Members Of Rehabilitation Team Research Articles

Cardiac rehabilitation centers in Romania: Where are we now?

Purpose: In 2024, Romania is still facing a critical challenge with high cardiovascular disease mortality rates despite extensive research and policy initiatives. Our study sought to examine the actual state of cardiac rehabilitation in Romania by identifying the healthcare facilities that provide and deliver cardiac rehabilitation services. Methods: The research began with a comprehensive investigation into cardiac rehabilitation centers across Romania. This involved leveraging search engines to identify these facilities. Keywords like “cardiac rehabilitation”, “cardiovascular rehabilitation”, and “cardiac rehabilitation centers” were instrumental in pinpointing relevant information, which included names, geographical locations, and contact details of the centers. Upon identification of potential centers, our research team initiated direct engagement with these facilities via telephonic interviews. Results: The data collected in 2024 was compared to previous findings from a 2017 research report to evaluate the progress and impact of prevention efforts over time. While the number of cardiac rehabilitation centers has grown (69.2% increase in the nationwide count of cardiac rehabilitation centers/facilities), an uneven geographic distribution persists, exacerbated by disruptions during the COVID-19 pandemic. Among the cardiac rehabilitation centers identified, 23% are located in balneoclimatic resorts, but the majority of cardiac rehabilitation centers are located in Bucharest. Overall, 65.3% of all identified centers in Romania belong to the private healthcare sector. Among these private centers, 41.1% offer cardiac rehabilitation programs as continuous inpatient care, with durations ranging from 5 to 16 days. All cardiac rehabilitation centers are equipped with the necessary equipment to perform basic cardiological investigations as well as physio-kinesiological rehabilitative procedures, in addition to aerobic physical training (53.8%). In 33.3% of the identified centers, diabetologists and psychologists/psychotherapists are integral members of the multidisciplinary cardiac rehabilitation team, while only 19.2% of the centers include a dietitian/nutritionist. Regarding costs, there is significant variation depending on the geographical area. In Bucharest, a single rehabilitation session costs between 100 to 400 lei (20 to 80 €), and a rehabilitation program spanning 4-6 weeks can cost up to 3350 lei. Comparing costs identified in 2017, we have observed an increase ranging from 47% to 188% in 2024. Conclusions: Despite an increase in the number of cardiac rehabilitation centers, their prevalence remains inadequate to fulfill the demands of the population. Telerehabilitation emerges as a promising solution, with limited adoption in only one center. Cost variations across regions pose a barrier to patient participation. Our article proposes strategies including decision algorithms for personalized recommendations, expanding cardiac rehabilitation centers, and advocating for comprehensive cost reimbursement. The urgent need for collaborative efforts is emphasized, envisioning innovative solutions like mobile applications to foster a sense of community and optimize cardiac rehabilitation, ultimately improving cardiovascular health outcomes in Romania. Keywords: cardiac rehabilitation, telerehabilitation, cardiac rehabilitation centers, healthcare disparities, cardiovascular health

Attitudes of cardiac rehabilitation and stroke teams towards integration of stroke survivors into adapted cardiac rehabilitation: A focus group study

Objective To explore the attitudes and beliefs of cardiac rehabilitation and stroke teams towards adapted cardiac rehabilitation, and the broader topics of exercise, healthy lifestyles and health behaviour change, for people with mild-to-moderate severity stroke in the sub-acute phase of recovery. Design Qualitative focus group-based study. Setting Acute and community national health service trusts. Participants Stroke and cardiac rehabilitation team members. Intervention Adapted cardiac rehabilitation. Main measures Focus groups. Thematic analysis was applied to the transcribed data. Results Overall, 57 health professionals participated in 12 focus groups. Positive impacts for teams and stroke survivors were identified particularly confidence. However, there were negatives, barriers and adaptations identified. In addition, there was a lack of knowledge for cardiac rehabilitation teams in relation to stroke survivors and stroke teams in relation to cardiac rehabilitation, exercise and healthy lifestyles. Conclusions Cardiac rehabilitation and stroke staff attitudes to cardiac rehabilitation for stroke survivors showed a range of benefits, negatives, barriers and adaptations needed. Confidence and knowledge of the cardiac rehabilitation and stroke teams needs to be addressed. Registration ISRCTN65957980.

