Delivering Rehabilitation Care Around the World: Voices From the Field.

OBJECTIVES: To identify the challenges and common issues that the rehabilitation health workforce experienced in delivering services in different practice settings across the world. These experiences could suggest approaches to improving rehabilitation care to people in need. DESIGN: A semi-structured interview protocol centering on 3 broad research questions was conducted to collect data. The data were analyzed to identify common themes across the cohort interviewed. SETTING: Interviews were conducted using Zoom. Interviewees not able to access Zoom provided written responses to the questions. PARTICIPANTS: Participants included 30 key rehabilitation opinion leaders from different disciplines from 24 countries, across world regions and income levels (N=30). INTERVENTIONS: NA. MAIN OUTCOME MEASURES: Although rehabilitation care deficiencies differ in severity, participants reported that the demand for services consistently outstrips available care, regardless of world region or income level. Access and social barriers, particularly in rural areas and remote regions, are common challenges for those delivering and receiving rehabilitation care. RESULTS: Individual voices from the field reported both challenges and hopeful changes in making rehabilitation services available and accessible. CONCLUSIONS: The descriptive approach undertaken has allowed individual voices, rarely included in studies, to be highlighted as meaningful data. Although the research findings are not generalizable beyond the convenience cohort included without further analysis and validation in specific local practice contexts, the authentic voices that spoke out on these issues demonstrated common themes of frustration with the current state of rehabilitation services delivery but also hopefulness that more solutions are on the horizon.

Evolving Models of Rehabilitation-Related Patient Safety and Quality: PIECES.

A conceptual framework for measuring and reporting safety and quality in medical rehabilitation is described in this special communication.

A call for action: Increasing the pediatric rehabilitation medicine workforce.

Pediatric Rehabilitation Medicine (PRM) is a unique blend of traditional medical rehabilitation knowledge and skills primarily focused on temporary and/or permanent disability conditions of childhood onset throughout the age continuum, with an emphasis on promoting function and participation. Although there are two established pathways to enhance knowledge and skills in PRM, one a combined residency with Pediatrics and the other a PRM fellowship, there has been a relative decline in participants in this training, as has been seen across other subspecialties in Physical Medicine and Rehabilitation (PM&R) and other medical specialties. Based on pediatric rehabilitation physician surveys and the increasing prevalence of children with disabilities, there has been a call to consider opening PRM fellowships to physicians not trained in PM&R. This commentary proposes establishing a commission to lead a transparent and inclusive process to assure that all options to address issues related to optimizing PRM care are considered and provide a course of action to address the needs of children and adults with childhood onset disabilities.

Patient Protection and Affordable Care Act: potential effects on physical medicine and rehabilitation.

The objective was to review pertinent areas of the Patient Protection and Affordable Care Act (PPACA) to determine the PPACA's impact on physical medicine and rehabilitation (PM&R). The law, and related newspaper and magazine articles, was reviewed. The ways in which provisions in the PPACA are being implemented by the Centers for Medicare and Medicaid Services and other government organizations were investigated. Additionally, recent court rulings on the PPACA were analyzed to assess the law's chances of successful implementation. The PPACA contains a variety of reforms that, if implemented, will significantly impact the field of PM&R. Many PPACA reforms change how rehabilitative care is delivered by integrating different levels of care and creating uniform quality metrics to assess quality and efficiency. These quality metrics will ultimately be tied to new, performance-based payment systems. While the law contains ambitious initiatives that may, if unsuccessful or incorrectly implemented, negatively impact PM&R, it also has the potential to greatly improve the quality and efficiency of rehabilitative care. A proactive approach to the changes the PPACA will bring about is essential for the health of the field.

Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital.

OBJECTIVE: The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. DESIGN: This is a retrospective review. SETTING: The setting is three freestanding inpatient rehabilitation hospitals operating as one system. PARTICIPANTS: The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. INTERVENTIONS: A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. OUTCOME MEASURES: Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. RESULTS: A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. CONCLUSIONS: The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.

