Community Rehabilitation Research Articles

Factors Affecting Employability of Patients with Schizophrenia who had First Participated in Vocational Training: A Pilot Study.

While vocational training may offer financial and health benefits for patients with schizophrenia (PwS), further empirical research is required to investigate the effectiveness of this intervention for PwS, as well as the factors influencing their employability. This study aimed to (i) identify the factors affecting the employability of PwS who had participated in vocational training and (ii) examine the effectiveness of vocational training. This prospective cohort study was conducted in a community rehabilitation center attached to a psychiatric hospital in southern Taiwan that provides vocational training. The participants completed two questionnaires: (i) a pre-test that served as the study's baseline; (ii) a post-test during a follow-up 12 months later. The questionnaire was divided into three parts: (i) participants' basic information, (ii) the work performance scale, and (iii) the mental state measure. The participants included 35 males and 30 females, with the average age being 45.85 years. The significant factors affecting their employability were social support, work behavior, thinking disorder, and cognitive impairment. In other words, participants with better social support, work behavior, and fewer thought disorders and cognitive impairment were more employable. Their work attitude and ability were found to have significantly improved after having participated in vocational training for 12 months. In conclusion, when conducting vocational training in the future, it is necessary to pay attention to individual participants' social support and work behavior and reduce thinking disorders and cognitive impairments. This may help improve the employability of PwS.

The RECAPACITA project: Description of the clinical, neuropsychological and functional profile of a sample of people with severe mental disorder and legal capacity modification in Spain

Severe mental disorder (SMD) includes people with long-term mental disorders, disability and social dysfunction. The mental capacity evaluation of the people has been a key aspect in legislative systems around the world and different proposals have been made. In countries like Spain, until 2021, the mental capacity of individuals was assessed by means of legal proceedings. In the last years, there has been a notable increase in the number of claims for legal incapacity, but no data are available on the total number of persons with CM, neither on the specific pathologies, or clinical and cognitive profiles. In view of the total absence of data on the profile of people with SMD and modification of capacity, the RECAPACITA study was born. This study includes patients with SMD and CM, as well as those without CM, with the aim to describe exhaustively their clinical, neuropsychological and functional profile of people with SMD and CM, as well as obtaining a basic description of the social environment. ObjectivesTo describe CM in SMD, to identify clinical diagnoses, clinical severity and neuropsychological deterioration. Methods: Cross-sectional descriptive study. 77 adult patients with SMD and CM, inpatients from the mental health sector of the Parc Sanitari Sant Joan de Déu (Spain), outpatients linked to the community rehabilitation services (CRS), and penitentiary inmates. CM, sociodemographic, clinical, functional and neuropsychological data are collected. ResultsIn the sample, 59.5% present total CM. 74.7% are men (mean: 52.5 years). 87,0% have a diagnosis of schizophrenia. The estimated premorbid IQ is 91.4. The Global Assessment of Functioning (GAF) had a mean of 50.5, the “Clinical Global Impression Scale” (CGI) was 4.6 and Scale Unawareness of Mental Disorders (SUMD) was 9.28. The cognitive results shows a profile with slow proceeding speed (mean scale score: 6.6), good working memory (mean SC: 8.3) and adequate verbal comprehension (mean SC: 7.3). In memory, coding is altered (Pz: −1.9), and long-term spontaneous recall (Pz: −2.3). In abstract reasoning, a slight alteration is obtained (Mean SC: 6), as well as in semantic fluency (Mean SC: 6.3), phonological (Mean SC: 5.9), and inhibitory capacity (Mean SC: 5.7). ConclusionsMost of the sample are men with schizophrenia, with a total MC assumed by a tutelary foundation. They show a moderate alteration in global functioning and clinical global impression, with partial awareness of the disease. They present dysexecutive mild cognitive impairment, with poor memory coding and free retrieval capacity, and a normal IQ, adequate verbal comprehension and working memory. This study is the first to present objective data on the psychiatric, functional and cognitive status of a group of patients with CM. Such research could be a good starting point to address a topic of great interest from the health, social and legal point of view of the CM processes of people with SMD.