Developing post-stroke psychometric properties for an Adherence to rehabilitation regimen scale: A sequential exploratory mixed-method study

IntroductionAdherence to rehabilitation in patients post-stroke plays a significant role in the effectiveness of rehabilitation and patient recovery. This study aimed to design and determine the psychometric properties of a scale for measuring adherence to the rehabilitation regimen in patients post-stroke in the Iranian community. MethodsThe present study used a sequential exploratory mixed method and was conducted in two phases (phase one qualitative and phase two quantitative). Participants in the first phase were patients post-stroke, caregivers, and rehabilitation team members (n=20). The second phase was conducted on patients post-stroke (n=198), and the psychometric steps, including face, content, and construct validity, as well as reliability, were assessed. ResultsThe Adherence to Rehabilitation Regimen Scale (ARRS)was designed with 26 items and four factors of participation: 1) physical exercises, 2) following prescribed regimens, 3) performing the activities of daily living, and 4) psychological follow-up. The internal consistency was 0.96 by calculating Cronbach's alpha coefficient. The Interclass Correlation Coefficient was 0.99 with a confidence interval of 0.96-0.99. ConclusionThe scale measuring adherence to the rehabilitation regimen in patients post-stroke has optimal psychometric properties. Therefore, as the first specific scale to measure the degree of rehabilitation regimen adherence in patients post-stroke, this tool may be beneficial for other rehabilitation programs interested in managing and improving program adherence.

Standardization of rehabilitation medical cards for adult patients with musculoskeletal and peripheral nervous systems dysfunction

Currently, each rehabilitation institution solves the problem of registration of rehabilitation medical records empirically, based on the existing realities of a particular institution.
 The study examined the development of a medical history template for the in- and outpatient medical rehabilitation of patients with peripheral nervous system (PNS) and musculoskeletal system (MSA) dysfunction.
 The medical history template corresponded to the currently approved forms 003/y (Medical record for inpatient care) and 025/y (Medical record for outpatient care) but supplemented with chapters, allowing entry of information in accordance with the requirements of the Ministry of Health of the Russian Federation Order for medical rehabilitation of adults (No. 788n dated July 31, 2020). Additional chapters, forms, and appendices designed to include specific information about the rehabilitation process included the physical and rehabilitation medicine doctor examination list, multidisciplinary rehabilitation team members, examination lists, rehabilitation routing scale blank, list of MDRC discussions, individual patient management forms, standard rehabilitation discharge form, and list of rehabilitation quality criteria for adult patients with MSA/PNS dysfunction. Validated scales and test forms were also included.
 The unification of rehabilitation medical records for patients with MSA/PNS impairment makes it easier for the staff of the rehabilitation departments and centers to file medical records in accordance with the current legislation.

A critical appraisal of professional competency frameworks: What guidance is provided for stroke rehabilitation clinicians managing 'complexity'?

Given current health system trends, clinicians increasingly care for patients with complex care needs. There is a recognized lack of evidence to support clinician decision-making in these situations, as complex or multimorbid patients have been historically excluded from the types of research that inform clinical practice guidelines. However, expert clinicians at sites of excellence (e.g., Stroke Distinction sites) provide measurably excellent care. We sought to review profession-specific competency frameworks to locate information that may be supporting the development of clinician expertise when managing the care of patients with complex care needs. We conducted a review of the professional competency frameworks for core members of the inpatient stroke rehabilitation team, to determine the degree of guidance and/or preparation for the management of patients with complex care needs. We developed and applied an assessment rubric to locate references to patient complexity, multimorbidity and complexity theory. Across the professional competency frameworks, there are some references to complexity at patient- and team-levels; there are fewer references to system-level complexity. We noted a lack of clear guidance for clinicians regarding the management of patients with complex care needs. Further research is needed to explore how clinicians develop expertise in the management of patients with complex care needs, as we noted minimal guidance in the professional competency frameworks. However, we suggest that integrating complexity-related language into professional competency frameworks could better prime novice clinicians for new learning in the workplace and ease their transition into working in a complex context.

Hyper-Acute Rehabilitation: A Step towards Rehabilitation 2030

Abstract There is a huge unmet need for rehabilitation services in low middle income countries like India. Rehabilitation needs are high in India with increasing demand for quality care. Making rehabilitation services financially viable for the hospitals and at the same time affordable for patients is one of the greatest challenges faced by the Rehabilitation Physicians. The article attempts to highlight Hyper acute rehabilitation as the need of the hour in India and urges training of rehabilitation team members in the same.

