Practice Of Rehabilitation Medicine Research Articles

Goal Attainment Scaling in rehabilitation: An educational review providing a comprehensive didactical tool box for implementing Goal Attainment Scaling.

Goal Attainment Scaling (GAS) is a person-centered and collaborative approach, allowing to assess the effectiveness of an intervention on personally relevant goals. However, GAS is not a "scale" but a heterogeneous group of methodologies, including many variations and lack of consensus on high quality GAS. The aim of this communication is to: 1. provide updated didactical information on GAS use in PRM practice and research; 2. increase awareness of GAS methodological challenges; 3. guide use of GAS as an integrated process of rehabilitation after goal setting and; 4. provide updated resources for self-directed learning and extensive supplemental material to increase knowledge and practical skills in GAS use. Educational literature review about current GAS applications relevant to PRM fields. Practical advice is provided regarding clinical challenges in GAS: definition of 0 level, time-frame and means employed to attain the goal, dealing with unforeseen pattern of improvement, synthesizing the numerous significations of "SMART" goal acronym to guide best use of GAS, and thinking flexibility on the type of relevant goals that can be set. Challenges with GAS in rehabilitation research are presented in order to promote researcher's and reviewer's awareness on reliable use of GAS and encouraging best-use of GAS.

Test of the Rehabilitation Goal Screening (ReGoS) Tool to Support Decision Making and Goal Setting in Physical and Rehabilitation Medicine Practice

It has already been shown that it is feasible to use International Classification of Functioning, Disability and Health (ICF) Sets as self-assessment instruments. We used this idea to design an ICF-based screening tool to assess patients of a broadly based rehabilitation department. It was developed for the purpose of having a screening tool before taking the anamnesis, as well as for rehabilitation planning and follow-up. The Rehabilitation Goal Screening (ReGoS) instrument is a self-report questionnaire which was developed based on the most relevant domains from the ICF Core Sets for chronic pain and rehabilitation. The ICF categories were translated into plain language and 0-10 Likert scales were used. A retrospective analysis of routine clinical data using the ReGoS tool, Work Ability Index (WAI) and Hospital Anxiety and Depression Scale (HADS) in paper- or tablet-based form was performed. The average age of the N = 1.008 respondents was 53.9 years (SD = 16.2). Of the respondents, 66% (n = 665) were female. At the time of the survey, 48.3% (n = 487) of the patients were employed. ReGoS results demonstrated that the highest restrictions on a scale from 0 to 10 were found in the areas of energy and drive (M = 5.79, SD = 2.575) and activities of daily living (M = 5.54, SD = 2.778). More than a third of the respondents rated their work ability as critical. The use of the ReGoS instrument as an ICF-based screening tool based on a self-report questionnaire provides relevant information for clinical diagnosis, participative goal setting and a detailed functional capacity profile.

Development status and prospects of rehabilitation sciences in China

<p indent="0mm">Rehabilitation medicine is a vital branch of medicine that focuses on the functional impairment of patients. In recent years, the practice of rehabilitation medicine has been continuously deepened, thanks to the support of governments at all levels and social forces, and rapid development has been achieved in terms of discipline direction, talent training, scientific research, academic exchanges, and landmark achievements. It has made significant contributions to the life and health of our people. In the future, it will be important to prioritize all-around and full-lifecycle rehabilitation as the orientation, functional rehabilitation as the goal, rehabilitation subspecialty as the focus, and “standardized innovation, scientific and technological rehabilitation” as the starting point to comprehensively promote the high-quality development of rehabilitation medicine.

Evidence based position paper on Physical and Rehabilitation Medicine practice for people with muscular dystrophies.

Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for people with muscular dystrophies. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-three recommendations resulting from the Delphi procedure. The role of the PRM physician is to assess the functional status of persons with muscular dystrophy and to plan, monitor and lead PRM program in an interdisciplinary setting within a multiprofessional team.

Evidence-based position paper on Physical and Rehabilitation Medicine practice for people with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM) physician and PRM professional practice for people with ALS. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The responsibility of the PRM physician is functional assessment of persons with ALS and delivering the optimal and most effective PRM program of care. The rehabilitation program of patients with ALS should be delivered and monitored by the multiprofessional team, with the PRM physician as principal coordinator.

