Community-based Rehabilitation Setting Research Articles

Utilising co-design to develop a lived experience informed personal safety tool within a mental health community rehabilitation setting.

Mental health personal safety tools aim to promote a recovery focus and empower an individualised approach to consumer care. These clinical tools are predominantly utilised in acute mental health settings with a person during or straight after a crisis. There is currently a gap in the literature regarding the preparation of personal safety tools in non-acute mental health settings. This descriptive article discusses the learnings and outcomes from a co-designed project that aimed to develop a personal safety tool suitable for a community mental health rehabilitation setting. Seven people with lived experience engaging within a mental health community-based rehabilitation service were recruited through convenience sampling to participate in the co-design project. A focus group approach was utilised during four group meetings to develop a personal safety tool template. Experiences and ideas about safety planning were transcribed during meetings and thematic analysis extracted key themes. Five steps underpinned the co-design process that included identifying the need, establishing the co-design group, planning, design and development, and review and closure. Consumer involvement commenced at step two of the co-design process. The completed personal safety tool was designed with consumer input and review. The personal safety tool consisted of nine intervention components. Four key themes emerged from focus group meetings that informed the content of the tool: (i) ensuring the personal safety tool is individualised and meaningful, (ii) promoting exploration of personal strengths and interests, (iii) enabling opportunities to learn self-management skills, and (iv) treating the personal safety tool as a dynamic and adaptable tool. Findings suggest that a personal safety tool targeted to a mental health community-based rehabilitation setting should have an individualised and preventative focus to mental health care. Embedding co-design principles can support opportunities for meaningful consumer engagement and establishing consumer and clinician partnerships.

Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions

BackgroundChronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory.MethodsRealist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory.ResultsFour contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client’s home, skilled occupational therapists, and clients feeling ready for making changes.ConclusionsThe ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings.Trial registrationThe trial was prospectively registered on www.ClinicalTrials.gov (registration date: 05/03/2020; identifier: NCT04295837) prior to data collection that occurred between August 2020 and October 2021.

Perspectives of patients on technology-supported community-based rehabilitation: a qualitative study

Introduction: The study's primary aim is to explore the perspectives and experiences of patients regarding technologysupported community-based rehabilitation in the Philippines. The secondary aim is to ascertain the utilization of technologysupported community-based rehabilitation based on the participants' responses. Methods: In this qualitative phenomenological study, purposive sampling for recruitment was utilized. Online focus group discussions were conducted with patients who have received rehabilitation in a technology-supported community-based rehabilitation setting. The recorded discussions were transcribed and coded using NVivo 12 software. The study employed an inductive approach of thematic analysis to extract significant themes. Continuous refinement and data analysis were done for data saturation. Results: Five themes emerged using Braun and Clarke’s thematic analysis: accessibility in technology-supported community-based rehabilitation, primary device and platforms used in technologysupported community-based rehabilitation, limitations of technology-supported community-based rehabilitation, perceived usefulness of technology in community-based rehabilitation, and patient satisfaction. Discussion: The facilitators and barriers found in the study affect the participants’ access and perceived usefulness of technology-based community-based rehabilitation which contributes to patient satisfaction. The study also found that patients perceived technology useful in community-based rehabilitation because it facilitates learning of exercises and enhances adherence to home exercise programs.

Speech pathologists’ perspectives when managing adults following traumatic brain injury in community-based rehabilitation settings: A qualitative investigation

Purpose: Across Australia and New Zealand, speech-language pathologists (SLPs) routinely assess and treat adults with cognitive-communication disorders following traumatic brain injury (TBI). Despite their regular involvement, little is known about how clinicians provide management to this client group, particularly in community-based contexts. Therefore the aim of this study is to explore the clinical practices of SLPs who have experience working in community-based rehabilitation services with adults with cognitive-communication disorders following TBI. Method: A qualitative descriptive study using one-on-one semi-structured interviews was conducted as part of an explanatory sequential mixed-methods design. Fourteen SLPs with experience working with individuals with TBI completed an interview with content analysis used to explore the data. Result: The overarching theme identified was that a “Client-centred and inclusive approach to community-based rehabilitation services” is required. The three subthemes to emerge from the data included the importance of utilising a (1) “flexible service delivery approach”, with (2) “meaningful therapy focus”, and (3) “collaboration” with multidisciplinary team members and significant others when managing this client group. Conclusion: SLPs play a crucial role in client-centred inclusive rehabilitation for community-dwelling adults with cognitive-communication disorders following TBI. The complexity of working with this population requires current and future models of care to incorporate an interdisciplinary approach that is flexible in its delivery and meaningful in focus.

