Effective Rehabilitation Services Research Articles

Fusing CNNs and attention-mechanisms to improve real-time indoor Human Activity Recognition for classifying home-based physical rehabilitation exercises

Physical rehabilitation plays a critical role in enhancing health outcomes globally. However, the shortage of physiotherapists, particularly in developing countries where the ratio is approximately ten physiotherapists per million people, poses a significant challenge to effective rehabilitation services. The existing literature on rehabilitation often falls short in data representation and the employment of diverse modalities, limiting the potential for advanced therapeutic interventions. To address this gap, This study integrates Computer Vision and Human Activity Recognition (HAR) technologies to support home-based rehabilitation. The study mitigates this gap by exploring various modalities and proposing a framework for data representation. We introduce a novel framework that leverages both Continuous Wavelet Transform (CWT) and Mel-Frequency Cepstral Coefficients (MFCC) for skeletal data representation. CWT is particularly valuable for capturing the time-frequency characteristics of dynamic movements involved in rehabilitation exercises, enabling a comprehensive depiction of both temporal and spectral features. This dual capability is crucial for accurately modelling the complex and variable nature of rehabilitation exercises. In our analysis, we evaluate 20 CNN-based models and one Vision Transformer (ViT) model. Additionally, we propose 12 hybrid architectures that combine CNN-based models with ViT in bi-model and tri-model configurations. These models are rigorously tested on the UI-PRMD and KIMORE benchmark datasets using key evaluation metrics, including accuracy, precision, recall, and F1-score, with 5-fold cross-validation. Our evaluation also considers real-time performance, model size, and efficiency on low-power devices, emphasising practical applicability. The proposed fused tri-model architectures outperform both single-architectures and bi-model configurations, demonstrating robust performance across both datasets and making the fused models the preferred choice for rehabilitation tasks. Our proposed hybrid model, DenMobVit, consistently surpasses state-of-the-art methods, achieving accuracy improvements of 2.9% and 1.97% on the UI-PRMD and KIMORE datasets, respectively. These findings highlight the effectiveness of our approach in advancing rehabilitation technologies and bridging the gap in physiotherapy services.

Perspectives and insights on physical therapy's function in COVID-19 rehabilitation

Abstract. Physical treatment is useful in reducing the many COVID-19 problems, according to recent studies. The significance of physical therapy in the all-encompassing management of the new coronavirus has been brought to light. Physical therapy is the main body of rehabilitation therapy, including a wide range of techniques (such as sound, light, cold, heat, electricity, force (movement and pressure) and other physical factors for treatment, as well as breathing, muscle training, for local or systemic body dysfunction or lesions, The use of non-invasive, non-drug treatment, reinforcement strategy exercises, immediate relief of symptoms and overall improvement of the patients physical function and restoration of the patients original body physiological function. This integrated approach enables patients to return to their previous level of activity and quality of life by highlighting the entire context of treatment. Physiotherapy is not without its limitations, though. Physiotherapy requires patient-specific care, because there arent enough doctors or patients during a pandemic. To ensure the provision of effective rehabilitation services, creative solutions are required to address issues including the shortage of specialists, the requirement for training units, and the return of telemedicine. Furthermore, further research efforts and interdisciplinary collaboration are required to establish effective practices and improve patient outcomes related to physical therapy engagement in COVID-19 recovery programs. As a result, the pandemic has brought attention to and strengthened an important shift in the role of physical therapy in the management of post-viral syndromes, opening the door for future advancements in the field of infectious disease medicine.

Theoretical Aspects of Transdisciplinarity in Telerehabilitation

This article explores the theoretical aspects of transdisciplinary research, with a specific focus on its application to telerehabilitation. The integration of multiple disciplines – ranging from medicine, digital health, and informatics to engineering and the social sciences – is increasingly necessary to address the complex challenges of delivering effective remote rehabilitation services. The article begins by outlining the conceptual framework, distinguishing between disciplinary, interdisciplinary, multidisciplinary, and transdisciplinary approaches, and highlighting the importance of transcending traditional disciplinary boundaries. The theoretical foundations discussed provide a basis for understanding how the convergence of diverse fields can lead to innovative solutions in telerehabilitation. The integration of disciplines is examined in detail, illustrating how collaborative efforts across medicine, technology, and behavioral sciences can enhance patient outcomes, improve accessibility, and foster the development of personalized rehabilitation plans. The article also covers the practical implications for clinical practice, emphasizing the need for a more collaborative model of care delivery and the potential for cost-effective, scalable solutions. Looking toward the future, the article identifies key areas for research, including the development of advanced technologies, exploration of new therapeutic modalities, and consideration of ethical and social impacts. The need for standardization and interoperability in telerehabilitation systems is also underscored, as these will be critical to ensuring the seamless integration of various technologies and platforms.

