The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness.

THE PROBLEM: Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19. HISTORY: Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided using other names (e.g. intermediate care). Patients with complex needs do not fit easily within this system. SYSTEM FAILURE: After Covid-19, patients have problems that cross existing condition-specific and/or treatment-specific services. Covid-19 has exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services. Consequently, in order to have their needs met, patients either have to engage with two or more separate services or they receive good management for some problems and sub-optimal management for other problems. THE GOALS: The multitude of small specific services need to coalesce into an integrated service able to meet all the needs of any patient referred. Second, rehabilitation needs to be fully integrated into all healthcare services. A SOLUTION: The purpose of healthcare is to 'improve our health and well-being . . . to stay as well as we can to the end of our lives'. (NHS constitution) All healthcare services need to consider patients holistically, giving equal attention to disease, disability, and distress. Rehabilitation, acute care, mental health and palliative care services need to work in parallel to achieve this purpose. Healthcare providers, supported by commissioners and rehabilitation experts, could achieve structural and organisational change, meeting the needs of patients.

[Dermatological rehabilitation : Program content, opportunities and application submission]. / Rehabilitation in der Dermatologie : Inhalte, Chancen und der Weg dorthin.

Among dermatologists, the opportunities regarding medical dermatological rehabilitation for cutaneous chronic inflammatory and dermato-oncological diseases are not fully exhausted. However, rehabilitation offers the chance to approach important aspects such as comorbidities, psychosocial burden and limitations at work in addition to treating the underlying disease itself. Furthermore, rehabilitation has the potential to relieve the dermatologist from healthcare responsibilities and to achieve treatment and healthcare targets much faster. The patients themselves are the ones who profit from a holistic dermatological and social medical regimen. In the following article the reader learns about the details of a specific dermatological rehabilitation program, how to successfully apply for it and which wording is essential.

Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center.

Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.

[Diagnostic and therapeutic therapeutic pathways, including rehabilitative ones or only "discharge" rehabilitation?] / Percorsi diagnostico terapeutici assistenziali anche riabilitativi o riabilitazione "da scarico"?

SUMMARY: Due to epidemiological and social changes related to the increase in the average life expectancy, hospital users are characterized by elderly chronic and comorbid patients who require recurrent hospitalizations often with disability outcomes. In this framework, an innovative clinical and management hospitalization model is the adequate answer to systematically promote the patient independence. Main features are interdisciplinary and integrated care pathways facing both disease and disability biologically and functionally diagnosed by ICD and ICF. The definition, personalization of pathways/protocols and outcome evaluation represent the foundations of this new model for patient care. The digitalization of hospital clinical data and medical knowledge make the model feasible and fitting the recent WHO guideline: recommendations on digital interventions for health system strengthening.

[Towards a baseline ontology for information technology in rehabilitation medicine: the nomenclator of the rehabilitation procedures]. / Verso un'ontologia di riferimento per i sistemi informativi in medicina riabilitativa: il nomenclatore delle prestazioni riabilitative.

SUMMARY: One of the main aims of Healthcare Information Technology is the safe and efficient management of significant amounts of clinical data. Now more than ever, such goal requires the creation of common semantics to ontologically organize knowledge enclosed in databases. By means of the application of the WHO ICD-ICF frameworks, the ensemble of rehabilitative activities lead in all the Maugeri institutes in Italy, has been formally standardized to create a Nomenclator, with the aim to: a) support clinicians in the definition of the individualized Care Pathway; b) program, optimize and maximize patient's rehabilitation activities, according to clinical and organizational requirements; c) qualitatively and quantitatively report the daily health-care professionals' workflows; d) provide a structured and detailed medical record meeting appropriateness requirements. In this regard, the application of the ICD-ICF framework as a baseline ontology, paves the path to an ongoing tracking of the rehabilitation processes, leading to a more accurate description of patient's functioning profile. The upcoming challenge for rehabilitation is the ultimate overcoming of a solely epidemiological perspective, in order to embrace a holistic approach, fostered by ontologically-based information technologies.

A mixed-methods approach to understanding partnership experiences and outcomes of projects from an integrated knowledge translation funding model in rehabilitation.

