Provision Of Rehabilitation Services Research Articles

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.

To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. Multicentre prospective cohort study. Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

Discourses of Blindness in Visual Impairment Rehabilitation: An Exploration of the Ideological Assumptions Embedded in Rehabilitation Practice in South Africa

ABSTRACT Rehabilitation services play an important role in the lives of persons who experience vision loss. These services provide necessary practical techniques for adjustment to visual impairment. However, there is insufficient research exploring the ways in which these services act at the level of meaning and identity. This paper summarises the findings from a study that investigated the operation of blindness discourses in rehabilitation services for adults with visual impairments in South Africa. The study posed questions concerning the meanings about blindness which are produced and reinforced in rehabilitation practice. It also considered the implications of exposure to these meanings for persons with visual impairments. Foucauldian discourse analytic reviews were conducted on digital documentary sources, as well as on data gathered through semi-structured interviews with rehabilitation service providers and service users. This paper discusses two overarching discursive practices in visual impairment rehabilitation, namely, ‘Journey discourse’ and ‘charitable discourse’. We conclude that, rather than an abstract exercise, considering the ideological assumptions embedded in rehabilitation practice is essential to uncover and address discursive systems that support the continued marginalisation of people with visual impairment.

PSYCHOSOCIAL ASPECTS OF IMPROVING THE EFFICIENCY OF REHABILITATION OF PERSONS WITH DISABILITIES IN COMMUNITY DURING WARTIME

In the article, the problem of increasing the effectiveness of rehabilitation of persons with disabilities in the community in wartime conditions is updated and substantiated at the theoretical, legal, and empirical levels. On the basis of a focus group survey, the importance and failure to fully realize the problems of rehabilitation of persons with disabilities in the community in wartime conditions were proven. It was established that according to the opinion of persons with disabilities and their parents, the problems of rehabilitation of persons with disabilities are solved to a greater extent by local authorities and local self-government bodies, social services and health care institutions, etc.; there is a need to create a permanent supportive and developmental environment in the community; there is a problem in the organization of work, employment, opportunities to get to work; a violation of the feeling of security is noted, there is a feeling of powerlessness, irritation, misunderstanding of the nearest prospects; fixed need to be listened to and heard, to regularly communicate with specialists. The foreign and Ukrainian experience of psychosocial aspects of increasing the effectiveness of rehabilitation of persons with disabilities in the community is analysed. The author's social project "Different and Equal" is proposed, aimed at improving the efficiency of providing rehabilitation services to persons with disabilities in the community in wartime conditions. The main feature of this social project is that it is maximally focused on integrating the efforts of community members, persons with disabilities and their family members to promote social adaptation, strengthening the resources of persons with disabilities to overcome the challenges and threats of war.

EvolvRehab–MoveWell telerehabilitation for stroke survivors: study protocol for a feasibility with embedded initial proof-of-concept study

IntroductionStroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb...

Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BackgroundPrimary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.MethodsA retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.ResultsThe findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.ConclusionThis study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

Needs for community-based rehabilitation services and support 12 months after moderate and severe physical traumatic injuries: a brief report.

Patients with physical traumatic injuries frequently require long-term rehabilitation services. To strengthen rehabilitation services in the post-acute phase, we need to assess characteristics of this population and their healthcare and rehabilitation needs in the community. This brief report summarizes the frequency of unmet rehabilitation needs in community-based rehabilitation during the first year after moderate and severe trauma. Additionally, the associations between sociodemographic, injury severity factors and unmet needs were examined. Data from a prospective multicenter cohort study of patients with moderate and severe trauma (New Injury Severity Score > 9) of all ages discharged alive from two regional trauma centers in 2020 were used. Needs were estimated using the Needs and Provision Complexity Scale. Overall, 46% of patients had unmet needs at 12 months post-injury, particularly related to the provision of rehabilitation services, specialist follow-ups, and social and family support. The probability of unmet needs was associated with age, pre-injury comorbidities, and impaired functioning. Our findings support strategies targeting younger patients, those with pre-injury comorbidities, and those with higher levels of disability and provide a starting point for the development of standardized rehabilitation needs assessment and guidelines following injury.

