Rehabilitation Consultation Research Articles

Perspective of Health Care Professionals and Cancer Survivors on the Usage of Technology in Consultations.

This study explored the integration of technology in healthcare consultations between healthcare professionals (HCPs) and cancer survivors. The research aimed to understand how technological tools influence the dynamics and environment of cancer survivor rehabilitation consultations. The study used Actor-Network Theory (ANT) to analyze the effects of new technological actors in consultations and Invisible Work Theory to uncover hidden workflows associated with technology implementation. The study combined observations and in-depth interviews with HCPs and cancer survivors conducted in March to May 2022, and a follow-up group interview in November 2023. The study revealed that technology's presence notably impacts the relationship between HCPs and cancer survivors, with HCPs expressing concerns that technology disrupts the consultation and challenges the relation. Over time, HCPs gradually began to use laptops during consultations to varying degrees, although the resistance to fully embracing technology persisted. This resistance is attributed to perceived pressure from management and a mismatch with established practices. The findings address the challenges in digital literacy and confidence among HCPs to facilitate the effective incorporation of technology and enhance the patient-clinician relationship. This research contributes to a deeper understanding of the interplay between digital health tools and patient-clinician relationships, highlighting the complexities and opportunities in digitizing healthcare consultations.

Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio

IntroductionTo assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methodsA multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. ResultsThe experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. ConclusionsIn patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.

Efficacy of the Rehabilitation Planning Consult for Survivors of Head and Neck Cancer: A Phase 2 Randomized Controlled Trial

Survivors of head and neck cancer may have significant lasting impairments and poor access to rehabilitation. To address this, our group developed and evaluated a rehabilitation planning consult (RPC). The RPC is conducted through an initial consultation and a single follow-up session with a rehabilitation professional. During the initial consultation, rehabilitation needs are determined and the survivor sets individualized goals and plans. They then implement their plans independently and are facilitated to evaluate and modify plans as necessary during the follow-up session. We used a waitlist control design to compare the proportion of participants attaining a minimally importantly different change in quality of life (QOL) on the Short Form 36 Physical Health Summary Score from baseline to 3 months after study enrollment, between patients randomized to receive (n=77) or wait 14 ± 3 weeks to receive (n=76) the RPC. Additional outcomes included goal attainment indicators measured using the Brief Rehabilitation Assessment for Survivors of Head and Neck Cancer (BRASH). Of 153 participants recruited, 95 (62%) completed the intervention; 57 were in the immediate (RPC) group and 38 were in the waiting list control (WLC) group. No significant between-group differences were seen in the proportion of patients achieving a minimally important improvement (2.5 units) on the Physical Health Summary Score from baseline to 3 months after recruitment. No between-group differences were seen on any secondary QOL indicators. Among the 67 (RPC n=42, WLC n=22) participants who set individualized rehabilitation goals, BRASH scores on goal performance and satisfaction with goal performance were significantly better in the RPC group. Our results suggest that the RPC may provide benefit in patients' individualized domains of choice among those who set goals, without affecting overall QOL. Future work could refine the subset of patients who benefit and explore the optimal timing and intensity of the intervention.

CLINICAL AND HEALTHCARE IMPACTS OF PORTABLE ULTRASONOGRAPHY IN AMBULATORY CARE MUSCULOSKELETAL REHABILITATION CONSULTATIONS.

We evaluated the impact of Point-of-care ultrasound (POCUS) in musculoskeletal consultations out of hospital using a Philips Lumify portable ultrasound device. We aimed to determine the impact of POCUS on the number of hospital referrals for injections as well as on the number of injections performed in consultation. Retrospective case study comparing 2 periods: June to September 2021 (pre-POCUS) and November 2021 to February 2022 (POCUS). Statistical comparisons were performed using the χ2. In both periods, 21 medical consultations were performed. In the pre-POCUS period, 470 patients were assessed, with an average of 1.29 hospital referrals made per day of consultation for hospital injections and an average of 2.05 injections performed per day of medical consultation. In the POCUS period, 589 patients were assessed, with an average of 0.1 hospital referrals per day (-92.6%; p < 0.00001) and an average of 2.76 injections performed per day (+34.9%; p < 0.00001). The introduction of POCUS at our practice reduced the number of hospital referrals made for injections and increased the number of injections performed every day of consultation. This suggests that POCUS is of great clinical value in out-of-hospital musculoskeletal rehabilitation consultations.

Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality.

In neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). The main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. In total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. The teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. Our results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers' burden distress management, mitigating distress and promoting positive aspects of caring. ClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT03709875.

The use of telephone and video consultations in upper limb musculoskeletal rehabilitation: A scoping review.

In 2020, the COVID-19 pandemic caused a rapid uptake of virtual consultations (VCs) to minimise disease transmission and for this reason, research into telerehabilitation has been expanding. This review aimed to map and synthesize evidence on the use of VCs in upper limb musculoskeletal rehabilitation, describe key characteristics, and identify gaps in the research. This scoping review investigated synchronous rehabilitation consultations performed over VC. All asynchronous, wearable or pre-recorded technology was excluded. CINAHL Complete, Medline, PEDro, Google Scholar and grey literature sources were searched. Screening and data extraction were done by a single researcher. Frequency counts were used to analyse the data. Nineteen studies were identified, with patients with shoulder injury/pain most frequently studied. Most sources (n = 9) used bespoke video programmes. Range of motion (ROM) was the most common assessment (n = 10) and exercise prescription (n = 7) was the most common treatment. Benefits included time and cost savings, maintaining therapeutic relationships and increasing patient independence. Most diagnostic assessments, except joint and nerve tension tests, were found to be reliable and valid. Studies noted increased function in activities, decreased pain and increased ROM after VCs. Limitations included restricted 'hands-on' treatment, resource and training concerns and limiting patient factors. This review mapped available evidence and identified several gaps in the literature. Further robust research into VCs for hand/wrist disorders, ROM assessment and cost-effectiveness is needed.

Effectiveness of a Telerehabilitation Evidence-Based Tablet App for Rehabilitation in Traumatic Bone and Soft Tissue Injuries of the Hand, Wrist, and Fingers

ObjectiveTo assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services. DesignA multicenter assessor-blinded, parallel, 2-group controlled trial. SettingTrauma and rehabilitation services of 4 hospitals. ParticipantsSix hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663). InterventionsThe experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper. Main Outcome MeasuresThe primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments). ResultsThe experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η2=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=−1.64; 95% confidence interval, −2.64 to −0.65) and physiotherapy sessions (mean difference=−8.52, 95% confidence interval, −16.92 to −0.65) compared to the control group. ConclusionsIn patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients’ functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.

Effect of three tongue needles acupoints Lianquan (CV23) and Hegu (LI4) combined with swallowing training on the quality of life of laryngeal cancer patients with dysphagia after surgery.

To evaluate the effect of acupuncture therapies administered in combination with swallowing training on the quality of life of laryngeal cancer patients with dysphagia after surgery. Seventy-one postoperative patients with laryngeal cancer participated in this study. The patients diagnosed with swallowing dysfunction by video fluoroscopic swallowing examination (VFSE) were randomly divided into experimental group (n = 36) and control group (n = 35). Patients in both groups were provided swallowing training and rehabilitation consultation. Patients in the experimental group were additionally provided with acupuncture therapies. All patients were evaluated using VFSE and MD Anderson dysphagia inventory (MDADI) and Quality of Life Questionnaire-core 30 (QLQ-c30) score immediately after surgery and three months later. The effective rate of 97.1% (n = 35) and the complete remission rate of 36.1% (n = 13) in the experimental group were higher than those in the control group of 60% (n = 21) and 14.3% (n = 5) (P < 0.01). The scores of VFSE, MDADI and QLQ-c 30 in the experimental group and the control group at three months after therapies were significantly improved compared with those before therapies (P < 0.05). The scores of VFSE, MDADI and QLQ-c30 in the experimental group at three months after therapies were significantly improved compared with the control group. The improvement in the intervention group was significantly better than that in the control group. There were no adverse reactions in two groups. Acupuncture therapies combined with swallowing training can improve the swallowing function and the quality of life of laryngeal cancer patients with dysphagia after surgery.

