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Ghai S, Hitzig SL, Eberlin L, Melo J, Mayo AL, Blanchette V, Habra N, Zucker-Levin A, Zidarov D. Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review. Arch Phys Med Rehabil 2024; 105:1158-1170. [PMID: 37708929 DOI: 10.1016/j.apmr.2023.08.028] [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: 03/09/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA). DATA SOURCES The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022. STUDY SELECTION To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting. DATA EXTRACTION The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer. DATA SYNTHESIS Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported. CONCLUSION The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstads Universitet, Karlstad, Sweden; Centre for Societal Risk Research, Karlstads Universitet, Karlstad, Sweden; Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany; Centre for Tactile Internet with Human-in-the-loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Sander L Hitzig
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lindsay Eberlin
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joshua Melo
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amanda L Mayo
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Québec, Canada; Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Natalie Habra
- Faculté de Médecine, Université de Montréal, Montréal, Canada; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Diana Zidarov
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada; École de readaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
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Gutierrez-Arias R, Neculhueque-Zapata X, Valenzuela-Suazo R, Oliveros MJ, Morales C, Vásquez L, Jalil Y, Marzuca-Nassr GN, Inostroza Quiroz JL, Fuentes-Aspe R, Solano R, Salgado-Maldonado G, Aguilera-Eguía R, Águila-Villanueva C, Garcés-Burgos C, Seron P. Assessment of activities and participation of people by rehabilitation-focused clinical registries: a systematic scoping review. Eur J Phys Rehabil Med 2023; 59:640-652. [PMID: 37721783 PMCID: PMC10664814 DOI: 10.23736/s1973-9087.23.07895-4] [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: 01/26/2023] [Revised: 07/11/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Rehabilitation is considered a key intervention in health care. Clinical registries, defined as an organized system that uses observational methods to collect information to assess specific outcomes in a defined population, can contribute to assessing the impact of the rehabilitation intervention. This review aims to identify and describe rehabilitation-specific registry systems with an emphasis on identifying outcomes that enable the assessment of vital areas and activities of daily living. EVIDENCE ACQUISITION A systematic scoping review was conducted. A systematic search was conducted up to August 2022 in MEDLINE/PubMed, Embase, Cochrane Library, Epistemonikos, and other search resources. Studies related to rehabilitation registries presented data on people with health problems that could limit their functioning were selected. The inclusion of studies/clinical registries was not limited by methodological design, year of publication, country, or language. The unit of analysis was rehabilitation registries. The measurement instruments used to assess the outcomes were explored to estimate the domain assessed from the vital areas related to functioning and disability as described by the International Classification of Functioning, Disability and Health (ICF). The vital areas were classified according to activities of daily living (ADLs). EVIDENCE SYNTHESIS Seventy-one registries in rehabilitation were identified. The registries included a median of 3 (IQR 2-5) assessment instruments designed to assess the impact of different rehabilitation programs. In total, 137 different assessment scales or instruments were identified. Each rehabilitation registry assessed 6 (IQR 2-8) domains of the ICF, and 15.4% of registries assessed all domains. The most assessed domain was "Mobility" (89.7%), and the least assessed was "General Tasks and Demands" (25.6%). In addition, 92.3% of rehabilitation registries assessed basic ADLs, 76.9% advanced ADLs, and 71.8% instrumental ADLs. CONCLUSIONS Although clinical registries do not claim to directly assess the impact of rehabilitation programs on people's functioning according to the ICF framework, it was identified that a low percentage of them assessed the nine vital areas through different outcome assessment instruments. However, most rehabilitation registries directly or indirectly assess some basic, instrumental, and advanced ADLs. The findings of this review highlight the need to improve the design of clinical registries focused on assessing the impact of rehabilitation programs to assess people in all areas of their lives.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Department of Support in Integral Cardiopulmonary Rehabilitation, National Thorax Institute, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Andres Bello University, Santiago, Chile
- INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile
| | - Ximena Neculhueque-Zapata
- Department of Rehabilitation and Disability, Subsecretary of Public Health, Ministry of Health, Santiago, Chile
| | - Raúl Valenzuela-Suazo
- Department of Rehabilitation and Disability, Subsecretary of Public Health, Ministry of Health, Santiago, Chile
| | - Maria-Jose Oliveros
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
- CIGES Center of Excellence, University of La Frontera, Temuco, Chile
| | - Camilo Morales
- Department of Therapeutical Protocols, Faculty of Health Sciences, Catholic University of Temuco, Temuco, Chile
| | - Luis Vásquez
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Yorschua Jalil
- Department of Intensive Care Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Kinesiology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Gabriel N Marzuca-Nassr
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | | | - Rocío Fuentes-Aspe
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
- CIGES Center of Excellence, University of La Frontera, Temuco, Chile
| | - Ricardo Solano
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Gabriel Salgado-Maldonado
- Department of Support in Integral Cardiopulmonary Rehabilitation, National Thorax Institute, Santiago, Chile
- INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile
- Laboratory of Cognitive Neurosciences (LANNEC), Clinic of Memory and Neuropsychiatry (CMYN), University of Chile, Santiago, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Raúl Aguilera-Eguía
- Department of Public Health, Faculty of Medicine, Catholic University of Santísima Concepción, Concepción, Chile
| | - Camilo Águila-Villanueva
- Department of Rehabilitation and Disability, Subsecretary of Public Health, Ministry of Health, Santiago, Chile
| | - Carolina Garcés-Burgos
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Pamela Seron
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile -
- CIGES Center of Excellence, University of La Frontera, Temuco, Chile
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Ramos SDS, Coetzer R. The Measure of an Outcome: Comparing Norming and Stacking to Benchmark the Effectiveness of Brain Injury Rehabilitation Services. Behav Sci (Basel) 2023; 13:705. [PMID: 37753983 PMCID: PMC10525701 DOI: 10.3390/bs13090705] [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: 06/19/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/28/2023] Open
Abstract
Practitioners have a clinical, ethical, academic, and economic responsibility to dispassionately consider how effective their services are. Approaches to measure how "good" or "bad" healthcare is include clinical audit, satisfaction surveys, and routine outcome measurement. However, the process of comparing the clinical outcomes of a specific service against the 'best' services in the same specialism, also known as benchmarking, remains challenging, and it is unclear how it affects quality improvement. This paper piloted and compared two different approaches to benchmarking to assess clinical outcomes in neurorehabilitation. Norming involved comparing routine measures of clinical outcome with external validators. Stacking involved pooling and comparing internal data across several years. The analyses of routine clinical outcome data from 167 patients revealed significant differences in the patient characteristics of those admitted to the same service provider over time, but no differences in outcomes achieved when comparing with historical data or with external reference data. These findings illustrate the potential advantages and limitations of using stacking and norming to benchmark clinical outcomes, and how the results from each approach might be used to evaluate service effectiveness and inform quality improvement within the field of brain injury rehabilitation.
