Community Rehabilitation Programs Research Articles

Factors Influencing Social and Community Participation of People with Spinal Cord Injury in Karnataka, India.

Social and community participation are major indicators to assess the adequacy of treatment and rehabilitation in patients with spinal cord injury (SCI). This study examined the relationship between functional independence, level of disability, and social and community participation among people with SCI in India. In this cross sectional study, 110 persons with SCI, aged 18 years and above participated in a community setting, in Karnataka, India. Spinal Cord Independence Measure Version III-self-reporting (SCIM III-SR), Craig Handicap Assessment and Reporting Technique (CHART), and WHO Disability Assessment Schedule 2.0 (WHODAS) were the clinical outcome measures. Spearman's correlation and stepwise multiple linear regression were done to determine association and identify the factors determining the community participation of people with SCI. CHART physical independence had a positive correlation with SCIM self-care (R = 0.446) and SCIM mobility (r = 0.434). CHART cognitive independence (R = -0.38) and CHART mobility (R = -0.396) had a weak correlation with WHODAS. SCIM self-care and SCIM mobility (R2 = 0.34) were determinants of CHART cognitive independence. SCIM respiratory and sphincter management and SCIM self-care (R2 = 0.327) were determinants of CHART mobility. Self-care and mobility of people with SCI determine their ability to successfully reintegrate into the community, warranting a comprehensive community rehabilitation program.

Quality of life for people with psychiatric disabilities employed in extended employment programs in two Arab towns in Israel: an exploratory study.

This study aims to examine the quality of life (QOL) for people with psychiatric disabilities who are engaged in extended employment programs (homogeneous versus heterogeneous) in the Arab-populated Triangle Area of Israel. The homogeneous program participants are exclusively Arab while the heterogeneous program includes both Arabs and Jews. Quantitative research study of 104 adults with psychiatric disabilities engaged in two communal extended employment programs. Participants completed demographic (age (years), gender, marital status (married, widowed/separated, married, single), religion (Muslim, Jewish, Christian), dichotomous nationality variable (Jewish/Arab), and years of education) and employment questionnaires (length of time in the employment program, number of working days/h and salary satisfaction); SF 12 Scale; and The Personal Wellbeing Index questionnaire. Two-sample T-Test, exploratory factor analysis and multiple linear regressions were conducted for tracking the differences between participants in homogeneous and heterogeneous programs. A significant difference was found between the programs in two QOL components, insofar as satisfaction with the standard of living, together with health satisfaction were rated higher for participants in the heterogeneous program than for their homogeneous program counterparts. Furthermore, the results indicate that physical health and gender were the most important variables in explaining QOL in both programs, while the employment variables were not significant. Since the research findings show that the employment-related-items aren't significant in predicting the employees' QOL, the definition and suitability of extended employment environments as a mental health service must be reexamined. Cultural elements may also have an impact on QOL when the programs are located in a traditional town, with gender playing a key role. The family's role is pivotal in traditional societies, influencing an individual's ability to participate in employment programs and the support they receive. In patriarchal societies, there can be added pressure on men with psychiatric disabilities to conform to societal expectations. Given the general lack of health awareness in Arab communities, there is a need to develop additional projects or incorporate physical health improvement as a rehabilitation goal when working with individuals with psychiatric disabilities, regardless of the type of community rehabilitation program.

Vocational rehabilitation service receipt, service expenditures, and ruralness

BACKGROUND: An important factor embedded within Vocational Rehabilitation (VR) delivery capacity relates to geography, such as distance from the VR office and availability of service providers or community rehabilitation programs. OBJECTIVE: We explored receipt of VR job search and placement services based on distance to an urban center, demographics, and disability variables after controlling for local employment conditions. METHODS: Using 2015 RSA-911 case services data, we used probit to produce estimates for each combination of service and service source (agency and purchased), and Ordinary Least Squares (OLS) and semi-parametric regression to estimate log expenditures for each service category. RESULTS: Being Black or living at a long distance from a metro area increased the probability of receiving agency-based services but lowered the probability of receiving purchased services. Conversely, being older and having less education lowered the probability of receiving agency services but increased the probability of receiving purchased services. Females, Blacks, and those living at a distance greater than 50 miles from a metro area received significantly lower expenditures. CONCLUSION: Systematic differences in the types of services provided call for more in-depth analysis to ensure that policies and procedures are in place to minimize sociodemographic disparities in service delivery and outcomes.

