Rehabilitation Therapists Research Articles

How does culture influence the implementation of strategy training in stroke rehabilitation? A rapid ethnographic study of therapist perspectives in Taiwan and the United States

Purpose Strategy training is a promising stroke rehabilitation intervention commonly delivered in Western countries. We examined the perspectives of rehabilitation therapists who have delivered strategy training in Taiwan and the United States to understand the influence of culture on strategy training implementation. Materials and methods In this rapid ethnographic study, the maximum variation sampling approach was used to recruit seven therapists in Taiwan and seven therapists in the United States with experience delivering strategy training. Data was collected from multiple sources, including interviews, study documents, therapist notes, and reflective memos. Interviews with the recruited therapists in Taiwan and the United States were conducted in Mandarin and English, respectively. Data were analyzed using a constant comparative approach. Results The following two themes were generated: (1) differences between conventional rehabilitation and strategy training, namely that conventional rehabilitation is therapist-directed and emphasizes impairment reduction, whereas strategy training empowers clients and focuses on real-life generalization, and (2) challenges in implementing strategy training in practice, including difficulty in achieving client buy-in and disengagement. Conclusions Therapists from both countries shared similar perspectives on the perceived advantages of strategy training, such as enhancing client empowerment and engagement, and the generalization of strategies. Family involvement was more prominently discussed by therapists in Taiwan than by those in the United States. IMPLICATIONS FOR REHABILITATION Strategy training differs from conventional rehabilitation in its emphasis on clients’ life participation and empowerment, generalization of strategies, and enhancement of their engagement, confidence, and problem-solving skills. Therapists may face challenges related to client buy-in and disengagement as well as difficulties in establishing a therapeutic rapport at the beginning of strategy training because clients have different expectations from those of conventional rehabilitation. Cultural differences in norms and expectations and the clinical experiences of therapists may influence the delivery of strategy training to clients. Family support may influence the success of strategy training. Thoughtful conversations to reach a mutual understanding regarding the expectations of strategy training among clients, family, and rehabilitation practitioners are necessary prior to implementing strategy training.

Design and optimization of actuator for multi-joint soft rehabilitation glove

PurposeCurrently, rehabilitation medical care is expensive, requires a large number of rehabilitation therapist and which can only limit in the fixed location. In addition, there is a lack of research on the structure optimization and theoretical analysis of soft actuators for hand rehabilitation. In view of the problems above, this paper aims to propose a cheap, portable, wearable soft multiple joints rehabilitation glove.Design/methodology/approachFirst, this paper determined the hyperelastic constitutive model by material tensile test. Second, the soft actuator’s internal longitudinal section shape was optimized through the comparison of three diverse chamber structures. Meanwhile, the motion model of the soft actuator is established by the finite element model analysis method. Then, this paper established the constitutive model of the soft actuator according to the torque equilibrium equation and analyzed the relationship between the soft actuator’s bending angle and the input air pressure. This paper has verified that the theoretical model is correct through the soft actuator bending test. Finally, rehabilitation gloves were manufactured according to the model and the rehabilitation performance and grasping ability of gloves were verified through experiments.FindingsThe optimization results show that the internal semicircular cavity has better performance. Then, the actuator performance is better after adding the external arc structure and optimizing the physical dimension. The experimental results show that the trajectory of the actuator conforms to the mathematical model and rehabilitation gloves can meet the needs of rehabilitation treatment.Practical implicationsRehabilitation gloves made of actuators can help patients with hand dysfunction in daily rehabilitation training. Then, it can also assist patients with some fine and complicated hand movements.Originality/valueThis paper proposes a new type of soft rehabilitation glove, which is composed of new soft actuators and adapting pieces. The new actuator is small enough to be fitted to the knuckle of the glove to move each joint of the finger.

Exploring the Opportunities and Challenges of a Virtual Community-Based Older Adult Fall Prevention Program During COVID-19

Rehabilitation therapists have traditionally been key players in the development and delivery of community-based programs, and the value of those programs is well documented. The onset of COVID-19 necessitated the closure or shift of many of these programs to virtual delivery, resulting in a change in the role of the rehabilitation therapist. The challenges and opportunities of traditional and virtual programming are explored. Factors influencing the participation of seniors in these programs are examined. The impact of COVID-19 and the resulting digital resources on future community-based practice is discussed.