Fitness to drive practices among non-driver trained occupational therapists in an Australian community-based rehabilitation setting.

Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process. A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data. A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process. All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs.

Sustainable support solutions for community-based rehabilitation workers in refugee camps: piloting telehealth acceptability and implementation

BackgroundThe lack of training and education of Community-Based Rehabilitation (CBR) workers poses one of the most significant barriers to receiving effective occupational, physical and speech therapy for individuals with disabilities in Low-to-Middle Income Countries (LMIC), especially in countries with significant refugee populations. The aim of this study was to successfully implement a telehealth support system for CBR workers, evaluate the feasibility and acceptability of this intervention’s implementation among CBR workers in the CBR setting, and further identify strategies to address the deficit of skilled rehabilitation workers in LMIC through technological intervention.MethodsThis pilot study included CBR workers and CBR managers to inform feasibility, acceptability, and sustainable implementation. The RE-AIM and Dynamic Sustainability Framework were incorporated to guide procedural design, survey development, data collection, data evaluation, and increase success of telehealth implementation. CBR workers participate in trainings, telehealth sessions, surveys and focus groups to inform feasibility and acceptability. CBR Managers participated in focus groups to inform feasibility and sustainable implementation. NVIVO 12 Software was utilized to develop themes from CBR worker and CBR manager responses.ResultsFindings from this study demonstrate the need for additional training support for CBR workers in CBR settings throughout the entire treatment process. The telehealth system demonstrated successful short-term implementation across several domains of feasibility. Telehealth utilization was also proven acceptable, appropriate and necessary. Cultural beliefs, CBR worker training, and CBR Center infrastructure pose the most significant barriers to implementation of telehealth technologies in CBR Centers. CBR workers and managers confirmed the demand for future telehealth-based support systems, strengthening effort towards sustainability and scale-up.ConclusionsTelehealth can be utilized to support CBR workers that serve vulnerable and marginalized populations, and in turn improve the global health status among refugee populations by reducing inequitable access to quality health care. The results support the need for further research to rigorously evaluate effectiveness of telehealth interventions to support CBR workers.

Identities Embedded in Our Bodies: Gendered Constructions at Work

Research in disability studies fail to highlight how the concepts of disability, gender and the underlying dynamics of power skillfully intersect and cast an irrefutable impact on each other. Gender inequality and injustice assume discriminative forms for women, often resulting in denial of sexuality and sexual rights, disparity, increasing violence and abuse. This paper addresses the problem of sexual assault of women with disabilities in the Indian context, highlighting loopholes in the Indian legal system and suggesting possible strategies to reinstall their position in a community-based rehabilitation setting.

The Use of the International Classification of Functioning, Disability and Health in Primary Care: Findings of Exploratory Implementation Throughout Life

Purpose: The International Classification of Functioning (ICF) has found widespread acceptance since it was launched in 2001. Yet, little is known about its use in Primary Care. This paper aims to contribute to the dialogue about the practical use of the ICF by exploring how this framework constitutes a supplementary source to inform disability-related decision making in integrated Primary Care. Method: The implementation process of the ICF in a Latin American Primary Care and Community-Based Rehabilitation setting is described and the ICF diagram is applied to a life story as an example of its current use. Participant observation, in-depth study of reports of team meetings and the review of clinical files are the main data collection methods. Data analysis is enabled by the combination of single-case study with theory testing, which facilitates the generation of hypotheses in this exploratory study. Results: A valuable time component of the ICF may support continuity in Primary Care and the universal application of the ICF framework can promote comprehensiveness by integrating individual rehabilitation and collective disability prevention. A way to mitigate the perceived dominance of biomedical disease and deficiency thinking is proposed in order to encourage the biopsychosocial focus of Primary Care. Finally, the implementation of the International Classification of Diseases (ICD-10) in the health condition domain of the ICF highlights the importance of social responsibility towards disability. Conclusion: This study suggests that a creative implementation of the ICF during life course to everyone who uses universally accessible healthcare may strengthen the integrative functions of Primary Care, and may be at the heart of the information system of this essential part of the healthcare system. Further research on the complementary use of ICF and ICD-10 is suggested in order to support community-based multisectoral intervention which may be coordinated by Primary Care.

