care, functional rehabilitative therapy, psychosocial services, medical care), while the CG (n = 57) received usual care during SC. Primary outcomes were transition to inpatient rehabilitation, home, and LTC, deteriorated care setting, care level, and mortality within 3months after SC. Secondary outcomes were functional, motor and psychological variables. The transition rate to inpatient rehabilitation (82% vs.37%) and home (86% vs.65%) was higher (p < 0.05) in the IG than in the CG. The proportion of persons utilizing LTC (12% vs.35%) and with deteriorated care setting (35% vs.60%) was lower (p < 0.01) in the IG than in the CG. The Barthel Index, visual analogue scale of the EQ-5D, and numerical pain scale improved (p < 0.05) during the SC stay in the IG but not in the CG. REKUP as anew care model for SC promotes the transition to inpatient rehabilitation, reduces the utilization of LTC and improves the chances of returning home and achieving greater independence in geriatric patients with rehabilitation needs after hospitalization.

Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review

BackgroundIt remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.MethodsStudies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.ResultsThirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues.ConclusionOur systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.

Acute Care Rehabilitation Services Utilization and Post-Acute Discharge Destination among Adults with Traumatic Brain Injury: The Moderating Effect of Functional and Physical Performance at Discharge

Objective: To investigate whether the relationships between acute care occupational therapy (OT) and physical therapy (PT) utilization and community discharge are moderated by functional or physical performance at discharge among individuals hospitalized with traumatic brain injury (TBI). Setting: 14 acute care hospitals in the state of Colorado. Participants: We studied 5599 adults hospitalized with TBI between June 2018 and April 2021. Design: In a secondary analysis of de-identified electronic health record (EHR) data, multivariable moderation logistic regression models were performed to calculate odds ratios (ORs) for the likelihood of community discharge among patients who utilized OT/PT services. Main Measures: Functional (activities of daily living [ADL]) and physical (mobility) performance at discharge, OT and PT utilization, and community discharge status. Results: Overall, 67% of patients discharged to the community. The mean age of the sample was 55 years (SD = 20 years). Most participants were male (64%) and non-Hispanic White (72%). Mean hospital length of stay was 6 days (SD = 6 days). Both OT and PT utilization (OT: OR = 1.21, 95% CI [1.11, 1.33]; PT: OR = 1.22, 95% CI [1.14, 1.30]) and discharge ADL and mobility scores (ADL: OR = 1.34, 95% CI [1.30, 1.39]; mobility: OR = 1.38, 95% CI [1.33, 1.42]) were significantly and positively associated with community discharge. The OT and PT utilization-by-discharge ADL and mobility interaction terms yielded slightly negative, but statistically significant moderation effects in both models (ORs = 0.99, 95% CIs [0.98, 1.00]); indicating the magnitude of the OT and PT utilization effect diminished as ADL and mobility scores increased. Several sociodemographic characteristics and clinical factors were also independently associated with community discharge in both models (p-values &lt; 0.001–0.04). Conclusions: Greater OT and PT utilization was associated with increased odds of community discharge. Similarly, higher ADL and mobility scores at discharge were associated with increased odds of community discharge. The small, but statistically significant negative interaction terms in both models indicated that the magnitude of the OT and PT utilization effect diminished as ADL and mobility scores increased. This study’s findings can guide occupational and physical therapists in their efforts to facilitate a safe transition to the community for patients with TBI.

Bundling implementation strategies supports outcome measure adoption in stroke rehabilitation: preliminary findings