Addressing the Rehabilitation Needs of Women Experiencing Infertility in Ethiopia: Time for Action.

The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability or potential target of rehabilitation interventions. This study aimed to determine what rehabilitation-related services and supports are available for women experiencing infertility in Ethiopia. We used an Interpretive Description design. We purposefully selected fourteen rehabilitation, medical, and policy service providers from diverse institutions across three geographical locations. We used semi-structured questions during our in-person and telephone interviews. The data were analyzed using reflexive thematic analysis with the assistance of NVivo. We identified five main themes, including (a) policies related to infertility, (b) the concept that disabilities are physically visible fails to recognize infertility, (c) the need for rehabilitation services for women with infertility, (d) the importance of wellness services for women experiencing infertility, and (e) the role of religion in rehabilitation services. In conclusion, it is essential to strengthen the policies around infertility, incorporate rehabilitation services in fertility care, and view infertility as a disabling condition for women who experience it in Ethiopia.

Stroke virtual rehabilitation in rural communities: exploring the perceptions of stroke survivors, caregivers, clinicians, and health administrators

Purpose Rural-dwelling stroke survivors have unmet rehabilitation needs after returning to community-living. Virtual rehabilitation, defined as the use of technology to provide rehabilitation services from a distance, could be a viable and timely solution to address this need, especially within the COVID-19 pandemic context. There is still a minimal understanding of virtual rehabilitation delivery within rural contexts. This study sought to explore the perceptions of rural stakeholders about virtual stroke rehabilitation. Methods Following an interpretive description approach, 17 qualitative interviews were conducted with stroke survivors (n = 5), caregivers (n = 2), clinicians (n = 7), and health administrators (n = 3), and analyzed to understand their experiences and perceptions of virtual stroke rehabilitation. Results We identified three overarching themes from the participant responses (1) The Root of the (Rural) Problem considered how systemic inequities impact stroke survivors’ and caregivers’ access to stroke recovery services; (2) Common Benefits, Different Challenges identified the unique benefits and challenges of delivering virtual rehabilitation within rural contexts; and (3) Ingredients for Success described important considerations for implementing virtual rehabilitation. Conclusion Virtual rehabilitation is generally accepted by all stakeholders as a supplement to in-person services. Addressing the unique barriers faced by rural clinicians and stroke survivors is necessary to provide successful virtual rehabilitation.

Perception and Experiences of Rehabilitation Service Providers of Teamwork Barriers in Tehran Province, Iran

Background and Objectives: The team plays a role as one of the crucial indicators in increasing the performance of the organization. Understanding the perspective of teamwork providers in rehabilitation regarding the existing obstacles can help a lot to improve the situation. This study aims to percept and experience rehabilitation service providers about teamwork barriers in Tehran Province, Iran. Methods: This qualitative study was conducted by conventional content analysis. The participants included 15 service providers with different genders and locations of activities from within Tehran Province in a snowball pattern. The data were collected by in-depth and quasi-structured interviews and analyzed by conventional content analysis method and using constant comparison. Results: After analyzing the meaningful statements of the interviewees, 3 sub-themes “regulations”, “procedural” and “executive” emerged and from the integration of these sub-themes, the theme of “obstacles” emerged. Conclusion: Some of the results of this research, such as defects in rehabilitation management, imposing double treatment costs on clients, and weakness of teamwork training in the university, have common results. Also, some phrases, such as not paying attention to the role of the municipality in rehabilitation and the number of rehabilitation trustees have not been mentioned in the interviews. Based on the results, it was found that obstacles based on regulations, processes, and implementation play a role in the development of teamwork in rehabilitation.

Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey.

