Successful Rehabilitation Outcomes Research Articles

Analysis of satisfaction of stroke patients with medical rehabilitation using multimodal correction technology

Introduction. The quality of medical care is determined not only by the dynamics of functional recovery, but also depends on the patient satisfaction index, which is highly informative and should be used in in its assessment. Aim. To study and analyze the level of satisfaction of patients after ischemic stroke (IS) with the quality of MR services provided using the technology of multimodal correction of motor and cognitive disorders in the early recovery period.Materials and methods. An anonymous survey was conducted of 186 patients with IS who underwent rehabilitation in inpatient and outpatient settings at the Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky, using a specially designed questionnaire including 20 questions, as well as an analysis of medical and social factors affecting MR satisfaction.Results. The majority of respondents (89.8%) were generally satisfied the results of MR, while more than half (65%) plan to undergo further MR using this technology. According to respondents, the favorable result of MR is influenced by the presence of relatives next to the patient (76.0%) and in 14.0% by the presence of a nurse, the availability of special training in rehabilitation of doctors and nursing staff (38%), awareness of the impact of rehabilitation measures for their existing functional disorders (94%). Almost three quarters of respondents noted that the individual regime of the rehabilitation program has the greatest impact on the successful outcome of rehabilitation (72.0%). At the same time, two thirds of specialists consider an important aspect to be the comprehensive work of all specialists engaged in MR (64.0%). The medical staff was highly appreciated by 44.1%, 34.9% and 21.0% highly. 36% of patients are highly satisfied with the results of MR, 42% are quite satisfied, and 16% of respondents gave an assessment of “average, normal”. Among the main reasons for dissatisfaction with MR are remoteness of residence from a medical organization, absence of relatives during the course of MR, the long duration of the MR course, lack of awareness information about the impact of multimodal correction technology on the restoration of impaired functions.Conclusions. Based on the analysis of the overall patient satisfaction with the medical care provided by MR for stroke patients, using the technology of multimodal correction of motor and cognitive impairments, directions for improving the quality of medical services were identified.

An Exploration of the Sources of Self-Efficacy Information in Athletic Injury Rehabilitation

Self-efficacy plays a vital role in an athlete’s injury and rehabilitation experience and is linked to successful rehabilitation outcomes. We sought to develop a deeper understanding of self-efficacy sources throughout injury rehabilitation using an interpretative phenomenological analysis design grounded in a pragmatist paradigm. Semistructured interviews were conducted with nine male Division II collegiate athletes throughout injury rehabilitation. Seven themes were identified as sources of athletes’ self-efficacy during rehabilitation phases, and two themes were identified as influencing participants in their selection and weighing of the sources of self-efficacy. Athletes described several sources as negatively impacting their self-efficacy, and differences were observed in the sources reported across the phases of injury rehabilitation. Results suggest the influence of sources of efficacy information fluctuates over the course of injury rehabilitation. These findings can contribute to further research in the area, as well as strategies and interventions to better assist athletes through injury rehabilitation.

Enlightening on Social Competencies and Problems Faced by Prisoners Families in India

The families of prisoners confront various social competencies and challenges resulting from the incarceration of their loved ones. This abstract provides an overview of prisoners' families' social dynamics and issues. It highlights the stigma and isolation experienced by families, often leading to a sense of exclusion from their communities. Financial difficulties arise due to the loss of income and increased expenses associated with supporting incarcerated individuals. Emotional distress, including shame, guilt, and anxiety, is prevalent among family members. Parenting challenges emerge as remaining caregivers struggle to maintain stability and nurture children while coping with the absence of an incarcerated parent. Disrupted family dynamics and strained relationships can result from lacking a family member. Limited support systems and difficulties in accessing resources further exacerbate the challenges faced by these families. Communication barriers hinder regular contact with incarcerated loved ones, impeding emotional support. Reintegration challenges arise when the incarcerated individual is released, necessitating adjustments and support for their return to society. Addressing these social competencies and problems necessitates a comprehensive approach that includes community support, resource availability, and policies promoting the well-being of incarcerated individuals and their families. Programs providing financial aid, emotional support, parenting education, and reintegration opportunities can significantly benefit prisoners' families and contribute to successful rehabilitation outcomes for incarcerated individuals. This abstract serves as a basis for further research and policy development in understanding and assisting prisoners' families in their unique social circumstances.

