Specialist Rehabilitation Services Research Articles

NURSING TELECONSULTATION FOR PEOPLE WITH SPINAL CORD INJURY: NURSES’ OPINION ON THE MAIN GUIDELINES

Objective: to identify the opinion of nurses on the main topics to be addressed in the nursing teleconsultation of a telerehabilitation program for spinal cord injuries. Methods: descriptive and exploratory study, carried out with experienced nurses in the rehabilitation of people with spinal cord injuries in a network of rehabilitation hospitals. 70 nurses participated in the study. The data were collected through self-administered questionnaires built on the Google Forms® platform and organized in an Excel® spreadsheet. A descriptive statistical analysis of objective responses and a categorical content analysis of discursive responses were performed. Results: Nurses considered it important to accompany people with spinal cord injuries in the transition from care to home and to provide guidance through social networks, telephones, and/or applications. It was found that the main topics to be addressed in the nursing teleconsultation in a telerehabilitation service are skin care and bladder and bowel reeducation. Conclusions: The nursing teleconsultation allows the exchange of information between the nurse of a specialized rehabilitation service and the person with a spinal cord injury in their home environment, encouraging learning and enabling the person’s co-participation and proactivity in managing their self-care.

Situation du parcours de réhabilitation concernant les patients hospitalisés au long cours. À partir d’une analyse clinique et catamnestique de 75 cas

This study aims to carry out a specific action on the rehabilitation path, with the support of the service of social work and housing, systematizing a thorough analysis of each long-term hospitalization situation. An integrated global management in a rehabilitation pathway can only be conceived by a better identification of the factors of complexity and variables likely to change, an organization regularly readjusted, and collaborative work between relevant departments. Extra-hospital facilities play an essential role in the prospects of exits, which requires that the care system be equipped with a rapid relay capacity towards a readmission, that the care accompaniment be efficient and that the patient's care project be adapted to his needs. The closure of intra-hospital rehabilitation units may result in many hospitalized patients no longer having access to the specialized rehabilitation services they need.

“I hope it’ll get better… in the end, it didn’t really get better”: a qualitative study of access to specialized rehabilitation services as experienced by adults with persistent MTBI symptoms

Purpose Persistent symptoms experienced by adults following mild traumatic brain injury (mTBI) can significantly impact their daily activities. It is often difficult for them to access specialized rehabilitation services. The aim of this study is to explore this population’s experience surrounding access to specialized rehabilitation services, including waiting time. Materials and methods This study used a qualitative phenomenological approach and was conducted using semi-structured interviews. Twelve adults with mTBI who had received specialized interdisciplinary rehabilitation services were recruited. The interviews focused on participants’ recollection of their patient journey after injury, their perception of waiting, barriers and facilitators to access, and the impacts of these experiences on their condition. Results Participants reported experiencing symptoms such as anxiety, depression, worry, sadness, and discouragement before accessing specialized services. They all agreed that they did not receive clear information about their recovery process or the health services available to them, which exacerbated their mental health symptoms. Conclusion The findings show that participants experienced uncertainty because they lacked information regarding recovery and access to health services after their injury. Education about symptoms and recovery, as well as emotional support for people with mTBI should be made available during the waiting period.

Pilot of a person-centred, interdisciplinary approach to goal setting in Ireland’s National Rehabilitation Hospital: a study protocol

Background: Research has emphasized the value of a person-centered, interdisciplinary approach to structured goal setting in rehabilitation; yet these approaches are not consistently implemented in clinical practice, limiting the effect that goal setting can have on rehabilitation. The introduction of a new interdisciplinary, person-centered goal setting process to Ireland’s national rehabilitation hospital offers an opportunity to gain novel insight into barriers to implementing and normalising IDT goal setting in complex, specialist rehabilitation services. Methods: The goal setting process was collaboratively designed based on iterative rounds of patient and staff feedback. It will be piloted in three different units of the hospital. The outlined study was co-designed by embedded academic researchers and knowledge stakeholders (the quality improvement team responsible for introducing the new process; and two former patients). The aim is to use a mixed methods approach to capture patient and staff experiences and perspectives of the new process. Data will be collected by embedded researchers with a combination of self-report measures and qualitative interviews with both staff and patients. Self-report measures focus on capturing person centeredness of goals, shared decision making, interprofessional socialization and process normalization. Quantitative data will be represented using descriptive and inferential statistics; qualitative data will be analysed using reflexive thematic analysis. Discussion & Conclusion: From this data the researchers aim to present a holistic view of the patient and staff experiences of the goal setting process. This may further illuminate challenges and potential solutions to implementing changes to goal setting within this context. Findings will be used to inform implementation within the hospital and will contribute to knowledge for rehabilitation practice around implementing IDT goal setting. This will add an Irish perspective to existing goal setting rehabilitation literature.

