Need for rehabilitation teamwork training in Europe.

Teamwork is the cornerstone of rehabilitation medicine. Rehabilitation workers in European countries are well educated in their own disciplines and attain appropriate professional knowledge; however, they lack educational opportunities for acquiring skills and attitudes necessary for effective teamwork, mainly communication, cooperation, and leadership. Consequently, teamwork is compromised and rehabilitation effectiveness reduced. Therefore, training in these components of professional competence needs scaling up in order to increase their impact on rehabilitation care.

Rehabilitation medicine in countries of Central/Eastern Europe.

PURPOSE: To describe attributes of rehabilitation medicine common to the five countries of Central Eastern Europe (CEE) and their implications for future challenges. METHODS: Critical collection and study of pertinent data on evolvement and present state of rehabilitation medicine in CEE countries by a coordinated team of rehabilitation experts from each of the relevant countries. RESULTS: CEE countries are similar in their need for rehabilitation medicine, its evolvement, present state and current practice. Settings largely emerged without strategic planning on the national level and lagged behind those in Central and Western Europe both in time and content. CONCLUSION: The framework that evolved in all except Slovenia is not appropriate to needs. In order to meet future challenges all five CEE countries need the incorporation of inpatient, outpatient and community-based rehabilitation into one system.

The system for medical rehabilitation in Croatia.

PURPOSE: To describe the framework for medical rehabilitation in Croatia and to discuss its influence on the practice of the specialty. METHODS: Collection, analysis and interpretation of data pertaining to the need for medical rehabilitation in the country and to its elements of structure, process and outcome of care. RESULTS: The practice of medical rehabilitation in Croatia has evolved without strategic planning on the national level and therefore without a designed system. This lack in the present framework causes shortcomings in all three elements of rehabilitation care and impedes the advancement of the specialty. CONCLUSION: Medical rehabilitation in Croatia needs a national strategic plan for a three-level system that incorporates inpatient, outpatient and community-based rehabilitation.

Rehabilitation medicine in Croatia -- sources and practice.

Sources of rehabilitation medicine, the need for rehabilitation and its practice in Croatia were studied, based on available data. The study revealed that current practice has advanced since the country's independence, but that there are many shortcomings; adequate care is not provided to all who could benefit from it, and there is wastage of resources.

Tai Chi Chuan practice in community-dwelling persons after stroke.

Eighteen community-dwelling first-stroke survivors, aged 45 to 65, underwent following examinations: Romberg's Test, standing on the unaffected leg, Emory Fractional Ambulation Profile, the Berg Balance Test, the Timed 'Up and Go' Test and the Duke Health Profile. They were then randomly divided into two matched groups of 9 subjects each. The study group (SG) received Tai Chi exercises and the control group (CG) physiotherapy exercises focused on improvement of balance, both groups for 1 h twice weekly for 12 weeks. On completion of exercises, SG subjects showed improvement in social and general functioning whereas CG subjects showed improvement in balance and speed of walking. It is concluded that there are potential and no adverse effects in Tai Chi practice in stroke survivors.

Academic medicine and quality of medical care.

Academic medicine comprises education, research, and medical care, respectively provided by medical schools, research institutions, and teaching hospitals. Thus far, academic medicine has been unsuccessful in establishing, protecting, promoting, and improving the quality of care. Its role in that area should therefore be reconsidered. Quality improvement activities require constant planning and perseverance, explicit standards of good practice, quantitative measurement, and comparison with previous performance or the performance of others. Preparedness and willingness to change attitude, approach, and behavior are pivotal to the success of such activities. Early exposure of medical students to the principles and practices of quality of care improvement would be a starting point for a life long process of experience-based learning that allows physicians to change and improve practice through the application of relevant knowledge and skills. It is essential that changes in graduate and postgraduate education and training be introduced, to improve an understanding of the importance of focusing on the care process from the patient's perspective as well as on the need for interdisciplinary cooperation and team performance as prerequisites for good medical care. Their education should also emphasize the measurement of the quality of delivered care, provide an understanding of the demand of society for accountability and how to meet it, as well as competence in using the principles and practice of quality improvement to provide, document, and improve the quality of care in institutions of academic medicine.

Effectiveness of home rehabilitation after stroke in Israel.

On discharge from an acute general hospital after a stroke, 191 patients were in need of, and were appropriate for, multidisciplinary rehabilitation. One-hundred-and-one patients (52.4%) received it in a rehabilitation institution as inpatients (the institutional rehabilitation group (IR) group) and 91 patients received it at home (the home rehabilitation (HR) group). Patients in the HR group had their mobility, activities of daily living (ADL), range of movements, tonus, coordination and sensation determined on admission to home rehabilitation and on discharge from it, 6 weeks to 2 months later. This group contained more women and more patients able to walk with devices and who were partially independent in ADL. The IR group consisted of more men and more patients with diabetes and marked difficulties in ADL and ambulation. In both groups the Barthel index and the Frenchay activities index were determined 1 year after the stroke by way of a telephone interview and no meaningful differences were found between the two groups. IR was considerably more expensive than HR. In Israel there exists a subpopulation of acute stroke survivors in need of, and appropriate for, multidisciplinary rehabilitation that can be provided at home; such rehabilitation was found to be effective in the short and long term, as well as cost effective.

