ABSTRACT
Objectives@#Perception about Physical and Rehabilitation Medicine provides information about awareness on identifying disabilities and managing their impact on activities of daily living; however, misconceptions about the field continue to exist among both students and physicians. This study aims to describe the perceptions of clinical clerks and interns towards the practice and role of Rehabilitation Medicine in management of patients. @*Methods@#This is a descriptive cross-sectional study. Students from the Learning Unit 6 and 7 of UP College of Medicine answered adapted online survey forms from a previous study and participated in online focus group discussions. Qualitative data were used to infer the perception of medical students towards the specialty. The effect of the respondent’s profile, background and affiliation on their knowledge, attitudes and perceptions were analyzed using One-Way ANOVA (α = 0.05). Qualitative data were analyzed using thematic analysis. @*Results@#Learning Unit 6 and 7 students were found to have a perceived broad level of knowledge with regards the specialty. The students associated the specialty with focus on holistic care, quality of life, interdisciplinary collaboration, and diversity of cases managed. No statistically significant differences were found between the perception among: 1) Learning Unit 6 and 7, 2) those with or without a previous encounter with the specialty, 3) allied medical and non-allied medical undergraduate courses in terms of: a) confidence in the knowledge (p = 0.489), b) familiarity with conditions managed (p = 0.93) and c) interest towards the specialty (p = 0.693). The Organ System Integrated (OSI) curriculum, which promotes horizontal and vertical integration of concepts, provided a wide understanding of the basic concepts related to physiatry. The students’ responses suggest a positive attitude towards Physical and Rehabilitation Medicine, as measured in their level of interest about knowing more regarding the specialty. Most common perceptions were that the specialty was multidisciplinary and holistic. However, the respondents’ perceptions regarding the roles of the Rehabilitation team were limited. @*Conclusion@#Learning unit level 6 and 7 students had a broad understanding of the practice and scope of the Physical and Rehabilitation Medicine specialty. Future researches can include other medical students in all year levels, including Learning Units 3, 4 and 5 of UPCM, to observe the development of their perceptions about the specialty throughout medical school.
Subject(s)
Perception , Students, Medical , CurriculumABSTRACT
@#In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
Subject(s)
Telerehabilitation , COVID-19 , Continuity of Patient CareABSTRACT
@#Musculoskeletal conditions are among the leading causes of consultations in Rehabilitation Medicine. A fellowship program in Musculoskeletal Rehabilitation Medicine was proposed to enrich physiatrists’ knowledge and skills in evaluating and managing musculoskeletal conditions. In this paper, we shared the process of developing the curriculum of the fellowship program, which was proposed to and eventually approved by the Postgraduate Institute of Medicine, College of Medicine, University of the Philippines Manila. A core group of consultants, considered as experienced clinicians and educators in Musculoskeletal Rehabilitation Medicine in the study institution, designed the program from the scope of training to learning competencies, outcomes, and assessment methods. To our knowledge, developing the fellowship program in this constantly evolving area in Rehabilitation Medicine is the first of its kind in the Philippines and a milestone in the history of postgraduate education in the longest-running training program for aspiring physiatrists.