BackgroundOver 80% of people who experience a stroke present with residual impairment of the upper extremity, such as the shoulder, elbow, wrist, and hand. However, rarely do stroke rehabilitation practitioners (e.g., occupational therapists) use standardized outcome measures to objectively evaluate upper extremity function. Accordingly, the purpose of this project was to develop a bundle of implementation strategies that supports practitioners’ adoption of the Fugl-Meyer Assessment of the Upper Extremity in stroke rehabilitation practice.MethodsWe used tenets of Implementation Mapping to guide the development of our implementation strategy bundle. We partnered with one, large academic health system serving over 200 stroke patients annually through intensive rehabilitation care. Strategies were selected and developed through a multi-method process that included a review of the literature, qualitative input from our health system’s practitioners and managers, and expert consultation. We also specified the hypothesized implementation “mechanisms” our strategies intended to change. Practitioners’ adoption (yes/no) of the Fugl-Meyer Assessment was calculated by analyzing electronic health record documentation of the 6-month time frame before strategies were deployed compared to the 6-month time frame after deployment.ResultsPractitioners were exposed to the following implementation strategies to support Fugl-Meyer adoption: conduct educational meetings, prepare outcome measure champions, provide equipment, develop training materials, and adapt documentation systems. In the 6-months before deployment of our implementation strategies, practitioners implemented the Fugl-Meyer with 14.8% of stroke patients. In the six months after deployment, adoption of the Fugl-Meyer increased to 73.8% (p < .001).ConclusionsWhen systematically developed in collaboration with health system partners, a bundle of implementation strategies may support outcome measure adoption in stroke rehabilitation. Improving the use of standardized outcome measures is of paramount importance in stroke rehabilitation to objectively monitor patients’ progress or decline, to demonstrate the value of rehabilitation services for enhancing patients’ recovery, and to advocate for continued reimbursement for rehabilitation care. Future opportunities lie in further specifying the mechanisms through which implementation strategies are intended to work and how those mechanisms contribute to strategy effectiveness.Trial registrationNCT registration: NCT04888416; May 06, 2021.

Construction of sensitive quality indicators for rapid rehabilitation care of patients after combined pancreaticoduodenectomy

AimTo construct evidence-based sensitive quality indicators for patients’ rapid rehabilitation care after combined pancreaticoduodenectomy (PD) and to provide a reference for clinical nursing professionals to scientifically evaluate the quality of patients’ rehabilitation post-PD.BackgroundSince PD is associated with higher surgical risk and anastomotic complications, it leads to higher complication rates and longer postoperative recovery cycles. This reiterates the need for rapid recovery of patients after PD; however, the evaluation of sensitive nursing care indicators regarding rapid recovery post-PD has not yet been established to date.MethodsBased on the Donabedian structure-process-result theory model, we used available literature, semi-structured interviews, the Delphi method, and hierarchical analysis to establish a sensitive indicator system for patients’ rapid rehabilitation after PD and evaluate the importance of such indicators.ResultsThere were two rounds of expert correspondence, and the effective recovery rate of the questionnaires of these rounds was 100%. The expert authority coefficients, as well as the Kendall coordination coefficients of the expert opinions, were 0.859 and 0.872 as well as 0.423 and 0.431, with statistically significant differences (p < 0.05), respectively. Consequently, we developed a sensitive quality index system for patients’ rapid rehabilitation care after combined PD, including 3 first-level, 12 s-level, and 23 third-level indexes, respectively.ConclusionThe constructed sensitive quality index system developed for patients’ rapid rehabilitation nursing care after combined PD is standardized, practical, and aligned with the specialty characteristics. Furthermore, this might help greatly in improving the quality and safety of patients’ rapid rehabilitation nursing care after combined PD, standardizing nursing management skills, and enhancing nursing quality.

Post Stroke Rehabilitation Awareness Among Stroke Patients - A Questionnaire Study

Background: The burden of stroke is increasing in India. Stroke is now the fourth leading cause of death and the fifth leading cause of disability. Following the acute phase of stroke management, rehabilitation becomes a cornerstone of recovery. However, despite the advancements in stroke rehabilitation, there exists a notable gap in patient awareness, with many individuals and their caregivers lacking sufficient knowledge about post-stroke rehabilitation options and the significance of their involvement in the recovery journey. Therefore, this survey was done to investigate the post stoke rehabilitation awareness among stroke patients and their family. Aims: The objective of this survey is to assess stroke rehabilitation awareness among family members and individuals undergoing inpatient or outpatient post-stroke rehabilitation, focusing on knowledge of stroke risk factors, warning signs, prevention measures, and available rehabilitation services. Method: From September’2023 to October’2023, 97 Participants were chosen, who underwent stroke rehabilitation either in-patient or out-patient rehabilitation for stroke recovery. Participants were made to fill out a structured questionnaire through an online link which consisted of 13 multiple-choice questions. Results: Out of 97 respondent 40% of respondents were fully aware of the key symptoms of a stroke. 80% of respondents were aware of physical therapy importance post stroke; 58% awareness on speech therapy. Only 27% and 26% were aware about occupational therapy &amp; robotic therapy as a post stroke rehabilitation option respectively. Around 73% of the respondents felt that post stroke rehabilitation at the Center is more effective than post stroke rehabilitation care at home. Conclusion: These findings underscore the need for improved education and outreach efforts to enhance rehabilitation access for stroke survivors. The data utilized in this research article are accessible upon reasonable request to the corresponding author, contingent upon adherence to applicable data protection regulations and ethical guidelines.