Understanding barriers to spinal cord injury rehabilitation services in Nepal: A qualitative study of rehabilitation professionals' perspectives.

This study aims to explore the perspectives of rehabilitation professionals regarding the barriers to spinal cord injury (SCI) rehabilitation services in Nepal. A qualitative study involved 15 rehabilitation professionals working in the Spinal Injury Rehabilitation Center in Nepal. After obtaining informed consent, in-depth semistructured interviews were conducted using Zoom and phone calls between June and July 2023. Braun and Clarke's thematic analysis approach was utilized to analyze the interviews and generate themes from the participants' responses. The participants represented nine different rehabilitation professions. Over half of them were female (53.33%), and 86.67% had one to 10 years of experience in SCI rehabilitation. From in-depth interviews, four themes depicting barriers to rehabilitation were identified: (a) resource constraints within the rehabilitation centers, (b) concerns related to finance, awareness, and support mechanisms, (c) systemic problems coupled with geographical and physical barriers, and (d) beliefs and practices influencing access and adherence to rehabilitation. Delivering effective rehabilitation services for people with SCI presents a range of barriers. Considering the critical importance of rehabilitation for this population, the findings underscore the necessity of engaging stakeholders at multiple levels, individuals, communities, and government agencies to address the identified barriers and improve rehabilitation services in Nepal. The implications of the findings are further discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Practitioner experiences of pulmonary rehabilitation service delivery during COVID-19 and impact on future service delivery

Introduction During COVID-19, pulmonary rehabilitation as we know it ceased to exist. The service needed to adapt rapidly to the requirements of the patient group, while complying with government isolation guidelines. Most groups moved online, but with little time to evaluate the service. What can we learn from this roll out to ensure practitioners continue to deliver a safe and effective pulmonary rehabilitation service. Aim To explore the opinions of physiotherapist and respiratory nursing specialists’ on how pulmonary rehabilitation has changed due to COVID-19 and the impact on future service delivery. Methods A qualitative design was used to gain in-depth understanding of lived experiences. Forty nine participants completed the online survey of 14 open ended questions, and a four-stage thematic analysis used to identify emergent themes. Findings Three main themes were identified- a need for best practice, a need for patient centred care, and acknowledging the emotional stressors of COVID-19 on vulnerable patients. Conclusion Patients should be offered both online and face-to-face options for pulmonary rehabilitation, to promote patient centred care; providing options to participate in effective rehabilitation without physical or emotional restriction; and to increase staff training to enable practitioners to provide the increasingly complex and holistic service required.

The Rehabilitation Landscape in a Low-to-Middle-Income Country: Stakeholder Perspectives and Policy Implications-A Qualitative Study.

The need for rehabilitation is increasing on a global level due to a rise in non-communicable diseases, aging and medical advances, and in South Africa (SA), due to the quadruple burden of disease. More information is required regarding rehabilitation scope and practices in SA to optimize the provision of rehabilitation interventions in the context of the transforming health care sector in SA, a low-to-middle-income country (LMIC). The purpose of this study is to explore the perspectives of South African rehabilitation stakeholders on the landscape of rehabilitation in SA. A descriptive qualitative study, with an interpretive approach, was used to explore stakeholder perspectives on rehabilitation practices in the public health care sector of SA. Semi-structured interviews were conducted with 12 rehabilitation stakeholders. Data were analyzed using a combination of deductive and inductive processes to generate themes and categories. We identified 5 main themes, with subsequent categories and sub-categories. The themes include a composite definition of rehabilitation, core elements of rehabilitation provision, challenges affecting rehabilitation practices, the importance of policy implementation, and the progress of rehabilitation in SA. Despite a common understanding of rehabilitation practices in SA amongst stakeholders, many persistent challenges hamper the delivery of effective rehabilitation services. We recommend that further research explore the rehabilitation needs of end-users, together with collaborative research for priority setting on the translation of policy to practice ensuring equitable and quality rehabilitation service delivery.

