Interdisciplinary Rehabilitation Team Research Articles

Benchmarking integrated care for people with long‐term neurological conditions

PurposeThis paper aims to report results from a national survey of primary care trusts (PCTs) that explored the strategic, organisational and practice context of services for people with long‐term neurological conditions (LTNCs). It seeks to provide benchmarks for integrated service provision and to discuss possible reasons for the variability in progress.Design/methodology/approachEarlier phases of the research identified three models of care that promoted continuity of care for people with LTNCs: community interdisciplinary neurological rehabilitation teams, nurse specialists and pro‐active day opportunities. Based on this evidence, a benchmarking questionnaire was developed and a telephone survey of PCTs in England undertaken in 2009.FindingsThe survey found that the prevalence of models of good practice varied widely across and within PCT areas. Strategic support and commissioning arrangements were also variable. A little over half of responding PCTs had completed a joint strategic needs assessment (JSNA) that included a reference to LTNCs and a quarter of PCTs had no joint commissioning arrangements in place for LTNCs. The complex interplay between strategy, organisational structures and models of delivery, in a context of competing priorities, may account for this variation and patchy progress.Originality/valueService provision for people with LTNCs is an under‐researched area, despite having major implications for long‐term care and support. The paper will be valuable to policy makers and commissioners in benchmarking organisational activity and models of good practice for integrated services.

Lessons for spinal cord injury rehabilitation taken from adult developmental psychology: 2011 Essie Morgan Lecture

Background/objectiveDevelopmental phases affect how individuals cope with and challenge threats to self-concept, health and functioning. Understanding prominent models of adult psychological development can help spinal cord injury/disease (SCI/D) rehabilitation professionals facilitate positive change and growth.DesignAuthor's theoretical model informed by literature review and personal experience.SettingVeterans administration (VA) medical center interdisciplinary outpatient clinic providing primary and specialty care to veterans with spinal cord injuries and disorders.ConclusionThreats to life expectations, health, well-being, identity, and other aspects of self create crises that can result in psychopathology or psychological growth. SCI/D can present multiple threats across the lifespan. For example, self-image, ability to perform various activities, ability to feel attractive, and even life itself may be challenged by SCI/D or its complications. Threats may be perceived at the time of injury or onset of symptoms. Also, as the injured body declines further over time, complications can cause significant temporary or permanent functional decline. Individuals interpret each of these threats in the context of current developmental needs. How people cope is influenced by developmental factors and personality traits. An integrated model of adult psychological development based on the works of Erikson, Gutmann, and Baltes is related to the literature on coping with SCI/D. This model provides insights that interdisciplinary rehabilitation teams may use to facilitate personal growth, optimal functioning, and physical health as adults with SCI negotiate normal developmental challenges throughout their lifetimes.

Evaluation und Prognostik in der Rehabilitation

The study has been designed to establish an integrated and evaluated pool of results of medical, psychological and social factors which could be the prognostic basis of success or failure of treatment approved by statutory accident insurance. The investigated sample included 108 patients who were presented for a diagnostic evaluation by an interdisciplinary rehabilitation team. Using lists containing extensive detailed information about the status quo of the patients in combination with standardized self-estimated psychological scales, a broad view of multiple aspects has been implemented. Following computer-assisted classification of the entire sample three patient groups could be identified. Catamnestic data provided information on contentment concerning the suggested rehabilitation and its success (via indices) estimated by rehabilitation managers and patients. Regression analysis led to the identification of two judgement levels (objective criteria) for the construction of six prognosis models. A pool of features selected from these models included components such as intensity of pain, depression tendency, motivation and performance, favorable work environment, extent of restrictions during occupation and private life and social support.

