Rehabilitation Services Research Articles

Guidelines for setting up low-vision and rehabilitation services in India.

Low vision and blindness are increasing public health issues impacting individuals' quality of life. During clinical low-vision services, vision rehabilitation is crucial for enhancing daily living skills and improving life quality. Low-vision and rehabilitation (LVR) services encompass comprehensive measures that aid visually disabled individuals in restoring function, autonomy, and social participation. Such holistic management requires a multidisciplinary approach, facilitating adaptation to environmental and sociocultural changes. However, the lack of awareness about the principles and practices of LVR services poses a major hindrance to setting up such a special clinic in the eye hospital. This article is about a consensus statement on the guidelines for establishing LVR services focusing on basic requirements, especially in low-resource countries. The present recommendation to set up an LVR clinic was made after group discussions and debates among various experts and stakeholders during the National Workshop on Strengthening Low-Vision and Rehabilitation Services organized at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. The event was participated by many ophthalmologists and optometrists coming from across the country. The recommendations required at the tertiary level are outlined under the four headings: Human resources and training: two ophthalmologists, that is, a low vision specialist or a well-experienced in low vision and one who has received one-week orientation and training, one optometrist, one rehabilitation supervisor, and two rehabilitation assistants; Assessment equipment: basic screening and diagnostic; Assistive devices for low vision, including, digital and non-digital; Assistive devices for rehabilitation, and methods for records maintenance. The institution may not follow strictly the present guidelines but will provide an idea on LVR services initiation.

Comparing outcomes of psychiatric rehabilitation between ethnic-religious groups in Israel.

Psychiatric rehabilitation for people with severe mental illness (SMI) has many documented benefits, but less is known about cultural related aspects. To date, no comparison of psychiatric rehabilitation outcomes between Israeli Jews and Israeli Arabs has been carried out. Thus, the purpose of the present study was to compare the outcome measures of Israeli Arabs and Israeli Jews consuming psychiatric rehabilitation services. As part of the Israeli Psychiatric Rehabilitation Reported Outcome Measurement project (PR-ROM), a cross-sectional study comparing different ethnic-religious groups was performed. Data is based on 6,751 pairs of psychiatric rehabilitation consumers and their service providers. The consumers filled questionnaires on quality of life (QoL) and functioning, and their providers completed mirroring instruments. The findings revealed that QoL and functioning ratings were lower among Muslim Arabs compared to Jews on both consumers' and providers' ratings. Among Muslim Arabs, differences in outcomes according to the service's location were indicated. The observed differences between Israeli Arabs and Israeli Jews with SMI in the PR-ROM point to the need for culturally adapted rehabilitation services that take into account how cultural differences may affect the benefits of such services.

A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia-Ukraine War

Since the full-scale Russian invasion, hospitals in Ukraine have been compelled to close or operate at reduced capacity due to inadequate supplies, damage, or destruction caused by war. To analyze hospital services in Ukraine during the period before and after the Russian invasion. Of the 450 hospitals currently functioning in Ukraine, a cross-sectional survey was carried out with the participation of 74 hospitals from 12 oblasts. Hospital administrators responded to an online survey with questions on the use of hospital services. Data were abstracted from hospital databases for the prewar period (before February 23, 2022) and during the war (February 23, 2022, to May 30, 2023). Hospital services (including emergency services, preventive services, screenings, laboratory tests, obstetrics, telehealth, pharmacy, and rehabilitation services) were compared during the prewar and war periods. Of 450 Ukrainian hospitals in operation, 74 hospitals (16.0%) across 12 oblasts provided data for the current analyses. During the war, daily emergency admissions increased to 2830, compared with 2773 before the war. At the same time, hospitals reported reduced laboratory testing (72 [97%] vs 63 [85%]), tobacco education (52 [70%] vs 36 [49%]), cancer screening (49 [66%] vs 37 [50%]), gynecological services (43 [58%] vs 32 [43%]), rehabilitation services (37 [50%] vs 27 [36%]), pharmacy services (36 [49%] vs 27 [36%]), and telehealth programs (33 [45%] vs 21 [28%]). Hospitals reported additional difficulties during the war, including disruptions in the supply chain for essential equipment and pharmaceuticals, shortages of laboratory test kits, delays in the delivery of crucial medications, and problems around appropriate medication storage due to power outages. The ongoing war has inflicted profound devastation on Ukraine's hospitals. The findings of this cross-sectional survey offer valuable insights into the formidable challenges that hospitals confront in war-affected regions and underscore the pressing necessity for bolstering support to sustain and enhance hospital services during wartime.