Effective Vocational Rehabilitation Services for Transition-Aged Youth: Lessons From the Literature

Objective:The purpose of this study was to provide an overview of the current literature regarding the vocational rehabilitation services found effective in promoting employment among transition-age youth with disabilities as well as identifying factors affecting the effectiveness of those services.Methods:This study utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to theoretically and methodologically ground the systematic review. Through a three-stage filtering process, 35 studies were identified that helped identify common and effective vocational rehabilitation services for transition-aged youth.Findings:Three major themes were observed in the review of literature: validated vocational rehabilitation services, vocational rehabilitation counselor factors, and demographic variables.Conclusions:Additional research is needed in the role of disability severity as a variable of successful service provision. Further identifying successful vocational services for varying levels of disability severity will provide vocational rehabilitation consumers with more individualized options and has the potential to increase positive case closure rates. Lastly, research indicated a need for continued training of VR counselors to ensure they are meeting the needs of their consumers.

Prioritising rehabilitation in early childhood for inclusive education: a call to action

Purpose This commentary examines the provisions for early childhood development (ECD) in the global action plan for rehabilitation published by the World Health Organisation (WHO) within the context of the United Nations’ Sustainable Development Goal (SDG) for inclusive education. Methods The meeting reports of the WHO Rehabilitation 2030 for 2017 and 2019 and the related documents were reviewed along with ECD policy documents from WHO, UNICEF, UNESCO, and the World Bank. Results The importance of a life-course approach to rehabilitation for the health and wellbeing of persons with disabilities was highlighted in the Rehabilitation 2030. However, the critical and foundational role of rehabilitation in ECD for children with disabilities to facilitate inclusive education, especially in low- and middle-income countries as envisioned by the SDG 4.2, was not clearly addressed. Children under 5 years with developmental delays and disabilities who are not developmentally on track in health and psychosocial wellbeing require timely rehabilitation to ensure that they benefit from inclusive education. Conclusions The culture and practice of rehabilitation should be nurtured from infancy as an indispensable component of ECD to adequately prepare children with developmental disabilities for inclusive education and ensure effective rehabilitation services over the life course. IMPLICATIONS FOR REHABILITATION Rehabilitation is an integral and critical component of early childhood development to optimise school readiness for children with developmental disabilities. Routine newborn screening, developmental assessment, and surveillance of children from birth are foundational to any effective rehabilitation in early childhood. Global investment to promote and support rehabilitation services from early childhood within the health systems and across all levels of service delivery including community settings is warranted to achieve the sustainable development goals for children with disabilities.

Characteristics of individual low-vision rehabilitation counseling among older adults: A qualitative 2-year follow-up study

Visual impairments (VI) burden particularly the aging population globally. To ensure healthy aging despite disability, the health care systems must provide effective low-vision rehabilitation services (LVR) for those in need. Low-vision rehabilitation counseling (LVRC) requires specialized multidisciplinary teamwork and has not been studied in detail among the elderly. This study aims to provide a comprehensive picture of individual LVRC actions and introduce a LVRC classification to use for attempts to improve the LVRC processes. This study employed a qualitative follow-up design. Data describing the individual LVRC processes in a prospective cohort of elderly patients with VI ( n = 39) were collected individually over 2 years during the years 2016–2019. The data were analyzed through deductive content analysis. The analyzed LVRC provided assistive devices, services, and home modifications, but problems related to independent movement in the living environment, psychosocial burdens, adaptation to disability, and learning new compensatory skills received less attention. To ensure effective LVRC, the multiprofessional team providing the rehabilitation should emphasize goal-setting and continuous assessment. LVRC should be seen as a process of adaptation, adherence, and learning. LVRC should support and promote older adults to participate and function to their full potential in the modern society, which includes utilizing digital technologies.

