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Magalhães JP, Faria-Fortini I, Menezes KK, Lara IA, Batista LR, Sant'anna R, Faria CD. Determinants of access to rehabilitation professionals by individuals with stroke in the first six months after hospital discharge in Brazil: a study based on the Andersen model. Top Stroke Rehabil 2024; 31:615-624. [PMID: 38319730 DOI: 10.1080/10749357.2024.2304969] [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: 10/24/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND determinants of access to rehabilitation professionals after stroke in middle-income countries, where the burden of this disease is higher, are little known. OBJECTIVES To identify the determinants of access to rehabilitation professionals by individuals with stroke at one, three, and six months after hospital discharge in Brazil and compare referral and access rates after discharge. METHODS Longitudinal and prospective study, with individuals with primary stroke, without previous disabilities. At hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. The possible determinants of access, according to Andersen's model, were: a) predisposing factors: age, sex, education levels, and belief that they could improve with treatment; b) need factors: stroke severity, levels of disability; c) enabling factors: socioeconomic status, disposable income for health care, and quality of care provided by rehabilitation professionals. One, three, and six months after hospital discharge, individuals were contacted to identify which rehabilitation professionals were accessed. Multiple linear regression model and Wilcoxon tests were used (α=5%). RESULTS 201 individuals were included. Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01) of access at one, three, and six months after hospital discharge, respectively. In all periods, there was less access than that recommended at the time of hospital discharge (p<0.01). CONCLUSION Need factors (disability levels and stroke severity) were determinants of access in all assessed periods. In addition, in all periods, the comprehensiveness of care for individuals with stroke was compromised.
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Affiliation(s)
- Jordana P Magalhães
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kênia Kp Menezes
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isadora A Lara
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ludmilla R Batista
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Romeu Sant'anna
- Department of Neurology, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Christina Dcm Faria
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Somerville L, Nagy L. The refurbishment and redistribution of disability equipment from the UK to low- and middle-income countries: a case study focusing on 2016-2021 redistributions to Romania. Disabil Rehabil Assist Technol 2024:1-7. [PMID: 39066516 DOI: 10.1080/17483107.2024.2367717] [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: 08/25/2023] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 07/28/2024]
Abstract
The surplus of used disability equipment contributing to waste in the UK and the lack of access to disability equipment in low- and middle-income countries (LMICs) are two issues in need of solution. To address such problems, UK charities refurbish and redistribute used disability equipment to LMICs. To date, there is a scarcity of data on how LMICs could access surplus disability equipment from UK organisations. This study aimed to collate and map out the process by which equipment is refurbished and redistributed from the UK to LMIC's and identify factors which influence the development and sustainability of the partnership. An explorative qualitative case study design was used. Nine semi-structured interviews were conducted with participants from sender (UK) and a receiver (Romania) organisation between January-February 2022, with real-time translation where necessary. Intelligent verbatim transcription was used, and data was analysed using latent thematic analysis. The process of collection, refurbishment and redistribution of disability equipment from the UK to a LMIC organisation was mapped. Three key themes were identified from the interviews: (1) Development out of need; (2) Service development requires an adequate working relationship; (3) Process consolidation and future. Strong, honest and transparent relationships between organisations was identified as underpinning the success of the initiative. Raising service provision standards to meet specific needs of LMIC organisations supports development of suitable equipment prescription. Development of similar partnerships has potential of reducing the inequity gap and waste. Global collaboration and planning are required to address challenges of access to disability equipment in LMICs.
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Affiliation(s)
- Lauren Somerville
- Occupational Therapy, Oxford Brookes University, Oxford, United Kingdom
| | - Liana Nagy
- Occupational Therapy, Oxford Brookes University, Oxford, United Kingdom
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3
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Shackleton C, Evans R, West S, Bantjes J, Swartz L, Derman W, Albertus Y. Robotic locomotor training in a low-resource setting: a randomized pilot and feasibility trial. Disabil Rehabil 2024; 46:3363-3372. [PMID: 37605978 DOI: 10.1080/09638288.2023.2245751] [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: 01/16/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT), an innovative technique, aims to enhance rehabilitation outcomes. This study aimed to conduct a randomized pilot and feasibility trial of a locomotor training program within South Africa. MATERIALS AND METHODS Individuals with chronic traumatic motor incomplete tetraplegia (n = 16). Each intervention involved 60-minute sessions, 3x per week, for 24-weeks. Outcomes included feasibility measures and functional capacity. RESULTS 17 out of 110 individuals initiated the program (recruitment rate = 15.4%) and 16 completed the program (drop-out rate = 5.8%) and attended sessions (attendance rate = 93.9%). Both groups showed a significant increase in upper extremity motor score (MS) and abdominal strength post intervention. Only the RLT group showed a significant change in lower extremity MS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group. CONCLUSIONS Feasibility rates of the intervention and functional outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.
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Affiliation(s)
- Claire Shackleton
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Robert Evans
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa
| | - Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- International Olympic Committee Research Center, South Africa
| | - Yumna Albertus
- Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
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Eastes K, Oyungu E, Jerop C, Ombitsa AR, Kigen B, McHenry MS. Understanding the need for pediatric neurodevelopmental services among households in western Kenya: A population-based study. SAGE Open Med 2024; 12:20503121241258849. [PMID: 38867719 PMCID: PMC11168041 DOI: 10.1177/20503121241258849] [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] [Received: 09/07/2023] [Accepted: 05/16/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction Existing estimates of rates of childhood disability in Kenya are based on data with important limitations. Individual-level data on childhood disability at the local level is also lacking, leaving critical knowledge gaps for clinical and programmatic development. Objectives We aimed to estimate the rates of children at-risk for disability, examine the external factors related to risk of childhood disability, and gain a better understanding of the challenges experienced by children at-risk for disabilities and their families within western Kenya. Methods We conducted a small, cross-sectional randomized community survey to assess the rates of childhood disability across six administrative locations in Uasin Gishu County, Kenya, and to understand the experiences of these children and their caretakers. Results Rate of childhood disability in Uasin Gishu county was estimated to be 5%, with the most common disabilities being mood disorders. Caretakers reported several barriers to accessing treatment for their children at-risk of having disabilities, including financial concerns and lack of transportation. Conclusions Our findings suggest a need for improved access to care in this region, including addressing significant barriers to accessing care such as stigma and socioeconomic challenges. These community-level data will inform the development of future infrastructure and programming for this population.
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Affiliation(s)
- Kaytlin Eastes
- Center for Global Health Equity, Indiana University, Indianapolis, IN, USA
| | - Eren Oyungu
- Department of Medical Physiology, Moi University School of Medicine, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Carolyne Jerop
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Barnabas Kigen
- Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya
| | - Megan S McHenry
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, USA
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Htwe O, Yuliawiratman BS, Tannor AY, Nor Asikin MZ, Soh E, DE Groote W, Naicker MS, Naicker AS. Barriers and facilitators for increased accessibility to quality rehabilitation services in low- and middle- income countries: a systematic review. Eur J Phys Rehabil Med 2024; 60:514-522. [PMID: 38551518 PMCID: PMC11258907 DOI: 10.23736/s1973-9087.24.08154-1] [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: 07/22/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION With an increasing number of people experiencing limitations in functioning during their life course, the need for comprehensive rehabilitation services is high. In 2017, the WHO Rehabilitation 2030 initiative noted that the need for the establishment and expansion of rehabilitation services is paramount in order to obtain well-being for the population and to ensure equal access to quality healthcare for all. The organization of rehabilitation services is however facing challenges especially in low-and middle-income countries with a very small proportion of people who require rehabilitation actually getting them. Various surveys conducted in low-and -middle income countries have revealed existing gaps between the need for rehabilitation services and the actual receipt of these services. This systematic review aimed to determine the barriers and facilitators for increasing accessibility to rehabilitation services in low- and middle-income countries. Recommendations for strengthening rehabilitation service organization are presented based on the available retrieved data. EVIDENCE ACQUISITION In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25th April 2021 (PubMed), 3rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review. EVIDENCE SYNTHESIS Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators. CONCLUSIONS Recommendations for improving and expanding rehabilitation service organization include funding, training, education, and sharing of resources.
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Affiliation(s)
- Ohnmar Htwe
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia -
| | | | - Abena Y Tannor
- Department of Health Promotion and Disability, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Muhamad Z Nor Asikin
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Elaine Soh
- Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wouter DE Groote
- Department of Rehabilitation Medicine, AZ Rivierenland, Bornem, Belgium
| | | | - Amaramalar S Naicker
- Rehabilitation Medicine Unit, Department of Orthopedics and Traumatology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Fayed N. Severe malaria-related disability in Ethiopian children from the perspectives of caregivers: an interpretive description study. Disabil Rehabil 2024; 46:2327-2337. [PMID: 37303154 DOI: 10.1080/09638288.2023.2221457] [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: 01/19/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE This study explored severe malaria-related disability in children from the perspectives of their caregivers. MATERIALS AND METHODS The interpretive description qualitative approach was employed. The participants were selected using the purposive sampling technique considering the child's history of severe malaria, age (0-10 years), and location (urban/rural). Data were collected through face-to-face interviews with sixteen caregivers. Reflexive thematic data analysis was utilized. Through prolonged engagement, reflective journaling, an audit trail, and co-authors' review, trustworthiness was enhanced. RESULTS The study generated five themes from the interviews: mitigators of disability, contributors of disability, impact on body function, impact on activities and participation, and uncertainties about future well-being. The findings revealed previously unstudied social components of disability and environmental factors. Furthermore, the research uncovered health-related quality of life aspects that are out of the scope of the current comprehensive disability framework. CONCLUSIONS The study contributes to a deeper understanding of severe malaria-related disability in children from the biopsychosocial perspective. The findings could help policymakers, researchers, and clinicians who want to design rehabilitation interventions for the affected children or examine the components of disability on a large scale using quantitative methods.IMPLICATIONS FOR REHABILITATIONVarious contextual factors interacted with severe malaria and influenced functioning either as facilitators or barriers, implying disability related to malaria can be prevented or created.The long-term impacts of severe malaria are not limited to functioning and disability but also affect the health-related quality of life of children who survive severe malaria.Rehabilitation professionals should consider applying comprehensive functioning and disability frameworks such as the ICF when designing (or applying) screening tools, planning interventions, and evaluating the outcomes of intervention for children with severe malaria-related disability.Rehabilitation interventions for children with severe malaria-related disability should consider patient- or caregiver-reported outcomes (components of disability).