Perceptions of pelvic floor dysfunction and rehabilitation care amongst women in southeast China after radical hysterectomy: a qualitative study

ObjectiveTo investigate the perceptions of pelvic floor dysfunction (PFD) and rehabilitation care amongst women after radical hysterectomy and to explore ways to improve quality of care.MethodsThirty-six women who underwent radical hysterectomy at a hospital in southeast China were enrolled via purposive sampling. Semi-structured in-depth interviews were conducted. The texts were analysed via qualitative content analysis.ResultsFour themes were obtained: serious lack of knowledge, heavy psychological burden, different coping strategies and great eagerness to receive multiparty support on PFD rehabilitation care.ConclusionThe society and professional staff should strengthen health education on PFD. Professionals should offer education before and after surgery and actively provide rehabilitation consultation to promote the availability of rehabilitation to support women with PFD rehabilitation care. In addition, family-centred care is an important way to support women to return to normal life, and women's need for family support should be more actively expressed. Moreover, knowledge of medical insurance should be popularised, especially in rural areas in China.

The impact of physical medicine and rehabilitation consultation on clinical outcomes in the surgical intensive care unit: A prospective observational cohort study.

The impact of a physical medicine and rehabilitation (PM&R) consultation on clinical outcomes in critically ill surgical patients remains unclear. The aim of this study is to examine whether the patients who received PM&R consultation will demonstrate better clinical outcomes in terms of the differences in clinical outcomes including muscle mass and strength, intensive care unit (ICU) length of stay (LOS) and functional outcomes between the PM&R consultation and no PM&R consultation and between early PM&R consultation and late PM&R consultation in critically ill surgical patients.A prospective observational cohort study was undergone in 65-year-old or older patients who were admitted > 24 hours in the surgical intensive care unit (SICU) in a tertiary care hospital. Data collection included patients’ characteristic, muscle mass and muscle strength, and clinical outcomes.Ninety surgical patients were enrolled and PM&R was consulted in 37 patients (36.7%). There was no significant difference in muscle mass and function between consulted and no consulted groups. PM&R consulted group showed worse in clinical outcomes including functional outcomes at hospital discharge, longer duration of mechanical ventilation, ICU, and hospital LOS as compared with no PM&R consulted group. The median time of rehabilitation consultation was 6 days and there were no significant differences in clinical outcomes between early (≤ 6 days) and late (> 6 days) consultation.PM&R consultation did not improve muscle mass, functional outcomes at hospital discharge, and ICU LOS in critically ill surgical patients. The key to success might include the PM&R consultation with both intensified physical therapy and early start of mobilization or the rigid mobilization protocol.

The role of Rehabilitation in pediatric amputation – A 10-year retrospective study in a Portuguese population

Introduction: Limb amputation in pediatric population, whether congenital or acquired, has a set of attributes that require a different medical approach and rehabilitation management. Objectives: To characterize the pediatric population referred to the Amputee Rehabilitation consultation and evaluate amputation type and segment relationship with prosthesis usage. Material and methods: We conducted a retrospective study based on the clinical information from patients referred to the Pediatric Rehabilitation consultation between January 2011 and March 2021. The variables analyzed included gender, type, and etiology of amputation, amputation level, age of prosthesis, time to the first prosthesis, pre-prosthetic training, number of components prescribed, waiting time per component, and prosthesis use. Results: The study included 50 patients, 68% of congenital etiology. Within the group of acquired amputations, 62.5% had neoplastic causes. The initial use of a prosthesis occurred in 91.7% of the population with upper limb amputations. However, the final adhesion of the upper limb prosthesis was only 50%. There was a statistically significant dependence and a moderate association between the amputated segment and the final use of the prosthesis. The abandonment risk of upper limb prosthesis was seven times higher than lower limb prosthesis. The remaining variables did not demonstrate any other type of significant association. Conclusion: In pediatric age, congenital amputations are more frequent than acquired causes. However, contrary to other data, malignancy was the most frequent etiology in this study within acquired amputations. Regardless of the type of amputation, the use of a prosthesis is related to the affected segment. The abandonment risk of upper limb prostheses is significant, given the development of compensatory strategies that allow the functional use of the limb. Physical and Rehabilitation Medicine plays an essential role in the assessment and management of pediatric amputation. Prescribing at the right time, carrying out an adequate program, with the child and family, is the key to their functional independence.