Enlightening on Social Competencies and Problems Faced by Prisoners Families in India

The families of prisoners confront various social competencies and challenges resulting from the incarceration of their loved ones. This abstract provides an overview of prisoners' families' social dynamics and issues. It highlights the stigma and isolation experienced by families, often leading to a sense of exclusion from their communities. Financial difficulties arise due to the loss of income and increased expenses associated with supporting incarcerated individuals. Emotional distress, including shame, guilt, and anxiety, is prevalent among family members. Parenting challenges emerge as remaining caregivers struggle to maintain stability and nurture children while coping with the absence of an incarcerated parent. Disrupted family dynamics and strained relationships can result from lacking a family member. Limited support systems and difficulties in accessing resources further exacerbate the challenges faced by these families. Communication barriers hinder regular contact with incarcerated loved ones, impeding emotional support. Reintegration challenges arise when the incarcerated individual is released, necessitating adjustments and support for their return to society. Addressing these social competencies and problems necessitates a comprehensive approach that includes community support, resource availability, and policies promoting the well-being of incarcerated individuals and their families. Programs providing financial aid, emotional support, parenting education, and reintegration opportunities can significantly benefit prisoners' families and contribute to successful rehabilitation outcomes for incarcerated individuals. This abstract serves as a basis for further research and policy development in understanding and assisting prisoners' families in their unique social circumstances.

The role of therapist-patient relationships in facilitating engagement and adherence in upper extremity rehabilitation.

Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation. To explore therapists' perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services. Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results. SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts. In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

Postoperative analgesic effectiveness of ultrasound guided combined femoral - sciatic nerve block versus combined adductor canal block – I PACK block in patients undergoing total knee arthroplasty: A double- blind randomized study

ABSTRACT Background For successful rehabilitation and optimal functional outcomes after total knee arthroplasty surgery, patients must have effective pain control. Peripheral nerve blocks offer an excellent solution for perioperative multimodal analgesia and are advocated to reduce postoperative opioid consumption. Objectives The objective of this study is to compare the efficacy of combined Femoral-Sciatic nerve block and Adductor- interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block in terms of total rescue analgesia dosage and ambulation on the first postoperative day. Method This is a prospective, randomized, double-blinded trial was conducted at Ain Shams University Hospital. Sixty patients scheduled for total knee arthroplasty (TKA) were randomly divided into two equal groups: one group received a Femoral-Sciatic nerve block, and the other received an Adductor-IPACK block. Both ultrasound-guided blocks were performed by injecting 20 mL of 0.25% bupivacaine immediately after anaesthesia induction. The postoperative opioid requirement in the first 24 hours was assessed using the visual analogue scale (VAS). Motor power, intraoperative fentanyl consumption, intraoperative hemodynamic changes, procedure time, surgery duration, tourniquet time, and technique complications were also recorded. Results Femoral-Sciatic group had lower opioid consumption. The Adductor-IPACK group showed a statistically significant higher Modified Bromage score. However, there was no statistically significant difference between the groups in the postoperative pain score assessed using the VAS. Conclusion Based on our study, we conclude that Femoral-Sciatic blocks required a lower dose of rescue analgesia compared to the Adductor-IPACK group. The Adductor-IPACK group also experienced lesser postoperative muscle power impairment.

Investigating Reliability, Validity, and Measurement Invariance of the Eight-Item Vocational Rehabilitation Engagement Scale With a Sample of Multilingual Clients

