Rehabilitation Experts Research Articles

Practice Recommendations for Early Mobilization in Critically Ill Children.

Prolonged immobility is associated with significant short- and long-term morbidities in critically ill adults and children. The majority of critically ill children remain immobilized while in the pediatric intensive care unit (PICU) due to limited awareness of associated morbidities, lack of comfort and knowledge on how to mobilize critically ill children, and the lack of pediatric-specific practice guidelines. The objective of this article was to develop consensus practice recommendations for safe, early mobilization (EM) in critically ill children. A group of 10 multidisciplinary experts with clinical and methodological expertise in physical rehabilitation, EM, and pediatric critical care collaborated to develop these recommendations. First, a systematic review was conducted to evaluate existing evidence on EM in children. Using an iterative process, the working document was circulated electronically to panel members until the group reached consensus. The group agreed that the overall goals of mobilization are to reduce PICU morbidities and optimize recovery. EM should therefore not be instituted in isolation but as part of a rehabilitation care bundle. Mobilization should not be delayed, but its appropriateness and safety should be assessed early. Increasing levels of physical activity should be individualized for each patient with the goal of achieving the highest level of functional mobility that is developmentally appropriate, for increasing durations, daily. We developed a system-based set of clinical safety criteria and a checklist to ensure the safety of mobilization in critically ill children. Although there is a paucity of pediatric evidence on the efficacy of EM, there is ample evidence that prolonged bed rest is harmful and should be avoided. These EM practice recommendations were developed to educate clinicians, encourage safe practices, reduce PICU-acquired morbidities, until future pediatric research provides evidence on effective rehabilitation interventions and how best to implement these in critically ill children.

The Role of Faith in Work, Religious Beliefs, and Spirituality in the Prediction of Job Satisfaction Among Rehabilitation Experts

The Role of Faith in Work, Religious Beliefs, and Spirituality in the Prediction of Job Satisfaction Among Rehabilitation Experts

Understanding and Treating Pain Syndromes in Parkinson's Disease.

Pain affects many people with Parkinson's disease (PD) and diminishes their quality of life. Different types of pain have been described, but their related pathophysiological mechanisms remain unclear. The aim of this chapter is to provide movement disorders specialists an update about the pathophysiology of pain and a practical guide for the management of pain syndromes in clinical practice. This chapter reviews current knowledge on the pathophysiological mechanisms of sensory changes and pain in PD, as well as assessment and treatment procedures to manage these symptoms. In summary, changes in peripheral and central pain processing have been demonstrated in PD patients. A decrease in pain threshold and tolerance to several stimuli, a reduced nociceptive withdrawal reflex, a reduced pain threshold, and abnormal pain-induced activation in cortical pain-related areas have been reported. There is no direct association between improvement of motor symptoms and sensory/pain changes, suggesting that motor and nonmotor symptoms do not inevitably share the same mechanisms. Special care in pain assessment in PD is warranted by the specific pathophysiological aspects and the complexity of motor and nonmotor symptoms associated with pain symptoms. Rehabilitation may represent a valid option to manage pain syndromes in PD. However, further research in this field is needed. An integrated approach to pain involving a multidisciplinary team of medical specialists and rehabilitation experts should allow a comprehensive approach to pain in PD.

Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gym.

Affordable technology-assisted stroke rehabilitation approaches can improve access to rehabilitation for low-resource environments characterized by the limited availability of rehabilitation experts and poor rehabilitation infrastructure. This paper describes the evolution of an approach to the implementation of affordable, technology-assisted stroke rehabilitation which relies on low-cost mechatronic/robot devices integrated with off-the-shelf or custom games. Important lessons learned from the evolution and use of Theradrive in the USA and in Mexico are briefly described. We present how a stronger and more compact version of the Theradrive is leveraged in the development of a new low-cost, all-in-one robot gym with four exercise stations for upper and lower limb therapy called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S). Three of the exercise stations are designed to accommodate versions of the 1 DOF haptic Theradrive with different custom handles or off-the-shelf commercial motion machine. The fourth station leverages a unique configuration of Wii-boards. Overall, results from testing versions of Theradrive in USA and Mexico in a robot gym suggest that the resulting presentation of the Rehab C.A.R.E.S robot gym can be deployed as an affordable computer/robot-assisted solution for stroke rehabilitation in developed and developing countries.

