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1.
Rehabilitation (Stuttg) ; 63(3): 189-196, 2024 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-38866029

RESUMO

BACKGROUND: The learning objectives in the current cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" have been revised as part of the further development of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM) to its new version 2.0. Since the NKLM is designed as an interdisciplinary catalogue, a subject assignment seemed necessary from the point of view of various stakeholders. Thus, the German Association of Scientific Medical Societies (AWMF) and the German medical faculties initiated a subject assignment process. The assignment process for the subject "Physical and Rehabilitative Medicine, Naturopathic Medicine" (PRM-NHV; according to the subject list of the first draft of the planned novel medical license regulations from 2020) is presented in this paper. MATERIAL AND METHODS: The AWMF invited its member societies to participate in the assignment of learning objectives of chapters VI, VII, and VIII of the NKLM 2.0 to the individual subjects to which they consider to contribute in teaching. For "PRM-NHV", representatives of the societies for rehabilitation sciences (DGRW), physical and rehabilitation medicine (DGPRM), orthopaedics and traumatology (DGOU), as well as for naturopathy (DGNHK) participated. In a structured consensus process according to the DELPHI methodology, the learning objectives were selected and consented. Subsequently, subject recommendations were made by the AWMF for each learning objective. RESULTS: From the NKLM 2.0, a total of 100 competency-based learning objectives of chapters VII and VIII for the subject "PRM-NHV" were consented by the representatives of the involved societies for presentation on the NKLM 2.0 online platform. CONCLUSIONS: In the context of the revision process of medical studies in Germany and under the umbrella of the AWMF and the German medical faculties, a broad consensus of competency-based learning objectives in the subject "PRM-NHV" could be achieved. This provides an important orientation for all medical faculties both for the further development of teaching in the cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" according to the 9th revision of the medical license regulations, which has been valid for twenty years, and for the preparation of the corresponding subjects in the draft bill of the novel license regulations.


Assuntos
Competência Clínica , Currículo , Naturologia , Medicina Física e Reabilitação , Alemanha , Medicina Física e Reabilitação/educação , Medicina Física e Reabilitação/normas , Catálogos como Assunto , Educação Baseada em Competências/normas , Sociedades Médicas , Sociedades Científicas , Reabilitação/normas , Humanos , Licenciamento em Medicina/normas , Licenciamento em Medicina/legislação & jurisprudência
2.
Eur J Phys Rehabil Med ; 60(3): 514-522, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38551518

RESUMO

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.


Assuntos
Países em Desenvolvimento , Acessibilidade aos Serviços de Saúde , Humanos , Reabilitação/organização & administração , Reabilitação/normas , Qualidade da Assistência à Saúde , Pessoas com Deficiência/reabilitação
3.
Intensive Crit Care Nurs ; 83: 103625, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38198928

RESUMO

BACKGROUND: Early rehabilitation in intensive care units (ICUs) may be beneficial but is not routinely performed for adults with critical illness. In April 2018, the Japanese government introduced a health policy to provide financial incentives to hospitals that met the requirements of interdisciplinary collaboration and had teams specialized in ICU rehabilitation practices. OBJECTIVES: The present study aimed to investigate whether the health policy is associated with improved clinical practices of ICU rehabilitation. METHODS: Using a nationwide administrative inpatient database and hospital statistics data from Japan, we identified hospitals that admitted adult patients to the ICU within two days of hospital admission from April 2016 to March 2019. Using hospital-level propensity score matching, we created matched cohorts of 101,203 patients from 108 intervention hospitals that introduced the health policy, and 106,703 patients from 108 control hospitals that did not. We then conducted patient-level difference-in-differences analyses to examine changes in the percentage of patients from the intervention and control hospitals, who underwent early ICU rehabilitation within two days of ICU admission before and after the implementation of the health policy. RESULTS: In the intervention group, patients undergoing early ICU rehabilitation increased from 10% and 36% after the policy implementation. In the control group, it increased from 11% to 13%. The difference-in-difference in the percentage of patients who underwent early ICU rehabilitation between the two groups was 24% (95% confidence interval, 19%-29%). CONCLUSIONS: Early ICU rehabilitation can be facilitated by financial incentives for hospitals that engage in interdisciplinary collaboration with specialist teams. IMPLICATIONS FOR CLINICAL PRACTICE: Our Findings are relevant for hospital administrators, professional organizations, and policymakers in other nations considering strategies to support the additional deployment burdens of early ICU rehabilitation. Future studies need to explore the long-term effects and sustainability of the observed improvements in ICU rehabilitation practices.