Goal Setting In Medical Rehabilitation: A Narrative Review.

Goal setting is an integral part of rehabilitation and the rehabilitation process. The aim of rehabilitation is to optimize functioning. Therefore, rehabilitation professionals and patients together have to determine mutually which aspects of functioning they should aim at. From a clinical view, a formal procedure for setting goals should help to motivate patients, ensure cooperation of rehabilitation team members, help to identify relevant blind spots and provide a system to monitor patient changes. Applying goalsetting in rehabilitation represents a purpose in its own right, as it serves to strengthen the autonomy of patients and is a valuable tool to integrate personal motives, attitudes, meanings into the rehabilitation process. There is evidence that the introduction of goal setting into rehabilitation practice could enhance health-related quality of life and emotional states, especially self-efficacy. Mixed results have been reported regarding the patient motivation as well as activities and participation outcomes.

"Intensive-Home-Rehabilitation" Intervention for Older Persons: A Follow-Up Study of Team Members' Perceptions.

Reablement as a concept includes a health-promoting perspective with the goal of strengthening health and the ability to perform and participate in daily activities, a broader perspective than in general home care and rehabilitation. Reablement interventions have shown to be both more effective and to a greater extent improve the function and health-related quality of life of older persons when compared to traditional home-based care. Success factors for intensive-home-rehabilitation (IHR), an intervention based on the reablement concept, have been described earlier; however, there is a lack of knowledge about why some persons do not recover despite receiving IHR. The aim was to shed light on the older persons' conditions during IHR from the perspective of the rehabilitation team members and to describe obstacles to recovery. Qualitative analysis of health and care records of persons (65+) who received IHR (n=19) performed by an interprofessional team. The analysis revealed various problematic situations, dilemmas, that occurred in the older persons' lives during IHR, as well as their consequences and the strategies employed by the older persons as a result. IHR aspects perceived as successful by the older persons also emerged, as well as differences in experiences of the physical and mental aspects of the IHR. Analysis also revealed reasons why the IHR might be experienced as broadly successful. The older persons seemed to be satisfied with IHR and achieved their goals; however, some seemed to need more time to reach their goals. Background factors such as having additional diagnoses and living alone might affect the rehabilitation process. The study provides knowledge regarding the importance of IHR for the recovery process for the increasing numbers of older persons, which might also be useful in other patient groups requiring otherwise long-term rehabilitation and recovery such as after covid-19 infection.

OCCUPATIONAL THERAPY AND PHYSICAL THERAPY IN INCLUSIVE EDUCATION

In the context of solving the tasks of inclusive education, the competencies of physical therapists and occupational therapists, defined by the Standard of Higher Education of the second (master's) level of higher education in the field of knowledge 22 Health care, specialty 227 Physical therapy, occupational therapy, in particular effective cooperation with all members of the multidisciplinary rehabilitation team and other health, education and social policy professionals involved in providing services to patients/clients.
 The purpose of the research is to reveal the content and tasks of physical therapy, occupational therapy in an inclusive educational space. In order to achieve the set goal, the following research tasks must be solved: to reveal the state of scientific study of the problem of using methods of physical therapy, occupational therapy in inclusive education; to analyze the task of the team of psychological and pedagogical support of a child with special educational needs; determine the types of health-preserving technologies in educational institutions with an inclusive form of education; to analyze the content, forms and methods of adaptive physical education in an inclusive educational space.
 Conclusions:
 
 The introduction of an inclusive form of education in Ukraine significantly actualized the need for the use of occupational therapy and physical therapy in corrective and developmental assistance for children with disabilities of different age and nosological groups. At the same time, the support of children with special educational needs in the implementation of the tasks of the individual development program by a multidisciplinary team of specialists in an inclusive educational space has become an important direction of ensuring their special educational needs.
 The use of various types of health-preserving technologies is an important condition for the effective functioning of inclusive education. In order to preserve, strengthen and increase the physical, mental and social health of pupils of inclusive groups of special education, such main groups of health-preserving technologies are used as: organizational-pedagogical, psychological-pedagogical and educational-educational. Organizational and pedagogical ones are used to determine the structure of the educational process, which is able to prevent overwork, hypodynamia, etc.
 Among the types of health-preserving technologies that are used in the inclusive educational space of primary schools, it is appropriate to single out: physical culture and health, medical and preventive technologies, and technologies for ensuring optimal mental and social health of preschoolers.
 The effectiveness of the introduction of AFV in the work with pupils of special educational institutions who have normative development and their peers with special needs of different nosological groups depends on ensuring an optimally favorable, barrier-free educational environment in special educational institutions. The results of AFV directly depend on taking into account and realizing the potential opportunities and needs of each child, individual characteristics, preservation and strengthening of his health. At the same time, it is necessary to take into account that regardless of the psychophysical development of preschoolers and their state of health, each of them has resource opportunities, the use of which can positively affect the quality of life.