Background Cognitive rehabilitation of people with traumatic brain injury is a complex and challenging area of practice. Practitioners working in cognitive rehabilitation require ongoing training to stay abreast of new research and best practice interventions. A needs analysis was conducted to inform the development of a capacity building program for cognitive rehabilitation providers. Methods A cross-sectional online survey of providers of cognitive rehabilitation services in Queensland collected data on demographic information, perceptions of knowledge, skills and confidence in cognitive rehabilitation, previously completed training, desired training opportunities and delivery methods, and barriers and facilitators to engaging in training. Results The 103 respondents included 67 occupational therapists, 17 speech pathologists, 12 psychologists and seven social workers with a broad range of practice experience. Participants perceived a need for further training, with executive function and functional cognition the most desired topics. The number of topics previously trained on was significantly correlated with levels of knowledge, skills and confidence (P Conclusion Cognitive rehabilitation providers in Queensland reported a need for further training, delivered flexibly, with a focus on managing complex cognitive impairments.

Compassion Satisfaction and Compassion Fatigue: Experiences of Rehabilitation Healthcare Workers in Rural and Remote Locations in Australia

Purpose. This study sought to gain an understanding of rural and remote rehabilitation healthcare workers’ perceptions and experiences of compassion satisfaction and compassion fatigue. Method. Sixteen rehabilitation workers from four national providers of rehabilitation services to rural and remote communities participated in semistructured interviews conducted by telephone over a four-month period in 2018-2019. Braun and Clarke’s six-phase framework guided the thematic analysis. Findings. Quality of work life, organisational and workplace culture, and organisational management practices, particularly key performance indicators (KPIs), were reported as impacting compassion satisfaction and compassion fatigue. Sources of compassion satisfaction were also common to the development of compassion fatigue, suggesting that it is unlikely for compassion satisfaction to be experienced without risk of compassion fatigue. Conclusion. Although there are similarities in experiences of compassion satisfaction and compassion fatigue with other remote healthcare workers, for rehabilitation workers, KPIs were a unique concern, mainly due to their uniformity regardless of geographic location. Participants’ concerns about meeting KPIs increased their work-related pressures, normalised unsafe work practices, and were a cause of recruitment and retention concerns. These perceived influences suggest that rehabilitation workers have a lower likelihood of developing and maintaining compassion satisfaction and a heightened risk of developing compassion fatigue than other rural or remote healthcare workers.

Organization of head and neck cancer rehabilitation care: a national survey among healthcare professionals in Dutch head and neck cancer centers

PurposeHead and neck cancer (HNC) treatment often leads to physical and psychosocial impairments. Rehabilitation can overcome these limitations and improve quality of life. The aim of this study is to obtain an overview of rehabilitation care for HNC, and to investigate factors influencing rehabilitation provision, in Dutch HNC centers, and to some extent compare it to other countries.MethodsAn online survey, covering five themes: organizational structure; rehabilitation interventions; financing; barriers and facilitators; satisfaction and future improvements, among HNC healthcare- and financial professionals of Dutch HNC centers.ResultsMost centers (86%) applied some type of rehabilitation care, with variations in organizational structure. A speech language therapist, physiotherapist and dietitian were available in all centers, but other rehabilitation healthcare professionals in less than 60%. Facilitators for providing rehabilitation services included availability of a contact person, and positive attitude, motivation, and expertise of healthcare professionals. Barriers were lack of reimbursement, and patient related barriers including comorbidity, travel (time), low health literacy, limited financial capacity, and poor motivation.ConclusionAlthough all HNC centers included offer rehabilitation services, there is substantial practice variation, both nationally and internationally. Factors influencing rehabilitation are related to the motivation and expertise of the treatment team, but also to reimbursement aspects and patient related factors. More research is needed to investigate the extent to which practice variation impacts individual patient outcomes and how to integrate HNC rehabilitation into routine clinical pathways.