Assuntos
Política de Saúde , Unidades de Terapia Intensiva , Humanos , Japão , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Política de Saúde/tendências , Pontuação de Propensão , Reabilitação/estatística & dados numéricos , Reabilitação/métodos , Reabilitação/normas , Reabilitação/tendências , Adulto , Idoso de 80 Anos ou mais , Equipe de Assistência ao Paciente/estatística & dados numéricos , Equipe de Assistência ao Paciente/tendências
4.
J Rehabil Med ; 55: jrm4471, 2023 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-37548542

RESUMO

OBJECTIVE: This implementation study aimed to enhance the key elements of clinical practice goal-setting across 5 rehabilitation services. DESIGN: This study followed a participatory action research approach guided by the Knowledge to Action framework. METHODS: Medical record audits and structured client interviews were conducted prior to and following 12 weeks of implementation, in order to evaluate the success of the goal-setting implementation package. RESULTS: Medical record audits and interviews conducted pre-implementation (audits n = 132, interviews n = 64), post-implementation (audits n = 130, interviews n = 56) and at 3-month follow-up (audits n = 30) demonstrated varied success across sites. Following implementation 2 sites significantly improved their common goal focus (site 1 p ≤ 0.001, site 2 p = 0.005), these sites also demonstrated a significant increase in clients reporting that they received copies of their rehabilitation goals (site 1 p ≤ 0.001, site 2 p ≤ 0.001). Four sites improved client action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. At 3-month follow-up 4 sites had continued to improve their common goal focus; however, all sites decreased the specificity of their goal-setting. CONCLUSION: Elements of the implementation package were successful at enhancing the goal-setting process; however, how the package is implemented within the team may impact outcomes.


Assuntos
Objetivos , Reabilitação , Humanos , Reabilitação/normas , Benchmarking , Auditoria Clínica
5.
Motriz (Online) ; 28: e10220019721, 2022. graf
Artigo em Inglês | LILACS | ID: biblio-1386376

RESUMO

Abstract Introduction: Chronic kidney disease (CKD) is a worldwide public health problem associated with an increased risk of death from cardiovascular complications. Although previous studies have described significant improvements in exercise in functional capacity and quality of life in patients with end-stage kidney disease (ESKD), there is a lack of studies that propose to assess its impact on cardiac function using transthoracic echocardiogram (ECHO). In addition, most of the intradialytic exercise protocols are inconsistent, and incomplete regarding their intensity prescription, time of intervention, and monitoring. Methods: The present study aims to evaluate the effects of an intradialytic cardiovascular rehabilitation protocol (ICRP) using medium intensity aerobic exercises, for 30 min. on cardiac function and functional capacity. In this 6-month longitudinal study, heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, peripheral oxygen saturation (SpO2) and modified Borg scale will be analyzed in all HD sessions. The cardiac function will be evaluated by left ventricular ejection fraction (LVEF) through ECHO; functional capacity by the six-minute walk test (6MWT); quality of life through the SF-36 questionnaire and routine laboratory tests and KT/Vsp calculation before and after the ICRP. Conclusion: ICRP protocol will be examined and is expected to improve cardiac function, functional capacity, and quality of life in ESKD patients on hemodialysis.


Assuntos
Humanos , Qualidade de Vida , Reabilitação/normas , Exercício Físico , Anormalidades Cardiovasculares/etiologia , Insuficiência Renal Crônica/fisiopatologia , Estudos Longitudinais , Frequência Cardíaca
6.
Medicine (Baltimore) ; 100(37): e27273, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664883

RESUMO

ABSTRACT: The purpose of this study is to investigate the predictive factors of home discharge for rehabilitation patients with cancer bone metastasis.Cancer patients with bone metastasis who underwent rehabilitation between April 2014 and March 2017 were retrospectively enrolled. Data on discharge destination were collected from medical records as outcomes. Multiple regression analyses were carried out to investigate the predictive factors of home discharge.Ninety-eight patients (mean age: 68.6 years, 42 females and 56 males) were included. Fifty patients were discharged home, 38 patients were discharged to other facilities, and 10 patients died. There were no skeletal-related events among these patients during their hospital stay. The receiver-operating curve for the predictive factors for home discharge of the Barthel Index at admission, Eastern Cooperative Oncology Group Performance Status at admission, and number of immediate family members living at home were 60 points (area under the curve [AUC] = 0.74, sensitivity = 0.6400, 1-specificity = 0.2766), 2 score (AUC = 0.65, sensitivity = 0.5400, 1-specificity = 0.2222), and 1 family member (AUC = 0.65, sensitivity = 0.9592, 1-specificity = 0.7222), respectively.In order to plan for cancer patients with bone metastasis to be discharged home, it is important to take into consideration the patients' Barthel Index and Performance Status at the time of hospital admission and the number of immediate family members living at home.


