Community-based Rehabilitation Services Research Articles

Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963–2016

Objective: A significant proportion of patients with severe mental illness also experience substance use disorder. For these dual diagnosis (DD) patients, treatment is more complicated and prognosis is worse. Despite the introduction of the Community Rehabilitation of Persons With Mental Health Disability Law in 2000 and ongoing national mental health reforms, psychiatric services in Israel are not meeting the needs of an increasing number of DD patients. This study examines, for the first time in Israel, the prevalence of DD and patterns of psychiatric hospitalizations of chronic psychotic disorder patients with and without substance use disorder. Methods: The National Psychiatric Case Registry provided data on 18,684 persons with schizophrenia/schizoaffective disorders, aged 18–65, with a psychiatric hospitalization during the period 1963–2016 (with at least one hospitalization in 2010–15). Patients were considered as having DD if their substance use disorder was indicated in at least two, or 20%, of hospitalizations. Regression modeling predicted hospitalization measures (number of hospitalizations, total days hospitalized, length of stay). Results were also analyzed by legal status of admission (voluntary or involuntary; psychiatrist-ordered and court-ordered). Results: One-third of patients with chronic psychotic disorder met DD criteria, with a threefold higher rate among males (37.1%) than females (12.8%). Particularly high rates of DD (nearly 50%) were noted among male immigrants from Ethiopia. Compared with non–substance use disorder patients, DD patients had a significantly younger mean age at first hospitalization and shorter average length of stay per hospitalization but a greater number of hospitalizations and total hospital days (p < .0001 for all comparisons). The associations between DD status and hospitalization characteristics remained significant even after accounting for the effects of confounding factors. Hospitalization characteristics were also associated significantly with sex, population group, age, age at first hospitalization, and country of origin. The rate of court-ordered observation or hospitalization was threefold higher in the DD group. Conclusions: These findings, which broadly align with other countries, reflect a scarcity of outpatient services for DD patients with schizophrenia/schizoaffective disorder and substance use disorder. To achieve long-term mental health improvements, an expansion of community-based integrative treatment and rehabilitation services is needed in Israel.

Arts-based psychiatric rehabilitation programs in the community: Perceptions of healthcare professionals.

Despite the increase in arts-based programs in community rehabilitation services in many countries, little is known about how these programs are perceived by health professionals who can refer individuals with mental health conditions to community-based psychiatric rehabilitation services. This study examined how senior professionals with key positions in the public health system perceive the integration of the arts in community-based psychiatric rehabilitation services in Israel. Semistructured interviews were conducted with 10 professionals. The thematic analysis revealed 2 main themes. The first reflected "the perceived position of arts-based programs among other rehabilitation services," and had 2 subthemes: arts as a legitimate supplemental service, and arts as a motivating rehabilitation. The second theme reflected "the unique contribution of the arts to recovery processes," and had 3 subthemes: art-making facilitates self-expression and communication and bypasses resistance, art-making facilitates socialization, and art-making shapes and enhances personal identity. Because most of the professionals were exposed to the creative arts in their workplace, they valued their contribution to the rehabilitation process. Thus, direct contact can provide more information, more accurate perceptions, and a better understanding of the benefits of arts-based services, which may in turn encourage service managers and policymakers to include these services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Integrated decision-making model for community-based rehabilitation service utilisation among persons with severe mental illness in China: protocol for a cross-sectional, mixed-methods study

IntroductionA common problem low-income and middle-income countries face is the scarcity of community-based rehabilitation (CBR) resources and low service utilisation among persons with severe mental illness (SMI). Despite this problem,...

Reproducibility, longitudinal validity and interpretability of the Disease Burden Morbidity Assessment in people with chronic disease.

