Impact of the COVID-19 pandemic on rehabilitation setting. Part 1: professionals' views on the changes in routine care provided by a rehabilitation centre for patients with muscle diseases.

The outbreak of COVID-19 has forced the health care system to undergo profound rearrangements in services and facilities, especially during the periods of lockdown. In this context, inpatient and outpatient services had to rethink and reorganize their activities to meet the needs of severely disabled patients, as those affected by Muscular Dystrophies (MDs). We present the preliminary results of a survey aiming to explore the staff views on the changes in the care provided by the Gaetano Torre Rehabilitation Centre, and, the impact of these changes on professionals, patients and their families. The survey was carried out using an open-ended questionnaire including six-items, on the practical and psychological aspects emerged during the pandemic in relation to the healthcare services provided by the Centre and to the patients/caregivers conditions. The participants, most of them physiotherapists, highlighted 169 aspects emerging in the pandemic, 48.5% referring to the resources used to cope with critical issues and 51.5% concerning the difficulties encountered. Emotional aspects prevailed on practical aspects both in resources (52.4 vs 47.6%) and in difficulties (57.5 vs 42.5%) categories. In particular, with regard to patients' resources, psychological benefits, despite the burden, were greater than practical ones (87 vs 13%), in the form of improved intra-family relationships, feeling more cared for, and satisfaction for the received care. As for the patients' relatives, the staff indicated more resources than difficulties (72.8 vs 17.2%). Among the former, 75% concerned the emotional sphere, such as the perception of having a point of reference even in such a difficult time.

The effects of vertically integrated care on health care use and outcomes in inpatient rehabilitation facilities.

OBJECTIVE: To understand the effects of receiving vertically integrated care in inpatient rehabilitation facilities (IRFs) on health care use and outcomes. DATA SOURCES: Medicare enrollment, claims, and IRF patient assessment data from 2012 to 2014. STUDY DESIGN: We estimated within-IRF differences in health care use and outcomes between IRF patients admitted from hospitals vertically integrated with the IRF (parent hospital) vs patients admitted from other hospitals. For hospital-based IRFs, the parent hospital was defined as the hospital that owned the IRF and co-located with the IRF. For freestanding IRFs, the parent hospital(s) was defined as the hospital(s) that was in the same health system. We estimated models for freestanding and hospital-based IRFs and for fee-for-service (FFS) and Medicare Advantage (MA) patients. Dependent variables included hospital and IRF length of stay, functional status, discharged to home, and hospital readmissions. DATA EXTRACTION METHODS: We identified Medicare beneficiaries discharged from a hospital to IRF. PRINCIPAL FINDINGS: In adjusted models with hospital fixed effects, our results indicate that FFS patients in hospital-based IRFs discharged from the parent hospital had shorter hospital (-0.7 days, 95% CI: -0.9 to -0.6) and IRF (-0.7 days, 95% CI: -0.9 to -0.6) length of stay were less likely to be readmitted (-1.6%, 95% CI: -2.7% to -0.5%) and more likely to be discharged to home care (1.4%, 95% CI: 0.7% to 2.0%), without worse patient clinical outcomes, compared to patients discharged from other hospitals and treated in the same IRFs. We found similar results for MA patients. However, for patients in freestanding IRFs, we found little differences in health care use or patient outcomes between patients discharged from a parent hospital compared to patients from other hospitals. CONCLUSIONS: Our results indicate that receiving vertically integrated care in hospital-based IRFs shortens institutional length of stay while maintaining or improving health outcomes.

Barriers and facilitators for implementation of a patient prioritization tool in two specialized rehabilitation programs.

INTRODUCTION AND AIMS: Prioritization tools aim to manage access to care by ranking patients equitably in waiting lists based on determined criteria. Patient prioritization has been studied in a wide variety of clinical health services, including rehabilitation contexts. We created a web-based patient prioritization tool (PPT) with the participation of stakeholders in two rehabilitation programs, which we aim to implement into clinical practice. Successful implementation of such innovation can be influenced by a variety of determinants. The goal of this study was to explore facilitators and barriers to the implementation of a PPT in rehabilitation programs. METHODS: We used two questionnaires and conducted two focus groups among service providers from two rehabilitation programs. We used descriptive statistics to report results of the questionnaires and qualitative content analysis based on the Consolidated Framework for Implementation Research. RESULTS: Key facilitators are the flexibility and relative advantage of the tool to improve clinical practices and produce beneficial outcomes for patients. Main barriers are the lack of training, financial support and human resources to sustain the implementation process. CONCLUSION: This is the first study that highlights organizational, individual and innovation levels facilitators and barriers for the implementation of a prioritization tool from service providers' perspective.

