Rehabilitation Literature Research Articles

Clinical decision rules, spinal pain classification and prediction of treatment outcome: A discussion of recent reports in the rehabilitation literature

Clinical decision rules are an increasingly common presence in the biomedical literature and represent one strategy of enhancing clinical-decision making with the goal of improving the efficiency and effectiveness of healthcare delivery. In the context of rehabilitation research, clinical decision rules have been predominantly aimed at classifying patients by predicting their treatment response to specific therapies. Traditionally, recommendations for developing clinical decision rules propose a multistep process (derivation, validation, impact analysis) using defined methodology. Research efforts aimed at developing a “diagnosis-based clinical decision rule” have departed from this convention. Recent publications in this line of research have used the modified terminology “diagnosis-based clinical decision guide.” Modifications to terminology and methodology surrounding clinical decision rules can make it more difficult for clinicians to recognize the level of evidence associated with a decision rule and understand how this evidence should be implemented to inform patient care. We provide a brief overview of clinical decision rule development in the context of the rehabilitation literature and two specific papers recently published in Chiropractic and Manual Therapies.

Oral Rehabilitation Considerations for Partially Edentulous Periodontal Patients

Traditional tooth-supported and implant-supported fixed/removable restorations are currently used to replace teeth lost due to periodontal disease. This article reviews the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed dental prosthesis (FDP) and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning in periodontal patients, and (c) preference by patients. To answer these issues, relevant articles were searched and critically analyzed, and their data were extracted. Data reviewed indicated that despite many advantages, implant-supported restorations have higher complication rates than tooth-supported restorations. Systematic reviews on conventional RDPs are lacking, but existing literature reviews provide limited evidence suggesting the use of RDPs with design modifications along with strict periodontal care in periodontal patients. Numerous systematic reviews on conventional FDPs and implant-supported restorations provide a moderate level of evidence favoring their survival in periodontal patients; however, for long-term success of these restorations, the patient's periodontal condition needs to be stabilized. In terms of patient preference, no restoration is superior, as they all are governed by their cost, advantages, and disadvantages. Thus, in the wake of existing weak evidence for prosthodontic rehabilitation of periodontal patients by these restorations (especially, conventional RDPs and for FDPs and SCs in implant-supported restorations), longitudinal studies with standardized treatment protocol and methodology are needed to evaluate and compare tooth-supported and implant-supported restorations in periodontal patients with regard to survival rates, cost, maintenance, and patient-centered outcomes.

Small Sample Research Designs for Evidence-Based Rehabilitation: Issues and Methods

Graham JE, Karmarkar AM, Ottenbacher KJ. Small sample research designs for evidence-based rehabilitation: issues and methods.Conventional research methods, including randomized controlled trials, are powerful techniques for determining the efficacy of interventions. These designs, however, have practical limitations when applied to many rehabilitation settings and research questions. Alternative methods are available that can supplement findings from traditional research designs and improve our ability to evaluate the effectiveness of treatments for individual patients. The focus on individual patients is an important element of evidenced-based rehabilitation. This article examines one such alternate approach: small-N research designs. Small-N designs usually focus on 10 or fewer participants whose behavior (outcomes) are measured repeatedly and compared over time. The advantages and limitations of various small-N designs are described and illustrated using 3 examples from the rehabilitation literature. The challenges and opportunities of applying small-N designs to enhance evidence-based rehabilitation are discussed.

The Exploration about Experiences of Love and Hope of People with Physical Disabilities Reviewed through Rehabilitation Literature

The Exploration about Experiences of Love and Hope of People with Physical Disabilities Reviewed through Rehabilitation Literature

Fabrication of custom made eye prosthesis for anophthalmic paediatric patients: 2 case reports

The loss of an eye is an emotional and psychological setback to the patient. After enucleation, evisceration or exenteration of the eye, the goal is to replace the missing tissues with an artificial prosthesis and restore the facial symmetry and normal appearance of the anophthalmic patient. In case of pediatric patients, the team approach of the ophthalmologist, the maxillofacial prosthodontist and pedodontist are required to rehabilitate the ocular defect, that improves not only the patient's comfort and cosmesis as well as maintain the near symmetrical bony orbital wall and eyelid development. This article illustrates two different cases of pediatric patients where the eye was surgically removed and ocular prosthesis was fabricated.Clinical Relevance to Interdisciplinary Dentistry A few case reports are mentioned in literature for prosthetic rehabilitation of anophthalmic pediatric patients. The presented case reports stressed the use of custom made eye prosthesis than prefabricated one for pediatric patients. As patient grows, the size of eye socket changes, hence periodic enlargement of the prosthesis is necessary for a growing child to aid in the normal development of the lids and the soft tissue lining the orbital bone. The custom made prosthesis can be adjusted whether needed at recall visits. The presented technique is simple and less time consuming. This technique is least depended upon artistic ability of dentist.