To evaluate the reproducibility, longitudinal validity, and interpretability of the disease burden morbidity assessment in people with chronic conditions including multimorbidity. The study was conducted using a longitudinal cohort design. A large consecutive sample of adult patients at an Australian community-based rehabilitation service was included with testing at baseline and three-month follow-up (testing longitudinal validity and interpretability). A smaller subsample of patients completed a one-week test-retest (testing reproducibility). Outcome measures included the Disease Burden Morbidity Assessment and 36-item Short-Form Health Survey. Participants in the study received tailored, interdisciplinary intervention between baseline, and three-month follow-up but did not typically receive intervention between baseline and retest. The longitudinal validity and interpretability sample included 351 participants and the reproducibility sample included 56 participants. Longitudinal validity and interpretability were generally supported with hypotheses supported or partly supported and a small percentage of lowest total scores for impact on daily activities (0.6% at baseline, 1.3% at three-month follow-up). Reproducibility parameters were acceptable for the total score measuring impact on daily activities (e.g. ICC = 0.76). Reproducibility, longitudinal validity, and interpretability of the disease burden morbidity assessment were generally supported for community-based chronic disease patients.

Status of the community-based rehabilitation in china reflected from multilevel medical institutions

The study was conducted to investigate the status of community-based rehabilitation in China, and to provide evidence for the formulation of relevant policies. From January to February in 2018, questionnaires were sent to the rehabilitation departments from 23 provinces, 4 municipalities and 5 autonomous regions in China. The questionnaire had 4 versions, for rehabilitation department (community hospital/general hospital), non-rehabilitation department (community hospital/general hospital). The questionnaires covered the configuration of equipment, professionals in community rehabilitation department and the deployment of community-based rehabilitation services. In total, 1798 valid questionnaires were retrieved, of which 434 were community hospital version (210 rehabilitation and 224 non-rehabilitation), 1364 were general hospital version (1118 rehabilitation and 176 non-rehabilitation). Among all the survived community hospitals, 54.4% of which had rehabilitation clinics, 51% had rehabilitation doctors, 60% had therapists and 33.4% had rehabilitation wards, 55.6% of rehabilitation department of community hospital receive < 500 patients per month. Rehabilitation department in community receive most patients with dysfunction after brain damage due to various reasons. More than 70% of rehabilitation department in community conducted therapeutic exercise, traditional Chinese medicine rehabilitation and therapeutic physical agents, and the rate of occupational therapy, language therapy, deglutition training and family rehabilitation indication were less than 50%. Only 27.8% of rehabilitation department in community has referral business with superior rehabilitation institutions, and nearly half of staff had no access to higher level rehabilitation training. The community rehabilitation in China has witnessed a rapid development over the past decade, but there are still many problems to be solved. A lack of corresponding medical policies, unbalance of regional development, relative weak basic construction, incomplete training system of community talents are all unsolved problems. With the growing problem of aging in China, the demand for community rehabilitation will increase day by day, which puts forward new challenges to China's medical and health decision-making.

Abstract 25: Late Functional Recovery After Lacunar Stroke: a Population-Based Prospective Cohort Study

Background: Non-acute interventions to enhance late stroke recovery are often tested initially in uncontrolled studies in patients with lacunar stroke owing to their low mortality and isolated motor deficits. It is often assumed that neurological recovery is near complete by 3 months after the stroke, but there have been few studies of the capacity for late recovery beyond 3 months. Methods: In 3-month ischaemic stroke survivors of the Oxford Vascular Study (OXVASC; 2002-2014), we examined changes in functional status (modified Rankin Scale [mRS], Rivermead Mobility Index [RMI], Barthel Index [BI]) in lacunar versus non-lacunar strokes from 3-60 months post-stroke, stratifying by age. We used logistic regression adjusted for age/sex/baseline disability to compare recovery (≥1 mRS grades, ≥1 RMI points and/or ≥2 BI points), particularly from 3-12 months. Results: Among 1,425 3-month survivors, the 234 lacunar stroke patients did not differ from others for outcome at 3 months (aOR for 3-month mRS&gt;2 adjusted for age, sex, NIHSS, pre-stroke disability: 1.14, 95%CI 0.75-1.74, p=0.55). However, they were much more likely to demonstrate further recovery between 3 months and 1 year (aOR for mRS recovery adjusted for age, sex, and 3-month mRS: 1.64, 1.17-2.31, p=0.004). Results were similar on restricting the analysis to patients with 3-month mRS 2-4 (the range commonly recruited into recovery studies) and on excluding recurrent events (aOR for 1-year mRS recovery adjusted for age, sex, and 3-month-mRS: 2.28, 1.34-3.86, p=0.002). Similar results were seen with the BI and RMI (e.g. aOR for 1-year RMI recovery adjusted for age, sex, 3-month-RMI: 1.78, 1.20-2.64, p=0.004). There was no difference between lacunar and non-lacunar strokes in utilization of thrombolysis or hospital-based or further community-based rehabilitation services (NIHSS-adjusted OR: 0.97, 0.63-1.49, p=0.88). Conclusions: Lacunar strokes have greater potential for late functional recovery from 3-12 months post-stroke, supporting the focus of studies of restorative therapies on this group. However, such studies cannot assume that improvements after 3 months are treatment-related, and should therefore be randomized and controlled.