Delphi Study to Determine Rehabilitation Research Priorities for Older Adults With Cancer

ObjectiveTo solicit expert opinions and develop consensus around the research that is needed to improve cancer rehabilitation for older adults. DesignDelphi methods provided a structured process to elicit and prioritize research questions from national experts. SettingNational, Web-based survey. ParticipantsMembers (N=32) of the American Congress of Rehabilitation Medicine completed at least 1 of 3 investigator-developed surveys. InterventionsNot applicable. Main Outcome MeasuresIn the first survey, participants identified up to 5 research questions that needed to be answered to improve cancer rehabilitation for older adults. In 2 subsequent surveys, participants viewed the compilation of questions, rated the importance of each question, and identified the 5 most important questions. This generated priority scores for each question. Consensus scores were created to describe the degree of agreement around the priority of each question. ResultsHighest priority research concerns the epidemiology and measurement of function and disability in older adult cancer survivors; the effects of cancer rehabilitation interventions on falls, disability, participation, survival, costs, quality of care, and health care utilization; and testing models of care that facilitate referrals from oncology to rehabilitation providers as part of coordinated, multicomponent care. ConclusionsA multipronged approach is needed to fill these gaps, including targeted funding opportunities developed with an advisory panel of cancer rehabilitation experts, development of a research network to facilitate novel collaborations and grant proposals, and coordinated efforts of clinical groups to advocate for funding, practice change, and policy change.

The use of virtual meetings and a project platform bring researchers and clinicians together in Knowledge Translation (KT)

Purpose: The Regional Center for Knowledge Translation (RKR) in Health Region of South Eastern Norway created and implemented a knowledge translation (KT) project that consists of synthesizing and adapting literature for use in the health region. To facilitate a geographically diverse collaboration among clinicians, scientists and educators, we implemented the use of virtual meetings, an online learning management system, and an online project platform. This technology fosters the development of evidence based summaries and recommendations for clinical practice. In the future, this technology will also support the implementation of recommended assessments and interventions in rehabilitation and improve patients’ outcomes throughout the health region.Context: RKR was established in 2013 with the mission of providing knowledge and competency for patients and health professionals in public and private rehabilitation institutions in Health Region of South Eastern Norway (2.8 million inhabitants). The center is focusing efforts on a KT project that aims to facilitate the rapid implementation of evidence into practice, standardize the delivery of assessments and interventions in rehabilitation, improve patient outcomes, and develop a network of mentors who are knowledgeable about research evidence. The project consists of two major components: the development of a database of Knowledge Translation Tools and an implementation model using Knowledge Ambassadors at each clinical site. The database includes the development and dissemination of summaries of evidence and recommendations for clinical practice. These summaries are developed by Knowledge Experts who are clinicians in the health region. The second component of the project is an implementation model that empowers Knowledge Ambassadors, who are peers at each clinical site, to facilitate practice changes at hospitals and clinics throughout the health region. The implementation process is based on the Knowledge-to-Action Framework.1 The technology used in this project provides a platform for education, training, interactions between group members, development of KTTs, and implementation of practice recommendations. Method: An online KT Project and E-learning resources have been developed. A network of clinician mentors who are knowledgeable about research evidence is being recruited. Norwegian clinicians attend bi-monthly virtual meetings (GoToMeeting) conducted by experts from USA and Norway. The groups also interact and share documents routinely through an online project platform (Project Place). Experts are educating, guiding and mentoring clinicians, as well as monitoring progress. The first group of knowledge experts (n=10) started in January, 2016. Four months after starting the project, individual interviews were conducted with each knowledge expert. Interviews were analyzed for themes, and strengths, weaknesses, opportunities and threats were identified.Results: Preliminary results from interviews with project participants focused on the benefits and challenges of a project conducted using online technology. Benefits of working together in virtual meetings include routine in-person access to international and national rehabilitation researchers and a rehabilitation expert network. Challenges are related to foreign languages, sound and video quality during virtual meetings and strictly virtual interaction of the group. Discussion: Focus group results indicate some initial benefits and challenges of conducting this project using internet-based technology. Solutions to overcome stated challenges are currently being implemented. These solutions include changing the format of the meetings to include both English and Norwegian languages, early engagement during online meetings, and a reduction of group size to 5-6 people. The online project platform will be used for social networking and encouragement of participants. Last, at least two in-person meetings will be conducted per year. Conclusion: Project participants reported they valued the opportunity to participate in this internet-based project. Challenges to using online technology were identified early in the project and solutions are being implemented.

