National Institutes of Health Research Plan on Rehabilitation: Analysis and Progress.

OBJECTIVE: To summarize the progress toward the National Institutes of Health (NIH) Research Plan on Rehabilitation goals and the methods by which tracking occurred. DESIGN: Each grant award was manually coded by NIH staff for research plan goals, type of science categories (eg, basic, applied, infrastructure, etc), and if applicable, training, and then validated by NIH institute and center (IC) experts. Data for years 2015 through 2017 were used to develop a coding algorithm to automatically code grants in 2018 for validation by NIH IC experts. Additional data for all years (2015-2018) were also analyzed to track changes and progress. SETTING: The research utilized administrative data from NIH Reporter and internal NIH databases. PARTICIPANTS: The data sample included research grants and programs funded from fiscal years 2015 through 2018. The year 2015 was considered a baseline year as the research plan was published in 2016. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome measures were substantial growth in NIH funding and numbers of awards for rehabilitation research, across most research plan goals and types of science, as well as validation of an automatic algorithm for coding grants. RESULTS: Number of grants, funding dollars, funding mechanisms, patent data, scientific influence and translational science, research plan goals, and type of science categories were tracked across years (2015-2018). Algorithm validation is presented for 2018 data. CONCLUSIONS: NIH advanced the goals stated in the Research Plan on Rehabilitation, but gap areas remain. Though funding in this portfolio is growing, continued focus and participation by the field is needed to advance rehabilitation science.

The COVID-19 rehabilitation pandemic.

The coronavirus disease 2019 (COVID-19) pandemic and the response to the pandemic are combining to produce a tidal wave of need for rehabilitation. Rehabilitation will be needed for survivors of COVID-19, many of whom are older, with underlying health problems. In addition, rehabilitation will be needed for those who have become deconditioned as a result of movement restrictions, social isolation, and inability to access healthcare for pre-existing or new non-COVID-19 illnesses. Delivering rehabilitation in the same way as before the pandemic will not be practical, nor will this approach meet the likely scale of need for rehabilitation. This commentary reviews the likely rehabilitation needs of older people both with and without COVID-19 and discusses how strategies to deliver effective rehabilitation at scale can be designed and implemented in a world living with COVID-19.

Taking the Next Steps in Regenerative Rehabilitation: Establishment of a New Interdisciplinary Field.

The growing field of regenerative rehabilitation has great potential to improve clinical outcomes for individuals with disabilities. However, the science to elucidate the specific biological underpinnings of regenerative rehabilitation-based approaches is still in its infancy and critical questions regarding clinical translation and implementation still exist. In a recent roundtable discussion from International Consortium for Regenerative Rehabilitation stakeholders, key challenges to progress in the field were identified. The goal of this article is to summarize those discussions and to initiate a broader discussion among clinicians and scientists across the fields of regenerative medicine and rehabilitation science to ultimately progress regenerative rehabilitation from an emerging field to an established interdisciplinary one. Strategies and case studies from consortium institutions-including interdisciplinary research centers, formalized courses, degree programs, international symposia, and collaborative grants-are presented. We propose that these strategic directions have the potential to engage and train clinical practitioners and basic scientists, transform clinical practice, and, ultimately, optimize patient outcomes.

[Rehabilitation medicine and appropriateness criteria: between chronicity, multi-morbidity and complexity]. / La medicina riabilitativa e i criteri di appropriatezza: tra cronicità, multimorbilità e complessità.

SUMMARY: In the last two decades, population aging has led to a substantial increase in the number of people living with moderate-to-severe disability and, consequently, an increased demand for rehabilitation care. It is estimated that, currently, 2.8 million people live with severe disability in Italy. Although greater access to rehabilitation care is required to meet the needs of disabled patients, the capacity to provide rehabilitation has not changed over the last years and fails to meet current rehabilitation needs. Efforts should be devoted for aligning the capacity to provide rehabilitation care to the increased demand for rehabilitation care.