Inciting Change Makers in an Online Community Engaged Learning Environment During Pandemic Restrictions: Lessons from a Disability Studies and Community Rehabilitation Program


 
 
 This practice-based article presents strategies employed in the shifting of the Community Engaged Learning (CEL) components of an undergraduate program in community rehabilitation and disability studies (CRDS) to an online modality during the 2020-2021 Covid-19 restrictions. The CRDS program, based in Calgary, Canada places high importance on CEL with a focus on critical engagement, mentorship, and community action for social justice. The Inciting Change Makers (ICM) framework, which we present here, is foundational to our teaching and learning in this field. During the pandemic restrictions, we found the framework not only supported us to engage learners in our focus areas for inciting change, but also provided the opportunity to consider ways that the online learning environment enhanced the CEL practica experience.
 Using vignettes, we demonstrate the successful use of the ICM framework in an online CEL context to develop a more authentic, engaged and inclusive community of learners. Three vignettes illustrate specific approaches used to carry out meaningful, impactful CEL opportunities in a mandated online environment. Lessons from these strategies may assist similar programs in adapting their own Community Engaged Learning programs in an increasingly online world.
 
 
 

Effectiveness of Therapeutic Community Rehabilitation Program for Drug Abuse in Social Institutions

This research conducts an evaluation of the Therapeutic Community (TC) Program implemented for residents grappling with drug abuse within social institutions. The study aims to assess the program's effectiveness, the impact on participants, and its implications for social institutions and the broader field of substance abuse treatment. Through a mixed-methods approach, the research scrutinizes quantitative data to measure changes in substance abuse levels, mental health, and readiness for reintegration, coupled with qualitative insights from participant experiences. The outcomes reveal significant reductions in substance abuse levels, improvements in mental health indicators, and positive behavioral changes among participants. The study highlights the pivotal role of peer support and community integration in residents' recovery journeys. The implications of the findings encompass enhanced recovery pathways for individuals, reinforcing the value of community support, while calling for sustained support mechanisms and comprehensive approaches within social institutions. This evaluation underscores the dynamic nature of substance abuse interventions and underscores the importance of continuous assessment, innovation, and adaptive strategies for improved rehabilitation initiatives.

Falls and associated risk factors in a sample of old age population in Egyptian community.

Falling is a major health problem among old age persons and are the sixth cause of mortality and morbidity among them. Assessing the prevalence of falls among elderly in an Egyptian community and investigating its associated risk factors using the Arabic translation of the SHARE-Questionnaire. This cross-sectional analytic study was a part of the pilot for AL-SEHA project. It included 289 old age people (50+ years age) residing in the study areas. The main project data were collected using the Arabic translation of the SHARE (Survey of Health, Aging, and Retirement in Europe) questionnaire. The original project data were collected by investigators from five universities, then uploaded to the internet server domain of the American University in Cairo (AUC) Social Research Center. The prevalence of falls was 11.07% (95% CI: 7.95-15.21). Falls were significantly more among 70 years or older (p < 0.001), unemployed or housewives (p = 0.026), have a family caregiver (p = 0.022), and home facilities for disability (p = 0.015). They had significantly higher rates of ischemic heart disease, hypertension, dyslipidemia, stroke, and diabetes mellitus. The most frequently reported problems were the fear of fall and dizziness (62.5%). The multivariate analysis identified the history of stroke and diabetes mellitus, the fear of fall and dizziness, and the total number of health problems and the score of difficulty in performing physical activities as significant independent predictors of fall occurrence. The history of stroke was the strongest risk factor (OR 33.49, CI: 3.45-325.40). The prevalence of falls among old age persons in the studied community is not alarmingly high. It is highest among stroke patients. Community interventions and rehabilitation programs are recommended to train and educate old age people, especially those at risk such as stroke and diabetic patients, and those with dizziness to improve their physical fitness and reduce the fear of fall among them.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

