Participation In Rehabilitation Services Research Articles

The association of environmental factors with neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia (ALL).

To investigate the association of environmental factors, rehabilitation services during therapy and socioeconomic status (SES - insurance type), with neurocognitive outcomes at the end of therapy for survivors of childhood acute lymphoblastic leukemia (ALL). Survivors (n = 236) treated on the St. Jude Total Therapy Study 16 completed end of therapy testing with performance measures (IQ, attention, processing speed, fine motor skills, academics) and caregiver ratings (attention, executive function, adaptive skills). Environmental factors were abstracted from the medical record. Distribution of sex (47.3% female, p = 0.399), treatment arm (45.5% low risk, 54.5% standard/high risk p = 0.929), insurance type (47.7% private, 52.3% public/none, p = 0.117), and mean age at diagnosis (7.7 vs. 6.8years, p = 0.143) were similar for groups with (n = 110; 46.6%) and without (n = 126; 53.6%) rehabilitation services during therapy. Compared to those without rehabilitation, the rehabilitation group (n = 110; 46.4%) had more caregiver reported problems with attention (Z = -0.28 vs. 0.43, p = 0.022), executive function (Z = -0.50 vs. -0.08, p = 0.003), and adaptive skills (Z = -0.41 vs.-0.13, p = 0.031). Among the rehabilitation group, there was no difference in outcomes by insurance status. Among those without rehabilitation, those with public insurance had worse neurocognitive outcomes than those with private insurance in IQ (Z = -0.04 vs. -0.45, p = 0.0115), processing speed (Z = -0.10 vs. -0.75, p = 0.0030), reading (Z = 0.18 vs. -0.59, p < 0.0001), and math (Z = -0.04 vs. -0.50, p = 0.0021). Participation in rehabilitation services during early intensive therapy is associated with end of therapy caregiver-reported neurocognitive outcomes in daily life.

Understanding the Experiences of Rural- and Remote-Living Patients Accessing Sub-Acute Care in Queensland: A Qualitative Descriptive Analysi.

The challenges associated with equitable healthcare access are often more pronounced for individuals living in rural and remote locations, compared to those in metropolitan locations. This study examined the health care transitions of rural- and remote-living patients with on-going sub-acute needs, following acute hospital discharge. This was done with the aim of exploring these patients' experiences of client-centeredness and continuity of care, and identifying common challenges faced by rural and remote sub-acute patients accessing and transitioning to and through sub-acute care in a non-metropolitan context. Semi-structured interviews were conducted with 37 sub-acute patients. A qualitative descriptive approach was used to analyze the interview data and explore key emergent themes in relation to client-centeredness, continuity of care, and sub-acute transition challenges. Interview participants' average length of stay in sub-acute care was 31.6 days (range = 8-86 days), with most transitioning from larger regional and metropolitan hospitals to on-going rural or remote sub-acute care (n = 19; 53%). Client-centeredness was primarily characterized by the quality of interpersonal experiences with staff, patient and familial involvement in care planning, and the degree to which patients felt their wishes were respected and advocated for. Continuity of care was characterized by access to and participation in rehabilitation services, and access to family and social supports. Challenges associated with sub-acute transitions were explored. The findings suggest important implications for health care providers, including the need to implement earlier and more frequent opportunities for patient involvement throughout the sub-acute journey. The results offer a unique perspective on the way that continuity of care is experienced and conceptualized by rural and remote patients, suggesting a revision of what is required to achieve equitable care continuity for rural and remote residents receiving care far from home. It is pertinent for health care providers to consider the unique complexities associated with accessing on-going health care as a rural or remote Australian resident, and to develop mechanisms that support equitable access and continuity and facilitate continuity of care closer to home.

Prevalence and correlates of mental illness among inmates in North-western Ethiopia: A new look into the roles of rehabilitation service use.

