Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section).

INTRODUCTION: The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future. AIM: The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions. METHODS: To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. RESULTS: The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure. CONCLUSIONS: It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

Thymol-Functionalized Hyaluronic Acid as Promising Preservative Biomaterial for the Inhibition of Candida albicans Biofilm Formation.

Hyaluronic acid (HA) is a naturally occurring biopolymer that has been employed for a plethora of medicinal applications. Nevertheless, as HA is a natural polysaccharide, it can be a substrate able to promote microbial growth and proliferation. Biopolymer-drug conjugates have gained attention over the years to overcome drawbacks of each single component. Within this context, thymol (Thy), a phenolic compound occurring in essential oils (EOs) extracted from Thymus and Origanum, has been largely studied for its antimycotic applications. However, it is characterized by a low water solubility and moderate cytotoxicity. Herein, we report an innovative HA-thymol conjugate (HA-Thy) biomaterial to circumvent the drawbacks of free thymol use by providing the polymer conjugate with the beneficial properties of both components. Preliminary biological tests evidenced the decrease of thymol cytotoxicity for the HA-Thy conjugate, paired with a promising antibiofilm formation activity against Candida albicans, similar to pure thymol, highlighting its potential application as a preservative biomaterial in formulations.

Traumatic Brain Injury Caused by Work Accidents: How can Occupational and Vocational Recovery be Achieved?

Issues connected with the reintegration of individuals affected by severe brain injury are numerous and complex. Extensive data indicate the effectiveness of treatments based on an holistic approach, which integrates medical interventions with social programmes and offers continuity, leading to the rapid achievement of independent living outcomes and return to work. In Italy, extensive resources are available for the clinical and rehabilitation management of individuals affected by traumatic brain injury in the acute and post-acute phase, but there are only a few organized services to support the reintegration phase. This paper describes a model created via a 2-year collaboration between the National Institute for Insurance against Accidents at Work (INAIL) in Rome and the National Federation of Traumatic Brain Injury Associations (FNATC). The combined effort of these organizations led to the development of an Italian Model of Vocational Rehabilitation (IMoVR), which was exportable to all 20 Italian Regions. Due to the experience gained by a few avant-garde teams, IMoVR was used to pioneer an approach characterized by structured phases and actions aimed at designing high-quality interventions, and at monitoring their long-term effectiveness. These teams comprised experts in different areas, including: forensic doctors, social workers, administrative managers of INAIL, neuropsychologists, psychotherapists, educators working in associations registered with FNATC, all of whom are members of a service network that had already activated small individual vocational projects. In total, the collaboration comprised 42 pro-fessionals working in 7 Italian cities: Ancona, Arezzo, Ferrara, Milano, Pordenone, Rimini and Vicenza.

Rehabilitation in obesity with comorbidities: a consensus document from experts of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), the Italian Society of Obesity (SIO) and the Italian Society of Eating Disorders (SISDCA).

Severe obesity is a chronic disease associated with medical and psychosocial comorbidity causing disability and poor quality of life that represents a social and economic burden for the National Health Systems worldwide. The Italian Society of Physical and Rehabilitation Medicine (SIMFER), the Italian Society of Obesity (SIO) and the Italian Society of Eating Disorders (SISDCA) have joined in a panel of experts to discuss a consensus document on the requisites of rehabilitation units devoted to patients affected by severe obesity with comorbidities. The main recommendations of the consensus document are the following: (1) the management of severe obesity should be characterized by the integration of nutritional, physical/functional rehabilitation, psycho-educational, and rehabilitative nursing interventions; (2) the intensity of the rehabilitative interventions should depend on the level of severity and comorbidities, frailty of the psychic status, degree of disability and quality of life of the patient; (3) the rehabilitative approach should be multidisciplinary and integrated in relation to the clinical complexity of obesity; (4) the estimated need for multidimensional rehabilitation of severe obesity is 1 bed per every 1,000 patients and of 4 beds in rehabilitative day-care ward every 1,000 patients suffering from severe obesity with comorbidities.

Analysis and implementation of a World Health Organization health report: methodological concepts and strategies.