Community-based rehabilitation offers cost-effective epilepsy treatment in rural Guinea-Bissau

Treatment of epilepsy in low-income countries is a challenge considering the lack of resources, availability of antiepileptic drugs, and cultural beliefs. We used a community-based rehabilitation (CBR) service for the detection, monitoring, and treatment of epilepsy. A local network of trained community volunteers provided education, good quality antiepileptic drugs, and clinical follow-up for people with epilepsy (PWE).In a period of 2years, approximately 22,500 people were screened in central Guinea-Bissau, and 112 PWE were identified and registered. Monthly check-ups were offered to monitor treatment effect and increase compliance. Retrospective analysis on 81 records of patients under treatment in June 2016 showed a decrease of seizure frequency in 88.8% after treatment initiation and was maintained throughout the clinical follow-up of 15months. A conservative estimation of the treatment and monitoring of a single person with epilepsy revealed a daily cost of $0.73.Despite acknowledging epilepsy as a neglected condition by the World Health Organization (WHO), most PWE still lack appropriate treatment. Although CBR service has been suggested as efficient strategy to reduce the treatment gap, little information is available on the efficacy of the programs. Our experiences show that CBR service is a cost-effective approach to monitor treatment and increase compliance in PWE. This experience may be of value for other resource-poor settings.

Endoscopic Third Ventriculostomy to address hydrocephalus in Africa: A call for education and community-based rehabilitation.

Endoscopic Third Ventriculostomy (ETV) and Choroid Plexus Cautery (CPC) are low-cost, safe, and promising interventions for spina bifida-associated hydrocephalus (SBHCP). The purpose of this review was to explore and describe these efforts in Africa in order to upscale surgical training and rehabilitation services. A PubMed search for articles on ETV and CPC as management of SBHCP in Africa was performed. Two authors appraised the results for key themes in content: indications, technique, outcomes, complications, education, and rehabilitation. Twenty of 47 articles identified were included for appraisal. Twelve described indications, ten and seven outlined technique and complications, respectively, and four described predictors of operative success. Fourteen studies describe outcomes, including operative and neurodevelopmental outcomes. Only two outlined educational efforts. Half of the literature stems from a single site in Uganda; in total, only six countries were represented. No articles described significant post-operative rehabilitation services or related training. The experience of ETV and CPC in Africa is promising, however, efforts to train and empower local staff in surgical technique and methods to upscale post-operative community-based rehabilitation services remain as a key to long-term success.