International Experience of Implementing Cognitive Remediation for People With Psychotic Disorders.

Cognitive remediation (CR) is an effective therapy for the cognitive impact of mental illness, especially schizophrenia. Global efforts are being made to implement CR into routine mental health services with the aim of improving functional outcomes for the population of people recovering from mental illness. Implementation and dissemination of CR in heterogeneous settings require knowledge gleaned from formal implementation research and pragmatic experiential learning. This article describes cross-cultural approaches to CR implementation, focusing on initiatives in France, the United States, Australia, and Japan. Key leaders in the implementation of CR in France, the United States, Australia, and Japan were asked to describe the implementation and dissemination process in their settings with respect to the categories of context, implementation, outcomes, facilitators, and barriers. All 4 sites noted the role of collaboration to leverage the implementation of CR into mental health rehabilitation services. In France, high-level, government organizational backing enhanced the dissemination of CR. Academic and clinical service partnerships in the United States facilitated the dissemination of programs. The advocacy from service users, families, and carers can aid implementation. The support from international experts in the field can assist in initiating programs but maintenance and dissemination require ongoing training and supervision of staff. CR is an effective intervention for the cognitive impact of schizophrenia. Programs can be implemented in diverse settings globally. Adaptations of CR centering upon the core components of effective CR therapy enhance outcomes and enable programs to integrate into diverse settings.

Spanish Version of the Netherlands Empowerment List: Adaptation, Psychometric Validation, and Gender Differential Item Functioning Analysis

AbstractThere is a lack of valid instruments to measure empowerment in Spanish-speaking populations. This study aimed to adapt the Netherlands Empowerment List (NEL), a 40-item scale, into Spanish and to test its psychometric properties examining its dimensional structure, internal consistency, temporal stability, relationships with other variables, and differential item functioning by gender. Participants were 406 users of mental health community rehabilitation services (52.5% male), with a mean age of 47.8 years. Results confirmed a six first-order factor structure of the scale. Internal consistency was excellent for the total score and ranged from excellent to adequate for subscale scores. Temporal stability was excellent for four subscales and good for the remaining two. The analysis of relationships between the Spanish NEL with other variables (i.e., empowerment, recovery, hope, perceived social support) provided additional evidence of its validity. Although four items showed uniform differential item functioning by gender, the effect size was negligible. The Spanish NEL yields valid and reliable scores, and it may be used to assess empowerment in Spanish-speaking countries.

Team-based digital communication reduced patient-initiated phone calls to the hospital and improved patient satisfaction after orthopedic surgery: a randomized controlled trial in 70 patients.

