Planning Of Rehabilitation Services Research Articles

Are healthy ageing trajectories suitable to identify rehabilitation needs of the ageing population? An exploratory study using ATHLOS cohort data.

The ageing process is highly heterogeneous leading to diverse ageing trajectories. Such trajectories have been modelled to study trends and determinants of ageing and could potentially be used to inform the planning of rehabilitation services at population level. The objective of this paper was to explore whether healthy ageing trajectories are suitable to identify targets for rehabilitation interventions for the ageing population. Data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) harmonized cohort and the English Longitudinal Study of Ageing (ELSA), which is included in ATHLOS, were used. Growth mixture models were implemented to replicate healthy ageing trajectories modelled elsewhere as 'high stable', 'low stable', and 'rapid decline'. Regularized partial correlation networks were used to estimate expected-influence and bridge expected-influence centrality measures. Healthy ageing trajectories modelled with ATHLOS (N = 131116) and ELSA (N = 14904) were consistent with previous work. At the first individual wave, prevalence of problems of respondents in the 'high stable' and 'rapid decline' trajectories were comparable; at the last individual wave, prevalence remained similar for the 'high stable' but increased substantially in all domains for the 'rapid decline' trajectory. Expected-influence centrality measures provided different results than prevalence estimates. For instance, in the first individual wave mobility and carrying, moving, and handling objects had highest impact on overall functioning for the 'rapid decline' and 'high stable' trajectories, while the most prevalent functioning problems concerned cognition, pain, as well as energy and drive functions. Our study stressed the relevance of healthy ageing trajectories for identifying functioning domains and categories that need to be targeted by rehabilitation services in a heterogeneous ageing population. The use of such trajectories at country level has the potential to make a meaningful contribution to the planning and delivery of rehabilitation interventions through health systems and to informed policy making.

Statistical analysis plan for the stepped wedge clinical trial Healing Right Way—enhancing rehabilitation services for Aboriginal Australians after brain injury

BackgroundAboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. MethodsThe trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL–5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care.DiscussionThe trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken.Trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018.

A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services.

This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.

Rehabilitation cost share and cost analysis of traumatic hand injuries: Our single-center results

Objectives This study aims to evaluate the cost expenses and rehabilitation share of hand and/or wrist injuries and to contribute to the development of health and economic policies. Patients and methods A total of 59 patients (55 males, 4 females; mean age: 39.1±11.3 years; range, 20 to 64 years) who presented with hand and/or wrist injuries between January 2015 and December 2017 were retrospectively reviewed. Demographic data, hand injury information, and the Modified Hand Injury Severity Scores (MHISS) were retrieved from the patient file system. The cost analysis with direct and indirect costs was performed. Results According to the MHISS, 27.1% of patients had a minor injury, 23.7% had a moderate injury, 18.6% had a severe injury, and 30.5% had a major injury. The mean direct cost of the patients was $726.00±641.87 and the total cost of the indirect cost was $2,776.93±1,619.00. The mean day-off time was 125±68.62 days. Indirect costs accounted for 79% of the total cost. The mean cost of rehabilitation was $150.18±86.88. Rehabilitation costs accounted for 4% of the total cost. There was a positive correlation between the MHISS and direct, indirect and total cost, but not between the MHISS and rehabilitation cost. Conclusion The proportion of the share allocated to rehabilitation expenditures, which is the subunit of direct cost, is low and not related to the injury severity. The data obtained from the study contributed to the creation of evidence-based health and economic policies. We believe that these data also contribute to the planning of rehabilitation services according to the severity of injury which would improve the quality of life and return to work.

