Health Rehabilitation Services Research Articles

Designing a Client and Family Empowerment Model to Promote Constructive Life Recovery Among Persons with Spinal Cord Injury: A Qualitative Study

Background: Spinal cord injury (SCI) causes financial, social, and psycho-emotional problems for both the person afflicted with SCI and the family. Family as an important source of care plays an important role in patients’ rehabilitation and complication reduction. Objectives: The present study aimed at designing a client and family empowerment model for SCI patients. Methods: This was a qualitative study with the grounded theory approach conducted in 2017. Unstructured interviews were used as the main method of data collection. Saturation was achieved with 43 participants, including people with SCI, family caregivers, and people involved in providing health care and rehabilitation services for people with SCI. Data analysis was performed on the basis of continuous comparative analysis of Strauss and Corbin (1998). In the second stage, the findings of the grounded theory study were used for designing the prescriptive model based on Walker and Avant (2005) three-step method. Results: The main concern of people with SCI and their families was the loss of physical ability, financial and physical independence, and lack of constructive life. Ultimately, a “client and family empowerment model to promote constructive life recovery for individuals with SCI” was developed based on the findings of the grounded theory study. This model includes four main concepts: correction of environment, educational empowerment of the clients and families, modification of the method of providing rehabilitation services, and recovery of a constructive life. Conclusions: There were several barriers to the client and family empowerment of people with SCI. In this study, a client and family empowerment model was developed to promote constructive life recovery and strategies were identified to remove the barriers. Hence, this model can help people with SCI to return their effective lives.

Promoting Healthcare Quality for Effective UHC: Thailand’s Trajectory

Universal health coverage (UHC) aims to ensure that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, and that these are of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship, according to the World Health Organization. There is an urgent need to place quality of care in the fabric of global, regional and country level action plans in order to make progress towards effective UHC. Hospital Accreditation (HA) is one of the mechanisms which encourages continuous quality improvement across levels of healthcare facilities and can address this need. This policy brief is a part of a series reflecting on Thailand’s experience of implementing universal health coverage.

A Qualitative Study of Implementation Challenges of Mental Health Clubhouse Rehabilitation Services in China's Hunan Province.

Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People's Republic of China. Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semistructured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods. Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness. Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment.

Advancing emergency preparedness for people with disabilities and chronic health conditions in the community: a scoping review

Background: Community-based service providers are optimally positioned to contribute to the inclusion of people with disability and chronic health conditions in community-level disaster risk reduction. However, little is known about how to enable emergency preparedness within existing community health care, disability, and rehabilitation service delivery.Purpose: This study synthesised findings from a scoping review of the literature on how community-based service providers can enable emergency preparedness for clients in the community. Emphasis was placed on the practice scope of service providers undertaking this emerging role, the knowledge, skills and attitudes required to enable preparedness in others, and the current tools and training available to support service providers.Method: Six electronic databases, hand and cited searches were undertaken to identify studies for inclusion. In total, 24 publications were included.Results: Providers have competencies in conducting functional assessments that make them well-suited to enabling emergency preparedness with clients. Findings revealed seven provider responsibilities associated with this role and eight tools and training resources to support providers.Conclusion: Whilst community-based service providers are willing and optimally placed to enact these roles, they require additional support to do so in a manner that espouses values of inclusion and enablement.Implications for RehabilitationA wide range of community-based service providers are willing to leverage their role to enable emergency preparedness with clients in the community.Research is needed to understand how to optimise the expertise of diverse health care, disability and rehabilitation providers in facilitating emergency preparedness with clients.Strengths-based tools are needed to increase client self-sufficiency in preparing for and responding to emergencies.Enablement processes should guide the development of emergency preparedness as a critically important and emerging role for community-based service providers.Disability and rehabilitation professionals can use this scoping review to self-assess their capacity and develop opportunities to embed emergency preparedness into routine practice with clients.

Frailty in the context of rehabilitation interventions for adults: protocol for a scoping review

IntroductionAlthough a growing number of frail adults can benefit from rehabilitation services, few are included in rehabilitation services, and reasons for their exclusion are not well understood. To inform research...