Content identification of the interdisciplinary assessment of cerebral palsy using the International Classification of Functioning, Disability and Health as reference

Purpose: To identify relevant items and most frequents categories related to functioning and disability recorded by professionals involved in rehabilitation of children with cerebral palsy (CP) and to assess the filling of the records. Methods: A retrospective cross-sectional study based on the written documents provided by an interdisciplinary rehabilitation team. Participated in the study 40 patients with CP, aged 10 months to 17 years. Two raters extracted information from the patients’ medical documents as recorded by physicians, physiotherapists, occupational therapists, speech therapists, social workers, psychologists and dieticians using the ICF-CY. Patients’ records were scored (+functioning, -disability and *environmental factors) using 27 ICF-CY items to assess the filling of the records. Results: Eighty-one items in the medical records [body structure(15), bodily functions(32), activity(24) and environmental factors(10)] were identified as related to the evaluation of the different professions involved with neuro-rehabilitation. Physiotherapy and occupational therapy provided the most comprehensive assessments performed. Fourteen categories had a minimum frequency of 40% during the registration process. Conclusions: The content of the information involves categories related to the structures and body functions, activities and environmental factors. The information follows a heterogeneous pattern in content and number of categories. The most frequent items can comprise a set of codes for triage of CP. It is necessary to establish an interdisciplinary consensus based on ICF-CY for systematize the information’s record.Implications for RehabilitationThe 81 ICF-CY categories identified can comprise a set of codes for cerebral palsy’s assessment in the rehabilitation practice.Professionals must identify and record not only the negative aspects, but also the positive aspects related to the functioning of children with CP.A standardized assessment based on the ICF model may contribute to a more efficient functioning evaluation, in agreement with the biopsychosocial model.There is a need for more specific training and education on the use of the ICF.

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: Some additional perspectives

Dear Sir, We read “Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan” by Shamim et al.[9] with interest. Their work is from one of the largest and well-established and respected private health care hospitals in Pakistan. Their observations and recommendations about non-surgical management of traumatic spinal cord injuries (SCIs) in the context of a developing country are very valid. We would, however, like to add few salient comments. In developing countries (including Pakistan), healthcare is more focused on curative medicine rather than preventive medicine. Unfortunately, SCI in the majority of cases in Pakistan results in neurological deficits that cannot be reversed by any surgical or pharmacological means at present. Prevention of SCI is, therefore, an important strategy that can reduce the number of traumatic SCI (secondary to motor vehicle accidents, falls, sports events, etc.) or prevent secondary injury after SCI occurs. The pre-hospital trauma care in Pakistan has improved in the last one decade.[1,10] Still there are deficient areas when it comes to initial management of SCI at the trauma site and evacuation to a medical facility.[8] We noted that one of the reasons of having a greater prevalence of paraplegia (instead of the global trend of tetraplegia) at presentation to the emergency departments is the poor evacuation and management techniques in the pre-hospital phase, such that persons with tetraplegia do not survive.[7] In Pakistan, most of the patients with SCI are from lower socioeconomic groups with low educational and literacy levels.[8] Many cannot understand the true nature of a permanent disability like SCI and often opt for surgical management in the hope that surgery will repair the injured cord. In our experience and interaction with SCI patients and their families over the last 6 years, we have found that most of these patients were not counseled about the difference between surgical stabilization of the bony spinal column versus their perceived idea of the injured spinal cord being surgically repaired. Moreover, many patients are operated weeks after their initial injury when the bony callous formation is already in progress and there is little hope left for neurological recovery. The reported benefits of spinal surgery are in cases operated within 72 hours.[3,5] This is not the case in Pakistan and most of the developing countries where patients may present weeks after sustaining the injury.[6] In these circumstances, spinal instrumentation should only be offered if it can be of any benefit to the patient. In most cases, the cost of the surgical implant has to be borne by the patient/patient's family. This leaves very little finances for the postoperative spinal injury rehabilitation which is the only intervention known to improve the long-term functional outcomes and improve Quality of Life in these patients. We have had several patients consulting at our institute for SCI rehabilitation who never underwent rehabilitation due to the lack of funds. Similar findings have been recently been reported from Nigeria where non-surgical management is more cost-effective than surgical interventions.[4] We propose the following as a food for thought for the healthcare policy makers and healthcare professionals involved in the care of SCI in Pakistan: A national trauma/SCI registry should be established to accurately determine the demographics and actual burden of this long-term disability in the country. “An ounce of prevention is worth more than a pound of cure” is the approach needed to reduce the incidence of traumatic SCI in Pakistan. Road safety laws should be enforced and the work conditions should be improved. The pre-hospital evacuation protocols should be revised to specifically address the immobilization and transport of a suspected case of SCI, so that further neurological damage during transport can be prevented.[2] Patient education and counseling is of paramount importance and should not be neglected or omitted in any case. Explaining the nature of the permanent disability should be completed before undertaking expensive spinal surgery without the prospects of improving neurological functions in a neurological complete injury. The facilities of spinal cord injury rehabilitation in the country are very inadequate.[7] The concept of a true interdisciplinary rehabilitation team is largely missing and SCI rehabilitation is being performed at some places without the active involvement and supervision of a physiatrist who specializes in SCI medicine. There is a need to educate the public as well as the healthcare professionals about the need and importance of an interdisciplinary SCI rehabilitation team to provide a comprehensive continuum of care to the patient. In the absence of large, good-quality studies proving that spinal surgery is better than the conservative management, especially if being performed weeks after injury, all patients with traumatic complete SCI should initially be considered for non-operative management.