Disability Characteristics of Community-Based Rehabilitation Participants in Kayunga District, Uganda

BackgroundApproximately 80% of individuals with disability reside in low- and middle-income countries where community-based rehabilitation (CBR) has been used as a strategy to improve disability. However, data relating to disability severity among CBR beneficiaries in low-income countries like Uganda remain scarce, particularly at the community or district level. ObjectivesTo describe severity of disability and associated factors for persons with physical disabilities receiving CBR services in the Kayunga district of Uganda. MethodsA cross-sectional sample of 293 adults with physical disabilities receiving a CBR service in the Kayunga district was recruited. Disability severity was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0), and analyzed as a binary outcome (low: 0-9, high: 10-48). Inferential statistics using odds ratios were used to determine factors associated with impairment severity. FindingsThe mean WHODAS 2.0 score of persons with physical disabilities was 12.7 (standard deviation = 8.3). More than half (52.90%) of people with physical disabilities reported a high level of functional impairment. Increased disability severity was significantly associated with limited access to assistive devices (adjusted odds ratio [AOR] = 4.55, 95% confidence interval [CI]: 1.87-14.08, P < .001), and increased use of medical health care (AOR = 5.55, 95% CI: 1.84-16.79, P = .002). ConclusionThese findings suggest a high level of moderate to severe functional impairments in persons with physical disabilities receiving CBR in Kayunga district. These data provide support for efforts to enhance CBR's ability to liaise with local health care, education, and community resources to promote access to needed services and ultimately improve the functional status of persons with disabilities in low-resource settings.

Integrated Care Pathway for Patients with Spinal Cord Injury in Ireland

Introduction: Trauma and rehabilitation networks in Ireland are largely underdeveloped and there is significant variance in patient pathway within and across acute hospital services, specialist rehabilitation services and post-acute regional or community based rehabilitation services. Currently, in the absence of established clinical pathways across existing acute and rehabilitation services, patient pathway is convoluted. For patients with the most complex and severest injuries access to complex specialist rehabilitation services is compromised and outcomes such as discharge to community is poor. The vision for this project was to develop an all systems approach to support the patient journey for patients with Spinal Cord Injury from acute hospitals, post-acute rehabilitation services, disability services and long term care. Short description of practice change implemented: The National Clinical Programme for Rehabilitation Medicine has developed a care pathway in collaboration with all key stakeholders which describe the ideal patient journey for all those with a spinal cord injury, including those who are ventilator dependent. This is the first time such a pathway has been developed and will promote a patient centred approach to the management of this cohort of patients while also giving clear parameters against which patient journey can be measured going forward. Currently there is a cohort of patients in Ireland with high level spinal cord injury including some who remain in need of chronic ventilation who are unable to be served through within existing services. These patients are experiencing prolonged stays in acute hospital and some are unable to access complex specialist rehabilitation services. Implementation of the pathway will see patients who are ventilator dependent being able to access specialist rehabilitation services in Ireland for the first time and will also see the possibility of a discharge home realised for many. Aim and theory of change: The reduction in unnecessary variation in the care pathway of patients with spinal cord injury was felt to be achievable through the development of an ICP in collaboration with all key stakeholders. Targeted population and stakeholders: The ICP for patients with spinal cord injuries spans numerous service delivery sites, as such, collaboration with a wide number of stakeholders including acute hospitals, critical care, rehabilitation services, disability and community services, patients and patient support groups was necessary. Timeline: This project was identified as an area needing development in the 2016 workplan of the Rehabilitation Medicine Programme. Highlights: The project is small in numbers but significant in terms of process changes. It requires services working together across organisational boundaries in a way that is not often seen within the Irish healthcare system. Implementation will see patients with complex disability being able to access services in Ireland which they previously would have had to travel oversees to access. Comments on sustainability: The Principles supporting the care pathway are reflective of evidence based practice. The extensive consultation process undertaken by the programme has supported multi-agency collaboration and buy-in which will sustain this new way of working. The parameters set out in the patient pathway will afford us the opportunity to objectively measure patient journey and identify unnecessary variation in a way previously not possible. Comments on transferability: While this pathway is for spinal cord injury, the underpinning principles should be consistent for all with a need for specialist rehabilitation service and thus applicable across other diagnostic groups. Conclusions: The high level objectives for the project are: Process Improvements: - Improved access to both the National Spinal Unit (NSIU) and NRH for all patients requiring the tertiary level services they provide - Allow access to post acute specialist rehabilitation services at the NRH, particularly for those who are ventilator dependent Quality: - Reduce the number of patients being discharged back to acute hospital setting post rehabilitation services - Improve patient experience Discussions: Quality care is care which is patient centred. To be truly patient centred, a move away from individual service priorities is required with a focus on aligning priorities to support the patient journey. Lessons learned: The patient voice should be central to all health care planning