Program Evaluation in Family-Centred Pediatric Rehabilitation Settings

Many health care professionals in pediatric rehabilitation settings are under pressure to evaluate programs that adhere to the philosophy of family-centred service (FCS). Although there is rhetoric about the importance of upholding this philosophy in program evaluation, the literature reveals that evaluation practices within these settings are often incongruent. This article provides a brief overview of the current evaluation approaches and methods found in the pediatric rehabilitation literature and explores the applicability and potential use of a variety of participatory and collaborative evaluation approaches that, in theory, are congruent with the philosophy of FCS.

The price of uncertainty in pavement infrastructure management planning: An integer programming approach

Currently there is a true dichotomy in the pavement maintenance and rehabilitation (M&R) literature. On the one hand, there are integer programming-based models that assume that parameters are deterministically known. On the other extreme, there are stochastic models, with the most popular class being based on the theory of Markov decision processes that are able to account for various sources of uncertainties observed in the real-world. In this paper, we present an integer programming-based alternative to account for these uncertainties. A critical feature of the proposed models is that they provide – a priori – probabilistic guarantees that the prescribed M&R decisions would result in pavement condition scores that are above their critical service levels, using minimal assumptions regarding the sources of uncertainty. By construction of the models, we can easily determine the additional budget requirements when additional sources of uncertainty are considered, starting from a fully deterministic model. We have coined this additional budget requirement the price of uncertainty to distinguish from previous related work where additional budget requirements were studied due to parameter uncertainties in stochastic models. A numerical case study presents valuable insights into the price of uncertainty and shows that it can be large.

Toward an Occupational Rehabilitation Policy Community for Cancer Survivors in Singapore: A Stakeholder Perspective from the SME Employers

Cancer and return to work has been extensively studied in the Western context and yet it has not received much academic attention in Asia. This paper aims to review the current Singapore government rehabilitation initiatives in collaboration with the policy community, identify the socio-environmental barriers to implementing the existing programs for cancer survivors, highlights the demand-side of research development and illustrates the viewpoints of small and medium enterprise employers in Singapore from a recent study. Implications and future directions in developing evidence-based rehabilitation policies and initiatives for cancer survivors in Singapore and the Southeast Asian region are also discussed. A review of occupational rehabilitation literature relevant to Singapore looking at legislation, policies, initiatives and services was performed. Current state-of-art research in occupational rehabilitation from an employer perspective was also synthesized. Challenges and barriers of adopting the current rehabilitation initiatives and programs for cancer survivors exist largely due to the lack of centralized effort, clear definitions and understanding between people with disabilities, chronic illness and cancer as well as an evidence-based policy community. In addition, too much emphasis on new hiring than retaining in current services and there are no specific guidelines to help employers deal with issues when retaining employees with health history, such as workplace accommodation, appraisal, discrimination and grievance handling. Palpable blind spots in the current occupational rehabilitation system and policy were highlighted in this paper. Coupled with systemic improvements, continuous government resource support and developing an evidence-based policy community between the government, employers, healthcare professionals, industry and community partners and non-profit organizations, a positive change of the rehabilitation initiatives and services is promising.

The role of music therapy in physical rehabilitation: a systematic literature review

Physiotherapists and occupational therapists provide physical rehabilitation to maximize independence of those with compromised function. Qualified music therapists have provided interventions to assist physical rehabilitation for over 20 years, however effectiveness of interventions are often questioned. This systematic literature review explores the effectiveness of music therapy (MT) in physical rehabilitation, the function of music and the role of the music therapist. The following databases were searched: Embase, Cinahl, Allied and Complementary Medicine, Cochrane Review, PsychInfo, Eric, Medline, Dissertation s and Voices. Research articles were selected if a MT technique was applied towards physical rehabilitation of those experiencing physical impairments. Consistent positive and significant results were found in MT methods in rehabilitation of most gait parameters, and fine and gross motor functioning. The utility of music included increasing motivation, providing an external timekeeper, and providing purposeful and structured rehabilitation interventions. Music therapists were employed to engage patients through music interventions such as instrumental tuition; assess behaviours; adapt interventions according to behaviours; and to provide physical support. These findings suggest that MT enhances physical, psychological, cognitive and emotional functioning within physical rehabilitation. These findings were compared with Staum's (2000) findings in her analysis of music based physical rehabilitation literature from 1950–1999. However, further research is necessary to explore the role of MT interventions in current standard rehabilitation services.

