Disability concentration and access to rehabilitation services: a pilot spatial assessment applying geographic information system analysis.

Purpose: Due to geographical disparities, many people with profound or severe disabilities experience considerable delays in rehabilitation treatment, resulting in threats to quality of life. This pilot study aims to identify areas in Greater Brisbane, Australia, with a higher concentration of people with profound or severe disabilities and to evaluate access to rehabilitation services in these areas. Methods: Data came from the 2016 Australian Census of Population and Housing and the National Health Services Directory. Four frequently used rehabilitation services by individuals with profound or severe disabilities (i.e., occupational therapy, physiotherapy, speech pathology and psychology) were the focus of the analysis. The data were analyzed using geospatial analysis methods (e.g., spatial scan statistic and network analysis). Results: A higher concentration of rehabilitation services was found in the regions with lower disability prevalence and lower potential demand for rehabilitation services. In contrast, the regions with higher disability prevalence and higher potential demand for rehabilitation services experienced poorer access to rehabilitation services. Conclusion: The findings are expected to inform policy decisions about the prioritization of rehabilitation resources and derive evidence for planning more responsive service delivery. Implications for rehabilitation The current study has demonstrated the utilization of geographic information system methods to facilitate rehabilitation service planning. Identification of disability concentration may inform locally responsive rehabilitation service delivery. Spatial assessment of mismatch between supply and potential demand may assist policy makers and service providers in the prioritization of rehabilitation resources. The current study contributes to the World Health Organization's call for action to ensure adequate access to rehabilitation services by people with profound or severe disabilities.

Requirements for and current provision of rehabilitation services for children after severe acquired brain injury in the UK: a population-based study.

OBJECTIVES: Survival with brain injury is an outcome of severe illness that may be becoming more common. Provision for children in this situation has received little attention. We sought to estimate rates of severe paediatric acquired brain injury (ABI) requiring rehabilitation and to describe current provision of services for these children in the UK. METHODS: This study conducted an analysis of Hospital Episode Statistics data between April 2003 and March 2012, supplemented by a UK provider survey completed in 2015. A probable severe ABI requiring rehabilitation (PSABIR) event was inferred from the co-occurrence of a medical condition likely to cause ABI (such as meningitis) and a prolonged inpatient stay (>=28 days). RESULTS: During the period studied, 4508 children aged 1-18 years in England had PSABIRs. Trauma was the most common cause (30%) followed by brain tumours (19%) and anoxia (18.3%). An excess in older males was attributable to trauma. We estimate the incidence of PSABIR to be at least 2.93 (95%CI 2.62 to 3.26) per 100 000 young people (1-18 years) pa. The provider survey confirmed marked geographic variability in the organisation of services in the UK. CONCLUSIONS: There are at least 350 PSABIR events in children in the UK annually, a health problem of similar magnitude to that of cerebral palsy. Service provision for this population varies widely around the UK, in contrast with the nationally coordinated approach to paediatric intensive care and major trauma provision.

[Cardiac Rehabilitation 2015]. / Kardiale Rehabilitation 2015.

The goals of cardiac rehabilitation are (re-)conditioning and secondary prevention in patients with heart disease or an elevated cardiovascular risk profile. Rehabilitation is based on motivation through education, on adapted physical activity, instruction of relaxation techniques, psychological support and optimized medication. It is performed preferably in groups either in outpatient or inpatient settings. The Swiss working group on cardiac rehabilitation provides a network of institutions with regular quality auditing. Positive effects of rehabilitation programs on mortality and morbidity have been established by numerous studies. Although a majority of patients after cardiac surgery are being referred to rehabilitation, these services are notoriously underused after catheter procedures.

[Inpatient Preventative and Rehabilitative Treatment for Informal Caregivers - An Explorative Investigation of Specific Offers in Germany]. / Stationäre Rehabilitation und Vorsorge für pflegende Angehörige - eine Sondierung der Angebote in Deutschland.

