Rehabilitation Practitioners Research Articles

Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners

Aim: The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners’ perspectives on the practices that constitute high quality hip fracture rehabilitation.Methods: Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners’ perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach.Results: Seven themes emerged: objectives of care; first 72 h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration.Conclusions: Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners’ perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes.Implications for RehabilitationThis study highlights occupational and physiotherapy therapy practitioners’ perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation.While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers.Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.

Rehabilitation Counselor Competencies When Working With Hispanic/Latino Immigrant Injured Workers: A Delphi Study

Purpose:To explore and identify attitudes, knowledge, and skills rehabilitation practitioners in the private sector need when working with Hispanic/Latino immigrant injured workers.Methods:This study employed a 3-round Delphi study to obtain a consensus of 8 rehabilitation practitioners who had experience and expertise working with Hispanic/Latino injured workers in the private sector about the essential competencies working with this population.Results:Participants identified 50 main competencies as important when working with Hispanic/Latino immigrant injured workers.Conclusion:Results indicate that the development of multicultural and ethical competencies received particular attention from participants. Implications for research and practice are discussed.

Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes.

Medical professionals and laypeople alike understand the fact that people with diabetes are at increased risk for serious medical complications such as cardiovascular disease, kidney disease, peripheral neuropathy, and lower extremity amputations.1 However, I have observed that many people, including people with diabetes and the rehabilitation health providers treating them, are not aware of a large body of evidence linking diabetes with increased risk for numerous musculoskeletal impairments and complications.2 These impairments are apparent in type 1 diabetes (due to beta cell destruction, usually leading to absolute insulin deficiency) and type 2 diabetes (due to progressive loss of insulin secretion on the background of insulin resistance). The purpose of this point of view is to highlight the musculoskeletal impairments that are exacerbated, or potentially even caused, by metabolic disorders associated with diabetes. This article will focus on those musculoskeletal impairments most often encountered by physical therapists and other rehabilitation practitioners, describe the systemic condition of limited joint mobility, and briefly outline a likely mechanism for musculoskeletal impairments. Finally, the article will briefly provide clinical and research implications for those in rehabilitation working with this population. Metabolic dysfunctions clearly leave people with diabetes at high risk for developing musculoskeletal pain and impairments. In a large Danish study that compared patients with type 2 diabetes (n=951) directly with age-, sex-, and region-matched control participants (n=22,923), the patients with diabetes were 1.7 to 2.1 times more likely to report musculoskeletal pain compared with those without diabetes.3 Consistent with this high risk for musculoskeletal disorders, the group with diabetes reported high incidences of shoulder or neck pain (52%); low back pain (60%); and arm, hand, knee, or hip pain (71%).3 Furthermore, people pursuing physical therapy for musculoskeletal pain and impairments often have a secondary diagnosis of diabetes or have risk …

Is recovery possible outside the financial mainstream?

As psychiatric rehabilitation practitioners, we have solid evidence that our field's services are effective in helping people become employed, participate in social and civic life, avoid restrictive and coercive psychiatric treatment, and thrive in stable and secure community residences. Yet, hundreds of thousands of people with psychiatric disabilities do not do these things. So we must ask ourselves, to what extent is this due to their location outside the financial mainstream, and if it is, what we can do as a field to address poverty among those we serve? This editorial addresses this question: Is recovery possible outside of the financial mainstream? (PsycINFO Database Record

The impact of Professional Boundaries for Health Professionals (PBHP) training on knowledge, comfort, experience, and ethical decision-making: a longitudinal randomized controlled trial

Purpose: A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client–practitioner boundary dilemmas.Methods: In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman’s two-way analysis of variance was used to examine the trajectories over time.Results: Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ2 = 10.673, p = 0.014) and comfort (χ2 = 9.727, p = 0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ2 = 3.609, p = 0.307) or control group (χ2 = 7.800, p = 0.050). Ethical decision-making improved in the control group (χ2 = 13.188, p = 0.004) following training, however remained unchanged in the experimental group.Conclusions: The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated.Implications for RehabilitationEthical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting.In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making.Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting.Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.