Burn Rehabilitation Therapists Competency Tool-Version 2: An Expansion to Include Long-Term Rehabilitation and Outpatient Care.

The Burn Rehabilitation Therapist Competency Tool (BRTCT) was developed in 2011 to define core knowledge and skill sets that are central to the job performance of occupational and physical therapists working with burn patients during acute hospitalization and initial rehabilitation. It was the first national effort to provide standards that burn centers could use for the training and evaluation of a BRT performance. The American Burn Association Rehabilitation Committee recently expanded the tool to include long-term rehabilitation and outpatient care in order to more fully represent all of the stages of care in which patients with burn injury receive therapy. Thirty-six burn centers contributed competencies, 17 rehabilitation experts participated in a systematic Delphi questionnaire process, and eight representatives from seven additional burn centers validated the tool. The revised BRTCT, called the BRTCT-2, includes four new practice domains and 28 new competency statements. The expanded tool provides a common framework of standards for performance for occupational and physical therapists working with patients throughout the full spectrum of burn care.

Interdisciplinary facilitation of the minimal participation of patients with severe brain injury in early rehabilitation

Aim: The purpose of the study was to shed light on the participatory aspect of early rehabilitation, when contact, communication and interaction between the patients and the professionals is minimal, because of the patients’ severe brain injury and complex conditions.Methodology: A qualitative study was chosen. The field study involved five patients (aged 39–64) and included: participant observation and video recordings of 41 rehabilitation situations, five individual interviews and one focus group interview with multidisciplinary rehabilitation experts; together with document review of hospital charts and memos. The data were analyzed using a four-step phenomenological analysis and NVivo 10.Major findings: Participation comes into play in various practices around the patient. Three main themes seem to be important: (1) The dynamic interplay of the multidisciplinary team as an element that influences participation, (2) significant relational encounters and meetings as aspects that impact on the promotion of participation, and (3) significant frameworks that affect involvement, engagement and participation.Principal conclusion: Patients’ participation and recovery are facilitated by a combination of the clinicians’ professional skills, their ability to create a rehabilitation environment in which patients can perform activities, the right framework for the meeting, and a suitable approach, to facilitate fruitful interaction with the patients.

Recommendations for clinical practice after neonatal arterial ischemic stroke: Clinical monitoring and early rehabilitation intervention

Neonatal arterial ischemic stroke (NAIS) affects one child in 6–17 100,000-birth term neonates, most of these children will keep long-term motor and cognitive impairment. In 2014, initiated by the French Center for Pediatric Stroke in association with the French Society of Neonatology, a steering committee was created to propose clinical guidelines after NAIS. From all the relevant questions, the importance is given to long-term outcomes after a NAIS with a need for a better description of motor and cognitive outcomes after a NAIS in order to propose a more consensual monitoring for these children to improve their management. Guidelines were proposed based on an extensive literature review and experts experience. About 30% of children after a NAIS will develop a unilateral cerebral palsy requiring a management by a team with expertise in physical medicine and rehabilitation. To quantify impairments, activity limitations and participation restrictions resulting from this NAIS, evaluations, with reliable tools must be carried out systematically, early and repeated annually through adolescence. A multidisciplinary team with a longitudinal follow-up, in all the different developmental dimensions, must conduct these evaluations in term of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation. Consequences on family functioning need to be evaluate in order to help children and family coping with this event. A number of data on brain plasticity and effect of early interventions in association with preliminary results in children with cerebral palsy are very much in favor of early treatment. It remains now important to determine the intensity and what types of early intervention. The importance is given in all cases to a comprehensive care of the child and his/her family with the goal to prevent limitations in terms of activity and participation.