INTRODUCTION: In line with a new law in 2012 (Pflege-Neuausrichtungs-Gesetz) a special regard to informal care givers in inpatient rehabilitation and prevention facilities was established. Thus possibilities were created to facilitate care for people requiring nursing within the rehabilitation hospital while the informal caregiver is treated. On behalf of the German Ministry of Health the BQS Institute of Quality and Patient Safety analysed what specific offers for this target group are available in the rehabilitation setting and to what extent the requirements of the new law are already implemented. METHODS: To identify those specific offers for informal caregivers, a nationwide e-mail survey was conducted in 1,167 rehabilitation hospitals in Germany which was complemented with an internet research. Additionally semi-standardised interviews with 28 experts in different specialty fields as well as a literature research were conducted. RESULTS: 31 rehabilitation hospitals were identified, which provide specific measures for informal caregivers and 53 hospitals which provide care for the dependent person, too (overlaps are possible). By providing those offers, the providers are in unchartered waters in regard to concepts. Usually providers are relating to already existing measures in their indication areas and extend those through specific measures. To date, a targeted allocation of informal caregivers to appropriate facilities is not established.

Stroke rehabilitation services in New Zealand: a survey of service configuration, capacity and guideline adherence.

AIM: To provide an up-to-date account of stroke rehabilitation services in all District Health Boards (DHB) in New Zealand in 2013. METHOD: An online survey was completed by clinicians at all 38 facilities in New Zealand providing rehabilitation services following acute stroke. RESULTS: There was some evidence of stroke rehabilitation specialisation, particularly in larger DHBs (seven of eight large DHBs provided a dedicated stroke rehabilitation unit or designated beds). Capacity was generally satisfactory with units accommodating all (68% of units) or most (further 29%) of stroke patients needing rehabilitation. Most units had guidelines for the management of common problems following stroke, apart from depression screening (7%), but intensity of therapy input remains below recommended levels. Post-discharge rehabilitation services are available in the majority of areas but significant delays (mean 14 days) are common in accessing these services. The results for New Zealand stroke rehabilitation services are broadly comparable with those from the recent Australian stroke rehabilitation service audit. CONCLUSION: Compared to previous surveys, New Zealand stroke rehabilitation services have shown progress. To maximise outcomes for stroke patients, improvements are still needed in provision of dedicated stroke rehabilitation units, rehabilitation intensity and access to prompt community rehabilitation in the community.

Neighbourhood income and cardiac rehabilitation access as determinants of nonattendance and noncompletion.

BACKGROUND: Despite known benefits of exercise-based cardiac rehabilitation (CR), attendance and completion rates remain low. Our objective was to review attendance and completion of CR overall and by level of neighbourhood income in Saskatoon, Canada and then determine the effect of opening a new CR facility in close proximity to low-income neighbourhoods. METHODS: From January 2007 to December 2011, our retrospective cohort included hospital discharge data, CR attendance, and completion rates, stratified according to neighbourhood income, and adjusted for sex and age. RESULTS: Residents from low-income neighbourhoods were more likely (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.60-1.94) to be hospitalized for ischemic heart disease (IHD), percutaneous transluminal coronary angioplasty (PTCA), or coronary artery bypass graft (CABG) than residents from high-income neighbourhoods. Among those hospitalized for IHD, PTCA, or CABG, 12.7% attended CR. Patients of low-income neighbourhoods were less likely (OR, 1.58; 95% CI, 1.39-1.71) to attend CR than patients of high-income neighbourhoods. Among those who attended, 66.7% quit before program completion. Participants from low-income neighbourhoods were more likely (OR, 1.38; 95% CI, 0.57-3.50) to not complete CR. In total, only 4.2% of patients hospitalized for IHD, PTCA, or CABG started and completed CR. Expanding access to those living in low-income neighbourhoods did not increase attendance (OR, 1.31; 95% CI, 0.79-2.19) or completion rates (OR, 1.25; 95% CI, 0.23-2.41) to a significant level. CONCLUSIONS: High rates of nonattendance and noncompletion of CR were observed. Living in a low-income neighbourhood was associated with lower rates of attendance and completion. Expanding access to CR did not increase attendance or completion among patients of low-income neighbourhoods to a significant level.

Acute neurorehabilitation versus treatment as usual.