Assuntos
Neoplasias Ósseas/terapia , Família/psicologia , Alta do Paciente/normas , Relações Profissional-Paciente , Reabilitação/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/psicologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/terapia , Alta do Paciente/estatística & dados numéricos , Reabilitação/psicologia , Reabilitação/normas , Estudos Retrospectivos
7.
Sci Rep ; 11(1): 18109, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518568

RESUMO

Artificial intelligence technology is becoming more prevalent in health care as a tool to improve practice patterns and patient outcomes. This study assessed ability of a commercialized artificial intelligence (AI) mobile application to identify and improve bodyweight squat form in adult participants when compared to a physical therapist (PT). Participants randomized to AI group (n = 15) performed 3 squat sets: 10 unassisted control squats, 10 squats with performance feedback from AI, and 10 additional unassisted test squats. Participants randomized to PT group (n = 15) also performed 3 identical sets, but instead received performance feedback from PT. AI group intervention did not differ from PT group (log ratio of two odds ratios = - 0.462, 95% confidence interval (CI) (- 1.394, 0.471), p = 0.332). AI ability to identify a correct squat generated sensitivity 0.840 (95% CI (0.753, 0.901)), specificity 0.276 (95% CI (0.191, 0.382)), PPV 0.549 (95% CI (0.423, 0.669)), NPV 0.623 (95% CI (0.436, 0.780)), and accuracy 0.565 95% CI (0.477, 0.649)). There was no statistically significant association between group allocation and improved squat performance. Current AI had satisfactory ability to identify correct squat form and limited ability to identify incorrect squat form, which reduced diagnostic capabilities.Trial Registration NCT04624594, 12/11/2020, retrospectively registered.


Assuntos
Inteligência Artificial , Aplicativos Móveis , Fisioterapeutas , Padrões de Prática Médica , Adulto , Estudos de Casos e Controles , Feminino , Feedback Formativo , Humanos , Masculino , Modalidades de Fisioterapia/normas , Melhoria de Qualidade , Reabilitação/métodos , Reabilitação/normas
8.
J Clin Epidemiol ; 139: 222-231, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34437947

RESUMO

OBJECTIVES: To analyze the reporting characteristics of Appraisal of Guidelines Research and Evaluation (AGREE) II appraisals in rehabilitation and explore how much quality ratings of Clinical Practice Guidelines (CPGs) vary applying different cut-offs. STUDY DESIGN AND SETTING: We conducted a methodological study re-analyzing data of an overview of AGREE II CPG appraisals in rehabilitation. Reporting characteristics of appraisals and methods used for quality rating were abstracted. We applied the most frequent cut-offs retrieved on all CPG sample to explore changes in quality ratings (i.e., high/low). RESULTS: We included 40 appraisals (n = 544 CPGs).The AGREE II overall assessment 1 (overall CPG quality) was reported in 26 appraisals (65%) and the overall assessment 2 (recommendation for use) in 17 (42.5%). Twenty-five appraisals (62.5%) reported the use of cut-offs based on domains and/or overall assessments. Application of the most reported cut-offs led to variability in quality ratings in 26% of the CPGs, of which 92% CPGs shifted their rating from low to high-quality and 8% shifted from high to low-quality. CONCLUSION: Rehabilitation stakeholders should take care to select the highest quality CPG in view of the poor reporting of AGREE II overall assessment 1 and 2 and moderate variability of quality ratings.


