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Motha SG, Naidoo N, Moyo-Chilufya M, Musekiwa A, Kgarosi K, Mostert K. Effectiveness of a physiotherapy self-management programme for adult patients with chronic non-specific low back pain in low- and middle-income countries: protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e073916. [PMID: 39089717 PMCID: PMC11293417 DOI: 10.1136/bmjopen-2023-073916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Chronic non-specific low back pain (CNLBP) is among the most common musculoskeletal system conditions reported worldwide; however, few studies are available from low- and middle-income countries (LMICs). Self-management is a set of tasks performed by the patient aiming at managing their symptoms and interference in activities, mood and relationships due to pain. A physiotherapy-guided self-management programme (SMP) following a biopsychosocial approach has been reported as effective and affordable in the management of CNLBP in high-income countries. The objective of this systematic review is to determine the overall effectiveness of SMPs for adults with CNLBP in LMICs. METHODS AND ANALYSIS In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocol (PRISMA-P) guidelines will be followed. A three-step search strategy will be used to search the electronic databases (PubMed, MEDLINE, SPORTDiscus, Scopus and CINAHL, Academic Search Complete and PEDro) for randomised controlled trials assessing the effectiveness of physiotherapy-guided self-management for CNLBP among adult participants in LMICs. The processes of screening search results for eligible studies, extracting data from included studies and appraising will be done independently by at least two review authors. Random effects meta-analysis will be used to synthesise results and heterogeneity will be assessed using the I2 test statistic and χ2 test. ETHICS AND DISSEMINATION Ethics clearance was obtained for the broader PhD study on the development of a physiotherapy-guided SMP for adult people with CNLBP in Limpopo Province, South Africa. The results of the manuscript for this protocol will be published in peer-reviewed journals and also presented at conferences, symposia, and congresses. PROSPERO REGISTRATION NUMBER CRD42023399572.
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Affiliation(s)
- Sergant Given Motha
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Niri Naidoo
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Maureen Moyo-Chilufya
- School of Heath Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Alfred Musekiwa
- School of Heath Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Kabelo Kgarosi
- School of Heath Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Karien Mostert
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
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Gärtner HS, Shabnam J, Aagesen M, Guldin MB, Vind AB, Marsaa K, Bergenholtz HM, Graven V, Sampedro Pilegaard M, Thuesen J. Combined rehabilitation and palliative care interventions for patients with life-threatening diseases - PREGOAL. A scoping review of intervention programme goals. Disabil Rehabil 2024; 46:2989-2998. [PMID: 37580981 DOI: 10.1080/09638288.2023.2246373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE WHO recommends integrating rehabilitation into palliative care when providing services for people with life-threatening conditions. Recently, there has been increasing interest in exploring how rehabilitation and palliative care approaches could be combined. The aim of this study was to map and discuss the goals of intervention programmes that combine rehabilitation and palliative care. METHODS A scoping review was performed. The electronic databases MEDLINE, EMBASE, and CINAHL were searched for papers published between January 2014 and September 2022. Papers were considered eligible if the participants in question had a life-threatening disease and if interventions included both rehabilitation and palliative care. All study types were included. RESULTS Ten papers describing five interventions were included. Qualitative goals were narratively described, and quantitative goals were analysed according to the International Classification of Functioning, Disability and Health, and the Total Pain framework. Findings showed an overall focus on functioning and quality of life. Further analysis indicated an emphasis on physical and psychological dimensions. Social participation, and the social and spiritual dimensions were rarely evaluated. CONCLUSION This review indicates that goals relative to social participation, the social and spiritual dimensions, and the patient's own goals may well be overlooked as points of orientation for interventions.
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Affiliation(s)
- Henriette Søby Gärtner
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jahan Shabnam
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Aagesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Public Health, Aarhus University, Aarhus, Denmark
| | - Ane Bonnerup Vind
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristoffer Marsaa
- North Zealand Hospital, University of Copenhagen, Kobenhavn, Denmark
| | - Heidi Maria Bergenholtz
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Zealand University Hospital, Research Support Unit, Koge, Denmark
| | - Vibeke Graven
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
| | - Jette Thuesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Deo P, Leupold O, Rau O, Cheng J, Prather H. Evaluation of sleep health documentation and sleep-related intervention by physiatrists treating musculoskeletal disorders: A retrospective investigation. PM R 2024; 16:700-706. [PMID: 37916613 DOI: 10.1002/pmrj.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Sleep health is linked to pain, function, and global health. Unfortunately, sleep health may not be consistently addressed as a part of musculoskeletal care. OBJECTIVE To describe the frequency of sleep health documentation and intervention by musculoskeletal physiatrists. Additionally, patient-reported outcome measures were compared between patients with and without sleep impairment. We hypothesized that sleep health is documented and addressed in less than half of initial patient encounters and that patients with a sleep impairment have worse patient-reported outcomes scores compared to those without sleep impairment. DESIGN Retrospective study. SETTING Tertiary orthopedic hospital. INTERVENTIONS None. MAIN OUTCOME MEASURES Frequency of provider documentation of sleep health, frequency and characteristics of sleep health intervention provided, and Patient-Reported Outcome Measurement Information System (PROMIS)-10 mental health and physical health scores. RESULTS Initial visits for a musculoskeletal condition of 39,452 patients from January 1, 2020 to October 1, 2022 were included. Documentation of sleep health was found in 33.0% (13,002/39,452) of patients. Of those with sleep health documentation, 59.2% (7697/13,002) were classified as having a sleep impairment. Only 19.0% of patients were provided with sleep-related education or other intervention. Patients with a sleep impairment had worse PROMIS-10 mental health and physical health scores (p < .001), as compared to those without a sleep impairment. CONCLUSIONS Patients with sleep impairment had worse mental and physical health scores than those without sleep impairment, and only 19.0% received sleep health intervention. These data suggest that sleep impairment is common in patients presenting for evaluation of a musculoskeletal condition, and advanced provider education and tools to help patients improve their sleep health are needed.
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Affiliation(s)
- Prabhav Deo
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Olivia Leupold
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Olivia Rau
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
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de Lima EA, Castro SS, Viana-Júnior AB, Sobreira-Neto MA, Leite CF. Could an increased risk of obstructive sleep apnoea be one of the determinants associated with disability in individuals with cardiovascular and cerebrovascular diseases? Sleep Breath 2024; 28:1187-1195. [PMID: 38252255 DOI: 10.1007/s11325-024-02989-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/21/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE To investigate a possible association between the risk of obstructive sleep apnoea (OSA) and disability in individuals with cardiovascular or cerebrovascular diseases. METHODS Cross-sectional study was conducted with 373 individuals (313 with cardiovascular or cerebrovascular diseases and 60 healthy). Disability was assessed by the 12-item World Health Organization Disability Assessment Schedule (WHODAS), and the risk of OSA was assessed by STOP-BANG. Anxiety and depression symptoms, daytime sleepiness, and cognition were assessed by the Hospital Anxiety and Depression Scale (HADS), Epworth Sleepiness Scale (ESS), and Mini Mental State Examination (MMSE). RESULTS Greater disability was found in individuals with intermediate or high risk of OSA, considering healthy individuals (p=0.03), or individuals diagnosed with arrhythmia (p<0.01) or coronary artery disease (p=0.04). A high risk of OSA and higher WHODAS scores was significant among women as well as between OSA risk categories (p<0.01). Cognitive deficit and level of education also showed differences between OSA risk categories. Age, depression, and sleepiness were also associated with the subjects' disability (p<0.01). Gamma regression model showed higher WHODAS scores in female, in those with intermediate and high risk of OSA, and in those with depressive symptoms and cognitive deficit. Age also showed a correlation with higher WHODAS scores. The presence of all investigated cardio and cerebrovascular diseases showed an increase in the WHODAS score, implying a greater disability compared to healthy individuals. CONCLUSION Moderate and high risk of OSA is associated with disability, as well as gender, age, depressive symptoms, cognitive deficit, and cardiovascular diseases.
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Affiliation(s)
- Eriádina Alves de Lima
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Shamyr Sulyvan Castro
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Antonio Brazil Viana-Júnior
- Clinical Research Unit of Hospital Universitário Walter Cantidio, Federal University of Ceara/EBSERH, Fortaleza, Ceara, Brazil
| | | | - Camila Ferreira Leite
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Ceara, Brazil.
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil.
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Araya BM, Velez MP, Gelaye KA, Dyer S, Aldersey HM. Addressing the Rehabilitation Needs of Women Experiencing Infertility in Ethiopia: Time for Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:475. [PMID: 38673386 PMCID: PMC11049831 DOI: 10.3390/ijerph21040475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability or potential target of rehabilitation interventions. This study aimed to determine what rehabilitation-related services and supports are available for women experiencing infertility in Ethiopia. We used an Interpretive Description design. We purposefully selected fourteen rehabilitation, medical, and policy service providers from diverse institutions across three geographical locations. We used semi-structured questions during our in-person and telephone interviews. The data were analyzed using reflexive thematic analysis with the assistance of NVivo. We identified five main themes, including (a) policies related to infertility, (b) the concept that disabilities are physically visible fails to recognize infertility, (c) the need for rehabilitation services for women with infertility, (d) the importance of wellness services for women experiencing infertility, and (e) the role of religion in rehabilitation services. In conclusion, it is essential to strengthen the policies around infertility, incorporate rehabilitation services in fertility care, and view infertility as a disabling condition for women who experience it in Ethiopia.