Training of Future Psychologists: Providing Sustainable Rehabilitation Services to War Victims

The paper examines the problem of training future psychologists to provide rehabilitation services to war victims. It has been found that the psychological rehabilitation of war victims involves the work of psychologists to accelerate their psychological adaptation and prevent psychological complications that provoke the results of mental traumas associated with the provision of leaving home, work, usual comfortable life, etc. Therefore, psychologists must be ready to work with such persons and have a high level of professional competence. All this ensures effective professional training of future psychologists in institutions of higher education and the development of components of their readiness to provide rehabilitation services to war victims. We have found that these readiness components include: motivational, cognitive, operational and personal. The results of the diagnosis of the readiness components of psychology students to provide rehabilitation services to war victims have shown that, in addition to the personal component of readiness, all other components are developed at a sufficient level and this is due to the need to develop measures that are able to contribute to improving the level of training of future psychologists for psychological rehabilitation activities.&#x0D; Key words: psychology students; psychological rehabilitation; war victims; readiness for professional activity

Joint angle estimation during shoulder abduction exercise using contactless technology

BackgroundTele-rehabilitation, also known as tele-rehab, uses communication technologies to provide rehabilitation services from a distance. The COVID-19 pandemic has highlighted the importance of tele-rehab, where the in-person visits declined and the demand for remote healthcare rises. Tele-rehab offers enhanced accessibility, convenience, cost-effectiveness, flexibility, care quality, continuity, and communication. However, the current systems are often not able to perform a comprehensive movement analysis. To address this, we propose and validate a novel approach using depth technology and skeleton tracking algorithms.MethodsOur data involved 14 participants (8 females, 6 males) performing shoulder abduction exercises. We collected depth videos from an LiDAR camera and motion data from a Motion Capture (Mocap) system as our ground truth. The data were collected at distances of 2 m, 2.5 m, and 3.5 m from the LiDAR sensor for both arms. Our innovative approach integrates LiDAR with the Cubemos and Mediapipe skeleton tracking frameworks, enabling the assessment of 3D joint angles. We validated the system by comparing the estimated joint angles versus Mocap outputs. Personalized calibration was applied using various regression models to enhance the accuracy of the joint angle calculations.ResultsThe Cubemos skeleton tracking system outperformed Mediapipe in joint angle estimation with higher accuracy and fewer errors. The proposed system showed a strong correlation with Mocap results, although some deviations were present due to noise. Precision decreased as the distance from the camera increased. Calibration significantly improved performance. Linear regression models consistently outperformed nonlinear models, especially at shorter distances.ConclusionThis study showcases the potential of a marker-less system, to proficiently track body joints and upper-limb angles. Signals from the proposed system and the Mocap system exhibited robust correlation, with Mean Absolute Errors (MAEs) consistently below 10∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$10^\\circ$$\\end{document}. LiDAR’s depth feature enabled accurate computation of in-depth angles beyond the reach of traditional RGB cameras. Altogether, this emphasizes the depth-based system’s potential for precise joint tracking and angle calculation in tele-rehab applications.

Development of a Conceptual Framework for Adult Community Rehabilitation Policy, Planning, Care, and Research: A Multimethod Qualitative Approach

To address recognized gaps in community rehabilitation service coordination and advance delivery of rehabilitation services for adults living outside of institutions, we have developed a conceptual framework to inform the design of community rehabilitation policy, planning, care, and research. Employing a multimethod qualitative approach, we developed a draft framework based on a document review as well as interviews with community rehabilitation service and system providers, older people receiving community rehabilitation services, and family caregivers. We then consulted with community rehabilitation service and system providers, older adults, and family caregivers to revise the framework. We identified 194 relevant documents and 30 programs, and we analyzed interview data from 29 service and system providers as well as 6 dyads of older persons and family caregivers. We developed a definition of community rehabilitation and identified 11 components for the draft framework, which was presented to 16 participants for consultation. We used their feedback to revise the terms and definitions for the 11 components. We organized the final set of components into two categories: principles (culturally safe; equity-focused; evidence-informed; person and family-centred; restorative) and organization (appropriate; coordinated; continuity; evaluated; stepped; team-based). The contextualized, action-oriented conceptual framework for adult community rehabilitation (CFACR) is supported by older people, family caregivers, and community rehabilitation health system providers. Continued work to refine and validate the components in more population groups and contexts will facilitate implementation and application of the CFACR.

