Beneficiaries of Rehabilitation

Range and Nature of Social Services for Children With Disabilities and Their Families: A Descriptive Study

OBJECTIVE

Children with disabilities and their families continue to face challenges in social inclusion and accessing resources. This study aimed to evaluate the availability and associated challenges of using services for these children and their families.

METHODS

A descriptive study was conducted to analyze social services for children with disabilities. Data were collected from the official websites of both public and private institutions across three regions in South Korea. These data included information on the service contents and the characteristics of the target beneficiaries.

RESULTS

A total of 12,841 service units were analyzed and grouped into 10 domains and 35 categories of social services. The most frequently identified service content was "Healthcare," followed by "Child and family care" and "Community services." The most frequently used characteristic of target beneficiaries was "Residential area," followed by "Income level," "Benefit," and "Type of disability."

CONCLUSION

The current services are limited in meeting the needs of children with disabilities, particularly in terms of selection criteria, service content, and the integration of policies and delivery systems, contributing to a lack of social inclusion and lower quality of life. Constructing a national scheme to expand eligibility and support tailored to individual circumstances and needs is necessary.

Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study

BACKGROUND

Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy.

OBJECTIVE

This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood.

METHODS

A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively.

RESULTS

The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score.

CONCLUSIONS

This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791.

Comparison of Diagnosis-Related Group Rehabilitation Reimbursement Payments With Those of a Novel Patient Classification-Based Payment System

Objective

To compare the difference of reimbursement payments between diagnosis-related group (DRG) and a novel patient classification-based payment system, diagnosis-intervention packet (DIP), among rehabilitation inpatients in tertiary hospitals.

Design

Retrospective cohort study.

Setting

TTertiary hospitals in Shenzhen, China.

Participants

We assessed the records of 268,362 individuals who visited tertiary hospitals providing rehabilitation services.

Interventions

Not applicable.

Main Outcome Measures

The outcome variable was the patients' rehabilitation hospitalization cost of in our study. A quantile regression analysis was conducted to estimate the effects of DIP payment on the rehabilitation hospitalization cost.

Results

The results showed that the predicted marginal hospitalization cost with DRG payment were 9%, 7%, 14%, and 10% higher than that with DIP payments in 2019, 2020, 2021, and 2022. The total difference in predicted marginal hospitalization cost between DRG and DIP was -1269 RMB (-193 USD). This difference in 2019, 2020, 2021, and 2022 was -1419 RMB (-228 USD), -1088 RMB (-158 USD), -1585 RMB (-246 USD), and -1034 RMB (-154 USD), respectively. All differences in predicted marginal hospitalization cost between DRG and DIP was significant (P<.001), after controlling for patients' age, sex, public or private hospital, the type of disease, and the length of stay of hospitalization.

Conclusions

The findings of DIP payment reduced the rehabilitation hospitalization cost would be helpful in developing more effectively and efficiently tailored interventions for rehabilitation health care in China. Furthermore, the results of this study could provide advice on building more effective strategies and intervention options for other countries that struggle with controlling rehabilitation hospitalization costs.

Rehabilitation after musculoskeletal injury: European perspective

Trauma is one of the main causes of death in younger people and ongoing disability worldwide. In Europe, while there is generally good organization of trauma reception and acute treatment, rehabilitation from major musculoskeletal injuries is less well defined and provided. This article documents the diverse approaches to rehabilitation after major injury in 6 European nations. The recognition of need is universal, but achieving a robust rehabilitation strategy is more elusive across the varying health care systems. Switzerland has the most robust service in the insured population. In the other countries, particularly where there is a reliance on public institutes, this provision is at best patchy. In the Netherlands, innovative patient-empowering strategies have gained traction with notable success, and in the United Kingdom, a recent randomized trial also showed this approach to be reproducible and robust. Overall, there is a clear need for learning across the national systems and implementation of a minimum set of standards.

Integrating rehabilitation into health systems: A comparative study of nine middle-income countries using WHO's Systematic Assessment of Rehabilitation Situation (STARS)

BACKGROUND AND OBJECTIVE

The need for rehabilitation is growing due to health and demographic trends, especially the rise of non-communicable diseases and the rapid ageing of the global population. However, the extent to which rehabilitation is integrated into health systems is mostly unclear. Our objective is to describe and compare the nature and extent of integration of rehabilitation within health systems across nine middle-income countries using available Systematic Assessment of Rehabilitation Situation (STARS) reports.

