Physical Rehabilitation Services Research Articles

Ultrasound imaging in the classroom to teach in vivo anatomy and arthrokinematics to first year physical therapy students

and with limited accessibility for part of the population, particularly women who are largely dependent on their families in the decisions to seek health care. Purpose:The aim of this study was to identify gender distribution of personswith disabilities attending the 12 physical rehabilitation centres run or supported by The International Committee of the Red Cross in Iraq in 2013. We also aimed to identify the prevalence of female landmine survivors and women with amputations due to landmine accidents, a group that is rarely described in the literature. Methods: The database of The International Committee of the Red Cross was used to undertake a descriptive analysis of persons who received services from the 12 physical rehabilitation centres in Iraq in 2013. Results:A total of 32 827 persons (12%women) received services from 12 supported physical rehabilitation centres in Iraq in 2013. Najaf and Hilla physical rehabilitation centres in Southern Iraq had 3.6% and 2.4% female patients. The highest number of female patients was reported in three centres in Baghdad (15.7%, 16.4% and 20.2%). These results indicate that women in the capital Baghdad in Central Iraq are better represented than women from Southern Iraq where a highly traditional society prevails. The number of persons with amputations was 16,342, and 8.9% of these were women. Additionally, among the persons with amputations, 7.1%were landmine survivors.Within the group of landmine survivors in this study, 3.9% were women. Conclusion(s): Women represent a minority in accessing the physical rehabilitation centres in Iraq supported by The International Committee of the Red Cross. This might be a consequence of men being more actively involved in conflict related violence where women are less often targeted. Another possible reason is that women are under social and cultural protective family actions. Further studies are needed to evaluate facilitating factors and barriers in accessing rehabilitation services, including a more comprehensive understanding of health seeking behaviour on individual, family and structural levels. Implications: This study adds to limited existing knowledge about access to physical rehabilitation services for women in Iraq. It highlights the small number of women seeking physical rehabilitation services compared to men, and indicates a need for more targeted approaches towards women and their families to increase accessibility.

Access to physical rehabilitation services for women in IRAQ

Access to physical rehabilitation services for women in IRAQ

Case Report: Nicotine Replacement Therapy (NRT) in Hospitalized Surgical Patient

Hospital surgical services are often reluctant to offer nicotine replacement therapy (NRT) to inpatients due to concerns that nicotine leads to vasoconstriction and impaired wound healing. However, multiple potential health benefits result from offering NRT to hospitalized surgical patients who use tobacco products. A 28-year-old female patient, hospitalized following a motor vehicle accident, experienced severe nicotine withdrawal symptoms and a strong desire to smoke. After a Tobacco Treatment Specialist (TTS) consultation, the Physical Medical and Rehabilitation service at the hospital began her on NRT with positive outcomes. The patient experienced decreased cravings and withdrawal symptoms, as well as an increased desire to remain tobacco free after discharge. More surgical patients may have an increased commitment to remain tobacco free after discharge, if their withdrawal symptoms are treated during hospitalization using NRT.

Low back pain and obesity.

Introduction:Low back pain poses a significant problem in clinics and public health. It presents one of the main problems with adults, since 70-80% of adults experience it at least once in their lifetime. Causes of the low back pain are numerous and often unknown.Objectives:The aim of the study is to find the most prevalent age group, pain localisation, and the frequency of physical therapy sessions in obese and non-obese subjects with LBP.Materials and Methods:The study has been conducted by the Physical Rehabilitation Service of the Occupational Medicine Institute, during one year period. The total number of patients studied was 101 and all were Kosovo Energy Corporation (KEC) employees. The study was retrospective.Results:Looking at the body weight index, out of 101 patients, 69.3% are classified as non-obese and 30.7% as obese. Using T-Test we have found a difference of high statistical significance between the average number of the physical therapy sessions applied in relation to the examined groups (T-Test=2.78, P=0.0065, so, P<0.01).Conclusion:Obesity and age have no direct influence in back pain, but they could prolong healing. Professional occupation and binding position are factors that affect back pain. Physical workload can cause the manifestation of sciatica; whereas psycho-social factors can prolong the overall healing process.

Unmet health and rehabilitation needs of people with long-term neurological conditions in Queensland, Australia.