Rehabilitation in primary care for an ageing population: a secondary analysis from a scoping review of rehabilitation delivery models

BackgroundThe world population is ageing rapidly. Rehabilitation is one of the most effective health strategies for improving the health and functioning of older persons. An understanding of the current provision of rehabilitation services in primary care (PC) is needed to optimise access to rehabilitation for an ageing population. The objectives of this scoping review are a) to describe how rehabilitation services are currently offered in PC to older persons, and b) to explore age-related differences in the type of rehabilitation services provided.MethodsWe conducted a secondary analysis of a scoping review examining rehabilitation models for older persons, with a focus on PC. Medline and Embase (2015–2022) were searched to identify studies published in English on rehabilitation services for people aged 50 + . Two authors independently screened records and extracted data using the World Health Organization (WHO)’s operational framework, the Primary Health Care Systems (PRIMASYS) approach and the WHO paper on rehabilitation in PC. Data synthesis included quantitative and qualitative analysis.ResultsWe synthesised data from 96 studies, 88.6% conducted in high-income countries (HICs), with 31,956 participants and identified five models for delivering rehabilitation to older persons in PC: community, home, telerehabilitation, outpatient and eldercare. Nurses, physiotherapists, and occupational therapists were the most common providers, with task-shifting reported in 15.6% of studies. The most common interventions were assessment of functioning, rehabilitation coordination, therapeutic exercise, psychological interventions, and self-management education. Environmental adaptations and assistive technology were rarely reported.ConclusionsWe described how rehabilitation services are currently provided in PC and explored age-related differences in the type of rehabilitation services received. PC can play a key role in assessing functioning and coordinating the rehabilitation process and is also well-placed to deliver rehabilitation interventions. By understanding models of rehabilitation service delivery in PC, stakeholders can work towards developing more comprehensive and accessible services that meet the diverse needs of an ageing population. Our findings, which highlight the role of rehabilitation in healthy ageing, are a valuable resource for informing policy, practice and future research in the context of the United Nations Decade of Healthy Ageing, the Rehab2030 initiative and the recently adopted WHA resolution on strengthening rehabilitation in health systems, but the conclusions can only be applied to HICs and more studies are needed that reflect the reality in low- and middle-income countries.

Method and organization for expert evaluating of rehabilitation services for lower limb prosthetics: problems and solutions

Relevance. Prosthetics of the lower limb after amputation restores the patient's ability to move and self-care. Preparation and prosthetics in the early stages after amputation, in the absence of contraindications, improves the physical, psycho-emotional state of patients, reduces the risk of complications due to forced exercise and exacerbation of concomitant somatic pathology, as well as increases exercise tolerance, restores mobility, functioning after amputation.The aim of the work is to improve the quality of life of patients with mobility disabilities.Materials and methods. The information base of the study was the normative legal acts of the Russian Federation, standards, clinical recommendations defining the existing system of providing rehabilitation services for prosthetics of the lower limb.Conclusion. Unsatisfactory prosthetics of the limb after amputation negatively affects the quality of life of the patient. For this reason, the assessment of the rehabilitation service of prosthetics of the lower limb, including using the tools of the International Classification of Functioning, Disability and Health, is both relevant and necessary.

Virtual Rehabilitation and COVID-19: Varied Adoption and Satisfaction Among Patients and Providers Participating in a Multi-Site Survey Study.

