Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR): A Logic Model

The REHAB-LAB model for individualized assistive device co-creation and production

Assistive devices are designed to enhance individuals with disabilities' functional abilities. The rise of 3D printing technology enabled the production of individualized assistive devices (IADs). A REHAB-LAB is intended for IAD provision involving technical referents and occupational therapists. This study aimed to develop the REHAB-LAB logic model; to explore its fidelity and desirability; and to explore the characteristics of arising initiatives of IAD production. The REHAB-LAB logic model development involved stakeholders throughout the research process. A pragmatic multimethod approach followed two phases 1) logic model development and 2) exploration of its fidelity and desirability. The REHAB-LAB logic model presented the resources (equipment, space, human) required to implement IAD provision in a rehabilitation center, and the expected deliverables (activities and outputs). The REHAB-LAB logic model highlights the interdisciplinarity of IAD provision including occupational therapists, doctors, engineers, managers, and technical referents and places the users at the center of the IAD production. Results confirmed the fidelity and desirability of the REHAB-LAB logic model. The REHAB-LAB logic model can be used as a reference for future healthcare organizations wishing to implement an IAD provision. This research highlighted the interest of IAD provision based on the REHAB-LAB model involving users and transdisciplinary practices.

Study Protocol for a Pilot Randomized Trial of a Virtual Occupational Therapy Fall Prevention Intervention for People With HIV and Alcohol Use

Background

People living with HIV (PLWH) are at risk for falls due to polypharmacy, unhealthy substance (risky alcohol and/or illicit drug) use, low physical activity, and frailty combined with typical age-related physical changes. Fall prevention is needed to reduce the morbidity related to falls and fractures, however, there is a paucity of data on the design of a fall prevention intervention and whether it can be delivered virtually. We describe the protocol of a pilot randomized trial of a virtual occupational therapy fall prevention intervention for people with HIV at high risk for falls and recent alcohol and/or drug use.

Method

PLWH will be recruited from the Boston ARCH 4F Cohort study, an observational study of PLWH to examine the impact of alcohol on falls. Trial participants will be randomized to either an occupational therapy-led fall prevention intervention or provided with written education about fall prevention and alcohol use (control). The 10-week fall prevention intervention was based upon results from qualitative interviews with PLWH about falls and will consist of weekly virtual group sessions, home exercises and phone-check-ins, delivered by occupational therapists. The primary outcome measures will be number of groups attended and a participant-completed satisfaction survey. Change in number of falls, alcohol and other drug use, and physical functioning will be examined.

Discussion

A virtual occupational therapy fall prevention intervention addresses the emerging concern of fall risk in PLWH and alcohol use. This pilot study will provide preliminary estimates of fall-related outcomes as well as feasibility of study procedures for a larger trial.

ClinicalTrialsgov Identifier

NCT04804579. Boston University Protocol Record H-41041.

Motor Skill, Motor Planning, and Motor Performance in Adults with Severe Mental Illnesses and Obesity

Motor functioning in persons with serious mental illness (SMI) is not well studied. We assessed motor functioning in people with SMI (n = 15) vs. adults with obesity (n = 15) and healthy controls (n = 15). Motor skills were assessed using balance and coordination tests. Motor planning and performance were assessed in Obstacle and Metronome Walking Tasks. The SMI group scored lower on balance and coordination tests (all ps < 0.001), and took longer steps when approaching obstacles (all ps < 0.001), but had unimpaired motor performance on the Metronome Walking Task. In obesity, excess body mass impairs motor skills, which adversely impacts motor performance. In persons with SMI, motor performance was unimpaired, with cognitive and neuroanatomical abnormalities likely underlying balance, coordination, and motor skill challenges.

Pivoting in Context: Using the Forging Alliances in Interdisciplinary Rehabilitation Research Model to Collaborate During COVID-19

ABSTRACT

With the onset of the COVID-19 pandemic, researchers have been faced with challenges in maintaining interdisciplinary research collaborations. The purpose of this article is to apply and expand a previously introduced model to sustaining new interdisciplinary research collaborations: Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR). FAIRR is a logic model that can be used as a guide to create interdisciplinary rehabilitation research teams. In this article, the authors propose expanding FAIRR by including strategies for sustaining interdisciplinary rehabilitation research collaborations: modifying inputs (resources needed to assemble a team and to conduct research activities), shifting activities (steps taken to move the interdisciplinary collaboration forward), and examining what impacts the fit between inputs and activities. Two examples are used to highlight the application of the FAIRR model to interdisciplinary collaborations during COVID-19.

The State of Cancer Rehabilitation in the United States

The field of cancer rehabilitation and prehabilitation has grown significantly over the past decade. Advancements in early detection and treatment have resulted in a growing number of cancer survivors in the United States (US), expected to reach 26 million by 2040.1 Health care professional graduate education is trying to catch up with anticipated clinical demand by increasing the number of cancer rehabilitation fellowship training programs and introducing rehabilitation/prehabilitation concepts earlier in training. Numerous national organizations have issued guidelines for cancer rehabilitation research and posttreatment cancer health care. As treatment modalities evolve, so too must research on side-effects and multisystem management over the continuum of care. Current research strategies address different cancer types with a broad focus on timing of interventions, cost effectiveness, efficacy of rehabilitation, and improving screening and assessment tools. A collaborative, interdisciplinary research model is paramount to deepen impact and broaden reach. Policy supports could advance cancer survivorship and rehabilitative care. Funding to advance evidence-based practices for distress screening, psychosocial support, survivorship care planning, and rehabilitation services remains critical. Current social policies and health care access protections must be expanded to best serve the growing number of cancer survivors in the US. Equitable health care access, health care experience and health care outcomes remain a critical area for research and policy supports. The cost of cancer treatment requires significant reform to ensure access to all. Rehabilitation services are elements of standards of care for many neurological, cardiovascular and orthopedic diagnoses, but currently are not standard for actual or potential dysfunctions among cancer survivors. Both the disease process and the variety of therapeutic modalities increase risks of dysfunction, impairments, poor survival, and diminished quality of life. Rehabilitation focuses on optimizing quality of life and maximizing function throughout the continuum of cancer care. Health care professionals are urged to integrate high quality interdisciplinary care to promote collaboration and dissemination of knowledge which will yield better care for cancer survivors. Prehabilitation has the potential to play key roles in reducing or eliminating many cancer-related impairments and disabilities.