Predicting outcomes within an innovative post-acute rehabilitation model for older adults.

BACKGROUND: Understanding the provision of health services to community-dwelling older adults is of great importance due to regulatory changes within post-acute care. The aim of this study was to illustrate pathways by which older adults, within an innovative post-acute care delivery model, move to either independence or re-admission back into higher levels of care to maximize the value of rehabilitation delivery. METHODS: Clinical data specific to an episode of care (n = 30,001) provided to Medicare beneficiaries treated via a rehabilitation house-calls model of care in their homes and senior living communites were separated into training and test sets. Classification trees were fit on the training set's administrative and clinical variables. Descriptive statistics were calculated for the overall sample, patient characteristics, clinical characteristics, and clinical outcomes. RESULTS: Subjects were 83.3 years on average, 69.4% were female, and 62.2% were seen in their own homes while 37.8% were in senior living. The key variables predictive of progressing to independence were total number of visits, the presence of the Patient Specific Functional Scale (PSFS), PSFS score at discharge and change in PSFS. Prediction accuracy of the classification tree on the test set was 82.4%. CONCLUSIONS: Older adults progress to a higher degree of independence, instead of higher levels of care, via several distinct pathways within a rehabilitation house-calls model of care. A mix of service utilization and outcome variables are key predictors of each pathway and may be used to maximize the value of service delivery. Further examination of the predictors of outcome using administrative datasets drawn from different sub-sets of older adults across the post-acute care continuum is warranted.

Introducing early and structured rehabilitation in critical care: A quality improvement project.

OBJECTIVES: To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation. DESIGN: Fifteen-month prospective before/after quality improvement project. SETTING: Seven-bed mixed dependency critical care unit. PARTICIPANTS: 209 patients admitted to critical care for ≥4 days. INTERVENTION: A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care. MAIN OUTCOME MEASURE: Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care. RESULTS: Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019). CONCLUSION: The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.

[Changes in disability, reduced working ability and rehabilitation benefits in Hungary between 1990 and 2015]. / A rokkantság, megváltozott munkaképesség, rehabilitációs ellátások változása Magyarországon 1990 és 2015 között.

INTRODUCTION: In our study, based on the data of the last 25 years, we analyzed the changes in the cash benefits paid to people with reduced working capacity, currently accounting for nearly 30% of the budget of the National Health Insurance Fund of Hungary. AIM: The purpose of our study is to compare the statistical data of the past 25 years and the changes in the legal environment. METHODS: Our research was based on the data series of the National Health Insurance Fund of Hungary and the Hungarian Central Statistical Office as well as on the public finance reports of the State Audit Office of Hungary and the Ministry for National Economy. For the period under review, we analyzed the extent of the cash benefits paid to people with reduced working capacity, the measures taken to reduce these benefits, and the related legal background. In the long term, we examined the relevant dimension of the complex sociological processes in the background as well as the medical evaluation of the changed working ability. RESULTS: In the last 25 years, benefits (annuity, retirement) paid under different denominations (disability, work ability reduction, health impairment, rehabilitation benefit) are still a decisive part of the health insurance budget (HUF 315 billion in 2016). Serious efforts have been made to replace the previously funded system of invalidity pension and annuity system, with the complex medical, occupational, and social rehabilitation, maintenance and improvement of the remaining state of health. The purpose of the measures is essentially to reduce budget expenditures and to improve the utilization of the amount paid on rehabilitation benefits. CONCLUSION: The sociological changes that occurred during the long period of time regrettably helped to initially increase the number of recipients of invalidity benefits, to stabilize them at a high level and to have a significant burden on the budget. This could not be counterbalanced by the rehabilitation approach of money supply either. Orv Hetil. 2019; 160(Suppl 1): 29-36.

[Cochrane and World Health Organization "Rehabilitation 2030: a call for action".] / Cochrane e "Rehabilitation 2030: a call for action" dell'Organizzazione Mondiale della Sanità.