METHODS

Cross-country comparative study with variable-oriented design using available rehabilitation health system assessment reports from nine middle income countries.

FINDINGS

The integration of rehabilitation into health systems is limited across countries. Governance and financing for rehabilitation are mostly established within health ministries but weakly so, while health information systems are characterized by no available data or data that is insufficient or not routinely generated. The overall numbers of rehabilitation workforce per capita are low, with frequent reports of workforce challenges. In most countries the availability of longer-stay, high-intensity rehabilitation is extremely low, the availability of rehabilitation in tertiary hospitals is modest and in government supported primary care its almost non-existent. Multiple concerns about rehabilitation quality arose but the lack of empirical data hinders formal appraisal.

CONCLUSION

The study sheds light on the limited integration of rehabilitation in health systems and common areas of difficulty and challenge across nine middle income countries. All countries were found to have a basis on which to strengthen rehabilitation and there were often multiple areas within each health system building block that required action in order to improve the situation. Findings can inform governments, regional and global agencies to support future efforts to strengthen rehabilitation. Additionally, our study demonstrates the value of STARS reports for health policy and systems research and can serve as a model for further comparative studies.

STASISM: A Versatile Serious Gaming Multi-Sensor Platform for Personalized Telerehabilitation and Telemonitoring

Telemonitoring and telerehabilitation have shown promise in delivering individualized healthcare remotely. We introduce STASISM, a sensor-based telerehabilitation and telemonitoring system, in this work. This platform has been created to facilitate individualized telerehabilitation and telemonitoring for those who need rehabilitation or ongoing monitoring. To gather and analyze pertinent and validated physiological, kinematic, and environmental data, the system combines a variety of sensors and data analytic methodologies. The platform facilitates customized rehabilitation activities based on individual needs, allows for the remote monitoring of a patient's progress, and offers real-time feedback. To protect the security of patient data and to safeguard patient privacy, STASISM also provides secure data transmission and storage. The platform has the potential to significantly improve the accessibility and efficacy of telerehabilitation and telemonitoring programs, enhancing patients' quality of life and allowing healthcare professionals to provide individualized care outside of traditional clinical settings.

Improving Access to and Coverage of Rehabilitation Services through the Implementation of Rehabilitation in Primary Health Care: A Case Study from Chile

The demand for rehabilitation services (RS) is increasing worldwide, particularly in low-and middle-income countries (LMICs), where up to 50% of people currently don't have access to the RS they need. This case report describes how Chile integrated rehabilitation into primary health care (PHC) to improve access, coverage, and equity. The report draws on the first-hand experiences of two Ministry of Health (MoH) officials involved in transitioning from specialized to PHC-centered rehabilitation. The cornerstone of Chile's strategy is the Comprehensive Rehabilitation in PHC Program (RehabPHC), launched in 2007. It has three main service delivery strategies: Community Rehabilitation Rooms (CRRs), Integrative Rehabilitation Rooms (IRRs) linked to Family Health Centers (CESFAM), and Rural Rehabilitation Teams (RRTs) that provide mobile rehabilitation in remote areas. RehabPHC revolutionized the delivery, organization, and financing of rehabilitation. Rehabilitation coverage increased from 12 CRRs in 2007 to 307 in 2022, available in 52.6% of CESFAMs. Key to this progress was strong leadership and financial commitment from the MoH to ensure a sustainable, PHC-centered national rehabilitation system. Essential to planning was collecting and continuously monitoring data on rehabilitation needs and RehabPHC service indicators, which promoted evidence-based resource allocation. A dedicated policy was also critical, defining development pathways and coordination mechanisms for rehabilitation financing, advocacy, data collection, and monitoring. Chile's experience underscores the importance of strong governance, financial commitment, and evidence-based planning in integrating rehabilitation into PHC. As such, it provides a valuable blueprint for countries facing similar challenges.

Integrating competency analysis into national rehabilitation workforce evaluation: a case study

BACKGROUND

Establishing a workforce capable of meeting population needs is contingent on evaluation that can inform sound policy and planning. Health workforce evaluation has traditionally relied on health labour market analysis and workload estimations. To date, competency analysis has not been included in national health workforce evaluation, despite that fact that the findings may go far in guiding decisions around workforce composition, optimisation and education and training. This case study sought to assess the feasibility and perceived added value of integrating competency analysis into national rehabilitation workforce evaluation, and to determine how competency analysis can shape rehabilitation workforce planning. The findings of the case study can be used to explore the integration of competency analysis in the evaluation of other health-related occupational groups.