Community rehabilitation program for addiction (cerp)

Community rehabilitation program for addiction (cerp)

Continuity of Care Advocate Model (CCAM): Healthcare Workers' Perspectives on Quality Stroke Care at an Acute Unit, Rehabilitation Center and Community Rehabilitation Program in Singapore.

Physicians, nurses, social workers, and allied health professionals including physiotherapists and occupational therapists play important roles as they work closely with stroke survivors to improve functional independence in daily activities and quality of life. Yet, in Singapore little is known about their perspectives on what constitute quality stroke care based on their clinical experiences. In this project, our qualitative interviews with 15 healthcare workers at a major stroke center in the country yielded a Continuity of Care Advocate Model (CCAM) to help us better understand our participants' experience-based perspectives on quality stroke care. We found that CCAM, constructed based on the perspectives of HCWs across a stroke care continuum, is a holistic model of quality stroke care which prioritizes support for patients and their families throughout the patient's health trajectory. We conclude by discussing how this model is aligned with and differs from current research on definitions of care continuity.

Quality of Life in COVID-19 Outpatients: A Long-Term Follow-Up Study.

The long-term issues faced by COVID-19 survivors remain unclear. Symptoms may persist for several months, even in non-hospitalized patients, probably impacting the quality of life. To assess the health-related quality of life of outpatients one year after SARS-CoV-2 infection. This prospective multicentre study, conducted in France from February 2020 to February 2022, compared 150 COVID-19 cases (PCR+ and/or CT scan+) and 260 controls (PCR-) selected from a database of four COVID centres. Health-related quality of life assessed using the EQ-5D-5L scale. COVID-19 outpatients (n = 96) had significantly lower health-related quality of life than controls (n = 81) one year after SARS-CoV-2 infection: the EQ-5D-5L index averaged 0.87 in cases and 0.95 in controls (p = 0.002); the EQ- VAS averaged 78 in cases and 86.7 in controls (p &lt; 0.001). This alteration in quality of life was more intense in the areas of pain or discomfort and daily activities. This study is the first to show an alteration in the quality of life of COVID-19 outpatients after one year. Appropriate guidance and community rehabilitation programs are required for outpatients with persistent symptoms of COVID-19. Research must continue to confirm these results in larger cohorts.

Implementation of a leisure reintegration programme for people with acquired brain injury in a community rehabilitation programme: a feasibility study.

Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients. To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service. A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed. Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was -3.63 (p = 0.11) and the LSM 4.25 (p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service. Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI.

Adherence rate, barriers to attend, safety and overall experience of a physical exercise program via telemonitoring during COVID-19 pandemic for individuals with Parkinson's disease: A feasibility study.

BackgroundTelemonitoring can maintain daily exercise routine during the COVID‐19 pandemic of individuals with Parkinson's disease (PD). However, there are barriers to adherence and attendance with remote physical rehabilitation. The main objective of this study was to evaluate adherence rate, barriers to attendance, and safety of a telemonitoring program for individuals with PD; and secondarily to evaluate the individual and their family members perceived overall experience when performing the telemonitoring physical exercise program.MethodsThis was a phase 1 of a clinical trial, engaging 19 individuals with idiopathic PD of an in‐person community rehabilitation program. For 24 weeks an asynchronous telemonitoring physical exercise program delivered two sessions per week by video including warm‐up, balance, aerobic and resistance exercises, and cool‐down. During the remote program were verified: adherence rate at entrance, attendance rate, barriers to attend, safety, and overall experience of the program.Results and conclusionOnly one participant did not perform any session and 18 participants completed between 2 and 34 sessions. Participants with a caregiver showed higher attendance rates. The most frequently cited barriers to attend the program were: pain; lack of motor skills; and reduced physical fitness. In relation to safety of the program, the most frequently reported was fear of falling. Although participants reported the telemonitoring program induced health benefits and they had positive experiences for themselves and for their families, most of participants prefer an in‐person program. In this sense, the asynchronous telemonitoring physical exercise program was safe, showed moderate adherence, with attendance rate depending on the presence of a companion.