The COVID-19 pandemic compelled rapid healthcare adaptations including increased use of telehealth (TH) and virtual care (VC) to provide rehabilitation services. This multi-site cross-sectional survey study examined rehabilitation patients' and providers' experiences with service delivery during the COVID-19 pandemic, including the use of TH/VC. Patients and providers who received or provided rehabilitation services were recruited from 1 of 3 large, post-acute rehabilitation systems located in the Southeastern and Midwestern United States during the COVID-19 pandemic. Participants rated personal satisfaction with rehabilitation services received or rendered during the pandemic and willingness to use TH/VC in the future. Questions also addressed accessibility, ease of use, and perceived barriers to TH/VC use. The adoption and personal satisfaction of TH/VC for rehabilitation care varied between patients and providers. Patients reported higher levels of satisfaction compared to providers (P < .001). Patients who did not use TH/VC had higher satisfaction than those who did (P < .05). Patients were less willing than providers to use TH/VC (P < .001). Those who used TH/VC prior to the pandemic were more willing to use post-pandemic (P < .001). Patients reported TH/VC was useful in increasing health services accessibility yet were neutral as to the ability of TH/VC to improve outcomes. Patients and providers agreed that TH/VC was easy to learn and use. Medical providers found TH/VC more useful than therapy providers. Participants who used TH/VC during the pandemic are more willing to use the service again in the future. Understanding patient and provider preferences and perspectives is key to the continued use of TH/VC in rehabilitation care.

National Disability Insurance Scheme timeframes and functional outcomes for inpatient rehabilitation patients: a 5-year retrospective audit.

Objective The aim of this study was to compare National Disability Insurance Scheme (NDIS) timeframes and functional outcomes for a patient population managed in an inpatient hospital rehabilitation unit. Methods A retrospective hospital audit was undertaken of adult patients admitted to a tertiary-level, regional inpatient rehabilitation unit between January 2017 and December 2021 who were either referred, or not, to the NDIS. A hospital NDIS patient database, Australasian Rehabilitation Outcome Centre episode data, and patient medical records were analysed. The main outcome measures included actual rehabilitation length of stay versus expected length of stay, and Functional Independence Measure (FIM) efficiency for all inpatients, with NDIS timeframes analysed for the NDIS-referred patient subgroup. Results Rehabilitation inpatients referred for NDIS services significantly exceeded expected rehabilitation length of stay compared to those not referred to the NDIS. Furthermore, expected length of stay was significantly exceeded for those patients who required implementation of a NDIS plan to safely transition from hospital. FIM efficiency was significantly lower for patients referred to the NDIS. Recent improvement in timeframes for being accepted as a NDIS participant did not reduce length of stay. Conclusions NDIS timeframes for rehabilitation inpatients incur a significant opportunity cost for the provision of efficient inpatient rehabilitation services that are unaccounted for in current benchmarking performance standards.

Barriers of Rehabilitation Services among the Stroke Patients in the Selected Community area of Dhaka, Bangladesh

Health care service is a global issue. Now a day’s rehabilitation services play a vital role to regain the normal health for participate in daily activities. At present, the need for rehabilitation services is largely unmet due the insufficient rehabilitation professionals, rehabilitation friendly infrastructures, skilled labor and awareness among the community, family and caregivers. World Health Organization (WHO) stated that in many low- and middle-income countries, there is a lack of trained professionals to provide rehabilitation services, with less than 10 skilled rehabilitation practitioners per 1 million populations. It is important to find the barriers in rehabilitation services provided among the stroke patients. The study was conducted to find out the barriers that effect on rehabilitation services among the stroke patients. So that concern authority can take necessary action to ensure the rehabilitation services among the mass people of the country. A qualitative phenomenological approach was used to collect information regarding the barriers experienced by stroke patients and their family. The main barriers to the rehabilitation services are low socio-economic status of the participants, inaccessible infrastructures and transports, high cost of the rehabilitation services, crisis of the graduate rehabilitation professionals, negative attitudes of the caregiver towards the stroke patients. Stroke rehabilitation service should be integrated towards the mainstreamed health system at community level to improve the lives of persons suffer from stroke in Bangladesh.