Assuntos
Confiabilidade dos Dados , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/normas , Reabilitação/normas , Revisões Sistemáticas como Assunto/normas , Humanos , Reabilitação/estatística & dados numéricos
9.
Arch Phys Med Rehabil ; 102(11): 2125-2133, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34052214

RESUMO

OBJECTIVE: To obtain expert consensus on indicators of quality rehabilitation services for individuals with limited English proficiency (LEP). DESIGN: Three-round Delphi study. SETTING: Delphi survey conducted online with 30 experts. Most experts worked in adult physical rehabilitation settings and were from Illinois (n=16), and the remaining participants were from 8 other US states or Canadian provinces. PARTICIPANTS: Experts (N=30) had a minimum of 2 publications on health care services for patients with LEP and/or a minimum of 5 years clinical experience in physical rehabilitation. Of 43 experts (11 researchers, 32 clinicians) who received the round 1 survey by e-mail, 30 returned complete responses (70% response rate). Of those, 25 completed round 2 and 24 completed round 3. Of round 1 participants, most (n =21) identified their primary professional activity as clinical, whereas the others worked in research (n =5) or education (n =4). Twenty-four were women. The median age was 43 years (range, 27-67y). Disciplines included occupational therapy (n =14), physical therapy (n =13), psychology (n=1), nursing (n=1), and medicine (n=1). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Indicators were rated on a 7-point Likert scale for importance and feasibility. Interquartile range (IQR) and 95% confidence intervals were calculated for importance and feasibility ratings. Indicators with an IQR <2 and a median importance score ≥6 were accepted as reaching consensus for importance. RESULTS: Round 1 responses were categorized into 15 structural, 13 process, and 18 outcome indicators. All 15 structural indicators reached consensus for importance; 8 were rated as feasible. All 13 process indicators reached consensus, of which 8 were deemed feasible. Sixteen outcome indicators reached consensus, of which 7 were deemed feasible. CONCLUSIONS: This Delphi study identified structural, process, and outcome indicators that can inform delivery and assessment of quality rehabilitation services for individuals with LEP. Future research should operationalize and measure these quality indicators in clinical practice.


Assuntos
Proficiência Limitada em Inglês , Indicadores de Qualidade em Assistência à Saúde/normas , Reabilitação/normas , Adulto , Idoso , Comunicação , Competência Cultural , Técnica Delphi , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Melhoria de Qualidade
10.
J Rehabil Med ; 53(6): jrm00207, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-33961056

RESUMO

Meta-analysis of clinical trials in rehabilitation is often inconclusive, even when similar interventions are investigated. A possible reason for this is the influence of the settings in which rehabilitation services are delivered. Examples show that factors related to service organization in rehabilitation can influence study outcomes. This, in particular, is relevant, as contextual factors in rehabilitation are known to influence the participation and functioning of persons with disability. The Consolidated Statement of Reporting Trials (CONSORT) group and other initiatives published standards for reporting relevant factors for clinical trials. However, description of the rehabilitation setting of factors related to rehabilitation service provision is under-represented. Systematic reviews show that, on the one hand, these factors are scarcely reported, and only a few studies systematically evaluated the influence of factors related to service organization on rehabilitation outcomes. The International Classification of Service Organization in Rehabilitation (ICSO-R) provides a framework to systematically describe rehabilitation services. It contains 40 categories and sub-categories for the domains "provider" and "service delivery". Therefore, it is important and relevant to develop a minimum reporting set for factors relevant to service organization for rehabilitation trials. This paper sets out a methodological approach for this purpose, including literature reviews, Delphi survey focus group discussion, and consensus conference.


Assuntos
Ensaios Clínicos como Assunto/normas , Reabilitação/normas , Padrão de Cuidado/normas , Humanos
13.
Phys Ther ; 101(8)2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33693902

RESUMO

OBJECTIVE: The purpose of this study was to link Activity Measure for Post-Acute Care (AM-PAC) Mobility and Daily Activity scales to the PROMIS Physical Function (PF) allowing for a common metric across scales. METHODS: Cross-sectional study of patients 18 years and older presenting to 1 of 8 outpatient rehabilitation clinics in southwestern Pennsylvania. Patients completed one survey with questions from the AM-PAC Daily Activity and Mobility short forms, and the PROMIS PF item bank. Using item response theory, 2 rounds of fixed-parameter calibration were performed. In the first, the AM-PAC Daily Activity and Mobility items were calibrated with 27 fixed item parameters from the PROMIS PF. Second, the AM-PAC Daily Activity items were calibrated with 11 PROMIS Upper Extremity fixed item parameters. This process uses the construct of physical function and equates AM-PAC items on the same underlying measurement scale for the PROMIS PF. RESULTS: Both scales measured a wide range of functioning and demonstrated good calibration. Data were appropriate for a fixed-parameter item response theory-based crosswalk. AM-PAC Daily Activity and Mobility raw scores were mapped onto the PROMIS PF metric. AM-PAC Daily Activity scores were also mapped onto the PROMIS PF Upper Extremity metric. CONCLUSION: Question items from the AM-PAC Daily Activity, AM-PAC Mobility, and PROMIS PF similarly measure the construct of physical function. This consistency allows for a crosswalk of AM-PAC scores onto the PROMIS PF metric. IMPACT: Crosswalk tables developed in this study allow for converting scores from the AM-PAC Daily Activity and Mobility scales to the PROMIS PF metric. This will facilitate monitoring of longitudinal change in function over time and across settings.


