Assessment of Rehabilitation Journal Requirements for the Use of Reporting Guidelines and Clinical Trial Registration.

OBJECTIVE: To assess reporting guideline and clinical trial registration requirements in rehabilitation journals. DESIGN: We examined rehabilitation journals with 5-year impact factors exceeding 1.00 from the 2021 Scopus CiteScore tool, alongside the 28 journals included in the 2014 rehabilitation and disability quality improvement initiative. Journals outside the traditional rehabilitation scope were excluded. SETTING: A publicly-funded academic health center in the United States. PARTICIPANTS AND INTERVENTIONS: N/A. MAIN OUTCOME MEASURE(S): The proportion of journals requiring/recommending reporting guideline use and clinical trial registration. RESULTS: Over 90% (57/63) of journals required/recommended clinical trial reporting guidelines, while 68% (39/57) specified guideline requirements for systematic review/meta-analysis protocols. The 2014 collaborative initiative journals demonstrated higher rates of requiring/recommending reporting guidelines for clinical trials (24/26; 92.3%), systematic reviews/meta-analyses (23/26; 88.5%), observational studies in epidemiology (22/25; 88%), and diagnostic accuracy studies (20/24; 83.3%). Conversely, the 2021 Scopus CiteScore journals displayed higher rates for the remaining study designs. Overall, 52/63 (82.5%) journals required/recommended trial registration. Trial registration policies were comparable, with a slight advantage favoring the 2021 Scopus CiteScore journals. CONCLUSION: Rehabilitation journals variably promoted reporting guideline use and clinical trial registration. Common study designs like clinical trials, observational studies in epidemiology, and diagnostic accuracy studies demonstrated robust requirement/recommendation rates, while less common designs like economic evaluations and animal research had suboptimal rates. Journals can enhance reporting guideline use and trial registration by directing authors to the EQUATOR Network, requiring adherence to registration and reporting standards, and clarifying language in author instructions.

Factors Influencing Physical Medicine and Rehabilitation Trainee Research Engagement.

ABSTRACT: Research engagement during physical medicine and rehabilitation residency and fellowship training is essential for advancing evidence-based medicine and fostering the development of clinician-scientists. Current Accreditation Council for Graduate Medical Education guidelines regarding research requirements during physical medicine and rehabilitation training are ambiguous, and it is unknown whether physical medicine and rehabilitation trainees receive adequate support to pursue research at the level they desire. This anonymous survey study aimed to identify perceived barriers and facilitators to research engagement among US physical medicine and rehabilitation residents and fellows. Our findings suggest that physical medicine and rehabilitation trainees value research engagement. However, research productivity during physical medicine and rehabilitation residency is limited, with many trainees reporting inadequate support and time to participate in research in a meaningful way. Additional support from residency and fellowship programs, including protected time for research, as well as research-specific education and mentorship should be considered to enhance physical medicine and rehabilitation trainee research engagement.

Learning Health Systems Research Competencies: A Survey of the Rehabilitation Research Community.

OBJECTIVE: The Learning Health Systems Rehabilitation Research Network (LeaRRn), an NIH-funded rehabilitation research resource center, aims to advance the research capacity of learning health systems (LHSs) within the rehabilitation community. A needs assessment survey was administered to inform development of educational resources. METHODS: The online survey included 55 items addressing interest in and knowledge of 33 LHS research core competencies in 7 domains and additional items on respondent characteristics. Recruitment targeting rehabilitation researchers and health system collaborators was conducted by LeaRRn, LeaRRn health system partners, rehabilitation professional organizations, and research university program directors using email, listservs, and social media announcements. RESULTS: Of the 650 people who initiated the survey, 410 respondents constituted the study sample. Respondents indicated interest in LHS research and responded to at least 1 competency item and/or demographic question. Two-thirds of the study sample had doctoral research degrees, and one-third reported research as their profession. The most common clinical disciplines were physical therapy (38%), communication sciences and disorders (22%), and occupational therapy (10%). Across all 55 competency items, 95% of respondents expressed "a lot" or "some" interest in learning more, but only 19% reported "a lot" of knowledge. Respondents reported "a lot" of interest in a range of topics, including selecting outcome measures that are meaningful to patients (78%) and implementing research evidence in health systems (75%). "None" or "some" knowledge was reported most often in Systems Science areas such as understanding the interrelationships between financing, organization, delivery, and rehabilitation outcomes (93%) and assessing the extent to which research activities will improve the equity of health systems (93%). CONCLUSION: Results from this large survey of the rehabilitation research community indicate strong interest in LHS research competencies and opportunities to advance skills and training. IMPACT: Competencies where respondents indicated high interest and limited knowledge can inform development of LHS educational content that is most needed.