An exploratory study on the role of occupational therapists in home‐based rehabilitation team

AbstractBackgroundCooperation among rehabilitation team member is essential in home‐based rehabilitation setting. Q‐methodology that can quantitatively analyze the subjectivity of members of the rehabilitation team was used to explore the role of occupational therapists (OTs) in home‐based rehabilitation.MethodA five‐step implementation procedure was constructed and applied to categorize the subjectivity of the rehabilitation team members. Representative statements about the role of OTs consisted of 7 areas (52 statements). A total of 34 rehabilitation team members categorized the statements according to their subjective viewpoints, and factor analysis was conducted based on the correlation between people.ResultThe roles of OTs perceived by members of the home‐based rehabilitation team were formed into five factor. In all factor, views on the role of OTs in helping clients participate in their roles and activities at home were included. These factors included issues and directions addressed in prior literature on the development of occupational therapy.ConclusionIn home‐based rehabilitation, OTs must play a professional role in ensuring clients to live fully at home, and cooperate with team members for an effective rehabilitation approach.

Medical staff's perception of factors contributing to accelerated rehabilitation in patients with cervical spinal cord injury: A qualitative research.

To explore the factors affecting the quality of accelerated rehabilitation for patients with cervical spinal cord injury, therefore, to propose targeted improvement strategies and provide reference for promoting the quality of nursing care for accelerated rehabilitation. This descriptive qualitative inquiry followed the COREQ guidelines. From December 2020 to April 2021, 16 subjects including orthopaedic nurses, nursing management experts, orthopaedic surgeons, anaesthesiologists and physical therapists experienced in accelerated rehabilitation were selected by objective sampling method to conduct semi-structured interviews. Thematic analysis was used to analyse the interview content. Through analysis and summary of the interview data, the following two themes and nine sub-themes were finally extracted. Factors related to the quality of accelerated rehabilitation structure include: construction of multidisciplinary teams, thorough system guarantee and adequate staffing. Factors related to the quality of accelerated rehabilitation process include: inadequate training and assessment, lack of medical staff's awareness, incapability of the accelerated rehabilitation team members, poor multidisciplinary communication and collaboration, lack of patient's awareness, and ineffective health education. Quality of implementation of accelerated rehabilitation can be improved by maximizing the role of multidisciplinary team, establishing a flawless accelerated rehabilitation system, increasing allocation of nursing resources, enhancing knowledge of medical staff, improving their awareness of accelerated rehabilitation, establishing personalized clinical pathways of accelerated rehabilitation, increasing communication and collaboration among multidisciplinary disciplines, and improving health education of patients.

CURRENT PRACTICE PATTERNS IN HOME HEALTH OCCUPATIONAL THERAPY

Abstract Occupational therapy practitioners are essential members of the home health rehabilitation team to support patients transitioning from acute care to home. However, home health occupational therapy services have been underutilized, in part, due to limited understanding of services that the profession provides. Improving this understanding is necessary to help patients receive timely services. The purpose of the study was to describe the current practice patterns in home health occupational therapy. Fifty home health occupational therapy practitioners from 27 states completed an electronic survey between May and June 2021. The survey consisted of questions about assessment and treatment, communication with physical therapy colleagues, and the impact of the Patient-Driven Grouping Model and the coronavirus disease 2019 pandemic on service delivery. Results showed that occupational therapy assessments focused on personal care activities, mobility and balance, and cognition. The treatment content usually included training in activities of daily living, functional mobility, the application of compensatory strategies (e.g., home adaptations), and fall prevention strategies. Most respondents communicated with their physical therapy colleagues at least once a week on topics related to scheduling, changes in a patient’s condition, and falls and safety concerns. Seventy percent of respondents experienced a reduction of home visits during the recent Medicare payment reform and the pandemic. These practitioners felt that some patients might be discharged prematurely because of this reduction. The survey results highlight the pertinence of occupational therapy services to support patients’ independence and safety at home and the need to increase these services for home health patients.