The Important Impact of COVID-19 Pandemic on the Reorganization of a Rehabilitation Unit in a National Healthcare System Hospital in Italy: Lessons From Our Experience.

ABSTRACT: Since March 2020, when COVID-19 pandemic broke out, the world's healthcare systems' main concern has been fighting the pandemic. However, patients with other diseases, also requiring rehabilitation evaluations and treatments, continued to need care. Our rehabilitation unit managed to maintain contact with patients through alternative communication methods even during the lockdown period and in a situation of staff shortage. If face-to-face evaluations and treatments were necessary, preventive measures were followed to avoid hospital-associated contagion. Rehabilitation beds were cleared to leave them to the acute wards, and consultations for the acute care patients were carried out using personal protective equipment. In the future, the lessons from our experience could contribute toward drawing a plan of measures applicable in similar situations and some of these actions could become part of the rehabilitative practice.

The War on COVID-19 Pandemic: Role of Rehabilitation Professionals and Hospitals.

The global outbreak of coronavirus disease 2019 has created an unprecedented challenge to the society. Currently, the United States stands as the most affected country, and the entire healthcare system is affected, from emergency department, intensive care unit, postacute care, outpatient, to home care. Considering the debility, neurological, pulmonary, neuromuscular, and cognitive complications, rehabilitation professionals can play an important role in the recovery process for individuals with coronavirus disease 2019. Clinicians across the nation's rehabilitation system have already begun working to initiate intensive care unit-based rehabilitation care and develop programs, settings, and specialized care to meet the short- and long-term needs of these individuals. We describe the anticipated rehabilitation demands and the strategies to meet the needs of this population. The complications from coronavirus disease 2019 can be reduced by (1) delivering interdisciplinary rehabilitation that is initiated early and continued throughout the acute hospital stay, (2) providing patient/family education for self-care after discharge from inpatient rehabilitation at either acute or subacute settings, and (3) continuing rehabilitation care in the outpatient setting and at home through ongoing therapy either in-person or via telehealth.

Assessing the Ability of Comorbidity Indexes to Capture Comorbid Disease in the Inpatient Rehabilitation Spinal Cord Injury Population.

OBJECTIVE: To examine whether commonly used comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, the Centers for Medicare and Medicaid Services [CMS] comorbidity tiers) capture comorbidities in the acute traumatic and nontraumatic SCI inpatient rehabilitation population. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: Data were obtained from the Uniform Data System for Medical Rehabilitation from October 1, 2015 to December 31, 2017 for adults with spinal cord injury (SCI) (Medicare-established Impairment Group Codes 04.110-04.230, 14.1, 14.3). This study included SCI discharges (N=66,235) from 833 inpatient rehabilitation facilities. MAIN OUTCOME MEASURES: International Classification of Diseases-10th Revision-Clinical Modifications (ICD-10-CM) codes were used to assess 3 comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, CMS comorbidity tiers). The comorbidity codes that occurred with >1% frequency were reported. The percentages of discharges for which no comorbidities were captured by each comorbidity index were calculated. RESULTS: Of the total study population, 39,285 (59.3%) were men and 11,476 (17.3%) were tetraplegic. The mean number of comorbidities was 14.7. There were 13,939 distinct ICD-10-CM comorbidity codes. There were 237 comorbidities that occurred with >1% frequency. The Deyo-Charlson comorbidity index, Elixhauser comorbidity index, and the CMS tiers did not capture comorbidities of 58.4% (95% confidence interval, 58.08%-58.84%), 29.4% (29.07%-29.76%), and 66.1% (65.73%-66.46%) of the discharges in our study, respectively, and 28.8% (28.42%-29.11%) of the discharges did not have any comorbidities captured by any of the comorbidity indexes. CONCLUSION: Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the SCI rehabilitation population. This work suggests that alternative measures may be needed to capture the complexity of this population.