Nocturia and obstructive sleep apnea in spinal cord injured patients - a cohort study.

To describe the prevalence of nocturia and obstructive sleep apnea (OSA) in a cohort of spinal cord injury (SCI) patients and to describe their association. Additionally, to assess clinical and urodynamic data explaining nocturia and to evaluate the effect of OSA management with continuous positive airway pressure (CPAP). Retrospective analysis of data from patients with SCI followed in a tertiary care rehabilitation center with a specialized sleep and neuro-urology units. All adult SCI patients who underwent urodynamic assessment before polysomnography (PSG) between 2015 and 2023 were eligible. Subjective (nocturia) and objective data (urodynamic data, polysomnography, CPAP built-in software) were collated from the Handisom database (database register no. 20200224113128) and the medical records of SCI patients. Statistical testing used Mann-Whitney test for non-parametric variables, Fisher's exact test for contingency analysis and the Spearman correlation test to assess correlations. A p-value < 0.05 was considered significant. Statistical analyses were performed using GraphPad Prism v9. 173 patients (131 males, 42 females) were included. The majority of patients were paraplegic (n = 111 (64,2%)) and had complete lesions (n = 75 (43,4%)). A total of 100 patients had nocturia (57,5%). The prevalence of OSA (Apnea Hypopnea Index (AHI) ≥ 15/h) in the studied population was 61,9%. No correlation was found between nocturia and OSA. A significant difference was observed between patients with and without nocturia in terms of the presence of neurogenic detrusor overactivity (p = 0,049), volume at the first detrusor contraction (p = 0,004) and the bladder functional capacity (p < 0,001). Nocturia and OSA are highly prevalent in patients with SCI, but no statistical association was found between these two disorders. A prospective study focusing on nocturnal polyuria will be needed to assess the impact of OSA on lower urinary tract symptoms in SCI patients.

Evidence from an Applied Health Research Question (AHRQ): Describing Bundled Care Use in Ontario among Individuals with Total Joint Arthroplasty from fiscal year 2018-2021.

ObjectiveTo describe clinical pathways and use of the bundled care funding model, where a patient’s treatment and payment is assigned to a group of providers, among individuals who underwent a total joint arthroplasty (TJA) in Ontario. The request for this work was submitted by the Rehabilitative Care Alliance through the Applied Health Research Question (AHRQ) program. ApproachAdults with TJA from April 1st 2018 to March 31st 2022 were included. Demographics, surgical characteristics, inclusion in bundled care, and use of health services were defined using administrative health data. Results were stratified by location of surgery (bilateral or unilateral hip, knee, or shoulder TJA). ResultsAmong 152,135 individuals with TJA during the study period, 71,996 individuals (47.3%) received services through a bundled care approach. Rate of bundled care use was highest among individuals with unilateral knee TJA (52.5% in bundled care), and the lowest among individuals with shoulder TJA (13.4% in bundled care). In fiscal year 2018, 33% of TJA patients used bundled care, in fiscal year 2019, over 50% of TJA patients used bundled care and 55% of TJA patients used bundled care by 2021. Most individuals used bundled care following an inpatient surgery (88.9% of individuals following a unilateral knee TJA) as opposed to a same day surgery (11.1% with a unilateral knee TJA). ConclusionThe purpose of bundled care service delivery is to provide integrated healthcare delivery and therefore improved patient experience and outcomes. Understanding bundled care use may improve healthcare planning and assessment of health services.

Introducing a New Paradigm in Occupational Therapy for Mental Health in Bangladesh

Bangladesh is making strides in supporting mental health needs by incorporating occupational therapy into rehabilitation care. Despite challenges like social stigma and limited resources, a shift toward a socio-humanistic approach is underway. Occupational therapy practitioners have set up a mental health day treatment service to help individuals transition from hospitals to the community, focusing on daily living skills and meaningful activities. Integrating mental health day treatment service with government psychiatric hospitals and improving rehabilitation and home care follow-up can significantly enhance support for people with mental health needs in low-resource settings.