Psychological Distress of Community Based Residents with Mental Illness in Perak, Malaysia

Community-based rehabilitation services in Malaysia have been established with the introduction of the National Mental health Act 2001. The Health Ministry’s aims of providing a comprehensive community care encountered difficulties due to the lack of support for the primary and secondary health care services. Given the lack of study into the challenges faced by individuals with mental illnesses, an apparent need has arisen to conduct a qualitative study to better understand the experiences and the psychological well-being of these individuals. The aim of this research is to investigate the psychological distress faced and experienced by these residents with mental illnesses in one of the community-based rehabilitation centres and to explore the problems they encounter. A total of eight residents were interviewed using a semi-structured interview approach. The findings revealed an obvious neglect of the residents’ psychological and social well-being. They felt the need for family support and social acceptance, to preserve their integrity and to get the understanding of the caregivers and the stigmatization that comes with mental illnesses. Mental health services should incorporate an integrative approach of public acceptance of these people living with mental illnesses by providing appropriate psychological services and facilities.

Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study.

BackgroundPsychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH).MethodsData were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value <0.25 in the bivariate analyses were entered into multivariate logistic regression and variables with P-value < 0.05 in the final model were declared to be significantly associated with the outcome variable.ResultsThe prevalence of relapse among patients with psychotic disorder was 24.6 % (n = 95). Of this, 25.4 and 22.4 % were males and females respectively. The odds of developing psychotic relapse among patients living with family was 72 % lower than that of patients living alone (aOR = 0.28, 95 % CI = 0.08, 0.93). The odds of developing psychotic relapse among patients compliant to medication was 69 % lower than that of patients who were not compliant to medications (aOR = 0.31, 95 % CI = 0.12, 0.80). The odds of developing psychotic relapse among patients having high score on social support score was 48 % lower than that of patients who were compliant to medications (aOR = 0.52, 95 % CI = 0.28, 0.95). The odds of developing psychotic relapse among patients reporting to have sought religious support was 45 % lower than that of patients who have not sought religious support (aOR = 0.55, 95 % CI = 0.31, 0.96). On the other hand, the odds of developing psychotic relapse among participants who have experienced medication side effects was 1.83 times higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31).ConclusionsThe high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services.

Community-Based Rehabilitation Services in Low and Middle-Income Countries in the Asia-Pacific Region: Successes and Challenges in the Implementation of the CBR Matrix

Purpose: This literature review aims to explore the importance of physical therapy services and the increasing awareness of CBR, specifically related to challenges in its implementation in low and middle-income countries in the Asia-Pacific region. Method: A literature review of multiple databases was conducted to locate relevant articles written within the past five years. The databases used for the search were Google Scholar, Cochrane Library, CINAHL, and PubMed. Results: Thirteen articles about CBR were included in the literature review. These consist of studies on the quality of life, access to healthcare services, and barriers to CBR, as well as about the impact of CBR to LMICs and stakeholders. The articles demonstrate the vast potential of CBR, especially in LMICs in the Asia-Pacific region, with a significant positive impact on the lives of people with disabilities. Conclusion: CBR has improved the quality of life, access to medical services, functional independence, autonomy, community inclusion, and empowerment of people with disabilities in LMICs in the Asia-Pacific region. However, challenges in the implementation of CBR remain. These include lack of awareness and understanding of CBR, and physical, environmental, socio-economical and personal barriers.