A Longitudinal Study of Sexuality Training for the Interdisciplinary Rehabilitation Team

Discipline specific and multidisciplinary training programs have been developed to provide practitioners working in health and disability fields with various combinations of knowledge, skills, attitudes and practitioner comfort important for such discussions. There is little, however, which demonstrates the long term effectiveness of such training programs. The current study is a 2-year follow-up to a randomized controlled trial that examined the effectiveness of a sexuality training program for rehabilitation practitioners working within spinal cord injury rehabilitation. Using both questionnaire-based and qualitative data, findings suggest that training can have long-lasting effects on practitioner knowledge, comfort and attitudes in addressing sexuality issues with clients. Training that is developed around the individualized needs of practitioners and the settings within which they work may be particularly effective. Future research is needed to explore the applicability of this type of training to other rehabilitation and healthcare settings.

Expert Panel recommendations-Based on research and deliberations from VA HSR&D project "Impact of the DOD paradigm shift on VA amputee prosthetic care"

[ILLUSTRATION OMITTED] Major limb amputations are part of the sacrifices made by over 2,500 living Vietnam veterans and nearly 1,000 servicemembers to date from the conflicts in Afghanistan and Iraq. The men and women from both conflicts who completed our survey report favorable health and quality of life ratings, tremendous resilience, and hard work to reintegrate into society despite serious injuries and comorbidities. Our 27-member Expert Panel was composed of professionals from academic and clinical settings, clinicians and researchers from the Department of Veterans Affairs (VA) and the Department of Defense (DOD), and three veterans with limb loss from the Vietnam, Operation Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF) conflicts. They identified issues and unmet needs and provided valuable insight. The Expert Panel communicated by teleconference and met in Seattle in June 2008. During the Expert Panel meeting, the members collaborated on strategies to extend the principles of the DOD paradigm shift to VA care. Expert Panel members share a common rehabilitation goal for servicemembers with limb loss: to restore and maintain function to the fullest extent possible over their lifetimes. Restoration provided by prosthetic limbs (though important) is but one of the contributions of the interdisciplinary rehabilitation team. CLINICAL RECOMMENDATIONS 1. We recommend a VA paradigm shift in limb-loss rehabilitation and prosthetic-device care, as described by Dr. Sigford in her editorial in this issue [1] and approved by VA Patient Care Services. This initiative includes creating VA Regional Limb Loss Centers, Polytrauma Amputation Network sites, Amputation Care Teams, and amputation points-of-contact for veterans with limb loss. We also recommend annual clinical and prosthetic-device reviews. We also recommend opportunities for supervised trials of new prostheses and related education, education on realistic expectations, telehealth options for veterans, and a toll free number for troubleshooting veterans' limb-loss-related issues. 2. We recommend a uniform standard of care based on functional ability, operationalized rehabilitation potential, personal preference, and safety considerations for all veterans with limb loss regarding training and provision of prosthetic devices [1-4]. Survey participants identified differences by military conflict in rehabilitation, training, opportunities for sports and physical activities, and availability of technologically advanced prosthetic devices for those with limb loss. 3. We recognize prostheses are but one component of the rehabilitation process. Therefore, we recommend continuing to allow servicemembers and veterans to select prosthetic-device providers--either in-house fabrication with direct purchase of components and assembly by board-certified VA providers or contracts with prosthetic device providers outside the VA. Veteran satisfaction, access, and proximity to care are enhanced using this approach [4]. 