Data on the magnitude of mental illnesses and associated factors among inmates in Ethiopia, in general and in the Amhara region in particular are scarce. The available studies either focused on specific type of mental illness or include inmates from a single correctional center and leave aside the role of rehabilitation service use in inmates' mental illness. Therefore, the present study was conducted to look into the prevalence of mental illnesses and to examine the associated demographic, imprisonment related and rehabilitation service use related factors among inmates in Northwestern Ethiopia. The study employed cross-sectional, descriptive and explanatory research design where data was collected from 422 inmates from three randomly selected prisons. Inmates' mental illness was assessed using the Self Reporting Questionnaire (SRQ-20). Frequency, percentage, bivariate and multiple logistic regressions were used to analyze the collected data. In the study it was revealed that 74.6% of the inmates in Northwestern Ethiopia have mental illnesses. Feeling unhappy, difficulty to play important role in life, headaches and bad sleep were experienced by majority of the respondents. Male inmates (AOR = 2.39, 95% CI = 1.07-5.37) and inmates who participate in the educational training services (AOR = 2.20, 95% CI = 1.36-3.55) were found to have higher chances of having mental illnesses. On the other hand, inmates who participate in life skill training programs (AOR = 0.45, 95% CI = 0.28-0.74) and inmates who participate in recreational and cultural activities (AOR = 0.26, 95% CI = 0.14-0.46) were found to have lower odds of developing mental illnesses. A high prevalence of mental illnesses among inmates was found in Northwestern Ethiopia and inmates' participation in rehabilitation services were important correlates of their mental health. Thus, prison administrators and policy makers need to conduct large scale studies and develop tailored interventions that could reform the rehabilitation services provisions, including mental health service provisions.

Utilization of Rehabilitation Services in Stroke: A Study Utilizing the Health and Retirement Study With Linked Medicare Claims Data

ObjectivesTo describe Medicare fee-for-service beneficiaries who used poststroke rehabilitation services and identified the strongest predictors of utilization after the initial stroke care episode. DesignPooled, cross-sectional design using data from 1998 to 2010 from the Health and Retirement Study (HRS) with linked Medicare claims data. SettingNA. ParticipantsStroke survivors who were Medicare fee-for-service beneficiaries and participated in the HRS were included (N=515). Main Outcome MeasureUtilization of rehabilitation services up to 10 years poststroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors, and social support. ResultsRehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and <16% in years 2, 4, 6, 8, and 10, respectively. Age was the primary factor predicting use of rehabilitation in the first 10 years poststroke (odds ratio: 1.14; P=.001). Recurrent stroke (odds ratio: 1.64; P=.051) was also significantly associated with utilization, whereas unspecified incident stroke at incident trended toward significance (odds ratio: 2.17; P=.077). None of the other factors was a significant predictor of participation in rehabilitation services in this period. ConclusionA small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years poststroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.

Does type of disability and participation in rehabilitation affect satisfaction of stroke survivors? Results from the 2013 Behavioral Risk Surveillance System (BRFSS)

BackgroundStudies show that stroke survivors typically have lower life satisfaction than persons who have not been diagnosed with stroke. ObjectiveTo determine if significant differences in life satisfaction exist between stroke survivors with and without functional limitations and whether specific functional limitations, as well as participation in outpatient rehabilitation affect the odds of reported life satisfaction for stroke survivors. MethodChi square analysis was used to examine data from the 2013 BRFSS to determine the relationship of functional limitations as well as participation in rehabilitation services to life satisfaction for stroke survivors. Logistic regression analysis was used to determine what variables increased the odds of reported poor life satisfaction. ResultsStroke survivors experiencing difficulty with cognition, depression and IADLs showed significantly lower life satisfaction than those who did not experience these functional limitations. Survivors exhibiting activity limitations had almost twice the odds of reporting poor life satisfaction and those experiencing limitations in cognition and IADLs had 2.88 times and 1.81 times the odds as others without these limitations of reporting poor life satisfaction, respectively. Participation in outpatient rehabilitation reduced the odds of reporting of poor life satisfaction by approximately one half. ConclusionsRehabilitation focused on addressing these functional limitations would increase life satisfaction for persons diagnosed with stroke. Future research on specific types of cognitive and daily living limitations would assist policy makers and referral sources in making appropriate referrals to rehabilitation.