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Affiliation(s)
- Bilen Mekonnen Araya
- Department of Rehabilitation Science, School of Rehabilitation Therapy, Queen’s University, 31 George St., Kingston, ON K7L 3N6, Canada
- Department of Clinical Midwifery, School of Midwifery, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Maria P. Velez
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON K7L 2V7, Canada;
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar P.O. Box 196, Ethiopia;
| | - Silke Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town 7701, South Africa;
| | - Heather M. Aldersey
- School of Rehabilitation Therapy, Queen’s University, 31 George St., Kingston, ON K7L 3N6, Canada;
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Pallesen H, Pedersen SKS, Sørensen SL, Næss-Schmidt ET, Brunner I, Nielsen JF, Kjeldsen SS. "Stroke - 65 plus. Continued active life." A randomized controlled trial of a self-management neurorehabilitation intervention for elderly people after stroke. Disabil Rehabil 2024:1-10. [PMID: 38587056 DOI: 10.1080/09638288.2024.2338190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Post-stroke sequelae among elderly often lead to a more inactive life while carrying a risk of overburdening close relatives. The objective of the present study was to determine if a novel self-management neuro-rehabilitation intervention added to usual treatment for people with stroke over the age of 65 years improved their self-efficacy. METHODS This randomised controlled trial included participants two weeks before discharge from subacute rehabilitation. All participants received usual treatment. The intervention entailed an add-on of six to eight self-management sessions lasting 45-60 min within a period of nine months after discharge. This novel neuro-rehabilitation intervention focused on promoting growth, development and self-efficacy by facilitating the participants' self-management strategies regarding their activities and social network. All participants were assessed at baseline, three months and nine months after discharge. The primary outcome was self-efficacy measured by the Stroke Self-Efficacy Questionnaire. RESULTS Sixty-nine individuals with stroke aged > 65 years were randomised. Their mean(SD) age was 76(6) years; 32 (46%) were female. No significant difference was found between the groups at baseline. Improvement recorded in the intervention group did not significantly differ from that of the control group with regard to primary outcome or secondary outcomes. CONCLUSIONS This novel self-management intervention had no significant effect measured by the primary outcome self-efficacy or quality of life. Furthermore, no impact was observed on participation and autonomy compared with usual treatment.Clinical trial registration-URL: ClinicalTrials.gov, NCT03183960. Registered on 12 June 2017.
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Affiliation(s)
- Hanne Pallesen
- Hammel Neurorehabilitation and Research Center, Hammel, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Susanne Lillelund Sørensen
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Regional Hospital Viborg, Viborg, Denmark
| | - Erhard Trillingsgaard Næss-Schmidt
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Regional Hospital Viborg, Viborg, Denmark
| | - Iris Brunner
- Hammel Neurorehabilitation and Research Center, Hammel, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Noé E, Gómez A, Bernabeu M, Quemada I, Rodríguez R, Pérez T, López C, Laxe S, Colomer C, Ríos M, Juárez-Belaúnde A, González C, Pelayo R, Ferri J. Guidelines: basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation. Neurologia 2024; 39:261-281. [PMID: 37116696 DOI: 10.1016/j.nrleng.2023.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. DEVELOPMENT We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. CONCLUSIONS All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45-60minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.
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Affiliation(s)
- E Noé
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain.
| | - A Gómez
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | | | - I Quemada
- Red Menni de Daño Cerebral, Bilbao, Spain
| | | | - T Pérez
- Clínica San Vicente, Madrid, Spain
| | - C López
- Centro Lescer, Madrid, Spain
| | - S Laxe
- Hospital Clínic, Barcelona, Spain
| | - C Colomer
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
| | - M Ríos
- Unidad de Daño Cerebral, Hospital Beata María Ana, Madrid, Spain
| | | | - C González
- Centro Estatal de Atención al Daño Cerebral-CEADAC, Madrid, Spain
| | - R Pelayo
- Institut Guttmann, Barcelona, Spain
| | - J Ferri
- NEURORHB Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Valencia, Spain
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Wade DT. A general theory of rehabilitation: Rehabilitation catalyses and assists adaptation to illness. Clin Rehabil 2024; 38:429-442. [PMID: 37885405 PMCID: PMC10898207 DOI: 10.1177/02692155231210151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND There is no general theory of rehabilitation, only definitions and descriptions, with the biopsychosocial model of illness as a structure. OBJECTIVE To develop a general theory of rehabilitation that explains how healthcare rehabilitation changes outcomes and to evaluate its validity. NEED A general rehabilitation theory would help research, improve services, increase understanding, modify resource allocation and explain some anomalies, such as how rehabilitation helps when no natural recovery occurs. BUILDING BLOCKS People adapt to change throughout their lives. Illness is a change, and people adapt to their illness. Adaptation's purpose is to maintain an equilibrium in a person's life. The balanced components are related to Maslow's five needs: basic, safety, affiliation, status and self-fulfilment. The general theory of behaviour suggests that a person's behaviours change to maintain balance, regulated by a central homeostatic mechanism. THE THEORY Rehabilitation aids adaptation to changes associated with illness through accurate diagnosis and formulation, catalysing adaptation, optimising the environment and assisting the person in making necessary changes by safely practising activities and teaching self-management. IMPLICATIONS The theory makes the person the central active agent, emphasises the importance of the environment in facilitating adaptation, explains why all conditions may benefit, including progressive and static conditions, suggests that health can be equated to someone maintaining their equilibrium and explains why a small dose may be very effective. CONCLUSION The general theory of rehabilitation emphasises the catalytic effects of rehabilitation in facilitating and guiding adaptation and suggests areas for research and improvement.
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Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Oxford Brookes University, Oxford, UK
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Mamtani HG. Is it time to incorporate the biopsychosocial model into medical practice: A call for action for medical practitioners across specialties. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:114. [PMID: 38726079 PMCID: PMC11081457 DOI: 10.4103/jehp.jehp_1667_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 05/12/2024]
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Forslund L, Arntzen C, Nikolaisen M, Gramstad A, Eliassen M. Physiotherapy as part of collaborative and person-centered rehabilitation services: the social systems constraining an innovative practice. Physiother Theory Pract 2023:1-16. [PMID: 37676077 DOI: 10.1080/09593985.2023.2255893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND A person-centered and collaborative practice is considered crucial in contemporary physiotherapy. These ideals are often embraced in theory but are difficult to put into practice. As problems and solutions are related, understanding and refining theory on practical problems can close the knowing-doing gap and link the problem to the development of possible solutions. OBJECTIVE To explore the challenges with providing physiotherapy as part of collaborative and person-centered rehabilitation services. METHODS This article reports on an all-day interactive workshop with eight focus group discussions where physiotherapists from six different professional settings participated. We draw on theories of institutional logics to interpret the results. RESULTS Challenges were linked to: 1) Professional level: Services being based on what the profession can offer - not on users' needs; 2) Organizational level: Rewarding efficiency instead of user outcomes; and 3) System level: Not knowing the other service providers involved or what they are doing. CONCLUSION An innovative practice was constrained by multilevel social systems: the professional logic shaping the perceived professional scope, the organizational logic shaping the understanding of what was expected in the organizational context, and a system logic within a biomedical paradigm. Transforming and transcending these social systems is needed to realize collaborative and person-centered practice.
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Affiliation(s)
- Lina Forslund
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Cathrine Arntzen
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
- Center for Care Sciences, North, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Morten Nikolaisen
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
- Center for Care Sciences, North, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Astrid Gramstad
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Marianne Eliassen
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
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Wade DT. Moving on. A farewell from the last Editor-in-Chief who says: 'Rehabilitation is a way of thinking, not a way of doing'. Clin Rehabil 2023; 37:287-293. [PMID: 36203369 DOI: 10.1177/02692155221131248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
What is rehabilitation? From 1994 to 2021, while I was privileged to be Editor of Clinical Rehabilitation, I explored this in editorials. I also encouraged and selected submissions that considered, in one way or another, the central features of rehabilitation. Why? Because when I started in rehabilitation, the general attitude among doctors and other healthcare professionals was that rehabilitation was pleasant but with no evidence of effectiveness. Further, they did not think a doctor had a role to play and did not think there was anything special for rehabilitation experts to know or have skills in. In this editorial, I discuss how, as editor, I used my position to support and encourage the publication of articles that produced evidence, considered the conceptual and scientific basis of rehabilitation, and ultimately answered the above question. I illustrate this with a few specific papers published in Clinical Rehabilitation. After 30 years, I have concluded that the essential feature characterising rehabilitation is its way of thinking about the patient's problems and how to solve them. Rehabilitation is holistic, person-centred, and concerned about social integration rather than disease or disability. Moreover, there is a mass of evidence showing it benefits patients.
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Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), 6395Oxford Brookes University, Oxford, UK
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12
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Cioeta M, Pournajaf S, Goffredo M, Giovannico G, Franceschini M. Improving Adherence to a Home Rehabilitation Plan for Chronic Neck Pain through Immersive Virtual Reality: A Case Report. J Clin Med 2023; 12:jcm12051926. [PMID: 36902713 PMCID: PMC10003452 DOI: 10.3390/jcm12051926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Idiopathic chronic neck pain is a highly disabling musculoskeletal condition. Immersive virtual reality shows a promising efficacy in the treatment of chronic cervical pain through the mechanism of distraction from the pain. This case report describes the management of C.F., a fifty-seven-year-old woman, who suffered from neck pain for fifteen months. She had already undergone a cycle of physiotherapy treatments including education, manual therapy, and exercises, following international guidelines. The patient's poor compliance did not allow adherence to the exercise's prescription. Home exercise training through virtual reality was therefore proposed to the patient to improve her adherence to the treatment plan. The personalization of the treatment allowed the patient to resolve in a short time period her problem and return to live with her family peacefully.
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Affiliation(s)
- Matteo Cioeta
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 000163 Rome, Italy
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Sanaz Pournajaf
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 000163 Rome, Italy
- Correspondence: (S.P.); (M.G.)
