[Development of rehabilitation medicine in Hungary, results of the last decades]. / A rehabilitációs medicina fejlodése hazánkban, az elmúlt húsz év eredményei.

In recent decades, medicine has undergone incredible development, the boundaries of the specializations have changed, they have become more differentiated, and new specialities have emerged. The evolution of rehabilitation medicine and the development of its current competencies correspond to this process. An independent new interdisciplinary clinical specialty was born in Hungary. The purpose of this publication is to present the development and results of rehabilitation medicine in Hungary over the past twenty years. A descriptive presentation of the results was made using Hungarian publications and data of rehabilitation medicine, without a systematic analysis. In the past 20 years, significant changes have taken place in the field of rehabilitation. A national network was established in inpatient care, and specialized departments for special tasks were organized. In 1998, only nearly 2,941 beds were used for rehabilitation, currently there are more than 6,500 rehabilitation beds in the country. The number of treated cases was 11,384 (1987), which rose to 95,693 in 2019. Since the beginning, 552 doctors have obtained rehabilitation qualifications, but the work of other team members (nurses, physiotherapists, occupational therapists, psychologists, speech therapists, social workers) is also indispensable for carrying out rehabilitation activities. Rehabilitation departments and chairs have been established at the four medical faculties, and graduate and postgraduate training is coordinated. The national institute remained the center of research and education. The development of the field of rehabilitation and the results of research were also presented at international conferences organized in Hungary. Orv Hetil. 2023; 164(19): 722-728.

Self-reported upper limb functioning of pupils with cerebral palsy by the International Classification of Functioning, Disability, and Health.

International Classification of Functioning, Disability, and Health: Children and Youth Version has shown an increasing role in the assessment of children with cerebral palsy (CP), but just a few researchers use it for individuals' self-assessment. In this study, we present the self-assessment of functioning of students with CP and changes by the end of a school year. Thirty-seven pupils with spastic CP involving upper limbs, 24 pupils with typical development, and 20 pupils with speech and language disorders were studied by International Classification of Functioning, Disability, and Health core sets for CP. The CP group reported limitations in sensory functions (P<0.05), movement-related functions (P<0.001), and mobility (P<0.001) as well as products and technology and support and relationships as supportive (P<0.05). Correlation between expert and self-evaluation was weak to moderate. The CP core set may appropriately serve in the self-assessment of pupils' functioning in longitudinal studies.

Precise isometric hand grip learning of hemiparetic stroke patients.

Rehabilitation of hand movements after stroke aims at skills that can be well retained and transferred to novel conditions. These functions may be altered by training schedules such as constant and variable practice. A total of 36 participants with hemiparesis completed one of these schedules counterbalanced. Precise isometric hand grip force production was practiced for 4 days with a target force of 25% maximum voluntary contraction. The constant group practiced only the target force, whereas the variable group practiced the same amount including ±5 and 10% maximum voluntary contraction. Target force presentation and feedback were provided visually. Results indicated that both practice schedule led to learning. Variable practice resulted in a superior performance in retention and transfer tests, suggesting that it may be effective not only in the healthy population but also in stroke rehabilitation.

[Taking patients' views into consideration at planning and evaluating care. Patient Reported Outcomes]. / A páciensek véleményének figyelembevétele az egészségügyi ellátás tervezése és értékelése során. A páciensek egészségértékelése.

Provision of patient-centred health care is impossible without the knowledge of the patient's perceptions, feelings and expectations. In contrast, participants feel the available time limited for satisfactory communication. This shortage may partially be compensated by measurements belonging to the concept of Patient Reported Outcomes. Concept definition, invention circle and use of the methods are largely diverse, eventually leading to misinterpretation of outcomes. For this reason, some organizations developed instructions, guidelines supporting uniform interpretation and application. Measures so far have rather served research goals yet may be applied in the clinical practice as well. They are not only appropriate for the evaluation of outcomes, judgement of adequacy and safety of care on systemic or institutional level, but also for the planning of individual patient care and supporting communication and co-operation. The present paper aims to provide general information and references for introducing the details. Orv Hetil. 2018; 159(6): 215-222.

Measuring quality of life in individuals with Parkinson's disease attending a self-help club: cross-sectional study in Hungary.

The prevalence of Parkinson's disease (PD) increases with aging. The aim of our cross-sectional study was to measure the quality of life of PD patients attending a self-help 'PD club' and to evaluate the potential positive effect of club life on quality of life. Data collection was carried out using questionnaires (PDQ-39, Hungarian version). Altogether, 101 individuals with clinically diagnosed PD were included, and finally 98 persons' data were analyzed. Among the eight dimensions, the highest score was found in 'bodily discomfort' and the lowest in 'social support'. The overall tendency of the results was similar to another Hungarian study, but the scores in all dimensions were significantly lower in our participants. These positive results seem to correlate with attending the 'PD club', indicating the potential beneficial effect of patients' organizations on promoting mental health.