A Comparative Study of Rehabilitation Information Systems in 8 Countries: A Literature Review

Objectives: This study aims to comparatively review the rehabilitation information systems in 8 countries: Canada, the United States, the United Kingdom, Sweden, Australia, Malaysia, Russia, and Iran. Methods: A comprehensive review of published studies without a time limit was explored by searching the keywords, titles, and abstracts. Studies were obtained from the Web of Science, Scopus, PubMed, and Embase databases on May 2, 2021. We also did a Google search engine to explore rehabilitation information system websites in each country. The inclusion criteria included all English and Persian articles in the field of rehabilitation information registration systems or minimum data sets and the availability of complete text of the articles. A total of 13151 related studies were extracted and finally 25 main articles and 6 websites were selected. A similar standard checklist was used to extract and compare the findings. The data items in this checklist included reference, country, registry name, established year, founder, scope, standard classification systems (coding system), data elements, and subcategories of data elements of the registry. Results: The literature review revealed that the United States has international rehabilitation outcomes in three areas of inpatient, outpatient, and pediatric rehabilitation that collect data from around the world. Australia has a national clinical registry for outpatient and inpatient rehabilitation outcomes for adults and children. Canada, with its national rehabilitation reporting system, gathers only adult inpatient rehabilitation information. In sweden, the Swedish Rehabilitation Medical Register includes rehabilitation activities in both inpatient and outpatient care. Rehabilitation in Malaysia with no data sharing and integration is still in its infancy. The rehabilitation information system in the UK only includes specialized rehabilitation services. In Iran, the Welfare Organization registers and collects (inpatient, outpatient, and home care) rehabilitation and financial data of the disabled with the “payment” system. In Russia, only some studies have proposed the launch of a rehabilitation information system. Discussion: The results of this literature review demonstrate that the most comprehensive rehabilitation information systems first belonged to the United States, and then to Australia, Canada, Sweden, the United Kingdom, and Iran in descending order. Meanwhile, a rehabilitation information system is being developed in Malaysia. However, Russia has not yet developed a comprehensive rehabilitation information system.

Identifying prioritization criteria for patients with mtbi waiting for multidisciplinary rehabilitation services: A Delphi study

ABSTRACT Introduction Rehabilitation service providers must take into account prognostic factors when making clinical decisions, which includes using these factors as prioritization criteria. The goal of this study was to establish consensus on patient prioritization criteria based on prognostic factors related to persistent symptoms for patients with mild traumatic brain injury (mTBI) waiting for outpatient specialized rehabilitation services. Materials and methods We conducted a Delphi survey involving clinicians, researchers, decision makers, and patients. Before the survey, we presented the results of an overview of systematic reviews summarizing the evidence on prognostic factors related to post-concussion symptoms. Results After two rounds, the 17 experts reached consensus on the inclusion of 12 prioritization criteria: acute stress disorder, anxiety and depression, baseline mental and physical health, functional impacts and difficulties in performing daily habits after the trauma, motivation to receive services, multiple concussions, prior neurological problems, PTSD, quality of sleep, return to work failures, somatic complaints, suicidal ideation. Conclusion Healthcare stakeholders must consider a wide range of factors to guide clinical decision-making, including about access to care and patient prioritization. This study shows that the Delphi technique can be used to reach consensus on such decisions regarding patients with mTBI who are waiting for outpatient specialized rehabilitation services.