Decision-Making in Evidence-Based Practice in Rehabilitation Medicine: Proposing a Fourth Factor.

According to the Sackett's model, evidence-based decision-making in medicine includes the clinical judgment, scientific evidence, and the patient's values and preferences. In rehabilitation medicine, it is well established that according to the International Classification of Functioning, Disability and Health model, contextual factors (environmental and personal factors) influence a person's individual level of functioning. This article argues that component of the health system (eg, health insurance coverage, availability of services, treatments, and assistive devices) and the service organization (eg, spectrum and training level of health professionals, availability of diagnostic, and treatment devices) have relevant influence on the decision-making in the individual case. For that reason, it is proposed to add the health system and service organization as a fourth factor to the model of evidence-based decision-making. Taking the influence of it into consideration and to describe it clearly will improve transparency of the decision-making process and the acceptance of health care users. This fourth factor is also relevant for other medical fields. However, the proposed factor and its components need to be discussed and further elucidated scientifically.

The State of the Field: Results from the 2014 and 2017 Pediatric Rehabilitation Medicine Practice Surveys.

Childhood disability is on the rise and there is a national shortage of pediatric physiatrists in the United States. The 2009 Pediatric Rehabilitation Medicine Practice Survey identified concerns regarding inadequate geographic dispersion of providers, salary inequities, and limited academic competitiveness and external funding for research. To describe the current state of the field of pediatric rehabilitation medicine. Survey of pediatric physiatrists in the United States in 2014 and 2017. National. Pediatric physiatrists INTERVENTIONS: Not applicable. Characteristics; clinical activities, responsibilities, and comfort; academic activities; and salaries and productivity. In both 2014 and 2017, the majority of pediatric physiatrists who responded were women (~63%) and worked at an academic teaching hospital (~68%). Pediatric physiatrists most commonly held the title of assistant professor and were overrepresented in the Midwest. Overall, 55.8% of providers felt that access was adequate in their area whereas only 3.7% felt access was adequate across the country. In 2017, 52.5% of pediatric physiatrists participated in research or other scholarly activities with 44.2% reporting having published original research at some point in their careers. The inflation adjusted mean salary in 2014 ($227 360) was not statistically different than in 2017 ($232 634, P = .422). In both years, full professors reported the highest academic full-time salaries. Individuals having at least one leadership title also reported significantly higher average full-time salaries than individuals with no titles. Although gains have been made in terms of academic competitiveness and engagement in research in pediatric physiatry, there are areas of ongoing concern including large geographic practice variations with associated access to care problems, challenges with recruiting physicians to the field, and salary malalignment within the field of PM&R.

Conceptual understanding of human being to redefine rehabilitation medicine

What is rehabilitation medicine? What is its aims and goals? These fundamental questions were rarely asked in rehabilitation medicine, although it has been practiced every day for decades. Since the practice of rehabilitation medicine affects physical, mental, and social aspect of patient at the same time, an interdisciplinary research of human being is required to understand what practitioners of rehabilitation medicine really do and should do. As a preliminary result of such research, this article focuses on philosophical understandings of human being, functioning, and disability with regard to ICF and also endeavor to establish a theoretical framework for rehabilitation medicine. Pairs of concepts defining human being, living, life in general, and their relationships with rehabilitation medicine are discussed on the basis of French philosophy of medicine from the 18th century to the present, in particular that of Pierre-Jean-Georges Cabanis (1757–1808) and Georges Canguilhem (1904–1995). From the theoretical consideration of French philosophy of medicine and rehabilitation medicine, an analogical framework between philosophical concepts and ICF is found. Furthermore, new aims and goals of rehabilitation medicine can be established under the name of ‘REHAB SMART’ (Sustaining Movement And Restorative Thinking) as shown in the following. According to the chart, living human being consists of not only functioning, but also disability. Disability should thus be understood as diversity and not as criteria of discrimination. Eventually, rehabilitation medicine should aim to recover self-identity of patient by restoring patient's neural and social network. In order to ensure more successful practice of rehabilitation medicine, it's basic concepts, underlying aims and goals should be examined with the help of philosophical understandings of patient as a holistic human being. Such broad and fundamental considerations will enforce the integrity of theory and practice in rehabilitation medicine.