Toward Uniform Insurer Coverage for Functional MRI Following Severe Brain Injury.

Functional magnetic resonance imaging (fMRI) now promises to improve diagnostic and prognostic accuracy for patients with disorders of consciousness, and accordingly has been endorsed by professional society guidelines, including those of the American Academy of Neurology, American College of Rehabilitation Medicine, National Institute on Disability, Independent Living, and Rehabilitation Research, and the European Academy of Neurology. Despite multiple professional society endorsements of fMRI in evaluating patients with disorders of consciousness following severe brain injury, insurers have yet to issue clear guidance regarding coverage of fMRI for this indication. Lack of insurer coverage may be a rate-limiting barrier to accessing this technique, which could uncover essential diagnostic and prognostic information for patients and their families. The emerging clinical and ethical case for harmonized insurer recognition and reimbursement of fMRI for vulnerable persons following severe brain injury with disorders of consciousness is explained and critically evaluated.

Impacts of Financial Assistance on Quality of Life Among People Living With Burn Injury: Matched Cohort Analysis of the National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System Database.

Disparities in socioeconomic status and minority status affect the risk of burn injury and the severity of that injury, thus affecting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Participants ≥18 from Burn Model System National Longitudinal Database (BMS) with complete demographic data were included (n = 4330). Nonresponders to financial assistance questions were analyzed separately. The remaining sample (n = 1255) was divided into participants who received financial assistance because of burn injury, those who received no financial assistance, and those who received financial assistance before injury and as a result of injury. A demographic and injury-characteristic comparison was conducted. Health-related quality of life metrics (Satisfaction with Life, Short Form-12/Veterans RAND 12-Item Health Survey, Community Integration Questionnaire Social Component, and the Post-Traumatic Growth Inventory) were analyzed preinjury, then 6-months, 1-year, and 2-years postinjury. A matched cohort analysis compared these scores. When compared to their no financial assistance counterparts, participants receiving financial assistance due to burns were more likely to be minorities (19% vs 14%), have more severe injuries (%TBSA burn 21% vs 10%), and receive workers' compensation (24% vs 9%). They also had lower health-related quality of life scores on all metrics except the post-traumatic growth inventory. Financial assistance may aid in combating disparities in posttraumatic growth scores for participants at the greatest risk of financial toxicity but does not improve other health-related quality of life metrics.

Making the Case for Patient-Reported Outcome Measures in Big-Data Rehabilitation Research: Implications for Optimizing Patient-Centered Care.

Advances in data science and timely access to health informatics provide a pathway to integrate patient-reported outcome measures (PROMs) into clinical workflows and optimize rehabilitation service delivery. With the shift toward value-based care in the United States health care system, as highlighted by the recent Centers for Medicare and Medicaid Services incentive and penalty programs, it is critical for rehabilitation providers to systematically collect and effectively use PROMs to facilitate evaluation of quality and outcomes within and across health systems. This editorial discusses the potential of PROMs to transform clinical practice, provides examples of health systems using PROMs to guide care, and identifies barriers to aggregating data from PROMs to conduct health services research. The article proposes 2 priority areas to help advance rehabilitation health services research: (1) standardization of collecting PROMs data in electronic health records to facilitate comparing health system performance and quality and (2) increased partnerships between rehabilitation providers, researchers, and payors to accelerate health system learning. As health care reform continues to emphasize value-based payment strategies, it is essential for the field of physical medicine and rehabilitation to be at the forefront of demonstrating its value in the care continuum.

Quality of reporting of economic evaluations in rehabilitation research: a systematic review.