SOBRE A REDE DE CUIDADOS À PESSOA COM DEFICIÊNCIA: NARRATIVAS DE PESSOAS COM DEFICIÊNCIA FÍSICA EM BUSCA DA INTEGRALIDADE DA ATENÇÃO

CONCERNING THE CARE NETWORK FOR DISABLED PERSONS: NARRATIVES OF PERSONS IN SEARCH OF INTEGRALITY IN HEALTH The aim of the study was to analyze the organization and access to the Care Network for Persons with Disabilities through the narrative of persons with physical disabilities who use a Specialized Physical Rehabilitation Service, a reference for two Health Regions of the State of Rio Grande do Sul, Brasil. This is an extract from the first of five axes outlined in the action research entitled Implementation of the International Classification of Functioning, Disability and Health (ICF): study in a Specialized Service in Physical Rehabilitation of Regional Reference of the Unified Health System in Rio Grande do |Sul. Thirty-seven users of a specialized physical rehabilitation service answered semi-structured interviews, which were hosted using the Content Analysis technique, culminating in two thematic categories, having as a guiding principle the theoretical conceptions of integrality of care. One category deals with the itineraries taken in the care network to obtain access to the specialized rehabilitation service, highlighting the primary role of Primary Health Care in this process for ordering and coordinating care. The other highlights the process of establishing and consolidating links with the aforementioned specialized service, pointing to its importance in the process of recovery and guarantee of integrality. The narrative of the interviewees indicated the need for effective networking, since the guaranteeing access to the insertion and establishment of bonds in a specialized rehabilitation service, while weaknesses and inequalities persist for the effectiveness of the integrality of the care. Key-words: Disabled Persons; Unified Health System; Integrality in Health

The impact of road safety strategy and policy on admissions to a national rehabilitation hospital; a 5-year retrospective review and reflection on trauma data

BackgroundGlobally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe.MethodsA retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher’s exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports.Results338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require.ConclusionData linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.

Satisfação no trabalho e contexto de trabalho entre profissionais de reabilitação em Alagoas, Brasil: um estudo observacional

ABSTRACT Job satisfaction is multifactorial and is directly related to the quality of health services. The main objective of this study was to characterize the level of job satisfaction and the work context of the multidisciplinary teams in specialized rehabilitation services in the state of Alagoas, Brazil. We evaluated the professional profile of participants and sociodemographic information. The Work Context Assessment Scale (WCAS) which is divided into three dimensions and questions adapted from the satisfaction and remuneration dimensions of the Great Place to Work methodology for the Organizational Climate Survey, was used. We included 190 professionals, the mean age was 35.47±9.25 and 86.3% were women. Most participants worked in the capital (60%) and 84.7% had a monthly wage ranging from R$1,000 to R$3,000. The dimension of “work organization” was crucial. The items “pace of work,” “strong demand,” “performance monitoring,” and “repetitive tasks” presented the worst results, but 92.7% are satisfied with their professional activities. The logistic regression analysis showed that more years since graduation and lower scores of Work conditions and Socio-professional relationships were associated with higher job satisfaction. Job satisfaction was found to be high, the dimension of work organization was crucial, and almost half of the participants have already thought about leaving their careers.

A Qualitative Study of the Factors Influencing Patients' Experience of Soft Tissue Sarcoma in the United Kingdom.

Treatment of soft tissue sarcoma frequently involves extensive surgery, loss of mobility, and complex rehabilitation programs. Poorer patient-reported outcomes are reported in comparison to those from patients with other cancer types. Understanding patient experience is therefore important to support patients and improve care. The aim of this study was an in-depth exploration of patients' experience of being diagnosed with soft tissue sarcoma. Semistructured interviews and focus groups were conducted with 68 patients with soft tissue sarcoma (59% female; aged 23-82 years). These were analyzed using adapted framework analysis. Two overarching themes explained the factors influencing patients' experiences: individual and social factors to manage the impact of soft tissue sarcoma; and context and processes of care. Access to professionals with sarcoma expertise and services in specialist hospitals had an impact on patients' well-being. Lack of access to specialist services and coordinated care were associated with worse experiences. These were influenced by age and support from family/friends/other patients and were crucial in patients' adaptation to living with and beyond a sarcoma diagnosis. We describe factors that both negatively and positively influenced the experience of patients with soft tissue sarcoma. Access to specialist soft tissue sarcoma and rehabilitation services and support tailored to patients' age and disease trajectory are needed to improve these experiences. Nurses are important for helping patients manage the long-term effects and directing them to supportive care services. Rehabilitation services need to be available and easily accessible.