The survival and life expectancy rates of people with traumatic and degenerative neurological conditions are increasing, sometimes up to several decades. Yet compared to the general population, people with a disability continue to experience poorer health and are at greater risk of developing secondary health problems and facing barriers to services they require. These trends have significant implications for provision of health and rehabilitation services. In this study, the adequacy of health and rehabilitation services provided to people with long-term neurological conditions and their unmet needs were explored from the perspectives of individual users, their nominated family members and key service providers. A qualitative research design with maximum variation sampling was used. Data were collected from semi-structured interviews with 65 participants comprising 25 long-term care service users, nominated family members or friends (n = 22) and care service providers (n = 18) in Queensland, Australia. All service users needed assistance with usual daily activities, and 22 were wheelchair dependent. The hours of funded personal care ranged from 2 to 201 hours per week. Data were analysed using framework analysis. Participants generally perceived that specialist medical and hospital services were adequate and satisfactory. They valued supportive health and rehabilitation professionals and receiving client-centred physical rehabilitation. However, the majority of participants (n = 17) had perceived unmet needs for physical rehabilitation (n = 14), other health or rehabilitation services (n = 10) or counselling (n = 6). Community-based physical maintenance rehabilitation was often perceived as inadequate, costly or inconveniently located. Participants highlighted the importance of personal and family counselling and information provision at time points such as diagnosis. The findings contribute to the limited international evidence on the gaps in health and rehabilitation services for people with neurological conditions receiving lifetime care services in the community. A continuum of integrated rehabilitation services to minimise avoidable impairments, optimise independence and functioning, and sustain quality of life is warranted.

Avaliação da implantação de uma Rede Estadual de Reabilitação Física em Pernambuco na perspectiva da Política Nacional de Redução da Morbimortalidade por Acidentes e Violência, 2009

Objective: to evaluate the implementation of the Public Physical Rehabilitation service in Pernambuco StateBrazil, from the perspective of the National Policy for Reducing Morbidity and Mortality from Accidents and Violence. Methods: eight municipalities with more than 100,000 inhabitants and 27 physical rehabilitation services were studied. Investigation design was a case study with implementation type analysis. We analyzed 37 indicators from three dimensions: management, health care and social policy watch. Results: implementation in Pernambuco was classified as intermediate, considering the established criteria. Both the political and the structural context were favorable for implementation at state level, differently to the municipal level which presented no favorable contexts. Conclusion: there were considerable efforts on the part of the state administration to move forward with the implementation of the Public Physical Rehabilitation System, although low commitment on the part of the municipal administrations was detected.

Compliance visits for physical medicine and rehabilitation services

Compliance visits for physical medicine and rehabilitation services

Perceptual weighting of pain behaviours of others, not information integration, varies with expertise

Being able to estimate effort pain in patients is important for health care providers working in physical rehabilitation services. Previous studies have shown that clinicians and physiotherapists underestimate patients' pain. The present study examined how two sources of visual information, namely body kinematics (movement speed and postural constraints) and facial expressions are integrated in order to estimate effort pain magnitude experienced by a paraplegic person performing a sitting pivot transfer. In addition, the effect of familiarity with paraplegia on judgment was assessed by comparing performance among physiotherapists, paraplegic patients and unfamiliar participants. Functional measurement was used to determine the psychophysical law of visual information integration carried by pain behaviours (guarding and facial expression). Results indicate that guarding behaviour (specified by movement speed) carried important information for perceived effort pain independently of familiarity. In contrast, facial expression of pain was relevant only to unfamiliar and physiotherapist participants and not to paraplegic participants. Even if physiotherapists underestimated effort pain as compared to the other groups, they relied more strongly on facial expression, than other participants, in their estimation of effort pain expressed by a paraplegic patient. These results bring further insights into understanding physiotherapists' perception of patients' pain. In order to improve their ability to adapt the difficulty of the rehabilitation sessions, they should learn to raise their global level of pain magnitude estimation (for example, by performing themselves the body movement) instead of overweighting facial pain expression signals.