Assuntos
Atividades Cotidianas , Medidas de Resultados Relatados pelo Paciente , Reabilitação/normas , Inquéritos e Questionários/normas , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria
14.
Am J Trop Med Hyg ; 104(3_Suppl): 110-119, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33534772

RESUMO

New studies of COVID-19 are constantly updating best practices in clinical care. However, research mainly originates in resource-rich settings in high-income countries. Often, it is impractical to apply recommendations based on these investigations to resource-constrained settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for tracheostomy, discharge, and rehabilitation measures in hospitalized patients recovering from severe COVID-19 in LMICs. We recommend that tracheostomy be performed in a negative pressure room or negative pressure operating room, if possible, and otherwise in a single room with a closed door. We recommend using the technique that is most familiar to the institution and that can be conducted most safely. We recommend using fit-tested enhanced personal protection equipment, with the fewest people required, and incorporating strategies to minimize aerosolization of the virus. For recovering patients, we suggest following local, regional, or national hospital discharge guidelines. If these are lacking, we suggest deisolation and hospital discharge using symptom-based criteria, rather than with testing. We likewise suggest taking into consideration the capability of primary caregivers to provide the necessary care to meet the psychological, physical, and neurocognitive needs of the patient.


Assuntos
COVID-19/complicações , Países em Desenvolvimento/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alta do Paciente/normas , Guias de Prática Clínica como Assunto , Reabilitação/métodos , Traqueostomia/métodos , Humanos , Controle de Infecções/métodos , Reabilitação/organização & administração , Reabilitação/normas , Índice de Gravidade de Doença , Traqueostomia/normas
15.
BMJ Open ; 11(1): e044278, 2021 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478966

RESUMO

OBJECTIVES: To evaluate the predictive utility of the Activity Measure for Post-Acute Care '6-Clicks' daily activity and basic mobility functional assessment short forms on inpatient discharge to home compared with skilled nursing facilities, including by diagnostic group (trauma injury, major lower joint replacement/reattachment, spinal fusion excluding cervical), as well as assess the effect of the short forms on 30-day inpatient readmissions. DESIGN: Retrospective, observational cohort study of electronic health record data. SETTING: Five hospitals in a multistate, integrated healthcare system serving a large, rural US population. PARTICIPANTS: The population-based adult (age ≥18) sample of acute care hospitalised patients receiving rehabilitation services included 10 316 patients with 12 314 hospital admissions from the year prior to 6-Clicks implementation (1 June 2015-31 May 2016) (pre-6-Clicks cohort) and 10 931 patients with 13 241 admissions from the year after 6-Clicks implementation (1 January 2017-31 December 2017) (post-6-Clicks cohort). Patients were admitted for major lower joint replacement/reattachment, spinal fusion excluding cervical, trauma injury or another reason. INTERVENTION: Occupational and physical therapist use of 6-Clicks daily activity and basic mobility short forms in the post-6-Clicks cohort. PRIMARY AND SECONDARY OUTCOMES: Discharge disposition (home, including to assisted living, or skilled nursing facility, including swing beds) and 30-day inpatient readmissions. RESULTS: Areas under the receiver operating characteristic curve were 0.82-0.92 (daily activity) and 0.87-0.94 (basic mobility) for discharge to home or skilled nursing facilities, with trauma and spinal fusion patients having the highest values. Daily activity and basic mobility standardised positive and negative predictive values were highest for the three diagnostic groups compared with the full study sample. Few significant differences in 30-day readmissions were seen between pre- and post-6-Clicks cohorts. CONCLUSIONS: 6-Clicks performed well when distinguishing between discharge home or skilled nursing facilities, especially by diagnostic group, supporting use by occupational and physical therapists in discharge planning. Future research could assess where additional intervention or training may reduce 30-day readmissions.