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 000163 Rome, Italy
- Correspondence: (S.P.); (M.G.)
| | - Giuseppe Giovannico
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 000163 Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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13
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Smart KM. The biopsychosocial model of pain in physiotherapy: past, present and future. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2177792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Keith M. Smart
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
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14
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S Battin G, Romsland GI, Christiansen B. Diminishing pain stigma: patient perceptions of encounters with interprofessional teams in biopsychosocial pain rehabilitation. Ann Med 2022; 54:2562-2573. [PMID: 36128674 PMCID: PMC9518607 DOI: 10.1080/07853890.2022.2124447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To explore how patients in biopsychosocial pain rehabilitation perceive encounters with interprofessional teams. The focus of this article is to explore how interactions can perpetuate or diminish chronic pain stigma. MATERIAL AND METHODS An ethnographic approach was applied to the study. Participant observation of interprofessional encounters and clinical encounters in a pain rehabilitation ward was undertaken in 2016 (19 weeks). Interviews with 12 professionals and seven patients were conducted. Data were analysed in an abductive process using thematic analysis. RESULTS The patients perceived their encounters with interprofessional teams as supportive, with implications for pain stigma. This is presented as two themes: (1) being seen as credible, involving patients being believed in and a concept of being overactive at the expense of their own health, and (2) being helped to see their situation in a new light, which involves enthusiasm about changing and challenging views in a process with professionals who were supportive and united across professions. CONCLUSION Interprofessional biopsychosocial pain rehabilitation may be an intervention that can diminish internalised stigma in patients suffering from chronic pain. The study contributes to increased understanding of patient perceptions of positive encounters with professionals during a learning process in rehabilitation and of the imbued influence on power relations. This appears to be fundamental to diminishing pain stigma, as the occurrence of stigma is dependent on differences in power.KEY MESSAGESInterprofessional biopsychosocial pain rehabilitation can be an intervention for diminishing internalised pain stigma in patients.Knowledge on how encounters with professionals induce personal learning processes among people with chronic pain.
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Affiliation(s)
- Gudrun S Battin
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, University of Stavanger, Stavanger, Norway
| | | | - Bjørg Christiansen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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15
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Eggen L, Thuesen J. Goals and Action Plans Across Time and Place-A Qualitative Study Exploring the Importance of "Context" in Person-Centered Rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:788080. [PMID: 36189011 PMCID: PMC9397753 DOI: 10.3389/fresc.2022.788080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
Background Person-centeredness is increasingly addressed in relation to rehabilitation interventions. Collaborative goal setting and action plans are key measures in person-centered rehabilitation. There is a lack of knowledge about how person-centered goals and action plans developed away from the patient's everyday life are experienced by patients after discharge. Purpose This aim of the study is to explore how patients with rheumatic diseases experience the relevance of goals and action plans after discharge from inpatient rehabilitation hospital stay. Methods Individual narrative interviews were conducted with eight patients with rheumatic diseases, aged between 40 and 60. A convenience sampling strategy was applied. Data collection, analysis and interpretation of data were performed within a phenomenological-hermeneutic framework inspired by Paul Ricoeur's interpretative philosophy. Results The analysis derived one core theme, “The relevance of goals and action plans is contextual” and three subthemes: “Admission—a protected bubble,” “Back home—a harsh reality,” and “Need for post-discharge support.” Conclusion This study indicates that the relevance of goals and action plans to patients with rheumatic diseases is context specific. On the basis of the study, it is suggested that the context should be considered in rehabilitation practice, including the social network of the patients. This is in order to support patients in rehabilitation interventions to manage everyday life with disease after discharge to their own homes. Moreover, the concept of context in person-centered rehabilitation should be reconsidered. The study also concludes that there is a need for further development and research in follow up programs, as it is not clear what may constitute an optimal design of follow up support.
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Affiliation(s)
- Linda Eggen
- Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
| | - Jette Thuesen
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
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16
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Cameron TM, Koller K, Byrne A, Chouliara N, Robinson T, Langhorne P, Walker M, Fisher RJ. A qualitative study exploring how stroke survivors' expectations and understanding of stroke Early Supported Discharge shaped their experience and engagement with the service. Disabil Rehabil 2022:1-8. [PMID: 35895746 DOI: 10.1080/09638288.2022.2102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore how stroke survivors' expectations and understanding of Early Supported Discharge (ESD) helped them make sense of their experiences, and shaped their engagement with the service. METHODS Data were collected as part of a study of large-scale implementation of stroke ESD: the WISE realist mixed-methods study. Semi-structured interviews were conducted with five purposefully selected stroke survivors from six sites in England implementing stroke ESD (n = 30). Participants were aged 32-88 years (20 males). Interviews were audio recorded, transcribed verbatim and transcripts were analysed using reflexive thematic analysis. RESULTS Three overarching themes were identified: (1) ESD as a post-stroke recovery tool, (2) desire to recover quickly, (3) psychosocial impact and support. Stroke survivors were uncertain about what to expect when they first entered the service, however, their experience of ESD exceeded their expectations and increased their engagement with the service. Stroke survivors especially valued the goal-oriented approach the team adopted. Rehabilitation at home was perceived as positive and practical, encouraging independence within real-life contexts. Psycho-social support played an important role in the stroke survivors' rehabilitation. CONCLUSIONS Ensuring stroke survivors are fully informed about ESD and what to expect, optimises engagement with the services, improves experience and could enhance outcomes.IMPLICATIONS FOR REHABILITATIONInforming stroke survivors about what to expect from ESD services could optimise engagement and improve their experience.The provision of personalised and target focussed therapy at home improves stroke survivors' experience and could potentially accelerate recovery.Preparing stroke survivors early for discharge from ESD can reduce anxiety and enhance engagement with the service.
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17
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The subjective minimal important change for the Six Spot Step Test in people with multiple sclerosis - The Danish MS Hospitals Rehabilitation study. Acta Neurol Belg 2022; 122:893-901. [PMID: 35705789 DOI: 10.1007/s13760-022-01991-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/24/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The Six Spot Step Test has shown good psychometric properties in terms of validity and reliability in people with multiple sclerosis. Yet, the responsiveness and minimal important change are unknown. The objective was to investigate the responsiveness of the Six Spot Step Test against the perceived change of walking limitations and establish estimates for the minimal important change in people with multiple sclerosis. METHODS The Six Spot Step Test was performed before and after four weeks of specialised multidisciplinary inpatient rehabilitation by 142 adults with mild to severe multiple sclerosis. Responsiveness was determined based on anchor- and distribution-based methods, using the Multiple Sclerosis Walking Scale-12 as external criterion. In a supplementary analysis, the Six-Minute Walking Test was used as an external criterion. RESULTS The correlation between the baseline (r = 0.56, p < 0.01) and discharge (r = 0.55, p < 0.01) Multiple Sclerosis Walking Scale-12 and Six Spot Step Test scores were acceptable. Furthermore, the change scores were weakly associated (r = 0.1, p = 0.27). This trend was similar for the Six-Minute Walking Test when used as anchor. The smallest detectable change was estimated to 1.7 seconds. An improvement in the Six Spot Step Test exceeding 2.1 (95% CI - 0.9 to 5.0) sec and 4.9 (95% CI 1.2-8.6) sec may be considered clinically important on a group level based on the Multiple Sclerosis Walking Scale-12 and the Six-Minute Walking Test, respectively. CONCLUSION In a sample of mild to severely disabled people with multiple sclerosis, the Six Spot Step Test showed fair responsiveness against a subjective and objective criterion, indicating a minimal important change between ≥ 2.1 and ≥ 4.9 seconds, respectively. However, a weak association between the change in the Six Spot Step Test and the subjective and objective external criterion calls for cautious interpretation. Hence, the results should be further verified against a valid external criterion.
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18
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Pilot of Patient Engagement in Continence Care on Geriatric Rehabilitation Units. Rehabil Nurs 2022; 47:109-118. [PMID: 35348531 DOI: 10.1097/rnj.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to pilot a process of engaging geriatric rehabilitation patients in the assessment and management of their continence concerns. DESIGN A descriptive study was conducted. METHODS The study has four phases: (1) staff education on continence with a pre-post knowledge quiz, (2) design of patient engagement process by a working group, (3) a 6-week pilot of a patient symptom questionnaire and process of engaging patients with audits of disciplinary admission histories and documentation, and (4) patient and staff feedback surveys. RESULTS Patients in geriatric rehabilitation identify a range of bladder and bowel symptoms. However, there was little documented evidence from the interprofessional team that corresponded to patients' reported symptoms. CONCLUSION Further research into symptoms bothersome to patients and engagement of both patients and the interprofessional team in addressing these in the rehabilitation setting is needed. CLINICAL RELEVANCE TO REHABILITATION NURSING Patients admitted to geriatric rehabilitation have a range of bladder and bowel symptoms, which need to be addressed.
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Dixon J, Cardwell FS, Clarke AE, Elliott SJ. Choices are inevitable: A qualitative exploration of the lifecosts of systemic lupus erythematosus. Chronic Illn 2022; 18:125-139. [PMID: 32183564 DOI: 10.1177/1742395320910490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Individuals with systemic lupus erythematosus experience considerable economic challenges. The aim of this research is to qualitatively investigate experiences of the lifecosts (direct and indirect economic costs and beyond) to those with systemic lupus erythematosus in Canada. METHODS Using a biopsychosocial conceptual framework and integrated knowledge translation approach, qualitative semi-structured interviews were conducted with 3 physicians, 5 representatives from systemic lupus erythematosus advocacy groups, and 29 adult systemic lupus erythematosus patients. Themes emerged deductively and inductively, and the theme code set was used to code all transcripts. RESULTS Three dominant themes emerged: (1) impacts of systemic lupus erythematosus on quality of life, relationships, and health; (2) costs linked to healthcare; and (3) impacts of living with systemic lupus erythematosus on employment/economic standing. DISCUSSION Whereas previous work has focused almost exclusively on the direct, individual costs of systemic lupus erythematosus, the biopsychosocial approach taken here emphasizes not only the individual and intermediate factors (such as the workplace and family), but also the system-level factors (i.e. system-level policies) that influence quality of life, healthcare, and employment/economic experiences of those with systemic lupus erythematosus. Results indicate a need to target interventions beyond the individual and their immediate context, and recognize that lifecosts are shaped significantly by systems-level action.