Allocation and preference of patients for domiciliary or institutional rehabilitation after a stroke.

On discharge from an acute-care hospital after a stroke, 191 patients were told that they needed rehabilitation and were offered the option of receiving care in an institution or in their homes. One hundred and one (52.4%) patients chose an institution and 91 (47.6%) preferred rehabilitation in their own home. A higher number of women than men chose to be rehabilitated at home. Multivariate logistic regression showed that odds for being included in the home rehabilitation group were higher for women and for those who had a stroke in the past. Odds for being included in the institutional rehabilitation group were individuals with diabetes and difficulty in ambulating and those who had a longer stay in the acute-care hospital. Findings of the study suggest that in Israel there is a sub-population of acute stroke survivors who may be appropriate for rehabilitation at home and accept the option when they are offered it.

Teaching disability and rehabilitation medicine at the Medical School in Split, Croatia.

We describe the unsatisfactory situation of teaching disability and rehabilitation to medical students, focusing on countries of Central/Eastern Europe (CEE), sourcing a selection of relevant literature and reports of competent colleagues from these countries. Further, we present a model of teaching disability and rehabilitation medicine as it is now taught at the Medical School in Split, after the program for teaching Physical Medicine and Rehabilitation to the 5th year medical undergraduates was reformed in the academic year 2001/2002 to make it a satisfying educational experience that focuses on rehabilitation medicine, allowing acquisition of the competence necessary for managing persons with disability in the community. In an anonymous evaluation questionnaire, 96% of students thought that the new program was very good, that it contributed significantly to their general medical education, and was useful for their future work as general practitioners. We believe that the new program, which is broad in scope and content, well received by students, and attains its objectives, deserves to be introduced to a wider medical community.

Croatian Medical Corps in Bosnia and Herzegovina during the 1992-1995 war.

OBJECTIVE: The purpose of this study was to review the establishment and operation of the Croatian Medical Corps in Bosnia and Herzegovina in the 1992-1995 war. METHODS: We analyzed pertinent documents available to one of the authors (B.I.) who served on the Headquarter of the Corps, the study of the 17 published articles describing medical activities in various parts of Bosnia and Herzegovina during the war, as well as other relevant medical-military literature. RESULTS: The Corps functioned effectively and, in fact, served as a new health care system for the Croats in Bosnia and Herzegovina. It was initiated, planned, and operated voluntarily by members of the medical community, established before the defense forces, and later incorporated within them, but retaining its autonomy. CONCLUSIONS: The development of the Corps represents a unique phenomenon in the history of military medicine.

Disability in rheumatoid arthritis after monotherapy with DMARDs.

Rheumatoid arthritis (RA) is a progressive disease that leads to an increasing loss of functional ability. Its management should be multidisciplinary, focused primarily at the prevention of functional loss. The aim of the present study was to investigate the effectiveness of monotherapy with disease-modifying antirheumatic drugs (DMARDs) on the prevention of functional loss in RA patients. Of 188 patients with RA, 95 had received DMARD monotherapy (mainly gold salts, but also antimalarials and sulfasalazin) for at least 36 months; 93 patients had not received DMARDs because of their inability to attend the rheumatology clinic regularly because of accessibility difficulties. All 188 patients were examined at the start of the follow-up and at its completion, some 42 months later. The following parameters were determined at the two examinations: tenderness and pain in individual joints, functional independence, functional and working status, and the results of ancillary tests. At the end of the follow-up there was a decrease in functional independence and deterioriation in the functional and working status in both groups. Long-term monotherapy with DMARDs had not prevented functional loss or the ensuing disability in RA patients.

The association of rehabilitation and war.

PURPOSE: To examine the assumed association of war and the development of rehabilitation through a review of the pertinent literature. METHODS: Search in the Medline databases from 1942-2002 for papers that described the impact of war on rehabilitation services and their practice, and the study of the relevant identified reports. The following search terms were used: history of rehabilitation, medicine and war, rehabilitation and war, rehabilitation of war casualties. RESULTS: In WWI physical and occupational therapy became adjuncts in the treatment of military orthopaedic casualties, artificial limb services were set-up and workshops and factories for vocational rehabilitation were created. During WWII further developments occurred, mainly in the field of amputation of limbs and spinal cord injuries. Additional advances took place in all armed conflicts after WWII, particularly in the field of brain injury. CONCLUSION: The literature review indicates that the assumed association of rehabilitation and war is correct. Rehabilitation services have developed partly in association with war and the experience of rehabilitating war casualties supplied valuable principles and practices to rehabilitation medicine enriching the specialty and contributing to the health care systems of the involved countries.

Health technology: challenge to public health.

Health technology includes drugs, procedures, techniques, and equipment used by health professionals to provide health care, and the organizational and supporting systems within which the care is delivered. Such new technology may comprehend new drugs, new medical devices and appliances, new medical activities and surgical procedures, health promotion and disease prevention activities, and organizational and supporting systems. To achieve maximal use of available resources and constant selection among alternatives offered, health technology assessment is indispensable as a scientific effort to determine the extent to which and under what conditions a specific technology is efficacious, effective, safe, and cost-effective. Since today the greatest benefit to patients must be achieved at the lowest cost, one of the ways to achieve this goal is to promote health technology assessment and thus build the healthcare infrastructure on more scientific and objective foundations.