Level of Evidence in Four Selected Rehabilitation Journals

Kocak FU, Unver B, Karatosun V. Level of evidence in four selected rehabilitation journals. Objective To investigate the methodologic quality and level of evidence of publications in major peer-reviewed general rehabilitation journals (Archives of Physical Medicine and Rehabilitation [APMR], American Journal of Physical Medicine and Rehabilitation [AJPMR], Clinical Rehabilitation [CR], and Physical Therapy [PT]). Design Descriptive, comparative. Main Outcome Measures All the articles published in AJPMR, APMR, CR, and PT between January 2005 and December 2009 were investigated. Type of study and level of evidence were recorded for all articles. Selection and assessment of articles were based on the title and abstract by 2 independent raters. Results The most frequently published reports were randomized controlled trials (12.7%), followed by cross-sectional studies (12.1%), case reports/case series (10.3%), validation studies (9.3%), cohort studies (8.9%), clinical trials (7.5%), case–control studies (6.8%), and other study types (32.4%). When the articles were classified according to their level of evidence, level I studies most frequently appeared in CR (29.1%), followed by PT (11.0%), APMR (10.5%), and AJPMR (7.1%). Most of the meta-analyses (10) were in APMR, and there were none in AJPMR. Conclusions Randomized controlled trials and meta-analyses form only a small proportion of articles published in the current rehabilitation literature. The numbers of randomized controlled trials and meta-analysis are comparable with those in other fields.

Efficacy of the use of evidence‐based algorithmic guidelines in the acute care setting for pain assessment and management in older people: a critical review of the literature

The aim of the literature review was to identify all examples of primary research using an algorithmic approach for the implementation of a clinical practice guideline relating to pain assessment and/or management within acute care, with a specific focus on older people. Critical literature review. Inclusion criteria were; English language publications within the past 13 years; peer reviewed; research conducted within a hospital; about adult inpatients. Exclusion criteria; research located outside of a hospital context; quality improvement studies; rehabilitation studies and literature reviews. Critical appraisal of the literature by using a qualitative interpretation of a translational approach. The literature was thematically mapped according to the criteria of credibility, transferability, plausibility and applicability. No clinical practice guideline was found that directly related to both assessment and management of pain using an algorithm in acute care for older people. Five studies were found to have relevance and were critically evaluated. A critique of the literature shows that an algorithmic approach is feasible for translation into a clinical practice guideline for assessment and management of pain in older people within the acute care setting. Implementation of any algorithmic approach requires consideration of the environment, culture and availability of resources.

Development and application of vision statements in river rehabilitation: the experience of Project Twin Streams, New Zealand

Vision statements are promoted within river rehabilitation literature as a tool to guide a shared perspective of an improved environmental future. This study analyses the visioning process applied in Project Twin Streams, a community–local government partnership river rehabilitation project in Waitakere City, New Zealand. The process of developing the vision statement through to its implementation was traced. This process was critiqued through discourse analysis of planning documents and transcripts from 14 semi‐structured interviews undertaken with key informants (managers and strategic planners involved in the project). Lines of questioning were informed by various discourses around sustainability and environmental management, with key attention paid to the core elements incorporated into the vision, who decides the vision, and notions of adaptivity. Community empowerment and restoration of biophysical processes are key attributes comprising the vision, providing a strong sustainability focus. While the vision was developed by a select few ‘visionaries’, the vision encapsulates the desire for broadened participation as community capacity is developed. The vision was also developed in anticipation that specific goals would change through time as biophysical, social and institutional systems change, and as the knowledge base broadens and deepens, creating a ‘living’ vision. This experience is not intended as a ‘blueprint’ for other river rehabilitation initiatives, rather it sheds critical insight as to how vision statements translate goals and ambition into action.

