Hospital Rehabilitation Services Research Articles

Evaluating cancer rehabilitation services: Insight from Australia and New Zealand

Background: Despite evidence supporting the benefits of rehabilitation for cancer survivors, the nature of cancer rehabilitation programs is inadequately described in Australia and New Zealand. This study provides insight into current service delivery and challenges for healthcare systems in implementation of cancer rehabilitation programs. Methods: A cross-sectional survey of directors of public and private rehabilitation services in hospital and ambulatory settings across Australia and New Zealand using the Australasian Rehabilitation Outcomes Centre (AROC) registry evaluated the current delivery of cancer rehabilitation programs, health professional workforce, core care components delivered, barriers and facilitators to service delivery, and unit/organisation-wide cancer rehabilitation activities. Descriptive statistics analyzed quantitative data, and qualitative analyses interpreted item responses. Results: Of the 300 services, 102 (34%) participants completed the survey. Most services provide non-dedicated cancer rehabilitation programs (n=63), led by rehabilitation physicians, followed by allied health. The common tumour streams referred included central nervous system (67%, n=56), haematological (59%, n=49), prostate (58%, n=48), and lung cancers (58%, n=48). Patients were frequently referred during post-treatment (87%, n=72) and treatment phases (66%, n=55). Core program components were multimodal exercises, fatigue management strategies, and management of medical complications and medications. The main barriers and facilitators toward the uptake of cancer rehabilitation programs were identified. Key activities in education, research, advocacy, and clinical practice improvement were also highlighted. Conclusions: The survey identified key barriers and facilitators for the implementation of cancer rehabilitation programs. Collaborative efforts of relevant stakeholders, clinicians, consumers, and policymakers need to address barriers to broader implementation of cancer rehabilitation services.

Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience

BackgroundDespite the growing interest in hospital rehabilitation services for communities, studies on existing community-based rehabilitation (CBR) services remain scarce owing to limitations in the development of community health services and regional cultural diversity. As a guaranteed measure for ensuring the quality of rehabilitation services and achieving the desired service outcomes, clear roles and responsibilities in multidisciplinary teams and effective service delivery are particularly important.ObjectiveThis scoping review aimed to determine the scope of community stroke rehabilitation programs involving existing multidisciplinary teams and to analyze the implementation content and implementers’ functional roles to provide guidance for future CBR programs.MethodsThe scoping review design followed the methodology of the Joanna Briggs Institute and was based on the normative scoping review framework proposed by Arksey and O’Malley. The comprehensive CBR framework was proposed by World Health Organization-guided data charting and analysis.ResultsOf the 22,849 identified citations, 74 studies were included, consisting of 6,809 patients with stroke and 49 primary caregivers, most of whom were from China. The most common working mode in CBR programs was a dual approach involving both healthcare professionals in medical institutions and community healthcare professionals. The number of programs in each discipline was in the following descending order: nursing, medical care, rehabilitation, psychology, nutrition, and public health. Among these, multidisciplinary teams comprising medical, nursing, and rehabilitation disciplines were the most common, with a total of 29 programs. Disciplinary members were mainly responsible for implementing their respective disciplinary content, with physicians providing guidance for the programs. More than 82.4% of the studies reported 2–4 intervention strategies. The intervention forms of rehabilitation content were the most diverse, whereas preventive interventions were more homogeneous than others. Physical function and socio-psychological measurements were the most commonly reported outcomes.ConclusionCBR services implemented by multidisciplinary teams can effectively achieve functional and emotional improvement in patients with stroke, and nurses are the most involved in implementation, especially in community settings. The results further emphasize the importance of strengthening the exploration of nurses’ maximum potential to implement CBR plans in future practice.Trial registrationThe registration information for this scoping review can be found at osf.io/pv7tg.

Current status of rehabilitation services and problems in Yunnan Province, Southwest China: a general doctors’ questionnaire-based study