Social Isolation and Its Impact on the Geriatric Community

Causes of social isolation and loneliness in older adults are multifactorial and can have significant effects on their health and quality of life. Older adults who have good social support exhibit lower levels of depression, higher levels of life satisfaction, lower stress levels, and lower health care costs. By assessing and addressing social isolation and loneliness in community-dwelling older adults, rehabilitation therapists can have a positive impact on their physical and mental health.

\u2018Bare-bones\u2019 to \u2018silver linings\u2019: lessons on integrating a palliative approach to care in long-term care in Western Canada

Background‘Whole-person’ palliative approaches to care (PAC) are important for enhancing the quality of life of residents with life-limiting conditions in long-term care (LTC). This research is part of a larger, four province study, the ‘SALTY (Seniors Adding Life to Years)’ project to address quality of care in later life.A Quality Improvement (QI) project to integrate a PAC (PAC-QI) in LTC was implemented in Western Canada in four diverse facilities that varied in terms of ownership, leadership models, bed size and geography. Two palliative ‘link nurses’ were hired for 1 day a week at each site over a two-year time frame to facilitate a PAC and support education and training.This paper evaluates the challenges with embedding the PAC-QI into LTC, from the perspectives of the direct care, or front-line team members. Sixteen focus groups were undertaken with 80 front-line workers who were predominantly RNs/LPNs (n = 25), or Health Care Aides (HCAs; n = 32). A total of 23 other individuals from the ranks of dieticians, social workers, recreation and rehabilitation therapists and activity coordinators also participated. Each focus group was taped and transcribed and thematically analyzed by research team members to develop and consolidate the findings related to challenges with embedding the PAC.ResultsThematic analyses revealed that front-line workers are deeply committed to providing high quality PAC, but face challenges related to longstanding conditions in LTC notably, staff shortages, and perceived lack of time for providing compassionate care. The environment is also characterized by diverse views on what a PAC is, and when it should be applied. Our research suggests that integrated, holistic and sustainable PAC depends upon access to adequate resources for education, training for front-line care workers, and supportive leadership.ConclusionsThe urgent need for integrated PAC models in LTC has been accentuated by the current COVID-19 pandemic. Consequently, it is more imperative than ever before to move forwards with such models in order to promote quality of care and quality of life for residents and families, and to support job satisfaction for essential care workers.

What is Person-Centered Care?

What is Person-Centered Care?

Pressure Injury Prevention Packets for Prone Positioning.