Background: Vocational rehabilitation (VR) engagement is a vital component for successful rehabilitation outcomes. Purpose: The purpose of this study is threefold: First, we investigated the item clarity of the Vocational Rehabilitation Engagement Scale (VRES); second, we explored the factorial structure; third, we examined the measurement invariance of the VRES across gender and education level for culturally diverse and bilingual clients in public VR program (i.e., clients speak English as a second language). Given the positive effects of client engagement in health and rehabilitative care on outcomes, it is important to validate this brief instrument to measure VR engagement for culturally diverse and bilingual clients. Method: Data, collected from 16 VR clients who completed the original VRES in the focus group, were subjected to content analysis, and data, collected from 264 clients who completed the eight-item VRES and Working Alliance Inventory Short Form (WAI-S), were subjected to confirmatory and multigroup confirmatory factor analysis (MGCFA). Results: Based on the feedback from the focus group, the first item was revised to increase clarity. However, the preliminary results indicated that the revised item had very low community value, and therefore, we removed the item from the subsequent analysis. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) results provided support for a unidimensional structure for the eight-item VRES. Measurement invariance across gender and education level was achieved after correlating error terms. The scale had strong reliability, and scores from the VRES were significantly moderately correlated with working alliance. Conclusion: The eight-item VRES is a reliable and valid measurement tool to use with culturally diverse and multilingual participants.

Cooperative leadership as a condition for patient-reported rehabilitation success.

Rehabilitation is a complex intervention that takes place in a complex setting. The MeeR project (characteristics of successful rehabilitation facilities) aims to identify complex conditions of successful rehabilitation outcomes. A project with a sequential mixed-methods study design with a quantitative prestudy and a qualitative main study was applied. In the quantitative study, quality assurance data of the German Pension Insurance was used to (1) develop and compute a multifacet z-standardized outcome index based on patient-reported outcome data, (2) rank k = 273 orthopedic rehabilitation facilities comprising n = 112,895 patients and k = 86 cardiac rehabilitation institutions comprising n = 30,299 patients based on their outcome index score by means of a league table, and (3) adjust the ranking by basic patient characteristics (age, gender, diagnosis, weeks out of work prior to rehabilitation, application for pension). In the qualitative main study, k = 6 rehabilitation facilities (orthopedic and cardiac rehabilitation centers) were recruited based on the results of the quantitative analysis: three facilities that ranked top 10% and three facilities that ranked lowest 10% of the adjusted league table. All six rehabilitation facilities were visited each for 1 week by two researchers. We conducted participant observations, expert interviews with medical and administrative leaders, group discussions with rehab team members, and group discussions with patients. Subsequently, a systematic comparison of the results of the upper and lower 10% facilities was conducted to identify those characteristics that distinguished those institutions from one another. One of the three clusters of characteristics that distinguished the above and below 10% facilities related to teamwork or interdisciplinary cooperation: among others, the extent of interdisciplinary cooperation was higher in the rehabilitation facilities with a higher degree of success, the leading medical doctors were less dominant in these institutions, and there was also a more comprehensive representation of the team within team meetings, i.e., the quality and amount of interdisciplinary cooperation were higher in these institutions compared to rehabilitation facilities with a lower level of success. This project provided qualitative evidence for the role of interdisciplinary cooperation and collaborative leadership and its different facets for patient-related successful rehabilitation in orthopedic and cardiac rehabilitation. It provides valuable insights into the fabric and structure of a rehabilitation institution and a variety of target points for team development and group-leading interventions.

Knowledge and attitudes of physiotherapists toward sleep: A survey study.

Sleep has been considered as a critical brain state that affects various body functions relevant to physiotherapy (PTs) practice such as motor learning and relearning, pain management, and cognitive function. Despite the importance of sleep for successful rehabilitation outcomes, sleep is often overlooked by PTs. The purpose of this study was to assess the attitude and perception of PTs on the need to assess sleep and provide education about sleep for their patients, as well as the perceived need for PTs to be educated on sleep topics. A survey questionnaire to assess physical therapist's perceptions and attitudes about sleep was utilized in this study. 90 PTs fill out the survey. All respondents agreed that poor sleep is important to people's health, 93% agreed that PTs should assess patients' sleep habits and sleep quality and 88% agreed that addressing sleep issues may impact PTs outcomes. The majority did not receive education about sleep during PT education (75%) or following graduation (86%). Most respondents (95%) think PTs should receive education about sleep. our findings indicated that PTs recognize that sleep impacts their outcomes and patients' sleep should be assessed, as well as the need to receive education about sleep. Therefore, PT education programs may consider incorporating education about sleep, and the development of continuing education courses is also needed.

The nature of positive encounters between disabled workers and insurers in the return to work process.