Towards a Core Set of Clinical Skills for Health-Related Community Based Rehabilitation in Low and Middle Income Countries

Purpose: This research aims to identify a core set of clinical skills for working in a Community Based Rehabilitation (CBR) setting, and to discuss whether they are appropriate for task shifting to a new or an alternative cadre of rehabilitation workers. Methods: The study focussed on work activities relating to the health component of the CBR Matrix. 40 health professionals working in CBR in Low and Middle Income Countries (LMIC) were surveyed to discover the clinical skills that were used most frequently during the past 3 months and to determine which of these skills were deemed most important in a CBR setting. Results: A core set of clinical skills for health-related CBR work in LMIC were identified: advocacy and sensitisation; assessment, monitoring and reporting; behavioural and cognitive interventions; collaboration and referral; communication; continuing professional development; education; gait training; group work; home-based rehabilitation; manual therapy; neurofacilitation techniques; positioning; prescription of strengthening exercises; prescription of stretching programmes; provision of aids, assistive devices and technologies; psychosocial support; recreational therapy; self-care; sensory interventions; supervision; upper body rehabilitation; vocational rehabilitation and working with families. Conclusions: It is possible to identify a core set of health-related CBR skills. These may be considered in the development of training programmes for new or alternative cadres of CBR workers, using a task-shifting model including appropriate support, supervision and referral mechanisms. Implications: Further research is required to establish the generalisability of the skills sets identified here, both across contexts and different client groups and their needs. The identification of core sets of skills for other areas of the CBR Matrix - livelihood, social, empowerment and education – could similarly facilitate access to these domains for people with disabilities.

Can virtual reality balance games enhance activities of daily living among stroke survivors?

Background Stroke survivors with residual physical disabilities are reported to have decreased muscle strength and balance. Balance ability is one of the prerequisite for performing activities of daily living independently. Virtual reality balance games performed in the community based rehabilitation settings may be beneficial for stroke survivors to improve their functional balance resulting in increased independence in activities of daily living. The aim of this study was to evaluate the use of virtual reality balance games in improving activities of daily living among stroke survivors.

“Our lives, our identity”: women with disabilities in India

Although there is a world-wide trend towards women with disabilities attempting to establish their own identity in this complex society, their condition remains very different in the developing countries particularly, India. The plight of women with disabilities is very depressing as they face a triple handicap and discrimination due to their disability, besides the gender issues. Violence against women with disabilities can range from neglect to physical abuse to denying them even the traditional roles of marriage and childbearing. This article addresses the problem of sexual assault of women with disabilities in the Indian context, highlighting on some of the loopholes in the Indian legal system. Method: The article has primarily been based on review of various books, articles and government and other related documents. Outcomes: Review of literature has revealed that in majority of the instances a significant portion of perpetrators have been found to be male caregivers followed by the male family members and strangers constitute only a miniscule of the percentage of the abusers. Adding to this legal system has further aggrieved the situation as the criminal law in India has also not adequately addressed the problem of sexual assault of women with disabilities. Conclusion and implications: The article concludes by suggesting possible strategies to reinstall the position of women with disabilities in a community based rehabilitation setting. It advocates the need to create a supportive environment for disclosure of sexual assault and responses to it will be characterised by belief in the victim, dignity and respect.Implications for RehabilitationIn India, women with disabilities need to be provided with adequate knowledge about sexuality which will equip them to understand that they have been sexually assaulted.There is the need for policy makers to ensure greater accessibility to complaint and redressal mechanisms for women with disabilities.Efforts need to be made to strengthen the legal system and necessary legal aid/help to bring the perpetrators of such crime to justice has to be provided.

A framework for evaluating community-based rehabilitation programmes in Chinese communities

Purpose. The primary aim of this study was to develop an evaluation framework that could effectively describe the quality of community-based rehabilitation (CBR) practice in Chinese communities.Method. This study adopted a case study approach to build and validate a CBR evaluation framework. Core elements of CBR programmes were defined from the literature to form an Initial Framework. Domains and elements of the Initial Framework were then verified with examples of CBR programmes cited in published articles. The revised framework was then further tested for relevance and appropriateness in the real life context through testing in five Chinese CBR programmes.Results. A final framework for evaluating CBR programmes was developed. It consists of 5 domains, 25 categorised core elements and 72 indicators.Conclusion. A comprehensive CBR evaluation framework was built and initially verified with domains, elements and indicators, and is ready for use in Chinese CBR settings.

