Rehabilitation Providers Research Articles

Ethical issues and the patient-provider relationship.

In enabling disabled persons to gain increased function and independence, rehabilitation practitioners try to emphasize the patient's goals by providing the patient with some control over the process. As the patient enters the active rehabilitation phase, the patient actively becomes involved with the design of the treatment plan. If the patient does not fully participate in this plan, his/her motivation may be questioned. Rehabilitation professionals prefer patients who comply with the original treatment plan. Conflicts arise when patients do not comply, and the war between patient autonomy and medical paternalism ensues. When the disabled person becomes an outpatient, we must learn to measure the quality of life, not just the functional outcome. Rehabilitation professionals have become masters of inpatient rehabilitation but are less prepared to facilitate comprehensive rehabilitation care in the outpatient setting. Outpatient rehabilitation also needs to measure community reintegration. In the continuum of chronic disability, the care-giver and the disabled person develop an intermittent interdependence with an alternating relationship between autonomy and paternalism. Mutal respect such as that experienced in friendship provides a useful model for this idealized patient-care enabler team. To understand more of the essence of the disabled person's life is the responsibility of the rehabilitation provider.

EXPERIENCING OCCUPATIONAL REHABILITATION IN NSW: NON‐ENGLISH SPEAKING BACKGROUND WOMEN'S VIEWS

Research suggests that work‐related disabilities suffered by women from non‐English speaking backgrounds (NESB) are disproportionate to their representation in the population. This paper presents data from a preliminary investigation into the experiences of work‐injured NESB women in the NSW workers' compensation system since 1987. It argues that NESB women are, and perceive themselves to be, disadvantaged by the present workers' compensation system particularly in regards to occupational rehabilitation. This is largely because the higher rates of chronic work‐related injury make the rehabilitation of NESB women less cost effective for rehabilitation providers. As a result both the quality of life and future productivity of these women are substantially degraded. The article concludes that changes at the organisational level, including improved data collection are required in order to meet the needs of this group of high injury‐risk workers more adequately and more equitably.

Current perceptions of rehabilitation professionals towards mild traumatic brain injury

There has been long-standing controversy in the medical literature and increasing interest within the rehabilitation field in mild traumatic brain injury and postconcussion syndrome. The Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine conducted an opinion survey to analyze the perceptions of rehabilitation professionals towards patient's with these problems. The survey initially compared response patterns of rehabilitation personnel to two earlier identical surveys made with a group of neurosurgeons and a group of neuropsychologists. As a group, rehabilitation professionals tend to have perceptions of mild traumatic brain injury that are similar to those of neuropsychologists. The survey also included a group of questions developed to analyze specific issues among rehabilitation professionals related to symptomatology, persistence, and treatment. The most salient findings concluded that rehabilitation providers: (1) want a grading system associated with the term to designate injury severity, symptom severity, and level of functional impairment; (2) most frequently use neuropsychologists in assessment and treatment of these patients; (3) report cognitive deficits as the most common symptom, followed by irritability and somatic complaints; (4) when medications are used, most frequently use antidepressants; (5) typically follow these patients anywhere from six to 18 months postinjury; and (6) report that most patients make a complete functional recovery, though there is a substantial proportion (about 25%) who do not. Implications drawn from the survey include that there is a need to better define the term and its associated features and that there is a substantial group of patients who remain at least partially functionally disabled and present a major challenge to the rehabilitation community.

DISCUSSING CARDIOPULMONARY RESUSCITATION WITH ELDERLY REHABILITATION PATIENTS

Studies have demonstrated that most elderly persons who undergo cardiopulmonary resuscitation do not survive to hospital discharge. Because resuscitation efforts among elderly patients may fail either to restore hemodynamic stability or the patient's prearrest functional levels, ethical arguments as well as regulatory standards have urged the involvement of patients and their families in deciding about the advisedness of cardiopulmonary resuscitation. This article examines various ethical dimensions of conducting do-not-resuscitate discussions with competent, elderly persons in acute rehabilitation environments. Viewpoints that seek to excuse or resist do not resuscitate discussions among elderly rehabilitation consumers will be discussed as well as programmatic or psychological factors that appear to bolster such positions. These arguments, however, will be shown to be inferior to others that urge rehabilitation providers to engage their patients in frank and sincere discussions regarding their resuscitation status in the event of arrest.

Learned resourcefulness as a moderator of burnout in a sample of rehabilitation providers.

Learned resourcefulness as a moderator of burnout in a sample of rehabilitation providers.

Learned resourcefulness as a moderator of burnout in a sample of rehabilitation providers.

Learned resourcefulness as a moderator of burnout in a sample of rehabilitation providers.

Learned resourcefulness as a moderator of burnout in a sample of rehabilitation providers.

Learned resourcefulness as a moderator of burnout in a sample of rehabilitation providers.

Applying psychometric criteria to functional assessment in medical rehabilitation: I. Exploring unidimensionality.

While rehabilitation providers are facing increasing pressure to document treatment outcomes, critics have warned against the inappropriate use of ordinal functional assessment data in arithmetic operations. Two salient criticisms concern the combination of items representing multidimensional abilities into a single total score, and the indeterminate distances between hierarchical functional assessment scale categories. In this initial study, the factor structure of the Patient Evaluation and Conference System (PECS) was studied to assess the potential for unidimensional measurement. Factor analysis of a multidiagnostic dataset (n = 3,564) yielded eight factors accounting for 60% of the variance among 68 PECS items. The factors indicate that several unidimensional measures may underlie the PECS. These factors are delineated, and further studies of unidimensionality and additivity are recommended.

Standards for Providers of Occupational Rehabilitation under Workcare

Standards for Providers of Occupational Rehabilitation under Workcare

Workers' Compensation Rehabilitation in Florida: A Survey of Providers

This article reports results from a survey of registered workers' compensation rehabilitation providers in Florida on eight provider activities: (a) accurately representing themselves and their business interests to clients, (b) delivering testimony before workers' compensation judges that is accurate and unbiased, (c) accurately representing client capabilities and limitations to employers, (d) placing clients in positions not likely to result in reinjury, (e) delivering only services they are professionally qualified to deliver, (f) documenting any lack of client cooperation with rehabilitation services, (g) recommending retraining when necessary for successful placement, and (h) bi1llng only for services actually provided. Responses were analyzed for providers as a whole and also in relation to educational background, certification, and years of Florida workers' compensation rehabilitation experience. Results indicated that providers see aIl of the above as occurring with regularity, with documentation of lack of client cooperation receiving the 'highest rating for extent of occurrence and recommendation for retaining the lowest. Years of experience was not associated with differing perceptions, but providers with credentials in rehabilitation counseling rated some of the above activities as occurring with less frequency than providers without such background.

Marketing Physiotherapy Services

Marketing is now a vital issue for all sectors of the physiotherapy profession. Changing public attitudes to health care, increasing competition from many quarters, advances in medical science and progressive deregulation of the profession are some of the trends necessitating a marketing orientation. Marketing is essentially about the management of the relationship between physiotherapists and their clients, where clients may be patients, doctors, employers, rehabilitation providers or others. Marketing enables physiotherapists to increase their understanding of clients' needs and to use this information to improve the quality, delivery and value of their product. Marketing of physiotherapy services offers important benefits to the community, to those who refer patients to physiotherapists, to individual practitioners and to the profession itself.