Previous research regarding interaction between disabled workers and insurers indicates that encounters between these parties are predominantly negative in nature and may result in psychosocial harm for workers. Further research is required to investigate positive interactions to foster return to work after illness or injury. To explore and conceptualize perceived positive encounters between disabled workers and insurers in order to identify the mechanisms that support successful rehabilitation outcomes. This qualitative study explored the experiences of twenty-four disabled workers who had undergone an occupational rehabilitation process. Data were collected with in-depth semi-structured interviews, transcribed, coded, and analyzed using inductive content analysis. Four main themes arose from the 24 key concepts relating to the positive encounters: (1) process flow, (2)customer orientation, (3) information and guidance, and (4) service attitude. The results also reveal that perceived positive encounters promote the return to work not only directly, but also indirectly by improving the informants' motivation, which has previously been found to be one of the most significant factors explaining the outcomes of rehabilitation. The positive relationship between disabled workers and insurers during an occupational rehabilitation could be better understood through a conceptualization of perceived positive encounters. Underlining the importance of positive encounters and their ability to improve the rehabilitee's motivation may contribute to better support methods for the return to work.

Retraining selective trunk muscle activity: A key to more successful rehabilitation outcomes for hemiparetic stroke patients.

Hemiparetic patients lose the ability to move their trunk selectively, abdominals are affected and neither voluntary nor reflex activity is present. To investigate if the inclusion of specific exercises for the trunk muscles in a rehabilitation program for chronic hemiparetic patients could lead to an additional improvement. A multiple-participant single-subject design was replicated in patients with hemiplegia. The study was conducted in two cycles: for the first cycle (A), patients received conventional rehabilitation program, then for the second cycle (B), six months later, the same subjects received conventional rehabilitation therapy plus an additional specific selective trunk muscles training. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), 10 meters distance walk test (10 MWT), Functional Independence Measure (FIM) and instrumental gait analysis were performed before and after both treatment cycles. Significant changes were observed in TIS and 10 MWT after the two treatment cycles. However, after treatment cycle B, BBS and FIM score showed an additional improvement. Whereas, after treatment cycle A gait analysis did not relevantly changed, but after cycle B a significant improvement was registered in velocity, cadence and percentage of stance in the gait cycle. In our patients, the training for selective activation of the trunk muscles had led to a consistent improvement of gait analysis parameters, and hemiparesis-related disability in stance and activities of daily living.

Retraining selective trunk muscle activity: A key to more successful rehabilitation outcomes for hemiparetic stroke patients.

Retraining selective trunk muscle activity: A key to more successful rehabilitation outcomes for hemiparetic stroke patients.

Importance of taxonomic group, life stage and circumstance of rescue upon wildlife rehabilitation in Ontario, Canada

Wildlife rehabilitation is an increasingly important and global practice, aiming towards advancements in animal welfare and species conservation. Although there are ongoing discussions on the benefits and limitations of wildlife rehabilitation, there is a general agreement on the importance of wildlife rehabilitation on improving the welfare of wild animals and identifying threats to wildlife. Determining which factors lead to a successful outcome of rehabilitation can allow wildlife rehabilitation centres to best focus their resources to benefit animals with the greatest chance of a successful release. In this study, three factors affecting the success of rehabilitation were evaluated: taxonomic group, life stage and circumstance of rescue. We used a large database of patients’ records (9561 animals from 198 species) from Sandy Pines Wildlife Centre (Ontario, Canada) over a three year study period (from 2015 to 2018). We found that reptiles had a higher rate of release (63.6 %), compared with mammals (42.1 %) and birds (48.3 %), although released reptiles spent longer in the centre than birds and mammals. Animals arriving to the centre in poor condition were less likely to be rehabilitated and spent longer in the centre than animals arriving in good condition. Overall, preadults were more likely to be released than adults, although the number of days spent at the centre did not differ by life stage. Animals suffering active damage (e.g. ‘collision’ and ‘projectile’) were less likely to be rehabilitated than animals suffering passive damage (e.g. arriving to the centre as ‘orphan’ or due to ‘habitat destruction’); however, when only considering those animals that left the centre, the number of days spent at the centre did not differ between animals suffering passive or active damage. The analysis of patients’ records can provide relevant information to rehabilitators about factors influencing rehabilitation efforts, which can be used to implement strategies that maximise release rates, given limited resources.

