Development of simple descriptions of the ICF Generic-30 Set in different languages: laying the foundation for an ICF-based clinical tool for Europe.

BACKGROUND: Functioning is considered a third indicator of health and a key outcome in rehabilitation. A universal practical tool for collecting functioning information is essential. This tool would be ideally based on the International Classification of Functioning, Disability and Health. AIM: To report the results of the development of country/language-specific versions of an ICF-based clinical tool in six European countries. DESIGN: Consensus process. SETTING: Expert conferences. POPULATION: Multi-professional group of rehabilitation professionals in six European countries. METHODS: 1) Developed an initial proposal by translating the published English-language version of the simple descriptions into the targeted language; 2) conducted a multi-stage consensus conference to finalize the descriptions; 3) employed a three-stage multi-professional expert panel translation back to English. The consensus conference model was modified for geographically large countries. RESULTS: Croatian, Flemish/Dutch, Greek, Polish, and Turkish versions were produced. CONCLUSIONS: The creation of the country/language-specific simple descriptions is a significant part of the "system-wide implementation of the ICF" initiative that will pave the way for the implementation of the ICF in national health systems. CLINICAL REHABILITATION IMPACT: The practical ICF-based clinical tool with country/language specific versions for standardized reporting of functioning will serve as a means of integrating functioning information in national health systems and additionally for monitoring the effects of rehabilitation interventions.

An international survey of the structure and process of care for traumatic spinal cord injury in acute and rehabilitation facilities: lessons learned from a pilot study.

BACKGROUND: To describe the key findings and lessons learned from an international pilot study that surveyed spinal cord injury programs in acute and rehabilitation facilities to understand the status of spinal cord injury care. METHODS: An online survey with two questionnaires, a 74-item for acute care and a 51-item for rehabilitation, was used. A subset of survey items relevant to the themes of specialized care, timeliness, patient-centeredness, and evidence-based care were operationalized as structure or process indicators. Percentages of facilities reporting the structure or process to be present, and percentages of indicators met by each facility were calculated and reported separately for facilities from high-income countries (HIC) and from low and middle-income countries (LMIC) to identify "hard to meet" indicators defined as those met by less than two-thirds of facilities and to describe performance level. RESULTS: A total of 26 acute and 26 rehabilitation facilities from 25 countries participated in the study. The comparison of the facilities based on the country income level revealed three general observations: 1) some indicators were met equally well by both HIC and LMIC, such as 24-hour access to CT scanners in acute care and out-patient services at rehabilitation facilities; 2) some indicators were hard to meet for LMIC but not for HIC, such as having a multidisciplinary team for both acute and rehabilitation settings; and 3) some indicators were hard to meet by both HIC and LMIC, including having peer counselling programs. Variability was also observed for the same indicator between acute and rehabilitation facilities, and a wide range in the total number of indicators met among HIC facilities (acute 59-100%; rehabilitation 36-100%) and among LMIC facilities (acute: 41-82%; rehabilitation: 36-93%) was reported. CONCLUSIONS: Results from this international pilot study found that the participating acute and rehabilitation facilities on average adhered to 74% of the selected indicators, suggesting that the structure and processes to provide ideal traumatic spinal cord injury care were broadly available. Recruiting a representative sample of SCI facilities and incorporating regional attributes in future surveys will be helpful to examine factors affecting adherence to indicators.

Up to 2.2 million people experiencing disability suffer collateral damage each day of COVID-19 lockdown in Europe.

BACKGROUND: The COVID-19 pandemic is having a great impact on health services. Patients not receiving care due to closure of outpatient services suffer a collateral damage. Our aim was to provide first data on impact of COVID-19 on people experiencing disability in Europe. METHODS: We developed an estimation from a survey and publicly available data. Thirty-eight countries have been inquired through the European Bodies of Physical and Rehabilitation Medicine - the rehabilitation medical specialty. The nine questions of the survey focused on March 31st, 2020. We used the following indicators: for inpatients, acute and rehabilitative hospital beds; for outpatients, missing uniform European data, we used information from Italy, Belgium and the UK, and estimated for Europe basing on population, number of rehabilitation physicians, physiotherapists, and people with self-reported limitations. RESULTS: Thirty-five countries (92%) including 99% of the population (809.9 million) answered. Stop of admissions to rehabilitation, early discharge and reduction of activities involved 194,800 inpatients in 10 countries. Outpatient activities stopped for 87%, involving 318,000 patients per day in Italy, Belgium and the UK, leading to an estimate range of 1.3-2.2 million in Europe. Seven countries reported experiences on rehabilitation for acute COVID-19 patients. CONCLUSIONS: COVID-19 emergency is having a huge impact on rehabilitation of people experiencing disability. This may lead to future cumulative effects due to reduced functional outcome and consequent increased burden of care. When the emergency will fade, rehabilitation demand will probably grow due to an expected return wave of these not well treated patients, but probably also of post-COVID-19 patients' needs.