Post-discharge inquiries to the hospital are predominantly conducted through phone calls. The rigid timing of these calls is inconvenient for patients and disrupts the workflows of healthcare professionals. The aim of this study was to investigate the effect of a team-based digital communication intervention (eDialogue) facilitated through a messenger-like commercial solution on patient-initiated phone calls to the hospital after discharge. Secondarily, we investigated other patient-initiated contacts, patients' perception of continuity of care, and their perception of feeling safe and satisfied after hospital discharge. On the day of discharge, 70 surgically treated orthopedic patients were randomized to the intervention group with access to eDialogue (n = 35) or the control group with standard communication pathways by phone call (n = 35) for the following 8 weeks. Through eDialogue, the intervention group had access to team-based asynchronous digital communication in text and photos with healthcare professionals across disciplines and sectors. Inclusion criteria were discharge to own home and receipt of rehabilitation services from both hospital and primary care after discharge. We found a significant reduction in the mean number of patient-initiated phone calls to the hospital from 2.3 (95% confidence interval [CI] 1.4-4.1) in the control group to 0.5 (CI 0.3-1.0) in the intervention group (P = 0.004). Across groups, patients reported similar perceptions of continuity of care; however, the participants in the intervention group expressed significantly improved perceptions of, and satisfaction with, access to healthcare after discharge. Access to eDialogue reduced patient-initiated phone calls to the hospital, enhanced patient satisfaction with healthcare accessibility, and did not compromise patients' perception of continuity of care after discharge compared with standard communication pathways.

Assessing the factors that influence the utilization and delivery of rehabilitation services among persons with Parkinson's disease: A scoping review.

Rehabilitation has the potential to significantly improve the lives of people and, most importantly, for persons with Parkinson's disease (PD). Although numerous studies have reported the benefits of rehabilitation for persons with PD (PwPD), these services are still limited and underutilized even when patients exhibit problems that require rehabilitation. This review aims to describe the (a) indication for referral for rehabilitation services, (b) patterns of referral for rehabilitation and (c) factors that facilitate or hinder the utilization and delivery of rehabilitation services among PwPD. A comprehensive literature search was conducted across selected databases, African Journals Online, EBSCOhost (CINAHL, Africa-wide), PubMed, SCOPUS and Web of Science. Studies published in English from January 2002 until December 2022 were applied as limiters. Reference and grey data sources tracking were also conducted. Two reviewers conducted the study selection, screening of titles, abstracts and full text and data charting. A descriptive analysis was performed. Findings were narratively presented and illustrated with tables, diagrams and descriptive formats as appropriate. Twelve studies were included in the review; however, none were from Africa. Impairments and activity limitations were the key functioning problems indicated for rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for referral to rehabilitation. Physiotherapy, occupational therapy and speech and language therapy were the most utilized rehabilitation services and were sometimes utilized together. The rate of rehabilitation service utilization among PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization. Per the studies reviewed, utilization of rehabilitation services is generally low among PwPD. Lack of referral and nonavailability of professionals are cited as barriers to access. Adequate measures are needed to improve rehabilitation services for all PwPD.

INNOVATION AND DIGITAL TRANSFORMATION IN HEALTHCARE. PROCESS OPTIMIZATION OF REHABILITATION ACTIVITIES IN IN REHABILITATION CARDIOLOGY IN SUPPORT OF PATIENT AND TEAM

Abstract Physical activity is a treatment for preventing and treating a wide range of diseases; its prescription must be precise and accurate in order to optimize the effects avoiding at the same time clinical risks due to frequent patients’ frailty.To deploy a “comprehensive digital rehabilitation” means to digitalize the whole process: from clinical and instrumental evaluations to the subsequent coherent prescriptions of the rehabilitation and care–related activities, from the case management planning – described in the individual rehabilitative project – to the individual rehabilitative program – that takes shape in semi–automated scheduling and in digitalized reporting. The deployed software must be easy to use and reliable, and must ensure safety, guaranteeing the exchange of clinical information among the team members. For all these reasons, we have pre–set pathways that, starting from the main and secondary clinical diagnosis (using the ICD classification) and based thereafter on the WHO ICF classification, the rehabilitation processes are governed in a standardized tailored granularity for each single patient by the aid of a computerized expert system. Even if it what just stated appears an oxymoron, thanks to the digital transformation and the adoption of the Internet of Things, it is possible to easily implement a personalized rehabilitation program through a shared and standardized ontology, providing benefits both to the patient and to the rehabilitation team. Based on this, the rehabilitation services that can be provided have been defined, providing not only those provided for by national and regional nomenclators but also those peculiar to the activities in our Institutes. The digital gym goes beyond the concept of equipment in a gym space; the gym space becomes both physical and virtual. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of IoT, that path of technological development whereby, through the Internet network, potentially every object of daily experience acquires its own identity in the digital world. All this will allow for real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine and cloud computing, begin to enable an integration of people, equipment and data.