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Queen's University School of Rehabilitation Therapy, Kingston, Canada
| | | | - Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- Queen's University School of Rehabilitation Therapy, Kingston, Canada
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Rodríguez-Vélez ME, Cantillo-Medina CP, Perdomo-Romero AY. Benefits of being part of a support group for caregivers of children with multiple disabilities: a qualitative study. Rev Peru Med Exp Salud Publica 2024; 41:54-61. [PMID: 38808845 PMCID: PMC11149755 DOI: 10.17843/rpmesp.2024.411.13218] [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: 09/14/2023] [Accepted: 03/06/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Motivation for the study. Filling a knowledge gap regarding support groups for caregivers of children with multiple disabilities. Main findings. Support groups are valuable spaces for social support and learning for caregivers of children with multiple disabilities. They facilitate resilience and coping strategies following the birth of a child with multiple disabilities. They promote the participation and empowerment of caregivers of children with multiple disabilities to address access barriers and advocate for the fundamental rights of children. Implications. It is important to promote and support support groups for caregivers of children with multiple disabilities. To explore the perceived benefits of participating in a support group of caregivers of children with multiple disabilities. MATERIALS AND METHODS. A qualitative study with a focused ethnographic approach was conducted from October 2022 to February 2023, in which we applied convenience sampling. We included 20 caregivers of children with multiple disabilities. Information was collected through participant observation, focus groups, and semi-structured interviews. Thematic analysis was performed by applying Braun and Clark's proposals. RESULTS. The emerging themes were: social support network: integrating, informing, and helping each other; learning space: learning to take care and to take care of oneself; promoting empowerment: identifying and facing access barriers. CONCLUSIONS. We found that the support group functions as a social support network provides information, reduces uncertainty, and facilitates coping and resilience after the birth and upbringing of a child with multiple disabilities. It is a space where one learns to care for and take care of oneself and where empowerment for the defense of the rights of children with disabilities is promoted.
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Affiliation(s)
- María Elena Rodríguez-Vélez
- Universidad Surcolombiana. Facultad de Salud, Programa de Enfermería. Huila, Colombia.Universidad SurcolombianaUniversidad SurcolombianaFacultad de SaludPrograma de EnfermeríaHuilaColombia
| | - Claudia Patricia Cantillo-Medina
- Universidad Surcolombiana. Facultad de Salud, Programa de Enfermería. Huila, Colombia.Universidad SurcolombianaUniversidad SurcolombianaFacultad de SaludPrograma de EnfermeríaHuilaColombia
| | - Alix Yaneth Perdomo-Romero
- Universidad Surcolombiana. Facultad de Salud, Programa de Enfermería. Huila, Colombia.Universidad SurcolombianaUniversidad SurcolombianaFacultad de SaludPrograma de EnfermeríaHuilaColombia
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Beltchika A, Maoneo I, Ketani T, Mukuetala P, Ojo O, Ntsambi G. Challenges and strategies in the surgical management of traumatic spinal cord injuries in the Democratic Republic of the Congo. J Clin Neurosci 2024; 125:132-138. [PMID: 38796959 DOI: 10.1016/j.jocn.2024.05.013] [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: 12/29/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Significant progress has been made in the management of traumatic spinal cord injuries. However, deep disparities persist in developing countries. This work aims to describe the different challenges in the surgical management of traumatic spinal cord injuries at the Kinshasa University Teaching Hospital and some strategies implemented to overcome them. METHODS This is a cross-sectional study of 105 patients from January 2016 to June 2023. The variables of interest included: gender, age, cause, levels of lesion, hospital admission modalities, time to admission, time to surgery, AIS score at admission and on discharge, treatment, pre, peri- and post-operative complications and outcome. RESULTS We admitted 105 patients. Only 16 % of them were taken to hospital in an ambulance. The average admission time was 49.9 ± 81.79 days. Seventy-two patients (68.6 %) were operated. The average time to surgery was 62.43 ± 85.20 days. No patient was stabilized at the trauma site. Osteosynthesis was performed with appropriate implants in 63.2 % and with improvised elements in 26.8 %. Four patients were operated without an image intensifier. Short-segmental fixation was performed in 8 patients. Twenty-one patients developed pressure ulcers. At discharge, 24 patients recovered their neurological function. Neurological status remained stationary in 43 patients. Five patients died. Seventeen patients went to rehabilitation center. There was no significant difference between the improvised strategies implemented and conventional procedures on functional recovery upon discharge from hospital or rehabilitation centre (p-value : 0.838 and 0.468 respectively). CONCLUSION Our establishment faces many challenges in TSCI surgery: lack of pre-hospital emergency services and mutual health insurance, delay in admission, lack of surgical implants and image intensifier, the poverty of the population. Some strategies have been implemented to overcome some of them.
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Affiliation(s)
- Antoine Beltchika
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
| | - Israël Maoneo
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo; Department of Surgery, Kisangani University Teaching Hospital, University of Kisangani, Democratic Republic of the Congo.
| | - Teddy Ketani
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
| | - Pierre Mukuetala
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
| | - Omotayo Ojo
- Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Glennie Ntsambi
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
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Sayeed MSI, Oakman J, Stuckey R. Factors influencing access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: the perspective of rehabilitation professionals - a qualitative study. Disabil Rehabil 2024; 46:2097-2116. [PMID: 37272783 DOI: 10.1080/09638288.2023.2217383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To identify barriers and enablers for access to and participation in rehabilitation for people with LLA in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals. MATERIAL AND METHODS A mixed-method study involving an anonymous cross-sectional screening survey followed by in-depth interviews of rehabilitation professionals in these regions following the COREQ guidelines. Participants were surveyed online using convenience and snowball sampling techniques to inform a purposive heterogenic sample for semi-structured online interviews, between September 2021 to February 2022. Interview transcripts were analysed and thematically coded using the modified Health Care Delivery System Approach (HCDSA) framework. RESULTS A total of 201 quantitative survey responses shaped the interview questions and participation of 28 participants from 13 countries for the qualitative investigation. Important factors at the patient level were sex, economics, health issues, language differences, and lack of awareness; at the care team level, peer and/or family support, referrals, and the gender of the professional; at the organizational level, service availability, resources, and quality; and at the environmental level, policies, supports, and physical and/or social accessibility. CONCLUSIONS Identified interlinked factors at multiple levels of the HCDSA underpin the need for a systems approach to develop and address regional rehabilitation service provision but requires contextually adapted policy.
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Affiliation(s)
- Md Shapin Ibne Sayeed
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
| | - Jodi Oakman
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
| | - Rwth Stuckey
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
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Garg R, Talwar Y, Garg N, Bhandari D. Accessibility audit of a health care institute in India: Are people with disabilities being provided their rights? Med J Armed Forces India 2024; 80:353-358. [PMID: 38799998 PMCID: PMC11116980 DOI: 10.1016/j.mjafi.2022.10.011] [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: 06/09/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022] Open
Abstract
Background Poor accessibility of health care facilities is a major barrier for differently abled people when seeking health care. Yet, accessibility is rarely audited. This study reports findings from the first assessment of the accessibility in a health care institution of national importance. This study also assumes importance from various laws and legislation that assure equality and rights for people with disabilities (PWDs). Keeping the objectives in mind, this study was performed with an aim to study the situational analysis of the health institution of national importance for assessing the compliance of hospital premises for being disabled friendly, to find any lacunae, and to suggest remedial measures based on the study finding. The aim was to conduct a content and quality review of research into the hospital experiences of PWD and to identify gaps. Methods This was a hospital-based cross sectional study done in a period of 30 days. The gap analysis was performed with validated checklist provided by Central Public Works Department, Government of India (CPWD). Results Out of total 126 pointers, 45 pointers were found to be totally compliant, 30 pointers were found to be partially compliant, and remaining 51 pointers were found to be not applicable to the hospitals. Conclusion This assessment of the accessibility of health care facilities showed that that it is feasible to undertake these audits on a large scale, and these audits should be repeated in other settings. It highlights important gaps in accessibility, increasing the risk of the violation of the right to health of PWDs.
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Affiliation(s)
- Ruchi Garg
- Assistant Professor (Hospital Administration), AIIMS, Jodhpur, India
| | - Yatin Talwar
- Resident (Hospital Administration), AIIMS, Jodhpur, India
| | - Neeraj Garg
- Associate Professor, Department of Hospital Administration, Armed Forces Medical College, Pune, India
| | - Divya Bhandari
- Assistant Medical Superintendent, Paras Hospitals, Gurgram, India
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11
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Manship S, Hatzidimitriadou E, Moore J, Stein M, Towse D, Smith R. The experiences and perceptions of health-care professionals regarding assistive technology training: A systematic review. Assist Technol 2024; 36:123-146. [PMID: 37399518 DOI: 10.1080/10400435.2023.2219294] [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] [Accepted: 05/23/2023] [Indexed: 07/05/2023] Open
Abstract
Worldwide, there is an increasing demand for assistive technologies (ATs) that can support people to live independently for longer. Health-care professionals (HCPs) often recommend AT devices, however there exists a lack of availability of devices and appropriate training in the field. This systematic review aimed to synthesize the available evidence into the experiences and training needs of HCPs in relation to AT. Six electronic databases were searched without date restrictions: MEDLINE, PsycINFO, SPP, SSCI, CINAHL, and ASSIA. Journal handsearching, searching reference lists of included studies and relevant reviews, and contacting experts in the field of AT were also conducted. Findings were analyzed using narrative synthesis. Data from 7846 participants from 62 studies were synthesized, eliciting perceived challenges in access to and provision of training, resulting in knowledge gaps across disciplines and geographic locations. Mechanisms to mitigate these issues included ongoing support following training and tailoring education to meet individual needs since comprehensive training is essential to maintain and improve competence, knowledge, and confidence. Further research is required to explore the impact and effectiveness of AT training for HCPs to ensure that users of devices are supported to live independent and healthy lives.
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Affiliation(s)
- Sharon Manship
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Eleni Hatzidimitriadou
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Julia Moore
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Maria Stein
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Debra Towse
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Raymond Smith
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
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12
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Mazzucchi A. Cognitive evaluation and rehabilitation in high- and low-income countries. J Neuropsychol 2024; 18:1-14. [PMID: 37424164 DOI: 10.1111/jnp.12338] [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: 12/22/2022] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Starting from her own personal experience, in the First Part of the article, the author reconstructs how the specialized sectors of cognitive evaluation and rehabilitation evolved in Western countries (Europe, the United States, Canada, and Australia, in particular) during the second half of the last century and the first decades of this century. In the Second Part, she describes her personal experience in setting up a rehabilitation centre dedicated to traumatic brain-injured subjects and her commitment to international cooperation (Bolivia, Rwanda, Myanmar, Tanzania) in the field of cognitive evaluation and rehabilitation in favour of people with congenital and acquired cerebral pathology, especially in the paediatric age, since there is an almost total lack of diagnostic, but above all, rehabilitative procedures for cognitive functions in low-middle income countries. In the Third Part of the article, the author carries out an extensive review of the international literature on the differences in access to cognitive diagnostic evaluation and cognitive rehabilitation in middle- and low-income countries - but not only - underlining the urgent need to launch a major international collaborative effort to reduce and eliminate these discrepancies.