4. We recommend creation of a VA Limb-Loss Registry using the VA Corporate Data Warehouse. The Corporate Data Warehouse currently maintains information on each veteran. A flag can be added to indicate limb-loss level and traumatic etiology for each veteran. This registry can facilitate care coordination, communication, and research by VA and DOD investigators. 5. We recommend a clinical template to document limb-loss-related care, services, and visits be added to the VA electronic medical record (Computerized Patient Record System). 6. We recommend linking to the VA Corporate Data Warehouse a common template for unique servicemembers' detailed prosthetic device data, including dates; number; and type of prostheses provided, repaired, and replaced. This common template would be used by the VA, VA contractors, and the DOD to better understand prosthetic device history and preferences. …

Separating Deployment-Related Traumatic Brain Injury and Posttraumatic Stress Disorder in Veterans

Traumatic brain injury in returning Iraq and Afghanistan combat veterans has been the subject of numerous articles by the popular press and congressional inquires. Recent research has questioned the accuracy of the traumatic brain injury diagnosis in veterans with depression and/or posttraumatic stress disorder and the validity of the Veterans Affairs traumatic brain injury screening tool to identify traumatic brain injury in returning combat veterans. Medical records of all combat veterans in the Veterans Affairs Connecticut Healthcare System who both screened positive for traumatic brain injury and received clinical evaluation for traumatic brain injury during the first year of the Veterans Affairs traumatic brain injury screening program were reviewed to explore the relationship between posttraumatic stress disorder and self-reported symptoms attributed to deployment-related traumatic brain injury. Ninety-four combat veterans identified from positive traumatic brain injury screens were seen in the Veterans Affairs Connecticut Healthcare System from April 1, 2007, to March 30, 2008. Eighty-five percent of the veterans with positive screens met the American Congress of Rehabilitation Medicine definition of probable traumatic brain injury. Symptom reporting was similar for veterans with and without a history of traumatic brain injury. Veterans with both posttraumatic stress disorder and traumatic brain injury were more likely to report falling as a mechanism of injury and indicated that they had suffered a head injury during deployment (P <or= 0.10). Veterans with both posttraumatic stress disorder and traumatic brain injury reported more exposures and symptoms compared with veterans with a history of traumatic brain injury. Veterans who screen positive for mild traumatic brain injury by the Veterans Affairs traumatic brain injury screening tool have high rates of posttraumatic stress disorder, which suggests that interdisciplinary rehabilitation teams need to include mental health professionals with expertise in posttraumatic stress disorder. Because both traumatic brain injury and posttraumatic stress disorder are defined, in part, by the same events and the same self-reported symptoms, the Veterans Affairs traumatic brain injury screening tool does not distinguish between these two commonly reported diagnoses in Operation Enduring Freedom/Operation Iraqi Freedom combat veterans.