ANALISIS PROGRAM INDONESIA SEHAT DENGAN PENDEKATAN KELUARGA (PIS-PK) INDIKATOR HIPERTENSI DAN KB DI DESA COMBONGAN RT 01, RT 02 DAN RT 03

The Healthy Indonesia Program with Family Approach (PIS-PK) integrates program implementation through the 6 main components in strengthening health systems (six building blocks), namely strengthening efforts to health services, availability of health workers, health information systems, access to essential medicines, financing and leadership or government. The purpose of this study is to increase family and member access to comprehensive (promotive-preventive, curative and rehabilitative health services) and to understand the healthy family approach program with a family approach (PIS-PK). The location of this study was in Combongan Village RT 01, RT 02 and RT 03, Bantul Regency. The population in this study were residents who lived in Combongan Village, Banguntapan District, Bantul Yogyakarta. The sample in this study was all families living in Combongan Village, Banguntapan District, Bantul, Yogyakarta. The results of this study the highest coverage value found in the indicators of families having access and using healthy latrines, which is 37%. There were 5 main problems in RT 01, RT 02, and RT 03. Hypertension and family planning were the priority problems in the area. The Healthy Indonesia Program is one of the programs from the 5th agenda of Nawa Cita, namely Improving the Quality of Indonesian Human Life. The goal of the Healthy Indonesia Program is to increase the health status and nutritional status of the community through health and community empowerment efforts supported by equitable health services and financial protection

Evaluating the Impact of Inpatient Mental Health Rehabilitation on Quality of Life and Recovery

Previous evaluations of mental health rehabilitation services have mostly examined clinician-rated or objective outcomes. There is also a need to consider subjective, patient-rated outcomes such as quality of life and recovery. Service users in a rehabilitation unit were invited to complete quality of life and recovery measures at admission and discharge. Of 79 eligible service users, 48 (60.8%) completed measures at both admission and discharge. Significant improvements were noted in overall quality of life and recovery, as well as most individual domains of quality of life. Satisfaction with family relationships showed only modest improvement. Satisfaction with sex life showed no significant change. Users of the rehabilitation service experienced improvements in quality of life and recovery. The evaluation’s main limitations were the lack of a control group, the lack of follow-up, and the possibility of differential drop-out. Clinical and research implications are discussed.

Culture, Health, Function, and Participation Among American Indian and Alaska Native Children and Youth With Disabilities: An Exploratory Qualitative Analysis

ObjectiveTo investigate the influence of traditional culture on health, disability, and health care services among American Indian and Alaska Native (AI/AN) children and youth with disabilities. DesignExploratory descriptive qualitative analysis. SettingTertiary children’s hospital. ParticipantsA purposively sampled group (N=17) of AI/AN youth (n=4) with disability lasting at least 6 months age 8-24 years old and parents (n=13) of AI/AN children with disability lasting at least 6 months age 6 months to 17 years old. InterventionsNot applicable. Main Outcome MeasuresParticipant responses to semistructured interview questions regarding health beliefs, daily activities, participation in cultural activities, and experiences receiving or having their child receive health care and rehabilitation services. ResultsThree themes were identified: (1) participation in cultural activities is important for health as an AI/AN person; (2) experiences participating in cultural activities with functional differences; and (3) lack of recognition of the culturally related functional needs of AI/AN children with disabilities by rehabilitation providers. Children participated in cultural activities primarily through attendance at community-wide events. Barriers to participation in cultural activities included environmental barriers and adaptive mobility devices ill-suited to rough terrain. Participants perceived addressing functional needs related to culture, and cultural activities was not an expected part of rehabilitation services. ConclusionsAI/AN children with disabilities experience barriers to participation in cultural activities, making it hard for them to achieve their definition of ideal health. Rehabilitation services have not identified or addressed these unmet culturally related functional needs.

Primary Health Care Matters.

Primary Health Care Matters.

Social integration in mental health rehabilitation services: new roles to enhance effectiveness and sustainability

Social integration in mental health rehabilitation services: new roles to enhance effectiveness and sustainability

BEHAVIOURAL ARCHITECTURE STUDY ON THE DESIGN OF SOCIAL REHABILITATION CENTER FOR THE BLIND AT SURAKARTA

<p class="AbstractTitle"><em>Social rehabilitation cente</em><em>r</em><em> for the blind in Surakarta is a learning centre for people who is visually impaired, specifically the totally blinded. This facility provides professional activities program in order to regaining and increasing the skills of people with vision impairment, both individuals, families, and group, to carry out their social function fairly, and to live in harmony with the dignity</em><em>;</em><em> for instance, social skill learning, provision of additional skills and knowledge, psychosocial and health rehabilitation services, as well as basic daily activities training in Surakarta. The goal of this research is to create a physical space as a place of rehabilitation and counselling for the blind to live independently by providing a safe, easy, and convenient infrastructure facilities. To meet the goal, the principles of behavioral architecture design will be applied on the concept of the building. Field observation on the blinds’ behavior is used as the research method, to analyze what the blind needed so the </em><em>facility</em><em> can accommodate them.</em></p><em></em><em></em>

