Clients with stroke and non-stroke and their guardians' views on community reintegration status after in-patient rehabilitation.

Aim: The aim of this study was to compare client community reintegration status following discharge from the Kachere Rehabilitation Centre (KRC), Blantyre, Malawi, in 2 consecutive years with client versus guardian perspectives on reintegration status. Methods: Using quantitative methods, 35 clients with stroke and non-stroke diagnoses (spinal cord dysfunction and neuropathic conditions) and 32 client guardians (the family caregivers in Malawi) were separately interviewed using the WHO Disability Assessment Schedule (DAS) 2.0 (a measure of disability due to reintegration problems back into the community). The results were analyzed using descriptive statistics and the Wilcoxon Signed-Rank Test or the Mann-Whitney U Test, as appropriate, to test for significant differences between groups. The clients' home environments were categorized using an original checklist, the Home Observation Data Form (HOD). Results: Moderate to severe perceived levels of disability related to reintegration difficulties were noted by clients in years 1 and 2. For those with non-stroke diagnoses, there was a significant change in year 2 results compared to year 1, but not for those with stroke diagnoses. Guardians agreed with their client's perceptions of difficulty in year 2. Major areas of concern were taking care of household responsibilities, participating in day-to-day work or school routines, joining in community activities, and walking one kilometer per day. Conclusions: Community reintegration challenges in suburban Blantyre, Malawi continued to plague individuals with stroke and non-stroke diagnoses for 2 consecutive years after discharge from KRC. Based on the important role guardians play during their client's rehabilitation phase and when they return to the community, opportunities may exist to improve client perception of disability related to their reintegration status. Future studies are important to replicate these results, investigate the idea of a more important role for guardians in patient-centered care, and the relationship between motor and cognitive function and reintegration status.

Fulbright project focuses on rehabilitation technician education and physiotherapy practice at the Kachere Rehabilitation Centre in Malawi.

Background: The aim of this project was to strengthen rehabilitation technician education and physiotherapy practice at the Kachere Rehabilitation Centre in the less-resourced country of Malawi by enlarging and reinforcing the skills of faculty, administrators, and adjunct clinicians, and fostering their continuing professional development. Methods: The project was developed through a partnership with the Kachere Rehabilitation Centre (KRC), the Medical Rehabilitation College (MRC), and a US-trained physical therapist (a Fulbright Program Scholar - FPS). The elements were education of staff, faculty, and students, and administrative consultation for rehabilitation managers, educational administrators, and faculty clinicians. Results: Formal and informal participant feedback on the project was positive. It indicated a receptive audience who expanded their knowledge and willingly considered ideas to modify teaching, clinical, and management approaches for optimal patient care, enhanced clinician/student learning, meeting curricular accreditation standards, and solving day-to-day challenges. Conclusions: The project made a positive impact on the participants, fostering their goal to parallel clinical practice and educational initiatives used by recognized international standard bearers. Lessons learned emphasized the power of partnerships, networking, flexibility, and creative thinking. For international physiotherapists, it is an underutilized opportunity to extend global outreach, scholarship, clinical practice, and academic knowledge in a less-resourced country eager to upgrade the background and skills of rehabilitation providers.

Measuring the Cross-Cultural Adaptability of a Graduate Student Team from a Global Immersion Experience.

BACKGROUND: Cultural competency skills for health and human services providers is important because of the growing diverse populous. Experiential learning through global immersion may promote these skills. METHODS: Using a non-randomized cohort design, there were two groups of unmatched graduate students. One reviewed an online educational module and participated in campus activities and an experience in Malawi; the other reviewed the module only. The students were assessed pre- and post-immersion using a measure of cross-cultural adaptability, a component of cultural competency skills. RESULTS: Comparing total scores on the Cross-Cultural Adaptability Inventory (CCAI™), pre-immersion (baseline), there was no significant difference between the groups. Comparing both groups' total scores pre/post-immersion, there was a significant difference. There was a significant difference for the experimental group between the pre/post-immersion total scores but not for the control group. Comparing both groups'post immersion, there was a significant difference between the groups. Comparing both groups' component scores, there was a significant difference in the Emotional Resilience and Perceptual Acuity variables for the experimental group but not for the control group. Comparing both groups' component scores, there was no significant difference in the Personal Autonomy and Flexibility Openness variables. CONCLUSION: Participation in a 6-week global immersion experience compared to education only made a greater change in the development of cross-cultural adaptability for a graduate student team.

Systematic review and evidence-based clinical recommendations for dosing of pediatric supported standing programs.

PURPOSE: There is a lack of evidence-based recommendations for effective dosing of pediatric supported standing programs, despite widespread clinical use. METHODS: Using the International Classification of Functioning, Disability, and Health (Child and Youth Version) framework, we searched 7 databases, using specific search terms. RESULTS: Thirty of 687 studies located met our inclusion criteria. Strength of the evidence was evaluated by well-known tools, and to assist with clinical decision-making, clinical recommendations based on the existing evidence and the authors' opinions were provided. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: Standing programs 5 days per week positively affect bone mineral density (60 to 90 min/d); hip stability (60 min/d in 30° to 60° of total bilateral hip abduction); range of motion of hip, knee, and ankle (45 to 60 min/d); and spasticity (30 to 45 min/d).