Objectives Community-based hospitals in China lack physicians, especially rehabilitation physicians. Recently, several financial resources have been developed to prepare general doctors for community-based hospitals. These doctors seem to be the best choices for assuming the role of a rehabilitation physician. However, their willingness and in-depth information from their perspectives have not been previously investigated. Materials and methods We conducted a general investigation of rehabilitation resources in Yunnan, a province located in Southwest China with a population of more than 40 million. Our investigation covered the entire Yunnan Province from December 2020 to May 2022. The questionnaire was administered to 670 general doctors in 112 community hospitals randomly selected in Yunnan Province based on their willingness to assume the role of rehabilitation physicians and obstructive factors to process the rehabilitation services. The reliability and validity of the questionnaire were evaluated, and items regarding their general condition were analyzed. Results Cronbach’s alpha and Kaiser–Meyer–Olkin values were 0.748 and 0.729, respectively. The measure comprises four factors: common disease, demand for training to improve skills, subjective/objective factors, and proactivity to recommend rehabilitation therapy. More than 20% of general doctors were unwilling to take on the role of rehabilitation physicians, and their willingness was related to satisfaction with their current job, comprehension of community-based rehabilitation, and comprehension of government support (p < .05). Conclusions From the perspective of general doctors, the reimbursement rate for medical insurance, which burdens patients, is the greatest problem in the process of developing community-based hospital rehabilitation services. Offering professional training to increase their capacity and developing common practices to increase doctors’ proactivity to recommend rehabilitation therapy may help increase the future support of medical insurance and increase general doctors’ willingness to take on the role of a rehabilitation physician.

Feasibility and acceptability of a mobile model of environmental enrichment for patients with mixed medical conditions receiving inpatient rehabilitation: a mixed methods study

ObjectivesTo investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient...

Rehabilitation Service Assessment and Workforce Capacity Building in Albania—A Civil Society Approach

Background: Rehabilitation is an important health strategy. Due to the lack of rehabilitation professionals (e.g., no physical and rehabilitation medicine, occupational therapist, and others) and lack of rehabilitation services (e.g., no multi-profession rehabilitation services in hospital, no post-acute rehabilitation services, no community-based rehabilitation services), the need to strengthen rehabilitation in Albania was pronounced. Therefore, this project aimed at rehabilitation service assessment and workforce capacity building in Albania. Methods: The World Health Organization’s Template for Rehabilitation Information Collection was used to collect available data related to rehabilitation services. Additionally, two site visits to different rehabilitation centers including interviews with relevant stakeholders were performed. A stakeholders’ workshop to prioritize recommendations was also performed before finalizing the report. Results: In Albania, rehabilitation service delivery, rehabilitation workforces, and financing in rehabilitation need to be strengthened. Conclusions: The project achieved the intended objectives. Additionally progress has been occurring in the development and implementation of the Physical and Rehabilitation Medicine specialization at the University of Medicine, Tirana.

Construction, Factor Structure, and Internal Consistency Reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS)

Patient satisfaction is a crucial aspect in the evaluation of the quality of health care provided by health services and units, especially in patients that require physical rehabilitation. This study aims to design and analyze the factor structure and internal consistency reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS) measuring the level of physical therapy patient satisfaction in hospital rehabilitation services. This study has a multicenter cross-sectional survey design. This study used the structural validity and internal consistency domains from COSMIN (consensus-based standards for the selection of health status measurement instruments) guideline. The H-PTPS questionnaire consists of 20 closed questions. A sample of 384 adult patients from physical therapy units from three Spanish public hospitals completed this questionnaire. A factor structure and internal consistency reliability analysis were performed. The factor analysis including the 20 items of the H-PTPS showed an adequacy index of 0.922 according to the Kaiser–Meyer–Olkin measure and the Barlett test allowed us to reject the null hypothesis (p < 0.001). In the rotated component matrix, four specific factors were obtained, explaining 66.75% of the accumulated variance. All factors present satisfactory internal reliability, achieving Cronbach’s alpha indices and Omega coefficients higher than 0.74. The H-PTPS questionnaire has shown a four-factor solution with satisfactory reliability evaluating the satisfaction of Spanish patients treated in physical therapy units in the hospital rehabilitation services.

Are people in residential care entitled to receive rehabilitation services following hip fracture? Views of the public from a citizens\u2019 jury

BackgroundAccess to rehabilitation services for people living in residential care facilities is frequently limited. A randomised trial of a hospital outreach hip fracture rehabilitation program in residential care facilities has demonstrated improvements in mobility at four weeks and quality of life at 12 months but was not considered cost-effective by standard health economic metrics. The current study aimed to explore the general public’s views on issues involved in the allocation of rehabilitation resources for residents of care facilities.MethodsA citizens’ jury comprising 13 purposively sampled members of the general public, representative of the South Australian age, gender and household income profile. The jury considered the questions “Should there be an investment of physical rehabilitation services in residential care for older people following a hip fracture? If so, what is the best way of providing this service (considering funding, models of service delivery and equity)?” Deliberations were in the context of a state-wide health reform program. The jury was conducted over two days with an experienced independent facilitator, addressing questions developed by a steering group of research academics and clinicians.ResultsThe mean age of the citizens’ jury members was 43 (range 26 to 61). Eleven members voted for investment in outreach hospital rehabilitation services in residential aged care. All jurors agreed a number of strategies in addition to investment should be implemented, including health care planning and decision making, increased emphasis on hip fracture prevention, training of aged care staff in rehabilitation and routine provision of hospital discharge summaries to families. The jury further advocated for an increased focus on rehabilitation in residential care, potentially through accreditation criteria, increasing health literacy of residents and families, implementation of age friendly environment strategies and improving connections of care facilities with community, hospital and tertiary services.ConclusionsThis citizens’ jury representative of the general public recommends that regardless of dementia and frailty, people who live in residential care and are walking and fracture their hips should have access to hospital outreach rehabilitation and recovery services.