Physiological basis and practice of rehabilitation medicine in the management of individuals with spinal cord injury

AbstractRehabilitation medicine has made dramatic and successful progress in recent years, and neurologists and physiatrists have faced greater challenges in coordinating the clinical management of patients with spinal cord injuries (SCI). To ensure the best clinical outcome in SCI, physiatrist need to comprehend the dysfunctions of various body systems and the physiological aspects of the central nervous, musculoskeletal and autonomic nervous system, as well as the social support system. Furthermore, the rehabilitation team, including physiatrists, nurses, physical therapists, social workers and peer supporters, should provide surgical treatment, clinical management, drug therapy and optimal assistance for SCI. We believe that the first important task in the management of SCI patients is precise diagnosis of the site of the spinal cord lesion. This should be followed as soon as possible by spinal surgery to stabilize the vertebral column. The day after surgery, the patient should be handled by the rehabilitation team. Orthostatic loads should be applied, and exercise of the remaining muscles should begin in order to ensure early mobilization and satisfactory repair. Our group has carried out extensive research into the pathophysiology of the cardiovascular, respiratory, endocrine and autonomic nervous systems and exercise responses in SCI, and reported the benefits and improvements of early mobilization and exercise, and the safety of physical medicine and rehabilitation. The rehabilitation team should follow these individuals closely to provide long‐term clinical care, and deal with social issues arising during the chronic phase. Participation in sports activities (para‐sports) could work well to improve the physical condition of these individuals.

The role of rehabilitation

In individuals with life altering diseases, palliative care allows the opportunity for patients to function with the support of trained professionals at the highest level possible until death. The goals of caring for patients with life limiting diseases can only be met by the continued efforts of many health care professionals. The entire practice of rehabilitation medicine addresses function as it relates to the disease process and the impact on the individual. Medical specialties are geared toward addressing function, modifying the disease process, as possible and treating symptoms. A palliative specialist should have a basic understanding of the scope of rehabilitation medicine and how these services can benefit the palliative patient. The review aims to define rehabilitation in the palliative patient, describe its components and services, and, by the use of two cases, help the palliative specialist in providing care.

ICF update－リハビリテーション臨床に活かすICF－

ICF update－リハビリテーション臨床に活かすICF－

Poster 547 Results from the Pediatric Rehabilitation Medicine Practice Survey

Poster 547 Results from the Pediatric Rehabilitation Medicine Practice Survey

Indwelling Catheter Related Pressure Ulcer in Groin in a Tetraplegic Patient: A Case Report

Abstract Ulcer prevention and its management has been a challenge in the practice of rehabilitation medicine and more so, with the tetraplegic subjects. We herein report a case of a 42-year-old tetraplegic male, who presented with multiple pressure ulcers and atypical grade-II ulcer in the right groin due to mismanagement of indwelling urethral catheter. Groin is extremely an unusual site for ulcer and no similar case has been previously reported with an ulcer in the groin in a spinal cord injury (SCI) patients. This case highlights the importance of proper positioning of indwelling urethral catheter, its care, and prevention of medical devices related (iatrogenic) complications in patients undergoing treatment.

Factors associated with patient selection for inpatient rehabilitation: an audit of decision-making in the rehabilitation assessment

Factors associated with patient selection for inpatient rehabilitation: an audit of decision-making in the rehabilitation assessment Joanne Lim,1 Leonid Churilov,2 Penelope Smith,1 Irina Churilov1 1Rehabilitation Unit, St Vincent's Health, Fitzroy, Victoria, Australia; 2Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia Background: Assessment of patients for their potential to participate and benefit from inpatient rehabilitation forms an integral component of the practice of rehabilitation medicine. There is limited information in the current literature to guide or standardize the decision-making in rehabilitation assessment. Setting: Inpatient rehabilitation unit within a major tertiary public hospital in metropolitan Melbourne, Australia. Objective: To determine which information routinely collected during the rehabilitation assessment is associated with the likelihood of a patient being accepted for inpatient rehabilitation. Design: A retrospective audit of consecutive rehabilitation assessments carried out over a 4-month period. Methods: Multivariable association between patient clinical and demographic characteristics and the likelihood of being accepted for inpatient rehabilitation was assessed for 219 acute inpatients referred to the inpatient rehabilitation unit. Results: Of the 219 patients, 74.9% were accepted for inpatient rehabilitation. There were statistically significant deficits in cognition, continence, personal care, and mobility at the time of patients' assessment for inpatient rehabilitation. Patients' premorbid level of independence with personal activities of daily living (PADLs) (P = 0.006) and continence (P = 0.04), as well as "at the time of assessment" need for assistance with PADLs (P < 0.001), mobility (P = 0.004), incontinence (P = 0.01), and impaired cognition (P < 0.001), were associated with the likelihood of being accepted for inpatient rehabilitation. Conclusion: Premorbid dependence with PADLs and current impaired cognition as well as incontinence reduce the likelihood of patient selection, while present dependence with PADLs and mobility increase the likelihood of patient admission. Our findings provide researchers, clinicians, and health managers with empirical evidence regarding the process of patient selection for inpatient rehabilitation. Keywords: rehabilitation, disability evaluation, rehabilitation centers, medical decision-making