Engagement in rehabilitation therapy and functional outcomes among individuals with acquired brain injuries

Purpose : The purpose was to examine the role of therapy engagement as a potential mediator for the relationship between neuropsychological performance and functional outcomes. Materials and method : Participants were 94 adults with medically documented ABI recruited from three outpatient rehabilitation clinics at the start of occupational therapy. Participants (57% men) ranged from 18 to 82 in age, with the majority (81%) having completed 12 or more years of education. They completed a comprehensive neuropsychological assessment at baseline. Separately, occupational therapists (OTs) assessed functional independence and disability at baseline and follow up. The OTs also rated the participants’ therapy engagement. Results : Therapy engagement predicted functional outcomes and mediated the relationship between neuropsychological performance and outcomes. Moreover, therapy engagement accounted for unique variance in functional outcome, even after accounting for education, comorbid health conditions, emotional distress, apathy, and baseline functional ability. Conclusions : Engagement in therapy is a crucial patient characteristic in successful rehabilitation outcome. Cognitive deficits associated with ABI undermine full engagement in rehabilitation therapy, which in turn diminishes potential gains made in therapy and functional recovery. Neuropsychological assessment can enhance rehabilitation outcomes by identifying characteristics that underlie therapy engagement, which can ultimately be used to maximize the effectiveness of individualized treatment plans. Implications for rehabilitation Neuropsychological assessment can identify cognitive abilities that are strongly related to functional outcomes during occupational therapy for acquired brain injury. Therapy engagement is an important pathway by which neuropsychological impairment predicts functional outcomes after acquired brain injuries.

Personal and Contextual Factors Associated With Successful Vocational Rehabilitation and Employment Outcomes

Some individuals with disabilities have relatively better labor outcomes than others. If vocational rehabilitation (VR) counselors can better understand what factors are correlated with positive outcomes, they could better identify what clients are at risk for poor outcomes and then intervene early to improve chances for success. Unfortunately, until recently VR survey and administrative data have had insufficient information to investigate these questions. We use a survey of 932 Ohio VR clients combined with administrative earnings data to examine the barriers and facilitators associated with employment and earnings outcomes. The survey data are from the 2014 Survey of Disability and Employment, a survey of VR applicants in three states. We compare VR case status and earnings through 2016, by demographics, functional limitation status, employment history and attitudes, and reasons stated for not working in the survey. We find that about 25% of survey respondents exited the program employed or had at least one quarter of average monthly earnings above the Social Security Administration’s substantial gainful activity amount. Pain, depression or anxiety, longer duration of job separation, personal and familial attitudes about work, and not working because of personal and health reasons were associated with poorer outcomes among survey respondents.

The Role of Working Alliance in Attainment of Personal Goals and Improvement in Quality of Life During Psychiatric Rehabilitation.

A key aspect of psychiatric rehabilitation is supporting individuals with serious mental illness in reaching personal goals. This study aimed to investigate whether various aspects of the working alliance predict successful goal attainment and whether goal attainment improves subjective quality of life, independent of the rehabilitation approach used. Secondary analyses were conducted of data from a Dutch randomized clinical trial on goal attainment by individuals supported with the Boston University approach to psychiatric rehabilitation (N=80) or a generic approach (N=76). Working alliance was measured with the Working Alliance Inventory (WAI) from the practitioner's perspective. Rehabilitation practitioners had backgrounds in social work, nursing, or vocational rehabilitation. Multiple logistic regression and multiple regression analyses explored effects of working alliance on goal attainment and of goal attainment on subjective quality of life at 24 months. Analyses were controlled for client- and process-related predictors, baseline quality of life, and rehabilitation approach. The WAI goal subscale predicted goal attainment at 24 months. No effect was found for the bond or task subscale. Goal attainment significantly predicted quality of life at 24 months. These effects were independent of the rehabilitation approach used. A good bond between client and practitioner is not enough to attain successful rehabilitation outcomes. Findings suggest that it is important to discuss clients' wishes and ambitions and form an agreement on goals. Attaining rehabilitation goals directly influenced the subjective quality of life of individuals with serious mental illness, which underscores the importance of investing in these forms of client support.