Several clinical and government reviews have recommended specialised rehabilitation services for those recovering from neurological insult or neurosurgical intervention. Despite this, provision of 'rapid access'/acute neurorehabilitation units is extremely limited in the UK. In some areas, millions of people have no access to such facilities. Numerous articles have indicated that delayed access to neurorehabilitation in the acute recovery stage may worsen clinical outcomes and increase length of stay for patients. However, there has been a lack of studies directly comparing clinical outcomes between matched samples of patients in acute neurorehabilitation units versus patients receiving treatment-as-usual. In a study believed to be the first of its kind, this paper: (A) Describes the rationale and evidence base for acute neurorehabilitation. (B) Provides a comparison of clinical outcome scores Functional Independence Measure/Functional Assessment Measure (FIM-FAM) and also length of stay times for both of the aforementioned groups. The results show that all outcome areas except the 'communication' domain saw clinically and statistically significant improvements in the acute neurorehabilitation group. Length of stay was significantly reduced in the acute neurorehabilitation group. The case for reviewing the provision of acute neurorehabilitation units is now even more urgent and difficult to ignore.

Community based rehabilitation: special issues.

The primary goal in the developing field of community based rehabilitation (CBR) for individuals with TBI / ABI is community participation and integration. At present, CBR is less than clearly defined and is represented by a set of interventions with varied types, degrees of clinical support and models of intervention that are conducted for a diverse and complex set of individuals, situations, deficits and settings. Nonetheless, holistic neurorehabilitation programs should be considered both evidence based and a practice standard. This paper attempts to address some of the significant issues relevant to optimizing long term adaptation for persons receiving CBR. The article also addresses the current need for definitions, models, program classifications and comparisons, as well as programmatic methodologies by attempting to integrate some of the best scientifically supported methodologies within an eclectic holistic rehabilitation model that is easily understood and teachable to persons with TBI, families and rehabilitation professionals. This model and associated methodologies are intended to inform best practices while offering a framework for hypothesis generation, clinical decision-making, evaluation of treatment outcomes and direction of future research.

Aphasia centers in North America: a survey.

There is a growing trend toward dedicated programs designed to improve the lives of people with aphasia and their families. We are referring to these programs collectively as "aphasia centers." These programs purportedly differ from more traditional medically based aphasia rehabilitation. However, there is no directory of aphasia centers and no definition of what constitutes such a program. Therefore, an online survey was designed to identify and describe aphasia centers in the United States and Canada. A 37-question survey was posted online via SurveyMonkey. An introductory letter was distributed by electronic mail to a listserv and mailing lists of programs associated with aphasia. Potential respondents who considered themselves an aphasia center were asked to complete the survey. A total of 33 survey responses were analyzed, and descriptive data were compiled resulting in a description of the following aspects of aphasia centers: demographic information, mission, admission and discharge policies, assessment practices, program logistics, staffing patterns, marketing, funding, and services offered. In addition, a qualitative analysis of written text responses revealed the following key themes that appear to characterize the responding programs: services that differ from traditional aphasia rehabilitation; a sense of community; a holistic focus on quality of life, psychosocial well-being, participation, and social support; the centrality of group interaction; and variety/intensity of services.

Integrating design and communication in engineering education: a collaboration between Northwestern University and the Rehabilitation Institute of Chicago.

The required course for freshmen in Northwestern University's engineering school - a 2-quarter sequence called Engineering Design and Communication (EDC) - is noteworthy not only for its project-based focus on user-centered design, but also for its innovative integrated approach to teaching communication, teamwork, and ethics. Thanks to the collaboration between EDC faculty and staff at the Rehabilitation Institute of Chicago, EDC students, at the beginning of their education, experience the excitement of solving problems for real clients and users. At the same time, these authentic design projects offer an ideal setting for teaching students how to communicate effectively to different audiences and perform productively as team members and future leaders in engineering.

[Selection criteria for patient admission to cardiac rehabilitation centers]. / Criteri per la selezione dei pazienti da inviare ai centri di cardiologia riabilitativa.

Current guidelines state that cardiac rehabilitation is indicated after the acute phase of major cardiovascular diseases and interventions; on the other hand implementation of these indications is difficult because of several barriers, i.e. the number of patients per year with an indication exceeds by far the accommodation offer of cardiac rehabilitation centers; the demand for access to cardiac rehabilitation from acute cardiac care hospitals is low because the attention is focused on the acute phase of cardiac diseases. The present Consensus Document describes the changes in clinical epidemiology of the main cardiovascular diseases, showing that complications are increasingly more frequent in the post-acute phase, especially in the setting of myocardial infarction. The Joint ANMCO/IACPR-GICR Committee defines priority criteria based on clinical risk for admission to cardiac rehabilitation centers as inpatients. This Consensus Document represents, therefore, an important step forward in the search for continuity of care in high-risk patients during the post-acute phase.