During the COVID-19 pandemic, many innovative ideas have been implemented in an attempt to combat the disease. Coronavirus disease may progress to acute respiratory distress syndrome, a complex and multifaceted disease process that requires mechanical ventilation and demands timely intervention to achieve optimal patient outcomes.Pronation is the act of physically turning onto one’s abdomen, and its use as therapy has been recommended as management for severely ill patients with acute respiratory distress syndrome.1 Pressure injuries are one of the main complications of pronation therapy,2 particularly in patients receiving mechanical ventilation, who have an increased risk of pressure injury because they cannot redistribute their weight on their own. The National Pressure Injury Advisory Panel acknowledges these high-risk patients and created a tip sheet to help decrease the risk of pressure injury.3 We thought that by developing a packet that contained necessary prophylactic skin protection, we could mitigate pressure injuries that occur during prone positioning.Within our hospital’s critical care area, the clinical nurse specialist and clinical nurse educator collaborated to summarize organizational recommendations to prevent pressure injuries among prone patients receiving mechanical ventilation. We created an outline for nurses that included high-risk skin areas that need to be protected with foam when patients are in the prone position.The wound nurses at our hospital were consulted to review the content and offer further suggestions. They created a handout for the nursing staff that included a diagram of the patient and where nurses should place protective foam, the number and size of foam dressings needed, and when to change the foam and assess the skin (Figure 1). We collaborated with anesthetists, respiratory therapists, and intensivists to obtain feedback and ensure buy-in. This handout allowed all staff to standardize the approach for preventing pressure injury while a patient is prone.To ensure nurses had easy access to supplies, we decided to create a prepackaged kit including the handout and all of the preventive foam dressings that would be needed to prepare a patient for pronation therapy. Clinical nurses created these prevention packets, which were distributed to the units caring for patients with COVID-19.As nursing and therapy staff continued to use pronation therapy, we needed to ensure staff adjusted the patient’s body slightly and repositioned their head (Figure 2). The writing on the window panes was difficult to interpret and took up a great deal of space. A small group, including a clinical nurse, clinical nurse specialist, and 2 rehabilitation therapists, created a flyer to standardize scheduling for repositioning patients (Figure 3); this flyer was posted outside of the rooms. Using the standardized template, we were able to operationalize a concrete schedule for assessing and repositioning patients for the duration of their pronation therapy.Throughout this pandemic, hospital staff have had to become savvy to continue to provide stellar care to their patients. Nursing staff’s critical thinking and decision-making can be influenced by many factors such as fellow nurses, patients, and unit workflow.4 By collaborating and assessing the flow of patients with COVID-19, our team lived up to this challenge, developing innovative ideas to improve patient outcomes. Adding the pressure injury prevention packets to the nursing workflow has been extremely helpful in ensuring a standard approach to prevent pressure injuries among our prone patients receiving mechanical ventilation.After the rollout of the pressure injury prevention packets, nursing staff shared their thoughts informally about the intervention. Nurses thought it was convenient to have all items necessary for preventing pressure injury available in 1 packet, which made them efficient when preparing their patients. Specifically, the staff appreciated the instructional diagram that assisted them in appropriately placing the preventive foam pads.No pressure injuries occurred on high-risk skin areas in our patients throughout the implementation of the pressure injury prevention packet. Using the Plan, Do, Study, Act method and reviewing pressure injury data, we modified the packets to include foam dressings and instructions for preventing pressure injury on previously unknown susceptible skin areas such as the bridge of the nose.Wound nurses were promptly consulted during the care of all prone patients and collaborated on protecting patient-specific high-risk skin areas. The interdisciplinary COVID-19 care team developed a comprehensive view of skin protection while caring for prone patients as the pressure injury prevention packets were implemented. Although the main focus of this intervention was to optimize prone positioning for patients with COVID-19, the concept has expanded to all patients requiring pronation therapy.

Goal setting practices of occupational therapists in spinal cord injury rehabilitation in Gauteng, South Africa.

Client-centered goal setting has multiple benefits in spinal rehabilitation. However, research has shown that many occupational therapists struggle to facilitate client-centered goal setting. South Africa presents unique challenges to client-centered goal setting, but no data is available on how it is applied. A qualitative research design following an appreciative inquiry stance was used. To explore how occupational therapists implement and envision the goal setting practices in spinal rehabilitation. Rehabilitation facilities in Gauteng, South Africa. A focus group consisting of five occupational therapists working within spinal rehabilitation was held. An appreciative inquiry stance was used to determine current successes and future ideas on how to implement goal setting in a spinal rehabilitation setting. Data was analysed thematically using Braun and Clark. Themes were developed under each phase of appreciative inquiry. Discovery phase: Participants felt that current effective goal setting is therapist-directed and that client insight facilitates effective goal setting. Dream phase: Participants agreed that client-centered goal setting is the ideal. In addition, effective collaboration within the team and adequate resources were identified during the dream phase as ideals to effective goal setting practices. Design and Destination phase: Participants generated ideas on how to improve on team collaboration during goal setting and how to ensure goal setting is client-centered for effective goal setting in spinal rehabilitation to take place. The study emphasizes that for effective goal setting to occur, the process must remain client-centered. Essential to this process is collaboration between both the team and family members. Adequate resources and a low therapist-patient ratio supports effective goal setting.

Role of Telerehabilitation in the Rehabilitation Medicine Training Program of a COVID-19 Referral Center in a Developing Country.