Patient routing system in rehabilitation after treatment for oncogynecological pathologies

Background. In recent years, oncogynecological diseases have been diagnosed more frequently in women of reproductive age. Despite the high efficiency of treatment measures, significant shortcomings in the rehabilitation system for such patients are noted.Objective: to present the continuity and features of the rehabilitation system for patients of oncogynecological profile.Material and methods. This review included 75 relevant publications from authoritative sources that presented unique findings. The search was conducted in Russian and foreign online libraries, databases and search engines. PRISMA recommendations were used for search and screening.Results. Oncogynecological patients need special attention in providing them medical care at the recovery stage. It is important to adhere to the principle of continuity between all steps of rehabilitation system: immediately after treatment, in rehabilitation department, and on outpatient stage. This system has been developed in Russia, but it needs scaling and solving a number of problems, ranging from a shortage of rehabilitation doctors, limited use of promising rehabilitation tools to insufficient provision of psychological assistance and the absence of generally accepted comprehensive rehabilitation system. At the same time, there is sufficient set of traditional and high-tech rehabilitation methods to provide highly specialized care.Conclusion. Aggressive treatment of oncogynecological diseases has a detrimental effect on the general well-being of women, significantly reducing their quality of life. Previously, proper provision of rehabilitation care encountered the rigidity of the system both at methodological and administrative levels. Recently, there have been positive shifts in solving problems of providing care to oncogynecological patients, however, the presented measures are not enough to qualitatively change the situation.

The Role of Multidisciplinary Rehabilitation in Enhancing Comprehensive Cancer Care: A Descriptive Review

Objective: This review aims to highlight the effectiveness of various forms of cancer rehabilitation in improving physical, emotional, and social outcomes for patients with cancer. It evaluates the impact of cancer rehabilitation on physical function, psychological health, and social reintegration while identifying barriers and facilitators in the implementation of cancer rehabilitation programs. Methods: A literature search was conducted from December 2023 to February 2024, using two electronic databases: MEDLINE (via PubMed) and Google Scholar. After screening the titles and abstracts, the study selected 34 articles, including RCTs, clinical trials, observational studies, and systematic reviews. The study did not include letters to the editor, editorials, special and short communications, animal-based research, and non-English language publications. There were no restrictions on geographical distribution, age of the sample population, type, severity, duration, and outcome of cancer, or the year range from which the studies were selected. Results: Rehabilitation interventions were effective in different cancer types, including breast, prostate, lung, and colorectal cancers. These interventions addressed common treatment-related challenges such as fatigue, pain, lymphedema, incontinence, and psychological issues, improving patients' quality of life and physical functioning. However, challenges such as physical limitations, emotional distress, access to care, financial barriers, and coordination of services were frequently noted. This highlights the need for tailored, accessible, and well-coordinated rehabilitation programs. Conclusion: Multidisciplinary and coordinated cancer rehabilitation has the potential to improve mobility, quality of life and physical functioning across various cancer types, but challenges in accessibility and coordination must be addressed.

COCHLEAR HAIR CELL REGENERATION BASED ON STEM CELLS: A SYSTEMATIC REVIEW

IntroductionAccording to the World Health Organization (WHO), by 2050 at least 700 million people will need access to hearing care and hearing rehabilitation services. The search for cell or gene therapies has been intensifying, and stem cell therapy looks a promising candidate to support hearing regeneration and reduce these numbers. The aim of this study is to provide an overview of current advances in stem cellbased therapies for cochlear hair cell regeneration and the processes being developed for future applicability.Material and methodsIdentification and review of all articles in the databases PubMed, Web of Science, and PLoS One using the terms &lt;i&gt;stem cell&lt;/i&gt;, &lt;i&gt;auditory hair cell regeneration&lt;/i&gt;, and &lt;i&gt;mammalian&lt;/i&gt; during February 2023 and following the PRISMA guidelines.Results50 articles were obtained, published between 2003 and 2022 and were systematically analyzed. The current research quantity is limited and further studies are needed, particularly in human tissue.ConclusionsThe simultaneous use of cell therapy and gene therapy may lead to more promising results. Moreover, advances in cochlear hair cell regeneration with stem cells suggest there is a realistic potential to make the technique a useful future therapy.