Abstract 100: Effects of time to Physical Therapy Order on Length of Stay and Discharge NIH Stroke Scale Scores in an Acute Stroke Unit

Introduction: Early physical therapy (PT) consults and subsequent rehabilitation services have been shown to improve functional and mobility outcomes post stroke. Shortage of PT staff may impact how soon patients can be seen after a physician’s order (PO) and rehabilitation outcomes. The current preliminary study purposed to assess the effects of time elapsed between PO for PT services and the first PT consult ≤ or &gt;48 hours (time to PT order = TPO), on patient’s length of stay (LOS) and scores on the NIH Stroke Scale (NIHSS) at discharge, in a busy acute stroke unit of a regional health care facility. It was hypothesized that TPO of ≤48 hours after initial PO for PT services will show better LOS and NIHSS scores (at discharge) outcomes compared to TPO &gt;48 hours. Methods: A total of 291 stroke patients who presented at an acute hospital were retrospectively placed in either a TPO ≤ 48 hours group, G1 (n=147), or a TPO &gt;48 hours group, G2 (n=144) based on the time of their first PT consult after a PO. The LOS and NIHSS data were subjected to statistical analysis. Results: There were no significant differences in LOS (G1=5.5 ± 4.61 vs. G2= 5.9 ± 5.62 days; p=0.6542 ) and discharge NIHSS scores ( p=0.6728 ) of either groups. A post hoc regression analysis to examine impact of factors such as demographics (age, gender, weight, etc), number of PT visits (PTV) and discharge destination (DD) revealed that TPO ( p&lt;0.0001 ), PTV (p&lt;0.0001) and DD (p&lt;0.0001) were significant contributors to observations in group G1; while PTV ( p&lt;0.0001 ) and DD ( p&lt;0.0001 ) were the only significant contributors to observations in the G2 group, TPO was not significant ( p=0.0646 ). Conclusions: Ideally, stroke patients should be evaluated for physical therapy services within 24 hours of a PO. Shortage of PT staff in a busy health care facility may impact how soon patients can be seen. Although the current pilot study did not reveal significant changes in LOS, and NIHSS scores of stroke patients at discharge irrespective of whether patients were seen by physical therapists ≤ or &gt;48 hours after a PO, severity of the stroke, previous history of stroke or TIAs, and other co-morbidities that could have confounded the results were not examined. Future study design will take into account these potential confounding variables and other outcome measures.

Physical rehabilitation services in Iraq

In Iraq, little information is available to describe the scope of disability. However, WHO estimates that about 0·5% of the world population is in need of a prosthetic or orthotic device.1 This figure would mean that, of roughly 31 million Iraqi citizens,2 155 000 are in need of devices. As per standards of the International Society for Prosthetics and Orthotics and WHO, one qualified prosthetist or orthotist with three assistants can manufacture 250 devices per year; the lifespan of an appropriate device (ie, one that is well made, well aligned, fitted, and finished cleanly) is 3 years.