Environmental and systems experiences of persons with spinal cord injury and their caregivers when transitioning from acute care to community living during the COVID-19 pandemic: a comparative case study

Comparative case study OBJECTIVES: To elevate the voices of and capture the lived environmental and systems experiences of persons with spinal cord injury (PWSCI) and their caregivers, in transitions from inpatient rehabilitation to the community. Also, to examine the perceived and actual availability and accessibility of services and programs for this group. Inpatient rehabilitation unit and community in Calgary, Alberta, Canada METHODS: As a comparative case study, this research included multiple sources of data including brief demographic surveys, pre- and post-discharge semi-structured interviews, and conceptual mapping of services and programs for PWSCI and caregivers in Calgary, Canada (dyads). Three dyads (six participants) were recruited from an inpatient rehabilitation unit at an acute care facility, from October 2020 to January 2021. Interviews were analyzed using the Interpretative Phenomenological Analysis approach. Dyads described transition experiences from inpatient rehabilitation to community as uncertain and unsupported. Breakdowns in communication, COVID-19 restrictions, and challenges in navigating physical spaces and community services were identified by participants as concerns. Concept mapping of programs and services showed a gap in identification of available resources and a lack of services designed for both PWSCI and their caregivers together. Areas for innovation were identified that may improve discharge planning and community reintegration for dyads. There is an intensified need for PWSCI and caregiver engagement in decision-making, discharge planning and patient-centered care during the pandemic. Novel methods used may provide a framework for future SCI research in comparable settings.

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes.

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes.

Social Functioning Deficits in Schizophrenia and Relevant Interventions

The social function of clients has been linked to the acquisition effect and prognosis during recuperation. Studies have shown that the impact of antipsychotics on cognitive impairment is limited to improving social ability. A previous study shows that cognitive rehabilitation (CR) aimed at improving social ability can increase recollection and concentration. Although recent evidence shows that schizophrenia patients have obstacles in using emotion regulation strategies in society, few studies have explored the relationship between these regulation strategies and emotion and social behavior in daily life. The social symptoms of schizophrenia are usually considered as a reflection of low social cognitive ability. Here, the research on the response to social reward is a feature of human engagement, which is not prominent in the published studies. Daily functions need to motivate individuals to negotiate the social environment and establish friendships by using their social psychological talents. There's evidence that some schizophrenias don't have the social skills that they need in daily life, such as social norms, and show social unhappiness and/or vexatious behaviors. It is suggested that community rehabilitation can address the social and clinical needs of schizophrenia patients in a resource deficient environment. Reinforcement production process is a technique that helps people stay motivated in social situations. The experience and expectation in the interaction determine the happiness in the interaction. Social rewards usually come from social cues, such as facial expressions. This review can provide some guidance to the prevention programs for at-risk children in schools and communities.

Occupational evaluation of community-based psychiatric rehabilitation outcomes in individuals with severe mental illnesses: A ten-year retrospective study

There is a lack of research on the effect of community-based psychiatric rehabilitation programs (CBPRs) in individuals with severe mental illness. This research used data from a retrospective study to examine the effect of a CBPR in a community rehabilitation center. Clinical outcomes measures from a retrospective study were collected. Outcome measures were the Allen Cognitive Level Screen assessment, Purdue Pegboard Test, Chu's Attention Test, and Activities of Daily Living Rating Scale-III (ADLRS-III) before and immediately after 12 months of intervention. The 141 participants with mental illness were an average age of 35.29 years (SD = 8.75). The retrospective review of medical records showed 46 people dropped out within 12 months, and 95 people continued to participate in the rehabilitation program for 1 year. After 1 year of community rehabilitation, there was a trend for the participants who completed the intervention to improve on the ADLRS-III, Purdue Pegboard Test, and Chu's Attention Test. Participants who performed better on the occupational assessment were more likely to transit to the employment status. This study found the benefits of CBPR in work-related intervention for people with mental illness. Occupational assessments are relevant for studying changes in functional outcomes in people with mental illness receiving community-based rehabilitation.