The Effects of Occupation-Based Community Rehabilitation for Improving Activities of Daily Living and Health-Related Quality of Life of People with Disabilities after Stroke Living at Home: A Single Subject Design.

Objective The aim of this study is to investigate the effect of occupation-based community rehabilitation on activity daily of living and health-related quality of life of people with disabilities after stroke at home. Method In this study of three people with disabilities after stroke living at home, A-B-A single-subject design was used. The occupation-based community rehabilitation was implemented during the intervention phase. It included task oriented and feedback, related information education, home environment modification, and community resource network. After applying the intervention, changes in activities of daily living and health-related quality of life were evaluated by the Modified Barthel Index (MBI), the EuroQol-5 dimension (EQ-5D), and the Assessment of Motor and Process Skills (AMPS). Result After applying the occupation-based community rehabilitation program, all three participants' daily life activities and quality of life improved. In addition, the occupational performance skills in all participants were maintained. Conclusion It was confirmed that individual occupational-based community rehabilitation had a positive effect on the activities of daily living and quality of life improvement of the people with disabilities after stroke at home.

Client and service factors associated with changes in health-related quality of life following community rehabilitation

Purpose To identify client and service factors associated with changes in health-related quality of life following community rehabilitation. Methods We conducted a retrospective observational cohort study within a community rehabilitation program. Health-related quality of life was measured using the EuroQol five Dimensions, five response level version (EQ-5D-5L). Our primary outcome was the Visual Analogue Scale (VAS) rating of overall health. Analyses were stratified by diagnostic group: traumatic orthopaedic, elective orthopaedic, neurological, medical, and other. The association between client and service factors and discharge VAS scores, adjusted for baseline scores were determined using multivariable regression. Results EQ-5D-5L data were available for 981 of 1350 participants. Treatment intensity was associated with a seven-point increase (β = 7.22, 95%CI 2.28–12.2, p = 0.004) in VAS scores for traumatic orthopaedic participants. For neurological participants, there was a positive interaction between comorbidities and intensity of therapy (β = 7.9, 95%CI 2.75–13.1, p = 0.003), indicating that greater therapy intensity in those with higher comorbidity scores was associated with an improvement in VAS scores. Age was negatively associated with VAS scores for traumatic orthopaedic participants and socioeconomic status was positively associated with VAS scores for elective orthopaedic participants. Conclusions Treatment intensity is a modifiable service factor that may positively influence health-related quality of life. Implications for rehabilitation In addition to providing information on client progress towards attainment of individual treatment goals, routine collection of patient reported outcome measures within a community rehabilitation program can elicit information that can inform rehabilitation service improvement. Clients of a community rehabilitation program with a neurological or medical condition demonstrate the least improvement in overall health profile and may require additional rehabilitation or supports. Across all diagnostic groups, problems with anxiety and depression were least likely to improve following receipt of community rehabilitation. Improving access to psychological services and associated referral pathways in community rehabilitation services could improve these outcomes. Initiatives aimed at increasing intensity of therapy such as targeted triage and resource allocation, may improve health-related quality of life for clients of a community rehabilitation program with traumatic orthopaedic conditions. For clients with a neurological condition, initiatives aimed at increasing intensity of therapy may improve health-related quality of life in more complex patients with comorbid health conditions.