One-year care pathway after acute myocardial infarction in 2018: Prescription, medical care and medication adherence, using a French health insurance reimbursement database

Myocardial infarction is a major cause of morbidity and mortality. Guidelines have been published to optimize medical care and involve optimization of the care pathway and hospital-city coordination. To describe the myocardial infarction care pathway during the year following hospital discharge, and the use of and adherence to secondary prevention drugs. A cohort study was conducted using data from the main French health insurance reimbursement database of the ex-Aquitaine region. Information about the medical and pharmaceutical care of hospitalized patients in 2018 was collected for 12 months. Medication adherence was assessed by using the proportion of days covered by the treatment and persistence. A total of 3015 patients were included, and the mean age was 66 years. Almost 76% of the patients had a reimbursement for BAS (combined prescription of beta-blocker/antiplatelet/lipid-lowering drug), BASI (combined prescription of beta-blocker/antiplatelet/lipid-lowering drug/angiotensin-converting enzyme inhibitor) or AS (combined prescription of antiplatelet/lipid-lowering drug) treatment. Medication adherence was around 83% for aspirin and 75% for lipid-lowering drugs for the 1-year persistence. During the same time, the proportion of days coveredwas suboptimal. Almost 4% of patients died after leaving hospital, 45% went to a cardiac rehabilitation centre and 23% had at least one hospital readmission, whatever the reason. Patients had a mean number of 11 general practitioner consultations during the year. Almost 41% of patients did not have a consultation with a cardiologist, and 38.4% had at least two consultations. Rehabilitation and general practitioner consultations were associated with adherence. These new results provide clear information on the medical care environment of patients, and help us to improve care transition. Close collaboration between healthcare practitioners is very important in the early stages of outpatient follow-up.

Needs assessment in patients surgically treated for head and neck cancer-a randomized controlled trial.

To investigate the effect and feasibility of a head and neck cancer-specific needs assessment tool integrated into nursing rehabilitation consultations early in the post-surgical period on quality of life, symptom burden, and referrals for multidisciplinary follow-up. Ninety-two surgically treated patients with head and neck cancer were enrolled in a two-arm randomized controlled trial. All participants received nursing rehabilitation consultations prior to discharge, and two weeks andtwomonths post-operative. The intervention group had their needs assessed using Patient Concerns Inventory, while standard care used a systematic questioning approach. Primary outcome was quality of life. Secondary outcomes were symptom burden and referrals for multidisciplinary rehabilitation follow-up. No significant differences were found in quality of life or symptom burden between groups. However, 35% more patients in the intervention group were referred for rehabilitation. The attrition rate was similar in both groups, with a dropout rate of six in each group. No patients declined using the Patient Concerns Inventory. The intervention showed no improvement in QoL or symptom burden compared to standard care. However, the results suggest that important needs were identified and addressed. Especially emotional and existential needs, which were accommodated through referrals and professional advice. Nursing rehabilitation consultations using the Patient Concerns Inventory are feasible and may ensure that patient preferences and priorities are incorporated in their care. ClinicalTrials.com (NCT03443258). Date of registration: May 31st, 2018.

The nurse-patient interaction during rehabilitation consultations in patients surgically treated for head and neck cancer– a qualitative study

Patients treated surgically for head and neck cancer may experience detrimental early and late effects of their treatment and are in need of rehabilitation post treatment to alleviate symptoms and effects. This study aimed to explore nurse-patient interactions during rehabilitation consultations assessing needs of patients in order to understand how nurses and patients experienced the consultation, the extent to which patients experienced being involved in the needs assessment and how patients experienced the information delivered.Findings in this study drew on three data sources: 15 observations of nurse-patient interactions during rehabilitation consultations; 15 individual patient interviews and a focus group interview with nurses. Observations and individual patient interviews took place at three different time points during the patient trajectory. The method and analysis applied Interpretive Description and Systematic Text Condensation. Analysis was performed across all three data sources and three time points.Four interrelated themes were identified, showing that conducting rehabilitation nursing consultations and actively involving patients is a complex process. The themes revealed the complexity: expectations for nurse-patient interaction differ; challenges of building rapport; barriers to adequately identifying rehabilitation needs; and factors inhibiting communication of advice and recommendations. Uncovering emotional needs were especially challenging. Patient further experienced an information overload, especially just prior to discharge.Nurse-patient interaction in the rehabilitation consultation is complex and involves many different interrelated aspects that require the nurse to have the necessary interpersonal and professional skills to support the patient to enhance their involvement in the encounter.

Physical Medicine and Rehabilitation Consultation for Stroke Patients in Acute Care Setting May Be Associated With an Increased Rate of Discharge to the Community From the Inpatient Rehabilitation Facility.