Sentencing: New trajectories in law By E.A.O.Freer, Abingdon: Routledge. 2021. pp. 131. £44.99 (hbk); pp. 146. £16.99 (pbk). ISBN: 9780067862619; 9781032063027

Sentencing: New trajectories in law By E.A.O.Freer, Abingdon: Routledge. 2021. pp. 131. £44.99 (hbk); pp. 146. £16.99 (pbk). ISBN: 9780067862619; 9781032063027

Power Differentials in the Counseling Relationship: A Conversation Analytic Study on Goal-Setting Meetings in a Clubhouse Mental Health Rehabilitation Community

We used conversation analysis to examine social support in a Clubhouse mental health rehabilitation community. We focused on goal-setting meetings, which is a very specific equality-promoting group counseling setting in which professionals and clients provide peer support to each other. We asked how the professionals commented on the clients’ goals and presented their own goals during the activity, pointing to the practices of affiliation that nonetheless served to construct and maintain power imbalances between the professionals and clients. Although the idea of casting group counseling as peer support is motivated by an attempt to foster equality at the level of group interaction, our analysis shows that such organization tends to invoke other inequalities that may be even deeper than the ones with which the participants begin.

Reliability and Utility of Load-Cell Derived Force–Time Variables Collected During a Constrained and Unconstrained Isometric Knee Extension Task on a Plinth

Rate of force development (RFD) and impulse (IMP) are important mechanical measures of muscular performance but are relatively unused within the rehabilitation and performance community. Due principally to access to low-cost testing devices and understanding the utility of these measures. The aim of this study therefore was to quantify the reliability of various force–time variables using load-cell technology collected via isometric knee extension whilst constrained in an isokinetic device (CON90) or unconstrained on a physiotherapy plinth at 60 and 90 degree angles (UNCON60 and UNCON90). Thirty-two volunteers had their peak force (PF), RFD, peak RFD (PRFD), and IMP assessed across three protocols. For all variables, UNCON60 had the largest variability across all measures. PF and PRFD were found to have small variability (ICC > 0.67 and CV < 10%). With regards to RFD 2080 all three protocols were found to have moderate variability all ICCs above 0.75, however, all CVs were greater than 10% ranging from ~ 11%–22%. Finally, IMP 2080 was found to have moderate variability for both CON90 and UNCON90, the absolute consistency once more greater than 10% (~ 11%–25%). Using the constrained and unconstrained protocols, PF and PRFD can be measured reliably between trials with 90 degree knee position.

View of the Work Community and Vocational Rehabilitation Services Among Adults With Autism Spectrum Disorder

Many adults diagnosed with autism spectrum disorder (ASD) face challenges in establishing and maintaining employment. These difficulties may be related to ASD symptomology or employer attitudes; however, vocational rehabilitation (VR) can provide employment-related resources. This study sought to understand how adults with ASD view their integration into workplace communities and VR services. Qualitative data were collected from 24 adults with ASD, and analysis identified themes surrounding the importance of workplace contributions, interesting work, and positive workplace relationships contributing to feeling integrated into the workplace community. Responses were also examined for perspectives on the role of VR in supporting workplace integration. Findings indicate the importance of attending to individual employment preferences and the need for long-term VR follow-along services to explore opportunities for employment growth. Implications and future recommendations for research and practice are also discussed.

Capacity Building of Forest Local Community, Tree Seeds Providers and Forestry Extension Workers on Plus Tree Selection Technique in Kediri, East Java, Indonesia

Community forests play significant role in supplying national demand of woods, sustaining local ecosystem and increasing benefit for local community. Tree plantings for both community forests and rehabilitation of degraded forests and lands, however often neglect utilization of good quality seeds, which resulted in low quality of forest plantation. In order to support the procurement of good quality seeds, it is necessary to raise awareness of local community, seeds providers and forest extension workers on the production of good quality seeds through tree selection program. This paper reported the activity to build the capacity of local community, seeds providers and forest extension workers on plus trees selection, as sources of good quality seeds production. The training activity took place two times at Ngancar Village, Kediri Regency, East Java. The participants in each training received lectures in a classroom and hand-in practical work on tree selection techniques in the field. The topics given are considered as important by participants, as evident from the increasing number of participants in the second time of training. Analysis of pre- and post-test conducted showed that the participants knowledge and skill increased by 27,9 % after training, regardless of their ages and educational backgrounds.

Learning Health Systems Research Competencies: A Survey of the Rehabilitation Research Community.