El paciente amputado: complicaciones en su proceso de rehabilitación

This article is centered in the presentation of the complications that can be given in the stump of an amputated patient, considering the context of the phases and the stages of the rehabilitation process through which it must pass this type of patient. Also, the boarding of this subject is framed specially in one of the main causes of amputation in the world and in a country like Colombia that for years has been submerged in a special situation of violence. It also defines different strategies from intervention for the mentioned complications and makes it relevant the necessity of a team of rehabilitation for the treatment of these patients, concluding with the importance that has the inclusion of the patient to its occupational, social and familiar roll, to really complete the rehabilitation process. It also defines different strategies from intervention for the mentioned complications and makes it relevant the necessity of an interdisciplinary rehabilitation team for the treatment of these patients. To finish with the part of the process in witch the patient returns back to its working, social and familiar roll.

The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams

Stakeholder cooperation in return to work has been increasingly emphasised in research, while studies on how such cooperation works in practise are scarce. This article investigates the relationship between professionals in Swedish interdisciplinary rehabilitation teams, and the aim of the article is to determine the participants' definitions and uses of the concept of work ability. The methods chosen were individual interviews with primary health care centre managers and focus groups with twelve interdisciplinary teams including social insurance officers, physicians, physiotherapists, occupational therapists, medical social workers and coordinators. The results show that the teams have had problems with reaching a common understanding of their task, due to an inherent tension between the stakeholders. This tension is primarily a result of two factors: divergent perspectives on work ability between the health professionals and the Social Insurance Agency, and different approaches to cooperative work among physicians. Health professionals share a holistic view on work ability, relating it to a variety of factors. Social insurance officers, on the other hand, represent a reductionistic stance, where work ability is reduced to medical status. Assessments of work ability therefore tend to become a negotiation between insurance officers and physicians. A suggestion from the study is that the teams, with proper education, could be used as an arena for planning and coordinating return-to-work, which would strengthen their potential in managing the prevention of work disability.

Preparing Students to Be Empathic Interdisciplinary Rehabilitation Team Members

Preparing Students to Be Empathic Interdisciplinary Rehabilitation Team Members

Interrater reliability of the Personal Care Participation Assessment and Resource Tool (PC‐PART) in a rehabilitation setting

The Personal Care Participation Assessment and Resource Tool (PC-PART), formerly the Handicap Assessment and Resource Tool (HART), assesses the domains of clothing, hygiene, nutrition, mobility, safety, residence and supports. To examine the interrater reliability of the PC-PART in a rehabilitation setting. Assessments made by the researcher were compared to the interdisciplinary rehabilitation team. The research and standard assessments occurred within three working days. Raters were blind to each other's scores. Sample participants were a consecutive case-series of rehabilitation clients with varied diagnoses, activity limitations and participation restrictions. Of 66 consecutive patients seen during the a priori determined enrolment period, 25 were included in the study (nine males and 16 females, aged 44-85 years). The remaining 41 patients did not meet the inclusion criteria. The PC-PART has good interrater reliability. Clinicians, administrators and researchers can be reassured about this aspect of the validity of the tool.

Therapists' Roles in Pressure Ulcer Management in Persons With Spinal Cord Injury

Background: Among veterans with spinal cord injury (SCI), severe pressure ulcers (PrU) are treated by interdisciplinary rehabilitation teams in SCI units.Method: Cross-sectional survey administered to therapists attending a conference of the Therapy Leadership Council in SCI.Participants: Respondents included physical therapists (PTs; n = 24) and occupational therapists (OTs; n = 15).Main Outcome Measurements: Wound care practices as indicated by 75% or more of participants as "usual practice."Results: In general, therapist involvement with wound care was initiated by physician order (eg, electrical stimulation) or postsurgery protocols. "Usual practice" after tissue healing included progressive range of motion; initial remobilization (first sitting after wound healing); progression of sitting time including assessment of skin tolerance; instruction in pressure relief maneuvers/techniques; and instruction in safe transfers. Practices in prevention of a new ulcer included education and evaluation of seating posture/ positioning.Conclusions: Results indicate that centers may delegate responsibilities for management of ulcers differentially by discipline. A limitation was that we were unable to determine whether these centers were the same or different for OT and PT respondents. Although sample size was small and some sites had multiple respondents, the survey showed a growing role for OTs and PTs in PrU treatment. Because 75% of each discipline reported that there were usual practices, including patient education and remobilization protocols, this area requires further study to determine the clinical outcomes in terms of preventing PrUs and recurrence.