This article describes the impact of the pandemic on physical medicine and rehabilitation in a COVID-19 referral center of a developing country. It describes how telerehabilitation can be leveraged to fill in the gaps in service, training, and research arms of the physical medicine and rehabilitation specialty. The ITAWAG ("to call") telerehabilitation program is the response of the Department of Rehabilitation Medicine at Philippine General Hospital, which is the country's national university hospital, to the ongoing COVID-19 crisis that continues to limit face-to-face access to physical medicine and rehabilitation services throughout the country. With the significant decline in the number of patients served since the start of the pandemic, the ITAWAG program aimed to bridge the physical distance between patients and clinicians after a set of eligibility criteria for teleconsultation or teletherapy and a step-by-step process used before, during, and after each virtual encounter. However, because many physical medicine and rehabilitation consultants, residents, and therapists were not trained for the virtual approach to patient care, a telerehabilitation curriculum was developed to help in providing quality and competent services. Finally, despite the growing awareness of telerehabilitation throughout the country, several research gaps about this emerging technology are identified to determine its acceptance, applicability, and cost-effectiveness among others.

Theoretical Foundations of Psychological and Physical Rehabilitation of Patients with Ischemic Stroke

The objectives of our article are: to study the characteristics of disorders of psychomotor function and psycho-emotional state of patients with ischemic stroke according to the initial examination; to develop a method of physical rehabilitation of patients with ischemic stroke at the inpatient stage of rehabilitation, depending on the severity of psychomotor functions and features of the psycho-emotional state; in a psychological and pedagogical experiment to evaluate the effectiveness of the proposed method of physical rehabilitation of patients with ischemic stroke at the inpatient stage of rehabilitation. The following theoretical methods of the research were used to solve the tasks formulated in the article: a categorical method, structural and functional methods, the methods of the analysis, systematization, modeling, generalization. Also in our research we used empirical methods, such as the observation, the interview, the questionnaire, the method of psychological observation, psychological and medical experiment, testing (M. Lucher’s test is used). The results of the research. It was developed a «Functional methodology for the restoration of motor function of patients with ischemic stroke, taking into account their psycho-physiological features», based on the psychological principles of stepwise, sequencing and complexity, as well as on the maximum and adequate psychological impact of the rehabilitation therapist on the patient. Also we proposed the «Functional methodology of physical rehabilitation in the early period of ischemic stroke». The main provisions of this methodology are: 1. The stabilization of the psycho-emotional state of the patient: reducing the level of anxiety, increasing motivation to exercise in the course of physical rehabilitation. 2. The actualization of stable static and dynamic stereotypes of the patient in all initial positions – from horizontal to vertical ones, using the influence of simple, eye-motor, tonic (labyrinthine tonic reflexes, symmetrical cervical tonic reflex, cervical asymmetric tonic reflex, etc.). Restoration and maintenance of stress resistance of patients is provided by symmetrical maintenance of a projection of the general center of gravity on a basic surface in such initial positions in which normal proper afferentation of joints and muscles will be stimulated. These are the positions that the human body consistently takes in the process of verticalization: a supine position on the back; a lying position on the side (right and left); a supine position; a standing position on the knees; a standing position on the knees (with additional vertical support and without such a support); a standing position (with additional vertical support and without such a support). It was proved that the starting position became a directly activated position with a torso extension, which had the aim to support all muscle groups of the patient, provided by the stimulation of a successive chain of muscle contractions directed from the center to the periphery of the body. The symmetry of maintaining the initial position of the patient during the lesson is constantly adjusted (passively or actively) in order to stimulate proper afferentation. Conclusions. The main directions of psychotherapy and psycho-correction of patients who suffered from ischemic stroke are: the assistance in the process of understanding the patients, his / her basic needs, motives, instructions, relationships; his / her internal conflicts and mechanisms of psychological protection; features of his / her behavior and emotional response, their adequacy and realism; the correction of patients’ instructions; the assistance in formulating and securing adequate forms of patients’ behavior based on personal achievements in the cognitive, motivational, and emotional spheres; the promotion of positive motivation for recovery and increased activity in treatment at the behavioral level. During the classes according to the proposed methodology, we have the aim to achieve the stabilization of a psycho-emotional state of the patient through the correction of his / her cognitive processes that motivate the patient to actions which generally affect the effectiveness of all rehabilitation measures.