BACKGROUND: Integrated knowledge translation (IKT) can optimize the uptake of research evidence into clinical practice by incorporating knowledge users as equal partners in the entire research process. Although several studies have investigated stakeholder involvement in research, the literature on partnerships between researchers and clinicians in rehabilitation and their impact on clinical practice is scarce. This study described the individual research projects, the outcomes of these projects on clinical practice and the partnership experiences of an initiative that funds IKT projects co-led by a rehabilitation clinician and a researcher. METHODS: This was a sequential explanatory mixed methods study where quantitative data (document reviews and surveys) informed the qualitative phase (focus groups with researchers and interviews with clinicians). Descriptive analysis was completed for the quantitative data and thematic analysis was used for the qualitative data. RESULTS: 53 projects were classified within multiple steps of the KTA framework. Descriptive information on the projects and outcomes were obtained through the survey for 37 of the 53 funded projects (70%). Half of the respondents (n = 18) were very satisfied or satisfied with their project's impact. Only two (6%) projects reported having measured sustainability of their projects and four (11%) measured long-term impact. A focus group with six researchers and individual interviews with nine clinicians highlighted the benefits (e.g. acquired collaborative skills, stronger networks between clinicians and academia) and challenges (e.g. measuring KT outcomes, lack of planning for sustainability, barriers related to clinician involvement in research) of participating in this initiative. Considerations when partnering on IKT projects included: the importance of having a supportive organization culture and physical proximity between collaborators, sharing motives for participating, leveraging everyone's expertise, grounding projects in KT models, discussing feasibility of projects on a restricted timeline, and incorporating the necessary knowledge users. Clinicians discussed the main outputs (scientific contribution, training and development, increased awareness of best practice, step in a larger effort) as project outcomes, but highlighted the complexity of measuring outcomes on clinical practice. CONCLUSION: The study provides a portrait of an IKT funding model, sheds light on past IKT projects' strengths and weaknesses and provides strategies for promoting positive partnership experiences between researchers and rehabilitation clinicians.

Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study.

OBJECTIVE: To investigate a model of community-based case management (CM). SETTING: New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP). PARTICIPANTS: All clinicians (N = 72) providing CM within 14 BIRP community rehabilitation teams. DESIGN: A prospective, multicenter study. MAIN MEASURES: A purpose-designed survey. METHODS: Participants from the 12 adult and 2 pediatric services (8 located in metropolitan areas, 6 in rural areas) completed a 3-part survey investigating their organizational context, clinical approach, and CM interventions. Between-groups analyses explored differences among individual services, as well as differences based on age (adult vs pediatric) and location (metropolitan vs rural). RESULTS: All services provided a direct service model of CM. The underlying principles were uniform across services (more direct than indirect service provision; with more client-related than administrative-related tasks; more holistic than service-led in defining client needs; with decision making equally directed by staff and clients; and undertaking a more comprehensive than minimalist range of tasks). CM interventions included the provision of individual support, family support, advocacy, and community development alongside assessment, monitoring, referral, and liaison tasks. There were little differences in practice based on age or location. CONCLUSION: The NSW BIRP has drawn upon the results to produce a model of service for CM.

[Infantile acquired brain injury, a personal experience. Demands from the socio-familial point of view]. / Daño cerebral sobrevenido infantil, una experiencia personal. Reclamaciones desde el punto de vista sociofamiliar.

We report on the experience of a family in which the youngest child has acquired brain injury and the struggle undertaken by the family to improve the neurorehabilitation resources in the public health service. The article outlines the main demands, from the socio-familial point of view, as regards the improvement of neurological rehabilitation and the resources needed to deliver it.

TITLE: Daño cerebral sobrevenido infantil, una experiencia personal. Reclamaciones desde el punto de vista sociofamiliar.Se describe la experiencia de una familia en la que el hijo menor tiene daño cerebral sobrevenido y la lucha emprendida por la familia para mejorar los recursos neurorrehabilitadores de la sanidad publica. Se recogen las principales reclamaciones, desde el punto de vista sociofamiliar, en cuanto a la mejora en la atencion neurorrehabilitadora y los recursos necesarios.