Effective long-term management of brachial plexus injury following surgery: What is needed from hand therapists’ perspectives

IntroductionTraumatic, brachial plexus injuries (BPI) result represent a significant cost to the individual and society. Recovery involves multiple surgeries, takes years, and often results in permanent physical dysfunction. While the last couple of decades have seen advancements in surgical management, the BPI rehabilitation literature has not kept pace with these developments. PurposeWe aim to explore the experience of public and privately employed hand therapists’ in delivering effective long-term rehabilitation services to inviduals with BPI in Australia. MethodsAn interpretative qualitative study. Two focus groups were conducted with Australian hand therapists’ (n = 10). Data were analyzed using an inductive thematic approach. ResultsThree key themes were generated from the data. The first theme ‘Falling through the gaps: overlooked components of therapy for BPI’ captures participants’ thoughts on postinjury health care and rehabilitation services. The second ‘Developing a therapeutic alliance: underpinned by time and trust’ relates to the relationship building challenges and opportunities following trauma that will withstand the long-term recovery of individuals following BPI. The last theme, ‘Factors required for professional development: knowledge and support,’ considers the variation seen with these clients in relation to therapy needs and outcomes. ConclusionsThe findings of this study highlight the need to better equip hand therapists’ skills and knowledge in responding to pain and psychological management post BPI. Our results reinforce the benefit of interdisciplinary models of care in the management of individuals with BPI.

EFFECTIVENESS OF INSTITUTIONAL SERVICES FOR CHILDREN IN NEED OF CARE AND PROTECTION: A REVIEW

The Nation’s development depends on the development of children. Child must be encouraged to live in a family environment which gives an atmosphere of happiness, understanding, love, affection and emotional support for development of child’s personality. The growth, development and personality of children is depended on the environment where the children grown up. Children are being institutionalized with various reasons such as destitution due to death of parents, poverty, inability of parents, unconducive family environment and health issues. As the children are living in the institutions away from their parents, it effects on physical, psychological and emotional development of children. The Government mandated child care institutions to maintain the minimum standards for providing effective rehabilitation services for children in need of care and protection. The child care institutions were managed by Government and Non-Government Organisations. Many studies have been conducted to see the services provided by child care institutions really meeting the needs of the children for their development to attain their goals and mainstreaming in the society. KEY WORDS: Vulnerability, protection, institutions, rehabilitation, development.

Review: How Can Intelligent Robots and Smart Mechatronic Modules Facilitate Remote Assessment, Assistance, and Rehabilitation for Isolated Adults With Neuro-Musculoskeletal Conditions?

Worldwide, at the time this article was written, there are over 127 million cases of patients with a confirmed link to COVID-19 and about 2.78 million deaths reported. With limited access to vaccine or strong antiviral treatment for the novel coronavirus, actions in terms of prevention and containment of the virus transmission rely mostly on social distancing among susceptible and high-risk populations. Aside from the direct challenges posed by the novel coronavirus pandemic, there are serious and growing secondary consequences caused by the physical distancing and isolation guidelines, among vulnerable populations. Moreover, the healthcare system’s resources and capacity have been focused on addressing the COVID-19 pandemic, causing less urgent care, such as physical neurorehabilitation and assessment, to be paused, canceled, or delayed. Overall, this has left elderly adults, in particular those with neuromusculoskeletal (NMSK) conditions, without the required service support. However, in many cases, such as stroke, the available time window of recovery through rehabilitation is limited since neural plasticity decays quickly with time. Given that future waves of the outbreak are expected in the coming months worldwide, it is important to discuss the possibility of using available technologies to address this issue, as societies have a duty to protect the most vulnerable populations. In this perspective review article, we argue that intelligent robotics and wearable technologies can help with remote delivery of assessment, assistance, and rehabilitation services while physical distancing and isolation measures are in place to curtail the spread of the virus. By supporting patients and medical professionals during this pandemic, robots, and smart digital mechatronic systems can reduce the non-COVID-19 burden on healthcare systems. Digital health and cloud telehealth solutions that can complement remote delivery of assessment and physical rehabilitation services will be the subject of discussion in this article due to their potential in enabling more effective and safer NMSDK rehabilitation, assistance, and assessment service delivery. This article will hopefully lead to an interdisciplinary dialogue between the medical and engineering sectors, stake holders, and policy makers for a better delivery of care for those with NMSK conditions during a global health crisis including future pandemics.