Mental health in Iraq: issues and challenges

Little research has been done into the mental health of Iraqis. Only one national survey is available—the Iraq Mental Health Survey (IMHS) of 2007, with 4332 respondents—which showed that anxiety disorders were the most common group (13·8%) and major depressive disorder the most common disorder (7·2%). 1 Alhasnawi S Sadik S Rasheed M et al. for the Iraq Mental Health Survey Study GroupThe prevalence and correlates of DSM-IV disorders in the Iraq Mental Health Survey (IMHS). World Psychiatry. 2009; 8: 97-109 PubMed Google Scholar Child and adolescent mental health issues are particularly important: the IMHS reported substantially increasing lifetime prevalence of most disorders across generations, and individuals younger than 18 years constitute almost half the population. 2 WHOMental Health Atlas 2011—Iraq. http://www.who.int/mental_health/evidence/atlas/profiles/irq_mh_profile.pdf Google Scholar Since 2008, myself and colleagues at the Johns Hopkins Bloomberg School of Public Health have done assessments of needs, and research into the feasibility and effect of mental health treatments in Iraq. These assessments have confirmed the importance of mental health problems among the many adult survivors of trauma in both Iraqi Kurdistan 3 Bolton P, Michalopoulos L, Ahmed A, Murray LK, Bass J. The mental health and psychosocial problems of survivors of torture and genocide in Kurdistan, northern Iraq: a brief qualitative study. Torture (in press). Google Scholar and southern Iraq (unpublished). In both regions most participants described substantial symptoms of depression, anxiety, and post-traumatic stress. Civilian mortality after the 2003 invasion of IraqA historical view of the war in Iraq is essential to the understanding of the internecine controversies that arose about the validity of mortality studies, and the political pressures that influenced their interpretation to the world. The US Department of State (DoS) and US Agency for International Development (USAID), which were responsible for humanitarian assistance and recovery, were aware that, in prolonged warfare, preventable mortality and morbidity can exceed direct deaths from violence as public health infrastructure and social protections rapidly deteriorate. Full-Text PDF Physical rehabilitation services in IraqIn Iraq, little information is available to describe the scope of disability. However, WHO estimates that about 0·5% of the world population is in need of a prosthetic or orthotic device.1 This figure would mean that, of roughly 31 million Iraqi citizens,2 155 000 are in need of devices. As per standards of the International Society for Prosthetics and Orthotics and WHO, one qualified prosthetist or orthotist with three assistants can manufacture 250 devices per year; the lifespan of an appropriate device (ie, one that is well made, well aligned, fitted, and finished cleanly) is 3 years. Full-Text PDF When the violence of war comes homeThere has been considerable focus on documenting the psychopathological sequelae of deployment-related trauma, but, despite much speculation, few data are available to ascertain the risk of violence arising from deployments. In The Lancet, Deirdre MacManus and colleagues1 extend the findings from self-report studies and use the data from criminal records to show for the first time the link between combat and interpersonal violence. The consequences of interpersonal violence are enormous in terms of human suffering, even greater than those caused by non-interpersonal trauma. Full-Text PDF

Differences Among Health Care Settings in Utilization and Type of Physical Rehabilitation Administered to Patients Receiving Workers’ Compensation for Musculoskeletal Disorders

Introduction There is a paucity of data describing the relationship between practice setting and the delivery of physical rehabilitation to injured workers. Purpose To determine differences in the number of visits, the number of treatment units, and the proportion of billing for physical agents over an episode of care between different practice settings’ providing physical rehabilitation to patients receiving workers’ compensation for a musculoskeletal problem. Methods A large administrative database was evaluated retrospectively. Practice settings were classified as physician office, corporate physical therapy clinic, occupational medicine clinic, hospital-based outpatient clinic, or private physical therapy practice. Results 70,306 subjects (72.7 % male; mean age = 44.6, SD = 11.8 years) were included in this study. Corporate physical therapy clinics had the highest mean values for total visits (13.1, SD = 12.7) and for total units (66.8, SD = 85.5), and the lowest mean values for proportion of physical agents during the episode of care (.22, SD = .18). Occupational medicine clinics had the lowest mean values for total visits (6.8, SD = 7.9) and for total units (30.4, SD = 36.5), and the highest mean value for proportion of physical agents during the episode of care (.41, SD = .22). When controlling for ICD-9-CM codes, body-part treated, surgical status, and geographical region there were small changes in effect size; however, the significance and directionality of differences between practice settings were not changed. Conclusions There were significant differences in billing for physical rehabilitation services between practice settings for patients receiving workers’ compensation. Corporate physical therapy clinics billed for more total visits and total units over an episode of care than did other practice settings; however they also billed for a lower proportion of physical agents indicating a greater use of those interventions supported by evidence-based guidelines (exercise and manual therapy) compared to other practice settings.

The Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context

Despite occupational therapists having strong historical ties to the Canadian military, there are currently no uniformed occupational therapists and only a few permanent occupational therapists employed by Canadian Forces. Occupational therapy is provided, in the main, through civilian occupational therapists. Occupational therapists have unique skills that can contribute to the existing Canadian Forces Physical Medicine and Rehabilitation Services Department. To establish the depth and scope of their work, this article explains the theoretical underpinnings of occupational therapy. Examples are provided of possible occupational therapy for populations of Canadian Forces members: (1) those with transient, intermittent injuries; (2) those returning from overseas missions with very serious injuries or severe injuries; and (3) those with permanent injuries who are transitioning from the Canadian Forces into the civilian workforce. Interventions for mental health issues are interwoven with those targeting physical issues. The article suggests that occupational therapists employed on a permanent basis by the Canadian Forces can contribute in a more comprehensive manner to the wider rehabilitation of Canadian Forces members. The article has applicability to occupational therapy military services in other countries.