Validation of the Casa Colina Fall Risk Assessment Scale in Predicting Falls in Inpatient Rehabilitation Facilities.

OBJECTIVE: The aim of this study was to assess the validity, efficacy, and generalizability of a fall risk assessment tool created specifically for inpatient rehabilitation facilities (IRFs). DESIGN: The Casa Colina Falls Risk Assessment Scale (CCFRAS) was assessed both retrospectively and prospectively on consecutive patients at three IRFs to determine the sensitivity and specificity of this tool in predicting fall risk. SETTING: The setting was in three IRFs. PARTICIPANTS: Individuals admitted to three IRFs participated in the study. MAIN OUTCOMES MEASURES: Each IRF quantified the number of falls detected for the patient population under evaluation and determined the site-specific sensitivity and specificity of the CCFRAS. RESULTS: The sensitivity and specificity of the CCFRAS ranged from 75% to 80% and from 47% to 70%, respectively, for the different IRFs. Using a logistic regression analysis, we identified the optimal CCFRAS cutoff score for identifying high-risk patients at each individual facility, thus improving the specificity to 70%-79%. CONCLUSION: Multisite evaluation of this assessment tool indicates that the CCFRAS is effective and broadly generalizable for predicting patients at high risk for falling.

What Characteristics Influence Whether Rural Beneficiaries Receiving Care From Urban Hospitals Return Home for Skilled Nursing Care?

PURPOSE: Skilled nursing care (SNC) provides Medicare beneficiaries short-term rehabilitation from an acute event. The purpose of this study is to assess beneficiary, market, and hospital factors associated with beneficiaries receiving care near home. METHODS: The population includes Medicare beneficiaries who live in a rural area and received acute care from an urban facility in 2013. "Near home" was defined 3 different ways based on distances from the beneficiary's home to the nearest source of SNC. Results include unadjusted means and odds ratios from logistic regression. FINDINGS: About 69% of rural beneficiaries receiving acute care in an urban location returned near home for SNC. Beneficiaries returning home were white (odds ratio [OR] black: 0.69; other race: 0.79); male (OR: 1.07); older (OR age 85+ [vs 65-69]: 1.14); farther from SNC (OR: 1.01 per mile); closer to acute care (OR: 0.28, logged miles); and received acute care from hospitals that did not own a skilled nursing facility (owned OR: 0.77) and hospitals with: no swing bed (swing bed OR: 0.47), high case mix (OR: 3.04), and nonprofit status (for-profit OR: 0.85). Results varied somewhat across definitions of "near home." CONCLUSIONS: Rural Medicare beneficiaries who received acute care far from home were more likely to receive SNC far from home. Because Medicare beneficiaries have the choice of where to receive SNC, policy makers may consider ensuring that new payment models do not incentivize provision of SNC away from home.

Frailty and Aging: How the Danish Experience Might Inform Canada.

Scandinavian countries are widely acknowledged as leaders in innovative models of care for their aging populations. To learn what might be potentially applicable to the health system in Canada, the Canadian Frailty Network (CFN) led a contingent of government, administrative, research and patient representatives to Denmark to directly observe Danish approaches for providing healthcare for older adults living with frailty. In this paper and based on what we learned from these observations, we discuss healthcare challenges faced by Canada's aging population for which Danish strategies provide clues as to where and how to improve care and system efficiencies, thereby maximizing the value of Canadian healthcare.

Slow Stream Rehabilitation for Older Adults: A Scoping Review.

ABSTRACTCanadian older adults with complex health problems are often considered ineligible for traditional rehabilitation programs but may benefit from slow stream rehabilitation (SSR). This scoping review summarizes the literature related to SSR for older adults, within single-payer health care systems. METHODS: Peer-reviewed and grey-literature documents relevant to older adults in SSR were systematically reviewed. RESULTS: 1,445 documents were screened independently by two reviewers [Cohen Kappa value of 0.78 (CI = 0.73, 0.83)], and included 18 documents. SSR programs were found to be multidisciplinary with a mean duration ranging from 30 to 141.2 days. SSR participants were more likely to be female, with a mean age range of 72-82 years, multiple co-morbidities and mild-to-moderate cognitive impairments. SSR participants demonstrated improvements in physical and functional measures. DISCUSSION: SSR programs have the potential to be an integral part of the continuum of care for older adults with complex medical histories.