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Affiliation(s)
- J Dixon
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - F S Cardwell
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Canada
| | - Ann E Clarke
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - S J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Canada
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20
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Card AJ. The biopsychosociotechnical model: a systems-based framework for human-centered health improvement. Health Syst (Basingstoke) 2022; 12:387-407. [PMID: 38235298 PMCID: PMC10791103 DOI: 10.1080/20476965.2022.2029584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism- both conceptual and pragmatic. This paper extends and fundamentally re-structures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more "practical theory" for human-centered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between "health status" and "health and needs assessment", [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on "interventions" vs. "treatments" to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement.
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Affiliation(s)
- Alan J. Card
- Department of Pediatrics, UC San Diego School of Medicine, La Jolla, CA, U.S.A
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21
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Kontou E, Thomas SA, Cobley C, Fisher R, Golding-Day MR, Walker MF. A Biopsychosocial Intervention for Stroke Carers (BISC): development and description of the intervention. Health Psychol Behav Med 2022; 10:92-103. [PMID: 34993008 PMCID: PMC8725872 DOI: 10.1080/21642850.2021.2016412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Family members of stroke survivors are often not supported for their caring role, with many reporting adjustment difficulties. This paper describes the development and content of a group-based intervention for informal carers of stroke survivors. Method The intervention is based on the theoretical foundation of the biopsychosocial model with the aim to understand and address the physical, psychological and social factors of caring for stroke survivors. Findings from a comprehensive literature review and a qualitative study with carers and stroke professionals were synthesized to guide the intervention development. The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework to describe the intervention. Results The intervention integrates cognitive-behavioural approaches via the identification of the biopsychosocial (physical, emotional, social) factors that can have an impact on the well-being of carers. It includes education on stroke-specific topics and advice on coping strategies. It consists of six structured two-hour group sessions facilitated in a community setting. It provides information and support on adjusting to the caring role in the first year post-stroke. Intervention materials were designed for addressing carers’ specific needs using psychological techniques, such as problem-solving, goal setting and relaxation exercises. Conclusion We have underlined the importance for describing and reporting the process of intervention development for complex interventions in the context of stroke rehabilitation. An intervention addressing the needs of informal stroke carers (Biopsychosocial Intervention for Stroke Carers; BISC) has been developed and described. BISC was further evaluated in a single-centre feasibility randomized controlled trial.
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Affiliation(s)
- Eirini Kontou
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK.,Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Shirley A Thomas
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Christine Cobley
- Department of Clinical Psychology, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Miriam R Golding-Day
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Marion F Walker
- School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
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22
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Geidl W, Sudeck G, Wais J, Pfeifer K. [Physical Activity Promotion in Exercise Therapy in Medical Rehabilitation: Consequences of the Nationwide Survey for Quality Development]. REHABILITATION 2021; 61:336-343. [PMID: 34933356 DOI: 10.1055/a-1693-8380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM This article aims to summarize the status quo of exercise therapy in medical rehabilitation with regard to the establishment of the biopsychosocial understanding of health with a special focus on physical activity promotion; based on this, consequences for the optimization of exercise therapy are derived. METHODOLOGY A three-step procedure was chosen, which builds on the elaboration of quality dimensions and quality-relevant areas of physical activity promotion in exercise therapy: 1.) the analysis of the current status quo of exercise therapy with regard to the quality-relevant characteristics. This is based on the current results from the project "Exercise therapy in medical rehabilitation: a national survey at facility and practitioner level" (BewegtheReha); 2.) the elaboration of optimization potential and 3.) the derivation of consequences for the systematic quality development of exercise therapy. RESULTS We analyzed the status quo of exercise therapy for the following areas: Assessment and information gathering, targets and impact areas, therapeutic contents, working methods and implementation, therapy control as well as allocation to exercise therapy (step 1). The results show that the physical activity promoting potential of exercise therapy within medical rehabilitation has not yet been optimally exploited. In particular, there is a need for more interdisciplinarity, more patient orientation, therapeutic work on the basis of theory- and evidence-based biopsychosocial therapy concepts with stronger manualization and standardization (step 2). Starting points for quality improvement can be found at the therapist level as well as at the program level and the system level. The derived recommendations for quality improvement of physical activity promotion in exercise therapy (step 3) refer to three levels: a) human resource development, e. g. with regard to improved use and quality of the education system, b) organizational development, e. g. promotion of interprofessional cooperation, and c) provision of resources, e. g. access to information. CONCLUSION The derived consequences form the basis for the systematic further development and optimization of physical activity in exercise therapy in the context of medical rehabilitation. Based on the results, next steps for improving quality of exercise therapy with a focus on the goal of physical activity promotion can be identified and initiated.
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Affiliation(s)
- Wolfgang Geidl
- Department für Sportwissenschaft und Sport, FAU Erlangen-Nürnberg
| | - Gorden Sudeck
- Institut für Sportwissenschaft, Eberhard-Karls-Universität Tübingen
| | - Judith Wais
- Institut für Sportwissenschaft, Eberhard-Karls-Universität Tübingen
| | - Klaus Pfeifer
- Department für Sportwissenschaft und Sport, FAU Erlangen-Nürnberg
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23
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Bøgdal J, Schmidt AM, Nielsen KØ, Handberg C. An Integrated Multidisciplinary Rehabilitation Program Experienced by Patients with Chronic Low Back Pain. Clin Med Res 2021; 19:192-202. [PMID: 34933952 PMCID: PMC8691428 DOI: 10.3121/cmr.2021.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
Purpose: To examine how an integrated, multidisciplinary rehabilitation program was experienced by patients with chronic low back pain and to gain insight into how these patients integrated knowledge, skills, and behaviors obtained by the program into their everyday lives.Materials and Methods: A phenomenological hermeneutic design using Ricoeur's interpretation theory was used in the analysis. Data were generated through nine semi-structured interviews in patients with chronic low back pain. The study adhered to the Consolidated criteria for reporting qualitative research (COREQ) checklist.Results: Standardized rehabilitation efforts adapted to individual needs and provided by a highly professional healthcare team in a combination of inpatient stay and home-based activities was experienced as beneficial, because the patients were able to integrate the obtained knowledge, skills, and behaviors into their everyday lives.Conclusions: The findings revealed that the multidisciplinary holistic approach led to higher bodily awareness, greater mental health, and increased social interaction, which improved happiness and quality of life among the patients. This study emphasizes and highlights a rehabilitation approach that promotes home-based activities to provide a base for co-creation across professions regarding rehabilitation initiatives for patients with chronic low back pain.
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Affiliation(s)
- Julie Bøgdal
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus C, Denmark.
| | - Anne Mette Schmidt
- Sano, Højbjerg, Denmark
- Diagnostic Centre, University Clinic for Innovative Patient Pathways, Regional Hospital Silkeborg, Silkeborg, Denmark
| | | | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus C, Denmark
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Tseung V, Verweel L, Harvey M, Pauley T, Walker J. Hospital Outdoor Spaces: User Experience and Implications for Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:256-267. [PMID: 34663106 DOI: 10.1177/19375867211045403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This article aims to describe users' perspectives about the impact of hospital outdoor spaces on the patient experience in a postacute setting. BACKGROUND Hospital outdoor space is an important element in healthcare facility design. There is growing evidence that access to green space within hospital outdoor spaces facilitates healing. However, limited studies have explored the users' perspective regarding how hospital outdoor spaces impact the patient experience. METHODS As part of a hospital preoccupancy evaluation, users (patients, family, and staff) were invited to participate in a semi-structured interview to describe their experiences in the hospital's outdoor spaces. Data were analyzed using inductive thematic analysis. RESULTS Seventy-four individuals participated in this study: 24 inpatients, 15 outpatients, 11 family, 23 staff, and one volunteer. Three themes were identified: (1) outdoor space benefits healing by helping patients focus on life beyond their illness, (2) design of healthcare spaces facilitates patients' access to outdoor space to benefit healing, and (3) programming in the outdoor space promotes healing and recovery. CONCLUSIONS This study describes the users' perspective regarding the value of outdoor spaces and the design elements that influence the patient experience.