133 A CO-ORDINATED EFFORT: THE ADDITION OF A REHABILITATION COORDINATOR TO GERIATRICIAN LED OLDER PERSONS REHABILITATION SERVICES

Abstract Background It is well recognised that acute illness and hospitalisation can be associated with significant deterioration in mobility and function in older people. Flow to appropriate rehabilitation services has impacts not only on individual recovery but also in efficient utilisation of healthcare resources. This study describes the impact of a therapy trained Rehabilitation Coordinator (RC) on access to off-site inpatient and day hospital specialist rehabilitation services. Methods Over 6 months the rehabilitation coordinator collaborated with acute and community services to triage, assess and effectively utilise off-site specialist rehabilitation services with specific reference to role development, feasibility and safety. Key performance indicators measured included assessments completed, time from referral to assessment, time from accepted to transferred, number of admissions and length of stay. This data was compared against a 6-month control. Results The rehabilitation coordinator was involved in over 445 assessments (n=258 patients) in the 6 months of the study. Trusted assessment by the RC was assessed as equivalent to assessments completed by Consultant Geriatricians. COVID restrictions resulted in a reduction in available rehabilitation beds between the control and pilot periods. There was a 22% increase in rehabilitation admissions and a 63% reduction in mean length of stay during the pilot period. There was also a reduction in average time from referral to assessment (1.5 working days versus 5.6 workings days); and time to transfer to rehabilitation (2.1 days versus 6.7 days). New pathways of care developed included rapid access to day hospital care from acute inpatient care. Additional benefits were seen in RC-led education, quality improvement and research projects. Conclusion The addition of a rehabilitation coordinator enhanced patient access to and progress through inpatient and outpatient older person’s rehabilitation services. The RC provided both oversight and continuity of care throughout the patient journey between hospital and home.

Pediatric spinal cord injury rehabilitation: A protocol for an international multicenter project (SINpedSCI)

PURPOSE:Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI.METHODS:A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with ≥20 adolescents aged 13–17 years at least 6 months’ post rehabilitation.RESULTS:Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents’ plans for the future.CONCLUSION:Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.

Stroke Telerehabilitation in Calabria: A Health Technology Assessment.

Introduction: Telerehabilitation (TR) is defined as a model of home service for motor and cognitive rehabilitation, ensuring continuity of care over time. TR can replace the traditional face-to-face approach as an alternative method of delivering conventional rehabilitation and applies to situations where the patient is unable to reach rehabilitation facilities or for low-income countries where outcomes are particularly poor. For this reason, in this study, we sought to demonstrate the feasibility and utility of a well-known TR intervention on post-stroke patients living in one of the poorest indebted regions of Italy, where the delivery of rehabilitation services is inconsistent and not uniform.Materials and Methods: Nineteen patients (13 male/6 female; mean age: 61.1 ± 8.3 years) with a diagnosis of first-ever ischemic (n = 14) or hemorrhagic stroke (n = 5), who had been admitted to the intensive rehabilitation unit (IRU) of the Institute S. Anna (Crotone, Italy), were consecutively enrolled to participate in this study. After the discharge, they continued the motor treatment remotely by means of a home-rehabilitation system. The entire TR intervention was performed (online and offline) using the Virtual Reality Rehabilitation System (VRRS) (Khymeia, Italy). All patients received intensive TR five times a week for 12 consecutive weeks (60 sessions, each session lasting about 1h).Results: We found a significant motor recovery after TR protocol as measured by the Barthel Index (BI); Fugl-Meyer motor score (FM) and Motricity Index (MI) of the hemiplegic upper limbs.Conclusions: This was the first demonstration that a well-defined virtual reality TR tool promotes motor and functional recovery in post-stroke patients living in a low-income Italian region, such as Calabria, characterized by a paucity of specialist rehabilitation services.

Prolonged exposure for pain and comorbid PTSD: a single-case experimental study of a treatment supplement to multiprofessional pain rehabilitation.