METHODS

Participant observation was complemented by key informant interviews with experts engaged in the national rehabilitation workforce evaluation in Poland. These experts represented stakeholders in policy, education, research, clinical practice and professional associations.

RESULTS

The results indicated that competency analysis can be feasibly integrated into national rehabilitation workforce evaluation, particularly when implementation is supported through the use of online platforms. However, the collection of additional data using other tools, such as a survey of the behaviours and tasks of a wider sample of rehabilitation workers, could strengthen data reliability. Experts perceived findings of the competency analysis to be valuable for expanding the understanding of rehabilitation, shedding light on task allocation and deployment of the existing rehabilitation workforce, and advocating for the rehabilitation workforce to be strengthened, especially in relation to those occupations which may not be recognised or valued as rehabilitation workers. Although it was not possible to fully explore the impact of competency analysis data on rehabilitation workforce planning and development in this study, experts suggested that its availability would likely foster greater cooperation among occupations, which has been missing at the policy and planning level to date. It further demonstrates what competency data should be collected and reported, and provides richer information to guide decisions.

CONCLUSIONS

Competency analysis complements traditional labour market analysis and workload estimates, adding depth to the understanding of how members of the workforce perform and perceive themselves, and how deficiencies in the workforce impact on the provision of care to specific population groups.

Public sector rehabilitation services for physical disabilities in tertiary care hospitals of Karachi, Pakistan: A qualitative study

BACKGROUND

Around the globe there are 2.4 billion people in need of rehabilitation. Disability and rehabilitation have not gained much importance in the public health arena, possibly due to limited research and awareness regarding the significance of rehabilitation. This study aimed to provide an in-depth understanding of the barriers and facilitators to the provision and utilization of rehabilitation services in public sector tertiary care hospitals of Karachi, Pakistan.

METHODOLOGY

This qualitative exploratory study was conducted from August to September 2015 in two tertiary care hospitals of Karachi. The criterion for hospital selection included the availability of functional rehabilitation services. Twenty-four key informant interviews were conducted with health professionals, including doctors, physiotherapists, occupational therapists, prosthetists, orthotists, as well as patients and caregivers. Qualitative content analysis was performed using a consensual qualitative research approach. Responses from key informant interviews were coded into free nodes and then categorized into themes.

RESULTS

Two themes emerged from the data: constraints to the provision of rehabilitation services, and barriers to the utilization of rehabilitation services. Basic infrastructure was available at both study sites; however, a lack of structured guidelines for referring patients to these services, a lack of information-sharing and guidance to the patients, and a limited supply of equipment (treatment modalities) hampered the provision of services. The barriers to rehabilitation services included cost pertaining to transport, environmental barriers, lack of support from the employer, and strain on and lack of support from caregivers.

CONCLUSION

Rehabilitation services require attention and investment in research and allocation of funds to strengthen the service delivery system. Hospitals, alongside the department of health, need to develop a strategic plan to set future directions and standards of available rehabilitation services.

Surveying people with spinal cord injuries in Brazil to ascertain research priorities

Scientists are concerned that the research they conduct accurately portrays the needs of people living with spinal cord injuries (SCI). As such, this study set out to investigate the main problems faced by people with SCI and their expectations for research. This quantitative, exploratory, analytical, and cross-sectional study was carried out online, with a non-probabilistic sample of 618 Brazilian adults with SCI who had registered voluntarily to participate in the research of the Neurorehab group. The virtual questionnaire consisted of 22 questions based on ISCOS Data Sets. The majority (68.9%) of participants were male, with higher education or a post-graduate qualification (49.5%). Most injuries had experienced traumatic injuries (78.5%) and 58.7% were paraplegic. The mean age was 38.04 years (SD = 9.85). The main difficulties faced after SCI were locomotion/accessibility (70.9%), neurogenic bladder (68.8%), neurogenic bowel (48.2%), and sexuality (36.1%). The highest demand was for experimental studies on stem cells (22.5%), rehabilitation (14.2%), and cures (13.9%). Most (84.3%) of those who reported sexuality problems after SCI were men (p = 0.013). The findings obtained empower people with SCI by enabling them to influence the agenda of scientific research based on their expectations and difficulties. This survey will also aid organizations to engage stakeholders to implement a comprehensive SCI management program.

Long-Term Change and Predictors of Change in Physical and Mental Function after Rehabilitation: A Multi-Centre Study

OBJECTIVE

To investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation.

DESIGN

Prospective cohort.