Community-based vision rehabilitation provision in England

Sight loss is more common among older than younger people. With an ageing population and increasing pressure on health and social care services, preventive and rehabilitation services are being prioritised. However, evidence around community-based vision rehabilitation services is underdeveloped. The focus of this article is on the prevalence, organisational models and capacity of community-based vision rehabilitation services in England that are wholly or partly funded by local authorities (LAs). In all, 89 of the 152 (57%) LAs responded to an online survey about vision rehabilitation services. Services vary widely in the type of provider, type of support offered, structure and skills of the team delivering interventions, caseloads and waiting times. Voluntary organisations appear to experience more pressure on budgets and staffing ratios than LA in-house services. The article discusses implications for practice.

Integrated staffing model for residential mental health rehabilitation

Purpose – A novel integrated staffing model for community-based residential rehabilitation services is described. The purpose of this paper is to achieve synergistic gains through meaningful integration of peer support and clinical workers within rehabilitation teams. Key features include the majority of roles within the team being held by persons with a lived experience of mental illness, the active collaboration between peer and clinical workers throughout all stages of a consumer’s rehabilitation journey, and an organizational structure that legitimizes and emphasizes the importance of peer work within public mental health service delivery. This staffing model is not anticipated to alter the core rehabilitation function and service models. Design/methodology/approach – The emergence of the integrated staffing model is described with reference to the policy and planning context, the evidence base for peer support, and the organizational setting. A conceptual and contextualized description of the staffing model in practice as compared to a traditional clinical staffing model is provided. Findings – There is a potential for synergistic benefits through the direct collaboration between horizontally integrated peer and clinical specialists within a unified team working toward a common goal. This staffing model is novel and untested, and will be subjected to ongoing evaluation. Originality/value – The integrated staffing model may provide a pathway to achieving valued and valuable roles for peer workers working alongside clinical staff in providing rehabilitation support to people affected by serious mental illness.

Challenges and coping strategies of parents of children with autism on the Kenyan coast

Research on the challenges of raising a child with autism is mostly conducted in Europe, North America and Australia, and has revealed that parents have to come to terms with living with a lifelong developmental disability. In addition, parents are faced with numerous concerns, such as caring burdens, poor prognosis, and negative public attitudes. Virtually no research has been conducted in Africa on this subject. Thirty-seven interviews and eight focus group discussions were conducted with parents of children with autism and professionals in regular contact with these parents from rural and urban counties of the Kenyan coast. The study investigated challenges faced by parents and how they cope with those challenges. A purposive-convenience sampling procedure was used in selecting the study participants. A digital recorder was used to record all the interviews and focus group discussions. Transcriptions were done in Swahili, translated into English, and then imported to the NVivo software program for content analysis. The results indicate that parents of children with autism on the Kenyan coast experience common challenges including stigma, lack of appropriate treatment, financial and caring burdens regardless of their religious and cultural backgrounds. Coping strategies applied by parents comprised problem-focused aspects that involve diet management and respite care, and emotion-focused aspects that consist of beliefs in supernatural powers, prayers and spiritual healing. This qualitative study reveals a range of challenges that could have significant impact when caring for a child with autism. Coping strategies applied by parents target the physical health of the child and the psychological wellbeing of the parent. Consideration of these outcomes is vital as they could impact the initiation of a community-based rehabilitation service delivery in rural settings where parents play an active role.

Predictors of health-related quality of life in people with a complex chronic disease including multimorbidity: a longitudinal cohort study.

Factors that predict the health-related quality of life (HRQoL) of people with complex chronic diseases have not been investigated to date. Determining the impact of disease on daily activities is a factor that is particularly important with this group of people. This study examined the influence of a range of predictors (including the impact of chronic diseases on daily activities), on HRQoL in patients with complex chronic diseases over a 12-month period. A longitudinal cohort study was conducted with outcomes measured at baseline, 3, 6 and 12months post-baseline. Adults attending an Australian community-based rehabilitation service were included. HRQoL was measured using the SF-36 and corresponding preference-based health utility. Predictor variables included sociodemographic factors, disease factors (e.g. impact of diseases on daily activities), intervention factors, psychosocial factors and HRQoL components that were not included as the dependent variable. Linear mixed-effects regression was used to examine the relationship between predictor variables and HRQoL. Data from 351 participants were included. The impact of chronic disease on daily activities was the most frequent significant predictor of HRQoL outcomes. Other significant predictors included the impact of chronic back pain or sciatica on daily activities, the number of comorbidities, general health functioning and psychological distress. Models of health care for people with complex chronic disease may be enhanced by greater focus on patients' daily activities during assessment and intervention delivery. The range of significant predictors highlights the importance of an interdisciplinary team for managing complex chronic disease or targeted intervention strategies.