It is unclear how to address PTSD in the context of chronic pain management. Here we examine the potential benefits of an addition of prolonged exposure (PE) therapy for PTSD for adults attending multidisciplinary CBT for chronic pain. Four adults seeking treatment for chronic pain from a specialized pain rehabilitation service were offered PE for PTSD using a replicated, randomized, single-case experimental phase design, prior to commencing a 5-week multidisciplinary CBT program for chronic pain. Pre-, post-, follow-up, and daily measures allowed examination of PTSD and pain outcomes, potential mediators, and the trajectory of these outcomes and potential mediators during the subsequent pain-focused CBT program. Visual inspection of the daily data demonstrated changes in all outcome variables and potential mediators during the PE phase. Changes came at different times andat different rates for the four participants, highlighting the individual nature of putative change mechanisms. Consistent with expectation, PE produced reliable change in the severity of PTSD symptoms and trauma-related beliefs for all four participants, either by the end of the PE phase or the PE follow-up, with these gains maintained by the end of the 5-week pain-focused CBT program. However, few reductions in pain intensity or pain interference were seen either during the PE phase or after. Although "disorder specific" approaches have dominated the conceptualising, study, and treatment of conditions like PTSD and chronic pain, such approaches may not be optimal. It may be better instead to approach cases in an individual and process-focused fashion. 2013/381.

Rehabilitation needs following COVID-19: Five-month post-discharge clinical follow-up of individuals with concerning self-reported symptoms.

BackgroundThis report describes and objectivizes reported problems among a cohort of previously hospitalized COVID-19 patients by clinical examination and determination of the required level of rehabilitation sevices.MethodsThis report forms part of the Linköping COVID-19 Study (LinCoS) that included 745 individuals from one of 21 Swedish healthcare regions, Region Östergötland (RÖ), admitted to hospital for COVID-19 during March 1st–May 31st, 2020. In this descriptive ambidirectional cohort study, all 185 individuals who had reported concerning persisting symptoms were invited to a multi-professional clinical assessment of somatic, functional, affective, neuropsychological status and rehabilitation needs. Rehabilitation needs were assessed using three sub-scales of the Rehabilitation Complexity Scale-Extended.FindingsAmong the 158 (85·4%) cases consenting and included in the analysis, we found a broad array of symptoms and signs attributable to COVID-19 involving respiratory, visual, auditory, motor, sensory and cognitive functions that could be confirmed clinically at five months post-discharge. This translated into 16% [95% CI 13–20] of survivors (70/433) of the total regional cohort of hospitalised patients requiring further rehabilitative interventions at follow-up. Weakness in extremities was reported in 28·5% [21·6, 36·2] (45/158). On examination, clinically overt muscle weakness could be corroborated in 15 individuals (10·5%) [6·1, 16·4]. 48% [40, 56] (76/158) reported cognitive symptoms, while the physician noted overt cognitive impairments in only 3% [1·1, 7·5]. In neuropsychological testing, 37% [28–46] (45/122) performed 1.5 SD below the norm, indicating neurocognitive deficits. Fifty-five individuals (34·8%) [27·4, 42·8] reported new or aggravated pain. In three fourths of them, it exerted a ‘moderate’ or worse detrimental effect on their ability to work.InterpretationOur study underscores the importance of providing extensive examination of cases with persisting problems after COVID-19, especially since symptoms such as fatigue and breathlessness are highly nonspecific, but may represent significant underlying functional impairments. Robust neurocognitive testing should be performed, as cognitive problems may easily be overlooked during routine medical consultation. In the Swedish context, most rehabilitative interventions could be provided in a primary care setting. A substantial minority of patients should be triaged to specialized rehabilitation services.

CNIB: Focus on the Future

In Canada, CNIB is the first place people turn to when they discover they are facing significant vision loss. CNIB helps people regain their independence by providing access to specialized rehabilitation services, innova­tive consumer products, and one of the world's largest libraries for people with print disabilities. Recently, the 88-year-old organization has made some changes, including a new brand and visual identity, as well as an exciting new approach to research.