Subject(s)
Physical and Rehabilitation MedicineABSTRACT
Background@#The Department of Rehabilitation Medicine of the University of the Philippines-Philippine General Hospital (UP-PGH) established its telerehabilitation service program in 2017. The program previously catered to patients in a partner rural community by providing teleconsultation and teletherapy over a distance. With the unprecedented coronavirus disease 2019 (COVID-19) pandemic, the program has expanded its service to outpatients previously managed face-to-face by the department, regardless of location. @*Objectives@#This study aimed to evaluate the usability of the telerehabilitation service program at UP-PGH when it was expanded during the pandemic and to associate telerehabilitation usability ratings with the participant groups, demographic characteristics, and prior telemedicine knowledge and experience. @*Methods@#This cross-sectional study involved the doctors, physical therapists, occupational therapists, psychologists, patients, and patients’ carers, who participated in at least one telerehabilitation session and consented to respond to a digital survey thereafter. Total enumeration sampling of all telerehabilitation participants was employed. The study outcome was the usability of the expanded telerehabilitation program based on the System Usability Scale (SUS) benchmarked at 68. Descriptive and inferential statistics were done at a 95% confidence interval. The participants’ responses to open-ended questions regarding telerehabilitation experience and recommendations were also presented. @*Results@#The participants consisted of 19 doctors, 11 therapists, 37 patients, and 74 caregivers. The majority of the participants were female and lived in urban areas. The primary online telerehabilitation platforms used were Viber™ and Zoom™. The mean of overall SUS scores was below average for health providers [doctors (mean = 61.71), therapists (mean = 67.73)]; and above average for end-users [patients (mean 74.56), and carers (mean = 71.89)]. There was a significant difference in the overall SUS scores between doctors (mean: 61.7) and patients (mean: 74.6), p<0.05. In terms of videoconferencing platform, participants reported significantly higher system usability for those who used either Zoom™ (mean: 75.0) or Viber™ (mean: 69.3), as compared to Google Meet™ (mean: 53.1), p<0.05. There was no significant difference in the overall SUS scores across sexes, places of residence, primary telerehabilitation techniques used, prior telemedicine knowledge, and experience. The majority viewed telerehabilitation as a valuable method to provide service during the pandemic, but they were mostly concerned with technical problems, particularly an unstable Internet connection. @*Conclusion@#The expanded telerehabilitation service program of the PGH was perceived as useful by patients and caregivers but not by the health providers. While the program succeeded in providing continued outpatient rehabilitation services during the pandemic, the challenges experienced by its telehealth providers must be investigated and addressed.
Subject(s)
Telemedicine , Telerehabilitation , Physical and Rehabilitation Medicine , Technology Assessment, Biomedical , Delivery of Health CareABSTRACT
Introduction@#The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. @*Objective@#This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). @*Methods@#The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. @*Results@#The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. @*Conclusion@#The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.
Subject(s)
Health Services Administration , Telemedicine , Telecommunications , Remote Consultation , COVID-19ABSTRACT
@#<p style="text-align: justify;"><strong>Background.</strong> Stroke remains a leading cause of death and disability in the Philippines, rendering its survivors unable to cope well with activities of daily living, including sexual functioning. Sexual dysfunction is an under-recognized complication post-stroke, and mobility and communication barriers among those with aphasia can further contribute to sexual dysfunction, potentially affecting their quality of life.</p><p style="text-align: justify;"><strong>Objective.</strong> To determine the changes in sexual functioning among patients with aphasia and the communication methods they used to compensate for language and communication deficits.</p><p style="text-align: justify;"><strong>Method.</strong> This was a descriptive cross-sectional study involving patients (?30 years old, with 1 episode of stroke, with non-fluent aphasia) and their respective sexual partners. Data were gathered using a clinician-administered questionnaire based on previous studies. Outcomes included changes in libido, coital frequency, time of resumption of sexual activity, erectile/ orgasmic ability, sexual satisfaction, and alternative methods of communication.</p><p style="text-align: justify;"><strong>Results.</strong> Forty participants were included comprising of 20 patients with aphasia and their respective sexual partners. There was a decline in sexual activity among the couples, with reduced frequency of sexual intercourse. Both patients and partners reported difficulties in expressing the desire for sexual activities, hindering initiation. There was noted difficulty in ascertaining the sexual experience of patients with aphasia (i.e., whether pleasure or pain), hindering maintenance and enjoyment of the sexual act. In response to the difficulties mentioned above, sexual innuendoes as communication strategies were described by the couples.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The study provides baseline local data on changes in sexual functioning among stroke patients with nonfluent aphasia and their sexual partners. Sexual rehabilitation is recommended in the holistic management of patients with aphasia to train couples develop compensatory techniques to adjust to the changes in their sexual lives.</p>