Risk assessment and management for providers of community-based rehabilitation to people with acquired brain injury: Health professionals' perspectives

Purpose. This study aimed to explore health professionals' perspectives regarding the presence, assessment and management of risks when providing community-based rehabilitation (CBR) to clients with acquired brain injury (ABI).Method. A qualitative approach using semi-structured interviews of health professionals working in CBR.Results. The main themes were: (1) risk assessment in CBR settings is an informal, unstructured, complex, multi-phase and cyclical process extending over a period of time; (2) structured and standardised risk assessments were not considered ideal for use in CBR services catering for people with ABI; (3) CBR services face numerous challenges in providing effective risk assessment and management; (4) the risks encountered by health professionals in CBR settings are not always predictable or preventable; and (5) CBR risk management focuses on implementing a range of practical strategies.Conclusions. A flexible risk assessment process supported by a range of practical risk management strategies to minimise and manage potential risks is advocated by health professionals working in CBR services for people with ABI. There is a need for more research into the effectiveness of current risk assessment and management strategies for CBR services.

Achieving Optimal Functional Outcomes in Community-Based Rehabilitation following Acquired Brain Injury: A Qualitative Investigation of Therapists' Perspectives

The aim of this study was to explore therapists' opinions about the rehabilitation approaches that they perceived contributed to positive outcomes for people with acquired brain injury in community-based rehabilitation settings in order to develop a set of practice principles for clinicians working in this area. Semi-structured interviews were conducted with eight Australian and three British therapists, with a mean of 5.2 years' experience of working with people with acquired brain injury in community-based rehabilitation settings. The interviews were analysed thematically. A summary of the themes was presented to a larger group of acquired brain injury service providers (n = 35) for validation. The participants emphasised the importance of environmental factors, such as collaboration with and inclusion of others in rehabilitation, especially those in the person's support network. Strategy use, client-centred goal setting, the provision of education and the development of a therapeutic relationship were identified as facilitators in community-based rehabilitation. Problems with self-awareness and motivation, drug and alcohol use, and behavioural difficulties were commonly identified barriers to optimal outcomes. The key practice principles derived from the findings were the need for community-based rehabilitation for people with acquired brain injury to be (1) environment focused and contextually appropriate, (2) collaborative and (3) goal directed and client centred.

The Effectiveness of Cultural‐Competence Training for Health Professionals in Community‐Based Rehabilitation: A Systematic Review of Literature

To find and review studies in which investigators evaluated cultural-competence training in community-based rehabilitation settings; critique study methods, describe clinical outcomes, and make recommendations for future research. A review of the effectiveness of cultural-competence training for health professionals in community-based rehabilitation settings was conducted. Research citations from 1991-2006 in CINAHL, Medline, Pubmed, PsycInfo, SABINET, Cochrane, Google, NEXUS, and unpublished abstracts were searched. Searching, sifting, abstracting, and assessing quality of relevant studies by three reviewers. Studies were evaluated for sample, design, intervention, threats to validity, and outcomes. A meta-analysis was not conducted because the studies did not address the same research question. Five studies and one systematic review were evaluated. Positive outcomes were reported for most training programs. Reviewed studies generally had small samples and poor design. The paucity of studies and lack of empirical precision in evaluating effectiveness necessitate future studies that are methodologically rigorous to allow confident recommendations for practice.

Response Prevention of Compulsive Behaviour: A Case Study Conducted in a Community-based Rehabilitation Program

The client, Susan, was a 25-year-old woman who had been engaging in checking rituals and repeating actions for at least five years. Staff, psychology students, high school volunteers and members of the client's family acted as observers and behaviour change agents. Data were collected daily, for up to 16 hours, over a 14-month period. The two major dependent variables comprised the number of rituals and the total time required to complete specific tasks. The major independent variable (response prevention) was also monitored. The results suggest that response prevention reduced the number of rituals and the time required to complete tasks and these changes were maintained at three months follow-up. In addition, a number of daily activities increased. The advantages and disadvantages of carrying out an intensive intervention within a community-based rehabilitation setting are discussed.