Functional outcomes and cost-efficiency of specialist in-patient rehabilitation following spinal cord injury: a multi-centre national cohort analysis from the UK Rehabilitation Outcomes Collaborative (UKROC)

Purpose: To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multi-centre cohort of inpatients with spinal cord injury (SCI)-comparison based on age and aetiology. Methods and materials: Retrospective analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database from 2012-2019. Adults with SCI admitted for a rehabilitation programme in levels 1 and 2 specialist rehabilitation Units in England, were included if they had valid UK Functional Assessment Measure (UK FIM + FAM) and Northwick Park Dependency Scale (NPDS) scores recorded on admission and discharge (n = 2506 of 3321 admissions). Results: Approximately 425 patients were admitted yearly. 1344(56%) patients were under 65. 736(29%) had traumatic aetiology. Older and Traumatic SCI patients were more likely to have cervical cord damage (X 2, p < 0.001). There was a significant improvement in all parameters of functional independence (UK FIM + FAM) (p < 0.001), with the reduction in dependency and care costs (NPDS/NPCNA) (p < 0.001). 1817(72.5%) patients were discharged home. Mean care-costs savings were £25 500/year per patient. Year-on-year trends showed admissions with increasing age, higher complexity and dependency with corresponding increasing episode costs (ANOVA p < 0.001). However, the time taken to offset the cost of rehabilitation did not change significantly (ANOVA p = 0.57). Conclusions: Specialist rehabilitation services provide effective and cost-efficient rehabilitation for patients with spinal cord injury. Implications for Rehabilitation Approximately a third of patients who access specialist inpatient rehabilitation following spinal cord injury (SCI) in England are managed in the Specialist Level 1 and 2 neuro-rehabilitation units, rather than in the eight designated national SCI Centres. Despite admitting progressively more complex and dependent patients over eight years, these specialist rehabilitation units continue to provide highly cost-efficient care. The mean annual savings amount to £25,500 per patient. With a mean admission rate of 425 patients, this would generate total savings in excess of £10 million per year for the cohort. Specialist rehabilitation services play an important, but under-recognised, role in the spinal cord injury care pathway.

Reviewing suitability of Essex Partnership University Foundation NHS Trust out of area locked rehab placements

AimsTo look at 14 EPUT out of area patient profiles, map their journey to the current locked rehab placements -To review the appropriateness of placement of 14 patients through reviewing whether the care provided is achieving the rehabilitation goals.To look at patients’ needs and whether the local alternatives can provide the careBackgroundRehabilitation services aim to help complex General Adult Mental health patients reintegrate in the community by promoting independent living skills. Some complex mental health patient's care needs mandate a specialist rehabilitation services. Currently there has been a nationwide shortage of local rehabilitation services. This resulted in placing complex needs patients out of area in locked rehabilitation hospitals and miles away from their local community connections. Families and local community team providers travel miles to keep in contact with their complex need persons. The NHS five year plan includes minimizing the current out of area placements and for local services to work together as per CQC recommendations to work together and bring those individuals closer to home.MethodWe designed a tool and examined the electronic records for all 14 out of area placed patient profiles, mapping their clinical journey and reviewing whether the care provided is achieving the rehabilitation goals.Result(N = 14), Patient profiles: 78.5% had residual symptoms (Psychotic symptoms 85%). Patient's Illness profile; treatment resistant with residual symptoms in 71.4% and 7% had comorbid illicit substance misuse, other illness profiles 21.4%. History of alcohol and illicit drug misuse was present in 78.5% and 45% of them were using illicit substances more than 5 years. .patients’ risk profile revealed 86.7% had history of non-compliance. Attempted suicide 21.4% has attempted suicide at list once in which 1/3 of them had more than one attempt. 64.3% Had positive history of offending behavior. All patients in the sample had history of violence 85.7% had risk of vulnerability and self-neglect, 28.5% has history of carrying weapons, 35.7 had a previous Custodial sentence. Average Duration of illness average 16.7 years, average distance from home was 149 miles though clozapine was considered in 92.8% only 35.7% of sample was on clozapine, and the other 64.3% were on combinations. Only 35.7% were on depot.ConclusionThere is a need for expert input for advice regarding complex Management of residual symptoms and rehabilitation needs in the community. Health and social care joint working is needed.