Subject(s)
Stroke , Aphasia , Sexuality , CommunicationABSTRACT
Background@#Sexuality remains to be a sensitive issue in the Philippines, but it encompasses real problems that stroke patients and their partners continue to face. Sexual dysfunction, an under-recognized complication post-stroke, is caused by an interplay of physical, emotional, cognitive, and language impairments, in combination with psychosocial factors. @*Objectives@#This study aimed to determine changes in sexual functioning (libido, coital frequency, sexual arousal, and sexual satisfaction) among stroke out-patients at the Philippine General Hospital and their sexual partners.@*Methods@#This cross-sectional study involved patients (≥30 years old with 1 stroke episode), and their partners. Through individual interviews and questionnaires, data were gathered on general attitude toward sex, ability to address sexual issues with partner, fear of recurrence of stroke, unwillingness to participate in coitus, risk of depression, and level of happiness. @*Results@#Twenty-nine patients and 23 partners participated. There was a statistically significant decrease in coital frequency post-stroke among patients (p<0.001) and partners (p<0.05). Majority reported lower level of libido, sexual arousal, and sexual satisfaction post-stroke. Participants unable to discuss sexual issues with partner were more likely to report sexual dissatisfaction (p<0.05). Those with higher scores on Zung’s depression scale were likely to be sexually dissatisfied (p<0.05). Level of happiness was moderately correlated with sexual satisfaction (r=0.51).@*Conclusion@#Sexual life of couples affected by stroke is commonly overlooked. There was a decline in libido, coital frequency, arousal, and sexual satisfaction among stroke patients and partners at the Philippine General Hospital.
Subject(s)
Stroke Rehabilitation , Sexuality , Sexual PartnersABSTRACT
Objectives@# Perception about Physical and Rehabilitation Medicine provides information about awareness on identifying disabilities and managing their impact on activities of daily living; however, misconceptions about the field continue to exist among both students and physicians. This study aims to describe the perceptions of clinical clerks and interns towards the practice and role of Rehabilitation Medicine in management of patients. @*Methods@#This is a descriptive cross-sectional study. Students from the Learning Unit 6 and 7 of UP College of Medicine answered adapted online survey forms from a previous study and participated in online focus group discussions. Qualitative data were used to infer the perception of medical students towards the specialty. The effect of the respondent’s profile, background and affiliation on their knowledge, attitudes and perceptions were analyzed using One-Way ANOVA (α = 0.05). Qualitative data were analyzed using thematic analysis. @*Results@#Learning Unit 6 and 7 students were found to have a perceived broad level of knowledge with regards the specialty. The students associated the specialty with focus on holistic care, quality of life, interdisciplinary collaboration, and diversity of cases managed. No statistically significant differences were found between the perception among: 1) Learning Unit 6 and 7, 2) those with or without a previous encounter with the specialty, 3) allied medical and non-allied medical undergraduate courses in terms of: a) confidence in the knowledge (p = 0.489), b) familiarity with conditions managed (p = 0.93) and c) interest towards the specialty (p = 0.693). The Organ System Integrated (OSI) curriculum, which promotes horizontal and vertical integration of concepts, provided a wide understanding of the basic concepts related to physiatry. The students’ responses suggest a positive attitude towards Physical and Rehabilitation Medicine, as measured in their level of interest about knowing more regarding the specialty. Most common perceptions were that the specialty was multidisciplinary and holistic. However, the respondents’ perceptions regarding the roles of the Rehabilitation team were limited. @*Conclusion@#Learning unit level 6 and 7 students had a broad understanding of the practice and scope of the Physical and Rehabilitation Medicine specialty. Future researches can include other medical students in all year levels, including Learning Units 3, 4 and 5 of UPCM, to observe the development of their perceptions about the specialty throughout medical school.