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Affiliation(s)
- Anna Mazzucchi
- Former Teacher of Neuropsychology and Neurological Rehabilitation, University of Parma, Parma PR, Italy
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13
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Linden MA, McKinlay A, Hawley C, Aaro-Jonsson C, Kristiansen I, Meyer-Heim A, Ewing-Cobbs L, Wicks B, Beauchamp MH, Prasad R. Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury. Brain Inj 2024; 38:151-159. [PMID: 38329039 DOI: 10.1080/02699052.2024.2309252] [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: 08/11/2022] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts. PRIMARY OBJECTIVE To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry. REVIEW OF INFORMATION Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus. OUTCOMES This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.
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Affiliation(s)
- Mark A Linden
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Carol Hawley
- Warwick Medical School - Mental Health and Wellbeing, University of Warwick, UK
| | | | - Ingela Kristiansen
- Department of Pediatric Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Meyer-Heim
- Rehabilitation Centre, University Children's Hospital Zürich, Zurich, Switzerland
| | - Linda Ewing-Cobbs
- Department of Pediatrics, UTHealth Houston, McGovern Medical School, USA
| | | | - Miriam H Beauchamp
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Rajendra Prasad
- Department of Neurosurgery, Indraprastha Apollo Hospitals, New Delhi, India
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Lipski E, Waters WF, Kenworthy S, Mullen A. A disparity in prosthetic access for Ecuadorians with lower-limb amputation. Prosthet Orthot Int 2024:00006479-990000000-00222. [PMID: 38377271 DOI: 10.1097/pxr.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 11/17/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services. OBJECTIVE To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry. STUDY DESIGN Retrospective study. METHODS A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed. RESULTS A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants' functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses' functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment. CONCLUSIONS These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study's analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist.
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Affiliation(s)
- Emily Lipski
- Orthotics and Prosthetics Program, School of Health Professions, Baylor College of Medicine, Houston, TX
| | - William F Waters
- Public Health, Universidad de San Francisco de Quito, Quito, Ecuador
| | - Sally Kenworthy
- Orthotics and Prosthetics Program, School of Health Professions, Baylor College of Medicine, Houston, TX
| | - Ashley Mullen
- Orthotics and Prosthetics Program, School of Health Professions, Baylor College of Medicine, Houston, TX
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Saito Y, Sato S, Nishikawa Y, Oguro F, Moriyama N, Sato K, Kobashi Y, Sawano T, Ozaki A, Nakayama T, Tsubokura M, Yasumura S, Sakai S. Outpatient rehabilitation for an older couple in a repopulated village 10 years after the Fukushima nuclear disaster:An embedded case study. Fukushima J Med Sci 2024; 70:49-54. [PMID: 37952979 PMCID: PMC10867431 DOI: 10.5387/fms.2023-01] [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: 01/06/2023] [Accepted: 09/21/2023] [Indexed: 11/14/2023] Open
Abstract
BackgroundLittle information is available on the role of community-based rehabilitation after a nuclear disaster. Here, we report the case of an older couple living in an area repopulated after the Fukushima nuclear disaster of 2011 who received outpatient rehabilitation.Case presentationAn 84-year-old woman underwent total hip arthroplasty (THA) after she fell and sustained a trochanteric fracture while caring for her husband with Alzheimer's disease. The 85-year-old husband experienced worsening behavioral and psychological symptoms of dementia (BPSD) following his wife's hospitalization. The couple received rehabilitation at an outpatient facility in a nearby village using a shuttle service. The woman's postoperative anxiety was relieved and her physical function improved. Moreover, the husband's BPSD symptoms decreased.ConclusionA wife and husband showed improvement in physical function after THA and alleviation of BPSD, respectively, following rehabilitation. In post-disaster, resource-scarce areas, older adults may benefit from utilizing the outpatient rehabilitation services available in the surrounding area.
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Affiliation(s)
- Yuta Saito
- Department of Rehabilitation, Hirata Central Hospital
| | | | - Yoshitaka Nishikawa
- Department of Internal Medicine, Hirata Central Hospital
- Department of Internal Medicine, Kawauchi Village National Health Insurance Clinic
- Department of Health Informatics, Kyoto University School of Public Health
| | - Fumiya Oguro
- Department of Internal Medicine, Hirata Central Hospital
| | - Nobuaki Moriyama
- Department of Public Health, Fukushima Medical University School of Medicine
| | | | - Yurie Kobashi
- Department of Internal Medicine, Hirata Central Hospital
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
| | - Toyoaki Sawano
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
| | - Masaharu Tsubokura
- Department of Internal Medicine, Hirata Central Hospital
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine
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Petrusevski C, Joy M, Wilson M, Richardson J. "You can because you do and you do, because you can": Using interpretative description to examine what it means to be a physically literate adult living with multiple chronic conditions. PLoS One 2024; 19:e0297261. [PMID: 38261565 PMCID: PMC10805309 DOI: 10.1371/journal.pone.0297261] [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: 07/06/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
AIMS Physical literacy is an emerging strategy to increase participation in movement activities for children and youth, however little is known about how to frame physical literacy for aging adults. The purpose of this qualitative study was to explore how adults with multiple chronic conditions describe physically literacy for adults and to understand the needs, preferences, barriers, and facilitators to acquiring and maintaining physical literacy despite fluctuations in health status. METHODS Sixteen semi-structured interviews were conducted with working and retired teachers in Ontario, Canada, with varying self-identified physical activity levels and are living with 2 or more chronic conditions. A semi-structured interview guide was used to conduct the interviews. Thematic analysis was used to analyze the data. RESULTS Participants identified 5 themes when describing physical literacy for adults: understanding one's body, conscious commitment to movement, access to and knowledge of rehabilitation health resources, valuable physical activities, and confident problem solver. Results indicate that when acquiring physical literacy for adults, there are important new constructs, such as self-management and the awareness of rehabilitation strategies to maintain mobility, that differ from the traditional physical literacy model. CONCLUSIONS To improve function and mobility outcomes for adults living with chronic conditions, programs should be guided by a physical literacy framework that addresses the needs unique to aging adults, such as understanding the changes that occur with aging, self-monitoring mobility changes and participating in rehabilitation strategies.
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Affiliation(s)
| | - MacDermid Joy
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, ON, Canada
| | - Michael Wilson
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
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Karami B, Rezaei S, Gillan HD, Akbari S, Maleki R, Moradi F, Jalili F, Karami M, Soltani S. Inpatient healthcare utilization among people with disabilities in Iran: determinants and inequality patterns. BMC Health Serv Res 2024; 24:62. [PMID: 38212742 PMCID: PMC10785394 DOI: 10.1186/s12913-023-10383-0] [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: 06/25/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND People with disabilities (PWD) have different health service needs and different factors affect the utilization of these services. Therefore, the aim of this present study was to identify determinants of inpatient healthcare utilization among PWDs in Iran. METHODS This research was a secondary data analysis of a cross-sectional study. The present study used data gathered for 766 PWDs (aged 18 years and older) within the Iranian Society with Disabilities (ISD) between September and December 2020. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals in order to identify determinants of inpatient healthcare utilization among PWDs. RESULTS Data for 766 people with disabilities were analyzed. A large number of participants were over 28 years of age (70.94%), male (64.36%), and single (54.02%). In the present study, more than 71% of participants had no history of hospitalization during the last year. In this study, males [aOR 2.11(1.14-3.91), participants with Civil Servants health insurance coverage [aOR 3.44 (1.16 - 10.17)] and individuals in the 3th quartile of disability severity [aOR 2.13 (1.01 - 4.51)] had greater odds of inpatient healthcare utilization compared to the other groups. The value of the concentration index (C) for inpatient healthcare utilization was - 0.084 (P.value = 0.046). The decomposition analysis indicated that gender was the greatest contributor (21.92%) to the observed inequality in inpatient healthcare utilization among participants. CONCLUSION Our findings suggested that the likelihood of hospitalization among the study participants could be significantly influenced by factors such as gender, the health insurance scheme, and the degree of disability severity. These results underscore the imperative for enhanced access to outpatient services, affordable insurance coverage, and reduced healthcare expenditures for this vulnerable population. Addressing these issues has the potential to mitigate the burden of hospitalization and promote better health outcomes for disadvantaged individuals.
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Affiliation(s)
- Badriyeh Karami
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hadi Darvishi Gillan
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Akbari
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Raheleh Maleki
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fardin Moradi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Faramarz Jalili
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Karami
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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18
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Sivan M, Negrini S. An expanded workforce is needed to strengthen rehabilitation in health systems. BMJ 2024; 384:q60. [PMID: 38212055 DOI: 10.1136/bmj.q60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Manoj Sivan
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust and Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale," Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Kushnir A, Kachmar O, Bonnechère B. STASISM: A Versatile Serious Gaming Multi-Sensor Platform for Personalized Telerehabilitation and Telemonitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:351. [PMID: 38257442 PMCID: PMC10818392 DOI: 10.3390/s24020351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Telemonitoring and telerehabilitation have shown promise in delivering individualized healthcare remotely. We introduce STASISM, a sensor-based telerehabilitation and telemonitoring system, in this work. This platform has been created to facilitate individualized telerehabilitation and telemonitoring for those who need rehabilitation or ongoing monitoring. To gather and analyze pertinent and validated physiological, kinematic, and environmental data, the system combines a variety of sensors and data analytic methodologies. The platform facilitates customized rehabilitation activities based on individual needs, allows for the remote monitoring of a patient's progress, and offers real-time feedback. To protect the security of patient data and to safeguard patient privacy, STASISM also provides secure data transmission and storage. The platform has the potential to significantly improve the accessibility and efficacy of telerehabilitation and telemonitoring programs, enhancing patients' quality of life and allowing healthcare professionals to provide individualized care outside of traditional clinical settings.
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Affiliation(s)
- Anna Kushnir
- Elita Rehabilitation Center, 79000 Lviv, Ukraine;
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
| | - Oleh Kachmar
- Elita Rehabilitation Center, 79000 Lviv, Ukraine;
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium;
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Department of PXL-Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium
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20
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Bsharat B, Al-Duhoun A, Ghanouni P. The acceptance and attitudes towards using assistive technology for people with stroke in Jordan: caregivers' perspectives. Assist Technol 2024; 36:40-50. [PMID: 37083581 DOI: 10.1080/10400435.2023.2202723] [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] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
The aim of this study is to evaluate the acceptance and attitudes toward assistive technology (AT) for people with stroke from their caregivers' perspectives in Jordan. Also, this study further validates the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. This is a cross-sectional study that includes a three-sections survey: the first section contains demographic data, the second section includes the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire, and the third section consists of two optional open-ended questions. Among 123 caregivers of people with stroke over 18 years of age who participated in this study, 23% were male. The findings indicate a moderate to high acceptance of using AT for stroke survivors, confirm the validity and reliability of the UTAUT questionnaire, and clarify novel issues regarding AT based on the caregivers' perspectives.