Continuity of care in hospital rehabilitation services: a qualitative insight from inpatients’ experience

BackgroundFew empirical studies have been conducted on the continuity of rehabilitation services, despite the fact that it may affect clinical outcomes, patient satisfaction, the perception of quality, and safety. ObjectivesThe aim of this study was to explore experiences and perceptions of inpatients receiving physical rehabilitation in an acute care hospital and how these experiences may have led to perceived gaps in the continuity of rehabilitation care. MethodUsing qualitative research methods, fifteen semi-structured interviews were conducted with patients who received physical rehabilitation during hospital stay in an acute care hospital in Murcia, Spain. Interviews were transcribed verbatim, analyzed, and grouped into predetermined and emergent codes. ResultsPatients described three main themes in continuity of care: informational, management, and relational continuity. Several factors were described as influencing the perceived gaps in these three types of continuity. Informational continuity was influenced by the transfer of information among care providers. Relational continuity was influenced by patient–therapist relations and consistency on the part of the provider. Management continuity was influenced by consistency of care between providers and the involvement of patients in their own care. ConclusionThe participants in this study identified several gaps in three types of continuity of care (informational, management, and relational). Inpatients often perceive their experiences of rehabilitation as being disconnected or incoherent over time.

'Well, if the kids can do it, I can do it': older rehabilitation patients' experiences of telerehabilitation.

Background and objectiveAlthough trials continue to emerge supporting the role of telerehabilitation, implementation has been slow. Key users include older people living with disabilities who are frequent users of hospital rehabilitation services but whose voices are rarely heard. It is unclear whether the use of technologies and reduced face‐to‐face contact is acceptable to these people. We report on a qualitative study of community dwelling participants who had received a home telerehabilitation programme as an alternative to conventional rehabilitation.DesignThirteen older participants, three spouses and one carer were interviewed. All had participated in an individualized therapy programme, using a combination of face‐to‐face and video consults with therapists. The programme used ‘off‐the‐shelf’ technologies including iPads for videoconferencing and electronic FitBitR devices. Interviews were recorded, transcribed verbatim and analysed using NVivo software.ResultsThematic analysis resulted in five emergent themes: (i) telerehabilitation is convenient; (ii) telerehabilitation promotes motivation and self‐awareness; (iii) telerehabilitation fosters positive therapeutic relationships; (iv) mastering technologies used by younger relatives is a valued aspect of telerehabilitation; and (v) Telerehabilitation does not replace traditional face‐to‐face rehabilitation therapies.ConclusionsParticipants found telerehabilitation convenient and motivating, coped well with the technology and developed positive therapeutic relationships. The learning and practice aspects sat well in the context of a rehabilitation programme. The use of commercially available technologies may have contributed to respondents' high levels of acceptability. The perception of telerehabilitation as complementary to in‐person care and the expectation of technological support have implications for the implementation and delivery of telerehabilitation services to older people.

Calidad de vida a los 6 meses tras un ictus

ObjectiveTo describe quality of life (QoL) in patients at 6 months poststroke and its relationship with sociodemographic, clinical and functional characteristics. Material and methodThis multicenter longitudinal cohort study (n=157) included patients from 2 hospital rehabilitation services who were admitted for stroke in the subacute phase. The following data were gathered at 6 months poststroke: gender, age, social risk, comorbidity, dysphagia, aphasia, cognitive status, depression, and disability measured by the modified Barthel Index. The influence of these variables on QoL was evaluated using the stroke-specific quality of life scale, ECVI-38. ResultsThe mean age was 70.93±11.85 years and was significantly higher in women. Most of the patients had high comorbidity, low social risk and moderate dependence. The mean total score on the ECVI-38 scale was 35.30±16.17 and the most affected domains were those concerning common and basic activities of daily living. The variables associated with QoL were gender, aphasia, dysphagia, depression, cognitive impairment, and functional status. High-intensity pain was present in 21% of patients. ConclusionNumerous variables influence QoL in patients with stroke and should be considered in the planning of rehabilitation interventions.