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Affiliation(s)
- Sara D. S. Ramos
- Brainkind, Wakefield WF5 9TJ, UK;
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Rudi Coetzer
- Brainkind, Wakefield WF5 9TJ, UK;
- School of Health & Behavioural Sciences, Bangor University, Bangor LL57 2DG, UK
- School of Psychology, Medicine, Health and Life Science Faculty, Swansea University, Swansea SA2 8PP, UK
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Wallace SJ, Barnett A, Cheng BB, Lowe J, Campbell KL, Young AM. What is 'successful rehabilitation'? A multi-stakeholder nominal group technique study to inform rehabilitation outcome measurement. Clin Rehabil 2023:2692155231157181. [PMID: 36785902 PMCID: PMC10387716 DOI: 10.1177/02692155231157181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To explore how stakeholders in rehabilitation conceptualise 'successful rehabilitation', to inform the development of a minimum dataset and core outcomes for sub-acute rehabilitation. DESIGN Qualitative consensus study using the nominal group technique. SETTING Online focus groups. PARTICIPANTS Consumer representatives (n = 7), clinicians (n = 15), and health service managers (n = 9) from Australia. INTERVENTION Participants responded to the question, 'What does successful rehabilitation look like?'. Following item generation, they prioritised their top five responses, allocating 100 points across items to denote relative importance. MAIN MEASURES Prioritised responses were analysed across stakeholder groups using qualitative content analysis. RESULTS Ten themes were identified. 'Successful rehabilitation' is: (1) person and family centred; (2) effective; (3) inter-professional; (4) accessible; (5) goal oriented with meaningful outcomes; (6) connected to the continuum of care; (7) evidence-based and supportive of innovation and research; (8) appropriately funded and skilled; (9) satisfying and engaging; and (10) safe. CONCLUSIONS Stakeholder-defined 'successful rehabilitation' aligned with principles of value-based care and evidence-based rehabilitation. Provision and receipt of person and family centred care was the most important indicator of successful rehabilitation. Measures of success should include indicators of structure, process, outcome, and experience, and be conducted at multiple time-points.
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Affiliation(s)
- Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Amandine Barnett
- Centre for Applied Health Economics, Menzies Health Institute Queensland, 5723Griffith University, Brisbane, Australia
| | - Bonnie By Cheng
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Joshua Lowe
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Katrina L Campbell
- Centre for Applied Health Economics, Menzies Health Institute Queensland, 5723Griffith University, Brisbane, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Australia
| | - Adrienne M Young
- Department of Nutrition and Dietetics, 3883Royal Brisbane and Women's Hospital, Brisbane, Australia
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Young AM, Chung H, Chaplain A, Lowe JR, Wallace SJ. Development of a minimum dataset for subacute rehabilitation: a three-round e-Delphi consensus study. BMJ Open 2022; 12:e058725. [PMID: 35338067 PMCID: PMC8961134 DOI: 10.1136/bmjopen-2021-058725] [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: 10/27/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To develop a minimum dataset to be routinely collected across a heterogenous population within a subacute rehabilitation service to guide best care and outcomes for patients, and value for the health service. DESIGN Three-round e-Delphi exercise, followed by consensus meetings. SETTING Multicentre study in Brisbane, Australia. PARTICIPANTS Rehabilitation decision-makers, researchers and clinicians were invited to participate in the e-Delphi exercise. A multidisciplinary project steering committee (rehabilitation decision makers, researchers, clinicians and consumers) participated in consensus meetings. METHODS In round 1 of the e-Delphi, participants responded to an open-ended question, generating data and outcomes that should be routinely collected in rehabilitation. In rounds 2 and 3, participants rated the importance of collecting each item on a nine-point scale. Consensus was defined a priori, as items rated as 'essential' by at least 70%, and of 'limited importance' by less than 15%, of respondents. Consensus meetings were held to further refine and define the dataset for implementation. RESULTS In total, 38 participants completed round 1 of the e-Delphi. Qualitative content analysis of their responses generated 1072 codes, which were condensed into 39 categories and 209 subcategories. Following two rounds of rating (round 2: n=32 participants; round 3: n=28 participants), consensus was reached for 124 items. Four consensus meetings (n=14 participants) resulted in the final dataset which included 42 items across six domains: (1) patient demographics, (2) premorbid health and psychosocial information, (3) admission information, (4) service delivery and interventions, (5) outcomes and (6) caregiver information and outcomes. CONCLUSIONS We identified 42 items that reflect the values and experiences of rehabilitation stakeholders. Items unique to this dataset include caregiver information and outcomes, and detailed service delivery and intervention data. Future research will establish the feasibility of collection in practice.
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Affiliation(s)
- Adrienne M Young
- Allied Health Professions, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Herston, Queensland, Australia
| | - Hannah Chung
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Alicia Chaplain
- Allied Health Professions, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Joshua R Lowe
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
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