Interprofesioanal Education (IPE) Sebagai Upaya Membangun Kemampuan Perawat Dalam Berkolaborasi Dengan Tenaga Kesehatan Lain

Latar Belakang : Pelayanan kesehatan yang bermutu menjadi tuntutan bagi pemberi pelayanan kesehatan di era global. Pelayanan kesehatan yang bermutu dapat dicapai dengan praktek kolaborasi. Pendidikan terintegrasi yang dicetuskan sebagai media kolaborasi menurut WHO adalah Interprofesional Education (IPE). IPE merupakan proses dimana sekelompok peserta didik atau tenaga kesehatan dengan latar belakang berbeda belajar bersama dalam jangka waktu tertentu pada masa pendidikan, dengan interaksi sebagai tujuan utamanya, untuk kolaborasi dalam menyediakan pelayanan preventif, promotif, rehabilitataif, dan pelayanan kesehatan lainnya (WHO, 2010). Konsep pembelajaran IPE dapat diterapkan dalam 3 kegiatan yaitu pada pembelajaran di Rumah Sakit, akademik, dan komunitas. Pembelajaran IPE di Rumah Sakit yang berjalan baik diharapkan dapat menghasilkan profesional di bidang kesehatan yang mampu berkolaborasi dengan profesi kesehatan lain, sehingga dapat berperan serta dalam pembangunan kesehatan di Indonesia. Tujuan : Literature review ini untuk mengetahui apakah IPE dapat membangun kemampuan perawat dalam berkolaborasi dengan tim kesehatan lainMetode : Literature review ini dilakukan dengan melakukan penelusuran artikel publikasi pada EBSCO, Googlesearch, PubMed, Sciencedirect.com dengan kata kunci yang dipilih yaitu interprofessional education (IPE), collaboration, interprofessional collaboration (IPC). Penelusuran dilakukan dengan membatasi terbitan dari tahun 2010-2015. Hasil : Dari hasil penelusuran literatur bahwa IPE secara efektif dapat membangun kemampuan perawat dalam berkolaborasi dengan tenaga kesehatan lain. Diharapkan pelaksanaan IPE dapat dilaksanakan secara berkelanjutan dengan persiapan yang lebih maksimal lagi, mengingat institusi kesehatan merupakan penyedia utama calon tenaga kesehatan professional.

Biological-Signal-Based User-Interface System for Virtual-Reality Applications for Healthcare

Biosignal interfaces provide important data that reveal the physical status of a user, and they are used in the medical field for patient health status monitoring, medical automation, or rehabilitation services. Biosignals can be used in developing new contents, in conjunction with virtual reality, and are important factors for extracting user emotion or measuring user experience. A biological-signal-based user-interface system composed of sensor devices, a user-interface system, and an application that can extract biological-signal data from multiple biological-signal devices and be used by content developers was designed. A network-based protocol was used for unconstrained use of the device so that the biological signals can be freely received via USB, Bluetooth, WiFi, and an internal system module. A system that can extract biological-signal data from multiple biological-signal data and simultaneously extract and analyze the data from a virtual-reality-specific eye-tracking device was developed so that users who develop healthcare contents based on virtual-reality technology can easily use the biological signals.

Social care: an essential aspect of mental health rehabilitation services.

This study is aimed at the importance of social care in rehabilitation. A brief overview of the social care theme is used as the methodology. There is a tension in mental health care between biological and psychological treatments that focus on deficits at the individual level (symptoms, disabilities) and social interventions that try to address local inequalities and barriers in order to improve access for service users to ordinary housing, employment and leisure opportunities. The history of mental health care tells us that social care is often underfunded and too easily dismissed as not the business of health care. But too much emphasis on a health model of individual deficits is a slippery slope to institutionalisation by way of therapeutic nihilism. Rehabilitation services follow the biopsychosocial model but with a shift in emphasis, recognising the vital role played by social interventions in improving the functional outcomes that matter to service users including access to housing, occupation, leisure facilities and the support of family and friends. In conclusion, rehabilitation is framed within a model of personal recovery in which the target of intervention is to boost hope and help the individual find a meaning to life, living well regardless of enduring symptoms.