It takes two to tango: The therapeutic alliance in community brain injury rehabilitation

AbstractObjective:A positive therapeutic (or working) alliance has been associated with better outcomes for clients in the psychotherapeutic and traumatic brain injury (TBI) rehabilitation literature. The aim of this pilot study was to gain an understanding of the therapeutic alliance in community rehabilitation from the perspectives of adults with TBI and their close others who have completed a community rehabilitation programme.Method:This study used a constructivist, qualitative methodology which applied grounded theory analysis techniques. Using purposeful sampling, three pairs of participants (adults with TBI and close others) who had finished a community rehabilitation programme completed separate in-depth interviews which were transcribed verbatim and progressively analysed using a process of constant comparison.Results:A preliminary framework illustrating participants’ experience of a therapeutic alliance was generated, comprising three interconnected themes: being recognised as an individual, working together and feeling personally connected. All participants viewed being able to work together as important in their experience of community rehabilitation and described features that helped and hindered the alliance.Conclusion:These pilot study results demonstrate the importance of the therapeutic alliance to the rehabilitation experience of individuals with TBI and those close to them.

Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators.

As the global population of older people increases, policies aimed at improving health care delivery for older people often include supports for ageing in place. Living in the community not only reduces institutionalisation but also improves quality of life and reduces health care costs. For older people, community rehabilitation offers the opportunity to preserve and maximise function while maintaining the ability to live in the community. However, limited research examines the delivery, coordination and integration of community rehabilitation services in health systems. Our case study explored the perspectives of service providers, managers and health system administrators on the strengths, limitations and gaps in community rehabilitation for older people in one Canadian urban health region. Using interpretive description and thematic analysis, we analysed interview data from: 16 service providers, eight managers and five health system administrators. Three themes were identified: (a) Limited Access to Programs and Services; (b) Need to Emphasise Promoting, Maintaining and Restoring Function; and (c) Lack of Flow Across the System. Participants highlighted that restrictive eligibility criteria limited access to services. Services were organised around health conditions that did not address the needs of older people. Long waitlists meant that services were delayed. Transportation costs limited participation of individuals from lower socioeconomic status (SES). Age restrictions did not reflect differences in the ageing process and the health inequities individuals from lower SES groups experienced. There was a lack of emphasis in community rehabilitation programs on maintaining or restoring function in older people, which is the primary focus of rehabilitation. Furthermore, key stakeholders stressed the need for strengthening the integration of service delivery across the continuum of care. The findings underscore the need to develop a conceptual framework for community rehabilitation to promote greater system integration, access and availability of services and to optimise functional outcomes for older people.

The Impact of Early Work Experiences on VR Outcomes

In response to the Workforce Innovation and Opportunity Act of 2014 (WIOA), Missouri Vocational Rehabilitation (MOVR) developed a new service designed to provide early work experiences for VR-eligible students with disabilities. The MOVR summer work experience was offered prior to a student’s final year of high school and consists of a 6-week paid work experience with an employer in a competitive integrated setting with support provided by a community rehabilitation program (CRP). The primary purpose of this evaluation was to determine whether participation in the summer work experience impacted postsecondary employment outcomes, as well as develop a better understanding of the underlying mechanism(s).

An Outcome Analysis of Community Rehabilitation Programs

State Vocational Rehabilitation (VR) programs frequently partner with community rehabilitation programs (CRPs) to provide key employment support to individuals with significant disabilities. However, the employment outcomes for many individuals have consisted of a lengthy period of time to placement, low wages, and limited hours. The Utah State Office of Rehabilitation (USOR) sought to learn whether recent agency CRP policy changes had a positive influence on client employment outcomes and use results to inform further internal evaluation efforts.

A Study on the Gender Sensitivity of Staffs in Community Rehabilitation Programs on Sexual Behavior of Adults with DD