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Affiliation(s)
- Bara'ah Bsharat
- Clinical Rehabilitation Science, Occupational Therapy, Amman, Jordan
| | - Ahmad Al-Duhoun
- Princess Muna College of Nursing and Faculty of Nursing, Mutah university, Zarka, Jordan
| | - Parisa Ghanouni
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
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21
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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Abebe AB, Chala MB, Fayed N. Severe malaria-related disability in African children: a scoping review. Disabil Rehabil 2024; 46:31-39. [PMID: 36533299 DOI: 10.1080/09638288.2022.2157053] [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: 02/13/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Disability is a consequence of severe malaria for a significant proportion of African children. This scoping review aims to describe the impact of severe malaria on African children according to current literature using an international biopsychical classification and framework of disability and functioning. MATERIALS AND METHODS MEDLINE, EMBASE, Global Health, and CINHAL databases were searched for original research conducted on African children aged 0-18 using terms related to severe malaria and components of disability. Independent and dependent variables were extracted and classified using the World Health Organization's International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY) using standardized coding methods. RESULTS Seventy-two percent of the measured variables in the 34 included studies were coded as "body functions," (i.e., impairments), such as mental, neuromusculoskeletal, movement, and sensory functions, and 23.3% of variables were coded as "activities and participation" (i.e., activity limitations/participation restrictions), such as difficulties with general tasks and demands, communication, mobility, interpersonal interactions, and relationships. "Environment" variables such as family support, health access, education, or societal attitudes were not found in the included studies. CONCLUSIONS Existing peer-reviewed quantitative research of severe malaria-related disability is focused on neurological sequelae, with less research about activity limitations and participation restrictions.
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Heather M Aldersey
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abey Bekele Abebe
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
- Department of Physiotherapy, School of Medicine, Gondar University Specialized Comprehensive Hospital, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Bayisa Chala
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
- Department of Physiotherapy, School of Medicine, Gondar University Specialized Comprehensive Hospital, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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22
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Ruiz Brunner MDLM, Jahan I, Cuestas E, Cieri ME, Escobar Zuluaga J, Condinanzi AL, Sanchez F, McIntyre S, Smithers-Sheedy H, Muhit M, Badawi N, Díaz R, Diaz A, Carranza J, Durán C, Quintero Valencia CA, Melaragno M, Khandaker G. Latin American Cerebral Palsy Register (LATAM-CPR): study protocol to develop a collaborative register with surveillance of children with cerebral palsy in Latin American countries. BMJ Open 2023; 13:e071315. [PMID: 38070889 PMCID: PMC10729276 DOI: 10.1136/bmjopen-2022-071315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR). METHODS AND ANALYSIS The LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared. ETHICS AND DISSEMINATION Individual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.
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Affiliation(s)
- Maria de Las Mercedes Ruiz Brunner
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET-UNC, Cordoba, Argentina
- Instituto de Investigaciones Clínicas y Epidemiológicas (INICyE), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Cordoba, Argentina
| | - Israt Jahan
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- Cerebral Palsy Program, CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Eduardo Cuestas
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET-UNC, Cordoba, Argentina
- Instituto de Investigaciones Clínicas y Epidemiológicas (INICyE), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Cordoba, Argentina
| | - Maria Elisabeth Cieri
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET-UNC, Cordoba, Argentina
- Instituto de Investigaciones Clínicas y Epidemiológicas (INICyE), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Cordoba, Argentina
| | - Johana Escobar Zuluaga
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET-UNC, Cordoba, Argentina
- Instituto de Investigaciones Clínicas y Epidemiológicas (INICyE), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Cordoba, Argentina
| | - Ana Laura Condinanzi
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET-UNC, Cordoba, Argentina
- Instituto de Investigaciones Clínicas y Epidemiológicas (INICyE), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Cordoba, Argentina
| | - Federico Sanchez
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET-UNC, Cordoba, Argentina
- Instituto de Investigaciones Clínicas y Epidemiológicas (INICyE), Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Cordoba, Argentina
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mohammad Muhit
- Cerebral Palsy Program, CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Raul Díaz
- Comité de Educación, Academia Mexicana de Parálisis Cerebral y Trastornos del Neurodesarrollo, Ciudad de México, Mexico
| | - Agripina Diaz
- Comité de Educación, Academia Mexicana de Parálisis Cerebral y Trastornos del Neurodesarrollo, Ciudad de México, Mexico
| | - Jorge Carranza
- Comité de Educación, Academia Mexicana de Parálisis Cerebral y Trastornos del Neurodesarrollo, Ciudad de México, Mexico
| | - Claudia Durán
- Comité de Educación, Academia Mexicana de Parálisis Cerebral y Trastornos del Neurodesarrollo, Ciudad de México, Mexico
| | - Carlos Alberto Quintero Valencia
- Departamento de Rehabilitación, Facultad de Medicina de la Universidad de Antioquia, Antoquia, Colombia
- Unidad de Rehabilitación para Niños, Comité de Rehabilitación de Antioquia, Medellín, Colombia
| | - Mariana Melaragno
- Docencia e Investigación, Fundación Teletón Argentina, Buenos Aires, Argentina
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- Cerebral Palsy Program, CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Central Queensland Public Health Unit, Central Queensland University, Rockhampton, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Chu SY, Rafi ABM, Lee J, Fierro V, Gan CH, Joginder Singh S, Hersh D, Lin LY. The relationship between affiliate stigma, stress, and quality of life for parents of individuals with cerebral palsy in Malaysia. Disabil Rehabil 2023; 45:4035-4047. [PMID: 36541160 DOI: 10.1080/09638288.2022.2153304] [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: 03/18/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the relationship between affiliate stigma, stress, and perceived quality of life among parents of children with cerebral palsy (CP). METHOD Surveys (Study 1) and semi-structured interviews (Study 2) were used to collect data. Thirty-eight respondents completed the Affiliate Stigma Scale (ASS), Caregiver Burden Inventory (CBI), and Care-related Quality of Life (CarerQol) scales (GMFCS). Eleven respondents took part in semi-structured interviews, which were then thematically evaluated. RESULTS Parents did not feel stigmatized because they had a child with CP. However, parents needed some form of short-term relief from caregiving. After controlling for demographics, high stress respondents experienced high affiliate stigma whereas low stress respondents had better quality of life. Although the respondents with less stigma had a better quality of life, this effect was moderate. Three major themes emerged from the interviews. CONCLUSION Counseling, support groups, and helper services should be offered to parents. Also, healthcare professionals participating in CP rehabilitation, community-based rehabilitation, and health institutions should be educated on how to better help parents of children with CP.
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Affiliation(s)
- Shin Ying Chu
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Adlina Binti Mohamed Rafi
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Veronica Fierro
- Department of Speech-Language Pathology, Delaware Valley University, Doylestown, PA, USA
| | - Chun Hong Gan
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Rehabilitation and Special Needs Studies (iCaRehab), Programme of Clinical Psychology and Behavioural Health, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Susheel Joginder Singh
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Rehabilitation and Special Needs Studies (iCaRehab), Speech Sciences Programme, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Deborah Hersh
- Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Ling-Yi Lin
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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Bolbocean C. Editorial: How best to deliver disability care in a cost-effective way: improving health care delivery and health outcomes for people with disability. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1307810. [PMID: 38028157 PMCID: PMC10643151 DOI: 10.3389/fresc.2023.1307810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Corneliu Bolbocean
- Nuffield Department of Primary Health Sciences, University of Oxford, Oxford, United Kingdom
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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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Sorici A, Băjenaru L, Mocanu IG, Florea AM, Tsakanikas P, Ribigan AC, Pedullà L, Bougea A. Monitoring and Predicting Health Status in Neurological Patients: The ALAMEDA Data Collection Protocol. Healthcare (Basel) 2023; 11:2656. [PMID: 37830693 PMCID: PMC10572511 DOI: 10.3390/healthcare11192656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
(1) Objective: We explore the predictive power of a novel stream of patient data, combining wearable devices and patient reported outcomes (PROs), using an AI-first approach to classify the health status of Parkinson's disease (PD), multiple sclerosis (MS) and stroke patients (collectively named PMSS). (2) Background: Recent studies acknowledge the burden of neurological disorders on patients and on the healthcare systems managing them. To address this, effort is invested in the digital transformation of health provisioning for PMSS patients. (3) Methods: We introduce the data collection journey within the ALAMEDA project, which continuously collects PRO data for a year through mobile applications and supplements them with data from minimally intrusive wearable devices (accelerometer bracelet, IMU sensor belt, ground force measuring insoles, and sleep mattress) worn for 1-2 weeks at each milestone. We present the data collection schedule and its feasibility, the mapping of medical predictor variables to wearable device capabilities and mobile application functionality. (4) Results: A novel combination of wearable devices and smartphone applications required for the desired analysis of motor, sleep, emotional and quality-of-life outcomes is introduced. AI-first analysis methods are presented that aim to uncover the prediction capability of diverse longitudinal and cross-sectional setups (in terms of standard medical test targets). Mobile application development and usage schedule facilitates the retention of patient engagement and compliance with the study protocol.