Reliability and Repeatability of the Hoffmann Sign

To determine the inter-rater, intrarater, and intrasubject reliability of the Hoffmann sign. Observational, cross-sectional study. Veterans Affairs medical center. Fifty-two consenting subjects without amputation of the first through third fingers, fixed finger contractures, relapsing remitting multiple sclerosis, or any acute central neurological illness or injury within the past 3 months requiring hospital admission were recruited from inpatients and outpatients in the Spinal Cord Injury and Physical Medicine and Rehabilitation services. The Hoffmann sign was elicited by 1 primary and 3 secondary investigators who used a standardized technique. The Hoffmann sign was considered positive if any reflexive flexion of the distal phalanx of the thumb or any of the fingers was present. In the first session, the primary and one secondary examiner performed 2 trials on both hands of each subject. Each investigator pair repeated the procedure in a second session. Cohen's κ coefficient was calculated to determine (1) inter-rater reliability, calculated per investigator pair per hand, for the first trial of a session; (2) intrarater reliability, calculated between the 2 trials of each session per investigator; and (3) intrasubject reliability, calculated per hand of each subject between the first trials of the 2 sessions. Inter-rater κ was 0.65 (188 pairs), intrarater κ was 0.89 (384 pairs), and intrasubject κ was 0.73 (178 pairs). All κ values were obtained with P < .01. The Hoffmann sign has substantial inter-rater and intrasubject reliability, in addition to outstanding intrarater reliability, when tested with the use of a standardized technique.

Using Technology to Enhance the Quality of Home Health Care: Three Case Studies of Health Information Technology Initiatives at the Visiting Nurse Service of New York

There is a growing recognition among health services researchers and policy makers that Health Information Technology (HIT) has the potential to address challenging issues that face patients and providers of healthcare. The Visiting Nurse Service of New York (VNSNY), a large not-for-profit home healthcare agency, has integrated technology applications into the service delivery model of several programs. Case studies, including the development and implementation, of three informatics initiatives at VNSNY are presented on: (1) Quality Scorecards that utilize process, outcomes, cost, and satisfaction measures to assess performance among clinical staff and programs; (2) a tool to identify patients at risk of being hospitalized, and (3) a predictive model that identifies patients who are eligible for physical rehabilitation services. Following a description of these initiatives, we discuss their impact on quality and process indicators, as well as the opportunities and challenges to implementation.

Resultados y eficiencia del tratamiento rehabilitador del hemipléjico. Estudio evolutivo

Introduction The analysis of the efficiency of a stroke rehabilitation program has special importance. It requires prolonged treatments and the results depend on the kind of injury and the type and intensity of the rehabilitation treatment. Objective Analyze the results and the efficiency of the cerebral vascular rehabilitation program in patients during these periods 2002–2007 (P02-07) and 1994–2001 (P94-01). Patients and method Is a study with a group of patients who suffered a cerebral vascular accident between the 01-01-2002 and the 31-12-2007 and they had admitted in the Physical Medicine and Rehabilitation service for a treatment. We used the Functional Independence Measure (FIM) before and after the rehabilitation program. The efficiency was considered like the quotient between gain and stay. It is constructed the pattern of results and the matrix of efficiency of Stineman. We compared the efficiency, the pattern of results and the matrix of efficiency of this period (2002–2007) with the one from 1994 to 2001. Results The patients of the P02-07 (129 patients) have a smaller age than those of the P94-01 (247 patients) (63,5 versus 69.1; IC95% 3,2 to 8,1), they have a similar FIM (76,9 and 76.8), but the gain (27,3 versus 33.7; IC95% 2,1 to 10,5) and the stay (29,3 versus 36.7; IC95% 0,7 to 13) are inferiors, and the efficiency is similar (1,5 and 1.4) in both periods. There are no differences between the patterns of results, although the percentile 75 is inferior in the P02-07 (96 versus 103). The matrix of efficiency are different in the group V (low efficiency) that falls in P02-07 (19, 5% versus 30, 4%; p=0.03). Conclusions There is a reduction in the stay and the gain in the FIM, but the efficiency is similar. The group of low efficiency improves but, in the results, percentile 75 of the FIM at discharge has lower values.