[Role of reporting and learning systems in the improvement of patient safety]. / A jelentési és tanulórendszerek szerepe a betegbiztonság javításában.

The principles and requirements of a patient safety related reporting and learning system were defined by the World Health Organization Draft Guidelines for Adverse Event Reporting and Learning Systems published in 2005. Since then more and more Hungarian health care organizations aim to improve their patient safety culture. In order to support this goal the NEVES reporting and learning system and the series of Patient Safety Forums for training and consultation were launched in 2006 and significantly renewed recently. Current operative modifications to the Health Law emphasize patient safety, making the introduction of these programs once again necessary.

[Exploration of the goals for the quality of life in primary rehabilitation after spinal cord injury]. / Életminoségcélok feltárása gerincvelosérültek primer rehabilitációjában.

BACKGROUND AND PURPOSE: Surveyed references indicate improvement of rehabilitation outcomes if based on exploration of personal rehabilitation goals or quality of life goals. Purpose of our study is mapping of quality of life goals of persons entering rehabilitation by structured interviews, and study of applicability of the method. METHODS: Structured interviews have been performed with persons consecutively admitted for their first rehabilitation intervention, meeting inclusion criteria. World Health Organization's quality of life measure brief version and disability module served as guideline for the interviews. For study any negative effect on rehabilitation of our approach we have compared rehabilitation outcomes of consecutively admitted persons immediately before starting our study (58) and those with closed rehabilitation intervention (53). For this purpose the Functional Independence Measure was used. Finally content analysis of the interviews has been performed. RESULTS: In 24 cases complications and psychological instability have prevented the inclusion, seven persons did not agree into participation in the study. Of the 71 interview participants the rehabilitation of 53 persons concluded. Their rehabilitation outcomes are better as of the control group significant difference has been measured in the social functions domain. Quality of life of included persons decreased during the rehabilitation process insignificantly, the autonomy domain showed insignificant improvement, the inclusion domain did not change. Content analysis revealed the outstanding role of the family among quality of life goals. CONCLUSIONS: Reported results indicate that exploration of quality of life goals of persons in early phase of rehabilitation after spinal cord injury is feasible. The selected quality of life measure may well support the interviews.

[Importance of secondary conditions in rehabilitation medicine]. / Másodlagos állapotok jelentosége a rehabilitációs medicinában.

The author interprets disability on the basis of the "International Classification of Functioning, Disability and Health (ICF)". In this review the applied method is a purpose oriented, restricted survey of continuously increasing articles published during the last two decades. Definition and interpretation of secondary conditions are based on the cited international classification. It is noted that secondary conditions frequently develop during acute care and usually require rehabilitation. Significance of secondary conditions in rehabilitation is highlighted by selected examples of traumatic spinal cord injury, stroke, lower limb amputation and intellectual disabilities. The author states that there is an insufficiency of presently available knowledge and raises the need for the use of the International Classification of Functioning, Disability and Health as foundation of future research.

Exploration of quality-of-life goals in individuals with spinal cord injury.

The aim of the study is to investigate the applicability of structured interviews for exploration of quality-of-life goals using an established instrument. Structured interviews were performed using WHOQOL-BREF and Disabilities Module as guideline with 35 clients admitted for first rehabilitation intervention after spinal cord injury. Although participants found some questions difficult to answer or psychologically stressful, most of them have appreciated the interviews' help considering their position in life at an early phase of rehabilitation. WHOQOL-BREF and Disabilities Module is an appropriate tool as an interview guideline for exploring quality-of-life goals.

[Disabled person's satisfaction with health and social care--an internationally developed instrument]. / Fogyatékos személyek elégedettsége az egészségügyi és szociális ellátással--nemzetközi fejlesztésu kérdoív.

INTRODUCTION: Quality of health and social care is being assessed by largely different methods. Obtaining comparable and valuable data is difficult. Thus, internationally developed instruments have special value. SAMPLE AND METHODS: A set of instruments has been developed simultaneously using World Health Organization's instrument development method. One of these is the instrument "Quality of Care and Support for People with Disabilities". Response scales contain five options for physically and three for intellectually disabled persons. Psychometric analysis of the Hungarian instrument version was based on interviews with 151 physically and 166 intellectually disabled persons. RESULTS: Answering rate was high, above 95% with the exception of one item. Internal consistency of the two instrument versions by Cronbach's alpha is 0.845 and 0.745 respectively. Lowest satisfaction was found in the domain "information" in both groups that correlates significantly with health conditions at p < 0.01 and p < 0.05 level respectively. CONCLUSIONS: The field trial confirms validity and reliability of the instrument. Its wider use may help the evaluation of satisfaction concerning different components of quality of care, consequently better tailoring of services to needs.

The Quality of Care and Support (QOCS) for people with disability scale: development and psychometric properties.