The Learning Health Systems Rehabilitation Research Network (LeaRRn), an NIH-funded rehabilitation research resource center, aims to advance the research capacity of learning health systems (LHSs) within the rehabilitation community. A needs assessment survey was administered to inform development of educational resources. The online survey included 55 items addressing interest in and knowledge of 33 LHS research core competencies in 7 domains and additional items on respondent characteristics. Recruitment targeting rehabilitation researchers and health system collaborators was conducted by LeaRRn, LeaRRn health system partners, rehabilitation professional organizations, and research university program directors using email, listservs, and social media announcements. Of the 650 people who initiated the survey, 410 respondents constituted the study sample. Respondents indicated interest in LHS research and responded to at least 1 competency item and/or demographic question. Two-thirds of the study sample had doctoral research degrees, and one-third reported research as their profession. The most common clinical disciplines were physical therapy (38%), communication sciences and disorders (22%), and occupational therapy (10%). Across all 55 competency items, 95% of respondents expressed "a lot" or "some" interest in learning more, but only 19% reported "a lot" of knowledge. Respondents reported "a lot" of interest in a range of topics, including selecting outcome measures that are meaningful to patients (78%) and implementing research evidence in health systems (75%). "None" or "some" knowledge was reported most often in Systems Science areas such as understanding the interrelationships between financing, organization, delivery, and rehabilitation outcomes (93%) and assessing the extent to which research activities will improve the equity of health systems (93%). Results from this large survey of the rehabilitation research community indicate strong interest in LHS research competencies and opportunities to advance skills and training. Competencies where respondents indicated high interest and limited knowledge can inform development of LHS educational content that is most needed.

From healthcare system to individuals through stroke rehabilitation pathways.Outcomes, information, and satisfaction along 12 months prospective cohort in Portugal

ABSTRACT Background The nature and quality of stroke survivor rehabilitation varies throughout Europe, including in Portugal, having not been widely monitored or benchmarked. Objectives This study analyses the stroke care pathway from three perspectives: healthcare system, process, and patient. Methods The study uses data from a one-year single-center prospective cohort of first stroke patients, assessed at baseline, 3, 6, and 12 months. Care pathways and settings were described in terms of organizational model, funding, patient involvement, frequency and intensity and multidisciplinary team. Patient-level information and satisfaction were evaluated using a 10-point numeric rating scale. Kruskal – Wallis and post-hoc tests were used to compare EQ-5D-3 L, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index, Mini-Mental State Examination scores between pathways and settings. Results A total of 391 acute stroke patients, with a mean disability of 3.7 (mRS) and severity of 11.7 (NIHSS) participated. Six pathways and eight settings were described. A lack of compliance between guidelines and care was identified. There were significant differences in the four outcomes between the six pathways (p-values 0.007 to 0.020) suggesting inefficiency and inequalities, with an inadequate level of information and patient satisfaction. After post-hoc analysis, pathways 1 and 2 showed highest outcomes (p-values 0.001 to 0.002). Within settings, short-term units showed high scores, followed by rehabilitation center, outpatient hospital, and community clinic (p-values 0.001 to 0.040). Conclusion A multilevel characterization of the post-stroke rehabilitation pathway showed a more complete perspective on stroke management which may contribute to future rehabilitation and stroke policies

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.

SARS-CoV-2 Infection in San Patrignano, the Largest European Drug Rehabilitation Community.

Studies on SARS-CoV-2 conducted in confined settings for prolonged times allow researchers to assess how the coronavirus spreads. San Patrignano (SP), Italy, is the largest European drug rehabilitation facility. Between 15 October and 31 December 2020, all SP residents were tested for SARS-CoV-2. We analyzed the relationships between individual characteristics and being SARS-CoV-2-positive. Three selected predictive models were used to calculate the number of expected hospitalizations. For each model, we summed the estimated individual risks to obtain the expected number of hospitalizations in our sample, and we tested whether the observed and expected numbers differed. Of 807 residents, 529 (65.6%) were SARS-CoV-2-positive. Of these 323 (61.1%) were symptomatic. A strong relationship was found between being positive and living connections (p-value < 0.001). No statistically significant relationship was found with age, sex, smoking history, or comorbidities. Although 9 to 17 hospitalizations were expected, no hospitalizations were observed (p-value < 0.001). No one died of COVID-19. The peculiar characteristics of SP residents or the SP environment might at least partially explain the null hospitalization rates. Despite the extreme uniqueness of our population and despite the protected environment and all precautions that were taken, the fact that the virus was able to circulate and infect a large portion of the population highlights the fundamental role of social interactions in the spread of the disease.