Screening Testing for SARS-CoV-2 upon Admission to Rehabilitation Hospitals in a High COVID-19 Prevalence Community.

BACKGROUND: While planning for the care of coronavirus disease 2019 (COVID-19) patients during the pandemic crisis has dominated the focus of leaders of inpatient rehabilitation facilities (IRFs), patients with injuries/illnesses unrelated to COVID-19 continue to need inpatient rehabilitation admission. To maintain a safe environment for all patients and staff, we established an admission screening plan of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to determine the presence of asymptomatic patients who were infected with the virus upon admission. OBJECTIVE: To determine the prevalence of patients who test positive for SARS-CoV-2 but were presumed to be COVID-19 negative at the time of admission to IRF in New Jersey. DESIGN: Retrospective analysis of SARS-CoV-2 testing results. SETTING: Four freestanding IRFs in New Jersey operated as one system. PATIENTS: All (N = 103) patients sequentially admitted from 4 to 27 April 2020 with no symptoms or evidence of COVID-19 disease at the time of transfer from the acute hospital. INTERVENTIONS: Specimens were collected for SARS-CoV-2 analysis at the time of admission to the IRF and patients were monitored for subsequent symptom development over the next 14 days. MAIN OUTCOME MEASURES: Results of SARS-CoV-2 testing upon admission and evidence of development of clinical signs or symptoms of COVID-19. RESULTS: Seven asymptomatic persons (6.8% of admissions) without clinical signs/symptoms of COVID-19 tested positive on admission. Of these, five developed symptoms of COVID-19, with a mean onset of 3.2 (range of 2-5) days. Five additional patients became symptomatic and tested positive within the next 3 to 10 days (mean of 5.2 days). Overall, 11.6% of admissions (12/103) had a positive test within 14 days of admission. CONCLUSIONS: Admission testing to postacute centers for SARS-CoV-2 can help identify presymptomatic or asymptomatic individuals, especially in areas where COVID-19 is prevalent. Negative results, however, do not preclude COVID-19 and should not be used as the sole basis for patient management decisions.

Postacute rehabilitation research and policy recommendations.

This article summarizes the research and health policy recommendations developed by participants at the symposium "State-of-the-Science on Post-Acute Rehabilitation: Setting a Research Agenda and Developing an Evidence Base for Practice and Public Policy," held in February 2007. A diverse group of participants represented federal government agencies, private insurers, professional organizations, providers of rehabilitation services, patients and their advocates, and health researchers. During roundtable discussions and theme-specific break-out sessions, participants were asked to consider 5 major topics regarding postacute rehabilitation care: (1) the extent of our knowledge, (2) the limitations of our knowledge, (3) the barriers that limit research, (4) research priorities to reduce these obstacles and assemble needed evidence, and (5) the major policy implications. Several key themes emerged: the need for improved measures, particularly of case-mix factors and treatment ingredients; the need for a more uniform and coherent system of postacute rehabilitation care to facilitate gathering of common data; the need to attend to underutilization as well as overutilization of rehabilitation services; the need for cooperation among payers, providers, and researchers to advance a rehabilitation effectiveness research agenda; and the desire to develop payment policies that are based on research evidence.

Pediatric critical care medicine: planning for our research future.

OBJECTIVE: To introduce to the pediatric critical care medicine community a new program in pediatric critical care medicine at the National Institutes of Health. DATA SOURCE: Summary of literature review and conference proceedings. DATA SYNTHESIS: At the National Institute of Child Health and Human Development (NICHD), a new program in pediatric critical care and rehabilitation research has been established in the National Center for Medical Rehabilitation Research. The program is directed by a pediatric intensivist and is focused on developing research directed toward improving long-term outcomes in pediatric critical care and on incorporating pediatric rehabilitation medicine as a partner in this goal. To provide strategic direction for the new program, the NICHD sponsored a planning conference May 3-4, 2002, at the NICHD in Bethesda, MD. The conference invitees represented a broad range of pediatric critical care medicine clinical and research interests, expertise, and career stages. It also included individuals with expertise in rehabilitation research. CONCLUSION: The composition of the new program, including its link to physical medicine and rehabilitation, is discussed. In addition, recommendations by the conference participants and program director are provided to foster the development of more randomized, controlled clinical trials and to develop successful clinician scientists in pediatric critical care medicine.