Alternative to supply of health services in physical medicine and rehabilitation: From mobile team to home hospitalization

In France, the notion of care pathway is enshrined in the circular of March, 2012 relative to the organization of care for patients’ victim of stroke. The rehabilitation-reinsertion mobile team of the pole Saint-Helier (EM2R) was created in 2012 in this context, with support from the Regional Health Agency of Brittany. The main mission of this newly created team is to implement the necessary devices to facilitate the home returning of people hospitalized after a neurological event or maintain home people with neurological disorders (more than 200 coverage a year). The neurodegenerative diseases plan of 2014–2019 points, especially in its 15th measure, that we shall remove all things slowing down the hospital care access at home for people with neurodegenerative diseases and this no matter where they live. And this is done mainly through mobile teams and home medical care (HAD in France) activities. In coherence with the activities recently developed “outside the walls” by the pole Saint Helier (EM2R and telemedicine), the establishment of a HAD-SSR (home medical care of rehabilitation care), further consolidated the healthcare pathway for people with disabilities.This activity has been developing since September, 2017 in relation with the HAD 35 and two rehabilitation centers which provide reeducation professionals’. 15 patients have already been cared, mostly persons with stroke. The aim is to ensure a global, coordinated and specialized care by bringing to patients’ home a variety of expertise in the field of rehabilitation: doctors of physical medicine and rehabilitation, physiotherapists, occupational therapists, speech therapists, neuropsychologists… and to propose an additional alternative to hospitalization in rehabilitation care when the situation permits it in the healthcare pathway of people with disabilities.

Labour market marginalisation in obsessive-compulsive disorder: a nationwide register-based sibling control study.

The impact of obsessive-compulsive disorder (OCD) on objective indicators of labour market marginalisation has not been quantified. Linking various Swedish national registers, we estimated the risk of three labour market marginalisation outcomes (receipt of newly granted disability pension, long-term sickness absence and long-term unemployment) in individuals diagnosed with OCD between 2001 and 2013 who were between 16 and 64 years old at the date of the first OCD diagnosis (n = 16 267), compared with matched general population controls (n = 157 176). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression models, adjusting for a number of covariates (e.g. somatic disorders) and stratifying by sex. To adjust for potential familial confounders, we further analysed data from 7905 families that included full siblings discordant for OCD. Patients were more likely to receive at least one outcome of interest [adjusted HR = 3.63 (95% CI 3.53-3.74)], including disability pension [adjusted HR = 16.36 (95% CI 15.34-17.45)], being on long-term sickness absence [adjusted HR = 3.07 (95% CI 2.95-3.19)] and being on long-term unemployment [adjusted HR = 1.72 (95% CI 1.63-1.82)]. Results remained similar in the adjusted sibling comparison models. Exclusion of comorbid psychiatric disorders had a minimal impact on the results. Help-seeking individuals with OCD diagnosed in specialist care experience marked difficulties to participate in the labour market. The findings emphasise the need for cooperation between policy-makers, vocational rehabilitation and mental health services in order to design and implement specific strategies aimed at improving the patients' participation in the labour market.

Institutionalizing the theme of violence within Brazil's national health system: progress and challenges.

This article reflects on the evolution of the theme of violence within the field of public health. It provides an overview of the strategies and actions developed within Brazil's Unified Health System developed in response to the country's main guiding policy on violence, the National Policy for the Reduction of Morbidity and Mortality due to Accidents and Violence, drawing on baseline documents, national and international research, data from the country's main violence information systems, and the firsthand experiences of the authors from their participation in the abovementioned actions. Violence against children and adolescents, women, and older persons have assumed a prominent position on the health agenda, while other forms of violence, such as child labor, human trafficking, homophobic and racial violence, and violence against street dwellers and people with disabilities, who are deprived of their liberty, are gradually finding their way onto the agenda. Despite undeniable progress in institutionalizing the theme, there is a need for greater investment in various areas including out-of-hospital emergency, rehabilitation, and mental health services. It is also necessary to incorporate the theme into the training and development of all of healthcare professionals and intensify continuing training to enhance capacity for detecting and reporting violence and delivering adequate care to victims.