HUMOR STYLES IN SOCIALLY MALADJUSTED GIRLS AND BOYS: A RESILIENCE PERSPECTIVE

Resilience-concept-driven research of humor in socially maladjusted youth has been prompted by an urgent need to redefine Poland’s crisis-ridden rehabilitation system, through embracing rehabilitative theories and practices inspired by new frameworks and related modern intervention models. The paper presents a research project aimed at encouraging rehabilitation researchers, theoreticians, and practitioners to engage with humor as a “site of resistance” that offers juveniles a springboard to achieve expected levels of social adjustment. The study aims to identify and compare humor styles in socially maladjusted girls (n1 = 56)and boys (n2 = 72). The research problem included the level (intensity) and gender-related differences in particular humor types (styles) across the juvenile sample. The research tool involved an adaption of the Humor Styles Questionnaire (HSQ). The findings suggest a greater intensity of adaptive rather than non-adaptive humor styles in both studied subsets of the sample. Furthermore, a statistically significant gender-related difference was found for self-defeating humor, with significantly higher scores in girls than in boys (p < 0.05). Although the findings do not confirm the research hypotheses conclusively, they shed light on the viability of using humor in juvenile rehabilitation and thus, encourage further systematic research in this area.

Assessing Community Functioning and Independent Living Skills of Individuals with Severe Mental Illness

Background: Community integration and participation are important predictors of successful rehabilitation and recovery in individuals with severe mental illness (SMI). However, individuals with SMI still experience considerable psychosocial barriers to meaningful participation in social, community, civic, and daily living activities. Aims: The purpose of this study was to evaluate and validate a revised version of the Independent Living Skills Survey-Self-Report (ILSS-SR), the R-ILSS-SR, for use by rehabilitation researchers and practitioners in psychiatric rehabilitation settings. Method: One hundred ninety-four individuals with SMI were recruited from four mental health agencies in two states in the Midwestern and Southern United States. Factorial validity of the R-ILSS-SR was evaluated using exploratory factor analysis (EFA). Findings: Principal components analysis of the R-ILSS-SR yielded a four-factor measurement structure (self-care, home maintenance, and health maintenance; meaningful activity/work; transportation; and job maintenance). R-ILSS-SR subscales also correlated with known predictors of community participation in the expected directions. Conclusions: This study validated the R-ILSS-SR as a measure of community participation in a sample of adults with SMI. The ILSS-SR is the only measure of community participation specifically developed and validated for adults with SMI. Given that community participation is an integral aspect of recovery for adults with SMI, the R-ILSS-SR can be used to assess participation in psychiatric rehabilitation research and practice.

Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care

ABSTRACTAims: Occupational and physical therapy in post-acute care (PAC) has reached the point where quality indicators for hip fracture are needed. This study characterizes the practitioners' prioritized hip fracture rehabilitation practices, which can guide future quality improvement initiatives. Methods: Ninety-two practitioners participating in a parent mixed methods study were asked to rank a series of evidence-based best practices across five clinical domains (assessment, intervention, discharge planning, caregiver training, and patient education). Results: Prioritized practices reflected patient–practitioner collaboration, facilitating an effective discharge, and preventing adverse events. The highest endorsed care processes include: developing meaningful goals with patient input (84%) in assessment, using assistive devices in intervention (75%) and patient education (65%), engaging the patient and caregiver (50%) in discharge planning, and fall prevention (60%) in caregiver education. Conclusions: Practitioners identified key care priorities. This study lays the foundation for future work evaluating the extent to which these practices are delivered in PAC.

A cross-sectional study investigating impressions and opinions of medical rehabilitation professionals on the effectiveness of the Ponseti method for treatment of clubfoot in Harare, Zimbabwe.

BackgroundThe Ponseti method of managing clubfoot was introduced in Zimbabwe in 2011. This followed massive training of health workers such as medical rehabilitation practitioners through a programme called the Zimbabwe Sustainable Clubfoot Programme. Today, the Ponseti method is the technique of choice for managing clubfoot in hospitals. However, since then, there is no published evidence documenting the efficacy and the relevance of the technique especially comparing to previously used methods. This is a significant shortcoming if sustainability issues are to be considered. Therefore, this study was designed to investigate the impressions and opinions of medical rehabilitation practitioners on the method in terms of its effectiveness, perceived challenges and possible recommendations for improvement of the technique application in their setting.MethodsA descriptive cross-sectional study was conducted targeting medical rehabilitation practitioners previously trained on the method and working in public or private clinics that offer clubfoot management in Harare. A questionnaire was self-administered to 41 participants who volunteered to participate in the study. Data from open-ended questions was analysed thematically. Statistica version 12 was used for analysis for quantitative data.ResultsThe Ponseti method was perceived as an effective method in the treatment of children with clubfoot by all the participants. All the participants 41 (100 %) felt that the method was relevant because of better clinical outcomes. Amongst challenges faced when using Ponseti method, 25 (61 %) participants agreed that caregivers to the children with clubfoot were not compliant to treatment. A total of 22 (54 %) participants felt that lack of adequate insight by the caregivers of this new method was a challenge which hinder progress in treating clubfoot.ConclusionsThe medical rehabilitation professionals in Harare, Zimbabwe trained to use the Ponseti technique for the management of clubfoot, perceived the method as an effective method resulting in better clinical outcome than previous methods. This probably highlights the need to continue training medical rehabilitation professionals so that there is widespread use of the technique in the country. However, there is need to increase awareness of the method among caregivers to improve compliance, which is key to successful rehabilitation of the clubfoot.