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Affiliation(s)
- Victrine Tseung
- Campus Development, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Lee Verweel
- Research and Innovation, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Martha Harvey
- Campus Development, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Tim Pauley
- Research and Innovation, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Jan Walker
- West Park Healthcare Centre, Toronto, Ontario, Canada
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Noé E, Gómez A, Bernabeu M, Quemada I, Rodríguez R, Pérez T, López C, Laxe S, Colomer C, Ríos M, Juárez-Belaúnde A, González C, Pelayo R, Ferri J. Guía: Principios básicos de la neurorrehabilitación del paciente con daño cerebral adquirido. Recomendaciones de la Sociedad Española de Neurorrehabilitación. Neurologia 2021. [DOI: 10.1016/j.nrl.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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26
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Olufson HT, Young AM, Green TL. The delivery of patient centred dietetic care in subacute rehabilitation units: A scoping review. J Hum Nutr Diet 2021; 35:134-144. [PMID: 34370342 DOI: 10.1111/jhn.12940] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient centred care (PCC) positively influences individual and organisational outcomes. It is important that dietitians working in rehabilitation units are supported to deliver PCC, as effective rehabilitation is a collaborative and patient centred process. The objective of this scoping review was to explore the literature available regarding the delivery of dietetic PCC, with patients undergoing rehabilitation in subacute inpatient units. METHODOLOGY PubMed, MEDLINE, CINAHL, Embase and Scopus were searched for relevant published literature. Searches for grey and unpublished literature were also completed. Studies were eligible for inclusion and data extraction if they demonstrated the delivery of PCC by qualified dietitians, through individual consultations with adult patients undertaking subacute rehabilitation. RESULTS Overall, 675 studies were identified and six were included in the review. From the literature available, documentation was lacking regarding conceptualisation and delivery of patient centred nutrition care, with only one study providing quality indicators for patient centred dietetic services. Elements of PCC cited were mostly limited to phrases such as, 'individualised care', 'tailored advice', 'follow-up', and 'team collaboration'. CONCLUSION This scoping review identified a considerable gap in the literature regarding the delivery of dietetic PCC in subacute rehabilitation units. Contemporary descriptions of PCC show that delivery of care which is truly patient centred is far more comprehensive than individualising interventions or organising ongoing services. This raises the question, is the delivery of nutrition care in subacute rehabilitation unit's patient centred? This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hannah T Olufson
- Faculty of Health & Behavioural Sciences, School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, QLD, Australia.,Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Hospital & Health Service, Herston, QLD, Australia
| | - Adrienne M Young
- Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, QLD, Australia.,Faculty of Health & Behavioural Sciences, School of Human Movement & Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Theresa L Green
- Faculty of Health & Behavioural Sciences, School of Nursing, Midwifery & Social Work, University of Queensland, Brisbane, QLD, Australia.,STARS Research & Education, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Hospital & Health Service, Herston, QLD, Australia
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27
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Vejlgaard C, Maribo T, Riisgaard Laursen J, Schmidt AM. Reliability and smallest detectable change of the Danish version of the Pain Self-Efficacy Questionnaire in patients with chronic low back pain. Scand J Pain 2021; 21:809-813. [PMID: 34062626 DOI: 10.1515/sjpain-2021-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Low back pain (LBP) is the leading cause of disability and a global public health concern. Studies indicate that pain self-efficacy is associated with the development of disability in chronic LBP (CLBP) patients. The Pain Self-Efficacy Questionnaire (PSEQ) is a commonly used questionnaire to assess pain self-efficacy in patients with CLBP. It is essential to examine the psychometric properties of the PSEQ in the population in which it is to be used. Thus, the aim of this study is to evaluate the reliability and smallest detectable change of the Danish version of the Pain Self-Efficacy Questionnaire (PSEQ-DK) in patients with CLBP before implementing it as an outcome measure in an inpatient rehabilitation context. METHODS This observational study including 92 patients with CLBP was conducted in a multidisciplinary rehabilitation facility in Denmark. The psychometric properties statistically tested included reliability, smallest detectable change and floor and ceiling effect of the PSEQ-DK. RESULTS The reliability analysis included 92 patients and revealed an weighted kappa of 0.82 (95% Cl 0.75; 0.88) and Intraclass correlation coefficient of 0.83 (95% CI 0.75; 0.88), which corresponds to a good reliability. The smallest detectable change was 12.67. CONCLUSIONS The present study demonstrated that the PSEQ-DK had a good reliability in patients with CLBP in an inpatient rehabilitation context. The current results expand our knowledge of the reliability and smallest detectable change of the PSEQ-DK. In order to implement PSEQ-DK in a rehabilitation context for evaluative purposes future studies should focus on examining responsiveness and interpretability.
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Affiliation(s)
- Camilla Vejlgaard
- The Faculty of Health, Aarhus University, Aarhus, Denmark.,Sano Aarhus, Aarhus, Denmark
| | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | | | - Anne Mette Schmidt
- Sano Aarhus, Aarhus, Denmark.,Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
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Cummins C, Payne D, Kayes NM. Governing neurorehabilitation. Disabil Rehabil 2021; 44:4921-4928. [PMID: 33989096 DOI: 10.1080/09638288.2021.1918771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Person centred approaches to rehabilitation are promoted as an ethical means of addressing paternalistic power relations in clinician dominated medical encounters and improving outcomes. However, they fail to account for the complex nature of power. We sought alternative ways to explain the use of power in health service provision. METHODS A poststructural discourse analysis using the view of power offered by Michel Foucault was undertaken. Foucault's concept of governmentality is useful to explain the way health services deploy technologies of power to achieve objectives of the state. Governmentality refers to not just political structures but all the strategies and procedures for directing human behaviour. RESULTS Our investigation uncovered a web of strategic relationships operating that were both potentially productive and problematic and illuminate how client centred approaches in neurorehabilitation intertwines its subjects in strategic power relationships that involve webs of obligations and responsibilities. CONCLUSION The client-professional relationship promoted in neurorehabilitation as a moral way to practice can be a tool for mastery of one over the other, and assist the client to achieve their desired ends, but also has the potential to marginalise others who are unable to shape themselves into the desired ideal client.Implications for rehabilitationThis analysis shows how power is subtle and productive in that it produces knowledge and roles for both clients and practitioners.It demonstrates how neurorehabilitation's disciplinary practices assist the client to achieve their recovery goals.It reveals how certain clients might be marginalised when they cannot shape themselves into the ideal rehabilitation client.As a final point we hope that by being aware of how power works in neurorehabilitation, practitioners can become aware of opportunities for challenging disciplinary practices that do not serve the best interest of the client.
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Affiliation(s)
- Christine Cummins
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Payne
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.,Centre for Midwifery and Women's Health Research, Auckland University of Technology, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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Battin GS, Romsland GI, Christiansen B. The puzzle of therapeutic emplotment: creating a shared clinical plot through interprofessional interaction in biopsychosocial pain rehabilitation. Soc Sci Med 2021; 277:113904. [PMID: 33839468 DOI: 10.1016/j.socscimed.2021.113904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/28/2022]
Abstract
Interprofessional collaboration is increasingly encouraged and studied. However, there remains a need to broaden the understanding of professionals' contributions through their day-to-day interactions to minimize the impact of professional boundaries that evoke gaps in patient care. Drawing upon narrative theory emphasizing therapeutic emplotment, this ethnographic study explores how professionals contribute to interprofessional collaboration through social interactions during teamwork. Data collection was undertaken in a biopsychosocial pain rehabilitation ward in a hospital in Norway in 2016, and included participant observation of the ward-based work of two teams, and interviews with professionals from six professions (12) and patients (7). Formal and informal interprofessional interactions and patient encounters were observed. The study found that through interactions, the professionals' shared their understandings across all professions about the successfulness of their own work and of what outsider professionals were doing incorrectly when addressing patients from a biomedical approach. Imbued in these interactions were the pieces of an implicit shared clinical plot for their patients' journeys through rehabilitation and life afterwards. We argue that creating the shared clinical plot enhances conciliation across professions and interpersonal motivation to carry out the work. A struggle between perspectives in interprofessional collaboration should not be prematurely interpreted as an obstruction to collaboration, since the struggle can imbue essential narrative work. This extends the theoretical study of therapeutic emplotment as a central motivational process in interprofessional collaboration in teams.
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Affiliation(s)
- Gudrun Songøygard Battin
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Pilestredet Campus, P.O. Box 4 St. Olavs plass, N-0130, Oslo, Norway.
| | | | - Bjørg Christiansen
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Pilestredet Campus, P.O. Box 4 St. Olavs plass, N-0130, Oslo, Norway
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Nielsen KT, Klokker L, Wæhrens EE. Self-reported quality of activities of daily living task performance in four diagnostic groups with chronic conditions. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims To design intervention programmes addressing activities of daily living task performance problems in individuals with chronic conditions, more knowledge about the types of challenges these individuals experience is needed. The aim of this study was to examine the types of activities of daily living tasks, as well as the types of problems related to the quality of task performance, that individuals with chronic conditions report and determine similarities and differences in four diagnostic sub-groups. Methods Data on self-reported quality of activities of daily living task performance were collected among 593 individuals with rheumatological disease, incurable cancer, chronic obstructive pulmonary disease and schizophrenia, using the ADL-Interview. Activities of daily living tasks most frequently reported as problematic were identified within each sub-group. Sub-group profiles were generated to identify similarities and differences in quality of performance. Results Participants reported problems performing similar types of activities of daily living tasks across diagnostic sub-groups, especially within instrumental activities of daily living. Moreover, participants mainly reported a decreased quality of performance in terms of using extra time and/or increased physical effort while performing personal activities of daily living. Conclusions As individuals across four chronic conditions reported somewhat similar problems related to activities of daily living task performance, generic activities of daily living interventions addressing these problems seem appropriate, especially interventions addressing problems related to use of extra time and increased effort.
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Affiliation(s)
- Kristina Tomra Nielsen
- Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark
| | - Louise Klokker
- The Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark
| | - Eva Ejlersen Wæhrens
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg, Copenhagen, Denmark
- Occupational Science and Occupational Therapy, User Perspectives and Community-based Research, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Abstract
OBJECTIVES Caring for a person with dementia is associated with poor mental, physical, and social health, which makes it important to consider how carers are best supported in their caring role to preserve both their and the person with dementia's well-being. At present, a robust instrument to assess carers' support needs does not exist. This study aimed to develop a self-reported questionnaire to assess the support needs of carers of people with dementia. The objectives were to: (1) generate items, (2) pilot test, and (3) field-test the questionnaire. DESIGN Development and field-testing of a new questionnaire. SETTINGS Primary and secondary health and social care of informal carers and people with dementia in nine municipalities and one dementia clinic in a hospital in Denmark. PARTICIPANTS Eight experts, 12 carers, and 7 digital users participated in pilot testing. 301 carers participated in field-testing. MEASUREMENTS Items for inclusion were generated based on interviews and literature review. An iterative process of data collection was applied to establish face and content validity of the Dementia Carer Assessment of Support Needs Tool (DeCANT) using Content Validity Index among experts and cognitive interviews with carers. Field-testing of DeCANT among carers included using the 12-item Short Form Health Survey, the Barthel-20 Index, and the Neuropsychiatric Inventory. RESULTS Initially, an item pool of 63 items was generated, and pilot testing reduced this to 42 items. Subsequent field-testing resulted in a 25-item version of DeCANT, and confirmatory factor analysis of three hypothesized models demonstrated a marginally better fit to a four-factor model with fit indices of: χ2 = 775.170 (p < 0.001), root mean square error of approximation = 0.073, Comparative Fit Index = 0.946, the Tucker-Lewis Index = 0.938, and weighted root mean residual (WRMR) = 1.265. CONCLUSIONS DeCANT is a 25-item carer-reported questionnaire that can be used to help identify their support needs when caring for a person with dementia to enable supportive interventions and improve carers' health and well-being.