Memory Assessment on an Interdisciplinary Rehabilitation Team: A Theoretically Based Framework

To describe a cognitive neuroscience model of memory that can be used to guide assessment and promote consistent terminology among members of the rehabilitation team, and to relate the model to frequently used assessment measures. Description of a model of memory, description of how frequently used memory measures relate to the model, and presentation of case studies to exemplify the application of the model to the clinical assessment of memory. Use of a theoretical framework is important for choosing assessment instruments, interpreting the results of test performance, and communicating with patients, their family members, and other members of the interdisciplinary team. Understanding where in the memory process a breakdown occurs can guide treatment recommendations and feedback to patients and family members.

The voice and laryngeal dysfunction in stroke: A report from the Neurolaryngology Subcommittee of the American Academy of Otolaryngology–Head and Neck Surgery

Stroke is the third leading cause of death in the United States, behind heart disease and cancer. It affects as many as 5% of the population over 65 years old, and this number is growing annually due to the aging population. A significant portion of stroke patients that initially survive are faced with the risk of aspiration, as well as quality-of-life issues relating to impaired communication. The goal of this paper is to define the scope of practice in otolaryngology for these patients, and to review pertinent background literature. Consensus report and retrospective literature review. Otolaryngology involvement in these patients is critical to their rehabilitation, which often requires an interdisciplinary team of specialists. This committee presentation explores epidemiological data regarding the impact of stroke and its complications on hospitalizations. A pertinent review of neuroanatomy as it relates to laryngeal function is also discussed. State-of-the-art diagnostic and therapeutic procedures are presented. There is a well-defined set of diagnostic and therapeutic options for laryngeal dysfunction in the stroke patient. Otolaryngologists play a critical role in the interdisciplinary rehabilitation team.

Individualized Intervention Model Aiming to Permanently Change Life Habits which Have an Impact on Modifiable Risk Factors

Background: A great challenge for clinicians working in a rehabilitation or prevention setting is to succeed in getting their clients to be physically active and to make them change their life habits. Five years ago at Centre de Réadaptation Lucie Bruneau, an interdisciplinary rehabilitation team took that challenge. This team is specialized in stroke rehabilitation and, in the last 5 yr, it has noticed a decline in the health condition, quality of life and social participation of its patients. Here are some statistics that illustrate the situation: 57% are &lt; 49 yr old, 24% have 3 modifiable risk factors, another 24% have four or more and 18% have five; 35% have associated heart, vascular problems or diseases; for most of them, there’s a 20% chance of having another stroke.&#x0D; &#x0D; Methods: From these observations, an innovative concept of intervention was born. It is a part of the rehabilitation process and is based on research in a variety of fields: the transtheoric model of Prochaska and DiClemente, the person centered neurodynamic approach; the ecological, psycho-biological (affordance) and pedagogical approaches. The team systematically identifies the risk factors in an individualized intervention plan which is based on the “handicap production process” model. From the start to the end of the rehabilitation program and according to his needs, the patient will be brought to understand, adopt and integrate new life habits in the following spheres: food, smoking, and physical activity. &#x0D; &#x0D; Results: This global responsibilization optimizes and strengthens their long term commitment. Concerning physical activity, results obtained from a pilot study show us that 70% of our patients maintain their level three months after their discharge. &#x0D; &#x0D; Conclusion: This type of intervention could be used in other type of settings (rehabilitation or prevention): hospital, school, CLSC’s and community centers.