Critique of Home Constraint-Induced Movement Therapy Trial: Constraint-Induced Movement Therapy Study Prompts the Need for Further Research.

Enhancing recovery from stroke with effective rehabilitation interventions remains an elusive goal.1 Although intensive rehabilitation therapies such as constraint-induced movement therapy (CIMT) show promise,2 the intervention has not been deployed in routine clinical practice. Slow uptake of CIMT in routine clinical practice has been attributed to its large demand on professional resources and patient compliance, as well as the costs associated with delivering high doses of therapy in a relatively short time. To remediate these limitations, there have been calls for modified versions of CIMT that are less intensive, lower cost, and easier to deliver.3 Recent work by Barzel et al4 attempted to advance the understanding of modified forms of CIMT by applying this therapy in the home setting. Home CIMT includes the basic elements of CIMT including repetitive training, transfer of activities, and constraint of the nonparetic hand. However, Home CIMT attempts to accomplish each of these goals within the individual’s home setting under the supervision of a nonprofessional coach.4 Although study participants were involved in overall goal setting for their therapeutic program, they only interacted with professional rehabilitation practitioners (Occupational or Physical Therapists) in 5 visits: 2 initial home visits to set up the program in the first week of a 4-week program and 3 additional sessions to adjust the program during the next 3 weeks. The overall goal was 40 hours of task practice with the paretic arm for a 20-day period.

Value Orientation as a Moderator on Self-stigma in People with Mental Illness

This study explores whether the self-stigma in people with mental illness is moderated by value orientation -- collectivism and individualism. A model of value orientation and self-stigmatization was depicted and tested with data collected in Taiwan, where 182 subjects voluntarily participated in the survey. The model demonstrated the ideas that collectivism thoughts alleviate self-stigma, while individualism beliefs strengthen the stigmatization process. All the hypotheses, including a measurement structure, a causal path with covariate variable and two separate moderator effects, were significantly supported. Implications of the findings for academicians and practitioners in psychiatric rehabilitation were discussed.

Diagnosis and management of urinary incontinence in older patient

Objective: To review the various causes of urinary incontinence (UI) in elderly patients and to outline a therapeutic approach to the clinical management of UI. Data sources: Online search of MEDLINE and additional references selected from the articles found during the search. Study selection: All peer-reviewed articles and review articles listed on MEDLINE published between 1966 and 2006. Key search terms included urinary incontinence, geriatric, aging, pelvic floor rehabilitation and indwelling catheter. Date extraction: Articles with clinical relevance to the geriatric population were selected based on the robustness of the study and reviews. If applicable, data from studies of healthier or younger populations was extrapolated to the elderly population examined in the reviews. Data synthesis: UI is a common occurrence among older adults treated in rehabilitation settings. The causes of UI in the elderly vary, including transient causes, established pathologic states of the urinary tract, and systemat ic multifactorial influences. Both behavioral and pharmacologic management strategies can successfully be implemented for UI, even in the frail elderly. Conclusion: UI can be effectively investigated and treated by rehabilitation practitioners by following a simple, stepwise approach.