Adaptation to Low Vision Caused by Age-Related Macular Degeneration: A Case Study

One in eight Americans aged 65 and older has an eye disease resulting in low vision (National Eye Institute, NEI, 2006), and more women than men are visually impaired, mainly because women live longer (NEI, 2002). Age-related visual impairments are an indicator of a decline in activities of daily living and self-help skills (Travis, Boerner, Reinhardt, & Horowitz, 2004). The top eye conditions that affect older adults are macular degeneration, glaucoma, and diabetic retinopathy. Age-related macular degeneration (AMD) is the leading cause of vision loss in the United States for persons aged 60 and older (NEI, 2007). It adversely affects the ability of an individual to read standard print and can limit a person's independence in preparing meals, using a telephone, taking care of finances, traveling, shopping, taking medications, and washing laundry (Ryan, Anas, Beamer, & Bajorek, 2003). Despite their decreased ability to perform activities of daily living and instrumental activities of daily living (Crews & Campbell, 2001; Heyl & Wahl, 2001; Horowitz, 2004; Raina, Wong, & Massfeller, 2004; Travis et al., 2004), persons with low vision still have the need and desire to perform everyday activities that support their life roles. Given their inability to engage in these activities in the same manner as they once did and their continued desire to do so, persons with low vision usually adapt to the challenges of performing these activities. The purpose of this study was to elucidate how a woman with AMD adapted to the challenges that she faced in performing everyday activities. The research question was What successful adaptations does a woman with AMD use to address the functional challenges of performing the activities? LITERATURE REVIEW Although the primary focus of vision rehabilitation needs to include methods to complete everyday activities, the complexity of the visual impairment leaves other needs to be addressed. Simply modifying physical performance does not yield adaptation (Crews & Campbell, 2001; Heyl & Wahl, 2001; Horowitz et al., 1998). Persons with low vision use multiple strategies to address the many difficulties they encounter (Horowitz et al., 1998; Lindo & Nordholm, 1999; Moore, 1999) and use different strategies at different times and in different situations (Lindo & Nordholm, 1999). Strategies for adapting are generally organized into three major areas: (overt, observable actions), psychological (cognitions or emotions), and social (involving other individuals) (Horowitz et al., 1998, p. iii). Behavioral coping strategies include the use of residual vision, adaptive devices, optical devices, other senses or memory, modification of tasks, participation in rehabilitation services, and the restriction of activities (Horowitz et al., 1998). Brennan and Cardinali (2000) found that novel coping strategies led to positive adaptation to age-related vision loss. They determined that novel coping strategies were used most commonly (49%) in the behavioral domain and included seeking low vision services to learn new skills or the use of adaptive or optical devices. Many researchers believe that psychological adjustment is the key to adaptation (Brennan & Cardinali, 2000; Horowitz et al., 1998; Thompson, Goldbaber, Amaral, & Ringering, 1992). Lindo and Nordholm (1999) examined the psychological adjustment and well-being of persons with low vision by using Persson's (1990) model of adaptation, which assumes that a person will adopt several strategies from among six positive adaptation strategies and five negative adaptation strategies. They studied the use of the positive strategies of acceptance (stoicism and revaluation), trust, positive avoidance, minimization, independence, and control, and the negative strategies of denial, resentment, shame, isolation, and helplessness. The participants in their study used the positive strategies of revaluation, minimization, and control less than did the control group, indicating a lower level of adjustment. …

Factors associated with patients' participation in rehabilitation services: a comparative injury analysis 12 months post-discharge

Purpose : To determine key characteristics or factors associated with rehabilitation participation during the first year following discharge for persons with either traumatic brain injury (TBI), spinal cord injury (SCI), intra-articular fracture (IAF), or burn injury (BURNS). Method : Medical records and longitudinal survey [telephone questionnaire] data were collected for persons in the four injury groups and analyzed using hierarchical logistic regression procedures for each domain of factors. Results : The only significant predictors with odds ratios greater than one were those for vocational rehabilitation participation. TBI patients lacking private insurance were 2.6 times more likely to participate in vocational rehabilitation; older SCI and TBI patients are about twice as likely to participate in vocational rehabilitation; and finally those with IAF or BURNS who are married at 12 months post discharge are 11.5 and 4.4 times respectively more likely to participate in vocational rehabilitation. Conclusion : Those lacking valuable socio-economic resources, such as private insurance (for TBI) and social support systems provided by marriage (for BURNS and IAF patients) are much more likely to be referred to vocational rehabilitation. This is true for older SCI and TBI patients as well. Lacking such resources, patients may be viewed by referral agents as less likely to benefit from in or outpatient rehabilitation.