Use and distribution of rehabilitation services: a register linkage study in one hospital district area in Finland.

This study focuses on a large set of rehabilitation services used between 2004 and 2005 in one hospital district area in Finland. The rehabilitation system consists of several subsystems. This complex system is suggested to produce arbitrary rehabilitation services. Despite the criticisms against the system during decades, no attempts have been made to study the performance of the system as a whole. Register data from several subsystems were linked to study the use and characteristics of rehabilitation services and users. Data consisted of 10 153 persons. We analysed differences in rehabilitation service use between age and sex groups and municipalities. Totally, 5.4% of the population used rehabilitation services in the studied 2 years. Medical rehabilitation was the most common type, users' mean age was 52.6 years, and 52.2% were women. Remarkable differences were detected between municipalities in usage rates in all rehabilitation types. The size of the population in home municipality had a varying relation to utilization in different rehabilitation types. We found differences in the service use within age groups, sex or home municipality. This study cannot rule out the possibility that these differences indicated inequitable distribution of services or whether they are explained by different needs.

Avaliação dos serviços descentralizados de reabilitação física direcionados aos portadores de deficiência no Estado de Alagoas / Evaluation of quality of decentralized services of physical rehabilitation directed to the disabled persons in Alagoas State

Objetivo: Avaliar os serviços descentralizados de reabilitação física direcionados aos portadores de deficiência à luz da portaria GM/MS nº818/2001, considerando-se também a percepção dos profissionais e usuários sobre os referidos serviços. Participaram 5 serviços de reabilitação, 10 profissionais e 42 usuários. Método: Utilizou-se um formulário estruturado, contendo 67 itens da portaria, 21 itens foram apontados pelos profissionais e uma pergunta foi realizada aos usuários sobre a qualidade do serviço. Elaborou-se um ranking de classificação entre os serviços de reabilitação. Resultados: Verificou-se que 100% dos serviços possuem uma classificação regular considerando a portaria e 80% dos profissionais consideraram o serviço que atuam como regular. A qualidade dos serviços foi ?muito boa? na opinião dos usuários. Existe uma relação entre os itens apontados na portaria ministerial e a opinião dos profissionais dos serviços Conclusão: A implantação dos serviços de reabilitação física no estado de Alagoas parece ser favorável, em especial na opinião dos usuários.

Objective: To evaluate the physical rehabilitation of decentralized services targeted to people with disabilities in light of the ordinance GM / MS n º 818/2001, considering also the perception of professionals and users of those services. 5 attended rehabilitation services, 10 professional and 42 users. Method: We used a structured form, containing 67 items of the ordinance, 21 items were raised by professionals and a question was held to users on the quality of serviço. Elaborou is a classification ranking between the departments of rehabilitation. Results: It was found that 100% of services have a regular classification considering the ordinance and 80% of the respondents considered the service that act as regular. The quality of services was ?very good? in the opinion of the users. Is there a relationship between the items listed by the ministry and opinions of service professionals Conclusion: The implementation of physical rehabilitation services in the state of Alagoas seems to be favorable, particularly in view of the users.

The distribution of health services for older people in Australia: where does transition care fit?

INTRODUCTION: The purpose of this study was to describe the distribution of hospital and aged care services for older people, with a particular focus on transition care places, across Australia and to determine the relationships between the provision of these services. METHODS: Aggregation of health and aged care service indicators by Aged Care Assessment Team (ACAT) region including: public and private acute and subacute (rehabilitation and geriatric evaluation and management) hospital beds, flexible and mainstream aged care places as at 30 June 2006. RESULTS: There was marked variation in the distribution of acute and subacute hospital beds among the 79 ACAT regions. Aged care places were more evenly distributed. However, the distribution of transition care places was uneven. Rural areas had poorer provision of all beds. There was no evidence of coordination in the allocation of hospital and aged care services between the Commonwealth and state/territory governments. There was a weak relationship between the allocation of transition care places and the distribution of health and aged care services. DISCUSSION: Overall, the distribution of services available to older persons is uneven across Australia. While the Transition Care Program is flexible and is providing rural communities with access to rehabilitation, it will not be adequate to address the increasing needs associated with the ageing of the Australian population. An integrated national plan for aged care and rehabilitation services should be considered.