BACKGROUND: The quality of reporting of health economic evaluations for rehabilitation services has been questioned, limiting the ability to provide accurate recommendations for health decisions. PURPOSE: To document current overall reporting quality of the published literature for economic evaluations of rehabilitation services using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and to identify factors that could influence the quality of reporting. DATA SOURCES: Electronic literature searches were performed using MEDLINE and the NHS Economic Evaluations Database via the Cochrane Library. STUDY SELECTION: Prospective rehabilitation economic evaluation articles from 2013 to 2020 were selected. DATA EXTRACTION: Data were extracted by one reviewer and independently verified by a second reviewer. DATA SYNTHESIS/RESULTS: Title and abstracts of 3,454 papers were reviewed. 204 papers were selected for a full text screening. From those, 129 potential papers were identified to be included in this study. LIMITATIONS: Only two databases were used in data collection, and papers were selected from 2013 to 2020 only. CONCLUSIONS: Inconsistent reporting in health economic evaluations of rehabilitation services has continued, despite the availability of the CHEERS checklist. The methods of the analyzed studies were frequently under-reported, thereby creating challenges in determining whether the results reported were valid.IMPLICATIONS FOR REHABILITATIONVariable quality of reporting has been identified in rehabilitation research assessing cost-effectiveness.To grow as an area of expertise, the field of rehabilitation must produce research demonstrating its cost-effectiveness.Both rehabilitation clinicians and funders would benefit from full and transparent information to identify optimal solutions for effective and efficient care.

The Value of Rehabilitation Interventions-Integrating Evidence, Clinical Expertise, Critical Assessment, and Patient Needs: A Conference Report.

To understand issues related to the value, outcomes, and cost-effectiveness of rehabilitation interventions, and to explore how scientific evidence, clinical expertise, and patient needs can be integrated, the Rehabilitation Research and Training Center on Developing Optimal Strategies in Exercise and Survival Skills to Increase Health and Function held a State of the Science Symposium on "The Value of Rehabilitation Interventions" at Shirley Ryan AbilityLab in Chicago in 2017. During this conference, 35 invited experts, including individuals with disabilities, professionals, and consumers, explored the topic of the "value" of rehabilitation interventions and discussed their perspectives on the means to integrate best scientific evidence with clinical expertise and patient preferences. This symposium also resulted in the production of several multifaceted articles providing perspectives on the topic of value and how to use evidence to best determine and demonstrate it. These articles comprise this supplement. The present article introduces the key concepts of value, evidence, and knowledge translation in an effort to provide a context for the articles that follow in the supplement.

Mini-review: Rehabilitation engineering: Research priorities and trends.

Rehabilitation Engineering is the use of engineering principles applied to rehabilitation, disability, and independent living. Google Scholar is a searchable resource that allows people from around the world to create profiles of their interests and collaborations, and it provides a means to search the broad scientific and technical literature. Google Scholar was used to identify the 150 most cited people who listed Rehabilitation Engineering in their profile. Research impact, characteristics, and areas of research of the most cited rehabilitation engineers were examined. Furthermore, gender and geographical differences in research metrics of the highest citied rehabilitation engineers were investigated. Consumer priorities in rehabilitation engineering were identified using a voice of consumer (VoC) survey and recent literature based on VoC studies. Gaps between research publication and activities and consumer priorities were identified to recommend seven areas of research with high demand and opportunity for growth and innovation. Implications.

A 'new normal' following COVID-19 and the economic crisis: Using systems thinking to identify challenges and opportunities in disability, telework, and rehabilitation.

BACKGROUND: The novel coronavirus (COVID-19) that emerged in late 2019, and later become a global pandemic, has unleashed an almost unprecedented global public health and economic crisis. OBJECTIVE: In this perspective, we examine the effects of COVID-19 and identify a likely 'new normal' in terms of challenges and opportunities within the fields of disability, telework, and rehabilitation. METHODS: We use a systems thinking lens informed by recent empirical evidence and peer-reviewed qualitative accounts regarding the pandemic to identify emerging challenges, and pinpoint opportunities related to health and changing employment infrastructure of people with disabilities and rehabilitation professionals. RESULTS: From our interpretation, the key leverage points or opportunities include: (1) developing disability-inclusive public health responses and emergency preparedness; (2) enabling employment and telework opportunities for people with disabilities; (3) addressing the new requirements in rehabilitation service provision, including participating as essential team members in the care of people with infectious diseases such as COVID-19; (4) embracing the added emphasis on, and capacity for, telehealth; and (5) developing greater resilience, distance learning, and employability among the rehabilitation workforce. CONCLUSIONS: The COVID-19 pandemic has become increasingly challenging to the lives of people with disabilities and rehabilitation professionals; however, key challenges can be minimized and opportunities can be capitalized upon in order to 'build back better' after COVID-19.