This paper describes the development of a Quality of Care and Support (QOCS) scale for use with adult persons with physical and intellectual disabilities. In the pilot phase of the study, 12 centers from around the world carried out focus groups with people with physical and disabilities, their carers, and with professionals in order to identify themes that were relevant for their quality of care. Items generated from the focus groups were then tested in a pilot study with 1400 respondents from 15 different centers worldwide, with items being tested and reduced using both classical and modern psychometric methods. A field trial study was then carried out with 3772 respondents, again with the use of both classical and modern psychometric methods. The outcome of the two rounds of data collection and analysis is a 17-item module for assessment of quality of care in physically or intellectually disabled people. Further modifications are also proposed for the use of the QOCS with adults with intellectual disabilities, including simplification of wording of some of the items, the use of a three-point response scale, and the inclusion of smiley faces.

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.

[Outpatient cardiac rehabilitation: initial experience in the first Hungarian multicenter study]. / Járóbetegformában végzett kardiológiai rehabilitácio: az elsô hazai kontrollált multicentrikus tanulmány néhány eredménye.

INTRODUCTION: This paper assesses the first controlled multicentric investigation of outpatient cardiac rehabilitation in Hungary. Framing and starting of the program was carried out beside the Hungarian experts by the United States Department of Health and Human Services. AIMS: To prove the extreme importance of cardiac rehabilitation, both inpatient and outpatient, after the hospital treatment of cardiac emergencies. METHODS: 531 patients were collected at the beginning of the study from three Hungarian cardiological centers having cardiac surgery and cardiac rehabilitation ward. 167 patients were ranked into the outpatients group (Group A), 311 were rehabilitated in hospital (Group B) and 53 served as control (group C). After physical, ergometric and echocardiographic examinations and psychometric evaluation (Beck and WHOBREF questionnaires) the patients of Group A and B performed a conducted training three times weekly for 3 months. All the patients were examined 3 and 12 months later. RESULTS: Significant improvement of ergometric data was observed in both groups of patients who underwent rehabilitation training, but this was not the case with control patients. This improvement could not be observed after one year. The number of anginal attacks and the need of hospital treatment also showed a significant reduction in Groups A and B. CONCLUSIONS: The data have proved that cardiac rehabilitation has an extremely important role in the stabilisation of heart functions and general health of patients after acute myocardial infarction or heart surgery. It was also proved, that 12-week rehabilitation training is not sufficient to achieve long-term stabilization. Sufficient data have accumulated during the study about the effectiveness and safety of outpatient cardiac rehabilitation as an alternative to inpatient service.

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.

[Applicability of the abbreviated version of the World Health Organization's quality of life questionnaire in Hungary]. / Az Egészségügyi Világszervezet rövidített életminoség kérdoívének hazai alkalmazhatóságáról.

INTRODUCTION: Quality of life, as a subjective parameter of the general condition, is suitable for characterization of the health status of populations or patient groups, and for studying the effects of therapeutic or preventive interventions. AIMS: To test the applicability and reliability in Hungary of the abbreviated form of the quality of life questionnaire developed by WHO, one of several ways to measure the quality of life. METHODS: Questionnaire-based cross-sectional investigation was performed among altogether 814 persons, in small settlements of population under 1000 and 2000, and in a small town for control, in Csongrád county, Hungary. The reliability and validity of the quality of life questionnaire was tested, within each group of questions, by means of Cronbach's alpha, ANOVA and Kruskal-Wallis tests, and by Spearman's rho correlation coefficient. RESULTS: The mean values of the four domains of quality of life - physical, psychological, social and environmental - showed no noteworthy differences. The Cronbach's alpha figures of the internal consistency test on separate groups of questions and on all questions were in all cases above the expected minimum of 0.7. The means calculated for each domain of quality of life were decreasing with increasing age. Healthy people estimated each aspect of quality of life as significantly better, compared to the sick. Correlation tests showed that all dimensions of the quality of life were in close positive correlation with the general quality of life, with the level of satisfaction with the own health, with the self-assessed health, and with the responses given on other questions related to the social or health situation of the questioned. CONCLUSION: The variation of the questionnaire, adapted to Hungarian conditions, proved to be suitable for testing the quality of life of persons with various demographical, social and health conditions, and for distinction between the healthy and the sick. The sheet, which can be filled in quickly and easily, enables the measurement of quality of life in the Hungarian population, and the comparison of that with international data.

Are problems of academic medicine a new phenomenon?

Many of the problems of academic medicine are related to the actual challenges of health-care. Some disciplines have high prestige; these have advantages in education, while the needs of the society may differ to some extent. Introduction of the World Health Organization (WHO) concept on health as well as on functioning and disability into the training of physicians and more training in communication may remedy some of the discrepancies. The increase in the demand for physicians calls for improved ethical standards in the practice of importing health workers by the wealthy nations.