Rehabilitation services must include support for sexual and gender-based violence survivors in Ukraine and other war- and conflict-affected countries.

Sexual and gender-based violence (SGBV)-both during times of war and peace-can have impactful negative social and health outcomes. Reports of rape being used as an act of war in Ukraine are drawing global attention to the need for specialized care for SGBV survivors during times of war and thereafter. While data remain limited, in 3 November 2022, 7 million people in Ukraine were reported to need SGBV prevention and response services. Services offered by the government and civil society include a coordination centre of free legal aid, online and mobile platforms, chat-bots, hotlines, assistance centres, shelters, crisis rooms and mobile brigades. Rehabilitation services to support women and girls who have experienced SGBV during times of conflict and war, however, remain limited. We must make sure that our understanding of rehabilitation extends beyond providing physical modalities or recovery after surgery and that SGBV survivors are not excluded from necessary care. This is particularly important if we want to ensure that rehabilitation services are meeting the needs of the most vulnerable populations. We call on the international rehabilitation community to ensure the availability of and access to these vital life-changing services.

Use of item response theory to develop a return to work measure for acquired brain injury: The employment feasibility checklist.

The 2001 Feasibility Evaluation Checklist (FEC) is an assessment of work readiness for individuals with acquired brain injury (ABI). It establishes the integrity of basic safety, productivity, and interpersonal factors in neurorehabilitation and vocational settings. This study represents an effort to further develop the FEC to increase its clinical utility. To redesign the FEC by conducting Item Response Theory (IRT) analyses on the study's results and combining those mathematical calibrations with clinical expert judgement. The result will be a new measure for use in clinical ABI neurorehabilitation and vocational settings: the Employment Feasibility Checklist (EFC). Seven participants with ABI were administered a situational assessment on multiple occasions by occupational therapists in a community rehabilitation clinic. The FEC was used to assess the participant's performance across three areas of basic employment feasibility: safety, productivity, and interpersonal factors. Results were analyzed with IRT-Rasch analysis and then subjected to clinical expert judgment, resulting in adjustment recommendations for the FEC. In this scale development study, IRT analysis of results from 89 observation trials was combined with expert clinical judgment resulting in a redesigned tool with increased clinical utility for persons with ABI. The EFC is a 12-item observational rating scale for employment feasibility constructs of Productivity and Interpersonal Relations, with an additional six-item Workplace Safety subsection. The EFC is a mathematically calibrated tool designed to gauge feasibility for competitive employment in clients with ABI. The tool may be useful in clinical neurorehabilitation settings and vocational rehabilitation settings.

The application of life-rebuilding based occupational therapy practice model in community rehabilitation

The application of life-rebuilding based occupational therapy practice model in community rehabilitation

Delivery of Rehabilitation Services: Opportunities and Threats During a Global Pandemic

Background: This presentation articulated a personal perspective of an Occupational Therapy (OT) practitioner regarding the changes already happening within the field of rehabilitation before the COVID-19 pandemic and its cataclysmic role that accelerated changes in the delivery of rehabilitation services, specifically in advancing the application technologies and innovative practices in the clinics, renewed focus on strengthening and supporting OT and rehabilitation professionals’ health and well-being, and use of transformational instructions to prepare students for future healthcare challenges. Included in this presentation is the global response to ensure the delivery of rehabilitation services, the exemplar of local innovations and resilience among Filipino OT and the rehabilitation community, emerging opportunities and threats brought about by the pandemic, and the lessons and innovations we bring forward as part of the new normal post-COVID-19 pandemic, and beyond.

Retracted: Construction of Community Medical Communication Service and Rehabilitation Model for Elderly Patients under the Internet of Things.

[This retracts the article DOI: 10.1155/2022/9689769.].