The aim of the study was to determine whether stroke patients who receive physical medicine and rehabilitation consultation in acute care setting are more likely to discharge from inpatient rehabilitation facility to a community setting compared with those who do not. This was a retrospective analysis of consecutive patients admitted with stroke to inpatient rehabilitation facility between June and October 2018. The primary outcome measure was discharge disposition. Other variables measured included functional independence measures and length of stay. Analysis of baseline covariates was conducted with t tests and analysis of primary outcome measured with Fisher exact test. We identified 184 consecutive patients, with 62 (33.7%) having and 122 (66.3%) not having a physical medicine and rehabilitation consult; 35 (56.5%) patients versus 51 (41.8%) in physical medicine and rehabilitation consult versus non-physical medicine and rehabilitation group were discharged home (P = 0.042). Between both groups, there were no differences in baseline admission/discharge cognitive or motor functional independence measure scores, total admission/discharge functional independence measure scores, functional independence measure efficiency, or length of stay. However, in both the groups, admission versus discharge overall functional independence measure scores were significantly improved, 71.34 vs. 94.76 and 66.52 vs. 89.94 (P < 0.0001). Despite no difference in baseline functional scores or length of stay, physical medicine and rehabilitation consultation of poststroke patients in hospital may be associated with discharge home after inpatient rehabilitation facility.

Motor Dysfunction in REM Sleep Behavior Disorder: A Rehabilitation Framework for Prodromal Synucleinopathy

Parkinson disease (PD) and other related diseases with α-synuclein pathology are associated with a long prodromal or preclinical stage of disease. Predictive models based on diagnosis of idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) make it possible to identify people in the prodromal stage of synucleinopathy who have a high probability of future disease and provide an opportunity to implement neuroprotective therapies. However, rehabilitation providers may be unaware of iRBD and the motor abnormalities that indicate early motor system dysfunction related to α-synuclein pathology. Furthermore, there is no existing rehabilitation framework to guide early interventions for people with iRBD. The purpose of this work is to (1) review extrapyramidal signs of motor system dysfunction in people with iRBD and (2) propose a framework for early protective or preventive therapies in prodromal synucleinopathy using iRBD as a predictive marker. Longitudinal and cross-sectional studies indicate that the earliest emerging motor deficits in iRBD are bradykinesia, deficits performing activities of daily living, and abnormalities in speech, gait, and posture. These deficits may emerge up to 12 years before a diagnosis of synucleinopathy. The proposed rehabilitation framework for iRBD includes early exercise-based interventions of aerobic exercise, progressive resistance training, and multimodal exercise with rehabilitation consultations to address exercise prescription, progression, and monitoring. This rehabilitation framework may be used to implement neuroprotective, multidisciplinary, and proactive clinical care in people with a high likelihood of conversion to PD, dementia with Lewy bodies, or multiple systems atrophy.

Determination of the vertical dimension occlusion – case report

Introduction Despite the improvement in oral health care, tooth loss, for reasons associated with caries or periodontal disease, continues to be a reality in our population [1]. The planning of a total or a partial dental prosthesis is the key for the creation of a harmonious and natural relationship between the prosthetic structures, the tissues and the face, combining functional rehabilitation with aesthetics. The correct Vertical Dimension of Occlusion (VDO) is a key aspect in oral Rehabilitation [2]. Materials and methods A 49-year-old female patient attended the Oral Rehabilitation consultation with complaints about the aesthetic viability of her partial upper prosthesis with decreased VDO, which she had been using for about 20 years. The patient was advised to make a new prosthesis, not only to improve the aesthetics but also to increase the VDO to restore harmony at the soft tissue level. Clinically we started the usual protocoled oral rehabilitation procedure: 1. Clinical History, Preliminary Impressions, Profile teleradiography with the old prosthesis; 2. Definitive Impressions; 3. Intermaxillary recording, VDO recording using the Willis method; 4. Wax try in with phonetic and aesthetic test; cephalometric analysis; 5. Prosthesis delivery; Results Our main objective was to measure and to establish a functional and ideal VDO. Considering the Wills Method, the 2/3 anterior facial height (AFH) was 67 mm, the patient prosthesis was 60 mm and the wax try in was 67 mm. In terms of cephalometry the angles related to VDO were lower compared the wax in and with the mean values in the prosthesis (i.e. Jaraback Analysis – Anterior Facial Height − 102° prosthesis 117°, wax in and mean value of 113°). We were able to safely assure the VDO not only from a soft tissue point of view, as well as phonetically, aesthetically and with cephalometry. Discussion and conclusions The establishment of a correct VDO using different methods is crucial in the construction of the dental prosthesis, allowing a stable, comfortable and functional rehabilitation for the patient [1]. The Willis method, soft tissue and phonetics analysis, as well as cephalometric analysis, obtained good clinical results, similar to those achieved by other authors [1–3]. Orthlieb et al. [3] also confirmed that cephalometric measurements are important references in the measurement of VDO in partial and total edentulous patients. Total / Partial prosthesis continue to be a valid solution for the rehabilitation of partial edentulous patient both functionally as aesthetically. It is possible to determine the VDO, in a simple and scientifically correct manner, using if possible, a combination of the available techniques, in a partially edentulous patient.