Problemorientiertes Lernen (POL) in der Rehabilitation am Beispiel eines Patienten mit Spondylitis ankylosans

Through innovative teaching and learning methods relevant topics in rehabilitation can be conveyed effectively. Therefore, in this paper a papercase for problem-oriented learning (POL) is presented concerning rehabilitation in rheumatology, exemplified by a patient with ankylosing spondylitis. This papercase can be applied in the integrated course Rehabilitation, Physical Medicine and Naturopathic Treatment, the curricular part of teaching rehabilitation during the medical training according to the 9 (th) revision of the Federal Medical Licensing Regulations (Approbationsordnung). In addition the teaching material presented can be used in other courses, such as elective courses for non-medical professionals of the interdisciplinary rehabilitation team. First experiences gathered with the papercase in the Health and Nursing Sciences study programme of the Faculty of Medicine of Martin-Luther-University Halle-Wittenberg are reported.

Establishing a super‐link system: spinal cord injury rehabilitation nursing

This paper reports a study to identify the needs of clients with spinal cord injury and their family/carers during rehabilitation, and the strategies used by rehabilitation nurses to meet those needs. In Taiwan, spinal cord injury is a major problem with financial implications for the state and major bio-psycho-social and spiritual implications for the individual. Rehabilitation nurses do not have an appropriate nursing theory to guide their care. Using a grounded theory approach, data were collected from October 2002 to March 2003 in a rehabilitation hospital in Taiwan by means of interviews, participant observations and documentary resources; analysis was an interrelated process. A total of 39 interviews was carried out with 31 individuals, including eight rehabilitation nurses, one nurse supervisor, seven clients with tetraplegia, eight with paraplegia and seven family/carers. There were 18 participant observations. Data were analysed using a multi-step analytic procedure, based on the works of Glaser, Charmaz, and Strauss and Corbin. The core category, 'establishing a super-link system', explained the complex structure of interactions observed during the investigation and the importance of developing a middle-range theory entitled the 'Super-Link System Theory'. This theory includes the following four links: 'linking to client', 'linking to family/carer', 'linking to interdisciplinary rehabilitation team' and 'linking to community'. This Super-Link System Theory will help rehabilitation nurses to organize their thinking about spinal cord injury rehabilitation nursing, to transfer their thinking into practice by making links effective, and to promote their professional position in the interdisciplinary rehabilitation team.

Rebuilding an Interdisciplinary Rehabilitation Team

1Reeves Rehabilitation Center, University Health System 2Reeves Rehabilitation Center, University Health System, San Antonio, TX Correspondence to Reeves Rehabilitation Center, University Health System, 4502 Medical Drive, San Antonio, TX 78229 or [email protected]

Interorganizational Collaboration in Occupational Rehabilitation: Perceptions of an Interdisciplinary Rehabilitation Team

Various obstacles to and facilitators of collaboration between an interdisciplinary work rehabilitation team and the stakeholders (workers, insurers, physicians, and employers) exist, but are not well characterized. An observational study was conducted, using videotapes of interdisciplinary team discussions of ongoing cases involving 22 workers absent from work due to musculoskeletal disorders. The actions taken and strategies adopted by the team in an effort to overcome the obstacles to collaboration were studied. Various factors influence collaboration between the rehabilitation team and the stakeholders. In general, stakeholder endorsement of the team's therapeutic principles and confidence in their approach emerged as particularly important factors. Diverse strategies, most often, education and awareness-raising, were used by the team to foster collaboration among the parties. This study provides greater insight into the factors affecting collaboration among a rehabilitation team, an injured worker and other stakeholders. The results may improve understanding of the actions taken by rehabilitation teams and help to optimize their practices.