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Cowley A, Goldberg SE, Gordon AL, Kerr M, Logan P. Exploring rehabilitation potential in older people living with frailty: a qualitative focus group study. BMC Geriatr 2021; 21:165. [PMID: 33676401 PMCID: PMC7937269 DOI: 10.1186/s12877-021-02107-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rehabilitation interventions are frequently cited as key in supporting frail older people's recovery following periods of decompensation and acute ill-health. Clinicians are required to make decisions about a patient's potential to respond to rehabilitation. 'Rehabilitation potential' decisions can determine access to services. In acute settings clinicians have limited time to assess and work with patients, families and carers. The complexities of ageing, recovery, rehabilitation and frailty may not be fully appreciated. This study aimed to explore multiple perspectives of the concept of rehabilitation potential and how it is assessed in older people living with frailty in the acute healthcare setting. METHODS Five focus groups with a purposive sample of 28 participants which included clinicians and members of the public were conducted. Analysis comprised a thematic approach using the Framework method. RESULTS Rehabilitation potential was found to encapsulate a complex decision-making process where clinicians judged an individual's ability to benefit from and participate in targeted rehabilitation. They asked, "Will it work?", "Is it wanted?" and "Is it available?" In order to predict who would benefit from rehabilitation interventions, clinicians assessed a range of holistic clinical and non-clinical factors. An iterative approach to assessment delivered by a multi-disciplinary team, centred around patient and carer needs and wants was needed to accommodate complexity. Participants believed that everyone had some form of potential but this was dependent on availability of rehabilitation resources and conceptualisations of frailty and rehabilitation. Tensions between iterative approaches to rehabilitation potential assessment and the realities of rapid decision making in the acute hospital setting were found. CONCLUSION Rehabilitation potential decisions involve a complex process of multidisciplinary decision-making and prognostication on the likely outcome and benefit from rehabilitation programmes. These findings lay the foundation for developing structured approaches to rehabilitation potential decision making tools and guidance.
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Affiliation(s)
- A Cowley
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Derwent House, City Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - S E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - A L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - M Kerr
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - P Logan
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
- Nottingham CityCare Partnership CIC, Nottingham, UK
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Reneman MF, Beemster TT, Welling SJ, Mierau JO, Dijk HH. Vocational Rehabilitation for Patients with Chronic Musculoskeletal Pain With or Without a Work Module: An Economic Evaluation. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:84-91. [PMID: 32816203 PMCID: PMC7954755 DOI: 10.1007/s10926-020-09921-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Vocational rehabilitation (VR) is a widely used intervention aimed to optimize work participation for patients on sick leave due to chronic musculoskeletal pain (CMP). Economic evaluations of care as usual VR are scarce, and may provide relevant information to guide clinical, reimbursement and policy decisions. The aim of this study was to evaluate the short-term cost-effectiveness and return on investment (ROI) of VR for patients on sick leave due to CMP with an additional work module (VR+) compared to VR without work module, from a societal and employers' perspective. Methods A retrospective longitudinal cohort study within a Dutch care as usual context was applied. Participants with CMP and decreased work participation originating from seven Dutch rehabilitation centers were included in this study. Participants underwent VR or VR+. Main data sources at baseline and discharge: Quality-adjusted life year (QALY) based on EQ-5D, intervention costs, self-reported productivity and health care utilization. Main analyses cost-effectiveness, including incremental cost-effectiveness ratio (ICER) and a cost-effectiveness acceptability curve (CEAC); and ROI analyses with use of the human capital method. Results N = 324 participants were analyzed. The results show that VR+ was cost-effective compared to VR: mean cost savings of €820 per 0.012 QALY gained. CEAC suggests probability of VR+ being cost-effective is > 0.91 for thresholds of €20.000 and higher. The mean ROI of VR+ for employers was 38%. Conclusion It was concluded that at discharge, VR+ was cost-effective compared to VR. ROI was positive for employers.
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Affiliation(s)
- Michiel F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, P.O. Box 30.002, 9750 RA, Groningen, The Netherlands.
| | - Timo T Beemster
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
- Department Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sybren J Welling
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Jochen O Mierau
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, The Netherlands
| | - Hermien H Dijk
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Skovbo MH, Agerbo K, Jakobsen A, Clausen SA, Langagergaard V, Rolving N. Description of content, structure and theoretical model of a group-based pain management programme in the treatment of patients with persistent non-specific low back pain and psychological risk factors in a secondary sector setting. Clin Rehabil 2021; 35:1077-1088. [PMID: 33586476 DOI: 10.1177/0269215521995185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present the theoretical foundation and methodological considerations for a group-based pain management programme for patients with persistent non-specific low back pain and psychosocial risk factors. METHOD The Template for Intervention Description and Replication (TIDieR) checklist was used as a framework for describing the content, structure and context of the program. The theoretical rationale underlying the pain management programme was described using the first three steps of the Intervention Mapping framework. The Fear-avoidance model and the Self-efficacy Theory were identified as the two main theories. These were used to establish specific factors addressed by the pain management programme as well as expected outcomes. INTERVENTION DESCRIPTION A multidisciplinary, group-based programme using a cognitive-behavioural approach was developed. The programme consisting of six sessions of two hours duration, took place at a spine clinic at a regional hospital in Denmark. Psychoeducation and cognitive restructuring were specific strategies hypothesised to induce changes in outcome measures. The outcomes expected to change as a result of the intervention were disability, quality of life, sick leave and physical activity. A pilot study was performed, subsequent adjustments made and the final content and educational materials completed by January 2017. CONCLUSION The theoretical foundation and underlying evidence for the hypothesised change mechanisms in the use of a cognitive-behavioural approach was presented. A theoretically sound and practically feasible intervention has been developed and its effectiveness is being determined in a randomised controlled trial, including 130 low back pain patients, which is currently underway.
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Affiliation(s)
- Mette Høj Skovbo
- Spine Clinic, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Karina Agerbo
- Spine Clinic, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Anna Jakobsen
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | | | - Vivian Langagergaard
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark.,University Research Clinic for Innovative Patient Pathways, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Nanna Rolving
- Spine Clinic, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Center of Rehabilitation Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Older Persons and Nursing Staff's Perspectives on Continence Care in Rehabilitation: A Qualitative Study. Rehabil Nurs 2021; 46:305-314. [PMID: 33492068 DOI: 10.1097/rnj.0000000000000313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of the study was to understand continence care in geriatric rehabilitation from the perspectives of older persons and nursing staff. DESIGN This is a qualitative descriptive study. METHODS Ten patients and 10 nursing staff participated in semistructured interviews. Observations of care were recorded in field notes. Content analysis was used to develop themes of patient and nursing staff perspectives. FINDINGS Three themes were developed: Perceptions of Assessment, Continence Management, and Rehab: The Repair Shop. Patients had limited insight into continence assessment and management by nursing staff. For older persons, incontinence was embarrassing and created dependence; independence in toileting meant gaining control. Staff viewed continence as an important part of rehabilitation nursing but focused on containment and regular toileting, with patients seeing absorbent pads as commonly suggested. CONCLUSIONS Continence care approaches that engage older persons during rehabilitation are needed. CLINICAL RELEVANCE Restoration of continence through patient-centered care is core to older person rehabilitation.
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Kaptain RJ, Helle T, Kottorp A, Patomella AH. Juggling the management of everyday life activities in persons living with chronic obstructive pulmonary disease. Disabil Rehabil 2021; 44:3410-3421. [PMID: 33470850 DOI: 10.1080/09638288.2020.1862314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Evidence regarding everyday life activities in people living with COPD is limited. Such evidence can improve our understanding when designing interventions for pulmonary rehabilitation that aim at increasing or maintaining participation in these activities. The aim of this study was to describe how people living with COPD experience and manage everyday life activities. MATERIALS AND METHODS The sample comprised four males and four females with an age ranging from 65-87 years. Participants were interviewed in their own homes regarding experiences of performing and managing everyday life activities. Data were transcribed verbatim and analysed using content analysis. RESULTS Findings from this study comprised the theme "Juggling to manage everyday life activities with COPD" and three categories representing the elements of this theme: (1) consequences of COPD symptoms, (2) adjustment of activities, and (3) contextual aspects. CONCLUSION This study found the participants with COPD juggling the management of everyday life activities. The juggle generated a manageable daily life, which came at the expense of making deliberate choices and prioritizing everyday life activities that were necessary for participation in valued and engaging activities in order to maintain health and well-being.Implications for RehabilitationPeople living with COPD experience a complex juggling between the consequences of COPD symptoms and contextual aspects when managing everyday life activities.The participants had largely accepted their disease and adjusted to their situation.The disease was still described as frustrating and generated less focus on making deliberate choices and prioritizing everyday life activities that are necessary for participation in valued and engaging activities.Health professionals need to support people living with COPD in making deliberate choices in order to continue participating in valued and engaging everyday life activities as they affect health and well-being.Pulmonary rehabilitation should focus more on supporting participation in social relations and on using everyday technologies.