Intervention development and treatment success in UK health technology assessment funded trials of physical rehabilitation: a mixed methods analysis.

OBJECTIVES: Physical rehabilitation is a complex process, and trials of rehabilitation interventions are increasing in number but often report null results. This study aimed to establish treatment success rates in physical rehabilitation trials funded by the National Institute of Health Research Health Technology Assessment (NIHR HTA) programme and examine any relationship between treatment success and the quality of intervention development work undertaken. DESIGN: This is a mixed methods study. SETTING: This study was conducted in the UK. METHODS: The NIHR HTA portfolio was searched for all completed definitive randomised controlled trials of physical rehabilitation interventions from inception to July 2016. Treatment success was categorised according to criteria developed by Djulbegovic and colleagues. Detailed textual data regarding any intervention development work were extracted from trial reports and supporting publications and informed the development of quality ratings. Mixed methods integrative analysis was undertaken to explore the relationship between quantitative and qualitative data using joint displays. RESULTS: Fifteen trials were included in the review. Five reported a definitive finding, four of which were in favour of the 'new' intervention. Eight trials reported a true negative (no difference) outcome. Integrative analysis indicated those with lower quality intervention development work were less likely to report treatment success. CONCLUSIONS: Despite much effort and funding, most physical rehabilitation trials report equivocal findings. Greater focus on high quality intervention development may reduce the likelihood of a null result in the definitive trial, alongside high quality trial methods and conduct.

Assessment for incipient hospital-acquired deconditioning in acute hospital settings: A systematic literature review.

OBJECTIVES: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning. DESIGN AND DATA SOURCES: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018. STUDY SELECTION: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospital-acquired deconditioning were selected. Included instruments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument. DATA EXTRACTION: Hospital-acquired deconditioning assessment items. RESULTS: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity. CONCLUSION: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.

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.

Parallel short forms for the assessment of activities of daily living in cardiovascular rehabilitation patients (PADL-cardio): development and validation.

PURPOSE: To develop and validate parallel short forms for the assessment of activities of daily living in cardiac rehabilitation patients (PADL-cardio I & II). METHOD: PADL-cardio I & II were developed based on a sample of 106 patients [mean age = 57.6; standard deviation (SD) = 11.1; 72.6% males] using Rasch analysis and validated with a sample of 81 patients (mean age = 59.1; SD = 11.1; 88.9% males). All patients answered PADL-cardio and the Short Form 12 Health Survey. RESULTS: Both versions of PADL-cardio are composed of 10 items. The fit to the Rasch model was given documented by a non-significant Item-trait interaction score (PADL-cardio I: χ2 = 31.08, df = 30, p = 0.41; PADL-cardio II: χ2 = 45.6, df = 40, p = 0.25). The two versions were free of differential item functioning. Person-separation reliability was 0.72/0.78 and unidimensionality was given. The two versions correlated with r = 0.98 and the correlation between PADL-cardio and the underlying item bank was 0.99 for both versions. Concurrent validity is indicated through correlations with the Short Form 12 Health Survey (r = -0.37 to -0.40). CONCLUSION: PADL-cardio provides a short and psychometrically sound option for the assessment of activities of daily living in cardiovascular rehabilitation patients. The two versions of PADL-cardio are equivalent. Hence, they can be used to reduce practice and retest effects in repeated measurement, facilitating the longitudinal assessment of activities of daily living. Implications for Rehabilitation New parallel test forms for the assessment of activities of daily living in cardiac rehabilitation (PADL-cardio I & PADL-cardio II) are available. PADL-cardio I & II consist of 10 items and are therefore especially timesaving. Concurrent validity is given through correlations with the Short Form Health Survey 12. Therapeutic success could be determined more precisely by the parallel forms reducing practice and retest effects.

Association between social factors and performance during Functional Capacity Evaluations: a systematic review.