A long-standing scientific discourse on the use of health research evidence to inform policy has come to produce multiple implementation theories, frameworks, models, and strategies. It is from this extensive body of research that the authors extract and present essential components of an implementation process in the health domain, gaining valuable guidance on how to successfully meet the challenges of implementation. Furthermore, this article describes how implementation content can be analyzed and reorganized, with a special focus on implementation at different policy, systems and services, and individual levels using existing frameworks and tools. In doing so, the authors aim to contribute to the establishment and testing of an implementation framework for reports such as the World Health Organization World Report on Disability, the World Health Organization International Perspectives on Spinal Cord Injury, and other health policy reports or technical health guidelines.

The World Report on Disability: a challenge for rehabilitation medicine.

To analyze the life situation of people with disabilities and to summarize the evidence of measures to support their participation, the World Health Assembly requested the World Health Organization to produce a World Report on Disability. This article highlights some of the main contents of the World Report on Disability, with a special focus on the rehabilitation chapter. It starts by presenting epidemiologic findings on the global disability prevalence, views on the role of rehabilitation medicine, discrepancies between met and unmet needs, and challenges for the quality of rehabilitation services and ends with an outlook on the report's recommendations and efforts toward their implementation.

Dissemination, analysis, and implementation of the World Report on Disability: the roadmap of the International Society for Physical and Rehabilitation Medicine.

The International Society for Physical and Rehabilitation Medicine has recognized the World Report on Disability as a guide for its future activities and endorsed its responsibility to disseminate, to analyze, and to implement the report's recommendations. The activities of the International Society for Physical and Rehabilitation Medicine on the global stage are embedded in a strategy that includes national and regional associations. This article reports on recent and forthcoming activities of the International Society for Physical and Rehabilitation Medicine regarding the World Report on Disability and identifies five major challenges that will impact future International Society for Physical and Rehabilitation Medicine activities. These challenges relate to (1) education and training, (2) the support of strong role models, (3) disaster management, (4) the development of innovative rehabilitation services, and (5) rehabilitation research.

Traumatic and nontraumatic brain injury.

The neurological consequences of an acquired brain injury (ABI), of traumatic or nontraumatic origin, are caused by an alteration of neuronal activity that compromises physical integrity or function of one or more areas of the brain. Impairments resulting from an ABI often affect cognitive function, as well as language, memory, attention, and information processing faculties, leading to partial or total disability that is likely to prevent people's functional and psychosocial recovery even in the long term. This situation has harmful clinical, social, and economic effects. Social costs caused by a patient's death or acquired disability are extremely high, and costs to healthcare systems rank among the top three in Europe. One of the main considerations when dealing with traumatic or nontraumatic brain injury is the complexity of the rehabilitation process. Many variables must be taken into account because of the great variety of clinical features that may occur, involving damage etiology, severity level, and health complications. Great advancements have been achieved over the past 10-15 years in the treatment of ABI, but new basic and clinical research must be encouraged and financially supported. Many challenging issues still occur when evaluating patients with ABI due to the lack of appropriate assessment measures and reliable prognostic indexes that could support clinical observation. Furthermore, researcher authors need to create a network of rehabilitation services that responds to the needs - medical, emotional, and social - of all brain-injured patients and their families, from initial hospitalization to reintegration into the community.

A position paper on Physical & Rehabilitation Medicine programmes in post-acute settings. Union of European Medical Specialists Section of Physical & Rehabilitation Medicine (in conjunction with the European Society of Physical & Rehabilitation Medicine).

Physical & Rehabilitation Medicine (PRM) programmes in post-acute settings cover interventions for the rehabilitation of people with a variety of disabling health conditions. The setting of the intervention is more important than the timing and these programmes can be carried out in a variety of facilities. This paper describes the role of PRM services and of PRM specialists in delivering rehabilitation programmes to people, who have initially been admitted to hospital. The emphasis is on improving patients' activities and addressing participation issues. PRM programmes in post-acute settings provide a range of treatments and have a major influence in the long-term on the pace and extent of return of function and recovery from ill-health. This paper will define the meaning of post-acute settings and will describe the patient's journey through the post-acute setting. In particular, it addresses the standards of care across Europe that patients should expect. This paper also examines the general principles of funding such programmes within the context of different health care systems across Europe. Coordinated care improves outcomes and economic profiles for both payers and providers of services. This paper describes the value of PRM interventions and PRM specialist-led teams in promoting better outcomes for people with disabilities with complex needs.