Catching our breath: reshaping rehabilitation services for COVID-19

Purpose War and natural disaster have been spurs to the creation of rehabilitation services. The COVID-19 pandemic poses a different question for existing rehabilitation services: how best to respond to a disaster that is anticipated from afar, but whose shape has yet to take full form? Methods Applying the 5-phase crisis management model of Pearson and Mitroff, we report our experience at one of Scotland’s largest centres for rehabilitation, in planning to cope with COVID-19. Results Contingency rehabilitation planning can be framed in a 5-phase crisis management model that includes (i) signal detection; (ii) prevention/preparedness; (iii) damage limitation; (iv) recovery; and (v) learning. We have reported the impact of COVID-19 on rehabilitation services within a Scottish context and shared some of our learning. Conclusion COVID-19 has challenged healthcare worldwide and has served as an amplifier for the recognised ill effects of poverty and inequality. As rehabilitation clinicians, we are in a position to continue advocating for people facing disability, and also seeking and responding to signals of COVID-19’s late effects in both COVID-19 and non-COVID-19 patients alike. IMPLICATIONS FOR REHABILITATION COVID-19 has resulted in unprecedented challenges in rehabilitation service planning. Contingency rehabilitation planning can be framed in a 5-phase crisis management model of Pearson and Mitroff, including (i) signal detection; (ii) prevention/preparedness; (iii) damage limitation; (iv) recovery; and (v) learning. COVID-19 has served as an amplifier for the recognised ill effects of poverty and inequality; as rehabilitation clinicians, we are in a position to continue advocating for people facing disability, and also seeking and responding to signals of COVID-19’s late effects in both COVID-19 and non-COVID-19 patients alike.

Functional status, pain and return to work of injured motorcyclists involved in a motorcycle crash over one-year post-injury in Vietnam

ObjectiveThis study aimed to determine changes in functional status, pain, and return to work/study (RTW/study) over 12 months post-injury in motorcyclists admitted to a large hospital in Ho Chi Minh City (HCMC), Vietnam. MethodsA prospective study was undertaken with adult motorcyclists who were injured due to a crash and were admitted to hospital for more than 24 h. Pain and functional status data were collected at baseline (time of injury), and follow-up at 6 and 12 months post-injury. RTW/study was collected at 6 and 12 months post-injury. Multilevel mixed models and multiple logistic regression models were used to determine the changes in outcomes and predictors of outcomes including age, sex, education, Injury Severity Score, length of stay in the hospital and health-related quality of life. ResultsA total of 352 hospitalised motorcyclists were followed-up. The proportion of motorcyclist RTW/study was 60% (n = 165) at 6 months and 82% (n = 210) at 12 months post-injury. After adjusting for covariates, pain scores improved significantly at 6 months (β = -3.31, 95% CI: -3.61, -3.01) and 12 months post-injury (β = -3.62, 95% CI: -3.92, -3.32) compared to baseline. Functional status increased significantly by 2.89 points (95% CI: 2.64, 3.13) at 6 months and by 3.51 points (95% CI: 3.27, 3.75) at 12 months compared to baseline. ConclusionsThe study found improvements in outcomes over the study period, although there was ongoing disability at 12 months post-injury (18% had not RTW/study). This study provides further evidence on the burden of motorcycle injuries in Vietnam and priorities for research, and further informs treatment and rehabilitation service planning.

To eat is to practice-managing eating problems after head and neck cancer.

The purpose of this qualitative study was twofold: (1) to explore head and neck cancer (HNC) survivors' experiences of everyday life with eating problems after cancer treatment and (2) to explore their experiences of participating in a multidisciplinary residential rehabilitation program with a primary focus on physical, psychological, and social aspects of eating problems after treatment. Semi-structured focus group interviews were conducted with 40 Danish HNC survivors who participated in a 5-day residential rehabilitation program with follow-up after 3months. The transcribed interviews were analyzed through qualitative content analysis. Physical nutrition impact symptoms and unmet needs for support were frequent. Participants experienced a feeling of loss due to impaired eating abilities. Eating had become an obligation or a training situation, and the eating problems challenged the relationship with their relatives when well-meaning encouragement was perceived as a pressure. Social eating was a challenge, and this often led to social withdrawal. The residential program was a safe and supportive environment to practice eating skills, and participants benefited from meeting peers. The program provided participants with knowledge and skills that many of them had been missing during and after treatment. Eating problems after treatment have substantial effects on the everyday life of HNC survivors. A multidisciplinary residential rehabilitation program may be beneficial to meet their rehabilitation needs. The results are useful for future planning of rehabilitation services and clinical studies that may contribute to improving current clinical practice and benefit HNC survivors.

‘I’ve got to row the boat on my own, more or less’: aboriginal australian experiences of traumatic brain injury

ABSTRACTBackground:The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges.Method:A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from diverse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity.Case Reports:Common themes included: significant long-term life changes; short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home; family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care; challenges related to lack of formal rehabilitation services in rural areas; poor communication channels; poor cultural security of services; and lack of consistent follow-up.Discussion and Conclusion:These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.

Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST)

BackgroundRehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of “leaving no one behind” countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to assess governments’ efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities.MethodsA systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators’ organizing framework which was verified and interpreted by a select number of participants.ResultsA concept map of 11 clusters of indicators emerged from the analysis grouped into three broader themes: Governance and Leadership (3 clusters); Service Delivery, Financing and Oversight (6 clusters); and Human Resources (2 clusters). The indicator framework was comprehensive and well aligned with the Convention. On average, there was a moderately positive correlation between importance and feasibility of the indicators (r = .58) with experts prioritizing the indicators contained in the clusters of the Governance and Leadership domain. Two of the most important indicators arose from the Service Delivery, Financing and Oversight domain and reflect the need to monitor unmet needs and barriers in access to rehabilitation. In total, 59 indicators achieved above average score for importance and comprised the two–tiered priority set of indicators.ConclusionConcept mapping was successful in generating a shared model that enables a system’s view of the most critical legal, policy and programmatic factors that must be addressed when assessing country efforts to reform, upscale and improve rehabilitation services. The Rehabilitation Systems Diagnosis and Dialogue framework provides a data driven basis for the development of standardized data collection tools to facilitate comparative analysis of rehabilitation systems. Despite agreement on the importance and feasibility of 59 indicators, further research is needed to appraise the applicability and utility of the indicators and secure a realistic assessment of rehabilitation systems.

The development of a specific database for rehabilitation centres in Madagascar

The service provision of PRM was dramatically improved by the establishment of a trained cohort of PRM doctors in 2013 following training in 2011–2013 for a Diplome Universitaire and the immediate establishment of the Association of Physical and Rehabilitation Medicine of Madagascar (AMPR Madagascar). The Ministry of Health database then used was not helpful to the development and planning of rehabilitation services having little about disabilities and rehabilitation. During training those doctors developed and refined e a data -base built on their knowledge of their patients. Data included demographic, diagnostic and treatment information. This database was then used systematically in all major Rehab centres where participants worked, nationwide. Data were then sent monthly to the author, the vice chair of AMPR, and the Ministry of Health, presented regularly at AMPR meetings and made available for the up-dating of the national Rehab plan for Madagascar. Initially in 2012, in the first month, 351 patients were seen in six centres, numbers increasing thereafter with 6148 persons being entered in 2014. Data for 2015 were incomplete. By 2016 data collection was complete, 5373 patients being entered, 1568 of these referred by other hospital departments; 51.2% were female, 46,8% were under the age of 15. The total numbers of patients seen yearly has increased substantially from 2012. Five main diagnoses were common to all centres, for children: cerebral palsy, clubfoot, acute respiratory disease; for adult lumbo-sacral pain and hemiplegia. The database has helped in the planning of rehabilitation services at national level where it is increasingly recognised that databases are of great importance for planning, surveillance and acquiring epidemiological data. It has informed the regular national teaching of AMPR which now concentrates on major pathologies.

Developing human rights based indicators to support country monitoring of rehabilitation services and programmes for people with disabilities: a study protocol.

BackgroundRehabilitation care is fundamental to health and human dignity and a human right enshrined in the United Nations Convention on the Rights of Persons with Disabilities. The provision of rehabilitation is important for reducing the need for formal support and enabling persons with disabilities to lead an independent life. Increasingly scholars and advocacy groups voice concerns over the significant barriers facing people with disabilities in accessing appropriate and quality rehabilitation. A growing body of research highlights a “respond-need” gap in the provision of rehabilitation and assistive technologies and underscore the lack of indicators for assessing performance of rehabilitation systems and monitoring States compliance with human rights standards in rehabilitation service planning and programming. While research on human rights and health monitoring has increased exponentially over the last decade far too little attention has been paid to rehabilitation services. The proposed research aims to reduce this knowledge gap by developing a human rights based monitoring framework with indicators to support human rights accountability and performance assessment in rehabilitation.Methods/DesignConcept mapping, a stakeholder-driven approach will be used as the core method to identify rights based indicators and develop the rehabilitation services monitoring framework. Concept mapping requires participants from various stakeholders groups to generate a list of the potential indicators through on line brainstorming, sort the indicators for conceptual similarity into clusters and rate them against predefined criteria. Multidimensional scaling and hierarchical cluster data analysis will be performed to develop the monitoring framework while bridging analysis will provide useful insights about patterns of agreement or disagreement among participants views on indicators.DiscussionThis study has the potential to influence future practices on data collection and measurement of compliance with human rights standards in rehabilitation service delivery and organization. The development of a valid and universally applicable set of indicators will have a profound impact on the design and implementation of evidence informed disability policies and programs as it can support countries in strengthening performance measurement through documentation of comparative information on rehabilitation care systems. Most importantly, the resulting indicators can be used by disabled people’s organizations as well as national and international institutions to define a minimal standard for monitoring and reporting progress on the implementation of the Convention on the Rights of Persons with Disabilities in the area of rehabilitation.