Creating disseminator champions for evidence-based practice in health professions education: an educational case report.

INTRODUCTION: In today's healthcare environment, it is a necessity to prepare nurses and other health professionals to provide and disseminate evidence-based practices (EBP) throughout their careers. PURPOSE: This educational case report describes a health professional education program's successful endeavor to educate and create evidence-based champions. CASE DESCRIPTION: The presented model for developing evidence-based practitioners is based on two distinct phases. Phase one is for EBP skill development and includes preparing students how to read, analyze and discuss levels of evidence within the didactic and clinical curriculum. Phase two is focused on developing dissemination skills by requiring students to complete a clinical case report project with the assistance of academic and clinical faculty mentors. Phase three reviews outcomes of the project and phase four provides the mechanism for future plans. Based on quality, student and faculty interest, a select number of case reports are chosen for presentation at a university Research Day as well as submitted for state and national conferences to further disseminate findings. OUTCOMES: This educational activity had positive outcomes including: increased student participation, Clinical Instructors and faculty scholarship, and dissemination of EBP. Data demonstrates student interest in presenting at Research Day to have steadily increased during the 3-year period of this endeavor. Dissemination occurred at university (n = 22), state (n = 13) and national (n = 9) levels. Additional educational benefits derived from this project included, 1) broader participation of clinical settings, 2) requests by additional clinics to participate for purposes of developing EBP and scholarly presentation skills of clinicians, and 3) increased opportunity for academic faculty to continue engagement in contemporary clinical practice. CONCLUSION: The evolution of this case report project has allowed an academic requirement to become a marker of distinguished commitment to professional advancement.

The effect of vestibular rehabilitation on adults with bilateral vestibular hypofunction: a systematic review.

PURPOSE: Adults with bilateral vestibular hypofunction (BVH) experience significant disability. A systematic review assessed evidence for vestibular rehabilitation (VR). NUMBER OF STUDIES: 14 studies. MATERIALS/METHODS: Search identification of studies based on inclusion criteria: (a) population: adults with BVH of peripheral origin; (b) interventions: vestibular exercises, balance training, education, or sensory prosthetics; (c) comparison: single interventions or compared to another psychophysical intervention, placebo, or healthy population; (d) outcomes: based on International Classification of Functioning, Disability and Health (ICF) Body Functions and Structure, Activity, and Participation; (e) study designs: prospective and interventional, Levels of Evidence I to III per Centre of Evidence-based Medicine grading. Coding and appraisal based on ICF framework and strength of evidence synthesis. RESULTS: Five Level II studies and nine Level III studies: All had outcomes on gaze and postural stability, five with outcomes on gait speed and perceptions of oscillopsia and disequilibrium. CONCLUSIONS: (a) Moderate evidence strength on improved gaze and postural stability (ICF-Body Functions) following exercise-based VR; (b) Inadequate number of studies supporting benefit of VR on ICF-Participation outcomes; (c) Sensory prosthetics in early phase of development. CLINICAL RELEVANCE: Moderate evidence strength in support of VR from an impairment level; clinical practice and research needed to explore interventions extending to ICF-Activity and Participation.

A systematic review of supported standing programs.

OBJECTIVE: The routine clinical use of supported standing in hospitals, schools and homes currently exists. Questions arise as to the nature of the evidence used to justify this practice. This systematic review investigated the available evidence underlying supported standing use based on the Center for Evidence-Based Medicine (CEBM) Levels of Evidence framework. DESIGN: The database search included MEDLINE, CINAHL, GoogleScholar, HighWire Press, PEDro, Cochrane Library databases, and APTAs Hooked on Evidence from January 1980 to October 2009 for studies that included supported standing devices for individuals of all ages, with a neuromuscular diagnosis. We identified 112 unique studies from which 39 met the inclusion criteria, 29 with adult and 10 with pediatric participants. In each group of studies were user and therapist survey responses in addition to results of clinical interventions. RESULTS: The results are organized and reported by The International Classification of Function (ICF) framework in the following categories: b4: Functions of the cardiovascular, haematological, immunological, and respiratory systems; b5: Functions of the digestive, metabolic, and endocrine systems; b7: Neuromusculoskeletal and movement related functions; Combination of d4: Mobility, d8: Major life areas and Other activity and participation. The peer review journal studies mainly explored using supported standers for improving bone mineral density (BMD), cardiopulmonary function, muscle strength/function, and range of motion (ROM). The data were moderately strong for the use of supported standing for BMD increase, showed some support for decreasing hypertonicity (including spasticity) and improving ROM, and were inconclusive for other benefits of using supported standers for children and adults with neuromuscular disorders. The addition of whole body vibration (WBV) to supported standing activities appeared a promising trend but empirical data were inconclusive. The survey data from physical therapists (PTs) and participant users attributed numerous improved outcomes to supported standing: ROM, bowel/bladder, psychological, hypertonicity and pressure relief/bedsores. BMD was not a reported benefit according to the user group. CONCLUSION: There exists a need for empirical mechanistic evidence to guide clinical supported standing programs across practice settings and with various-aged participants, particularly when considering a life-span approach to practice.