Protecting the Health Service and Managing the COVID-19 Pandemic Surge: The Unintended Impact of Service Reconfiguration on the Specialist Rehabilitation Service at a Regional Teaching Hospital

As part of the UK National Health Service (NHS) preparations to manage the impact of the COVID-19 pandemic on hospital services, clinical guidelines that emphasized the expansion of the acute care capacity in managing the anticipated surge in COVID-19 cases were implemented. Clinical wards were reconfigured and routine face-to-face outpatient clinics were suspended. Some of the changes include workforce and facilities reorganization. One of the changes implemented at the Hull University Teaching Hospitals NHS Trust (HUTHT), was the relocation of the Complex Rehabilitation Ward from its 15- bed base in the Queen’s Centre for Oncology to a repurposed 12-bed surgical ward within the main Castle Hill Hospital (CHH) building in March 2020. Methods: A comparative review of the admissions and outcome measures data (admission diagnosis; referral source; PCAT: Patient Categorization Tool; LOS: Length of Stay; Bed occupancy and discharge destinations) over a 4-month period (March-June 2020) was undertaken and compared to retrospective data from a corresponding 4-month (March-June 2019) period in the previous year to determine the impact of the ward relocation on the delivery of specialist rehabilitation to patients with complex needs during the pandemic episode. Results: A reduction in total number of admitted patients (n=28 in 2019; n=18 in 2020) with reduced bed occupancy from 99% in 2019 to 72% in 2020 despite a reduction in bed base was noted following the ward relocation. A shorter length of stay with a mean of 29 days was noted following relocation of the ward while an increase in patient complexity as demonstrated by the PCAT scores was observed. The proportion of patients achieving a home discharge destination as opposed to other residential care facilities increased, accounting for 89% among discharged patients. Conclusion: This review demonstrated some of the impact of the measures implemented to combat the 1st wave of the coronavirus pandemic, specifically the relocation of the specialist inpatient rehabilitation ward in a tertiary hospital setting. Though a higher proportion of the admitted patients had increased complexity, a shorter length of stay with a significant proportion of the patients achieving a home discharge destination were observed following ward-relocation in 2020 compared to a similar quarter in 2019. The findings also reflected a reduction in bed occupancy despite reduced bed base capacity. Though there is a noted reduction in duration of stay in hospital and a greater proportion the patients achieved a home discharge destination, this was achieved with a compromise on the rehabilitation process due to the constraints of the new ward environment. Significant impact in the quality of the therapy programmes delivered was observed. The longer-term impact of this will need to be monitored. This review highlights the need for consideration of specialist rehabilitation as part of the acute response planning process in pandemic and mass casualty events.

Telerehabilitation Guidelines in Saudi Arabia.

Rehabilitation needs are increasing globally due to population growth, aging population, high survival rates for people with disability, and severe health conditions. In the past few years, new telecommunication-based practices, including various forms of e-rehabilitation have gained attention all over the world, including the Kingdom of Saudi Arabia (KSA). Telerehabilitation is an alternative way of delivering rehabilitation services in which information and communication technologies are used to expedite communication between the health care professional and the patient at a distant location. It can be beneficial to people in rural areas, especially individuals in isolated communities. At present, the COVID-19 pandemic has forced speedy adoption of telerehabilitation due to restricted traditional in-person visits all over the world, including KSA; however, no telerehabilitation guidelines are available in the country. Since specialized rehabilitation services are limited to main cities of the country, the provision of care by reaching out the underserved areas using telemedicine technology is deemed important. These guidelines were established collaboratively by panel of various rehabilitation experts with input from other practitioners in the field and strategic stakeholders. It will facilitate rehabilitation clinicians practicing in KSA providing consultation, counseling, education, assessment, monitoring, therapy, or follow-up to a patient remotely using telemedicine communication technologies. This document includes administrative, clinical, and technical guidelines, which are aimed to standardize telerehabilitation practice across the country. The core principles are based on standards set forth by American Telemedicine Association and are guided by telemedicine policy in KSA. Additionally, ethical considerations of telerehabilitation practice pertinent to Saudi culture and health care system are elaborated as well. This document serves as a general guide for the provision of telerehabilitation services and do not describe a specialty-specific clinical practice guideline.