Comparative parenting stress measures between segmental and community-based rehabilitation services in parents of children and adolescents with intellectual and developmental disabilities (IDD): A cross-sectional survey

BACKGROUND: There is a dearth of information on the effects of different types (Segmental rehabilitation service (SRS) vs Community-based rehabilitation service (CRS)) on the parenting stress and family quality of life in parents of children who have individuals with intellectual and developmental disabilities (IDD).OBJECTIVE: This paper is to compare the effects of SRS and CRS on parenting stress and family quality of life in parents of individuals with IDD.METHODS: A cross-sectional design was used to examine parenting stress and family quality life in cohorts of 120 fathers and mothers of children with IDD who had received either SRS or CRS participated in the survey. The outcome measures included the modified Parenting Stress Index (PSI) and the modified Beach Center Family Quality of Life Scale (mBCFQLS). The Mann-Whitney test was performed at 0.05.RESULTS: A significant difference was observed in social stress in PSI between the SRS and CRS groups ( 0.03). The child rearing, emotional well-being, and physical and material well-being variables in mBCFQLS were different between the SRS and CRS groups ( 0.05), indicating superior benefits from CRS than SRS.CONCLUSIONS: These findings provide important information and about parenting stress and family quality of life in children with IDD, for developing effective rehabilitation programs and services for these parents.

Eye health and the Decade of Action for the Sustainable Development Goals

Eye health and the Decade of Action for the Sustainable Development Goals

Xia-Gibbs Syndrome: A Review of Literature.

Xia-Gibbs syndrome (XGS) is a rare genetic disorder that has been discovered as a distinct clinical entity in the recent past. The occurrence has been attributed to the mutation of AT Hook DNA binding motif Containing 1 (AHDC1) gene that is carried on chromosome 1p36. The concerned gene participates in deoxyribonucleic acid (DNA) repair apart from other crucial functions. The mutation results in dysfunction that leads to neurodevelopmental delay. The spectrum of manifestations constitutes intellectual disabilities, hypotonia, expressive language delay, sleep difficulties, and short stature. Dysmorphic facial features include depressed nasal bridge, hypertelorism, down-slanting or up-slanting palpebral fissures, horizontal eyebrows, dysplastic dentition, thin upper lip vermilion, and micrognathia. The phenotype is still expanding. The condition may range from mild to severe dysfunction depending on the area and site of genetic aberration but variation is evident. Thus, the correlation between genotype and phenotype is largely unclear. XGS should be considered as a differential diagnosis for patients presenting with intellectual as well as developmental disabilities. Whole-exome sequencing (WES) is the genetic test that is largely used for the confirmation of diagnosis. Less is known about the natural history as only a few adults with XGS have been documented in the literature. Age-appropriate cancer screening is recommended for patients with XGS as the gene mutation alters DNA repair mechanisms that may trigger tumour formation. The management of patients diagnosed with XGS is an area that needs investigation. Though use of growth hormone replacement therapy and physiotherapy intervention have been reported as effective in previous studies, research on effective means of care of these patients is warranted on a larger number of patients. We present a review of current literature on what is known about XGS that would facilitate to identify knowledge gaps for paving a way for further studies. This, in turn, will help in provision of early and effective rehabilitation services for patients with XGS.

Methods for development of structure, process and outcome indicators for prioritized spinal cord injury rehabilitation Domains: SCI-High Project

Background: High-quality rehabilitation care following spinal cord injury or disease (SCI/D) is critical for optimizing neurorecovery and long-term health outcomes. This manuscript describes the methods used for developing, refining, and implementing a framework of structure, process, and outcome indicators that reflect high-quality rehabilitation among adults with SCI/D in Canada.Methods: This quality improvement initiative was comprised of the following processes: (1) prioritization of care Domains by key stakeholders (scientists, clinicians, therapists, patients and stakeholder organizations); (2) assembly of 11 Domain-specific Working Groups including 69 content experts; (3) conduct of literature searches, guideline and best practice reviews, and outcome synthesis by the Project Team; (4) refinement of Domain aim and construct definitions; (5) conduct of cause and effect analysis using Driver diagrams; (6) selection and development of structure, process and outcome indicators; (7) piloting and feasibility analysis of indicators and associated evaluation tools; and, (8) dissemination of the proposed indicators.Result: The Project Team established aims, constructs and related structure, process, and outcome indicators to facilitate uniform measurement and benchmarking across 11 Domains of rehabilitation, at admission and for 18 months thereafter, among adult Canadians by 2020.Conclusion: These processes led to the selection of a feasible set of indicators that once implemented should ensure that adults with SCI/D receive timely, safe, and effective rehabilitation services. These indicators can be used to assess health system performance, monitor the quality of care within and across rehabilitation settings, and evaluate the rehabilitation outcomes of the population to ultimately enhance healthcare quality and equity.

