Rehabilitation Health Professionals Research Articles

“This is not just a little accident”: a qualitative understanding of paediatric burns from the perspective of parents

Purpose: To describe the experiences of parents of children admitted to hospital for a burn. Methods: In-depth interviews were conducted with 21 parents (14 mothers and seven fathers) of children who had sustained a burn requiring hospitalisation. Face-to-face interviews were conducted six months post-burn, in rural, remote and metropolitan areas. The interview guide explored the overall experience of parents and included probing questions exploring the perceptions, thoughts and feelings of participants. Interviews were digitally recorded and transcribed verbatim. Transcripts were analysed according to the seven-step Coliazzi method. Relationships between themes were explored to identify core concepts. Results: Analysis of interview transcripts revealed three phases that describe the parents’ journey: experiencing the accident, the in-patient phase and the return to community. Within these phases, themes were identified. Themes represented subthemes of stressors, behavioural and emotional responses and coping factors. Conclusion: Findings from this research will allow health professionals to optimise a holistic clinical service from a consumer’s perspective at all stages of the burn journey. These research conclusions could be used for the development of protocols to underpin a comprehensive information and social support management plan for families that would complement and support the surgical, medical and therapeutic treatment plan, providing direction for comprehensive service delivery.Implications for RehabilitationHealth professionals should optimise a holistic clinical service from a consumer’s perspective taking into consideration all stages of the burn journey.Therapeutic supports are required to target each phase of the burn journey and address changes in coping strategies and behavioural responses.There is a need for the development of protocols to underpin a comprehensive information and social support management plan for families that will complement and support the surgical and medical treatment plan.

A Clinical Perspective on the Need for Psychosocial Care Guidelines in Spinal Cord Injury Rehabilitation

Objective: Spinal cord injury (SCI) is a catastrophic physical injury presenting substantial obstacles to adjustment in the long-term, often being associated with additional challenges, including traumatic brain injury, frequent hospitalization, substance abuse, co-morbid psychiatric conditions, chronic pain and fatigue, social discrimination and poor employment prospects. Methods: In an effort to improve rehabilitation and outcomes for people with SCI in the state of NSW, Australia, psychosocial guidelines have been developed to provide direction for enhanced service delivery, staff training and care processes. A major goal was to ensure persons with SCI would receive comprehensive psychosocial care, arguably leading to improved quality of life and functionality in daily living. It is believed that implementation of psychosocial recommendations into care settings will improve decision-making concerning assessment, treatment, referral and living arrangements by rehabilitation health professionals (such as physicians, psychologists, social workers, occupational and physical therapists, rehabilitation counselors and nurses). A secondary goal was to provide guidelines that would promote improved understanding of the psychosocial needs of people with SCI in legislators, policy-makers and other stakeholders within the health and social care environments. Conclusion: This paper provides details of the developed guidelines, discussing implications for their application in rehabilitation practice within the hospital inpatient setting, as well as the significance for research directions into psychosocial aspects of SCI rehabilitation.

Parenting a child with a traumatic brain injury: Experiences of parents and health professionals

Objective: To qualitatively explore the experiences, challenges and needs of parents of children with traumatic brain injury (TBI) in order to inform future intervention research through incorporation of participant knowledge and experience.Methods: Parents of children with TBI (n = 10) and experienced health professionals in paediatric rehabilitation (n = 5) took part in focus groups or individual interviews. Audio recordings were transcribed verbatim and an inductive thematic analysis performed.Findings: Participants reported that, beyond the impact of the injury on the child, TBI affects the entire family. Parents need to adjust to and manage their child’s difficulties and can also experience significant emotional distress, relationship discord and burden of care, further adding to the challenges of the parenting role. Parents can feel isolated and the importance of empowerment, support and information was emphasized. Coping styles of disengagement and avoidance were often reported, despite acknowledgement that these were not beneficial.Conclusions: Parenting interventions may provide essential support for parents in adjusting to and managing their child’s difficulties and the efficacy of existing programmes needs evaluation. Addressing parent emotional adjustment and coping strategies is vital following paediatric TBI, given the impact on parent well-being and the potential negative effects on child outcomes through reduced parenting effectiveness. Group programmes may enable connection and support.