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Affiliation(s)
- Rina Juel Kaptain
- Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark.,Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Tina Helle
- Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark.,Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Anders Kottorp
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Ann-Helen Patomella
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
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Schmidt AM, Laurberg TB, Moll LT, Schiøttz-Christensen B, Maribo T. The effect of an integrated multidisciplinary rehabilitation programme for patients with chronic low back pain: Long-term follow up of a randomised controlled trial. Clin Rehabil 2020; 35:232-241. [PMID: 33040598 PMCID: PMC7874370 DOI: 10.1177/0269215520963856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: To compare the long-term effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme, in terms of back-specific disability, in patients with chronic low back pain. Design: A single-centre, pragmatic, two-arm parallel, randomised controlled trial. Setting: A rheumatology rehabilitation centre in Denmark. Subjects: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. Interventions: An integrated programme (a pre-admission day, two weeks at home, two weeks inpatient followed by home-based activities, plus two 2-day inpatient booster sessions, and six-month follow-up visit) was compared with an existing programme (four-week inpatient, and six-month follow-up visit). Main measure: The primary outcome was disability measured using the Oswestry Disability Index after one year. Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). Analysis was by intention-to-treat, using linear mixed models. Results: 303 patients were assessed for eligibility of whom 165 patients (mean age 50 years (SD 13) with a mean Oswestry Disability Index score of 42 (SD 11)) were randomly allocated (1:1 ratio) to the integrated programme (n = 82) or the existing programme (n = 83). The mean difference (integrated programme minus existing programme) in disability was –0.53 (95% CI –4.08 to 3.02); p = 0.770). No statistically significant differences were found in the secondary outcomes. Conclusion: The integrated programme was not more effective in reducing long-term disability in patients with chronic low back pain than the existing programme.
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Affiliation(s)
- Anne Mette Schmidt
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus C, Denmark.,Sano, Højbjerg, Denmark.,DEFACTUM, Central Denmark Region, Aarhus C, Denmark
| | - Trine Bay Laurberg
- Sano, Højbjerg, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Line Thorndal Moll
- Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, University Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Thomas Maribo
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus C, Denmark.,DEFACTUM, Central Denmark Region, Aarhus C, Denmark
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McClure J, Leah C. Is independence enough? Rehabilitation should include autonomy and social engagement to achieve quality of life. Clin Rehabil 2020; 35:3-12. [PMID: 32959679 DOI: 10.1177/0269215520954344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This discussion paper argues that holding independence as the central goal for rehabilitation has limitations that hinder successful outcomes. It shows why autonomy and social engagement should also serve as goals of rehabilitation, in order to achieve quality of life and effective functioning. METHODS The paper reviews problems arising from the over-emphasis on independence in rehabilitation. Although independence is a valuable goal on some tasks, it is sometimes not possible or desirable and is best complimented by autonomy and social engagement. Autonomy recognises that enacting some goals requires the support of other people. Autonomy is thus linked to social engagement (connectivity) in the workplace and personal relationships. The paper applies this framework to motor and cognitive disabilities. RESULTS The inclusion of autonomy and social engagement as goals for rehabilitation addresses the limitations of independence and can serve the unifying aim of enhancing the person's quality of life. These goals apply equally to motor disabilities and the cognitive and behavioural effects of injuries which affect personal and work relationships. CONCLUSIONS Rehabilitation is likely to be more effective if it aims at a combination of independence, autonomy and social engagement, in service of the goal of a good quality of life.
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Affiliation(s)
- John McClure
- School of Psychology, Victoria University of Wellington, New Zealand
| | - Caspian Leah
- School of Psychology, Victoria University of Wellington, New Zealand
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39
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Merriman NA, Gillan D, Pender N, Williams DJ, Horgan F, Sexton E, Johnston M, Bennett KE, Donnelly NA, Wren MA, Hickey A. The StrokeCog study: development and description of a cognition-focused psychological intervention to address cognitive impairment following stroke. Psychol Health 2020; 36:792-809. [PMID: 32924891 DOI: 10.1080/08870446.2020.1820009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the process of developing a cognitive rehabilitation intervention for patients with post-stroke cognitive impairment (PSCI) and to describe the intervention prior to evaluation in a pilot randomised controlled trial (RCT). Method: The Medical Research Council framework, 'Developing and evaluating complex interventions', was used to develop the cognitive rehabilitation intervention. We conducted a combined analysis of the existing evidence base for PSCI rehabilitation alongside qualitative exploration of the perspectives of stroke survivors, their families, and healthcare professionals providing stroke care, on the necessary components for a cognitive rehabilitation intervention for PSCI. The Template for Intervention Description and Replication checklist was used as a structural framework for the description of the intervention. Results: The intervention comprises a five-week intervention integrating group-based activities, supported by a clinical neuropsychologist, with home-based activities to encourage self-efficacy through the practice of adjustment and compensatory strategies learned in the group format to achieve the patients' identified goals in managing their PSCI. Conclusion: A cognitive rehabilitation intervention for patients with PSCI has been developed and described. We are in the process of developing a structured intervention manual to standardise the content and delivery of the intervention for further testing in a pilot RCT.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Diane Gillan
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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40
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Burrus C, Vuistiner P, Léger B, Stiefel F, Rivier G, Luthi F. The self-assessment INTERMED predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments. Clin Rehabil 2020; 35:135-144. [PMID: 32851861 PMCID: PMC7814092 DOI: 10.1177/0269215520949170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To use the self-assessment INTERMED questionnaire to determine the relationship between biopsychosocial complexity and healthcare and social costs of patients after orthopaedic trauma. Design: Secondary prospective analysis based on the validation study cohort of the self-assessment INTERMED questionnaire. Setting: Inpatients orthopaedic rehabilitation with vocational aspects. Subjects: In total, 136 patients with chronic pain and impairments were included in this study: mean (SD) age, 42.6 (10.7) years; 116 men, with moderate pain intensity (51/100); suffering from upper (n = 55), lower-limb (n = 51) or spine (n = 30) pain after orthopaedic trauma; with minor or moderate injury severity (severe injury for 25). Main measures: Biopsychosocial complexity, assessed with the self-assessment INTERMED questionnaire, and other confounding variables collected prospectively during rehabilitation. Outcome measures (healthcare costs, loss of wage costs and time for fitness-to-work) were collected through insurance files after case settlements. Linear multiple regression models adjusted for age, gender, pain, trauma severity, education and employment contract were performed to measure the influence of biopsychosocial complexity on the three outcome variables. Results: High-cost patients were older (+3.6 years) and more anxious (9.0 vs 7.3 points at HADS-A), came later to rehabilitation (+105 days), and showed higher biopsychosocial complexity (+3.2 points). After adjustment, biopsychosocial complexity was significantly associated with healthcare (ß = 0.02; P = 0.003; expß = 1.02) and social costs (ß = 0.03; P = 0.006, expß = 1.03) and duration before fitness-to-work (ß = 0.04; P < 0.001, expß = 1.04). Conclusion: Biopsychosocial complexity assessed with the self-assessment INTERMED questionnaire is associated with higher healthcare and social costs.
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Affiliation(s)
- Cyrille Burrus
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.,Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Friedrich Stiefel
- Service of liaison psychiatry, Lausanne University and Lausanne University Hospital, Lausanne, VD, Switzerland
| | - Gilles Rivier
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - François Luthi
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.,Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.,Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
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41
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Landstad BJ, Hedlund M, Kendall E. Practicing in a person-centred environment - self-help groups in psycho-social rehabilitation. Disabil Rehabil 2020; 44:1067-1076. [PMID: 32673133 DOI: 10.1080/09638288.2020.1789897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The increasing prevalence of chronic conditions and impairments in the population is putting new demands on health and rehabilitation services. Research on self-help groups suggest that participation in these groups might have a positive impact on people who are struggling with chronic illnesses or disabilities. In this study, we explore person-centred support in which participants in self-help groups are undergoing rehabilitation to develop their knowledge, skills and confidence necessary to handle life's challenges. METHOD The design is exploratory, analysing data from informant interviews and focus groups (a total of 32 participants) using a Grounded Theory inspired approach to analyse. The participants were rehabilitation clients aged between 20 and 60 years; eight were men and twenty-six were women. RESULTS Three main categories emerged as being important self-help processes that were likely to promote positive rehabilitation outcomes: (1) Learning and practicing safely, (2) A refuge from expectations, (3) Internal processes that accentuate the positives. CONCLUSION Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote acceptance and adjustment, facilitate the establishment of new skills and enable transfer of learning to new environments, including the workplace.IMPLICATIONS FOR REHABILITATIONSelf-help groups may support the process of rehabilitation.Participating in self-help groups provides an enabling context for individuals to address challenges and limitations.Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote adjustment, and facilitate the establishment of new skills.Participating in peer led self-help groups can assist with the transfer of learning to new environments, including development of potential work capacity.
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Affiliation(s)
- Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Marianne Hedlund
- Faculty of Health Science, Nord University, Levanger, Norway.,Department of Social Work and Health Science, Norwegian University of Technology and Science, Trondheim, Norway
| | - Elizabeth Kendall
- The Hopkins Centre, Disability, Rehabilitation & Resilience Program, Menzies Health Institute Qld, Griffith University, Logan Campus, Australia
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Abstract
After severe COVID-19 disease, many patients will experience a variety of problems with normal functioning and will require rehabilitation services to overcome these problems. The principles of and evidence on rehabilitation will allow an effective response. These include a simple screening process; use of a multidisciplinary expert team; four evidence-based classes of intervention (exercise, practice, psychosocial support, and education particularly about self-management); and a range of tailored interventions for other problems. The large number of COVID-19 patients needing rehabilitation coupled with the backlog remaining from the crisis will challenge existing services. The principles underpinning vital service reconfigurations needed are discussed.