Compliance with standards of practice for health-related rehabilitation in low and middle-income settings: development and implementation of a novel scoring method.

Purpose: To (A) develop a method for measuring compliance with standards, and (B) implementation of the method in 12 rehabilitation centers in six low and middle-income countries (LMICs). Methods: In part A, existing standards were compiled and operationalized into scores, organized into 5 'scorecards' and 15 'sub-scorecards', then tested and refined in an iterative process. In part B, 12 rehabilitation centers in 6 countries implemented the standards using the new method, revealing relative performance between centers, and across different standards. Internal consistency of scores within domains was computed using Chronbach's alpha. Results: A standardized method for scoring compliance with standards for rehabilitation was developed. The method evaluated compliance with standards in five domains of practice: user focused approach, service outputs, finances, staff, and general management. Multiple standards within domains were strongly related, with Chronbach's alpha >0.80 for all but the equipment and supplies domain. Overall, in the 12 rehabilitation centers examined, 36% of standards were met or exceeded. Compliance within each scoring domain was 56% (user-focused approach), 38% (service outputs), 27% (financial management), 30% (staff management), and 33% (general management). Two out of 12 (17%) of centers met more than two-thirds of the standards, 3 (25%) met more than one-third of standards, while the remaining 7 (58%) met less than one-third of standards. Conclusions: A new, standardized method for measuring performance of rehabilitation services in LMICs was developed. The method examines standards in five rehabilitation practice domains, and can be used to understand barriers to quality performance, particularly in resource-constrained settings. Implementation of the method demonstrated that current compliance with standards is modest. Ongoing interest in new standards for rehabilitation practice should be accompanied by measures to ensure they are used to strengthen quality in an emerging rehabilitation sector. Implications for rehabilitation We developed a method for measuring compliance with standards for rehabilitation, and implemented the method in 12 rehabilitation centers in low and middle income countries. We demonstrate modest compliance with an adapted list of known standards of practice. New standards, scoring methods and evidence of current performance may assist service providers and policy makers to implement standards, and methods to strengthen rehabilitation services. Modest compliance with current standards suggest new emphasis on quality performance of health-related rehabilitation is needed New emphasis on standards for rehabilitation should be accompanied by consideration of how performance against those standards can be measured and improved.

Observing the influence of the physical environment on family involvement in a rehabilitation setting.

INTRODUCTION: Health professionals and institutions need to understand how to facilitate family involvement within settings designed prior to the adoption of patient- and family-centered philosophies. This study sought to explore how the physical environment of an inpatient rehabilitation setting influenced family involvement in health care delivery. METHOD: We conducted this study on the inpatient acquired brain injury ward of a Canadian adult rehabilitation center. This study used a basic interpretive qualitative approach. We conducted observations of how the physical environment influenced the conversations, interactions, and activities, which were central to family involvement, in this setting. We used a systematic qualitative analysis method. This study received research ethics board approval prior to commencing. RESULTS: We conducted 26 2-hr observation sessions. Five sessions occurred in the morning, 17 in early and late afternoon, and 4 in the evening. Eighteen sessions occurred on a weekday and 8 on a weekend day. The following 6 categories emerged from the field data: (a) accessing health professionals, (b) awareness of family presence, (c) facilitating family presence, (d) facilitating patient-family activities, (e) providing information for families, and (f) facilitating family involvement in therapy. DISCUSSION: This study provided information to inform future discussions and strategies for facilitating family involvement within the existing physical environments of health care institutions. Initial steps should consider ways to help families feel welcomed, such as including additional seating in spaces, posting signage inviting families into spaces, having resources tailored to families readily available, and creating a visible sign-in/sign-out board for families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The relationship between pain psychological factors and job stress in rehabilitation workers with or without chronic pain.