An exploratory study on the role of occupational therapists in home-based rehabilitation team in South Korea.

Introduction: Cooperation among rehabilitation team members is essential in the home-based rehabilitation setting. Q-methodology that can quantitatively analyze the subjectivity of members of the rehabilitation team was used to explore the role of occupational therapists (OTs) in home-based rehabilitation. Methods: The Q-methodology process was implemented in five steps: Step 1 - Representative statements about the role of OTs were collected through in-depth interviews, open questionnaires, and literature reviews (Q-sample); Step 2 - A total of 34 rehabilitation team members (physical therapists, OTs, social workers, nutritionists) were recruited (P-sample); Step 3 - The statements were classified according to their subjective perspective (Q-sort); Step 4 - Factor analysis was performed based on the correlation among the responses from the participants (Q-factor analysis); Step 5 - The awareness factor for roles was interpreted (Interpretation of awareness factors). Results: The roles of OTs perceived by members of the home-based rehabilitation team were formed into five factors (A) Adaptation within home environments; (B) Professional development; (C) Reliable service execution; (D) Client needs resolution; and (E) Focus on activity participation. In all factors, perspectives on the role of OTs in helping clients participate in their roles and activities at home were included. These factors included issues and directions addressed in prior literature on the development of occupational therapy. Conclusions: In home-based rehabilitation, OTs must play a professional role in ensuring clients live fully at home, and cooperate with team members for an effective rehabilitation approach.

ANALYSIS OF THE SOMATIC COMPONENT OF DEPRESSION IN THE DEVELOPMENT OF A PHYSICAL THERAPY PROGRAM

Depressive disorders occupy a leading position among mental disorders in Ukrainians. The work of a physical therapist with patients with recurrent depressive disorder has its characteristics, which arise in connection with the somatic component in the clinical picture.
 The study aimed to analyze the polymorphism of complaints of patients with recurrent depressive disorder and to determine the correlation between them and the degree of the depressive disorder according to the results of the Patient Health Questionnaire - 9 (PHQ-9). The age of the patients was 45.37±12.01 years (min – 23 years; max – 69 years). The results showed that the most common complaints were: low mood (85.1%), headache (47.8%), apathy and insomnia (38.8%), changes in body weight (37.3%), loss of appetite and increased irritability (34.3%). The wide variety of complaints in the group of patients with recurrent depressive disorder is a confirmation of the work of scientists who claim that the most important diagnostic sign of a mental disorder is the phenomenon of "multiple somatic symptoms". This set of complaints required a more detailed study of their relationship. In fact, the determination of the correlation relationship by calculating Spearman's rank correlation coefficient revealed positive and negative relationships of different strengths. According to our study, a strong positive relationship was identified between impaired sexual function and loss of appetite (r = 0.72), a significant direct correlation was found between complaints such as decreased mood and loss of appetite (r = 0.52); between impaired sexual function, low mood (r = 0.53), fear of the evening (r = 0.5) and dizziness (r = 0.61).
 A strong negative correlation was observed between dizziness and loss of appetite (r= - 0.86). A significant inverse correlation was found between changes in body weight and low mood (r = - 0.53); between sensations of pain in the stomach and headache (r = - 0.64); between disorders of sexual function and changes in body weight (r = - 0.65), sensations of pain in the stomach (r = - 0.62); between tearfulness and apathy (r = - 0.5). Actually, a relationship with weak strength was noted between other complaints.
 While determining the degree of depressive disorder based on the results of the PHQ-9 survey, we found that a third of the respondents (34.4%) had a mild depressive disorder, a quarter (23.9%) had moderate depressive symptoms, and 14.9% of respondents had severe depressive disorders. When Although some correlation was found, no direct relationship was identified between the severity of depression and complaints during the calculation of the relationship between the degree of depressive disorder and existing complaints.
 According to the results of the PHQ-9, mild depressive disorder has a negative relationship with the change in body weight. Moderate depressive disorder is strongly correlated with loss of appetite. Severe depression disorder has a strong negative relationship with increased irritability and a significant negative relationship with headache. Therefore, further studies with larger cohorts of patients are needed to better understand this aspect of depression.
 To conclude, the data obtained would be important for physical therapists and other members of the multidisciplinary rehabilitation team, as the results indicated that patients with depression had multiple somatic symptoms that were not always associated with the health condition and the degree of depressive disorder.