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Wade DT. What attributes should a specialist in rehabilitation have? Seven suggested specialist Capabilities in Practice. Clin Rehabil 2020; 34:995-1003. [PMID: 32466680 DOI: 10.1177/0269215520925869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM Many services and professionals refer to themselves as providing rehabilitation. There is no agreed method for determining whether someone has specific expertise in rehabilitation. This makes it difficult for patients and payers to know whether professionals who claim to provide rehabilitation are specifically expert in rehabilitation. CONTEXT Doctors have a medical speciality of rehabilitation. The medical training curriculum gives attributes that differentiate a rehabilitation specialist from other doctors. Until recently, these attributes were competencies to undertake activities associated with specialization. Apart from nurses, who have at least one, unofficial, curriculum identifying specific competencies, other professions involved in rehabilitation do not have any way to show specialization in rehabilitation. CAPABILITIES IN PRACTICE The U.K. General Medical Council accredits specialist medical training. It has moved from specifying multiple practical clinical competencies to specifying fewer high-level 'Capabilities in Practice'. Six are generic to all doctors, eight identify the trained doctor as having specialist rehabilitation skills. This article adopts this approach to put forward seven generic and seven specialist capabilities to identify any professional as having special expertise in rehabilitation. The seven specialist capabilities centre on the biopsychosocial model of illness and multidisciplinary teamwork. Four of them could be used to define a specialist rehabilitation team. CONCLUSION Seven capabilities identifying specialization in rehabilitation are put forward for discussion. They could form the basis of a formal recognition that any professional has additional expertise in rehabilitation. A validating authority would be needed to provide oversight and governance.
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Affiliation(s)
- Derick T Wade
- OxINMAHR, and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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de Thurah A, Bremander A, Primdahl J. High-quality RMD rehabilitation and telehealth: Evidence and clinical practice. Best Pract Res Clin Rheumatol 2020; 34:101513. [PMID: 32307230 DOI: 10.1016/j.berh.2020.101513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Within rheumatology, telehealth is essential to modern rehabilitation due to the demographic development with more and more elderly people. At present, telehealth solutions are used as part of the rehabilitation process in assessment, interventions and evaluation. Telehealth interventions are as effective as conventional follow-ups or self-management assessments, but the evidence on the effect is still sparse. Telehealth interventions seem to support a physically active lifestyle in the short term. In general, telehealth solutions are well received by patients, but the development must be based on user involvement, behaviour theory and the World Health Organisation principles of creating health literate organisations in order to ensure usability, effectiveness and further implementation.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Jutland, Sønderborg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology, Lund, Sweden.
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Jutland, Sønderborg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark.
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Schmidt AM, Schiøttz-Christensen B, Foster NE, Laurberg TB, Maribo T. The effect of an integrated multidisciplinary rehabilitation programme alternating inpatient interventions with home-based activities for patients with chronic low back pain: a randomized controlled trial. Clin Rehabil 2020; 34:382-393. [PMID: 31912752 PMCID: PMC7029437 DOI: 10.1177/0269215519897968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To compare the effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme in patients with chronic low back pain. Design: A single-centre, pragmatic, two-arm parallel, randomized controlled trial (1:1 ratio). Setting: A rheumatology inpatient rehabilitation centre in Denmark. Subjects: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. Interventions: An integrated rehabilitation programme comprising an alternation of three weeks of inpatient stay and 12 weeks of home-based activities was compared with an existing rehabilitation programme of four weeks of inpatient stay. Main measures: Patient-reported outcomes were collected at baseline and at the 26-week follow-up. The primary outcome was back-specific disability (Oswestry Disability Index). Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). A complete case analysis was performed. Results: A total of 303 patients were assessed for eligibility of whom 165 (mean age: 50 years (SD 13) and mean Oswestry Disability Index score 42 (SD 11)) were randomized (83 to existing rehabilitation programme and 82 to integrated rehabilitation programme). Overall, 139 patients provided the 26-week follow-up data. Baseline demographic and clinical characteristics were comparable between programmes. The between-group difference in the Oswestry Disability Index score when adjusting for the corresponding baseline score was −0.28 (95% confidence interval (CI): −4.02, 3.45) which was neither statistically nor clinically significant. No significant differences were found in the secondary outcomes. Conclusion: An integrated rehabilitation programme was no more effective than an existing rehabilitation programme at the 26-week follow-up.
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Affiliation(s)
- Anne Mette Schmidt
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark.,Sano, Højbjerg, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Lillebælt Hospital, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Nadine E Foster
- Clinical Trials Unit, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Trine Bay Laurberg
- Sano, Højbjerg, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Maribo
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Riis-Djernæs LM, Jensen CM, Madsen E, Maribo T. Should rehabilitation goals reflect all aspects of functioning in relation to a biopsychosocial ICF perspective? Disabil Rehabil 2019; 43:1669-1674. [PMID: 31589085 DOI: 10.1080/09638288.2019.1672108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To classify short-term and long-term rehabilitation goals and analyse how they capture functioning in a biopsychosocial International Classification of Functioning, Disability and Health (ICF) perspective. MATERIALS AND METHODS A retrospective study was conducted at two specialised outpatient multidisciplinary rehabilitation centres for polio survivors and accident victims. Rehabilitation goals extracted from patient journals were linked to the ICF according to linking rules. RESULTS One hundred patients were included. Four hundred and eighty-seven short-term and long-term rehabilitation goals were linked to the ICF. Fifty-seven per cent were linked to Activity and Participation, 22% to Body Functions, 1% to Body Structure, 4% to Environmental Factors, 4% to Personal Factors, whereas 11% were not defined and 1% was not covered. The identified categories covered all ICF domains. The most frequent categories for short-term goals were d450 "Walking" and d570 "Looking after one's health." For long-term goals, d850 "Remunerative Employment" and d920 "Recreation and Leisure" were the most frequent. CONCLUSION The study showed challenges in capturing all aspects of biopsychosocial functioning in rehabilitation goals, particularly Contextual Factors. This study indicates that rehabilitation goals capture capacity rather than performance. Further research could highlight if functioning is captured in the rehabilitation plan, and in this way include both capacity and performance.Implications for rehabilitationHealth professionals in a post-acute or long-term rehabilitation setting should pay attention to capacity and performance when rehabilitation goals are set.The rehabilitation plan should contain goals and a description of patient's contextual factors and both should be equally valued and combined in a description of functioning.In a post-acute or long-term rehabilitation setting short-term and long-term goals are affected by the context. A longer rehabilitation intervention lead to goals linked to activity and participation.
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Affiliation(s)
- Line M Riis-Djernæs
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | - Charlotte Maria Jensen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Ellen Madsen
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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47
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Johansen I, Klokkerud M, Anke A, Børke JB, Glott T, Hauglie U, Høyem A, Klovning A, Lande KA, Larsen M, Nordvik JE, Wigers SH, Øyeflaten I, Hagen KB, Kjeken I. A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing. BMC Health Serv Res 2019; 19:265. [PMID: 31036000 PMCID: PMC6489243 DOI: 10.1186/s12913-019-4091-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. Methods The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of “yes”) of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants’ numeric rating of face validity (0–10, 10 = high validity) were recorded. Results Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. Conclusion To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway. Electronic supplementary material The online version of this article (10.1186/s12913-019-4091-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Inger Johansen
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway. .,Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway.
| | - Mari Klokkerud
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Janne-Birgitte Børke
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Thomas Glott
- Sunnaas Rehabilitation Hospital, 1453, Bjørnemyr, Norway
| | - Uno Hauglie
- The Municipality of Sandefjord, PO Box 2025, 3202, Sandefjord, Norway
| | - Audhild Høyem
- Centre for Quality Improvement and Development, University Hospital of North Norway, Box 20, N-9038, Tromsø, Norway
| | - Atle Klovning
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway
| | | | - Mona Larsen
- Norwegian Rheumatism Association, PO Box 2653, Solli, N-0203, Oslo, Norway
| | | | - Sigrid H Wigers
- Unicare Jeløy Rehabilitation Centre, Bråtengaten 94, N-1515, Moss, Norway
| | - Irene Øyeflaten
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20. 3864, Rauland, Norway.,Uni Research Health, Nygårdsgaten 112, 5008, Bergen, Norway
| | - Kaare Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, 0319, Oslo, Norway
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Skjaerven LH, Gard G, Gómez-Conesa A, Catalan-Matamoros D. A vocabulary describing health-terms of movement quality – a phenomenological study of movement communication. Disabil Rehabil 2019; 42:3152-3161. [DOI: 10.1080/09638288.2019.1585970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Liv Helvik Skjaerven
- Department Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Gunvor Gard
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
- Department of Health Sciences, Division of Physiotherapy, Luleå University, Luleå, Sweden
| | - Antonia Gómez-Conesa
- Murcia University Research Group in Physiotherapy and Health Promotion, Regional Campus of International Excellence “Campus Mare Nostrum”, Murcia, Spain
| | - Daniel Catalan-Matamoros
- Department of Journalism and Communication, University Carlos III of Madrid, Madrid, Spain
- Research Group of Health Sciences CTS-451, University of Almeria, Almeria, Spain
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Lykke S, Handberg C. Experienced Loneliness in Home-Based Rehabilitation: Perspectives of Older Adults With Disabilities and Their Health Care Professionals. Glob Qual Nurs Res 2019; 6:2333393619831661. [PMID: 30859114 PMCID: PMC6402052 DOI: 10.1177/2333393619831661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 11/16/2022] Open
Abstract
This study aimed to describe and interpret perspectives of older adults with disabilities and their health care professionals (HCPs) on experienced loneliness during home-based rehabilitation. The interpretive description methodology guided the study. Data included semistructured individual interviews with seven older adults and a focus group interview with three HCPs. The analysis revealed four main findings that symbolized experienced loneliness. “Unspoken pain” and “gatekeeping emotions” concerning experienced loneliness as a taboo and stigma during rehabilitation were closely connected. “Resignation” and “awaiting company” signified the consequences of experienced loneliness when not addressed. Unspoken pain, gatekeeping emotions, resignation, and awaiting company were dominating experiences in the lives of the older adults during a home-based rehabilitation program following disability. This had restrained them from verbalizing and coping with loneliness during rehabilitation and life in general. The HCPs’ attempt to provide support for the older adults in coping with loneliness appeared to be characterized by gatekeeping emotions and keeping hidden agendas.
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50
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