Reflective processes of practitioners in head and neck cancer rehabilitation: a grounded theory study

Purpose: This study systematically examined how experienced Speech-Language Pathologists (SLPs) use the processes of reflection to develop knowledge relevant for practice in the context of head and neck cancer (HNC) rehabilitation.Method: In-depth, semi-structured interviews were conducted with 12 SLPs working in HNC rehabilitation in North America. Grounded theory methodology was adopted for data collection and analysis.Result: The findings inform a preliminary reflective practice model that depicts the processes of reflection used by practitioners interviewed. Nine categories of reflective processes were identified by participant SLPs in terms of the processes of reflection: ongoing questioning, experimenting through trial and error, integrating knowledge from past cases, embracing surprise, thinking out of the box, being in the moment, consulting with colleagues, putting oneself in the patients’ shoes, and discerning ethical issues. These findings provide empirical evidence that supports Schön’s theory of reflective practice and contribute to knowledge about the ways in which SLPs use processes of reflection in the context of HNC rehabilitation.Conclusion: The findings of this study have implications for how SLPs perceive and consider their role as knowledge-users and knowledge producers in their day-to-day clinical work, as well as for building capacity for reflective practice.

The Cardiac Rehabilitation Inventory: A New Method of Tailoring Patient Support.

Uptake and adherence to cardiac rehabilitation (CR) are low, and a contributing factor to this may be the practical difficulties of providing a tailored CR environment suited to individual preferences and needs. The aim of this study was to develop and test a short questionnaire that CR practitioners can use to understand individual patient need and tailor support accordingly. A conceptual framework of engagement in CR was derived from a comprehensive literature review and the content analysis of semistructured interviews with 15 CR patients. The conceptual framework was used to construct the first version of the Cardiac Rehabilitation Inventory (CRI), which comprised 42 items. Responses on the CRI were measured using a 5-point Likert scale. The CRI was administered to 380 phase III and IV CR patients, and factor analysis (FA) was used to identify salient CR engagement factors. The simplest structure found using FA was three 6-item subscales that all had good levels of internal consistency (Cronbach's α) and were labeled (a) outcome anxiety, α = .726; (2) process anxiety, α = .724; and (3) autonomy, α = .653. The 3-factor CRI model was verified using confirmatory FA (CMin/df = 3.2, root-mean-square error of approximation = 0.073). Attenders were found to have higher levels of outcome anxiety than nonattenders (P < .001), and precontemplator nonattenders were found to have lower autonomy compared with attenders (P < .001). Standard multiple regression analysis indicated outcome anxiety was a strong predictor of CR intentions (r = 0.716), followed by autonomy (r = 0.110) and process anxiety (r = 0.031). The CRI is a reliable method of measuring CR outcome anxiety, process anxiety, and autonomy. These CRI measurements provide rehabilitation practitioners with valuable information that can help provide individual tailored support.

Collaborative Documentation in Mental Health: Applications to Rehabilitation Counseling

Purpose: In this article, the emerging practice of collaborative documentation (CD) in community mental health care and its applications to rehabilitation counseling were explored. CD has the potential to promote greater client empowerment, clinical transparency, and documentation efficiency and quality; however, the CD process is not well validated through rigorous research.Method: We provide a critical analysis of issues with current documentation systems, principles of creating collaborative paperwork, and the potential outcomes for rehabilitation clients, agencies, and counselors who use CD.Results: The benefits of CD for rehabilitation educators, researchers, and practitioners will be provided for implementation in rehabilitation settings.Conclusion: Rehabilitation practitioners may be increasingly exposed to CD and transparency of treatment records. CD is a developing practice that fits well with the rehabilitation counseling philosophy and the profession’s history of client inclusion in treatment planning.

Supporting the Health and Wellness of Individuals With Psychiatric Disabilities

Purpose: Psychiatric rehabilitation is recognized as a field with specialized knowledge and skills required for practice. The certified psychiatric rehabilitation practitioner (CPRP) credential, an exam-based certification process, is based on a regularly updated job task analysis that, in its most recent iteration, identified the new core competency domain of “supporting health and wellness.” This article explains the relevance of this domain to the current practice of psychiatric rehabilitation.Methods: We present a multidimensional foundation model of wellness that describes the job tasks highlighted in the newest CPRP competency domain and examines implications for rehabilitation educators and practitioners who do not hold the CPRP credential but still provide rehabilitation services to individuals with psychiatric disabilities.Results: The health and wellness competencies identified for CPRPs may not translate directly into competencies needed by service providers in other roles; however, practices that involve experiencing personal goal setting and action plan implementation, especially around wellness goals, can be included across service domains.Conclusion: Attending to the health and wellness of people with psychiatric disabilities is imperative. Rehabilitation practitioners who embrace the multidimensional foundation model of wellness can effectively provide services that are holistic and promote recovery and achievement of rehabilitation goals.

Relationships Between World Health OrganizationInternational Classification of Functioning, Disability and HealthConstructs and Participation in Adults With Severe Mental Illness

Purpose:To examine the World Health OrganizationInternational Classification of Functioning, Disability and Health(ICF) constructs as correlates of community participation of people with severe mental illnesses (SMI).Methods:Quantitative descriptive research design using multiple regression and correlational techniques was used to analyze 193 persons with SMI.Results:This study examined the unique relationships between each of the ICF constructs and participation in a series of simultaneous regression analyses. Age, schizophrenia/schizoaffective diagnosis, insight, self-care activity, social competency, and social support from friends were significant predictors of participation when compared to variables in the same ICF constructs. In addition, these significant ICF predictors of participation were entered in a hierarchical regression, and only insight, social competency, and social support from friends were found to be significant predictors of participation after controlling for the effect of other ICF variables.Conclusion:In this ICF model, insight, social competency, and social support from friends were found to be associated with participation and mediated the individual contributions of types of psychiatric disabilities and self-care activity to participation. Rehabilitation practitioners should focus on interventions that increase these factors for people with SMI. Rehabilitation researchers should continue to use the ICF as a model from which to predict participation in specific life activities (e.g., employment) for people with SMI. Continued application and validation of the ICF model could positively impact recovery-oriented outcomes for individuals with SMI.

Lessons Learned from a Major Near Miss: A Case Report Including Recommendations to Improve Future Patient Safety in Rehabilitation

Background: Most medical errors can be traced to system failure, but often individual providers are blamed. Few articles in the allied health literature address the topic of error or the analysis of error using a system approach. Purpose: This case report analysis illustrates how both individual and system factors contribute to error in rehabilitation settings and how identification of these factors allows development of methods to improve future patient safety. Case Description: A young male was admitted to a rehabilitation hospital with residual impairments following recent surgical resection of a benign meningioma. He was treated daily by a physical therapist intern as part of a large interdisciplinary team. On separate occasions over a three week span, the patient presented with isolated calf tightness, right-sided and central chest pain, and fever with increased heart rate. Although the intern considered possible deep vein thrombosis (DVT), each symptom was attributed to other causes by the intern, supervising physical therapist, physician assistant, and/or physician (i.e. muscle fatigue, heartburn, infection). On day 22, the patient was diagnosed with DVT and pulmonary embolism (PE). This event represents a major near miss due to the potential deadly outcomes of a missed DVT/PE diagnosis. The intern retrospectively completed an analysis of the event to identify contributing system factors. Outcome of Analysis: Active failures and latent system conditions on multiple levels of the healthcare system were identified as contributors to the major near miss. Discussion: The contributing factors identified in this paper are not unique to this case, intern, or facility, and may be widespread across rehabilitation settings and practitioners. Team members can and should consider how system-wide factors contribute to their own clinical actions and decisions. Once factors are identified, strategies for reducing risk can be implemented; ultimately creating a culture of safety.

Improving the re-introduction of rescued Magellanic penguins through extended health evaluation with minimal sampling volume and material

Improving the re-introduction of rescued Magellanic penguins through extended health evaluation with minimal sampling volume and material

Opinions of occupational therapists on the positioning of vocational rehabilitation services in Gauteng Public Healthcare

INTRODUCTION: A collaborative effort to transform occupational therapist's vocational rehabilitation services in Gauteng's public healthcare was hampered by the fact that role players were unclear as to what the scope of the service should be within the various sectors and staffing levels of public healthcare. This article reports on the opinions of occupational therapists on the positioning of vocational rehabilitation services in the Gauteng Province. METHOD: A collaborative action research team launched a non-experimental descriptive inquiry within the planning phase of a larger transformative project. Data were generated through an opinion survey to capture the perspectives of occupational therapists on the potential positioning of vocational rehabilitation services in the province. The opinions of three groups of occupational therapists were collected, i.e. clinicians working in Gauteng public healthcare, experienced vocational rehabilitation practitioners from all fields of service delivery who acted as critical friends and occupational therapy academia. RESULTS: The purposive sample was composed of 307 potential respondents. A low response rate of 31% was achieved. There was a lack of consensus as to which vocational rehabilitation services occupational therapists should render in public health care. The results reflected the need to address the scope and position of vocational rehabilitation services in public health care. CONCLUSION: Positioning of vocational rehabilitation services in public health care remains a point of contention. However, the process of asking occupational therapists their opinion created awareness and directed continuous efforts to address the issues within the field of practice. Key words: occupational therapy, vocational rehabilitation services, public healthcare action research, opinion survey