A Mixed-Methods Evaluation of a Virtual Rehabilitation Program for Self-Management in Post-COVID-19 Syndrome (Long COVID).

Long COVID (LC) symptoms can be long standing, diverse and debilitating; comprehensive multidisciplinary rehabilitation programs are required to address this. A 10-week LC Virtual Rehabilitation Program (VRP) was developed to provide early education and self-management techniques to address the main symptoms of LC and was delivered to a group of persons with Long COVID (PwLC) online, facilitated by members of the multi-disciplinary rehabilitation team. This paper describes an evaluation of this VRP. Questionnaires completed by Healthcare Professionals (HCP) delivering the VRP were thematically analyzed to gain a priori themes and design semi-structured telephone interview questions for PwLC. Template analysis (TA) was used to analyze interview data. Routinely collected patient demographics and service data were also examined. Seventeen HCP survey responses were obtained and 38 PwLC telephone questionnaires were completed. The HCP interviews generated three a priori themes (1. Attendance and Availability, 2. Content, 3. Use of Digital Technology). TA was applied and three further themes emerged from the combined HCP and PwLC responses (4. Group Dynamics, 5. Individual Factors, 6. Internal Change). Key outcomes demonstrated that: the VRP was highly valued; digital delivery enabled self-management; barriers to attendance included work/life balance, use of technology, health inequalities; and LC was poorly understood by employers. Recommendations are provided for the design of VRPs for LC.

Implicit Bias and Health Disparities in the Incarcerated Population: A Review With a Focus on Neurological Care and the Canadian Perspective

Implicit bias held by health care providers can adversely affect the care provided to vulnerable populations and contribute to existing healthcare inequities. Few reports exist on the health of incarcerated individuals. We herein aimed to report how implicit bias affects the care of incarcerated and detained individuals, especially for those experiencing neurological diseases. We frame our review by providing an overview of the organization of the Canadian correctional system and of its population. We highlight the flagrant overrepresentation of Indigenous people and racialized groups in Canadian prisons, which is germane to the healthcare in this population, particularly when viewed through the lens of intersectionality. We also discuss health disparities between incarcerated individuals and the general population, whether it be in terms of neurological, psychiatric, or infectious diseases. Factors other than implicit bias found to affect medical care for these individuals include the perception of safety issues for both healthcare providers and patients in hospital and clinic settings, as well as resource limitations, confounding psychiatric comorbidities and non-organic disorders, and systemic barriers to adequate follow-up in this population. Using illustrative cases from our institution’s experience, paired with findings from our review of the literature, we demonstrate that incarcerated or detained individuals represent a vulnerable group disadvantaged through a series of inequitable policies and actions, which put this group at higher risk of poor general and neurological health. Data specific to neurological diseases in this population are lacking, especially pertaining to long-term healthcare experiences and outcomes. In addition to highlighting literature gaps in this population, we propose ways in which barriers to care can be addressed, such as the development of multidisciplinary care teams to facilitate care and follow-up in these populations. Healthcare providers should make use of opportunities presented to diagnose and treat diseases in this population. Follow-up by specializing nursing and physician teams, as well as care during incarceration by medical and rehabilitation team members including occupational and physiotherapists may help build bridges between healthcare and carceral institutions. Education to raise awareness of implicit bias and mitigation strategies amongst health care providers is another way in which care provided to incarcerated individuals can be improved. J Neurol Res. 2022;12(2):34-42 doi: https://doi.org/10.14740/jnr733

Rehabilitation Diagnosis Based on the International Functioning Classification (ICF) in Patients under Lower Limb Joint Endoprosthetics

To date, the introduction of the International Classification of Functioning, Disability and Health (ICF) into the practical work of rehabilitation institutions and units of different levels and different profiles is a key moment in the organization of the rehabilitation process in accordance with a new legislative framework and a new model of the medical rehabilitation system being created in Russia. Namely, the ICF is the basis for the rehabilitation diagnosis formulation as well as rehabilitation goals and the development of the rehabilitation strategy for each individual patient, and the practical ICF use presents the greatest difficulties for members of the multidisciplinary rehabilitation team (MDRT), since it requires to restructure their thinking stereotypes and behavior « from dysfunction – to limitation of activity», «from correction of disorders to restoration of activity». In this regard, the ICF usage issues in the process of rehabilitation of patients who underwent arthroplasty of large joints, presented in this article, are very relevant. Aim. To describe the most frequent ICF domains used in the formulation of a rehabilitation diagnosis in patients who have undergone the lower limb joints replacement. Conclusion. Identification of key problems based on ICF in patients undergoing total knee and hip arthroplasty allows a more focused and specialized approach to the rehabilitation process for this category of patients, correct formulation of rehabilitation goals and drawing up a plan of rehabilitation measures. In patients who have yet to undergo joint replacement, the use of classification allows to clarify the indications for surgical intervention.