INTRODUCTION: The World Health Organization (WHO) has launched in February 2017 "Rehabilitation 2030: a call for action". This is likely to have a deep impact in the Health Systems in the next few years. The new Cochrane Rehabilitation Field has been invited by WHO as a relevant stakeholder in this effort. WHO recognizes the dramatic changes in health and demographic profiles of populations that are characterizing the 21st century. Main goals of WHO are to ensure healthy lives and promote well-being for all at all ages, and to promote healthy life expectancy. METHODS: Health systems and health policies are placing increased emphasis on services targeted at improving functioning, and not only at decreasing morbidity and mortality. According to WHO, rehabilitation could be an answer to this need. Cochrane's strategy becomes significant in this context, as it is based on the production of high-quality evidence through systematic reviews to inform health decision making. RESULTS: Cochrane Rehabilitation is the appropriate instrument in this endeavour: its main goal is to convey to all rehabilitation professionals the best available evidence, but also to improve the Cochrane methods for evidence synthesis. This will help rehabilitation professionals to make decisions according to the best and most appropriate evidence. CONCLUSION: An important challenge of Cochrane Rehabilitation in the next future is to respond to the WHO "Rehabilitation 2030" call for action.

[A Projection of the Need for Rehabilitation in Germany Till 2040 Based on Demographic Factors]. / Eine Fortschreibung des Rehabilitationsbedarfs in Deutschland bis 2040 anhand demografischer Faktoren.

The demographic changes in Germany leads to a significant shift in the composition of the population and the workforce, this affecting the future need for medical rehabilitation. This paper estimates the future change in rehabilitation demand based on a forecast for demographic changes till 2040. First, the sensitivity of the rehabilitation demand with respect to demographic factors is estimated. Second, the demographic factors are projected by stochastic methods, resulting in forecasts for the future need for medical rehabilitation. The projections show that the short-term demand is likely to rise. Theoretically, yearly wage increases of about 2.2% are needed for covering the increasing medical rehabilitation costs from 2010 till 2017. For the mid-term demand, the model predicts a slight decline in rehabilitation cases. Considering all these facts, the budget for rehabilitation will probably not cover the future costs for rehabilitation. However, the long-term forecast is subject to considerable uncertainty.

Uso de tecnología en rehabilitación / Use of technology in rehabilitation

Technology has had a great impact in daily life, and also in medicine. In rehabilitation, it has been introduced for assistance of disabilities, improve adherence to therapies, etc. There is a gap in the needs of these devices and the access to them, and one of the issues is that there are few trained personnel. This narrative review focuses on some definitions of robotics, wearable technology and virtual reality, with the aim of providing the reader of basic knowledge to understand further research in the area. Some examples of applications of technology in stroke, spinal cord injury and brain injury are summarized. (AU)

The Unmet Need for Postacute Rehabilitation Among Medicare Observation Patients: A Single-Center Study.

BACKGROUND: Medicare beneficiaries admitted under observation status must pay for postacute inpatient rehabilitation (PAIR) services, out of pocket, at potentially prohibitive costs. OBJECTIVE: To determine if there is an unmet need for PAIR among Medicare observation patients and if this care is associated with longer hospital stay and increased rehospitalization. DESIGN/SETTING: Observational study using electronic medical record and administrative data from a regional health system. PATIENTS: 1323 community-dwelling Medicare patients admitted under observation status. MEASUREMENTS: Summary statistics were calculated for demographic and administrative variables. Physical therapy (PT) and case management recommendations for a representative sample of 386 medical records were reviewed regarding need for PAIR services. Linear regression was used to measure the association between PT recommendation and hospital length of stay, adjusting for ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis, age, sex, and provider. Chi-square test was used to determine the association between PT recommendation and 30-day hospital revisit. RESULTS: Of the 1323 study patients, 11 (0.83%) were discharged to PAIR facilities. However, 17 (4.4%) of the 386 patients whose charts were reviewed received a recommendation for this care. Adjusted mean hospital stay was longer (P ⟨ 0.001) for patients recommended for rehabilitation (75.9 h) than for patients with no PT needs (46.8 h). In addition, the 30-day hospital revisit rate was higher (P = 0.037) for the patients who had been recommended for rehabilitation (52.9%, 9/17) than for those who had not (25.4%, 30/118). CONCLUSIONS: Medicare observation patients' potential need for PAIR services is 5- to 6-fold higher than their use of these services. Observation patients recommended for this care may have worse outcomes. Journal of Hospital Medicine 2017;12:168-172.