Abstract 26: Disparities in Post-Acute Stroke Rehabilitation Services Delivery: Preliminary Findings From the COMprehensive Post-Acute Stroke Services (COMPASS) Study

Background: Timely rehabilitation after stroke is essential for optimizing recovery. Patients discharged home can experience unnecessary service delays and gaps in care. Our aim was to examine sociodemographic characteristics associated with receipt of rehabilitation services within 30 days after discharge home in stroke or transient ischemic attack (TIA) patients. Methods: COMPASS is a cluster-randomized pragmatic trial measuring the effectiveness of the COMPASS model of care vs. usual care on functional status 90 days after stroke or TIA for patients discharged home. We analyzed data from 369 participants who enrolled in the intervention arm of the COMPASS trial, completed the post-acute clinic visit within 14 days, and the 30-day call between July 2016 and May 15, 2017. For those who were referred to rehabilitation services at hospital discharge or at the clinic visit, receipt of home health (HH) and outpatient (OP) rehabilitation services was reported by the participant during the 30-day call. Sociodemographic differences between those who did and did not receive these services were evaluated. We computed adjusted odds ratios with 95% confidence intervals using logistic regression to identify factors associated with receipt of rehabilitation services. Results: Of the 369 patients, 176 (47.7%) had ascertainment of receipt of services. Of the 115 patients referred to HH, 50 (43.5%) received it, and of 85 patients referred to OP therapy, 29 (34.1%) received it. There were no statistically significant differences in sociodemographic characteristics related to receipt of HH, but non-whites were less likely (3 of 20, or 15%) than whites (25 of 64, 34.9%) to receive OP therapy. After adjustment for NIHSS, ambulatory status at hospital admission, and age, non-white participants had a 78% decreased odds (OR 0.22; 95% CI 0.05, 0.95; p=0.04) of receiving OP therapy. Conclusion: These findings indicate that a significant gap exists between referral to and receipt of recommended post-acute stroke rehabilitation services. In addition, despite the small sample size, our results suggest that there may be a disparity in receipt of OP therapy for non-white patients relative to white patients.

Factors Impacting Discharge Destination From Acute Care for Patients With Traumatic Brain Injury: A Systematic Review

Purpose: The purpose of this systematic review was to identify factors likely to impact discharge destination from acute care in patients with a traumatic brain injury (TBI). Methods: PubMed, CINAHL, Web of Science, Scopus, and ProQuest databases were systematically searched in November 2016 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Inclusion criteria consisted of patients diagnosed with TBI in the acute care setting, descriptive and quantitative factors impacting discharge destination, and publishing dates from 2007 to 2016. Results: Nine articles were included in this review and demonstrated good validity determined by the Evidence Based Library and Information Practice Critical Appraisal Checklist. Findings suggest that increased length of stay, high injury severity, and older age have the greatest effect on discharge destination. These factors increased the likelihood of discharge to post–acute care, including settings such as skilled nursing, inpatient rehabilitation, outpatient rehabilitation, or home health services. Conclusion: This review presents quantitative information related to factors likely to impact the corresponding discharge destination for patients with TBI. Clinically, professionals may consider this information when determining discharge destination for a patient with TBI following an acute care hospital stay.

Criminal Behavior among the Elderly: A Look into What People Think about This Emerging Topic

The elderly population is growing fast. With this changing demographic fact we can expect to see overall crime rates among the elderly growing right along with it. This study explored people’s knowledge about elderly crime and their perceptions about elderly offenders. Survey data were collected from 229 respondents living in Southern California. Statistical analyses on the key variables revealed a number of significant group differences in regard to age F(7, 221) = 2.15, p = 0.039, and ethnicity F(5, 223) = 2.60, p = 0.026. The data revealed that most of the respondents believe that elderly crime is going to get worse over time (58.5%) and that white-collar crimes were the biggest problem (44.5%). Male respondents (M = 1.80, SD = 3.83) on average knew more elderly offenders than female respondents (M = 0.99, SD = 2.39). Respondents from all ages tended to believe that older people were less likely to commit street crimes but were about as likely to commit white-collar crimes as younger people. There also appears to be a pattern of increasing drug use and drug abuse among both elderly men and women. Increasing problems with criminal offending among the elderly are going to have major implications across different social systems and institutions, such as political, economic, and legal systems, corrections, rehabilitation, and medical and mental health services.