Development of the Participation Measure–3 Domains, 4 Dimensions (PM-3D4D): A New Outcome Measure for Rehabilitation

ObjectivesTo describe the development of a participation measure that assesses 3 domains (productivity, social, and community) and 4 dimensions (frequency, diversity, desire for change, and perceived difficulty) of participation and to evaluate the initial psychometric properties in rehabilitation outpatients. DesignA mixed-method approach included a literature review, item selection, expert reviews, cognitive interviews, and field testing with rehabilitation outpatients. Confirmatory factor analysis (CFA) and Rasch analysis were used to validate the construct validity of the difficulty dimension of the instrument. SettingOutpatient rehabilitation programs. ParticipantsAn expert panel consisting of 12 rehabilitation and measurement experts contributed to measurement development; 20 rehabilitation outpatients participated in cognitive interviews; and a sample of rehabilitation outpatients (N=556) (average age, 61.36±23.62y; 53% men) participated in field testing. InterventionsNot applicable. Main Outcome MeasureThe Participation Measure–3 Domains, 4 Dimensions (PM-3D4D). ResultsA scoring method for each dimension of the PM-3D4D was established. The instrument displayed good overall model fit in the CFA and unidimensionality across 3 domains after removing and collapsing locally dependent items identified from a principal component analysis. However, considering the poor personal reliability of the social subscale and its high correlation with the community subscale, we decided to merge the 2 subscales into 1. The combined subscale showed improved reliability and good construct validity by demonstrating a good model fit (comparative fit index, .985; Tucker-Lewis Index, .982, root mean square error of approximation, .061) and item fit. ConclusionsThe PM-3D4D is a newly developed participation measure designed to assess multiple domains and dimensions of participation by rehabilitation patients. The psychometric analysis results supported the construct of the instrument and helped item revision. Further examination of the validity and reliability of the PM-3D4D will be conducted.

Development and evaluation of an early specialised traumatic brain injury vocational rehabilitation training package

Background In a feasibility randomised controlled trial, training was developed to equip occupational therapists to deliver early specialised traumatic brain injury vocational rehabilitation in the English National Health Service (NHS). Method The package was developed by experts in vocational rehabilitation and traumatic brain injury, and included a manual, direct instruction by six trainers and opportunity for mentorship by four therapists. Following training, therapists were interviewed regarding the effectiveness and ease of use of the package. Interviews were analysed using the framework approach. Results Five trained therapists were interviewed regarding the package. Results were organised into six categories: (1) motivation to participate in research; (2) impact of the learning environment; (3) changing confidence levels over time; (4) growing appreciation of complexities about the intervention; (5) acceptability of the training package; and (6) lessons for future implementation. Conclusion The therapists reported acquiring the knowledge necessary to implement the intervention. The data indicate that the training packages require detailed descriptions of the interventions being taught for local implementation in the NHS and for future research. The training materials are valued by therapists but require time for familiarisation, and reminders from mentors help put training into practice. The therapists have concerns about implementing the interventions within a research context, which researchers should address.