An improved model for provision of rural community-based health rehabilitation services in Vhembe District, Limpopo Province of South Africa.

BackgroundIn 1991, Riakona Community Rehabilitation Programme initiated community-based rehabilitation (CBR) in the Vhembe District of Limpopo Province. Subsequently, the South African government adopted the programme.AimThe aim of the study was to suggest an improvement in the model of providing CBR services.SettingThe study was conducted in six rehabilitation centres located in hospitals in the Vhembe District in Limpopo Province of South Africa.MethodA mixed-mode research design with qualitative and quantitative elements was used to conduct the study. Content analysis, the chi-square test for Goodness of Fit and the Kruskal–Wallis and Mann–Whitney non-parametric tests were conducted.ResultsThe key determinants of client satisfaction with the services that the community rehabilitation workers rendered included provision of assistive devices and the adoption of a holistic approach to their work. Overall, satisfaction per domain for each one of the five domains of satisfaction scored less than 90%. More than 80% of clients were satisfied with empathy (83%) and assurance (80%) domains. Tangibles, reliability and responsiveness domains had scores of 78%, 72% and 67%, respectively. These results, together with the reasoning map of conceptual framework description, were used as the building blocks of the CBR model.ConclusionThe improved CBR model is useful for putting the programme into practice. This is particularly so for the CBR managers in the districts of the Limpopo Province.

Remission of symptoms in community-based psychosocial rehabilitation services for individuals with schizophrenia.

The aims of this study were to determine the prevalence of remission in individuals with schizophrenia at baseline and 6 months after admission to community-based psychosocial rehabilitation and whether baseline intrapersonal and environmental resources predicted remission at 6 months, controlling for relevant demographic and clinical variables. The sample featured 187 individuals with schizophrenia spectrum disorder. To determine remission status, consensus-based criteria proposed by the Remission in Schizophrenia Working Group were adapted to identify predictors of remission outcomes, direct binary logistic regression analysis was performed. Findings indicated that 34.57% and 55.61% of the sample was in remission at baseline and 6 months, respectively. Remission at 6 months was predicted by shorter length of illness and being in remission at admission. Remission of schizophrenia is an achievable outcome in community psychosocial rehabilitation settings. Clinical characteristics exerted a significantly stronger influence on remission outcomes compared with psychosocial factors.

Interaction effects of in-hospital rehabilitation and the use of community-based services after hospital discharge on patients' subsequent functional abilities.

Patients' functional abilities after hospital discharge are influenced by rehabilitation during their hospital stay and their use of community-based services after hospital discharge. This study examined the interaction between rehabilitation during hospital stay, the use of community-based rehabilitation and non-rehabilitation services and their influence on patients' subsequent functional abilities. This cohort study included 509 inpatients who underwent rehabilitation between 2008 and 2011 in Japan. Participants were categorized into 2 groups based on their condition: stroke and other. Interaction effects between the change in Functional Independence Measure (FIM) and the use of community-based rehabilitation and non-rehabilitation services on patients' subsequent functional abilities were estimated by sequential linear regression analyses in which the dependent variable was the FIM score 3 months after hospital discharge. A significant interaction between the change in FIM and the use of community-based rehabilitation or non-rehabilitation services after hospital discharge was observed among stroke and other patients. Rehabilitation during hospital stay and the use of community-based rehabilitation or non-rehabilitation services interacted to influence the subsequent functional abilities of patients discharged home. These findings may be useful for maintaining patients' functional abilities after hospital discharge.