[Trends in Medical Rehabilitation : Supply Structure and Target Groups]. / Trends in der medizinischen Rehabilitation : Angebotsstruktur und Zielgruppen.

Medical rehabilitation in Germany has been changing continuously since its inception following the Bismarck Legislation. This article describes its development in past years and discusses quantitative and qualitative changes. Central quantitative changes are discussed using the examples of rehabilitation utilisation, spectrum of diseases, setting and follow-up rehabilitation. Important qualitative changes in medical rehabilitation pertain to multiple morbidities, the emphasis on work-related problems in rehabilitative concepts and their implementation, more flexible forms of rehabilitation, prevention, rehabilitation for people from other countries, mobile rehabilitation and rehabilitation after-care (also with new media). The article ends with an outlook on future developments within legislation, access to rehabilitation and the budget for rehabilitation, in addition to cooperation with the workplace.

Pulmonary Rehabilitation Utilization in Older Adults With Chronic Obstructive Pulmonary Disease, 2003 to 2012.

PURPOSE: To assess the trends in pulmonary rehabilitation (PR) utilization and factors associated with its use in older adults with chronic obstructive pulmonary disease (COPD). METHODS: We examined data for Medicare beneficiaries with COPD who received PR from January 1, 2003, to December 31, 2012. Persons with COPD were identified by (1) ≥2 outpatient visits >30 days apart within 1 year with an encounter diagnosis of COPD or (2) an acute care hospitalization with COPD as the primary diagnosis or a primary diagnosis of acute respiratory failure with a secondary discharge diagnosis of COPD. PR utilization was the study outcome identified by health care common procedure coding system codes G0237, G0238, G0239, and G0424 (after year 2010) or current procedural terminology codes (97001, 97003, 97110, 97116, 97124, 97139, 97150, 97530, 97535, and 97537) in a calendar year. RESULTS: Patients with COPD who received PR increased from 2.6% in 2003 to 3.7% in 2012 (P = .001). In a multivariable analysis, factors associated with receipt of PR were younger age, non-Hispanic white race, high socioeconomic status, multiple comorbidities (OR = 1.20; 95% CI = 1.13-1.27), and evaluation by a pulmonary physician (OR = 2.23; 95% CI = 2.13-2.33). Increased use of PR was attributed to prior users rather than new users of PR. CONCLUSIONS: Utilization of PR during the study period increased only 1.1% in these Medicare beneficiaries with COPD and remained low.

Rehabilitation - a new approach. Part four: a new paradigm, and its implications.

This editorial proposes changes in healthcare services that should greatly improve the health status of all patients with disability. The main premises are that: rehabilitation usually involves many actions delivered by many people from different organisations over a prolonged period; specific rehabilitation actions cover a wide range of professional activities, with face to face therapy only being one; and the primary patient activity that improves function is practice of personally relevant activities in a safe environment. This editorial argues that: rehabilitation should occur at all times and in all settings, in parallel with medical care in order to maximise recovery and to avoid loss of fitness, skills and confidence associated with rest and being cared for; hospitals and other healthcare settings should adapt the environment to encourage practice of activities at all times; and that measuring rehabilitation, whether in research or for re-imbursement, should not simply consider face-to-face 'therapy time' but must include: all the other important activities undertaken by the team; 'structures' such as the appropriateness of the environment; and a process measure of the time spent by patients undertaking activities.