Moving between positions: a qualitative study of mentoring relationships in chronic eating disorders

PurposeEating disorders (ED) are chronic and challenging-to-treat conditions, often persisting over extended periods. Some patients with EDs require prolonged intensive rehabilitation services, which may include weekly home visits by paraprofessional mentors serving as support persons, providing guidelines, emotional care, and assistance. This study aims to enhance our understanding of the nature of the relationship formed between mentors and patients with EDs.Design & MethodsFifteen in-depth qualitative interviews were conducted with patients and paraprofessional mentors. Interviews were analyzed using a descriptive phenomenological approach by two researchers to enhance reliability.FindingsQualitative analysis highlighted that mentors play a crucial role in patients’ rehabilitation. Mentors adapt two positions (investigative and embracing) to address the encountered difficulties, including conflicts, tension, and confusion associated with (in)equality and reciprocity in the mentoring relationship.Practice ImplicationsParaprofessional mentors can assist people with ED in their rehabilitation process. To support patients with EDs effectively, it is crucial to train and supervise the mentors in navigating between roles and dealing with boundaries, secrets, lies, and exposure to various aspects of the rehabilitation process. Additionally, we recommend further research using quantitative and empirical tools to complement the qualitative findings presented.

Health economic evaluation of rehabilitative short-term care : Analysis of the costs of geriatric patients with and without rehabilitative short-term care after inpatient hospital stay

Geriatric patients requiring rehabilitation and admitted to short-term care after an acute inpatient hospital stay seldom receive rehabilitative services later. Rehabilitative short-term care (REKUP) supplements short-term care with rehabilitative measures, aiming to prevent functional restrictions and long-term care. To conduct acost and cost-effectiveness analyses of REKUP and provide data for anationwide rollout. Anon-randomized controlled prospective study was carried out. The intervention group (IG) was paired 1:2 with acontrol group (KG), resulting in the formation of three collectives with follow-up periods of either 30,90 or 180 days (each with IG and KG). Using administrative claims data from the AOK Baden-Württemberg, the mean total costs from the perspective of the health insurance were calculated. Apotential impact of the intervention on costs was analyzed using the difference in differences approach. The analysis comprised 129 patients (IG43; KG86). During the follow-up periods, the IG presented higher rates of rehabilitation and lower rates of long-term care and mortality. Regarding costs, no statistically significant differences were found between the IG and KG in any of the three collectives. For nursing care and medication costs, costs were significantly higher in the follow-up period for the KG, whereas costs for rehabilitation were significantly higher for the IG (p < 0.001). Patients receiving REKUP utilize rehabilitation services more often and have alower likelihood of requiring nursing care or dying with no statistically significant differences in costs. There are potential advantages of REKUP in the target population, which warrant further investigation due to methodological limitations.

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners’ and people living with Long COVID: a qualitative study

ObjectivesTo explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).DesignQualitative descriptive study employing one-to-one semistructured virtual interviews analysed...

A Structured Literature Review on the Research and Design of Rehabilitation Environments.

This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.

Patient and Caregiver Satisfaction With the Brain Injury Rehabilitation: Improving the Transition Experience (BRITE) Intervention.