Role of diversity in assembling of rehabilitation teams in Central Europe.

BACKGROUND: Multiprofessional teamwork in physical and rehabilitation medicine (PRM) allows achieving patient-centered goals in accordance with the assumptions of the bio-psycho-social model of functioning. Team composition and methods of collaboration depend of the specificity of goals to be achieved, as well local contextual factors. International comparative studies on rehabilitation teamwork are lacking, despite data on how teams differ between countries are crucial for the process of harmonization of PRM practice across Europe. AIM: To compare models of collaboration within rehabilitation teams in Central Europe. DESIGN: A cross-sectional explorative study. SETTING: The data were collected in Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Slovakia between February and June 2018. POPULATION: PRM physicians. METHODS: An anonymous questionnaire inquiring of rehabilitation teamwork details was spread through national PRM societies, and other organizations associating PRM physicians. An ordered logit regression was applied to analyze the results. RESULTS: Responses were obtained from 455 respondents. Significant differences between the studied countries in the composition of rehabilitation teams and frequencies of team meetings were detected. In the analyzed population of PRM physicians, we found positive associations between the chance of participation in team meetings and working in a hospital, the amount of time devoted to PRM practice, and older age. The chance for patients and caregivers to participate in rehabilitation team meetings was correlated with PRM physician's hospital practice, activity as a PRM teacher, older age and devoting more time to PRM practice. Country specificities of rehabilitation team content were analyzed with regards to local economic, legal, and historical backgrounds, and availability of human resources. Underrepresentation of key professionals (e.g. occupational therapists, orthotists/prosthetists), inadequate distribution of professionals in healthcare and as well as outdated educational systems in some countries may affect the efficacy of the comprehensive care in rehabilitation. CONCLUSIONS: Central European countries differ in rehabilitation teamwork with regard to the contribution of professionals, meeting frequencies, and participation of patients and caregivers. Well-designed studies on teamwork models delineating ways to improve teamwork efficacy are in demand. CLINICAL REHABILITATION IMPACT: Between-country diversity of rehabilitation team content should be considered while planning activities aimed at European harmonization of PRM practice.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section).

INTRODUCTION: Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions. EVIDENCE ACQUISITION: A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS: The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure. CONCLUSIONS: The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.

Education of physical and rehabilitation medicine specialists across Europe: a call for harmonization.

BACKGROUND: Physical and rehabilitation medicine (PRM) is well established in Europe and officially recognized by the European Union of Medical Specialists (UEMS). The European PRM Board works to promote patient safety and quality of care through the development of the highest standards of medical training and healthcare across Europe as well as the harmonization of PRM specialists' qualifications. In its Action Plan for 2014-2018, the UEMS PRM Board has included the harmonization of the PRM curriculum among the EU countries, as one of its main goals. Based on a European Directive, the Belgian Superior Council is envisaging a reform of the PRM curriculum. AIM: The aim of this paper is to present the current situation of PRM education in Europe according to the survey carried out by the Belgium Task Force. DESIGN: An online survey was posted on May 3rd 2015 to all delegates of the UEMS PRM Section and Board. Two questions were formulated: 1) What is the duration and curriculum of PRM training in your country? 2) Does a Postgraduate Rehabilitation training exist for other medical specialties? RESULTS: The majority of the PRM training programs in Europe have a duration ranging from 4 to 5 years, and are not aiming at downsizing the duration to the European minimal training period of 3 years. The vast majority (70%) of the responding countries don't offer an additional accreditation of Rehabilitation for other medical specialties. CONCLUSIONS: Comparing PRM training programs in Europe can support the long-awaited reform of the PRM postgraduate curriculum in Belgium and gives perspective to agree on a transparent and comparable specialty training throughout Europe. Providing a more comparable training promotes the establishment of PRM and its rehabilitation service provisions in the world.

What medical doctors and medical students know about physical medicine and rehabilitation: a survey from Central Europe.