Measures of Knowledge and Skills for Evidence-Based Practice: A Systematic Review

Lack of knowledge and skills in seeking, evaluating, and applying evidence are barriers to evidence-based practice (EBP). The measurement of these constructs can inform educational initiatives aimed at reducing EBP barriers. The purpose of this systematic review is to provide a critical appraisal of the rehabilitation literature describing quantitative measures of EBP knowledge and skills. Measures used with occupational therapists to evaluate EBP knowledge or skills were compiled from a search of the EMBASE, MEDLINE, CINAHL, EBM Reviews, and PSYCINFO databases. Measures were evaluated using adapted criteria from the CanChild Outcome Measures Rating Form. Of the 15 measures identified, three met criteria as being adequate for the measurement of EBP knowledge and skills. Further measure development needs to address limitations of existing measures. Research to evaluate the psychometric properties of existing or novel measures of knowledge and skills related to EBP may improve their utility.

Treatment Theory, Intervention Specification, and Treatment Fidelity in Assistive Technology Outcomes Research

ABSTRACT Recent reports in the rehabilitation literature have suggested that treatment theory, intervention specification, and treatment fidelity have important implications for the design, results, and interpretation of outcomes research. At the same time, there has been relatively little discussion of how these concepts bear on the quality of assistive technology (AT) outcomes research. This article describes treatment theory, intervention specification, and treatment fidelity as interconnected facets of AT outcome studies that fundamentally affect the interpretation of their findings. The discussion of each is elucidated using case examples drawn from the AT outcomes research literature. Recommendations are offered for strengthening these components of AT outcomes research.

Periodization: current review and suggested implementation for athletic rehabilitation.

Background:Clinicians are constantly faced with the challenge of designing training programs for injured and noninjured athletes that maximize healing and optimize performance. Periodization is a concept of systematic progression—that is, resistance training programs that follow predictable patterns of change in training variables. The strength training literature is abundant with studies comparing periodization schemes on uninjured, trained, and untrained athletes. The rehabilitation literature, however, is scarce with information about how to optimally design resistance training programs based on periodization principles for injured athletes. The purpose of this review is to discuss relevant training variables and methods of periodization, as well as periodization program outcomes. A secondary purpose is to provide an anecdotal framework regarding implementation of periodization principles into rehabilitation programs.Evidence Acquisition:A Medline search from 1979 to 2009 was implemented with the keywords periodization, strength training, rehabilitation, endurance, power, hypertrophy, and resistance training with the Boolean term AND in all possible combinations in the English language. Each author also undertook independent hand searching of article references used in this review.Results:Based on the studies researched, periodized strength training regimens demonstrate improved outcomes as compared to nonperiodized programs.Conclusions:Despite the evidence in the strength training literature supporting periodization programs, there is a considerable lack of data in the rehabilitation literature about program design and successful implementation of periodization into rehabilitation programs.

Abstracts

Introduction This paper presents findings from a PhD study exploring autonomy of adults with physical disability. The plethora of descriptions of autonomy in psychological, occupational therapy and rehabilitation literature (e.g. Ryan and Deci 2000, Rogers 1982, Cardol et al 2002) detracts from the centrality of autonomy and results in difficulty incorporating it into occupational therapy practice. This paper presents a framework providing an integrated, clinically useful approach to autonomy. Methods Sixteen people were recruited, based on age, gender, impairment and living circumstances (community/residential settings). All have significant physical disability, use a wheelchair and require personal assistance for some/all self-care activities. Qualitative methods were used for data collection, including life-history narrative, diary information and extensive interview. An integrated method of analysis was used, including content analysis and bracketing. Results The ‘Choice and Autonomy Framework’ consists of five strands, including: • the meaning of autonomy • whether or not autonomy is a goal or value • the experience of autonomy • personality factors that impact autonomy • environmental features that enhance or negate autonomy. This paper will describe each strand, as derived from the research. The results suggest that, contrary to common wisdom (Hmel and Pincus 2002), autonomy is not necessarily a universal goal for people with physical disability; an understanding of the person’s own perspective will enhance person-centred practice and enable therapists to further recognise individuality of clients. It will argue that the concept of autonomy needs to be further understood and incorporated into occupational therapy practice.