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Affiliation(s)
- Alexandru Sorici
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Lidia Băjenaru
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Irina Georgiana Mocanu
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Adina Magda Florea
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Panagiotis Tsakanikas
- Institute of Communication and Computer Systems, National Technical University of Athens, 10682 Athens, Greece;
| | - Athena Cristina Ribigan
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy;
| | - Anastasia Bougea
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
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Kuper H, Ssemata AS, Smythe T, Drazdzewska J, Waiswa P, Kagurusi P, Rosato M, Mbazzi FB. Is it feasible to implement a community-based participatory group programme to address issues of access to healthcare for people with disabilities in Luuka district Uganda? A study protocol for a mixed-methods pilot study. BMJ Open 2023; 13:e074217. [PMID: 37770271 PMCID: PMC10546107 DOI: 10.1136/bmjopen-2023-074217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION On average, people with disabilities face many difficulties in accessing healthcare and experience worse health outcomes. Yet, evidence on how to overcome these barriers is lacking. Participatory approaches are gaining prominence as they can generate low-cost, appropriate and scalable solutions. This study protocol is for the pilot testing of the co-created Participatory Learning and Action for Disability (PLA-D) groups to assess feasibility. METHODS AND ANALYSIS We will pilot test PLA-D in five groups in Luuka district, Uganda during 2023. Each group will include approximately 20 members (people with disabilities, family members, carers) who will meet every 2-3 weeks over a 9-11 month period. The groups, guided by a trained facilitator, will identify issues about health and healthcare access and plan and implement locally generated solutions (eg, raising awareness of rights, advocacy and lobbying, establishing health savings and financing schemes). We will collect diverse sources of data to assess feasibility: (1) in-depth interviews and focus group discussions with group participants, non-participants and group facilitators; (2) monitoring of group activities; (3) direct observation of groups and (4) quantitative survey of group participants at baseline and endline. Data analyses will be undertaken to assess feasibility in terms of: acceptability, demand, implementation and practicality. We will develop and refine evaluation tools in preparation for a future trial. ETHICS AND DISSEMINATION Ethical approval for the study has been received by the London School of Hygiene & Tropical Medicine and the Uganda Virus Research Institute ethics committees. Informed consent will be obtained from all study participants, making adaptations for people with disabilities as necessary. We will reach different groups for our dissemination activities, including (1) people with disabilities (eg, community meetings); (2) policy and programme stakeholders in Uganda and international (eg, individual meetings, evidence briefs) and (3) academics (journal articles, conference/seminar presentations).
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Tracey Smythe
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Peter Waiswa
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Femke Bannink Mbazzi
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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Yoo S, Choi JY, Yang SS, Koh SE, Jeong MH, Song MK. Medical service utilization by children with physical or brain disabilities in South Korea. BMC Pediatr 2023; 23:487. [PMID: 37752492 PMCID: PMC10521495 DOI: 10.1186/s12887-023-04309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Children with physical or brain disabilities experience several functional impairments and declining health complications that must be considered for adequate medical support. This study investigated the current medical service utilization of children expressing physical or brain disabilities in South Korea by analyzing medical visits, expenses, and comorbidities. METHODS We used a database linked to the National Rehabilitation Center of South Korea to extract information on medical services utilized by children with physical or brain disabilities, the number of children with a disability, medical visits for each child, medical expenses per visit, total medical treatment cost, copayments by age group, condition severity, and disability type. RESULTS Brain disorder comorbidities significantly differed between those with mild and severe disabilities. Visits per child, total medical treatment cost, and copayments were higher in children with severe physical disabilities; however, medical expenses per visit were lower than those with mild disabilities. These parameters were higher in children with severe brain disabilities than in mild cases. Total medical expenses incurred by newborns to three-year-old children with physical disorders were highest due to increased visits per child. However, medical expenses per visit were highest for children aged 13-18. CONCLUSION Medical service utilization varied by age, condition severity, and disability type. Severe cases and older children with potentially fatal comorbidities required additional economic support. Therefore, a healthcare delivery system for children with disabilities should be established to set affordable medical costs and provide comprehensive medical services based on disability type and severity.
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Affiliation(s)
- Sunyong Yoo
- Department of ICT Convergence System Engineering, Chonnam National University, Gwangju, Republic of Korea
| | - Ja Young Choi
- Department of Physical and Rehabilitation Medicine, Chungnam National University College of Medicine, Daegeon, Republic of Korea
| | - Shin-Seung Yang
- Department of Physical and Rehabilitation Medicine, Chungnam National University College of Medicine, Daegeon, Republic of Korea
| | - Seong-Eun Koh
- Department of Physical & Rehabilitation Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Myeong-Hyeon Jeong
- Department of ICT Convergence System Engineering, Chonnam National University, Gwangju, Republic of Korea
| | - Min-Keun Song
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School & Hospital, 160 baekseo-ro Dong-gu, Gwangju, 61479, Republic of Korea.
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Mills JA, Krzepkowska W, Cieza A, Cuchi P, Zurn P, Short SD, Middleton JW. Integrating competency analysis into national rehabilitation workforce evaluation: a case study. HUMAN RESOURCES FOR HEALTH 2023; 21:69. [PMID: 37612589 PMCID: PMC10463812 DOI: 10.1186/s12960-023-00843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Establishing a workforce capable of meeting population needs is contingent on evaluation that can inform sound policy and planning. Health workforce evaluation has traditionally relied on health labour market analysis and workload estimations. To date, competency analysis has not been included in national health workforce evaluation, despite that fact that the findings may go far in guiding decisions around workforce composition, optimisation and education and training. This case study sought to assess the feasibility and perceived added value of integrating competency analysis into national rehabilitation workforce evaluation, and to determine how competency analysis can shape rehabilitation workforce planning. The findings of the case study can be used to explore the integration of competency analysis in the evaluation of other health-related occupational groups. METHODS Participant observation was complemented by key informant interviews with experts engaged in the national rehabilitation workforce evaluation in Poland. These experts represented stakeholders in policy, education, research, clinical practice and professional associations. RESULTS The results indicated that competency analysis can be feasibly integrated into national rehabilitation workforce evaluation, particularly when implementation is supported through the use of online platforms. However, the collection of additional data using other tools, such as a survey of the behaviours and tasks of a wider sample of rehabilitation workers, could strengthen data reliability. Experts perceived findings of the competency analysis to be valuable for expanding the understanding of rehabilitation, shedding light on task allocation and deployment of the existing rehabilitation workforce, and advocating for the rehabilitation workforce to be strengthened, especially in relation to those occupations which may not be recognised or valued as rehabilitation workers. Although it was not possible to fully explore the impact of competency analysis data on rehabilitation workforce planning and development in this study, experts suggested that its availability would likely foster greater cooperation among occupations, which has been missing at the policy and planning level to date. It further demonstrates what competency data should be collected and reported, and provides richer information to guide decisions. CONCLUSIONS Competency analysis complements traditional labour market analysis and workload estimates, adding depth to the understanding of how members of the workforce perform and perceive themselves, and how deficiencies in the workforce impact on the provision of care to specific population groups.
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Affiliation(s)
- Jody-Anne Mills
- Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland.
| | - Weronika Krzepkowska
- World Health Organization Country Office, Poland, Al. Jerozolimskie 155, 02-326, Warsaw, Poland
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Paloma Cuchi
- World Health Organization Country Office, Poland, Al. Jerozolimskie 155, 02-326, Warsaw, Poland
| | - Pascal Zurn
- Health Workforce Department, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Stephanie Doris Short
- Faculty of Medicine and Health, WHO Collaborating Centre for Strengthening Rehabilitation Capacity in Health Systems, The University of Sydney, Sydney, Australia
| | - James W Middleton
- Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, Australia
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Saito T, Imahashi K. Barriers and enablers of utilization of low-vision rehabilitation services among people 50 years or older in East and Southeast Asia: a scoping review protocol. JBI Evid Synth 2023; 21:1687-1696. [PMID: 36974445 DOI: 10.11124/jbies-22-00429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVES This scoping review aims to explore and describe the barriers and enablers of low-vision rehabilitation service utilization among people 50 years or older in East and Southeast Asia. INTRODUCTION Vision impairment is strongly associated with aging. East and Southeast Asia are experiencing a rapidly growing aging population and the associated eye-related health burdens. Despite the benefits of low-vision rehabilitation services, they are underutilized in these regions. Identifying the barriers and enablers of service utilization could be a crucial first step in making the services more accessible and, ultimately, easing the burden of this health issue. INCLUSION CRITERIA This review will include published quantitative, qualitative, or mixed methods studies and reviews that examine the barriers and/or enablers of low-vision rehabilitation service utilization among people aged 50 years or older living in East and Southeast Asia. Low-vision rehabilitation services are defined as any kind of intervention that aims to mitigate the impact of disability induced by eye-related health conditions. METHODS A literature search of 4 databases (MEDLINE, Web of Science, Academic Search Ultimate, and Ichushi-Web), as well as a manual search of the reference lists of included articles, will be conducted to identify eligible articles. Two independent reviewers will assess the articles for inclusion. Data extraction will focus on general information of the study, demographic or descriptive information about the study population, the eye condition being studied, means of low-vision rehabilitation, and the barriers and/or enablers of service utilization. The information will be tabulated to depict the categories of barriers and enablers that influence access to services. REVIEW REGISTRATION Open Science Framework https://osf.io/8y2wp.
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Affiliation(s)
- Takashi Saito
- Department of Social Rehabilitation, Research Institute of National Rehabilitation Center for Persons with Disability, Tokorozawa, Saitama, Japan
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Kumurenzi A, Richardson J, Thabane L, Kagwiza J, Urimubenshi G, Hamilton L, Bosch J, Jesus T. Effectiveness of interventions by non-professional community-level workers or family caregivers to improve outcomes for physical impairments or disabilities in low resource settings: systematic review of task-sharing strategies. HUMAN RESOURCES FOR HEALTH 2023; 21:48. [PMID: 37344907 DOI: 10.1186/s12960-023-00831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND In low-resource settings, access to basic rehabilitation could be supplemented by community-level interventions provided by community health workers, health volunteers, or family caregivers. Yet, it is unclear whether basic physical rehabilitation interventions delivered to adults by non-professional alternative resources in the community, under task-shifting or task-sharing approaches, are effective as those delivered by skilled rehabilitation professionals. We aim to synthesize evidence on the effectiveness of community-level rehabilitation interventions delivered by non-professional community-level workers or informal caregivers to improve health outcomes for persons with physical impairments or disabilities. METHODS We performed a systematic review with a PROSPERO registration. Eight databases were searched for (PubMed, CINAHL, Global Health, PDQ Evidence, Scopus, ProQuest, CENTRAL, and Web of Science), supplemented by snowballing and key-informant recommendations, with no time restrictions, applied. Controlled and non-controlled experiments were included if reporting the effects of interventions on mobility, activities of daily living (ADLs), quality of life, or social participation outcomes. Two independent investigators performed the eligibility decisions, data extraction, risk of bias, and assessed the quality of the evidence using the GRADE approach. RESULTS Ten studies (five randomized controlled trials [RCTs]) involving 2149 participants were included. Most common targeted stroke survivors (n = 8); family caregivers were most frequently used to deliver the intervention (n = 4); and the intervention was usually provided in homes (n = 7), with training initiated in the hospital (n = 4). Of the four RCTs delivered by family caregivers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; confidence interval [CI] 121.81-122.19; [p = 0.04]) and another one in ADLs (effect size: 0.4; CI 25.92-35.08; [p = 0.03]). Of the five non-RCT studies by community health workers or volunteers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; CI 10.143-16.857; [p < 0.05]), while two demonstrated improved statistically significant improvement in ADLs (effect size: 0.2; CI 180.202-184.789 [p = 0.001]; 0.4; CI - 7.643-18.643; [p = 0.026]). However, the quality of evidence, based on GRADE criteria, was rated as low to very low. CONCLUSIONS While task-sharing is a possible strategy to meet basic rehabilitation needs in low-resource settings, the current evidence on the effectiveness of delivering rehabilitation interventions by non-professional community-level workers and informal caregivers is inconclusive. We can use the data and experiences from existing studies to better design studies and improve the implementation of interventions. Trial registration PROSPERO registration number: CRD42022319130.