The Italian System of Free Aids Provision for People with Disability:Future Developments / 中国康复理论与实践

The Italian care situation with regards to prostheses and aids is satisfying.The norm which establishes the ways in which aids can be supplied to disabled people goes back to 1999 and,even though it is based on correct principles and even though it has produced positive effects in the improvement of the life of disabled people,it must be updated in the light of the more recent technological and scientific innovations and of the new information instruments such as the diffusion of information and communication systems.

The Italian System of Free Aids Provision for People with Disability / 中国康复理论与实践

Aids are only one of the instruments with which the disabled person can often reach a good level of autonomy,he can improve his conditions of life and prevent the aggravating of his situation.Aids serve also to facilitate care on the part of the family.The rights confirmed by Law 104 can also be achieved through the use of aids.The Italian state has planned a system of care with regards to aids so that some of them can be purchased with different tax concessions but essential aids,those necessary for the reaching of autonomy goals and prevention defined by an individual rehabilitative project,are supplied free of charge.In Italy essential aids are part therefore of a rehabilitation plan that is identified for each person with disabilities by a team made up of different professionals.

Italian Legislative Framework and Policies of Disability / 中国康复理论与实践

The most important reference in Italian legislation concerning interventions in favour of people with disabilities came about with Law 104 from February 5th 1992 in which the most important fights for disabled people were established.This law led to a new vision,the person with disabilities is no longer seen only a subject needing help but as a person who has the right to live his life in the best possible way that his condition allows him to and thus,it is society's duty and that of the Government,to do everything possible to remove invalidating causes,to promote a disabled person's autonomy and to realise his best social integration possible.To implement what is foreseen by this law it was necessary to activate different important interventions,two of which are very significant:the realisation of Guidelines from the Ministry of Health on rehabilitation activities in which the aims are defined on how rehabilitation should be implemented and how it should be organised on a national level and at a community level.Law 68 from March 12th 1999 decreed the full rights of people with disability to be integrated into the workplace.In the article we will also report some significant data concerning the results of the applications of the law.

European Union of Medical Specialists (UEMS) section of Physical & Rehabilitation Medicine: a position paper on physical and rehabilitation medicine in acute settings.

Physical and rehabilitation medicine (PRM) specialists have an important role in the clinical care of patients during the acute phase of a disabling health condition. This phase is defined as once definitive care or resuscitation has taken place and a patient's need to stay in hospital as an inpatient is primarily for PRM services for rehabilitation. This paper describes 4 options for the delivery of services for people, who continue to require to be inpatients and who will benefit from PRM interventions. These are described, along with their clear benefits during the acute phase of a health condition. The first 2 models are the most effective in making best use of the acute facilities and PRM services. The benefits of dedicated PRM beds appear to outweigh those of the other options and may be cheaper, although no cost-effectiveness studies comparing the first 2 options have yet been undertaken. Prospective trials are required to show this benefit, and a number of examples need to be set up to pilot this in order to provide realistic cost-effectiveness data.

Interdisciplinary team working in physical and rehabilitation medicine.

Effective team working plays a crucial role in Physical and Rehabilitation Medicine (PRM). As part of its role of optimizing and harmonizing clinical practice across Europe, the Professional Practice Committee of Union of European Medical Specialists (UEMS) Physical and Rehabilitation Medicine (PRM) Section reviewed patterns of team working and debated recommendations for good practice at a meeting of national UEMS delegates held in Riga, Latvia, in September 2008. This consensus statement is derived from that discussion and from a review of the literature concerning team working. Effective team working produces better patient outcomes (including better survival rates) in a range of disorders, notably following stroke. There is limited published evidence concerning what constitute the key components of successful teams in PRM programmes. However, the theoretical basis for good team working has been well-described in other settings and includes agreed aims, agreement and understanding on how best to achieve these, a multi-professional team with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and expertise and to speak openly. UEMS PRM Section strongly recommends this pattern of working. PRM specialists have an essential role to play in interdisciplinary teams; their training and specific expertise enable them to diagnose and assess severity of health problems, a prerequisite for safe intervention. Training spans 4-5 years in Europe, and includes knowledge and critical analysis of evidence-based rehabilitation strategies. PRM physicians are therefore well-placed to coordinate PRM programmes and to develop and evaluate new management strategies. Their broad training also means that they are able to take a holistic view of an individual patient's care.