BACKGROUND: Pain is affected by pain psychological factors (PPFs), whereas relationship between PPFs and job stress are unclear. OBJECTIVE: This study aimed to elucidate the relationship between PPFs and job stress in workers. METHODS: The study participants were the staff of the rehabilitation department of a core hospital. After undergoing a preliminary survey (38/43, 88% response rate), the rehabilitation workers were divided into the chronic pain group (CPG, n = 18) and the nonpain group (NPG, n = 13). RESULTS: Depression, anxiety, and magnification in the CPG were significantly associated with depressed mood and total stress response. Anxiety in the NPG was also significantly associated with all stress responses, except irritability and feelings of anxiety. Furthermore, all subscales of the Pain Catastrophizing Scale in the NPG were significantly and negatively associated with the vigor of stress responses. CONCLUSIONS: Chronic pain in workers was associated with severe job stress, and increased job stress worsened the state of chronic pain. Pain catastrophizing may be associated with early job stress in a person with no pain. This finding revealed a difference between the CPG and NPG and may be important for managing workers with job stress or pain.

The Intersection of Rehabilitation and Palliative Care: Patients With Advanced Cancer in the Inpatient Rehabilitation Setting.

BACKGROUND: Patients diagnosed with advanced cancer often differ from the traditional patient typically seen in the inpatient rehabilitation setting. PURPOSE: To identify differences in care while highlighting the considerable similarities between the complementary specialties of palliative care and rehabilitation, and to provide rehabilitation clinicians with knowledge and skills to enhance care for palliative care patients and their families. METHODOLOGY: Narrative literature review describing common functional losses in patients diagnosed with advanced cancer, followed by articulation of the intersection of palliative care with traditional rehabilitation approaches and goals. CONCLUSION: The evidence supports implementation of a distinct body of skills and knowledge, referred to as "palliative rehabilitation," among inpatient rehabilitation providers. CLINICAL IMPLICATIONS: Implementing palliative rehabilitation skills can improve the quality of care within the inpatient rehabilitation setting for patients with advanced cancer.

Drafting a dual diagnosis program: a tailored intervention for patients with complex clinical needs

Background: Clinical practice of mental health services changed in 1978 after the Basaglia Law was passed, and it is now characterized by usually voluntary treatments offered by community-based services. That broadened the interventions' focus from the single subject to their environment. Dual diagnosis is defined by WHO as «the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder¼. It is considered to be a "border territory" since entails networking between different medical services. Materials and methods: A literature search was performed in PubMed, Web of Science, Scopus and Google Scholar. Search terms were: "guidelines", "treatment", "comorbidity", "substance abuse", "alcohol", "dual-diagnosis", "psychiatric illness", "outpatient", "inpatient", "health care service", "clinical practice". National and regional regulations about health and addiction were screened too. Out of 598 titles, 31 studies were included in this article for their relevance on treatments and networking between services for dual diagnosis cases. Results: There are not any guidelines for clinical practice in the literature, neither there are any shared treatment strategies on a national level. Considering the autonomy that every regional health service has, several different courses of action are possible. Here there are reported the ones available. Conclusions: After discussing the weak points of the treatment options, we suggest the "Multidisciplinary Healthcare" model to best address the difficulties represented by dual diagnosis cases.

Family Needs on an Inpatient Brain Injury Rehabilitation Unit: A Quantitative Assessment.

OBJECTIVE: To examine the needs of family members in an inpatient setting and factors predicting extent to which needs are perceived as met. SETTING: University health system inpatient rehabilitation unit. PARTICIPANTS: Adult survivors of traumatic brain injury and family members (n = 85). DESIGN: Prospective, cross-sectional. MAIN MEASURE: Family Needs Questionnaire-Revised (FNQ-R). RESULTS: Needs related to the Health Information subscale were most frequently rated as met, whereas needs related to the Instrumental Support and Emotional Support subscales were most frequently rated as unmet. Predictors related to the FNQ-R included family income, gender, and ethnicity. For 4 of 6 subscales, white family members were more likely to rate needs as unmet than minority members. For 3 subscales, females were more likely to rate needs as unmet than males. Greater household income was associated with fewer met needs for 2 subscales. CONCLUSIONS: The ranking of met and unmet needs in the present study was remarkably similar to previous studies within and outside the United States. Clinicians should not assume that families with relatively higher incomes will experience fewer unmet needs. Through structured assessment, clinicians can reveal perceived needs that might have otherwise been unrecognized and facilitate appropriate supports. Findings provide direction for inpatient program development.