PARTICIPANTS

Patients, across diseases, living in western Norway, accepted for somatic specialized interprofessional rehabilitation (n = 984).

METHODS

Physical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling.

RESULTS

In the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b = -0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years.

CONCLUSION

Physical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation.

Virtual reality applications for rehabilitation of COVID-19 patients: A systematic review

Background and Aims

The COVID-19 pandemic has changed people's lifestyles as well as the way healthcare services are delivered. Undoubtedly, the difficulties associated with COVID-19 infection and rehabilitation and those associated with quarantine and viral preventive efforts may exacerbate the need for virtual reality to be used as a part of a complete rehabilitation strategy for these individuals. Thus, the present research aimed to evaluate the potential uses of virtual reality for the rehabilitation of individuals suffering from COVID-19.

Methods

From 2019 to March 1, 2022, a systematic search was conducted in PubMed, Cochran Library, Scopus, Science Direct, ProQuest, and Web of Science databases. The papers were selected based on search terms and those that discussed the use of virtual reality in the rehabilitation of COVID-19 patients were reviewed. Each step of the study was reviewed by two authors.

Results

A total of 699 papers were found during the first search. Three papers were chosen for further investigation after a thorough evaluation of the publications' titles, abstracts, and full texts. Cross-sectional studies, randomized controlled clinical trials, and case reports comprised 33%, 33%, and 33% of the publications, respectively. Based on the results, people suffering from COVID-19 were the focus of two papers (66%) that employed immersion virtual reality for cognitive rehabilitation, whereas one study (33%) used non-immersive virtual reality for physical rehabilitation. In two papers (66%), virtual reality was also offered to patients in the form of a game.

Conclusion

According to the results of the present research, virtual reality games may enhance functional and cognitive consequences, contentment levels among patients, and their ability to take charge of their own health care. In light of the obstacles faced by COVID-19 patients, alterations in the delivery of healthcare, and the significance of rehabilitation in this group during quarantine, new techniques have been considered for these patients to maintain treatment, return to regular life, and enhance their standard of life.

Advancing Academic Capacity in Physical and Rehabilitation Medicine to Strengthen Rehabilitation in Health Systems Worldwide: A Joint Effort by the European Academy of Rehabilitation Medicine, the Association of Academic Physiatrists, and the International Society of Physical and Rehabilitation Medicine

Not available.

Development of an innovative strategy to determine functioning attributed to health conditions in low-resource settings

Objectives

Rehabilitation is a health strategy that aims to reduce functioning problems. There is a lack of country-level data on the burden and type of functioning problems to inform service planning and management of patients' rehabilitation needs, particularly at primary care level in low-resource settings. Health researchers need an application that automates synthesis of data extracted from several peer-reviewed publications to determine the most prevalent functioning problems compared across several health states. This article describes the journey leading to the conceptualization and development of the Rehab4all application and compares the application's performance to a standard desktop program.

Methods

A descriptive case study approach was used to report on the following steps involved in the development of the web-based Rehab4all application: (i) preliminary literature review to assess the evidence gap of country-level data on functioning problems comparable across several health states; (ii) an initial attempt to perform data extraction and synthesis in Excel; (iii) design and development of Rehab4all; (iv) piloting of the Rehab4all application; and (v) implementation of application with input data from South Africa and Zimbabwe.

Results

The Rehab4all application offers a feasible solution for synthesizing data from several peer-reviewed publications to provide information on context-specific, priority functioning problems at country level through the integrated global International Classification of Functioning, Disability and Health Framework (ICF).

Conclusion

This bespoke innovation provides impetus for further development, profile comparison and shared information between countries to co-develop strategies which can strengthen rehabilitation service delivery.

Why and How to Demonstrate the Value of Rehabilitation Services

The health care delivery landscape in the United States is changing as payment models consider both costs and health outcomes, which are key components of value in health care. Without evidence about the effectiveness and costs of rehabilitation interventions, it is difficult to judge the value of rehabilitation interventions. Understanding the short- and long-term costs associated with implementing a rehabilitation intervention and the intervention's cost-effectiveness compared with other alternatives is critical to supporting decision-making by policymakers, health care administrators, and other decision makers. This article describes the policy context for considering the costs and outcomes of postacute care and rehabilitation interventions, introduces methods for assessing the value of rehabilitation interventions, and summarizes the challenges and opportunities associated with applying value measurement to rehabilitation services. Assessing the value of rehabilitation interventions is critical as we continue to identify, implement, and sustain evidence-based interventions that promote the health and function of people with disabilities.