To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain injury (TBI). Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems sites in the United States. Adult, English-speaking patients with TBI who had moderate-to-severe TBI and were discharged from a TBI Model Systems site and who were in the intervention arm of the Brain Injury Rehabilitation: Improving the Transition Experience pragmatic clinical trial, as well as their caregivers. A survey of participants in the intervention arm, which included an individualized case management program administered by a TBI Care Manager (TCM) who facilitated resource connection, education, and support. Satisfaction with intervention was measured through Likert-scaled and open-ended questions. The survey was administered verbally through telephone, audio-recorded, and transcribed. Descriptive statistics were calculated for categorical variables, and content analysis was conducted for open-ended responses. Patient and caregiver participants were satisfied with the intervention and highlighted the benefits of the interpersonal and practical support provided by the TCM. Participants identified the need for a more intensive intervention and clear expectations of the TCM role, as well as gaps in available medical and rehabilitation services in the community, as areas for improvement. Patients with TBI and their caregivers reported satisfaction with the individualized case management program in supporting their transition from inpatient rehabilitation to the community. Further research is needed to understand the impact on outcomes.

Corrigendum to: Healing Right Way randomised control trial enhancing rehabilitation services for Aboriginal people with brain injury in Western Australia: translation principles and activities

Corrigendum to: Healing Right Way randomised control trial enhancing rehabilitation services for Aboriginal people with brain injury in Western Australia: translation principles and activities

Understanding housing preferences and challenges of older adults in Kalisz, Poland

Purpose: This study aimed to identify the demographic, economic, and social factors that influence the housing demand of older adults in Kalisz, Poland, and assess their preferences and challenges in meeting their housing needs. Methodology: A quantitative survey was conducted among individuals aged 50 and above in Kalisz. The survey questionnaire covered various aspects, including current housing conditions, housing preferences, knowledge of senior housing options, and willingness to relocate to such housing. Data analysis involved descriptive statistics and correlation analysis. Results: The findings revealed that while most respondents were satisfied with their current housing situation, they acknowledged the need for housing options tailored to older adults. However, there was a lack of interest in relocating to designated senior housing due to concerns about affordability, accessibility, and amenities. Respondents expressed a preference for independent living arrangements with access to medical, care, and rehabilitation services. Theoretical contribution: The study contributes to the understanding of the housing needs and preferences of older adults in the context of a medium-sized city in Poland. It highlights the importance of considering demographic shifts and adapting housing policies and urban planning strategies to meet the diverse requirements of an aging population. Practical implications: The findings can inform policymakers, urban planners, and housing developers in designing and implementing housing solutions that cater to the specific needs of older adults, ensuring accessible, affordable, and supportive living environments. The study also emphasizes the need for public awareness and education regarding senior housing options.

Comprehensive Geriatric Assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial

RationaleMany people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated.AimTo determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation.MethodsMulticentre mixed-methods randomised controlled feasibility trial (“Breathe Plus”;ISRCTN13051922). People with COPD, aged ≥50, Clinical Frailty Scale ≥5, and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during Covid-19 restrictions. Outcomes (physical, psycho-social, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews.ResultsRecruitment stopped at 31 participants (mean age 72.4 [sd10.1], 68% MRC 4–5), due to Covid-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8–129) and prompted 46 individual care recommendations (median 3 per participant, range 0–12); 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it.ConclusionIntegrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.

Customized employment for transition-age youth in state vocational rehabilitation program PY2017 - PY2020: Analysis of service outcomes and related factors

BACKGROUND: Customized employment (CE) is positively correlated with competitive integrated employment (CIE) outcomes and potentially supports transition-age youth in achieving sustainable employment. OBJECTIVE: This study examines the employment outcomes and related factors for transition-age youth with disabilities who received CE services through state vocational rehabilitation agencies (SVRAs) and their vendors from program year 2017 to 2020. METHODS: Employing a combination of descriptive analysis, binary logistic and multiple regression, chi-square tests, and t-tests, the study investigates the demographics, potential barriers, and vocational rehabilitation (VR) services received by the research sample using the RSA-911 dataset. RESULTS: The sample comprised 672 individuals with a mean age of 22.30 years. The most prevalent barrier to employment among CE participants was long-term unemployment, while Supplemental Security Income (SSI) was the most common social security benefit. Furthermore, only 13.2% of transition-age youth achieved CIE status, compared to 30.1% of adults. The key predictors of employment outcomes, including CIE status, weekly earnings, and working hours were identified. CONCLUSION: The research reveals significant differences in employment outcomes between transition-age youth and adult VR consumers. These insights emphasize the necessity for SVRAs to consider a range of factors, including demographics, potential employment barriers, and the effects of various VR services, to increase the CE service effectiveness for transition-age youth.