Cooperation of return-to-work professionals: the challenges of multi-actor work disability management

Purpose: This article explores which concrete factors hinder or facilitate the cooperation of return-to-work (RTW) professionals in a complex system of multiple stakeholders.Method: The empirical material consists of in-depth interviews with 24 RTW professionals from various organizations involved in work disability management in Finland. The interviews were analyzed using thematic content analysis.Results: The study revealed several kinds of challenges in the cooperation of the professionals. These were related to two partly interrelated themes: communication and distribution of responsibility. The most difficult problems were connected to the cooperation between public employment offices and other stakeholders. However, the study distinguished notable regional differences depending primarily on the scale of the local network. The main areas of improvement proposed by the interviewees were related to better networking of case managers and expansion of expertise.Conclusions: The article argues for the importance of systematic networking and stresses the role of public employment services in the multi-actor management of work disabilities. The article contributes to existing work disability case management models by suggesting the employment administration system as an important component in addition to health care, workplace and insurance systems. The study also highlights the need for expansion of expertise in the field.Implications for RehabilitationCooperation between RTW professionals in public employment offices and other organizations involved in work disability management was considered inadequate.In order to improve the cooperation of RTW professionals, the stakeholders need to create more systematic ways of communication and networking with professionals in other organizations.There is a need to expand the expertise in work disability management and rehabilitation, partly by increasing the role of other professionals than physicians.

Employing the International Classification of Functioning, Disability and Health framework to capture user feedback in the design and testing stage of development of home-based arm rehabilitation technology

ABSTRACTThe purpose of this study was to evaluate the International Classification of Functioning, Disability and Health (ICF) as a framework to ensure that key aspects of user feedback are identified in the design and testing stages of development of a home-based upper limb rehabilitation system. Seventeen stroke survivors with residual upper limb weakness, and seven healthcare professionals with expertise in stroke rehabilitation, were enrolled in the user-centered design process. Through semi-structured interviews, they provided feedback on the hardware, software and impact of a home-based rehabilitation device to facilitate self-managed arm exercise. Members of the multidisciplinary clinical and engineering research team, based on previous experience and existing literature in user-centred design, developed the topic list for the interviews. Meaningful concepts were extracted from participants’ interviews based on existing ICF linking rules and matched to categories within the ICF Comprehensive Core Set for stroke. Most of the interview concepts (except personal factors) matched the existing ICF Comprehensive Core Set categories. Personal factors that emerged from interviews e.g. gender, age, interest, compliance, motivation, choice and convenience that might determine device usability are yet to be categorised within the ICF framework and hence could not be matched to a specific Core Set category.

The Unmet Educational Needs of Patients with Interstitial Lung Disease. Setting the Stage for Tailored Pulmonary Rehabilitation.

There is no standardized education program for patients with interstitial lung disease (ILD). Pulmonary rehabilitation is a resource for structured disease education that is still geared primarily toward patients with chronic obstructive pulmonary disease. The goals of this qualitative study were to identify the educational needs of patients with ILD and explore how pulmonary rehabilitation can become an appropriate setting for ILD education. Four focus groups including 24 patients with ILD and 10 semistructured interviews with healthcare professionals with expertise in ILD and/or pulmonary rehabilitation were conducted in two academic centers (University of California San Francisco and Centre Hospitalier de l'Université de Montréal). We conducted a qualitative thematic analysis of the transcripts using an iteratively developed codebook. The transcript analysis highlighted four major themes: patient dissatisfaction with the current educational model, lack of attention to emotional well-being, specific recommendations for educational content, and operationalizing education in the context of pulmonary rehabilitation. Seven key topics to be included an ILD-specific, pulmonary rehabilitation-based education program were identified: disease education, symptom management, clinical tests, autonomy, oxygen use, medications, and end-of-life counseling. This study provides a better understanding of the needs of patients and healthcare providers regarding education of patients with ILD. It lays the foundation for the development of a structured education intervention that could be delivered in the context of pulmonary rehabilitation.

Política de atenção à fissura labiopalatina: a emergência do Centrinho de Salvador, Bahia

Resumo Analisou-se a emergência do enfrentamento das fissuras labiopalatinas na Bahia entre 1990 e 2000, em estudo exploratório da emergência do Centro de Reabilitação de Anomalias Craniofaciais da Bahia, utilizando a análise do espaço social, dos agentes e seus capitais, segundo Bourdieu (2014). Foram conduzidas entrevistas semiestruturadas, análises de relatórios e de documentos oficiais. O estudo revelou que a criação do "Centrinho" em Salvador-BA, resultou de condições de possibilidade de financiamento de alta complexidade, associado à conjunção de disposições distintas dos diferentes agentes fundadores. Nesse espaço, coexistem especialistas na reabilitação e disputas sobre a definição do que é a atenção integral à pessoa com fissura labiopalatina.