Rehabilitation of Geriatric Patients

Primary care physicians play an important role in the rehabilitation of geriatric patients: they must be able to assess rehabilitation potential, determine specific patient needs, and then determine the appropriate setting to optimize patient care. Rehabilitation service planning is usually based on a different model of diagnosis and treatment than traditional medical care. This chapter describes the key aspects of rehabilitation planning for stroke, amputation and peripheral vascular disease, hip fracture, rheumatoid arthritis, and arthroplasty. The revised World Health Organization International Classification of Functioning, Disability and Health (ICIDH-2), included in a figure, can be used to assess the causes of disability, plan treatment approaches, and determine the outcomes of care. Tables describe selected results of the neurologic examination of a patient with stroke, assessment and management of complications of stroke and other disabling conditions, and pharmacologic therapy for poststroke depression. An algorithm shows the selection of the appropriate setting for rehabilitation after hospitalization for acute stroke. The Orpington Prognostic Scale for estimating stroke recovery is provided, as is a list of current Internet resources pertaining to geriatric care. This chapter contains 96 references.

Use of Statistics From National Data Sources to Inform Rehabilitation Program Planning, Evaluation, and Advocacy

Data on people with disabilities can be used to confirm service needs and to evaluate the resulting impact of services. Disability statistics from surveys and administrative records can play a meaningful role in such efforts. In this article, the authors describe the array of available data and statistics and their potential uses in rehabilitation service planning and evaluation. They discuss the 2000 Decennial Census Long Form, the American Community Survey, the National Health Information Survey, the National Health Information Survey on Disability, the Current Population Survey Annual Demographics Survey, the Survey of Income and Program Participation, and the Health and Retirement Survey, administrative records such as the Rehabilitation Services Administration (RSA) 911 and the Social Security Administration (SSA) Title 2 and Title 16 records, and matched data such as linked RSA and SSA records. They also provide examples of applications of these data sets to rehabilitation service planning and evaluation, along with recommendations for rehabilitation education, practice, and research.

The importance of cultural factors in the planning of rehabilitation services in a remote area of Papua New Guinea

Purpose: The aim of this study in the Middle Ramu, Papua New Guinea, was to gain a better understanding of how cultural factors work to influence the lives of persons with disability in a remote area. The study also explores how this information can be used for the planning of rehabilitation services.Method: Two phase screening identified persons with disability in the study area and questionnaires were completed for all those identified. Information documented included the nature of the disability, a biomedical cause (where appropriate), the perceived cause of the disability, as well as some indication as to where help had been sought for the disability. In depth interviews were later done with disabled individuals and their families, to determine how they explained their disability.Results: Thirty-two per cent of persons with disability and their families attributed disability to sorcery or other supernatural causes, a greater proportion than for any other category of perceived aetiology. There was widespread acceptance of Western medicine, although help was more likely to be sought from sources in the community for disabilities believed to have a supernatural origin.Conclusions: This study demonstrates that an understanding of cultural factors is fundamental to implementing rehabilitation services that are culturally appropriate and address the social dimension of disability.

The development of strategic guidelines for regional planning of rehabilitation services.

After sketching in the background of services for the disabled and of rehabilitation facilities in England, this paper then proceeds to record the authors' experience in participating in the strategic planning process of a regional health authority serving a population of almost 4 1/2 million people. Model strategic guidelines for rehabilitation services are then presented; these include target service levels for personpower, and a consideration of some of the physical resources needed. The paper concludes with an appendix citing estimates for the frequency of occurrence of various classes of impairment and disability within the region considered.