Evaluation of the implementation of an integrated program for musculoskeletal system care. / Evaluación de la implementación de un programa integrado de atención a las enfermedades del aparato locomotor.

INTRODUCTION: The chronic nature of musculoskeletal diseases requires an integrated care which involves the Primary Care and the specialities of Rheumatology, Traumatology and Rehabilitation. The aim of this study was to assess the implementation of an integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease using Deming's continuous improvement process and considering referrals and resource consumption. MATERIAL AND METHODS: A simulation model was used in the planning to predict the evolution of musculoskeletal diseases resource consumption and to carry out a Budget Impact Analysis from 2012 to 2020 in the Goierri-Alto Urola region. In the checking stage the status of the process in 2014 was evaluated using statistical analysis to check the degree of achievement of the objectives for each speciality. RESULTS: Simulation models showed that population with musculoskeletal disease in Goierri-Alto Urola will increase a 4.4% by 2020. Because of that, the expenses for a conventional healthcare system will have increased a 5.9%. However, if the intervention reaches its objectives the budget would decrease an 8.5%. The statistical analysis evidenced a decline in referrals to Traumatology service and a reduction of successive consultations in all specialities. DISCUSSION: The implementation of the integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease is still at an early stage. However, the empowerment of Primary Care improved patient referrals and reduced the costs.

Efectividad de la imaginería o práctica mental en la recuperación funcional tras el ictus: revisión sistemática / Effectiveness of motor imagery or mental practice in functional recovery after stroke: a systematic review

Introducción: En las últimas décadas han surgido diferentes métodos de tratamiento rehabilitador para pacientes con hemiparesia. Uno de ellos es la práctica mental (PM) del movimiento, consistente en la evocación de un movimiento o gesto por parte del sujeto con el fin de aprender o mejorar su ejecución. A pesar de que las técnicas de neuroimagen han demostrado que durante la PM se ejecutan patrones de activación neuronal similares a los que aparecen durante el movimiento, es necesario demostrar su efectividad clínica en la rehabilitación y recuperación funcional de pacientes. Desarrollo: Para ello, entre diciembre de 2011 y octubre de 2012 se realizó una búsqueda sistemática en las principales plataformas bibliográficas y bases, seleccionándose 23 ensayos clínicos referentes a distintos protocolos de PM en pacientes con hemiparesia. Conclusiones: La PM es efectiva cuando se combina con terapia convencional en la recuperación funcional del miembro tanto inferior como superior, así como para el entrenamiento de actividades y gestos cotidianos. Dada la heterogeneidad de los estudios en cuanto a la técnica de evocación mental, el volumen de entrenamiento, los sujetos incluidos…, se necesitan más estudios para determinar el tipo de paciente y el protocolo ideal de tratamiento

Introduction: In recent decades, many stroke rehabilitation methods have been developed. Mental practice (MP) is a dynamic state in which the subject evokes an imaginary representation of a motor action or skill in order to learn or perfect that action. Although functional imaging has shown that MP produces similar cortical activation patterns to those of movement, the clinical effectiveness of such methods in rehabilitation and functional recovery has yet to be demonstrated. Development: Systematic search of all clinical studies published in the main scientific databases between December 2011 and October 2012 concerning mental practice in stroke rehabilitation. We selected 23 clinical trials testing different MP protocols in patients with hemiparesis. Conclusions: MP is effective when used in conjunction with conventional physical therapy for functional rehabilitation of both upper and lower limbs, as well as for the recovery of daily activities and skills. Owing to the heterogeneity of the studies with regard to the intervention protocol, specific imagery technique, time spent practicing, patient characteristics, etc., more studies are needed in order to determine the optimal treatment protocol and patient profile

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.

[Development of a consented set of criteria to evaluate post-rehabilitation support services]. / Entwicklung eines konsentierten Kriterien-Sets zur Bewertung von Reha-Nachsorgeangeboten.