Health system challenges affecting rehabilitation services in South Africa

Background The World Health Organization (WHO) recommends that access to rehabilitation is a human right. To date, however, rehabilitation in South Africa has not been a health priority. The focus has rather been on saving lives from communicable diseases such as HIV/AIDs and TB, which has been increasingly successful. Whilst more South Africans are now living with pharmacologically managed chronic, communicable diseases, they often suffer significant challenges to their physical and mental health. Moreover, there are many health conditions in South Africa that have not attracted as much attention, and which also compromise individuals’ capacity to contribute effectively to their own wellbeing, that of their families and communities, and to the general economy. These include birth trauma, degenerative neurological conditions, acquired injuries such as spinal cord damage, limb amputation or head trauma, and chronic noncommunicable diseases (heart or kidney disease, stroke). In the absence of robust prevalence studies, it is estimated that one-in-three adults suffer from at least one chronic health challenge. For South Africa not to invest in rehabilitation is counter-productive, as it means that a significant percentage of its population cannot contribute to its economy. In the face of scant health resources to underpin equitable rehabilitation services, evidence needs to be provided to demonstrate that for increased expenditure on rehabilitation, there will be increased return at individual, family, society, and country levels. Purpose This article presents challenges and solutions to ensure that South Africa can meet WHO 2030 Rehabilitation Goals for equitable provision of effective public rehabilitation services using the WHO’s health system building block framework. IMPLICATIONS FOR REHABILITATION To meet the challenge of providing rehabilitation for those in need requires country-specific, strategic, evidence-informed, and planned decisions in terms of best investment for highest return. Whilst there is sound international evidence for best-practice rehabilitation care, country-specific strategies are required to identify and address local barriers to evidence implementation. In South Africa, where rehabilitation has not been a priority to date, it is important that a planned and well-costed approach is taken to ensure provision of equitable, accessible, affordable, and evidence-based rehabilitation. Measuring social, economic, and educational return on investment from rehabilitation should be part of the South African service-delivery planning process. National data could be obtained through adding additional questions on disability to the national census and through local surveys and reports at various public health care facilities.

Randomized Controlled Trials of Rehabilitation Services in the Post-acute Phase of Moderate and Severe Traumatic Brain Injury - A Systematic Review.

Background and aims: There is a gap in knowledge regarding effective rehabilitation service delivery in the post-acute phase after traumatic brain injury (TBI). Recently, Gutenbrunner et al. proposed a classification system for health-related rehabilitation services (International Classification System for Service Organization in Health-related Rehabilitation, ICSO-R) that could be useful for contrasting and comparing rehabilitation services. The ICSO-R describes the dimensions of Provision (i.e., context of delivered services), Funding (i.e., sources of income and refunding), and Delivery (i.e., mode, structure and intensity) at the meso-level of services.We aim to:-Provide an overview of randomized, controlled trials (RCTs) with rehabilitation service relevance provided to patients with moderate and severe TBI in the post-acute phase using the ICSO-R as a framework; and-Evaluate the extent to which the provision, funding and delivery dimensions of rehabilitation services were addressed and differed between the intervention arms in these studies.Materials and methods: A systematic literature search was performed in OVID MEDLINE, EMBASE, CINHAL, PsychINFO, and CENTRAL, including multidisciplinary rehabilitation interventions with RCT designs and service relevance targeting moderate and severe TBI in the post-acute phase.Results: 23 studies with 4,644 TBI patients were included. More than two-thirds of the studies were conducted in a hospital-based rehabilitation setting. The contrast in Context between the intervention arms often co-varied with Resources. The funding of the services was explicitly described in only one study. Aspects of the Delivery dimension were described in all of the studies, and the Mode of Production, Intensity, Aspects of Time and Peer Support were contrasted in the intervention arms in several of the studies. A wide variety of outcome measures were applied often covering Body function, as well as the Activities and Participation domains of the International Classification of Functioning, Disability, and Health (ICF).Conclusion: Aspects of service organization and resources as well as delivery may clearly influence outcome of rehabilitation. Presently, lack of uniformity of data and collection methods, the heterogeneity of structures and processes of rehabilitation services, and a lack of common outcome measurements make comparisons between the studies difficult. Standardized descriptions of services by ICSO-R, offer the possibility to improve comparability in the future and thus enhance the relevance of rehabilitation studies.