Enhancing return-to-work in cancer patients, development of an intervention and design of a randomised controlled trial

BackgroundCompared to healthy controls, cancer patients have a higher risk of unemployment, which has negative social and economic impacts on the patients and on society at large. Therefore, return-to-work of cancer patients needs to be improved by way of an intervention. The objective is to describe the development and content of a work-directed intervention to enhance return-to-work in cancer patients and to explain the study design used for evaluating the effectiveness of the intervention.Development and content of the interventionThe work-directed intervention has been developed based on a systematic literature review of work-directed interventions for cancer patients, factors reported by cancer survivors as helping or hindering their return-to-work, focus group and interview data for cancer patients, health care professionals, and supervisors, and vocational rehabilitation literature. The work-directed intervention consists of: 1) 4 meetings with a nurse at the treating hospital department to start early vocational rehabilitation, 2) 1 meeting with the participant, occupational physician, and supervisor to make a return-to-work plan, and 3) letters from the treating physician to the occupational physician to enhance communication.Study design to evaluate the interventionThe treating physician or nurse recruits patients before the start of initial treatment. Patients are eligible when they have a primary diagnosis of cancer, will be treated with curative intent, are employed at the time of diagnosis, are on sick leave, and are between 18 and 60 years old. After the patients have given informed consent and have filled out a baseline questionnaire, they are randomised to either the control group or to the intervention group and receive either care as usual or the work-directed intervention, respectively. Primary outcomes are return-to-work and quality of life. The feasibility of the intervention and direct and indirect costs will be determined. Outcomes will be assessed by a questionnaire at baseline and at 6, 12, 18, and 24 months after baseline.DiscussionThis study will provide information about the effectiveness of a work-directed intervention for cancer patients. The intention is to implement the intervention in normal care if it has been shown effective.Trial registrationNTR1658

Stroke Rehabilitation 2009

The past year has continued to see growth in stroke rehabilitation literature, ranging from important insights into the basic science of stroke recovery to broader multidisciplinary aspects aimed at improving global quality of life in stroke survivors. The areas that particularly stand out include 1) new evidence on old treatment strategies in clinical rehabilitation; 2) developments in the treatment of "neglected" impairments, such as hemianopia and sensory loss; 3) evaluation of the use of technology in stroke rehabilitation; and 4) advances in neurorestorative treatments after stroke.

Parents' perspectives on occupational therapy and physical therapy goals for children with cerebral palsy

Contemporary rehabilitation literature emphasises functional goals for children with disabilities and use of a collaborative goal-setting process grounded in principles of family centred service delivery.Purpose. To explore parents' experiences with goals and goal setting.Method. We conducted a qualitative study with 11 focus groups and two individual interviews with 39 parents of children with cerebral palsy living in western Canada. We used an inductive, thematic analysis to identify prominent themes.Results. The analysis revealed five themes representing goals that were meaningful to parents and provided insight into parents' experiences with goal-setting processes in occupational and physical therapy: (1) movement as the means to functional success; (2) physical health and fitness are important therapy goals; (3) the importance of leading happy, fulfilling lives and being accepted by others; (4) ‘We can't do it all’: balancing therapy with the demands of everyday life; and (5) shifting roles and responsibilities in goal setting.Conclusions. The variability noted both in parents' desired role in goal setting and in goals important to parents highlights the importance of establishing trusting relationships with families so that family goals, values, individual circumstances, and desired level of participation in goal setting can be openly discussed.

Invited Commentary on “Allowing Intralimb Kinematic Variability During Locomotor Training Poststroke Improves Kinematic Consistency: A Subgroup Analysis From a Randomized Clinical Trial”

We congratulate Lewek and colleagues1 on this contribution to PTJ and the rehabilitation literature. Their work provokes consideration of a timeless question: What is the goal of gait rehabilitation? To walk faster—regardless of the locomotor strategy? Or to walk better? Of course, these ruminations beg the question: What is “better”? Moreover, is it even possible to change the fundamental locomotor pattern in people poststroke? The research by Lewek et al inspires some reflection on the remaining unanswered questions and raises a few points of possible alternative interpretation. Does their measure of intralimb coordination fully capture the intended construct? How certain can we be that the participants in the study actually did change their fundamental motor patterns following rehabilitation? How certain can we be that this change, if present, represents a positive adaptation? And, finally, should this adaptation be attributed to the presence of variability during manual training? The current environment for neurorehabilitation research and practice is unparalleled in history. Contemporary basic and clinical research reveal tremendous potential for plasticity in the adult nervous system following central nervous system injuries, including stroke, spinal cord injury, traumatic brain injury, and even degenerative conditions such as Parkinson disease or multiple sclerosis. Our knowledge of biomechanics and neuromotor control as it relates to pathologic movement …