Purpose: Determine the association of different social factors with Functional Capacity Evaluation (FCE) performance in adults. Materials and methods: A systematic literature search was performed in MEDLINE, CINAHL, and PsycINFO electronic databases. Studies were eligible if they studied social factor's association with the performance of adults undergoing FCE. Studies were assessed on methodological quality and quality of evidence. The review was performed using best-evidence synthesis methods. Results: Thirteen studies were eligible and 11 social factors were studied. Considerable heterogeneity regarding measurements, populations, and methods existed among the studies. High quality of evidence was found for the association of FCE performance with the country of FCE and examiner's fear behavior; moderate quality of evidence with previous job salary; and low or very low quality of evidence with compensation status, litigation status, type of instruction, time of day (workday), primary or mother language, and ethnicity. Other social factors were not studied. Conclusions: Evidence for associations of various social factors with FCE performance was found, but robust conclusions about the strength of the associations cannot be made. Quality of evidence ranged from high to very low. Further research on social factors, also within a biopsychosocial context, is necessary to provide a better understanding of FCE performance. Implications for Rehabilitation Research on Functional Capacity Evaluation (FCE) performance and its association with biopsychosocial factors have scarcely addressed the impact of social factors, limiting full understanding of FCE results. The social factors, healthcare (examiner's fear behavior and type of instruction), personal or cultural systems (country of FCE, primary or mother language, and ethnicity), workplace system (previous job salary, time of day (workday)), and legislative and insurance system (compensation and litigation status), have a bearing in FCE performance. Better understanding of factors associating with functional capacity provide insights in FCE, allowing clinicians to improve the evaluations and interpretations of the assessment and better design the rehabilitation program. Better understanding of factors that influence FCE performance, and of unstudied factors, will allow researchers guidance to further investigate the construct of functional capacity.

LiveWell RERC State of the Science Conference Report on ICT Access to Support Community Living, Health and Function for People with Disabilities.

This article summarizes the proceedings of the three session State of the Science (SOS) Conference that was conducted by the Rehabilitation Engineering Research Center for Community Living, Health and Function (LiveWell RERC) in June 2019 in Toronto, Canada. RERCs customarily convene an SOS conference toward the end of their five-year funding cycle in order to assess the current state and identify potential future research, development, and knowledge translation efforts needed to advance their field. The first two sessions focused on the current and future state of information and communication technology (ICT) for mobile health (mHealth) and mobile rehabilitation (mRehab). The third session was a wide-ranging discussion of pressing needs for future research and development in the field. Several "big ideas" resulted from the discussion among participants in the SOS Conference that should inform the structure and operation of future efforts, including: (1) identifying active ingredients of interventions, (2) incorporating effective behavior-change techniques into all interventions, (3) including measures of social determinants of health in evaluation studies, (4) incorporating user-customizable features into technology solutions, and (5) ensuring "discoverability" of research and development outputs by stakeholders via structured and continuous outreach, education and training. Substantive areas of work include gaming and esports, the gamification of interventions for health and fitness, the cultivation of community supports, and continuous outreach and education wherever a person with a disability may live.

Challenges of Conducting Research With Young Offenders With Traumatic Brain Injury.

The purpose of this commentary is to highlight the challenges encountered when conducting research with young offenders. This is drawn from the first-hand experience of 3 researchers working on separate projects within this environment. Young offenders present as a complex clinical population with high levels of illiteracy, substance abuse, and mental health issues. Significant planning is therefore required before working with this group. Consideration must be given to the heterogeneity of prison populations alongside the potential limitations of datacollection methods, in particular, reliance on self-report. The capacity of young offenders to comprehend and effectively engage with research is also of concern, posing issues of both a practical and ethical nature. The absence of a consistent "research culture" within prison environments poses further practical challenges, potentially also placing significant burden on both researchers and prison resources. The challenges discussed in this article may help inform future studies in the area and emphasize the need for greater critical reflection among researchers conducting work of this type.

Association of Academic Physiatrists Federal Funding of Disability and Rehabilitation Research Position Statement.

The Association of Academic Physiatrists seeks to advocate for policies that are supportive of academic rehabilitation, with elected officials, agency leaders, and other policy makers. Accordingly, the Association of Academic Physiatrists' Public Policy Committee identifies policy issues of importance to the organizational mission, conducts background research on those issues, and develops position statements that articulate the organization's position. These position statements require approval by the Board of Trustees and are used to support advocacy efforts by Association of Academic Physiatrists' members. Federal funding for disability and rehabilitation research is an important issue for the Association of Academic Physiatrists and its members. This position statement addresses the need for greater federal funding in this area, better coordination of the agencies providing funding, and an appropriate balance of merit-based funding with funding targeted to building capacity in critical rehabilitation-relevant methodology and content areas.