Targeted rehabilitation may improve patient flow and outcomes: development and implementation of a novel Proactive Rehabilitation Screening (PReS) service

Rehabilitation programmes can be delivered to patients receiving acute care (‘in-reach rehabilitation’) and/or those who have completed acute care but experience ongoing functional impairments (‘subacute rehabilitation’). Access to these programmes...

Assessing unmet rehabilitation needs and the feasibility of a telehealth rehabilitation consultation service for road trauma survivors recently discharged from hospital

Purpose Persistent activity limitations are common among road trauma survivors, yet access to rehabilitation in hospital and in the community remains variable. This study aimed to identify unmet rehabilitation needs following road trauma and assess the feasibility of a novel rehabilitation consultation service delivered via telehealth following hospitalization. Methods A pilot cohort study was conducted with survivors of road trauma who were hospitalized but did not receive formal inpatient rehabilitation. All participants received a multidisciplinary rehabilitation consultation via telehealth 1–3 weeks post-discharge, to assess rehabilitation needs and initiate treatment referrals as required. Functional and qualitative outcomes were assessed at baseline (1–7 days); one month and three months post-discharge. Results 38 participants were enrolled. All (100%) reported functional limitations at baseline; 86.5% were found to have unmet rehabilitation needs, and 75.7% were recommended rehabilitation interventions. Functional ability improved over time, but more than half the cohort continued to report activity limitations (67.6%), pain (64.7%) and/or altered mood (41.2%) for up to three months. Participants found the telehealth service to be acceptable, convenient, and helpful for recovery. Conclusions A high proportion of mild-moderate trauma survivors report unmet rehabilitation needs following hospital discharge. Telehealth appears to be a feasible, convenient and acceptable mode of assessing these needs. Implications for rehabilitation Survivors of road-related injuries often experience ongoing impairments and activity limitations. Among those who don’t receive rehabilitation in hospital, we found a high proportion (86.5%) had unmet rehabilitation needs after discharge. A telehealth rehabilitation service was feasible to deliver and could successfully identify unmet rehabilitation needs. The piloted telehealth intervention was viewed as acceptable, convenient and beneficial by patients.

COVID-19 Pandemic: Ethical and Medical issues arising for people with disability in Bangladesh

The disability viewpoint is the fundamental for understanding social justice in a given population. Disability rights need to be obeyed in the inclusive preparedness and response to all the disasters or during the crisis period including COVID-19 pandemic. COVID-19 pandemic jeopardized the health and rehabilitation services globally. The impact is much more in low resource developing countries like Bangladesh. In general, people with disability (PWD) suffer from multiple medical and rehabilitation complications and they need frequent rehabilitation consultations or hospital admissions in comparison to people without disability. As a developing country, Bangladesh has poor ratios of doctors, nurses and technologists of 1:0.4:0.24 (WHO: 1:3:5) to face the COVID-19 challenge. Rehabilitation services have been disrupted in almost two-thirds (63%) of countries of the world. Even though rehabilitation is the key to recovery following severe illness from COVID-19. There are many concerns and debates about the preparedness, response and mitigation the process of COVID-19 on the part of the national government. According to recent study reports, the lives of about 100% of PWD have been impacted by the COVID-19 pandemic. COVID-19 National Technical Advisory Committee is working for strategic planning, response and mitigation process but omission of a representative of PWD or a rehabilitation physician in the committee has created much dissatisfaction. The difficult COVID-19 testing process due to country wide shutdown of rehabilitation essential services and central pulling of rehabilitation physicians have side lined the PWD inclusiveness. It is expected that the rehabilitation preparedness, response and mitigation of the pandemic should be based on an ethics driven process.