OBJECTIVE: Existing rehabilitation aftercare offers in Germany are heterogeneous, and there is a lack of transparency in terms of indications and methods as well as of (nationwide) availability and financial coverage. Also, there is no systematic and transparent synopsis. To close this gap a systematic review was conducted and a web-based database created for post-rehabilitation support. To allow a consistent assessment of the included aftercare offers, a quality profile of universally valid criteria was developed. This paper aims to outline the scientific approach. METHODOLOGY: The procedure adapts the RAND/UCLA method, with the participation of the advisory board of the ReNa project. Preparations for the set included systematic searches in order to find possible criteria to assess the quality of aftercare offers. These criteria first were collected without any pre-selection involved. Every item of the adjusted collection was evaluated by every single member of the advisory board considering the topics "relevance", "feasibility" and "suitability for public coverage". Interpersonal analysis was conducted by relating the median and classification into consensus and dissent. All items that were considered to be "relevant" and "feasible" in the three stages of consensus building and deemed "suitable for public coverage" were transferred into the final set of criteria (ReNa set). RESULTS: A total of 82 publications were selected out of the 656 findings taken into account, which delivered 3,603 criteria of possible initial relevance. After a further removal of 2,598 redundant criteria, the panel needed to assess a set of 1,005 items. Finally we performed a quality assessment of aftercare offers using a set of 35 descriptive criteria merged into 8 conceptual clusters. CONCLUSION: The consented ReNa set of 35 items delivers a first generally valid tool to describe quality of structures, standards and processes of aftercare offers. So finally, the project developed into a complete collection of profiles characterizing each post-rehabilitation support service included in the database.

Exploring the scope of community-based rehabilitation in ensuring the holistic development of differently-abled people.

BACKGROUND: Globally, it has been estimated that almost 15% of world's population live with some form of disability, of which the majority are from developing nations. OBJECTIVES: To explore the role of community-based rehabilitation (CBR) in the health sector, identify the prevalent challenges, and to suggest measures to facilitate its smooth implementation in community. METHODS: An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline and World Health Organization. Keywords used in the search included community, community-based rehabilitation, disabled, and public health. RESULTS: The notion of community-based rehabilitation (CBR) emerged in 1978 with an aim to improve the accessibility of disabled people to rehabilitation services, especially in developing countries, by ensuring optimal use of locally available resources. CBR programs support people with disabilities by providing health services at their doorsteps, and thus estalish a strong linkage between people with disabilities and the health-care system. CONCLUSION: CBR encompasses a set of interventions that are implemented for a diverse and complex group of disabled people, and thus necessitates careful planning and systematic execution for ensuring welfare of these vulnerable people.

[Integrated stroke care]. / Integrierte Versorgung bei Schlaganfall.

The structures and processes of stroke care provision in the acute and chronic phases, during rehabilitation and societal integration, the needs of patients, and the means of meeting those needs are described and analyzed. Deficits mainly involve local multidisciplinary professional aid, focusing on participation under the supervision of a neurologist experienced in rehabilitation. Deficits are mainly caused by a lack of funding from statutory and private health insurance.

[Geriatric health care structures in Germany. The cross-border cooperation in geriatric medicine as a needs-driven further development]. / Geriatrische Versorgungsstrukturen in Deutschland. Der Geriatrische Versorgungsverbund als bedarfsgerechte Weiterentwicklung.

BACKGROUND: To cover future needs of specialised geriatric patient-centred care, existing structures need to be developed further. MATERIALS AND METHODS: Taking into account regional structures of providing care, the Federal Association of Geriatric Medicine in Germany developed the concept of Cross-Border Cooperation in Geriatric Medicine. RESULTS: This concept combines specific geriatric expertise provided by inpatient health care with specialised networking in ambulatory treatment of elderly with a typical geriatric profile. The objective is to provide geriatric patients with a holistic and specific care and case management that overcomes existing limitations.

[The Karachi health resort: synthesis of science and practice].

This article is devoted to the history of one of the oldest Siberian health resorts known as "The Karachi Lake". It describes the stages of its development, the scientific component of the system of spa-and-resort therapy and medico-social rehabilitation of the patients. The detailed analysis of the mechanisms underlying the beneficial action of the natural therapeutic factors, cooperation with the leading research institutions, and the formation of the modern scientific and technical basis have strengthened the position of the resort on the market of the medical, health-promoting, and recreational services due to the development of the new activities in this field.