Is PM&R teetering on the precipice of a dark age?

Physical medicine and rehabilitation has had a fascinating history of creation, growth, evolution, maturation, and challenge in the 80 or so years it has existed. Today, we are on the brink of the most serious challenges ever to face the specialty. In this address, I review briefly the history of the field, show evidence of our successes, identify the many overwhelming challenges we now face, and forecast a potential doom for our field. In the end, I offer specific strategies and tactics that the field should follow to guide us to a bright and reinvigorated future.

The 34th Walter J. Zeiter lecture: creating the future of PM&R: building on our past.

The founders of the field of physical medicine and rehabilitation (PM&R) took advantage of a confluence of political, technical, and economic opportunities to launch our specialty. In the process, they expressed their values of belief in the importance of function, the team approach to health care, the utility of physical agents and modalities in the management of neuromuscular conditions, the impact of education for our patients and their families, the rights of persons with a disability (PWD), and the responsibility of our field to advocate for public policy issues concerned with the needs of PWD. Advances in the technology of health care delivery and biomedicine will shape our future. Specific trends and factors are addressed. Equally important will be the political dimension, including the aging of our global population, and the economic consequences of health insurance pressures. The field of PM&R should focus on activities that take advantage of emerging trends but are rooted in our traditional values. In particular, the field should look forward to the massive growth of populations in need of our services because of aging and longevity, the emerging global health community, and our increasing technical capacity to impact improvements in health and function. The field is charged to preserve awareness of our core values, to support the common good of research, to keep the use of new and emerging technology in check to serve the needs of our patients, to continue our advocacy for social justice for PWD, and to embrace the emerging global community.

Tratado de medicina de reabilitação: princípios e prática / Treaty of rehabilitation medicine: principles and practice

Houve um número surpreendente de transformações no campo da medicina física e reabilitação (MF e R) desde a publicação da segunda edição deste livro. Entre estas mudanças estão avanços no tratamento da lesão de medula espinhal e do traumatismo cranioencefálico, avanços em robótica e microeletrônica, a explosão da Internet como o canal de comunicação, e alterações substanciais no sistema de assistência à saúde, com a evolução do atendimento médico gerenciado encabeçando a lista. Esta edição apresenta os mais recentes conhecimentos destes e uma miríade de outros assuntos, ao exercerem sua influência sobre o núcleo da prática da MF e R . Na compilação do livro, salientamos a base científica da nossa especialidade, mas simultaneamente nos esforçamos para que a informação seja prática e clinicamente útil. Os capítulos são de multiautoria, e os autores foram escolhidos pela sua proficiência na sua área específica

Tratado de medicina de reabilitação: princípios e prática / Treaty of rehabilitation medicine: principles and practice

Houve um número surpreendente de transformações no campo da medicina física e reabilitação (MF e R) desde a publicação da segunda edição deste livro. Entre estas mudanças estão avanços no tratamento da lesão de medula espinhal e do traumatismo cranioencefálico, avanços em robótica e microeletrônica, a explosão da Internet como o canal de comunicação, e alterações substanciais no sistema de assistência à saúde, com a evolução do atendimento médico gerenciado encabeçando a lista. Esta edição apresenta os mais recentes conhecimentos destes e uma miríade de outros assuntos, ao exercerem sua influência sobre o núcleo da prática da MF e R . Na compilação do livro, salientamos a base científica da nossa especialidade, mas simultaneamente nos esforçamos para que a informação seja prática e clinicamente útil. Os capítulos são de multiautoria, e os autores foram escolhidos pela sua proficiência na sua área específica