ABSTRACT
PURPOSE: Mobility impairments are a common consequence of stroke and spinal cord injury (SCI). Assistive products (APs) such as wheelchairs are often needed for activities and participation. The aim of the study was to explore the provision and use of APs in Germany and to identify associated factors underlying this practice. MATERIALS AND METHODS: Semi-structured interviews were conducted with 19 professionals from outpatient neurorehabilitation services (three general practitioners, five physical therapists, five occupational therapists, one speech therapist, one neuropsychologist, two outpatient nurses, one rehab technician and one social worker), two patient advocates (long-term survivors, each stroke and SCI) and 20 patients (10 each after stroke and SCI with mobility impairment, and first-ever affected). Analysis was performed by qualitative content analysis. RESULTS: Reported experiences were mixed, varying from high satisfaction to unusable APs and unmet needs. Identified factors associated with these experiences were related to care pathways, care coordination, inter-professional collaboration, professionals' knowledge and patient information, cost coverage, and approval procedures. CONCLUSION: Overall, patients seem satisfied with the APs they receive, but patients with more severe mobility impairments in particular experience deficits in the provision and use of APs. Further research is needed to develop and test strategies for the provision and use of APs.
Interprofessional collaboration between the multiple stakeholders and the involvement of end users is needed to realise the full potential of specific assistive products (APs).A care pathway should be implemented for the provision of appropriate APs.Professionals' expertise in both APs and end user empowerment needs to be improved.The approval process of the public health insurance should be accelerated and geared more towards the individual needs of patients.
ABSTRACT
PURPOSE: When mobility deficits persist after stroke or spinal cord injury (SCI), outpatient neurorehabilitation services are required. This study aimed to explore the current practice of German outpatient neurorehabilitation services and identify factors associated to this practice. METHODS: This was a qualitative observational study in which semi-structured interviews were conducted with professionals from outpatient neurorehabilitation services and mobility-impaired patients. A qualitative content analysis with a data-driven coding process was used. RESULTS: Three general practitioners, five physical, five occupational, and one speech therapist, one neuropsychologist, two outpatient nurses, one rehabilitation technician, one social worker, two patient advocates (long-term survivors, each stroke and SCI), and 20 patients (10 after stroke, 10 after SCI, all first-ever affected since approximately one year) participated. The reported experiences ranged from high satisfaction to perceived deficits in participation-oriented, evidence-based, and coordinated care. Identified associated factors were: (a) availability of specialised therapists and professional education, (b) outpatient service catalogue, (c) cost coverage, (d) setting rehabilitation goals, and (e) physician as care coordinator. CONCLUSION: Areas of improvement identified focused on: setting rehabilitation goals towards participation, training therapists on evidence-based treatments and shared decision-making, updating the outpatient service catalogue, and implementing coordination actions. Implementation of these recommendations should be evaluated.
Professionals need to be trained in setting rehabilitation goals and treatments. The continuing education should be based on current evidence and address interprofessionalism. Academization and continuing education in scientific work for therapists should be advanced.Professionals should educate patients about rehabilitation goals and set rehabilitation goals together, both interprofessional coordinated and with the patient (shared decision-making). Activity and participation should be the central aspects. Rehabilitation clinicians should give instructions to therapists on what to do if rehabilitation goals are not worked on.Rehabilitation clinicians should encourage interprofessional collaboration and information exchange where this is not the case. The exchange of information between outpatient professionals should be promoted through appropriate measures, that is, interprofessional meetings could be introduced.The outpatient service catalogue should be revised regarding evidence-based and participation-oriented treatments and enable appropriate cost coverage.
ABSTRACT
INTRODUCTION: Due to the COVID-19 pandemic, the German health system has faced major challenges since spring 2020. In addition to restrictions in the inpatient health care sector, the maintenance of outpatient care by health care providers has also been affected by the pandemic-related restrictions. Both a decline in treatment frequencies and temporary practice closures have been observed. The aim of the study was to survey the work and care situation in outpatient physiotherapy practices during the first wave of the pandemic. METHODS: An anonymous online survey including quantitative and qualitative items was conducted among physiotherapists in the outpatient sector in Germany between June 1 and August 31, 2020. The survey is part of the mixed-methods study "ArTheCo", which was conducted throughout Germany including outpatient therapists and patients in physiotherapy, speech therapy and occupational therapy. RESULTS: In total, 577 physiotherapists from all over Germany took part in the survey. During the first wave of the pandemic, the occupancy rate fell below 50% at 45% of the facilities. 15% of the facilities had to close temporarily. Short-time work was announced at 58% of the respondents' practices. This and the implementation of hygiene measures restricted the provision of physiotherapy. This mainly affected patients with a higher risk of a severe clinical course of disease, such as nursing home patients. Due to complex changes in practice organisation and patient care, many of the interviewees felt that their economic existence was threatened and also described a large physical and psychological burden. Existing dissatisfaction seemed to have increased by the pandemic. DISCUSSION: To maintain continuous physical therapy, a reorganisation of the reimbursement system as well as easily accessible, consistent and feasible action plans for practices are needed. In combination with threats to existence due to the pandemic and increasing skill shortage, the outpatient physiotherapeutic care also appears to be threatened beyond the pandemic. CONCLUSION: The current pandemic has highlighted long-standing challenges causing dissatisfaction and making the profession increasingly unattractive for some of the respondents. Political action to support physiotherapists needs to be initiated. This study indicates potential starting points.
Subject(s)
COVID-19 , Pandemics , Germany , Humans , Outpatients , Physical Therapy Modalities , SARS-CoV-2ABSTRACT
BACKGROUND: A central goal of rehabilitation in patients with paralysis syndromes after stroke or spinal cord injury (SCI) is to restore independent mobility as a pedestrian or wheelchair user. However, after acute rehabilitation, the mobility frequently deteriorates in the ambulatory setting, despite the delivery of rehabilitative interventions such as physical therapy or the prescription of assistive devices. The aim of the NeuroMoves study is to identify factors that are associated with changes of mobility in the ambulatory setting after acute inpatient rehabilitation, with a particular focus on participation according to the ICF (International Classification of Functioning, Disability and Health). METHODS: The NeuroMoves study is intended as a national multicenter observational cohort study with 9 clinical sites in Germany. A total of 500 patients with mobility-restricting paralysis syndromes (i.e. stroke or SCI) are to be recruited during acute inpatient rehabilitation prior to discharge to the ambulatory setting. Patients will have 8 months of follow-up in the ambulatory setting. Three study visits at the clinical sites (baseline, midterm, and final) are planned at 4-months intervals. The baseline visit is scheduled at the end of the acute inpatient rehabilitation. During the visits, demographical data, neurological, functional, quality of life, and implementation measures will be assessed. At baseline, each study participant receives an activity tracker (sensor for recording ambulatory mobility) along with a tablet computer for home use over the 8 months study duration. While mounted, the activity tracker records mobility data from which the daily distance covered by walking or wheelchair use can be calculated. Customized applications on the tablet computer remind the study participants to answer structured questionnaires about their health condition and treatment goals for physical therapy. Using the study participants' tablet, therapists will be asked to answer structured questionnaires concerning treatment goals and therapeutic measures they have applied. The primary analysis concerns the association between mobility (daily distance covered) and the degree of participation-oriented rehab interventions. Further exploratory analyses are planned. DISCUSSION: The findings could inform healthcare decision-making regarding ambulatory care in Germany focusing on mobility-promoting interventions for patients with mobility-restricting paralysis syndromes. STUDY REGISTRATION: German Clinical Trials Register, DRKS-ID: DRKS00020487 (18.02.2020).