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Affiliation(s)
- Anne Kumurenzi
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada.
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Canada
- Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Jeanne Kagwiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gerard Urimubenshi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leah Hamilton
- Population Health Research Institute, Hamilton, Canada
| | - Jackie Bosch
- Occupational Therapy, School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tiago Jesus
- Feinberg School of Medicine, Northwestern University, Evanston, United States of America
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Fang L, Zhu RR, Sang Z, Xu XT, Zheng LY, Xiang Y, Guo C, Li Z, Espinosa SA, Zhang Q, Shan C. World Health Organization survey on the level of integration of traditional Chinese medicine in Chinese health system rehabilitation services. Integr Med Res 2023; 12:100945. [PMID: 37122485 PMCID: PMC10134443 DOI: 10.1016/j.imr.2023.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Background To meet the growing global demand for rehabilitation services, the World Health Organization (WHO) launched Rehabilitation 2030. This study was commissioned by the WHO to investigate the integration degree of traditional Chinese medicine (TCM) in Chinese health system rehabilitation services and the demand for TCM rehabilitation in China. Methods Twenty TCM rehabilitation experts and relevant government administrators were invited to complete the questionnaire between September 2019 and January 2022. The development of traditional, complementary, and integrative medicine (TCI) rehabilitation in China was assessed primarily based on six different health system components. Results 26 policies, regulations, and national strategic plans related to TCI rehabilitation were issued by relevant government departments since 2002; notably, 14 policies related to TCI rehabilitation development were intensively introduced from 2016 to 2021. These policies cover the three main areas of financing, infrastructure development, and service delivery. The National Administration of Traditional Chinese Medicine's investment in TCM clinical capacity infrastructure and scientific research in 2019-2021 increased by 66% compared to 2010-2012, and the average number of TCM hospitals with rehabilitation departments in 2020 increased by 6.5% compared to 2018. The proportion of community health service centers providing TCM services in primary medical and health institutions has increased by 30.8% over the past 10 years. Conclusion Long-term continuous policies, substantial financial investment, and expansion of the scope of TCI rehabilitation services in primary care institutions have effectively contributed to the rapid development of TCI rehabilitation. However, human resources and financing mechanisms for TCI rehabilitation need further improvement.
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Affiliation(s)
- Lei Fang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ran-ran Zhu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhen Sang
- Institute of TCM International Standardization, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-ting Xu
- Institute of TCM International Standardization, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin-yun Zheng
- WHO Collaborating Centre for Traditional Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanwei Xiang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Chaoyang Guo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhenrui Li
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Stéphane Alexandre Espinosa
- Traditional, Complementary and Integrative Medicine Governmental Agencies of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | - Qi Zhang
- Traditional, Complementary and Integrative Medicine, Integrated Health Services Department, World Health Organization, Geneva, Switzerland
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Kaniamattam M, Oxley J. Qualitative analysis of social support for caregivers of children with neurodevelopmental disorders in South India. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 138:104539. [PMID: 37224595 DOI: 10.1016/j.ridd.2023.104539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Despite its importance, limited formal social supports are available for caregivers of children with neurodevelopmental disorders (NDDs) navigating rehabilitation and caregiving in low-resource contexts. The current study investigates the social support sources and coping processes of caregivers of children with NDD at a rural rehabilitation center in South India. An emphasis is placed on interactions between the study participants and families of other children with NDD receiving services at the center. METHODS AND PROCEDURE A constructivist grounded theory methodology was adopted. Data analysis was based on data obtained from twenty-two parents obtaining rehabilitation services in the center over two phases. OUTCOMES AND RESULTS Constant comparative analysis of caregivers' perceptions and experiences generated a theoretical framework of the long-term emergence of social support and coping, comprising three subcategories: accessing service, gaining acceptance and experiencing support at a grassroots level, and coping at a grassroots level. CONCLUSIONS AND IMPLICATIONS Findings illustrate the need for and benefit of supporting caregivers of children with NDD to find informal social support. Critical considerations for rehabilitation providers, researchers, and policymakers to facilitate caregivers' formal and informal social support and coping skills are discussed.
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Affiliation(s)
- Monica Kaniamattam
- School of Rehabilitation Sciences, Moravian University, Bethlehem, PA, USA.
| | - Judith Oxley
- Department of Communicative Disorders, University of Louisiana at Lafayette, Lafayette, LA, USA
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Dee-Price BJM. Using Communication Assistants in Qualitative Health Research. QUALITATIVE HEALTH RESEARCH 2023:10497323231169495. [PMID: 37217459 DOI: 10.1177/10497323231169495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Qualitative health research is hampered by narrow constructs of human communication that privilege participants with access to spoken and written (normative) language. With limited awareness of such things as augmentative and alternative communication (AAC) or the rights of people with complex communication access needs, qualitative research becomes a 'picker and chooser' of whose voices are included in studies and whose are not. In order for 'voices' to be heard, adaptations are required which include the acknowledgement and support of communication assistants (informal and formal) who can help provide a communication bridge between people with complex communication access needs and researcher(s). Yet little is known of who qualifies as a communication assistant nor the scope and limitations of this role in health research. Beginning with communication diversity arguments the article compares communication assistants with language interpreters before discussing practice and implications for health research.
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Sohn DG, Yoon J, Ro JS, Leigh JH. Geographic Distribution of Central Nervous System Rehabilitation Treatment in Korea and Its Associated Factors. J Korean Med Sci 2023; 38:e147. [PMID: 37218350 DOI: 10.3346/jkms.2023.38.e147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/12/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Health disparity is defined as a difference in the accessibility of medical resources among regions or other factors. In South Korea, there might be a disparity because of the low proportion of public medical institutions. This study aimed to investigate the geographic distribution of rehabilitation treatment and examine the factors associated with the rates of rehabilitation treatment in Korea. METHODS We used administrative claims data in 2007, 2012, and 2017 from the National Health Insurance Database in Korea. We defined physical therapy and occupational therapy as rehabilitation treatments and analyzed the rate of rehabilitation treatments for administrative districts in 2007, 2012, and 2017. Interdecile range and coefficient of variation were used to investigate the geographic distribution of rehabilitation treatment over time. We applied multiple random intercept negative binomial regression to examine the factors associated with rehabilitation treatment. A total of 28,319,614 inpatient and outpatient claims were submitted for 874 hospitals that provided rehabilitation treatment in 2007, 2012, and 2017. RESULTS The increase in the mean rates of physical therapy inpatients and outpatients was greater than those for occupational therapy inpatients and outpatients from 2007 to 2017. Both physical therapy and occupational therapy were concentrated in the Seoul Capital Area and other large urban areas. More than 30% of the districts received no rehabilitation treatment. The interdecile range and coefficient of variation for physical therapy declined more than those for occupational therapy from 2007 to 2017. The deprivation index was negatively correlated with physical therapy inpatients, physical therapy outpatients, occupational therapy inpatients, and occupational therapy outpatients. Furthermore, a 1-unit increase in the number of hospital beds per 1,000 people was associated with 1.42 times higher physical therapy inpatient, 1.44 times higher physical therapy outpatient, 2.14 times higher occupational therapy inpatient, and 3.30 times higher occupational therapy outpatient treatment. CONCLUSION To reduce the geographic inequality in rehabilitation treatment, it is necessary to narrow the gap between the supply and demand of rehabilitation services. Providing incentives or direct provisions from the government might be an alternative.
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Affiliation(s)
- Dong-Gyun Sohn
- Graduate School of Public Health, Seoul National University, Seoul, Korea
- Outpatient Rehabilitation Center, Korea Workers' Compensation and Welfare Service Incheon Hospital, Incheon, Korea
| | - Jaehong Yoon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Jun-Soo Ro
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
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Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 DOI: 10.1186/s12939-023-01896-5] [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: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD, USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Sarah N Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Georgia J Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Farrar M, Niraula YR, Pryor W. Improving access to prosthetic services in Western Nepal: a local stakeholder perspective. Disabil Rehabil 2023; 45:1229-1238. [PMID: 35387522 DOI: 10.1080/09638288.2022.2057599] [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] [Indexed: 11/03/2022]
Abstract
PURPOSE Evidence of effective strategies to improve access to assistive technology (AT) like prostheses is limited, especially in rural and remote areas of low- and middle-income countries where unmet needs are the greatest. This study aimed to identify barriers and facilitators to accessing prosthetic services in rural areas of western Nepal and explore strategies to improve access from the perspective of local stakeholders. METHOD Semi-structured interviews were conducted with 13 service providers and consumers. Barriers and facilitators of access were highlighted and potential solutions to overcome access barriers were explored using thematic analysis of transcripts. RESULTS Six themes concerning barriers and facilitators arose: awareness and literacy of prosthetic services, attitudes and belief systems, financial supports, geographical access, health system and referral processes, as well as service provider capacity and regulation. Six themes regarding potential solutions were also identified: awareness campaigns, procurement pathways, referral pathways, subsidised and shared costs of AT, professional support networks and development opportunities, as well as task shifting and sharing. CONCLUSIONS While facilitating interventions support access to prosthetic services, they remain insufficient to overcome several barriers that continue to inhibit this access. Nevertheless, real opportunities to alleviate barriers and address the unmet need exist and must be explored.Implications For RehabilitationIt is advised that rehabilitation professionals, particularly those delivering prosthetic services in rural and remote settings of Nepal, consider piloting alternative service delivery strategies which utilise resources accessible to them in order to overcome several existing barriers to AT access e.g., task shifting.Rehabilitation professionals in Nepal have the opportunity to support others working in low-resources settings to expand professional development opportunities through online and digital platforms.Gathering and sharing data on the current state of prosthetic and AT service delivery within Nepal is highly valuable to the development of the prosthetic rehabilitation profession and ultimately equity in access to appropriate AT.Proposed interventions identified within this study can potentially serve to guide stakeholders in rural and remote settings of other LMICs in developing strategies to overcome barriers to AT access suitable to their context.