Hypokalaemic Periodic Paralysis Associated with Hypothyroidism

Abstract Periodic paralysis is also seen as one of the uncommon cause of quadriplegia in the physical and rehabilitation medicine practice. There have been anecdotal reports of periodic paralysis associated with hypothyroidism. However, there is no clear cut evidence of hypothyroidism causing hypokalaemia leading to periodic paralysis or vice versa. This case report highlights the importance of keeping periodic paralysis as an important cause of the recurrent paralytic attack, importance of serum potassium and thyroid function tests and recovery pattern without active physical therapy intervention which may actually aggravate the disease process. Its occurrence in a young male patient is also a rare phenomenon.

How Item Banks and Their Application Can Influence Measurement Practice in Rehabilitation Medicine: A PROMIS Fatigue Item Bank Example

Lai J-S, Cella D, Choi S, Junghaenel DU, Christodoulou C, Gershon R, Stone A. How item banks and their application can influence measurement practice in rehabilitation medicine: a PROMIS fatigue item bank example. Objective To illustrate how measurement practices can be advanced by using as an example the fatigue item bank (FIB) and its applications (short forms and computerized adaptive testing [CAT]) that were developed through the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. Design Psychometric analysis of data collected by an Internet survey company using item response theory–related techniques. Setting A U.S. general population representative sample collected through the Internet. Participants Respondents used for dimensionality evaluation of the PROMIS FIB (N=603) and item calibrations (N=14,931). Interventions Not applicable. Main Outcome Measures Fatigue items (112) developed by the PROMIS fatigue domain working group, 13-item Functional Assessment of Chronic Illness Therapy-Fatigue, and 4-item Medical Outcomes Study 36-Item Short Form Health Survey Vitality scale. Results The PROMIS FIB version 1, which consists of 95 items, showed acceptable psychometric properties. CAT showed consistently better precision than short forms. However, all 3 short forms showed good precision for most participants in that more than 95% of the sample could be measured precisely with reliability greater than 0.9. Conclusions Measurement practice can be advanced by using a psychometrically sound measurement tool and its applications. This example shows that CAT and short forms derived from the PROMIS FIB can reliably estimate fatigue reported by the U.S. general population. Evaluation in clinical populations is warranted before the item bank can be used for clinical trials.

Forty years History of Physical Medicine and Rehabilitation in Iran

J Rehabil Med 43 © 2011 The Authors. doi: 10.2340/16501977-0785 Journal Compilation © 2011 Foundation of Rehabilitation Information. ISSN 1650-1977 While physical modalities and therapeutic exercise have been used traditionally in Persian medicine, some rehabilitation issues have also been discussed, in particular, in The Canon of Medicine by Avicenna (980–1037). For example, the recommendation of long-term exercise for weak limbs (1), the benefits of moderate-intensity exercise, and his concept of pain (2). Modern rehabilitation medicine practice in Iran dates back to 1951 with the participation of physicians in the military and public health systems (3). Physical medicine and rehabilitation (PM&R) was introduced into the academic health system with the education of medical students in Shiraz University in 1967 (4) and Tehran University in 1971 by physiatrists who supported the education of medical students in this field. Soon afterwards, Shafa Yahiaian Rehabilitation Hospital was set up in Tehran and quickly became well-known internationally as an outstanding inpatient and outpatient rehabilitation centre. The Iranian Society of PM&R was established in 1973. After the Iranian revolution Shiraz University of Medical Sciences became the pioneering participant in education. In 1979, just at the start of the Iran–Iraq war, the first residency training was set up (3). The Iranian Board of PM&R was established in 1982. Residency programmes were subsequently established in other areas, mainly by graduates of this department, and now include seven departments, training approximately 20 residents annually through a 3-year programme after medical school and the fulfilment of 2 years’ general practice. PM&R residency positions are now among the most highly competitive positions. A 1-month elective programme for medical interns at Shiraz and Tabriz University and short courses in other universities have increased the popularity of this field with young physicians. In private practice, PM&R wards have been set up in the most reputed hospitals and have a substantial role in the introduction of PM&R into the healthcare system. Fewer than 250 physiatrists are currently practising in Iran, which has a population of 70 million. However, this specialty is growing rapidly in different fields.