BACKGROUND: Physical and rehabilitation medicine (PRM) is a relatively new and dynamically developing branch of the contemporary medicine. The unique role of PRM is bridging pure clinical outcomes with overall functional improvement. The concepts of disability and rehabilitation may be difficult to comprehend by medical students (MS) and Non-PRM specialists (NPRMS). AIM: The aim of this study was to assess the level of knowledge of NPRMS and MS regarding the role of PRM in health care systems in Poland, Hungary and Croatia. DESIGN: Cross-sectional observational study. SETTING: Anonymous questionnaire distributed in Hungarian, Polish and Croatian universities. RESULTS: Knowledge of definitions of a person with disability and PRM was poor (MS: 58% and 35%, NPRMS: 39% and 30%, PRMT: 72% and 62%). Prevalence of disability was correctly estimated by 58% of MS and 62% of doctors. 76% of MS, 72% of NPRMS and 99% of PRMT perceived PRM as a basic medical specialty. Leading role of PRM physician in comprehensive management of patients with stroke, multiple injury, spinal cord injury and congenital limb defect was perceived respectively by 42%, 49%, 53% and 64% of respondents. Functional statement as an important criterion in referring a patient for rehabilitation was perceived by 48% of NPRMS. Inadequate perception of the PRM role in health care system results from the lack of unified programme and scope of PRM in under- and postgraduate medical education, inappropriate allocation of funds in public PRM services, and claims of certain paramedical professions to extend their qualifications over interventions assigned to PRM doctors. CONCLUSIONS: Low knowledge of PRM among all studied groups testifies to the inadequacy of education of the medical community in rehabilitation. CLINICAL REHABILITATION IMPACT: The existing system of under- and postgraduate education of PRM should be urgently rearranged according to European harmonized guidelines.

[Urinary tract dysfunction in spinal cord injury patients]. / Uroloska disfunkcija u osoba s ozljedom kraljeznicne mozdine.

Spinal cord injury (SCI) results with paralysis but also with micturition dysfunction; therefore rehabilitation management and long-term follow-up include lower urinary tract care in order to prevent upper urinary tract pathology and complications. That comprises timely and standardized neurological and urological diagnostics and eliminatory techniques with intermittent catheterisation in majority of patients. Urological diagnostics include blood and urine tests, urine culture, ultrasound and X-ray of urinary tract, and cystometry to assess dynamic properties of neurogenic bladder. It has been proven that incomplete SCI patients have neurogenic bladder with similar findings as patients with complete injuries, i.e. cystometric capacities are reduced while intravesical pressures are increased, which endanger upper urinary tract. Furthermore, it has been shown that there is no difference of these findings between particular levels of injury: cervical, thoracic, thoracic-lumbar and lumbar, so these risks are similar in every group. Conclusively, it is necessary to conduct urinary tract diagnostics in SCI patients for sake of the quality and quantity of patients' lives.

Neurological outcome in road traffic accidents with spinal cord injury.

The aim of the study was to investigate neurological outcome in road traffic accidents (RTA) with spinal cord injury (SCI). The study was undertaken in National Spinal Unit of Special Medical Rehabilitation Hospital, in Varazdinske Toplice, Croatia. Hospital records of 154 inpatient RTA SCI patients, in years 1991-2001 were reviewed. Six groups of patients were formed: car drivers, co-drivers, back seat passengers, motorcycle drivers, bicycle drivers and pedestrians. Neurological assessments at admission to rehabilitation and before discharge were done according to American Spinal Injury Association (ASIA) impairment scale. Methods of descriptive statistics were used. Overall 49% of RTA SCI patients presented with complete injury (ASIA A) at admission to rehabilitation, 93% of initially complete spinal cord injured patients remained complete at discharge and 72% previously non-ambulatory incomplete (ASIA B-E) patients achieved ambulation. Complete injury was acquired more often in motorcycle drivers and car drivers group (67% and 54%, respectively). Road traffic spinal cord injuries are, and will remain the leading cause of traumatic SCI, with high proportion of complete injury at rehabilitation onset, especially in motorcycle drivers and car drivers groups.

[Case report of a patient with ochronosis and arthroplasty of the hip and both knees]. / Prikaz bolesnika s ohronozom i artroplastikom kuka i oba koljena.

Alkaptonuria is a rare hereditary metabolic disorder characterised by absence of the enzyme homogentisic acid oxidase. As a result of this defect homogentisic acid accumulates and is excreted in the urine. The term ochronosis is used to describe bluish-black pigmentation of connective tissue. Ochronotic arthropathy results from the pigmented deposits in the joints of the appendicular and axial skeleton. Findings simulate those of uncomplicated degenerative joint disease, with effusion, articular space narrowing, and bony sclerosis. Our patient is a 70-year old male with ochronotic arthropathy. He has typical ears and sclera discoloration, and had arthroplasty of knees 7 and 4 years ago, respectively. In year 2002, he had undergone total right hip arthroplasty and has been admitted for rehabilitation 14th postoperative day. Individually designed rehabilitation regimen included kinesitherapy, hydrokinesitherapy, and ambulation training with gradual increase in weight bearing exercises and electro-analgesia of associated low back pain. In course of rehabilitation our patient improved his endurance with satisfying range of motion of right hip (flexion 90 degrees, abduction 40 degrees) and strength of hip and thigh musculature. The patient was able to walk with crutches without limitation. We conclude that joint destruction followed by painful locomotion due to ochronotic arthropathy is best treated by total joint arthroplasty, as described in our patient.