Increasing Successful Vocational Rehabilitation Outcomes for Individuals with Substance Use Disorders

Employment is essential during the treatment and recovery process for individuals with substance use disorders. As such, rehabilitation counselors play a vital role in ensuring the success of these consumers by offering services that increase the likelihood of employment. State and federal vocational rehabilitation programs can offer any of 19 services to consumers and by identifying services offered to those with substance use disorders who have been rehabilitated successfully, counselors can make a concerted effort to incorporate them when most appropriate. As a replica of a study conducted over 10 years ago, the current study seeks to determine if the services identified as increasing successful employment outcomes using data from 2005 still hold true today especially since gainful employment remain low for this population. After effective services are identified, one may then determine how to best incorporate these services into the overall Individual Plan for Employment (IPE) to better assist those with substance use disorders (SUDs). Rehabilitation Services Administration (RSA) 911 datasets were analyzed for years 2010-2014, and chi-square analyses identified five services as increasing the probability of successful case closure (i.e., employment): 1) job placement, 2) on-the-job supports, 3) maintenance, 4) job search, and 5) other. Descriptions of each service are provided as well as suggestions for application and implementation.

A qualitative analysis of patient-identified adaptive behaviour changes following interdisciplinary Acceptance and Commitment Therapy for chronic pain.

Interdisciplinary treatment programmes for chronic pain have strong evidence of treatment effect both immediately after treatment and at follow-up. However, despite strong outcome evidence, it is less clear which specific changes in behaviour are most relevant to patients or to outcomes. Indeed, it is not unknown for clinicians and patients to have different views with regard to goals of treatment. This study sought to evaluate the patients' perspective regarding important behavioural changes that occurred while they were enrolled in a 4-week interdisciplinary programme of Acceptance and Commitment Therapy (ACT) for chronic pain. Qualitative data were collected during a treatment session towards the end of treatment. In total, 104 completers from 16 consecutive treatment groups contributed to a data set consisting of 315 unique qualitative comments. Thematic analysis resulted in a theme hierarchy including overarching themes, midlevel themes and subthemes. Three overarching themes were identified as follows: (1) interacting with self - describing an interplay between various aspects of the individual, (2) activity - concerning how individuals practically and sustainably undertook activities and (3) interacting with others - exploring relationships with other people. The results section further describes the midlevel and subthemes that cluster under the overarching themes. These data provide initial insights into the patient's perspective of adaptive behavioural changes gained as part of an interdisciplinary programme of chronic pain rehabilitation. Overall, the data suggest the importance of a mix of both ACT-specific and more universal coping/pain rehabilitation elements. Future research may examine how these processes relate more directly to treatment outcome. This study provides new qualitative insights into the patient's perspective of adaptive behavioural changes gained as part of interdisciplinary pain rehabilitation. This and future work may help provide a more detailed understanding of the processes and behaviours that result in successful rehabilitation outcomes.

Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia.

The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved.

Determinants of outcome of vocational rehabilitation.

Information regarding the determinants of successful vocational rehabilitation (VR) is scarce. Investigate whether sex, duration, quality of life and financial circumstances influence the success of VR. The study group consisted of 519 participants (293 women, 56%), who finished VR in the period 2000-2014. The group was divided into the following subgroups: dropouts, unsuccessful and successful VR. Data were collected by questionnaire. Income had the most impact on whether the outcome was successful. Having supplemental income when entering the VR program increased the likelihood of a successful conclusion, odds ratio (OR) 5.60 (95% CI; 2.43-13.59) (p < 0.001), being on sick leave OR 5.02 (95% CI 1.93-13.79) (p < 0.001) or rehabilitation pension OR 1.93 (95% CI 1.07-3.52) (p < 0.03). The participants in the successful sub-group were older (p < 0.06) and stayed in rehabilitation longer (p < 0.001), compared to those who were unsuccessful. However, the effect on OR was limited: 1.03 (95% CI 1.01-1.06) and 1.04 (95% CI 1.02-1.07), respectively. For this sample, supplemental income appears to be the most important factor for a successful rehabilitation outcome. Checking financial status at the beginning of the rehabilitation process could minimize financial strain and increase the likelihood of success.