THE APPLICATIONS OF INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) BY WORLD HEALTH ORGANIZATION(WHO) IN REHABILITATION MEDICINE PRACTICE

Context: Rehabilitation Medicine is dedicated to optimise patients function and health in the most comprehensive manner. ICF, the latest International Classification by World Health Organization (WHO) is a conceptual framework for the assessment of functioning, disability and health. The purpose of this paper is to describe the applications of ICF in Rehabilitation Medicine practice in the Medical Rehabilitation Unit, University of Malaya Medical Centre (UMMC), Kuala Lumpur. Issues: ICFconsists of body function, structure, activity, participation and environmental factor. ICF categories are exhaustive, but are not practical to be used entirely and not applicable in clinical practice on theirown. How is ICF used from the clinical perspective' It has to be dapted to make it usable. In Rehabilitation Medicine settings, the following are ways ICF is applied in clinical practice: research in terms of validating the use of available ICF Core Sets and development of new ICF Core Set; clinical practice based on the ICF-based sheet; and educational tools. Conclusion: The practice of Rehabilitation Medicine is in line and compatible with the concept of ICF and can serve as a new important language that can improve the practice of Rehabilitation Medicine. It can be a universal language in functioning, disability and health and can improve understanding in addressing issues on disability within the medical community, improve multi professionals' communication among patients, healthcare providers and stakeholders.

Cardiopulmonary Rehabilitation and Cancer Rehabilitation. 1. Cardiac Rehabilitation Review

Bartels MN, Whiteson JH, Alba AS, Kim H. Cardiopulmonary rehabilitation and cancer rehabilitation. 1. Cardiac rehabilitation review. Cardiac rehabilitation includes not only the rehabilitation of people with ischemic heart disease but also those with congestive heart failure, heart transplantation, congenital heart disease, and other conditions. New advances in medical treatment have arisen, and there are new approaches in treatment, including alternative medicine and complementary care. New surgical approaches that help restore cardiac function have also been introduced, and rehabilitation professionals must be aware of these advances and be able to incorporate this knowledge into the practice of rehabilitation medicine. Overall Article Objectives (a) To identify major categories of cardiac disease, (b) to elucidate appropriate interventions and support for patients with coronary artery disease, (c) to describe the new interventions available for the treatment of cardiac disease, and (d) to describe the appropriate role of cardiac rehabilitation for people with various forms of cardiac disease.

Cardiopulmonary Rehabilitation and Cancer Rehabilitation. 2. Pulmonary Rehabilitation Review

Alba AS, Kim H, Whiteson JH, Bartels MN. Cardiopulmonary rehabilitation and cancer rehabilitation. 2. Pulmonary rehabilitation review. Pulmonary rehabilitation includes the rehabilitation of not only patients with respiratory failure in need of ventilatory support but also patients with primary pulmonary disease. New advances in medical management now offer treatment to patients with end-stage emphysema, pulmonary hypertension, and interstitial disease, and the principles of rehabilitation can add both function and quality to the lives of these patients. New surgical approaches and better transplantation outcomes that restore pulmonary function have also been introduced. Rehabilitation professionals need to be aware of these advances and be able to incorporate this knowledge into the practice of rehabilitation medicine. Overall Article Objectives (a) To identify major categories of pulmonary disease seen in pulmonary rehabilitation, (b) to know appropriate interventions and support for patients with respiratory failure, (c) to describe the new interventions available for end-stage lung disease, and (d) to describe the appropriate pulmonary rehabilitation for people with pulmonary disease.