Using a bimanual lever-driven wheelchair for arm movement practice early after stroke: A pilot, randomized, controlled, single-blind trial

Objective: Many patients with subacute stroke rely on the nonparetic arm and leg to propel manual wheelchairs. We designed a bimanual, lever-driven wheelchair (LARA) to promote overground mobility and hemiparetic arm exercise. This study measured the feasibility of using LARA to increase arm movement, achieve mobility, and improve arm motor recovery (clinicaltrials.gov/ct2/show/NCT02830893). Design: Randomized, assessor-blind, controlled trial. Setting: Two inpatient rehabilitation facilities. Subjects: Nineteen patients with subacute stroke (1 week to 2 months post-stroke) received 30 minutes extra arm movement practice daily, while admitted to inpatient rehabilitation (n = 10) or before enrollment in outpatient therapy (n = 9). Interventions: Patients were randomized to train with the LARA wheelchair (n = 11) or conventional exercises with a rehabilitation therapist (n = 8). Main measures: Number of arm movements per training session; overground speed; Upper Extremity Fugl-Meyer score at three-month follow-up. Results: Participants who trained with LARA completed 254 (median) arm movements with the paretic arm each session. For three participants, LARA enabled wheelchair mobility at practical indoor speeds (0.15–0.30 m/s). Fugl-Meyer score increased 19 ± 13 points for patients who trained with LARA compared to 14 ± 7 points with conventional exercises (P = 0.32). Secondary measures including shoulder pain and increased tone did not differ between groups. Mixed model analysis found significant interaction between LARA training and treatment duration (P = 0.037), informing power analysis for future investigation. Conclusions: Practising arm movement with a lever-driven wheelchair is a feasible method for increasing arm movement early after stroke. It enabled wheelchair mobility for a subset of patients and shows potential for improving arm motor recovery.

Health Policy and Health Services Delivery in the Era of COVID-19.

Health Policy and Health Services Delivery in the Era of COVID-19.

Facilities, Equipment and Personnel in Education of Persons with Visual Impairment

The paper discussed that education of persons with visual impairment cannot gain any achievement without the use of special learning facilities and equipment and personnel. The special learning facilities and equipment can either be electronic or manual. Also highlighted in the paper includes assistive technologies for reading, writing, mobility, mathematics among others. The personnel in education of persons with visual impairment include Braillist, opticians, Rehabilitation therapist among others. Facilities for education of persons with visual impairment requires; Braille room, Typing pool, Resource room, among others were highlighted. The equipment for persons with visual impairment; Braillers, typewriters, audible ball among others were included in the paper. Equipment for mathematics; Taylor frame, Abacus Raised clock faces among others. Equipment for geography; Brailled atlas, Moulded plastic dissected relief maps among others. Equipment for writing; Raised-line writing paper among others. Assistive technologies for computer access; JAWS Talking Software, Refreshable Braille displays among others. The paper concluded that it is a necessity to have facilities, equipment and personnel as they are very useful in the education of persons with visual impairment as they are to every other living being.

Association of patient quality of life with the degree of agreement in the perceptions of patient disability within the stroke patient–rehabilitation therapist dyad: a cross-sectional study in postdischarge rehabilitation setting

ObjectivesThe purpose of study was to explore the association between patient physical and psychological quality of life (QOL) with the degree of agreement in perceptions of patient disability within the...

P077 Upskilling rheumatology therapists in work rehabilitation: an evaluation of the Workwell training programme