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Affiliation(s)
| | - Yeti Raj Niraula
- Humanity and Inclusion, Prosthetics Orthotics Society Nepal, Kathmandu, Nepal
| | - Wesley Pryor
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Rose Hill EJ, Bertelli JA. Spinal Cord Injury: Epidemiology, Spontaneous Recovery, and Hand Therapy for the Reconstructive Hand Surgeon. J Hand Surg Am 2023:S0363-5023(23)00031-X. [PMID: 36963997 DOI: 10.1016/j.jhsa.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/13/2022] [Accepted: 01/08/2023] [Indexed: 03/26/2023]
Abstract
People with spinal cord injury (SCI) prioritize hand function above all else as a reconstructive goal, yet remain a markedly undertreated population by hand surgeons. This review article provides an overview of the epidemiology of SCI and the unmet clinical need of these patients. Further, this article outlines the natural history of SCI, including the expected spontaneous recovery over time and the expectations of hand function when treated with hand therapy alone. This review aims to equip reconstructive hand surgeons with a sound understanding of the basic principles of SCI and recovery and provide a rationale for when to intervene with surgery. In the last decade, this field has changed dramatically with the advent of reliable nerve transfers, making referral and surgical intervention time-sensitive. Therefore this review aims to highlight the expectations from hand therapy alone in this group, the urgent need for early referral to allow nerve transfer options to be viable, and the strategies for overcoming the barriers to these referrals. This offers the opportunity for surgeons to expand their tetraplegia practices while maximizing the considerable contributions to the hand function and quality of life of these patients.
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Affiliation(s)
- Elspeth Jane Rose Hill
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
| | - Jayme Augusto Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil; Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil; Department of Plastic Surgery, Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil
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Shetty T, Ganesan S, Johari A, Mullerpatan R. Gross motor function profile of children with cerebral palsy in a low-resource setting: A call for reflection on the model of care. J Pediatr Rehabil Med 2023; 16:211-218. [PMID: 36872801 DOI: 10.3233/prm-220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
PURPOSE The current study aimed to explore Gross Motor Function Measure (GMFM) profiles among children with cerebral palsy (CP) at various Gross Motor Function Classification System (GMFCS) levels in a low-resource setting. Seventy-one ambulatory children with CP (61% males), were studied after signed informed consent was obtained from parents and assent from children older than 12 years. METHODS Ambulatory capacity of children with CP was classified using GMFCS levels. Functional ability of all participants was measured using GMFM-88. RESULTS Children with CP in a low-resource setting had 12-44% lower GMFM scores in dimensions of standing, walking, running, and jumping with reference to children from high-resource settings with similar ambulatory capacity reported previously. The most affected components across various GMFCS levels were 'sitting on a large and small bench from floor,' 'arm-free squatting,' 'half-kneeling,' 'kneel-walking,' and 'single-limb hop'. CONCLUSION Knowledge of GMFM profiles can guide clinicians and policymakers in low-resource settings for strategic rehabilitation planning and extend the focus of rehabilitation from restoration of body structure and function to the wider domain of social participation in leisure, sport, work, and the community at large. Additionally, providing tailored rehabilitation based on a profile of motor function can ensure an economically, environmentally, and socially sustainable future.
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Affiliation(s)
- Triveni Shetty
- Department of Neurophysiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Sailakshmi Ganesan
- Department of Neurophysiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | | | - Rajani Mullerpatan
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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Demeke ZD, Assefa YA, Abich Y, Chala MB. Home-based therapy and its determinants for children with cerebral palsy, exploration of parents' and physiotherapists' perspective, a qualitative study, Ethiopia. PLoS One 2023; 18:e0282328. [PMID: 36848380 PMCID: PMC9970053 DOI: 10.1371/journal.pone.0282328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore the perceptions of parents and physiotherapists regarding home-based therapy programs for children with cerebral palsy and to understand the factors affecting adherence to home-based therapy programs. MATERIALS AND METHOD Thematic analysis method was used to identify, analyse and report findings. Twelve physiotherapists and five caregivers were purposively sampled and interviewed. RESULTS All transcripts were coded line by line, and the codes were then organized into categories for the development of descriptive themes and the generation of analytical themes. The data analysis followed the steps of the thematic analysis process. Seven themes emerged during the analysis: Why Home-Based Therapy? Ways of Teaching, Types of the therapy, Strategies of assessing adherence, Environmental factors, Attitude and knowledge; and Family participation. Physiotherapists use home-based therapy to prevent complications and improve functioning. They use various ways of teaching, such as explaining, demonstrating, and using pictures and videos. Physiotherapists consider several factors such as severity, age, and availability of resources before they decide the type of home therapy programs. However, parent's participation was low; and strategies to monitor and evaluate adherence were also low. Low family support, limited recourse, lack of knowledge and poor attitude negatively affected adherence to home-based therapy. CONCLUSIONS Our finding revealed that physiotherapists use quite limited methods of teaching, and do not properly monitor adherence of the home-based therapy. Additionally, family participation to select type of therapy and to set goal were low.
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Affiliation(s)
| | - Yohannes Awoke Assefa
- Occupational Therapy department, School of Medicine, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Yohannes Abich
- Physiotherapy Department, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Mulgeta Bayisa Chala
- Postdoctoral (OHT Impact) Fellow, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Nguyen DT, Bricout VA, Tran HT, Pham VH, Duong-Quy S. Sleep apnea in people with Down syndrome: Causes and effects of physical activity? Front Neurol 2023; 14:1123624. [PMID: 36816555 PMCID: PMC9931749 DOI: 10.3389/fneur.2023.1123624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Poor sleep quality is recognized as a major risk factor for poor health, increasing the incidence of serious chronic diseases. In people with Down syndrome, sleep apnea prevalence is significantly greater, it is caused by genetic, anatomical, endocrine, and metabolic abnormalities. The consequences of sleep disruption due to sleep apnea are very serious, especially in terms of neurocognitive and cardiovascular effects, leading to reduced life expectancy and quality of life in this population. However, the management, care, and treatment of related disorders in people with Down syndrome are still inadequate and limited. Therefore, this article wants to increase understanding and awareness about sleep apnea and the benefits of physical activity in improving sleep quality in the Down syndrome community, families, and their care specialists.
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Affiliation(s)
- Duy-Thai Nguyen
- Clinical Research Committee, Vietnam Society of Sleep Medicine (VSSM), Da Lat, Vietnam,National Institute for Control of Vaccines and Biologicals, Ministry of Health, Hanoi, Vietnam
| | | | - Hong-Tram Tran
- National Institute for Control of Vaccines and Biologicals, Ministry of Health, Hanoi, Vietnam
| | - Van-Hung Pham
- National Institute for Control of Vaccines and Biologicals, Ministry of Health, Hanoi, Vietnam
| | - Sy Duong-Quy
- Sleep Lab Centre, Bio-Medical Research Centre, Lam Dong Medical College, Da Lat, Vietnam,Immuno-Allergology Division, Hershey Medical Center, Penn State Medical College, Hershey, PA, United States,Sleep Lab Unit, Outpatient Department, Pham Ngoc Thach Medical University, Ho Chi Minh City, Vietnam,Department of Respiratory Functional Exploration, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam,*Correspondence: Sy Duong-Quy ✉
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Zeng X, Balikuddembe JK, Liang P. Impact of community-based rehabilitation on the physical functioning and activity of daily living of stroke patients: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:403-414. [PMID: 35200068 DOI: 10.1080/09638288.2022.2037755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed at establishing the impact of community-based rehabilitation (CBR) on the physical functioning and activity of daily living (ADL) of patients with stroke (PWS). MATERIALS AND METHODS Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was conducted in five databases, including PubMed, OVID Embase, OVID Medline, Cochrane Library, and Web of Science between May 2010 and 2020. Meta-analysis was performed using the Comprehensive Meta-Analysis Version 2 software to establish whether the studies were sufficiently homogenous. RESULTS Twenty studies out of 828 publications were included in the present systematic review. A significant difference between CBR intervention and control groups was identified about the physical functional capacity in mobility, 6-metre walk test (6MWT) (g = 0.351, 95% CI (0.110, 0.592)), community walking test (g= -0.473, 95% CI (-0.926, -0.020)) and on the other hand a significant improvement in ADL was found (g = 0.138, 95% CI(0.051, 0.224)). CONCLUSIONS CBR is revealed to be effective in improving the physical functioning and ADL for PWS and is drawn based on eligible studies which were conducted in high-income countries (HICs). This highlights a gap between developed and less-resourced countries as far as CBR for PWS is concerned and calls for a further study. Protocol Registration: CRD42020159683Implication for rehabilitationCommunity-based rehabilitation (CBR) is recommended as one of the best programme for treating stroke patients with stroke (PWS) after they are discharged from hospitals.CBR is effective in improving the physical functioning and activity of daily living of PWS.Further research should be carried out to compare between CBR and institution-based rehabilitation for PWS, especially the less-resourced settings which are grappling with a challenge of limited skilled rehabilitation professionals.
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Affiliation(s)
- Xinglin Zeng
- Rehabilitation Department, West China Medical School, Sichuan University, Chengdu, PR China
| | - Joseph K Balikuddembe
- Institute for Disaster Management and Reconstruction, Sichuan University and Hong-Kong Polytechnic University, Chengdu, PR China
| | - Ping Liang
- Cardiac Rehabilitation Center, Fuwai Hospital, Beijing, China
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De Rubeis G, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Saba L, Gasperini C, Pampana E. Is Mechanical Thrombectomy or Thrombolysis Universally Cost-Effective? A Systematic Review of the Literature. World Neurosurg 2023; 169:e29-e39. [PMID: 36202340 DOI: 10.1016/j.wneu.2022.09.127] [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: 07/25/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thrombolysis (rTPA) and mechanical thrombectomy (MT) are cost-effective treatments for ischemic stroke. However, little is known about the impact of different types of health systems (HSs) on the outcome and cost of ischemic stroke. METHODS Literature search was performed on PubMed/OVID for studies without time limits. The year of publication, type of HS, cost of intervention treatment (rTPA/MT), cost of control strategy (conservative treatment or rTPA), quality-adjusted life years (QALYs) gained, and percentage of gross domestic product spent on health were recorded. The inclusion criteria were English literature, cost-effectiveness, and cost-utility analyses. The exclusion criterion was the absence of geographic coherence between the derived QALYs and the costs. The costs were inflated to 2021 and then converted to US dollar/euro. An analysis of variance or Kruskal-Wallis test was used to compare the percentage of cost reduction and the QALYs gained. Gross domestic product percentage was correlated with the QALYs gained. RESULTS Thirty-five studies were analyzed. No significant differences in the percentage of cost reduction were found among the different types of HS (Beveridge -14.74% [95% confidence interval {CI} -57.94/53.08] vs. Bismarck -2.27% [95% CI -122.73/118.18] vs. national insurance -0.015% [95% CI -16.96/51.00] vs. private insurance -4.05% [95% CI -32.62/13.18]). No differences were found in QALYs gained among the different HS (Beveridge 1021 [95% CI -36.37/1705.04] vs. Bismarck 440 [95% CI -2290.68/3870.68] vs. national insurance 643 [95% CI -137.54/2366.21] vs. private insurance 550 [95% CI 131.54/1128.06]). No differences were found among the QALYs gained between rTPA/conservative treatment versus rTPA/MT and rtPA + MT/MT. The percentage of gross domestic product spent on health did not correlate with the QALYs gained (rho = -0.16; P = 0.56). CONCLUSIONS MT and rTPA are independently cost-effective among different HS.