Conceptualizing person undergoing rehabilitation care in the light of Axel Honneth’s theory of recognition

Objective: To reflect on the concept of person, in the context of rehabilitation, in the light of Axel Honneth’s Theory of Recognition. Methods: Theoretical-philosophical essay. Results: The concepts of person, patient, user or client have given rise to central debates in health care models, especially in the area of rehabilitation. In this context, the concept of person stands out, from an anthropological and theological perspective to the inclusion of the complexity of social interactions in this meaning. Axel Honneth adds to this view by reflecting on the individuation of the being through the foundation of recognition, sustained by the need for self-confidence, self-respect and self-esteem, making it possible to draw up a collaborative care plan that strives for the good life of the person undergoing rehabilitation. Conclusion: We can conclude that conceiving of care centered on people with disabilities is much more coherent nowadays than perpetuating other debatable expressions in terms of health. Regardless of the term to be used, recognizing all the dimensions inherent in the concept of person is fundamental in terms of establishing the integral dialogical relationship that is intended between health professionals and the person-patient-user-client undergoing rehabilitation.

Quality indicators to monitor the quality and safety of care for older people: a scoping review protocol.

The objective of this review is to identify quality indicators used to monitor the quality and safety of care provided to older people (≥ 65 years old) in 8 care settings: primary care; hospital/acute care; aged care (including residential aged care and home or community care); palliative care; rehabilitation care; care transitions; dementia care; and care in rural areas. There is a need for high-quality, holistic, person-centered care for older people. Older people receive care across multiple care settings, and population-level monitoring of quality and safety of care across settings represents a significant challenge. National and international quality indicators used to monitor and evaluate the quality and safety of care at the population level for older individuals in the 8 key care settings will be considered for inclusion. English-language quantitative and mixed method studies published from 2012 will be considered. Academic (MEDLINE, Embase) and gray (government websites, clinical guidelines, Google) literature searches will be conducted. A standardized data extraction tool will be used to describe the identified quality indicators and associated tools. Quality indicators will be categorized by key domains (ie, pain, function, consumer experience, service delivery); quality indicator type (structure, process, outcome); and the Institute of Medicine's 6 dimensions of care quality (eg, efficiency, effectiveness, appropriateness, accessibility, acceptability/person-centered, safety). The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Open Science Framework https://osf.io/8czun.

Factors impacting hospitalisation and related health service costs in cancer survivors in Australia: Results from a population data linkage study in Queensland (COS-Q).

The global economic cost of cancer and the costs of ongoing care for survivors are increasing. Little is known about factors affecting hospitalisations and related costs for the growing number of cancer survivors. Our aim was to identify associated factors of cancer survivors admitted to hospital in the public system and their costs from a health services perspective. A population-based, retrospective, data linkage study was conducted in Queensland (COS-Q), Australia, including individuals diagnosed with a first primary cancer who incurred healthcare costs between 2013 and 2016. Generalised linear models were fitted to explore associations between socio-demographic (age, sex, country of birth, marital status, occupation, geographic remoteness category and socio-economic index) and clinical (cancer type, year of/time since diagnosis, vital status and care type) factors with mean annual hospital costs and mean episode costs. Of the cohort (N = 230,380) 48.5% (n = 111,820) incurred hospitalisations in the public system (n = 682,483 admissions). Hospital costs were highest for individuals who died during the costing period (cost ratio 'CR': 1.79, p < 0.001) or living in very remote or remote location (CR: 1.71 and CR: 1.36, p < 0.001) or aged 0-24 years (CR: 1.63, p < 0.001). Episode costs were highest for individuals in rehabilitation or palliative care (CR: 2.94 and CR: 2.34, p < 0.001), or very remote location (CR: 2.10, p < 0.001). Higher contributors to overall hospital costs were 'diseases and disorders of the digestive system' (AU$661 m, 21% of admissions) and 'neoplastic disorders' (AU$554 m, 20% of admissions). We identified a range of factors associated with hospitalisation and higher hospital costs for cancer survivors, and our results clearly demonstrate very high public health costs of hospitalisation. There is a lack of obvious means to reduce these costs in the short or medium term which emphasises an increasing economic imperative to improving cancer prevention and investments in home- or community-based patient support services.