Music Therapy in Parkinson’s Disease

This paper presents the results of music therapy interventions with Parkinson’s patients at the Physical Medicine and Rehabilitation Service of the National Institute of Geriatrics in Santiago of Chile.

Determinants of Utilization of Physical Rehabilitation Services for Persons With Chronic and Disabling Conditions: An Exploratory Study

Elrod CS, DeJong G. Determinants of utilization of physical rehabilitation services for persons with chronic and disabling conditions: an exploratory study. ObjectiveTo determine which variables influence the receipt of physical rehabilitation services (ie, physical, occupational, speech therapy) for a population of people with chronic and disabling conditions. DesignA convenience sample of 502 adults with cerebral palsy (CP), multiple sclerosis (MS), and spinal cord injury (SCI), drawn from diverse parts of the United States. SettingRespondents were surveyed in the general community. ParticipantsPersons (91% under the age of 65y) with CP, MS, or SCI who responded to the 1999 component of a national longitudinal survey. InterventionsNot applicable. Main Outcome MeasuresSelf-reported need for physical rehabilitation services. Bivariate and multivariate analyses were used to examine variables that influenced utilization of services. ResultsSome 53% of respondents did not receive self-reported needed physical rehabilitation services. Respondents who had Medicaid were more likely than those with Medicare or private insurance to receive physical rehabilitation services. Respondents having a lower household income and poorer health were less likely to receive services. ConclusionsOur findings indicate that health care funding sources provide widely disparate coverage for physical rehabilitation services to persons with 3 specific chronic and disabling conditions. Policy-makers and health plan administrators should re-evaluate their coverage of physical rehabilitation services designed to enhance quality of life and reduce the burden of lost independence.

Continuous passive motion compared with intermittent mobilization after total knee arthroplasty. Elaboration of French clinical practice guidelines

Objective To develop clinical practice guidelines concerning the use of continuous passive motion (CPM) compared with intermittent mobilization after total knee arthroplasty (TKA). Method We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review and collection of everyday clinical practice concerning postoperative rehabilitation techniques and external review by a multidisciplinary expert panel, to develop the guidelines. Results The literature contains no evidence of the advantages of CPM over other techniques of mobilization, although CPM could be adjuvant therapy used to accelerate short-term recovery. However, in France, CPM remains widely used after TKA, both in orthopedic surgery units and in physical medicine and rehabilitation services. Conclusion Good methodological quality studies are needed to assess different CPM modalities and compare them to alternative intermittent mobilization techniques, particularly those with therapy starting from a flexed position.

Evaluation of Neurologic Deficit Without Apparent Cause: The Importance of a Multidisciplinary Approach

Background/Objective: A patient presenting with an acute neurologic deficit with no apparent etiology presents a diagnostic dilemma. A broad differential diagnosis must be entertained, considering both organic and psychiatric causes.Methods: A case report and thorough literature review of acute paraplegia after a low-energy trauma without a discernible organic etiology.Results: Diagnostic imaging excluded any bony malalignment or fracture and any abnormality on magnetic resonance imaging. When no organic etiology was identified, a multidisciplinary approach using neurology, psychiatry, and physical medicine and rehabilitation services was applied. Neurophysiologic testing confirmed the absence of an organic disorder, and at this juncture, diagnostic efforts focused on identifying any psychiatric disorder to facilitate appropriate treatment for this individual. The final diagnosis was malingering.Conclusions: The full psychiatric differential diagnosis should be considered in the evaluation of any patient with an atypical presentation of paralysis. A thorough clinical examination in combination with the appropriate diagnostic studies can confidently exclude an organic disorder. When considering a psychiatric disorder, the differential diagnosis should include conversion disorder and malingering, although each must remain a diagnosis of exclusion. Maintaining a broad differential diagnosis and involving multiple disciplines (neurology, psychiatry, social work, medical specialists) early in the evaluation of atypical paralysis may facilitate earlier diagnosis and initiation of treatment for the underlying etiology.