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Affiliation(s)
- Gianluca De Rubeis
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy.
| | - Sebastiano Fabiano
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Bertaccini
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Wlderk
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Sabrina Anticoli
- Emergency Department, UOSD Stroke Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Claudio Gasperini
- Department of Neuroscience, UOC Neurology, S Camillo Forlanini Hospital, Rome, Italy
| | - Enrico Pampana
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
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Paiva KMD, Böell AL, Haas P, Samelli AG, Hillesheim D, Figueiró TH, d’Orsi E. Self-reported hearing loss and cognitive impairment: a cross-sectional analysis of the EpiFloripa Aging study. CAD SAUDE PUBLICA 2023; 39:e00127622. [PMID: 37018772 DOI: 10.1590/0102-311xen127622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/24/2023] [Indexed: 04/05/2023] Open
Abstract
This study aimed to investigate the association between self-reported hearing loss and cognitive impairment in older adults in a city in Southern Brazil. In this cross-sectional, population-based cohort study of older adults, data were collected in the third wave of the EpiFloripa Aging study (2017/2019), which had been performed since 2009 in the city of Florianópolis, Santa Catarina State. Cognitive impairment was the dependent variable analyzed by the Mini-Mental State Examination (MMSE), and self-reported hearing loss, which was included in the cohort only in the last wave, was the main exposure variable. Logistic regression analyses were conducted, considering the study design and sample weights. Data from 1,335 older adults were evaluated. The prevalence was 20.5% for cognitive impairment and 10.7% for hearing loss. Older adults with hearing loss were 2.66 (95%CI: 1.08-6.54) times more likely to have cognitive impairment than older adults without hearing loss. The association between hearing loss and cognitive impairment highlights the need to integrate the early identification of these problems into primary care, as both are risk factors for healthy aging and potentially preventable and/or treatable conditions.
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Gever VC, Iyendo TO, Obiugo-Muoh UO, Okunade JK, Agujiobi-Odoh N, Udengwu N, Talabi FO, Nwokolo PN. Comparing the effect of social media-based drama, music and art therapies on reduction in post-traumatic symptoms among Nigerian refugees of Russia's invasion of Ukraine. J Pediatr Nurs 2023; 68:e96-e102. [PMID: 36470757 DOI: 10.1016/j.pedn.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE The objective of this study was to ascertain the effectiveness of social media-based music, art and drama therapies in treating PTSD symptoms among Nigerian evacuees from the Russia-Ukraine war. DESIGN AND METHODS This study was a quasi-experiment involving a sample of 330 participants that were randomly assigned to control and treatment groups. The treatment group was further classified into three groups according to the different contents of the therapies they received. RESULTS The study result showed that social media-based therapies effectively reduced PTSD symptoms for participants in the treatment group, unlike those who did not receive the intervention. Comparatively, drama therapy was more effective than art and music therapies. The reason drama therapy was more effective could be because it engaged the minds and body of the participants more than the other therapies. CONCLUSION Although art, music and drama therapies are effective treatment options for reducing symptoms of PTSD among victims of war, drama therapy is the most effective among them all. PRACTICAL IMPLICATIONS The result of this study has practical implications for health promotion from the perspective of nursing services by showing that social media-based therapies could serve as viable and cost-effectivealternativese to face-to-face group therapy.
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Affiliation(s)
| | - Timothy Onosahwo Iyendo
- Department of Architecture, Faculty of Engineering, Nile University of Nigeria, Abuja, Nigeria.
| | | | | | | | - Ngozi Udengwu
- Department of Theatre and Film Studies, University of Nigeria, Nsukka, Nigeria.
| | - Felix Olajide Talabi
- Department of Mass Communication, Redeemer's University, Ede, Osun State, Nigeria.
| | - Peter N Nwokolo
- Department of Mass Communication, University of Nigeria, Nsukka, Nigeria.
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Debrah AF, Adebusoye FT, Shah MH, Awuah WA, Tenkorang PO, Bharadwaj HR, Wellington J, Ghosh S, Abiy L, Fernandes C, Abdul-Rahman T, Lychko V, Volodymyrivna BT, Mykolayivna NI. Neurological disorders in pregnant women in low- and middle-income countries-Management gaps, impacts, and future prospects: A review perspective. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231210265. [PMID: 37955275 PMCID: PMC10644749 DOI: 10.1177/17455057231210265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023]
Abstract
Neurological disorders during pregnancy are a substantial threat to women's health, particularly in low- and middle-income countries. Furthermore, a critical shortage of mental health workers and neurologists exacerbates the already pressing issue, where a lack of coordination of respective healthcare among multidisciplinary teams involved in managing these conditions perpetuates the current state of affairs. Financial restrictions and societal stigmas associated with neurological disorders in pregnancy amplify the situation. Addressing these difficulties would necessitate a multifaceted approach comprising investments in healthcare infrastructure, healthcare professional education and training, increased government support for research, and the implementation of innovative care models. Improving access to specialized treatment and coordinated management of antenatal neurological diseases will precipitate improved health outcomes for women and their families in low- and middle-income countries.
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Affiliation(s)
| | | | | | | | | | | | - Jack Wellington
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Lydia Abiy
- Donetsk National Medical University, Kropyvnytskyi, Ukraine
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INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now? J Head Trauma Rehabil 2023; 38:1-6. [PMID: 36594855 DOI: 10.1097/htr.0000000000000826] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Banks LM, O’Fallon T, Hameed S, Usman SK, Polack S, Kuper H. Disability and the achievement of Universal Health Coverage in the Maldives. PLoS One 2022; 17:e0278292. [PMID: 36542614 PMCID: PMC9770361 DOI: 10.1371/journal.pone.0278292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess access to general and disability-related health care among people with disabilities in the Maldives. METHODS This study uses data from a case-control study (n = 711) nested within a population-based, nationally representative survey to compare health status and access to general healthcare amongst people with and without disabilities. Cases and controls were matched by gender, location and age. Unmet need for disability-related healthcare is also assessed. Multivariate regression was used for comparisons between people with and without disabilities. RESULTS People with disabilities had poorer levels of health compared to people without disabilities, including poorer self-rated health, increased likelihood of having a chronic condition and of having had a serious health event in the previous 12 months. Although most people with and without disabilities sought care when needed, people with disabilities were much more likely to report difficulties when routinely accessing healthcare services compared to people without disabilities. Additionally, 24% of people with disabilities reported an unmet need for disability-related healthcare, which was highest amongst people with hearing, communication and cognitive difficulties, as well as amongst older adults and people living in the lowest income per capita quartile. Median healthcare spending in the past month was modest for people with and without disabilities. However, people with disabilities appear to have high episodic healthcare costs, such as for disability-related healthcare and when experiencing a serious health event. CONCLUSIONS This study found evidence that people with disabilities experience unmet needs for both disability-related and general healthcare. There is therefore evidence that people with disabilities in the Maldives are falling behind in core components relevant to UHC: availability of all services needed, and quality and affordability of healthcare.
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Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Timothy O’Fallon
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shaffa Hameed
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Umaefulam V, Gómez-Díaz IC, Uribe-Calderón LM, Pedrozo-Araque E, Premkumar K, Maldonado-Molina E, Basualdo ML, Bidonde J. Critical perspectives on rehabilitation education, practice and process: northern Honduras case study. BMC Health Serv Res 2022; 22:1561. [PMID: 36544144 PMCID: PMC9768948 DOI: 10.1186/s12913-022-08875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rehabilitation services are an integral part of patient care, but in many developing countries, they are not prioritized and either unavailable or easily accessible to those who need them. Although the need for rehabilitation services is increasing in Honduras, rehabilitation workers are not included in the health care model that guides the care provided to communities, particularly in rural and remote areas. To understand the need for providing impactful rehabilitation services in disadvantaged communities, we explored the education and perception of the community relating to rehabilitation, investigated training available for rehabilitation workers, and examined the rehabilitation processes and practices in Northern Honduras from stakeholders' experiences. METHODS We utilized a qualitative descriptive and interpretive approach grounded in case study methodology to understand rehabilitation education, process, and practice in Northern Honduras. Three rehabilitation centres were purposefully selected as the cases, and participants consisted of rehabilitation workers and managers from these centres. We collected data via interviews and focus group sessions. We analyzed the data via thematic analysis using NVivo version 12. RESULTS In Northern Honduras, rehabilitation workers' limited training and continuing education, along with awareness about rehabilitation by community members and other health providers influence rehabilitation care. Although policies and initiatives to support people with disabilities and the broader community in need of rehabilitation exist, most policies are not applied in practice. The sustainability of rehabilitation services, which is rooted in charity, is challenged by the small range of funding opportunities strongly affecting rehabilitation care processes and clinical practices. The lack of trust and awareness from the medical profession towards rehabilitation workers sets a major barrier to referrals, interdisciplinary work, and quality of life for individuals in need of rehabilitation. CONCLUSION This study advances knowledge of the need to increase understanding of rehabilitation care among community members and health providers, improve care processes and resources, and foster interprofessional practice, to enhance the quality of care and promote equitable care delivery, especially in rural and remote communities.
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Affiliation(s)
- Valerie Umaefulam
- grid.25152.310000 0001 2154 235XDepartment of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Isabel Cristina Gómez-Díaz
- grid.442204.40000 0004 0486 1035Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Neurotrauma Centre, Bucaramanga, Santander Colombia
| | - Laura Marcela Uribe-Calderón
- grid.442204.40000 0004 0486 1035Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Santander Colombia
| | - Eliany Pedrozo-Araque
- grid.442204.40000 0004 0486 1035Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Santander Colombia
| | - Kalyani Premkumar
- grid.25152.310000 0001 2154 235XDepartment of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Ethel Maldonado-Molina
- grid.10601.360000 0001 2297 2829Universidad Nacional Autónoma de Honduras, Departamento de Rehabilitación, Facultad de Ciencias Médicas, Tegucigalpa, M.D.C. Honduras
| | - Maria Laura Basualdo
- grid.28046.380000 0001 2182 2255Ontario Public Interest Research Group, University of Ottawa, Ottawa, ON Canada
| | - Julia Bidonde
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway ,grid.25152.310000 0001 2154 235XSchool of Rehabilitation Science, College of Medicine, University of Saskatchewan, Suite 3400, 3Rd Floor, 104 Clinic Pl, Saskatoon, SK S7N 2Z4 Canada
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