50th Anniversary Department of Rehabilitation Medicine, UP-PGH

50th Anniversary Department of Rehabilitation Medicine, UP-PGH

Engaging Rehabilitation Technicians Through a Career Ladder During a Pandemic.

Nursing assistant turnover is a growing healthcare concern that negatively impacts healthcare organization work environments and has significant financial implications. The purpose of this study was to implement a career ladder program for rehabilitation nursing technicians-nursing assistants who specialize in performing care duties aligned with therapeutic goals in inpatient rehabilitation. The study evaluated the effect on organizational quality metrics of employee engagement, job satisfaction, and annual turnover of rehabilitation nursing technicians. This pilot study was conducted using a quality improvement approach and a between-subjects pretest-posttest design. A three-tier career ladder intervention for rehabilitation nursing technicians in a 76-bed inpatient rehabilitation facility was implemented. Employee engagement and job satisfaction were evaluated in all rehabilitation nursing technicians (n = 44), with a pre-implementation sample size of n = 23 and a post-implementation sample size of n = 21, from January 2020 through December 2020. Twelve rehabilitation nursing technicians participated in the intervention, which consisted of online learning modules, added job responsibilities, and continuing education and were included in the post-implementation sample size. Nondirectional statistical tests were performed with the level of significance set at .05 (two tailed). A majority of the pre-post intervention sample (n = 44) were female (91%), African American (91%), and aged 30-59 years. Employee engagement increased from 78% favorable in 2019 to 86% favorable in 2020. Overall job satisfaction improved from 74% favorable in 2019 to 86% favorable in 2020. Annual turnover decreased from 35% in 2019 to 31% in 2020. In this pilot study, a career ladder program for rehabilitation nursing technicians was effective in increasing and improving employee engagement and job satisfaction while reducing turnover. Rehabilitation nursing technicians are crucial members of the interdisciplinary rehabilitation team providing direct bedside care to optimize patient function. Rehabilitation nursing technician career ladders have the capacity to engage an often underrecognized employee population by creating a positive work environment that promotes job growth and retention in the rehabilitation setting.

Practical application of the International classification of functioning during medical and social expertise of a child with cerebral palsy

The aim of the work is to assess the degree of dysfunction and limitation in daily life activities in a child with cerebral palsy, to provide an expert opinion for medical and social expertise by Medical Supervisory Committee (MSC) in accordance with the principles of the International Classification of Functioning, Disability and Health (ICF). Materials and methods. A clinical example of measuring the degree of disability of the cerebral palsy child in accordance with the ICF principles using standardized tools for functional status assessment and the ICF Categorical Profile. International standardized scales recommended by the international expert group to be applied for cerebral palsy children were used at the State Institution “Ukrainian Medical Center for Rehabilitation of Children with Organic Nervous System Disorders of Ministry of Health”. Results. During a comprehensive examination of the child with cerebral palsy, a multidisciplinary team of specialists determined the degree of body dysfunction and limitation in daily life activities as well as environmental effect influence on the level of functioning and social adjustment. Based on these findings, ICF Categorical Profile of the patient was formed capturing all spheres of his activity according to the functional state. Parents of the child received the medical conclusion based on the results of the examination for MSC expertise at the place of residence. Conclusions. The IСF covers the whole complex of life activity and functioning of CP children and reflects all the changes associated with their growth, development and state of health, as distinct from the classical clinical examination of patients. Standardized tools for the assessment of the degree of dysfunction and life activity limitations in CP children allow to avoid controversies between specialists from different medical institutions during medical and social assessment and when making a rehabilitation diagnosis. Members of multidisciplinary rehabilitation team can timely identify and correct dysfunctions, provide early career guidance based on child functional capacity by using the IСF principles to assess life activity in CP children.