“Every day you are working you have to prove it”: Navigating the costs of work and ableism with visual impairment

BACKGROUND: People with visual impairment often need many items that their sighted counterparts do not, such as assistive devices, transportation services, and other disability-related goods and services. Acquiring these items represents a major barrier to the employment of people with visual impairment. OBJECTIVE: This study aimed to explore the nature of disability-related employment costs as they relate to engagement in the labor market of people with visual impairment. METHODS: The research consisted of a qualitative analysis of interviews and focus groups with 15 visually impaired adults from the New York metro area. RESULTS: What emerged were the costs of accessing and maintaining employment— particularly related to meeting the expectations of expediency in the modern world— in areas like communication and transportation. These costs interacted with perceived ableism in the labor market and created a climate of job scarcity and anxiety, which came at additional cost to participants who felt stuck in low-paying work. CONCLUSIONS: Further research is needed on the impact of perceived ableism and disability-related employment costs, and on decreasing barriers to programs that may ameliorate these costs, such as vocational rehabilitation services. Such research would inform policy interventions geared toward enhancing disabled people’s participation in the labor market.

Promoting quality career pathways for individuals with disabilities through the public vocational rehabilitation program

BACKGROUND: Career Pathways initiatives in Vocational Rehabilitation (VR) have emerged as a crucial strategy for enhancing quality employment outcomes among individuals with disabilities. This paper conducts a comprehensive examination of the integration of Career Pathways within VR, emphasizing its significance in aligning vocational goals with evolving labor market demands. OBJECTIVE: Drawing from the innovative Career Pathways initiatives introduced by the Rehabilitation Services Administration (RSA), this paper addresses the RSA Career Pathways Demonstration Initiatives from 2015 to 2019 alongside the ongoing Disability Innovation Fund-Career Advancement Initiative Model Demonstration Project. The paper also discusses the strengthening of Career Pathways through the development of high-quality Individualized Plans for Employment and program evaluation. METHODS: This study utilized a modified exploratory case study approach to examine past and present career pathways initiatives in state VR agencies. Data were gathered from publicly available documentation and archival records, focusing on 12 cases from two national initiatives: the RSA Career Pathways Demonstration Initiatives (2015–2019) and the Disability Innovation Fund-Career Advancement Initiative Model Demonstration Project (2021–2026). RESULTS: The study reveals a substantial, positive impact on employment outcomes for individuals with disabilities through Career Pathways in VR programs, facilitated by the integration of adaptable pathways, individualized planning, and program evaluation.

How much does dysphagia cost? Understanding the additional costs of dysphagia for New Zealand in patients hospitalised with stroke.

Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand. Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between 1st May 2018 and 30th October 2018 including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a Speech Language Therapist review. Patients that required a nasogastric feeding tube in hospital were classified as 'severe'. Optimal linear propensity score matching was utilised to provide a group for patients to compare with stroke and dysphagia. All costs were converted to 2021NZ$. Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age:78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12-months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95%CI, 0.028 to 0.100), and severe dysphagia by 0.12 index points (95%CI, 0.03 to 0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was $24,200 on average per patient. This estimate includes the additional hospitalisation costs ($16,100), community rehabilitation services ($570), hospital-level aged residential care ($4,030) and reduced HRQoL ($3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was $34,000 per patient. We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.