Trends in the supply of inpatient rehabilitation facilities services: 1996 to 2004.

OBJECTIVES: Describe the supply of inpatient rehabilitation facilities (IRFs) services in 1996 and examine changes between 1996 and 2004, including the impact of the IRF prospective payment system (PPS) in 2002 on organizational trends. DESIGN: Retrospective pre-post design. SETTING: Freestanding and subprovider (distinct-part units) IRFs. PARTICIPANTS: IRFs (N=1424), including 257 freestanding IRFs and 1167 IRF units reported in the Healthcare Cost Report Information System database, from years 1996 to 2004. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Number of IRF openings, IRF closures, beds, and inpatient days. RESULTS: The number of IRFs grew from 1037 to 1183 between 1996 and 2001 and grew to 1235 between 2001 and 2004. The likelihood of IRF closures trended lower after PPS, and there was a significant increase in the likelihood of openings when PPS was introduced. For-profit, rural, and small IRFs were more likely to open over the entire period. There was a 12.9% increase in the number of total inpatient days, somewhat less than the 15.7% growth in IRF beds over the period. There was no impact of PPS on beds available but a significant decline in total inpatient days after PPS. CONCLUSIONS: Inpatient days rose under the Tax Equity and Fiscal Responsibility Act and declined after 2002. Yet the likelihood of openings and closures did not appear to respond to these changes, perhaps because they were modest compared with changes in local IRF markets. The IRF PPS did little to affect service distribution in less well-served areas, although we did find growth in rural areas. Occupancy rates in 2004 were close to rates at the start of the period (70%). This observation implies that IRFs were implementing strategies to recruit a sufficient number of patients, even though bed numbers were increasing and length of stay was declining. Consequently, policy that limits the potential of IRFs to increase patient admissions, such as the limits on admissions to IRFs of patients with conditions other than those included in the 75% rule, is likely to produce substantial decreases in total inpatient days.

Rehabilitation after stroke: changes between 2002 and 2007 in services provided by district health boards in New Zealand.

AIM: To determine changes between 2002 and 2007 in stroke rehabilitation services provided by district health boards (DHBs) in New Zealand (NZ). METHOD: A questionnaire about organisation of stroke rehabilitation services and use of recommended guidelines was sent to hospitals in all 21 DHBs. RESULTS: Seven DHBs serving 49% of the NZ population provided a designated inpatient area for stroke rehabilitation in 2007 compared with one DHB serving 10% of the population in 2002 (p<0.001). In six DHBs (37%), this designated area was within a general rehabilitation unit. Only one DHB (12%) had a dedicated stroke rehabilitation unit. DHBs with a designated stroke rehabilitation area (SRA) were more likely to have multidisciplinary teams that spent more than half of the time with stroke patients (94% population with SRA versus 22% without SRA; p<0.001), audit their services (90% vs 39%; p<0.001), and provide education sessions for patients/families (82% vs 55%; p 0.004). However, many DHBs did not have guidelines for the management of common aspects of stroke care. CONCLUSION: Stroke rehabilitation services have improved since 2002 but concerns exist about the variability and quality of services provided. A consistent national approach to implementation of guideline recommendations and audit of services is required.

"To care for him who shall have borne the battle and for his widow and his orphan" (Abraham Lincoln): the Department of Veterans Affairs polytrauma system of care.

The initiation of combat in Iraq and Afghanistan has resulted in a new cohort of active-duty service members and veterans seeking rehabilitation care through the U.S. Department of Veterans Affairs (VA). Service members injured in combat most often sustain multiple injuries (polytrauma) and require a unique service delivery model to meet their needs. The VA recognized this need and responded with the development of the Polytrauma System of Care (PSC). This national system of care balances access and expertise to provide specialized life-long care to the combat injured. The PSC is comprised of: 4 specialized regional rehabilitation centers that are accredited in brain injury by the Commission on Accreditation of Rehabilitation Facilities; 21 specialized outpatient and subacute rehabilitation programs; designated polytrauma teams at smaller, more remote VA facilities; and a point of contact at all other VA facilities. In addition, the PSC has developed a proactive case-management model, a specialized telehealth network, guidelines for long-term follow-up, and services for those individuals who are unable to return home. The following commentary and articles provide additional detail on this new and unique system of care.