Survey of the Reporting Characteristics of Systematic Reviews in Rehabilitation

Systematic reviews (SRs) have become increasingly important for informing clinical practice; however, little is known about the reporting characteristics and the quality of the SRs relevant to the practice of rehabilitation health professionals. The purpose of this study was to examine the reporting quality of a representative sample of published SRs on rehabilitation, focusing on the descriptive, reporting, and bias-related characteristics. A cross-sectional study was conducted by searching MEDLINE for aggregative and configurative SRs indexed in 2011 that focused on rehabilitation as restorative of functional limitations. Two reviewers independently screened and selected the SRs and extracted data using a 38-item data collection form derived from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The data were analyzed descriptively. Eighty-eight SRs published in 59 journals were sampled. The median compliance with the PRISMA items was 17 (63%) out of 27 items (interquartile ratio=13-22 [48%-82%]). Two thirds of the SRs (n=66) focused on interventions for which efficacy is best addressed through a randomized controlled trial (RCT) design, and almost all of these SRs included RCTs (63/66 [95%]). More than two thirds of the SRs assessed the quality of primary studies (74/88 [84%]). Twenty-eight reviews (28/88 [32%]) meta-analyzed the results for at least one outcome. One half of the SRs reported positive statistically significant findings (46%), whereas a detrimental result was present only in one review. This sample of SRs in the rehabilitation field showed heterogeneous characteristics and a moderate quality of reporting. Poor control of potential source of bias might be improved if more widely agreed-upon evidence-based reporting guidelines will be actively endorsed and adhered to by authors and journals.

A Meta-Analysis of Mental Health Treatments and Cardiac Rehabilitation for Improving Clinical Outcomes and Depression Among Patients With Coronary Heart Disease

To quantify the efficacy of mental health (antidepressants & psychotherapies) and cardiac rehabilitation treatments for improving secondary event risk and depression among patients with coronary heart disease (CHD). Using meta-analytic methods, we evaluated mental health and cardiac rehabilitation therapies for a) reducing secondary events and 2) improving depression severity in patients with CHD. Key word searches of PubMed and Psychlit databases and previous reviews identified relevant trials. Eighteen mental health trials evaluated secondary events and 22 trials evaluated depression reduction. Cardiac rehabilitation trials for the same categories numbered 17 and 13, respectively. Mental health treatments did not reduce total mortality (absolute risk reduction [ARR] = -0.001, confidence interval [95% CI] = -0.016 to 0.015; number needed to treat [NNT] = ∞), showed moderate efficacy for reducing CHD events (ARR = 0.029, 95% CI = 0.007 to 0.051; NNT = 34), and a medium effect size for improving depression (Cohen d = 0.297). Cardiac rehabilitation showed similar efficacy for treating depression (d = 0.23) and reducing CHD events (ARR = 0.017, 95% CI = 0.007 to 0.026; NNT = 59) and reduced total mortality (ARR = 0.016, 95% CI = 0.005 to 0.027; NNT = 63). Among patients with CHD, mental health treatments and cardiac rehabilitation may each reduce depression and CHD events, whereas cardiac rehabilitation is superior for reducing total mortality risk. The results support a continued role for mental health treatments and a larger role for mental health professionals in cardiac rehabilitation.

Physical Medicine and Rehabilitation: Interdisciplinary, Interventional, and International