Assuntos
Registros Eletrônicos de Saúde , Alta do Paciente , Readmissão do Paciente , Reabilitação/normas , Cuidados Semi-Intensivos , Adulto , Estudos de Coortes , Feminino , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Valor Preditivo dos Testes , Melhoria de Qualidade , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem
16.
J Formos Med Assoc ; 120(1 Pt 1): 83-92, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32863084

RESUMO

The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice.


Assuntos
COVID-19 , Protocolos Clínicos/normas , Controle de Infecções , Reabilitação , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/reabilitação , Consenso , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Recuperação de Função Fisiológica , Reabilitação/métodos , Reabilitação/normas , SARS-CoV-2/isolamento & purificação , Taiwan
17.
Arch Phys Med Rehabil ; 102(3): 543-548, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33239179

RESUMO

Recent research and the actions of the World Health Organization (WHO) have clarified the nature and value of rehabilitation as a key health strategy of the 21st century. However, strengthening rehabilitation in national health systems around the world is a challenge, partly because there is not an evidence-based argument that rehabilitation is a good economic and social investment. This argument, in turn, depends on characterizing the current and potential beneficiaries of rehabilitation, namely the individuals who could benefit from rehabilitation services whether or not they currently receive these services. Although identifying current beneficiaries is essential for evaluating the current demand for rehabilitation in existing health systems, as well as for making the economic investment case for rehabilitation within national health systems, it is only by characterizing potential beneficiaries that we can identify unmet needs and the potential social effect of rehabilitation. The objective of this study is to take a preliminary step toward both tasks by offering an overview of intuitively plausible approaches to characterizing beneficiaries of rehabilitation and to highlight limitations and challenges with each approach. We rely on the WHO's definition of rehabilitation, particularly the aim of rehabilitation to "optimize functioning and reduce disability," as our starting point.


Assuntos
Pessoas com Deficiência/reabilitação , Saúde Global , Avaliação das Necessidades , Reabilitação/normas , Humanos
18.
Arch Phys Med Rehabil ; 102(3): 521-531, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33065124

RESUMO

Although significant advances have been made in measuring the outcomes of rehabilitation interventions, comparably less progress has been made in measuring the treatment processes that lead to improved outcomes. A recently developed framework called the Rehabilitation Treatment Specification System (RTSS) has potential to identify which clinician actions (ie, ingredients) actively improve specific patient functions (ie, targets). However, the RTSS does not provide methodology for standardly identifying specific unique targets or ingredients. Without a method to evaluate the uniqueness of an individual target or ingredient, it is difficult to know whether variations in treatment descriptions are synonymous (ie, different words describing the same treatment) or meaningfully different (eg, different words describing different treatments or variations of the same treatment). A recent project used vocal rehabilitation ingredients and targets to create RTSS-based lists of unique overarching target and ingredient categories with underlying dimensions describing how individual ingredients and targets vary within those categories. The primary purpose of this article is to describe the challenges encountered during the project and the methodology developed to address those challenges. Because the methodology was based on the RTSS's broadly applicable framework, it can be used across all areas of rehabilitation regardless of the discipline (speech-language pathology, physical therapy, occupational therapy, psychology, etc) or impairment domain (language, cognition, ambulation, upper extremity training, etc). The resulting standard operationalized lists of targets and ingredients have high face and content validity. The lists may also facilitate implementation of the RTSS in research, education, interdisciplinary communication, and everyday treatment.


Assuntos
Tomada de Decisão Clínica , Protocolos Clínicos/normas , Avaliação de Resultados em Cuidados de Saúde , Planejamento de Assistência ao Paciente/normas , Reabilitação/normas , Técnica Delphi , Humanos , Reprodutibilidade dos Testes
19.
Nurs Inq ; 28(1): e12370, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32662213

RESUMO

Based on action research as a practitioner-involving approach, this article communicates the findings of a two-year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice-oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.


Assuntos
Empoderamento , Enfermeiras e Enfermeiros/psicologia , Participação do Paciente/psicologia , Reabilitação/normas , Dinamarca , Educação/métodos , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/tendências , Humanos , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Participação do Paciente/métodos , Participação do Paciente/estatística & dados numéricos , Reabilitação/métodos , Reabilitação/psicologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia
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