이 연구는 장애인복지시설 종사자가 교육 및 일상의 돌봄 과정에서 경험한 성인 발달장애인의 성행동 유형과 대응태도를 알아보고 종사자의 성인지 감수성 향상방안을 탐색하는데 연구의 목적이 있다. 이를 위해 장애인복지시설 종사자 12명을 연구참여자로 선정하였고 심층면담 후 전사 및 코딩분석을 통해 범주화 과정을 거쳐 67개의 개념화, 13개의 소주제, 6개의 핵심주제를 도출하였다. 연구결과는 첫째, 시설 종사자에게 인식된 성인 발달장애인의 성행동은 부정적으로 나타났으며 이들은 성인권 보장과 통제 속에서 갈등하는 것으로 나타났다. 둘째, 종사자가 인식하는 성인지 감수성은 미흡한 것으로 나타났으며 이로 인해 성인 발달장애인을 성적 존재로 인지하지 못하고 혼재된 감정과 시선으로 성인 발달장애인의 성행동에 양가감정을 나타내고 있었다. 셋째, 허술한 성교육 등 종사자가 풀어야 할 과제와 함께 성인 발달장애인의 성(性)을 긍정적 활동으로 인지할 수 있는 성인지 감수성 향상 방안이 필요함을 알 수 있었다. 결론으로 성인 발달장애인 성(性)에 대한 인권적 접근이 필요하고 이들을 지원하기 위한 전제로 장애인복지시설 종사자 자신의 성(性)에 대한 자기점검과 지속적인 성찰이 필요한 것으로 나타났다. 또한 성인 발달장애인을 위한 시설의 성인지적 지원은 성인지 감수성에 기반한 조직문화·정서로 자리매김 되어야함을 알 수 있었다.The purpose of this study was to investigate the sexual behavior patterns of adult with DD (Developmental Disabilities) and response attitudes of staffs in community rehabilitation programs for the adult with DD in the process of education and daily care, and to explore ways to improve workers gender sensitivity. For this study, 12 staffs in community rehabilitation programs were selected as research participants, Data collection consisted through in-depth interviews. The results of the study were as follows: First, the sexual behavior of the adult with DD perceived by staffs in community rehabilitation programs was negative, and it was found that they were in conflict with the guarantee and control of adult rights. Second, staffs did not recognize adult with DD as sexual beings, and expressed ambivalence on the sexual behaviors of adults with DD through mixed emotions. Third, it was found that there is a need to improve gender sensitivity to recognize the sex of adults with DD as positive activities along with tasks that staffs need to solve, such as poor sex education. In c onclus ion, a h uman r ights approach to a dult DD i s needed, and as a p rerequis ite to support them, self-examination on the sex, attitudes toward sexual life are required. In addition, it was found that the gender sensitive support of community for adults with DD should be positioned as an organizational culture and sentiment based on gender sensitivity.

The frequency and impact of undiagnosed benign paroxysmal positional vertigo in outpatients with high falls risk.

The frequency and impact of undiagnosed benign paroxysmal positional vertigo (BPPV) in people identified with high falls risk has not been investigated. To determine the frequency and impact on key psychosocial measures of undiagnosed BPPV in adult community rehabilitation outpatients identified with a high falls risk. A frequency study with cross-sectional design. A Community Rehabilitation Program in Melbourne, Australia. Adult community rehabilitation outpatients with a Falls Risk for Older People in the Community Screen score of four or higher. BPPV was assessed in 34 consecutive high falls risk rehabilitation outpatients using the Dix-Hallpike test and supine roll test. Participants were assessed for anxiety, depression, fear of falls, social isolation and loneliness using the Hospital Anxiety and Depression Scale, Falls Efficacy Scale-International and De Jong Gierveld 6-Item Loneliness Scale. A total of 18 (53%; 95% confidence interval: 36, 70) participants tested positive for BPPV. There was no significant difference between those who tested positive for BPPV and those who did not for Falls Risk for Older People in the Community Screen scores (P = 0.555), Hospital Anxiety and Depression Scale (Anxiety) scores (P = 0.627), Hospital Anxiety and Depression Scale (Depression) scores (P = 0.368) or Falls Efficacy Scale-International scores (P = 0.481). Higher scores for the De Jong Gierveld 6-Item Loneliness Scale in participants with BPPV did not reach significance (P = 0.056). Undiagnosed BPPV is very common and associated with a trend towards increased loneliness in adult rehabilitation outpatients identified as having a high falls risk.