Abstract Background/Aims Keeping people with arthritis working is an important goal of rehabilitation. Rheumatology therapists may provide work advice to employed patients but conducting a structured work assessment and providing vocational rehabilitation (VR) is unusual. As part of a VR trial, we developed a VR training course (Workwell). The course consisted of 3 elements: a pre-training self-study module (reading on ergonomics and activity analysis; activity analysis of at least 2 videos of people working; observing people working); a 2-day training course (how to conduct a structured work interview (the Work Environment Survey: WES); case studies; planning work interventions; practical workshops about VR strategies and solutions; addressing disclosure; writing reports); followed by a 1:1 one hour telephone call practising conducting the WES with a trainer, developing a treatment plan, and individual feedback. A “Workwell Solutions Manual” was also provided for use in practice, with information on legislation, patient booklets and work solutions linked to problems identified in the WES. Our aim was to evaluate therapists’ views about the course and its impact. Methods All therapists attending the Workwell course were asked to complete questionnaires pre- and post-training. These included: knowledge of and confidence in providing VR (measured on a 0-4 scale of very limited to excellent); the Evidence Based Practice Attitude Scale (EBPAS); and views about course content and duration. Results Three courses were delivered: 32/40 attendees completed pre-and-post training questionnaires. All were occupational therapists (OTs): 30 women and 2 men; 2 NHS Band 5, 15 Band 6, 11 Band 7 and 4 Band 8; with 11 (SD 7) years’ experience in Rheumatology. Median scores of Knowledge of: VR; the VR process; VR strategies; relevant legislation and policies; and Confidence in: conducting a work assessment; and identifying work solutions, significantly increased from 1 (limited: IQR 1-2) to 3 (good: IQR 2-3) (p < 0.001). Total EBPAS scores did not change. However, Openness sub-scale scores did (i.e. extent to which willing to use new research -based interventions): Pre 2 (moderate: IQR2-3) to Post 3 (great: IQR 3-3): p = 0.04. Most (i.e. 26-30) considered very/extremely relevant: the pre-training self-study; conducting the WES and case studies; practical workshops (workstation assessment; upper limb strategies; load handling; environment; disclosure); and the post-training 1:1 practice WES, treatment planning and feedback. The training about using the WES (roleplay by trainers; case studies and 1:1 telephone practice) was considered the most beneficial aspect. Of the 21 commenting on course length, 16 considered it about right and 5 wanted longer. Conclusion The 2-day VR course, plus 2 days self-study, led to significant improvements in knowledge and confidence in delivering VR amongst attending OTs. Work is a key component of OT. This training course could help expand work services in Rheumatology to keep patients working. Disclosure A. Hammond: None. S. Woodbridge: None. R. O'Brien: None. A. Ching: None. J. Parker: None.

Therapists’ perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study

ABSTRACT Background Facial palsy rehabilitation therapy plays an essential role in treating facial palsy. Purpose This study aimed to gain insight into therapists’ perceptions and attitudes toward facial palsy rehabilitation therapy and to examine whether therapists could be categorized into distinct groups based on these attitudes and perceptions. Methods Thirteen semi-structured, in-depth interviews were conducted in a purposive sample of therapists. Interviews were analyzed using thematic analysis. Next, a questionnaire containing questions about therapists’ characteristics and perceptions and attitudes toward facial palsy rehabilitation therapy was sent to all facial palsy rehabilitation therapists in the Netherlands and Flanders (n = 292). Latent class analysis (LCA) was performed to identify and analyze distinct groups of therapists. Results Seven themes were derived from the interviews: treatment goals, therapy content, indications, measurement instruments, factors influencing success, emotional support, and cooperation with colleagues. The questionnaire was filled out by 127 therapists. A 2-group structure consisting of a positive class and a negative class was found to fit the questionnaire data best. No distinction could be made regarding therapists’ characteristics. Conclusion Considerable variation in stated treatment practices was present among therapists. Therapists could be classified into 2 groups. This study raises several hypotheses that require further study.

Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients.

With the growing number of dialysis patients with frailty, the concept of renal rehabilitation, including exercise intervention and nutrition programs for patients with chronic kidney disease (CKD), has become popular recently. Renal rehabilitation is a comprehensive multidisciplinary program for CKD patients that is led by doctors, rehabilitation therapists, diet nutritionists, nursing specialists, social workers, pharmacists, and therapists. Many observational studies have observed better outcomes in CKD patients with more physical activity. Furthermore, recent systematic reviews have shown the beneficial effects of exercise intervention on exercise tolerance, physical ability, and quality of life in dialysis patients, though the beneficial effect on overall mortality remains unclear. Nutritional support is also fundamental to renal rehabilitation. There are various causes of skeletal muscle loss in CKD patients. To prevent muscle protein catabolism, in addition to exercise, a sufficient supply of energy, including carbohydrates, protein, iron, and vitamins, is needed. Because of decreased digestive function and energy loss due to dialysis treatment, dialysis patients are recommended to ingest 1.2-fold more protein than the regular population. Motivating patients to join in activities is also an important part of renal rehabilitation. It is essential for us to recognize the importance of renal rehabilitation to maximize patient satisfaction.

Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study.

ObjectiveCOVID-19 has widely affected delivery of health care. In response, telerehabilitation (TR) has emerged as alternative care model. Aims were: (1) describe baseline patient characteristics and available unadjusted outcomes for episodes of care administered during COVID-19 using TR vs. traditional in-person care, (2) describe TR frequency levels by condition and telecommunication modes.MethodsA descriptive retrospective observational design was used to report patient variables and outcomes including physical function, number of visits, and patient satisfaction, by TR frequency (few, most, or all visits) and telecommunication modes. Standardized differences were used to compare baseline characteristics between episodes with and without TR.ResultsSample consisted of 222,680 patients [59% female; mean age (SD) = 55(18)]. Overall TR rate was 6% decreasing from 10% to 5% between 2nd and 3rd quarters of 2020. Outcome measures were available for 90% to 100% of episodes. Thirty-seven percent of clinicians administered care via TR. Patients treated using TR compared to in-person care were more likely to be younger, and live in large metropolitan areas. From those with TR, 55%, 20%, and 25% had TR during few, most, or all visits, respectively. TR care was administered equally across orthopedic body parts, with lower use for non-orthopedic conditions such as stroke, edema, and vestibular dysfunction. TR was primarily administered using synchronous (video or audio) modes. The rate of patients reported being very satisfied with their treatment results was 3% higher for no TR compared to TR.ConclusionsThese results provide new knowledge about to whom and how TR is being administered during the pandemic in outpatient rehabilitation practices throughout the USA. The database assessed was found to be suitable for conducting studies on associations between TR and diverse outcome measures, controlling for a comprehensive set of patient characteristics, to advance best TR care models, and promote high quality care.ImpactThis study provided detailed and robust descriptive information using an existing national patient database containing patient health and demographic characteristics, outcome measures, and TR administration data. Findings support the feasibility to conduct future studies on associations between TR care and patient outcomes, adjusting for a wide range of patient characteristics and clinical setting factors that may be associated with the probability of receiving TR. Finding of limited and decreasing use of TR over the study period calls for studies aimed to better understand facilitators and inhibitors of TR use by rehabilitation therapists during everyday practice to promote its use when clinically appropriate.

Frontline clinician concerns during the COVID-19 pandemic: A qualitative inquiry

Objective: The COVID-19 pandemic has strained healthcare systems worldwide, placing a high psychological burden on frontline clinicians. There is an urgent need to better understand their stressors and determine if stressors differ by clinical role. The present study assessed the concerns among frontline clinicians across a large healthcare system during the COVID-19 pandemic to inform the development of tailored supportive services.Methods: From March – June 2020, frontline clinicians across the Mass General Brigham healthcare system were invited to register for an adapted mind-body resiliency group program. Clinicians completed pre- and post-program assessments asking them to report their COVID-19-related concerns. Qualitative data were analyzed in aggregate and by clinical role using content analysis to identify overarching domains.Results: Frontline clinicians’ concerns fall within seven domains: concerns for self, patients, family members, staff, existential concerns, systems-level concerns, and job-level concerns. Concerns for self and existential concerns were most commonly reported across clinical roles. Long-term care clinicians were highly concerned about patients’ wellbeing while rehabilitation therapists were highly concerned about their family members’ health. Across groups, nurse practitioners and physician assistants more often reported job-level concerns. Concerns for staff and systems level concerns were less frequently reported across clinical roles.Conclusions: Frontline clinicians share common pandemic-related concerns, but nuances exist among the concerns most frequently reported across clinical roles. Interventions that offer stress management and resiliency training may be helpful for addressing pandemic-related concerns overall. Future research should determine if tailored support services by clinical role may be warranted.

Staff Family Day in the Pediatric Intensive Care Unit

Staff Family Day in the Pediatric Intensive Care Unit