In this issue of PM&R, a new featured column is being introduced: The International Perspective. In this column, the journal will facilitate a broad look at our specialty from a global perspective. Indeed, physical medicine and rehabilitation (PMR) is not only interdisciplinary and interventional, it is also international. This new section will focus on areas of scientific and clinical relevance, and on issues of importance for the advancement of PMR in an international context. We are confident that much can be learned from each other through narrative descriptions, perspective viewpoints, and summary reviews on contemporary topics of international importance to the field of PMR. Disability is truly an international issue. In the recent World Heath Organization (WHO) “World Report on Disability,” it is stated that more than 1 billion people in the world live with some form of disability, of whom nearly 200 million experience considerable difficulties in functioning [1]. The report further states that disability will be an even greater concern in the years ahead because its prevalence is on the rise. This is due to a growing number of people over 65 years old and the higher risk of disability in older people, as well as the global increase in chronic health conditions such as diabetes, cardiovascular disease, neurologic disorders, cancer, and mental health disorders. The WHO report also presents innovative policies and programs that can improve the lives of persons with disabilities and facilitate implementation of the United Nations Convention on the Rights of Persons with Disabilities, which came into force in May 2008. The WHO report emphasizes the necessity to create or amend national plans on rehabilitation and to establish infrastructure and capacitytoimplementtheplans,soastoimproveaccesstorehabilitationservices.Weknow that there are numerous efforts being made around the world to do this. We hope that this new column will serve as a medium to present, describe, and discuss these efforts. Our specialty is young and has evolved over the past century. As an example of a highly specialized rehabilitation service, it has been less than 60 years since spinal cord injury rehabilitation was developed at Stoke Mandeville Hospital in England. In many parts of the world, the first PMR specialists were certified within the past 2 decades. The evolutionary history of PMR societies varies in different regions and countries around the world. For example, simply consider the various names of the specialty: “physical medicine and rehabilitation (PMR),” “rehabilitation medicine (RM),” or “physical and rehabilitation medicine (PRM)”[2]. These differences may reflect subtle variations in viewpoints. Understanding our varied histories, evolution, and type of worldwide training programs should help us to appreciate the role of PMR, PRM, or RM in the international medical community. Universally, PMR interacts with many other medical disciplines, usually in the spirit of cooperation but occasionally in a conflicting manner. These positive and negative interactionsusuallyoccuronissuesofdiagnosingandtreatingdiseaseandmanagingdisability.The strengthandvalueofPMRcanbedemonstratedbythedevelopmentofmedicalcareservices that have not been historically provided by other disciplines [3]. This development will be facilitated if we recognize evolutionary histories of individual PMR societies that describe how they have coped with various kinds of challenges. There is a strong need to focus on our medical education system and our training of young physicians and allied health professionals in rehabilitation [2]. Around the world, there are many examples of how core curricula in PMR and rehabilitation medicine have developed as part of our university medical systems. By describing such endeavors, we can continue to learn, agree on commonalities, and in the long term, progress toward a more unifiedknowledgeofrehabilitationinterventions.Manycountrieshavealsotakeninitiatives

Health-related quality of life of individuals with traumatic brain injury in Barranquilla, Colombia

Objective: To assess health-related quality of life (HRQoL) of individuals with traumatic brain injury (TBI) in Barranquilla, Colombia.Participants/methods: Thirty-one individuals with TBI and 61 healthy controls completed the SF-36, a self-report HRQoL measure composed of eight component areas: physical health problems, pain, role limitations due to physical problems or due to emotional problems, emotional well-being, social functioning, energy/fatigue and general health perceptions.Results: The samples were statistically similar with respect to age, gender and education and statistically different with respect to depression, SES, social support and cognition. Compared to healthy controls, individuals with TBI had significantly lower means on all SF-36 sub-scales. However, after adjusting for depression, SES, social support and cognitive performance, significant differences remained on three of the SF-36 sub-scales. Specifically, individuals with TBI had lower adjusted means on Role-Physical (p-value < 0.005), Role-Emotional (p-value < 0.005) and Bodily Pain (p-value < 0.05).Conclusion: Even after controlling for depression, SES, social support and cognitive performance, individuals with TBI living in Barranquilla Colombia report having poorer quality of life across various domains, including Role-Physical, Role-Emotional and Bodily Pain. These findings suggest the need for rehabilitation health professionals to develop and implement culturally-appropriate interventions to improve quality of life in Colombian individuals with TBI.

Weekend Physiotherapy Practice in Community Hospitals in Canada

To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal-Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.

Development and validation of the Diet Quality Tool for use in cardiovascular disease prevention settings

The aim of this study was to develop and evaluate a dietary screening tool for use in a secondary cardiovascular disease (CVD) prevention setting to identify an individual's overall dietary quality. The Diet Quality Tool (DQT) was validated against a 4-day food diary for 37 individuals with established CVD attending cardiac rehabilitation. Construct validity was demonstrated for % energy from saturated fat (P=0.002, r=-0.500), dietary fibre (P<0.001, r=0.559) and omega-3 fatty acids (P=0.048, r=0.327). Criterion validity was established with a significant difference found between mean (95% CI) dietary intakes of fibre (28.2g, 4.4 to 17.3) and % total energy from saturated fat (10.6%, -4.8 to -0.8) for those with better DQT scores (>60%) versus those with poorer scores (≤60%) when compared with 4-day food diary nutrient values. The usefulness of the DQT was confirmed by both patients (n=25) and cardiac rehabilitation health professionals (n=8). The DQT was found to be a valid and useful dietary assessment tool with potential for use in a secondary CVD prevention setting. The tool has the capacity to be used in a wider variety of settings and further refinement of the tool would enable a greater amount of nutrients to be reliably screened.