A multicenter investigation of reablement in Norway: a clinical controlled trial

BackgroundReablement is an emerging approach in rehabilitation services, but evidence for its efficacy is rather weak and inconsistent. The purpose of the present study is therefore to investigate the health effects of reablement in home-dwelling adults.MethodsA multicenter, clinical controlled trial involving 47 municipalities in Norway, with assessments at baseline, and after 10 weeks and at 6 and 12 months. The sample consisted of 707 persons that received a 4–10 week reablement program and 121 underwent treatment as usual.Primary outcomes were activity performance and satisfaction with performance measured by the Canadian Occupational Performance Measure (COPM, 1–10). Secondary outcomes included the Short Physical Performance Measure Battery (SPPB), the European Quality of Life Scale (EQ-5D-5 L), and the Sense of Coherence Questionnaire (SOC). Overall treatment effects were estimated with mixed-model repeated measures analyses.ResultsSignificant treatment effects in the rehabilitation group compared with the control group were found in COPM-Performance and COPM-Satisfaction scores at 10 weeks (mean differences between groups (MD), 1.61, 95% confidence interval (CI), 1.13, 2.10 and MD 1.47, CI 0.98, 1.97, respectively), and at 6 months (MD 1.42; CI 0.82,2.02 and MD 1.37; CI 0.77,1.98, respectively). There were also significant treatment effects in the SPPB-subscales for balance and walking after 6 months, in the total SPPB score and in the subscale for sit-to-stand after 12 months. In the EQ-5D-5 L assessment, significant treatment effects were found in the subscales for mobility, and for usual activities and health after 6 months. There was a significant difference in the SOC after six months.ConclusionReablement seems to be a more effective rehabilitation service for persons with functional decline than traditional home-based services after six months. After 12 months, the differences between the groups decreased.Trial registrationThe trial was registered at ClinicalTrials.gov on October 24, 2014, (retrospectively registered) identifier: NCT02273934.

Serotonin transporter gene linked polymorphism (5-HTTLPR) determines progredience of alcohol dependence in Belarusian young males

PurposeAllelic duality and functional impact of degenerate repeat at 5′- flanking promoter region in SLC6A4 gene of the serotonin transporter (5-HTTLPR), have been in the focus of investigations over the years. Various outcomes regarding an association of its polymorphism with risks of alcohol dependence syndrome (ADS) were presented. Such studies have not been conducted in the Eastern European population e.g. Belarus. We therefore checked: the association of 5-HTTLPR polymorphism with ADS, and functional impact of the polymorphism on progredience of ADS in Belarusian population. Material and methodsThe study involved 499 Belarusian males: 377 subjects with ADS (AG), and a control group (CG) with 122 subjects without alcohol-related problems. The ADS group was further divided into two groups of individuals with rapid (AG (R)) and delayed (AG (D)) progression of ADS. Clinical diagnosis was carried-out using ICD-10 criteria, Belarusian Addiction Severity Index, “B-ASI” and Alcohol-Use-Disorders-Identification-Test (AUDIT). PCR-RFLP analysis was performed. ResultsThere were no significant differences in the distribution of frequencies of either the 5-HTTLPR genotype or the short and long allele among AG and CG. However, the ADS 5-HTTLPR genotype and allele distribution frequencies differ significantly by the variation in progression of ADS. ConclusionsThere is no significant association between polymorphism of serotonin transporter gene and risk of ADS. However, the polymorphism significantly determines progredience of ASD in subjects with pathological patterns of alcohol consumption. Findings from this study carry preliminary significance as a facility to effective alcohol addiction treatment, rehabilitation and preventive services in the Eastern Europe.