National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II).

The aim of this paper is to compare the state of Cardiac Rehabilitation Programs (CRP) in 2009 with 2015. Focus is directed on health care, training of health-providers, research, and the barriers to their implementation. All authors of RENAPREC-2009, and other cardiac rehabilitation leaders in Mexico were requested to participate. These centres were distributed into two groups: RENAPREC-2009 centres that participated in 2015, and the new CRP units. In 2009 there were 14 centres, two of which disappeared and another two did not respond. CRP-units increased by 71% (n=24), and their geographic distribution shows a centripetal pattern. The coverage of CRP-units was 0.02 centres per 100,000 inhabitants. Only 4.4% of eligible patients were referred to CRP, with a rate of 10.4 patients/100,000 inhabitants in 2015. The ratio of Clinical Cardiologists to Cardiac Rehabilitation Specialists was 94:1, and the ratio of Intervention Specialists to cardiac rehabilitation experts was 16:1. Cardiac rehabilitation activities and costs varied widely. Patient dropout rate in phase II was 12%. Several barriers were identified: financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%). CRPs in Mexico are still in the process of maturing. Mexican CRP-centres have several strengths, like the quality of the education of the professionals and the multidisciplinary programs. However, the lack of referral of patients and the heterogeneity of procedures are still their main weaknesses.

American Cancer Society Head and Neck Cancer Survivorship Care Guideline.

Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.

Four Common Simplifications of Multi-Criteria Decision Analysis do not hold for River Rehabilitation.

River rehabilitation aims at alleviating negative effects of human impacts such as loss of biodiversity and reduction of ecosystem services. Such interventions entail difficult trade-offs between different ecological and often socio-economic objectives. Multi-Criteria Decision Analysis (MCDA) is a very suitable approach that helps assessing the current ecological state and prioritizing river rehabilitation measures in a standardized way, based on stakeholder or expert preferences. Applications of MCDA in river rehabilitation projects are often simplified, i.e. using a limited number of objectives and indicators, assuming linear value functions, aggregating individual indicator assessments additively, and/or assuming risk neutrality of experts. Here, we demonstrate an implementation of MCDA expert preference assessments to river rehabilitation and provide ample material for other applications. To test whether the above simplifications reflect common expert opinion, we carried out very detailed interviews with five river ecologists and a hydraulic engineer. We defined essential objectives and measurable quality indicators (attributes), elicited the experts´ preferences for objectives on a standardized scale (value functions) and their risk attitude, and identified suitable aggregation methods. The experts recommended an extensive objectives hierarchy including between 54 and 93 essential objectives and between 37 to 61 essential attributes. For 81% of these, they defined non-linear value functions and in 76% recommended multiplicative aggregation. The experts were risk averse or risk prone (but never risk neutral), depending on the current ecological state of the river, and the experts´ personal importance of objectives. We conclude that the four commonly applied simplifications clearly do not reflect the opinion of river rehabilitation experts. The optimal level of model complexity, however, remains highly case-study specific depending on data and resource availability, the context, and the complexity of the decision problem.

Evaluation of the feasibility and acceptability of the ‘Care for Stroke’ intervention in India, a smartphone-enabled, carer-supported, educational intervention for management of disability following stroke

Objectives(1) To identify operational issues encountered by study participants in using the ‘Care for Stroke’ intervention; (2) to evaluate the feasibility and acceptability of the intervention.DesignMixed-methods research design.SettingParticipant's home. Participants...

Nursing expertise in post-stroke rehabilitation

The pathway of a patient after a stroke involves a continuation of care, from their admission to the emergency department to their discharge from the rehabilitation unit. Here, a Genevan hospital team shares its experience in the creation of a video of information for the patients and their family about the process of rehabilitation.