An HIV mentorship programme for rehabilitation professionals: lessons learned from a pilot initiative

Aims: This article describes a pilot programme aiming to identify the strengths and challenges associated with a human immunodeficiency virus (HIV) mentorship programme for rehabilitation professionals. Methods: This unique pilot programme incorporated elements of problem-based learning, interprofessionalism and multiple mentoring models. A group of five physiotherapy mentees met initially with three clinician mentors, and three mentors who were persons living with HIV, for a one day workshop to develop relationships, identify learning needs and engage in learning through discussion of case scenarios. Subsequently they met formally every month via teleconference, over a five-month period, followed by a final one-day workshop. Qualitative evaluation included interviews and focus group methodology. Transcripts from these were analyzed through qualitative content analyses. Findings: Participants viewed the mentorship programme positively, in particular the networks they were able to establish, and learning from the mentors living with HIV. However, barriers to participation were related to scheduling and lack of support to devote time to the programme from the mentees' clinical managers. Other challenges related to the mentees' limited opportunities to implement new knowledge, and to difficulties in engaging in informal mentorship activities. Conclusions: Lessons learned from this pilot programme are of value to those interested in developing HIV-related mentorship experiences for rehabilitation health professionals or for those in other emerging areas of practice.

Health-related quality of life in individuals with spinal cord injury in Colombia, South America

To assess health-related quality of life (HRQOL) of individuals with Spinal Cord Injury (SCI) in Neiva, Colombia. Cross-sectional. 40 Colombians with SCI and 42 age- and gender-matched controls completed the SF-36, a self-report measure composed of eight component areas (physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions). Compared to healthy controls, individuals with SCI had significantly lower means on five SF-36 subscales: physical functioning (22.5 vs. 94.0; p < 0.001), role limitations due to physical problems (54.4 vs. 77.4; p < 0.01), social functioning (67.5 vs. 80.1; p < 0.05), pain (65.4 vs. 79.5; p < 0.01), and general health (54.9 vs. 69.4; p < 0.01). Both groups scored similarly on the SF-36 emotional well-being subscale. Individuals with SCI from Neiva, Colombia report having poorer quality of life across various domains than healthy controls, primarily in the area of physical functioning. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve HRQOL in individuals with SCI.

Health-related quality of life in caregivers of individuals with dementia from Colombia.

The purpose of this study was to compare the health-related quality of life (HRQoL) of 99 caregivers of individuals with dementia and 95 healthy individuals from the general population in Colombia. The 36-item short-form (SF-36), a self-report measure composed of 8 component areas (physical function, role-physical, bodily pain, general health, energy/vitality, social function, role-emotional, and mental health), was used to measure HRQoL. Results indicated that the healthy control group had a higher level of education, socioeconomic status (SES), and number of male participants. After adjusting for education, SES, and gender, the caregivers of individuals with dementia scored significantly lower on all of the SF-36 subscales than the healthy controls. These findings suggest the need for rehabilitation health professionals to develop and implement culturally appropriate interventions to improve the HRQoL of caregivers of individuals with dementia in Colombia.

A Blueprint for Transforming Stroke Rehabilitation Care in Canada: The Case for Change

Teasell RW, Foley NC, Salter KL, Jutai JW. A blueprint for transforming stroke rehabilitation care in Canada: the case for change. Stroke is a major source of disability in Canada and other developed countries, which carries with it a high toll in terms of personal suffering for the stroke survivor and their family in addition to the associated economic costs. Despite the impressive body of evidence describing effective and feasible stroke rehabilitation practices, stroke survivors, their families, and health professionals currently do not benefit from a rehabilitation system that is well organized and evidence based. Using the principles of best evidence, we make the case for needed changes to the current system based on 5 processes of care known to be important in the pursuit of optimal outcomes: (1) admission to specialized stroke rehabilitation units, (2) early admission to stroke rehabilitation units, (3) intensive stroke rehabilitation therapies, (4) task-specific rehabilitation therapies, and (5) well-resourced outpatient programs. Implementation of these strategies will be expected to result in improved functional gain, fewer complications, decreased mortality, and reduced need for institutionalization. In addition to providing improved care for both the stroke survivor and their family, evidence-based stroke rehabilitation care is more efficient and may reduce costs. Our experience in Canada suggests that instituting these 5 measures alone will result in significant improvements to the health care system.