Study protocol: to investigate effects of highly specialized rehabilitation for patients with multiple sclerosis. A randomized controlled trial of a personalized, multidisciplinary intervention

BackgroundMultiple sclerosis (MS) is a complex, chronic and progressive disease and rehabilitation services can provide important support to patients. Few MS rehabilitation programs have been shown to provide health improvements to patients in a cost-effective manner. The objective of this study is to assess the effects in terms of changes measured by a variety of standardized quality of life, mastery, coping, compliance and individual goal-related endpoints. This combination provides the basis for analyzing the complexity of MS and outcomes of a personalized rehabilitation.Methods/DesignPatients with MS referred to hospital rehabilitation services will be randomized to either early admission (within two months) or usual admission (after an average waiting time of eight months). They will complete a battery of standardized health outcome instruments prior to randomization, and again six and twelve months after randomization, and a battery of goal-related outcome measures at admission and discharge, and again one, six and twelve months after randomization.DiscussionThe results of the study are expected to contribute to further development of MS rehabilitation services and to discussions about the design and content of such services. The results will also provide additional information to health authorities responsible for providing and financing rehabilitation services.Trial registrationCurrent Controlled Trials (ISRCTN05245917)

Stress in caregivers of aphasic stroke patients: a randomized controlled trial

Background: Communication difficulties due to aphasia following stroke are particularly stressful to caregivers. Objective: To examine the impact of a psychoeducation programme on caregivers’ burden and stress and communication between the caregiver and aphasic stroke patient. Design: Randomized wait-list controlled trial with immediate or three-month delayed treatment. Setting: Three public hospital rehabilitation services in Sydney, Australia. Subjects: Thirty-nine caregivers of aphasic stroke patients, up to 12 months post stroke: 19 given immediate treatment and 20 in a delayed treatment control group. Interventions: Four-session weekly caregiver programme that included elements of education, support and communication skills conducted by a speech pathologist, social worker and clinical psychologist. Main measures: The General Health Questionnaire (GHQ) was used to measure caregiver stress, the Relatives’ Stress Scale was used to measure caregiver burden and a communication questionnaire was designed specifically for this project. Results: Thirty-one caregivers completed the study. Caregivers in the immediate treatment group had significant reductions in GHQ measured stress (GHQ mean (SD) at baseline= 6.26 (5.67), GHQ post treatment 3.21 (SD 4.20), P = 0.006). There was no improvement in wait-listed caregivers. Improvement was not maintained at three-month follow-up. There were no significant effects of the programme on communication skills or on caregiver burden. Conclusions: Stroke caregiver support, education and training programmes have short-term effects on caregiver stress levels but are likely to require ongoing involvement to maintain their effect.

Swing Beds and Rural Hospitals in New York, 1991 to 1994

Abstract: New York implemented a hospital swing bed program in 1991 to allow rural hospitals access to Medicare Part B financing, increase utilization of hospital rehabilitation services, and facilitate the care of patients in their home communities. Between the years 1991 and 1994, 13 hospitals participated in the program. The authors used the New York State Department of Health annual hospital reporting data to examine the hospital swing bed experience for length of stay, payer type, and discharge disposition. Eighty‐six percent of swing bed admissions came from the acute care units of the host hospital or a referral hospital. The average length of stay decreased from 25 days to 19 days during the study period with almost one‐half of the patients being discharged. Swing bed revenues accounted for 3.4 percent of the total hospital gross revenues by 1994. Respite care, a component unique to New York, accounted for an increasing percent of admissions throughout the study period. The program served a useful rehabilitative function, and it represents one strategy to care for rural patients near their homes.

Community-based alternatives to hospital rehabilitation services: a review of the evidence and suggestions for approaching future evaluations

Community-based alternatives to hospital rehabilitation services: a review of the evidence and suggestions for approaching future evaluations

Access by general practitioners to physiotherapy department of a district general hospital.

There has been much opposition, voiced most notably in the Tunbridge Report, to general-practitioner access to hospital rehabilitation services. Co-operation between general practitioners, physiotherapists, and the consultant with responsibility for the physiotherapy department at a general district hospital has provided an efficient open-access service. This service has been welcomed by the general practitioners because it supplies prompt treatment for their patients and by the physiotherapists because it enables them to minimise disability by treating musculoskeletal problems at an early stage.

Investigation of the need for physical treatment during prolonged absence from work.

For this purpose the circular suggested that hospital rehabilitation services should be expanded, and should include physiotherapy departments, remedial gymnasia, and occupational therapy rooms. Responsibility for these services falls mainly upon Regional Hospital Boards. The Boards are, however, finding it difficult to finance expansion of the traditional services, and require to know whether the cost of extending the rehabilitation services will be justified. According to the Ministry circular, experience has shown that: