Rehabilitation Providers Research Articles

Complexity and Fractal Dynamics of Gait in Treadmill Ambulation: Implications for Rehabilitation Providers

Evidence is emerging that treadmill training for rehabilitative purposes may constrain the locomotor system and alter gait dynamics in ways that mimic pathological states. The objective of this study was to examine if complexity and fractal dynamics of inter-stride gait parameters differ between overground and treadmill ambulation. We hypothesized that walking on a treadmill would induce less complex and less self-similar (i.e., more random) gait dynamics.

Benefits and Challenges of Delivering Tele-rehabilitation Services to Rural Veterans.

Veterans residing in underserved rural areas face many barriers to accessing high-quality rehabilitation services. This article describes the benefits and challenges of using technology for delivery of rehabilitation services to rural Veterans using TeleHOME, an innovative tele-rehabilitation program. TeleHOME enables rehabilitation providers to remotely assess the Veteran's functional abilities and needs in his or her own home where these tasks must be performed. This technology increases the ability of all team members to contribute to interdisciplinary care, but also requires greater levels of team integration. One month after the completion of the TeleHOME project, we met with clinicians to discuss their perceptions of whether and how use of the technology affected interdisciplinary care processes, and what approaches were used to meet team-based goals. TeleHOME can improve access to rehabilitation services for rural Veterans, but will also bring about novel integrative care processes that may improve the effectiveness of such services. Recommendations to overcome challenges to optimize the implementation and delivery of TeleHOME services as well as to better inform clinicians working with rural Veterans are discussed.

Perspectives on Postural Control Dysfunction to Inform Future Research: A Delphi Study for Children With Cerebral Palsy

ObjectiveTo identify whether consensus can be achieved in how clinicians and researchers define, describe, assess, and treat postural control dysfunction in children with cerebral palsy (CP). DesignDelphi study with 3 iterative rounds. SettingElectronic survey. ParticipantsResearchers and/or clinicians (N=43) from 7 countries with a mean ± SD of 20±11 years of experience working with children with CP participated. Participants included authors of published works on postural control in CP (identified from a recent systematic review), members of the Australasian Academy of CP and Developmental Medicine, and 2 major Australian rehabilitation providers. InterventionsNot applicable. Main Outcome MeasuresThe Delphi study consisted of 3 iterative rounds of surveys. In Round 1, respondents answered open-ended questions regarding their views on (1) definition items for postural control, (2) theoretical frameworks, (3) methods for assessment, and (4) interventions for postural control dysfunction in children with CP. Rounds 2 and 3 were made up of items generated by participants in Round 1 and combined with items identified from the literature. Participants indicated their level of agreement for each item on a 7-point Likert scale. Threshold for consensus was ≥85% agreement. ResultsOf 306 items generated, 174 reached consensus by Round 3. Most postural control definition items (90%) achieved consensus. Two theoretical frameworks (14%) reached consensus. Less than half (42%) of assessment items reached consensus. More individual assessment items (89%) reached consensus than multi-item tools (4%). Just over half (61%) of the items generated for interventions reached consensus. ConclusionConsensus was achieved for a postural control definition. However, substantial research is needed to establish a comprehensive, postural control–specific framework and suite of assessments. These would provide a foundation to improve intervention selection and dosage.

"It Is an Eye-Opener That There Is a Relationship between Rehabilitation and HIV": Perspectives of Physiotherapists and Occupational Therapists in Kenya and Zambia on the Role of Rehabilitation with Adults and Children Living with HIV.

Purpose: To present the perspectives of rehabilitation providers-physiotherapists and occupational therapists-in Kenya and Zambia on the role of rehabilitation in the care of adults and children living with HIV. Methods: This qualitative, interpretivist study was part of a broader project to adapt a Canadian e-module on HIV-related disability for rehabilitation providers in Sub-Saharan Africa (SSA). Focus groups, demographic questionnaires, and knowledge-attitude-belief surveys were conducted with rehabilitation providers in Kenya and Zambia. Focus group data were analyzed inductively using an iterative content analysis. Results: Sixty-three rehabilitation providers (52 physiotherapists, 11 occupational therapists) participated in 10 focus groups in Nyanza Province, Kenya, and Lusaka, Zambia. The participants described the role of rehabilitation in HIV care in terms of missed opportunities related to (1) HIV disclosure; (2) inter-professional and inter-sectoral collaboration; (3) community-based rehabilitation; (4) training for rehabilitation providers; (5) pediatric rehabilitation; and (6) the connections among disability, HIV, and poverty. Conclusions: The results point to the need for HIV policy and practice leaders to develop new models of care that recognize the crucial role of rehabilitation in the long-term management of HIV to address the shifting needs of the 25 million people living longer with HIV in SSA.

Rehabilitation Providers' Perspectives of Patient Engagement in Postacute Care: A Social–Ecological Approach

Abstract Date Presented 4/8/2016 The purpose of this presentation is to identify barriers and facilitators to patient engagement in postacute care from the perspective of rehabilitation providers to inform providers and consumers about the different influential factors on patient engagement in health care. Primary Author and Speaker: Carin Wong Contributing Authors: Natalie Leland, Heather Gillies, Paul Nash

General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care.

BackgroundIn Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD).MethodA cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman’s correlation, and multiple ordered logistic regressions were performed.ResultsOverall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education on road traffic crash injury management.ConclusionThis study has enhanced understanding of the knowledge skills and attitudes of GPs towards road traffic crash injury care in Australia, and has identified areas for further education and training. If delivered, this training has the potential to reduce unnecessary imaging for WAD and optimise the early referral of patients at risk of delayed recovery following a road traffic crash.

Model Programs to Address Obesity and Cardiometabolic Disease: Interventions for Suboptimal Nutrition and Sedentary Lifestyles

Problems posed by obesity-related endocrine diseases embody a national health crisis. Caloric excess and sedentary lifestyle from which they develop also pose significant challenges for rehabilitation providers. Almost two thirds of the U.S. population are currently overweight or obese, a number that has increased by >10% within the last decade and is expected to grow. An overweight body habitus is strongly associated with clinical hazards, including cardiometabolic syndrome, diabetes hypertension, and coronary artery disease. The component health risks of the cardiometabolic syndrome include coalescing of risk factors that predict a health calamity unless effective interventions can be developed and widely adopted. Obesity by itself is now considered an American Diabetes Association–qualified disability, but it is also disturbingly prevalent in other physical disability groupings of adults and children. This monograph describes successes of the Diabetes Prevention Program (DPP), a National Institutes of Health multisite randomized controlled trial that reported significant weight reduction and a 58% decreased incidence of type-2 diabetes accompanying 1 year of structured lifestyle intervention. This treatment benefit (1) exceeded that of metformin pharmacotherapy, (2) was so powerful that the trial was closed before reaching endpoints, and (3) was judged cost-effective for the patient and society. The DPP roadmap incorporating physical activity, diet, and behavioral approaches has been widely adapted to specific community, faith, racial, ethnic, school, and national populations with excellent outcomes success. The lockstep physical activity approach, activity prescription, and long-term success of the program are described and compared with other programs to illustrate effective countermeasures for the pandemics of obesity and obesity-related cardioendocrine disease. We will illustrate adaptation of the DPP for a cohort of persons with disability from spinal cord injury and the benefits observed.

Cardiac Rehabilitation After Complex Procedures

Purpose of Review The population of patients with congestive heart failure is increasing at a steady rate. This increase is leading to a parallel increase in patients seeking care from rehabilitation providers to address a multitude of functional impairments that reduce their quality of life. Rehabilitation providers need to be aware of the common mechanical devices and what potential issues can arise with the medically complex patient who is receiving rehabilitation services.

The 2015 Nepal Earthquake(s): Lessons Learned From the Disability and Rehabilitation Sector's Preparation for, and Response to, Natural Disasters.

The frequency of natural disasters appears to be mounting at an alarming rate, and the degree to which people are surviving such traumatic events also is increasing. Postdisaster survival often triggers increases in population and individual disability-related outcomes in the form of impairments, activity limitations, and participation restrictions, all of which have an important impact on the individual, his or her family, and their community. The increase in postdisaster disability-related outcomes has provided a rationale for the increased role of the disability and rehabilitation sector's involvement in emergency response, including physical therapists. A recent major earthquake that has drawn the world's attention occurred in the spring of 2015 in Nepal. The response of the local and international communities was large and significant, and although the collection of complex health and disability issues have yet to be fully resolved, there has been a series of important lessons learned from the 2015 Nepal earthquake(s). This perspective article outlines lessons learned from Nepal that can be applied to future disasters to reduce overall disability-related outcomes and more fully integrate rehabilitation in preparation and planning. First, information is presented on disasters in general, and then information is presented that focuses on the earthquake(s) in Nepal. Next, field experience in Nepal before, during, and after the earthquake is described, and actions that can and should be adopted prior to disasters as part of disability preparedness planning are examined. Then, the emerging roles of rehabilitation providers such as physical therapists during the immediate and postdisaster recovery phases are discussed. Finally, approaches are suggested that can be adopted to "build back better" for, and with, people with disabilities in postdisaster settings such as Nepal.

Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury.

To describe the prevalence of postdischarge outpatient rehabilitation among Medicaid-insured children hospitalized with a traumatic brain injury (TBI) and to identify factors associated with receipt of services. Retrospective cohort of children <21 years, hospitalized for a TBI between 2007 and 2012, from a national Medicaid claims database. Outcome measures were receipt of outpatient rehabilitation (physical, occupational, or speech therapies or physician visits to a rehabilitation provider) 1 and 3 years after discharge. Multivariable regression analyses determined the association of demographic variables, injury severity, and receipt of inpatient services with receipt of outpatient rehabilitation at 1 and 3 years. The mean number of services was compared between racial/ethnic groups. Among 9361 children, only 29% received any type of outpatient rehabilitation therapy during the first year after injury, although 62% sustained a moderate to severe TBI. The proportion of children receiving outpatient therapies declined to 12% in the second and third years. The most important predictor of receipt of outpatient rehabilitation was receipt of inpatient therapies or consultation with a rehabilitation physician during acute care. Compared with children of other racial/ethnic groups, Hispanic children had lower rates of receipt of outpatient speech therapy. Hospitalized children who received inpatient assessment of rehabilitation needs were more likely to continue outpatient rehabilitation care. Hispanic children with TBI were less likely than non-Hispanics to receive speech therapy. Interventions to increase inpatient rehabilitation during acute care might increase outpatient rehabilitation and improve outcomes for all children.

Wellness for life: A pilot of an interprofessional intervention to address metabolic syndrome in adults with serious mental illnesses.

This paper evaluates a pilot multidisciplinary intervention intended to increase health-promoting behaviors and reduce the negative effects of metabolic syndrome disorders among persons with serious mental illnesses. Exercise, nutritional counseling, health literacy education, and peer wellness coaching were provided by allied health professionals and students. Participants with serious mental illnesses were recruited from partial hospitalization and supported housing programs. Initially, there were 77 participants, with 64 completing the study measures. A single-group, pre-post design was used. They participated in an 8-week program (3 hr each week). Individuals set their own personal health goals and received the interprofessional set of allied health interventions. Body weight, body mass index (BMI), blood pressure, and several measures of physical strength and flexibility were collected. Paired t tests evaluate the statistical significance of possible changes. Average blood pressure decreased. Waist circumference decreased. Participants improved on measures of strength and flexibility as measured by the functional reach test, the half sit-up test, and the sit-to-stand test. Participants reported increased readiness to exercise and make dietary changes. Significant improvements in metabolic syndrome risk factors, physical strength, and flexibility were found. Next steps include a longer intervention likely to further reduce metabolic syndrome risk factors. Future studies should include a comparison intervention group and a follow-up to see if gains are maintained. The study highlights the potential utility of psychiatric rehabilitation providers collaborating with other allied health practitioners to promote overall health. (PsycINFO Database Record

A New Framework and Practice Center for Adapting, Translating, and Scaling Evidence-Based Health/Wellness Programs for People With Disabilities.

Supporting the transition of people with newly acquired and existing disability from rehabilitation into community-based health/wellness programs, services, and venues requires rehabilitation professionals to build evidence by capturing successful strategies at the local level, finding innovative ways to translate successful practices to other communities, and ultimately to upgrade and maintain their applicability and currency for future scale-up. This article describes a knowledge-to-practice framework housed in a national resource and practice center that will support therapists and other rehabilitation professionals in building and maintaining a database of successful health/wellness guidelines, recommendations, and adaptations to promote community health inclusion for people with disabilities. A framework was developed in the National Center on Health, Physical Activity and Disability (NCHPAD) to systematically build and advance the evidence base of health/wellness programs, practices, and services applicable to people with disabilities. N-KATS (NCHPAD Knowledge Adaptation, Translation, and Scale-up) has 4 sequencing strategies: strategy 1-new evidence- and practice-based knowledge is collected and adapted for the local context (ie, community); strategy 2-customized resources are effectively disseminated to key stakeholders including rehabilitation professionals with appropriate training tools; strategy 3-NCHPAD staff serve as facilitators assisting key stakeholders in implementing recommendations; strategy 4-successful elements of practice (eg, guideline, recommendation, adaptation) are archived and scaled to other rehabilitation providers. The N-KATS framework supports the role of rehabilitation professionals as knowledge brokers, facilitators, and users in a collaborative, dynamic structure that will grow and be sustained over time through the NCHPAD.Video abstract available for additional insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A130).

An evaluation framework to measure usability of Assistive Technology at workplace: A demonstration study

BACKGROUND:Assistive Technology (AT) devices are vastly used by individuals with disabilities in their workplace to accommodate their disability and enable productivity. However, barriers and gaps with integration and use of AT in workplace are well documented in literature. OBJECTIVE:This research study demonstrates the application of a systematic evaluation framework, the Usability Scale for Assistive Technology-Workplace, to examine the usability of work-related AT devices for employees, employers, and vocational rehabilitation providers to identify gaps and optimize the implementation of AT. The framework is fundamentally driven by the employee’s vocational context and range of work-related tasks, and comprehensively accounts AT devices and related accommodations that address each task. METHODS:Five employees with different motor and sensory impairments are presented as case scenarios to highlight the application of the evaluation framework. RESULTS:By using the evaluation framework, it was found that the employees in general were successful in the use of AT devices and rated their productivity as high. However, some unique as well as common barriers were also reported and pertained to technical knowledge and training, reliability and compatibility of the AT devices, and limitations in accessibility. CONCLUSION:Future research is required to derive and establish a standardized evaluation tool using the framework.

Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury: Differences by Language and Insurance Status.

The objective of this study was to explore associations between English proficiency, insurance status, outpatient rehabilitation service availability, and travel time for children with traumatic brain injury. The authors used an ecologic cross-sectional design. Data were analyzed from a cohort of 82 children with moderate to severe traumatic brain injury and rehabilitation providers in Washington State. Main measures included availability and travel time to services. Less than 20% of providers accepted children with Medicaid and provided language interpretation. Mental health services were most limited. Adjusted for median household income, multilingual service availability was lowest in counties with greater language diversity; for every 10% increase in persons older than 5 yrs speaking a language other than English at home, there was a 34% decrease in availability of multilingual services (prevalence ratio, 0.66; 95% confidence interval, 0.48-0.90). Adjusted for education and Medicaid status, children from Spanish-speaking families had significantly longer travel times to services (mean, 16 additional minutes to mental health; 9 to other therapies). Children in households with limited English proficiency and Medicaid faced significant barriers in availability and proximity of outpatient rehabilitation services. Innovative service strategies are needed to equitably improve availability of rehabilitation for children with traumatic brain injury. Similar studies in other regions will inform one's understanding of the scope of these disparities.

The New Normal of Military Orthopaedic and Rehabilitative Care.

The New Normal of Military Orthopaedic and Rehabilitative Care.

Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury.

Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury.

Fall prevention in patients with neurological disorders, as viewed by rehabilitation provider

Fall prevention in patients with neurological disorders, as viewed by rehabilitation provider

Discharge from the acute hospital: trauma patients' perceptions of care.

Objective The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community. Methods The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18-64 years with lower limb trauma. Thematic analysis was used to derive important themes. Results Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients' perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy. Conclusion The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of in-patient rehabilitation. What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. What does this paper add? The present large qualitative study provides information on patients' opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hospital should be considered, including the use of rehabilitation prediction tools to ensure patient involvement in decision-making and a discharge and/or follow-up coordinator to ensure patients are aware of how to access information after discharge.

Causal attributions following a cardiac event: Short- and long-term differences in health appraisals and outcomes.

This study examined attributions generated by cardiac rehabilitation patients shortly after experiencing a cardiovascular event, exploring whether attribution type was associated with health appraisals and outcomes concurrently and 21 months later. Attributions fell into three categories: controllable behavioral ones, uncontrollable biological ones, and stress-related causes. Linking attribution type to appraisals and outcomes showed that creating a behavioral attribution was beneficial in the short-term for control appraisals, but was associated with increased anxiety symptoms 21 months later. Thus, cardiac rehabilitation providers should encourage patients to maintain a future-focus that promotes perceived control over health promotion behaviors that reduce risk for recurrence.

Telemedicine: determining "critical to quality" characteristics for a healthcare service system design based on a survey of physical rehabilitation providers

Purpose: This study examines the key attributes of telemedicine from the healthcare provider's perspective and to show how telemedicine may impact healthcare service delivery. Methodology: The study was based on a review of current telemedicine/ telehealth research and the analysis of data from a survey of healthcare professionals/providers in the physical rehabilitation sector. Using a six-sigma process development approach that identified "critical-to-quality" characteristics, the study identified specific telemedicine characteristics that healthcare service providers in the physical rehabilitation sector saw as being useful and essential. Findings: Empirical data from the survey indicated the application of telemedicine technologies can assist in making the delivery of healthcare services more efficient while maintaining the same high quality of service. Contribution: This study aided in determining what specific functions and capabilities healthcare providers would prefer to see in a telemedicine enabled service system design to achieve improved cost and time savings for both the patient and the provider. In view of the specialized area from which the data was obtained, healthcare providers were interested in viewing their patients in real time, communicating with them, and gathering relevant vital signs and treatment data meant for use in emergency and daily routine notifications and consultations.