Book Review: Chan, F., Berven, N. L., &amp; Thomas, K. R. (Eds.) (2004). Counseling Theories and Techniques for Rehabilitation Health Professionals. New York: Springer Publishing. 483 pages, $52.95 (hardcover)

Book Review: Chan, F., Berven, N. L., &amp; Thomas, K. R. (Eds.) (2004). Counseling Theories and Techniques for Rehabilitation Health Professionals. New York: Springer Publishing. 483 pages, $52.95 (hardcover)

International Classification of Functioning Disability and Health (ICF)

The present article has the objective of updating rehabilitation health professionals on the International Classification of Functioning Disability and Health (ICF) developed by the World Health Organization. The ICF’s history, application and perspectives in rehabilitation are discussed

Addressing the Sexual Concerns of Persons With Traumatic Brain Injury in Rehabilitation Settings: A Framework for Action

AbstractTraumatic brain injury (TBI) impacts upon people's sexuality with 50% to 60% of persons reporting some level of disruption post-injury. However, only small proportions of patients/family members report that rehabilitation health professionals made inquiries about whether they had any sexual concerns. Rehabilitation programs have a responsibility to meet the challenge of addressing this important area of human functioning. An agency framework is described that provides a non-threatening, structured way for services to conceptualise, introduce or upgrade sexuality services in a manner that can be maintained over the long term. The framework contains an underlying philosophy of sexuality, five proposed modalities of service provision and detail of the underlying organisational structures that are required to provide sexuality services with consistency and effectiveness over the long term. Finally, organisational strategies that can be employed to implement the framework are discussed as well as suggestions about the sequencing of such strategies. By using the framework, rehabilitation services can put sexuality back onto their treatment agenda, as they seek to restore patients/clients with TBI to the “highest level of adaptation attainable” (World Health Organisation, 1996, p. 1) in all areas of their lives.

The Quality of Life of Persons with Severe and Persistent Mental Illness: A Typology Based on Cluster Analysis

Recently rehabilitation and mental health professionals have placed increased emphasis on quality of life as a service outcome for individuals with severe and persistent mental illness. Research has indicated that when services are based on quality of life improvement, consumers are able to achieve higher levels of independence, satisfaction, production, and community integration. Individuals with severe and persistent mental illness completed Lehman's Quality of Life Index. Respondents were grouped based on their subjective assessment of quality of life in specific life domains. Although cluster analysis revealed that most respondents viewed quality of life as satisfactory, the heterogeneous nature of the groups suggested that it is important to view quality of life from a multifaceted perspective. The multifaceted nature of quality of life is discussed in terms of implications for rehabilitation counselors, administrators, and policy makers.

Predictors of post-hospital employment status for persons with psychiatric disability: Perceptions of rehabilitation health professionals in Hong Kong.

Predictors of post-hospital employment status for persons with psychiatric disability: Perceptions of rehabilitation health professionals in Hong Kong.

An educational program's effects on students' attitudes toward people with disabilities: a 1-year follow-up.

The purpose of the study described here was to examine the attitudes of nursing students toward people with disabilities 1 year after the students had participated in an educational program on caring for such people. The program provided (a) information about this care, (b) simulated experiences related to different aspects of care, and (c) contact with disabled people as well as with rehabilitation health professionals. The study also examined how students' attitudes were influenced by the students' age, the number of years they had spent in the nursing program, their degree of experience in caring for people with disabilities, and their amount of personal interaction with disabled people. The Attitudes Towards Disabled Persons (ATDP) scale was administered to 67 nursing students before they completed the workshop. The participants were tested again 1 year later, thereby providing a matched group for examining attitude changes over time. The participants' attitudes were significantly more positive at the follow-up. At the 1-year follow-up, the ATDP scores of the intervention group were also compared with those of a second group of nursing students (n = 170) who had not participated in the educational program. The findings suggested that completion of the educational program was an important influence on students' development of positive attitudes toward people with disabilities.

The mental health needs of the severely physically disabled.

Severely physically disabled individuals, advocates for the disabled, and rehabilitation and mental health professionals were surveyed to determine their perceptions of the need for services for 12 mental health problems encountered by persons with physical disability and the kinds of services needed. All groups surveyed agreed that vocational, social-interpersonal, personal-emotional, self-concept, and marital-family problems were in greatest need of services, but their perceptions of the extent of service need for each of the 12 problems differed significantly. The groups unanimously perceived rehabilitation counseling as the most needed service but differed significantly in their perception of the extent of service need for other services that were also highly rated, such as family, group, and individual therapy; peer counseling; respite care; and social skills training. The groups unanimously agreed that services designed to treat major mental illness were the least needed.