Describing community-based rehabilitation services in Indonesia by using The International Classification of Service Organization in Rehabilitation 2.0.

OBJECTIVE: Describing rehabilitation services in a standardized way is a challenge. The International Classification of Service Organizations in Rehabil-itation (ICSO-R) 2.0 was published for this purpose. The ICSO-R was criticized for being tested mainly in high-income countries, and because the testing in lower-income countries did not include community-based rehabilitation services. Therefore, this study was performed to describe community-based rehabilitation services by using ICSO-R 2.0. METHODS: The ICSO-R 2.0 was used to describe 8 community-based rehabilitation services located in 3 cities in 3 different provinces in Indonesia: 6 community-based rehabilitation services in Bandung, West Java; 1 in Tanah Datar, West Sumatra; and 1 in Gowa, South Sulawesi. RESULTS: All the community-based rehabilitation services were owned by the government, as a public body, and in the context of the community. The 6 community-based rehabilitation services in Bandung, West Java, are under the government city of Bandung, while the other 2, from Tanah Datar and Gowa, are integrated within primary healthcare centres. Social welfare supports all 6 community-based rehabilitation services in Bandung. The other 2 community-based rehabilitation services are supported by their respective primary healthcare centres. CONCLUSION: The ICSO-R 2.0 is a feasible tool to describe rehabilitation services, including community-based rehabilitation.

A comparison and synthesis of rehabilitation definitions used by consumers (Google), major Stakeholders (survey) and researchers (Cochrane Systematic Reviews): a terminological analysis.

BACKGROUND: The term "rehabilitation" is heterogeneously used in the health context. Different interpretations can lead to disagreements, misunderstandings and different interpretations of what rehabilitation is between who provides it, who receives it and who studies it. The aim of this study was to conduct a terminological analysis of the different rehabilitation definitions used by different audiences: consumers, rehabilitation stakeholders and researchers. METHODS: We performed a terminological analysis with comparison of three different collections of rehabilitation definitions in English language. We performed: systematic reviews of databases representing consumers and lay persons (Google) and researchers (Cochrane Systematic Reviews [CSRs]), and a survey of rehabilitation stakeholders (Cochrane Rehabilitation Advisory Board). To aggregate words that had the same underlying concepts, their roots were extracted, and their occurrences counted. The 30 most frequent roots of each search were included. The 3 obtained collections were compared and similarities calculated. An overall collection of the most important 30 roots was obtained weighting those obtained in each single collection. All analyses have been performed using Excel. RESULTS: One hundred and eighty-seven rehabilitation definitions were identified: 23 from CSRs, 36 from the survey and 128 from Google. The most frequent roots were "function*" (92%), followed by "proces*" (69‰), "health*" (59‰), "disab*" (53‰), and "person*" (50‰). The most common relevant roots related to rehabilitation concept were "proces*" (73‰) in Google, "function*" (109‰) in the survey and "disab*" (41‰) in CSRs. The noun "function" prevailed in Google and "functioning" in the survey. CONCLUSIONS: According to our findings, any definition of rehabilitation for research purposes should include the identified terms, focusing on the concept of process and considering the main elements of functioning (and function), disability, person, health, optimization and environment.

Current rehabilitation definitions do not allow correct classification of Cochrane systematic reviews: an overview of Cochrane reviews.

BACKGROUND: During the first three years of its work, Cochrane Rehabilitation was faced with the challenge of defining the inclusion and exclusion criteria of what is rehabilitation on four different occasions: when we worked on classifying all Cochrane systematic reviews (CSRs) for relevance to rehabilitation, when we checked for newly published CSRs, when we started the process to set up the reporting guidelines for the Randomized Controlled Trials Rehabilitation Checklist (RCTRACK) project, and during our collaboration with the World Health Organization for the Package of Rehabilitation Interventions. The aim of this paper was to check how the word "rehabilitation" gets used by researchers in the health field. METHODS: This overview of reviews included all CSRs that used the term "rehabilitation" in the title. They were compared with the authors' judgement (AJ) and with the contents of two main sources: CSRs identified by Cochrane Rehabilitation as relevant to rehabilitation (CRDB), and PubMed MeSH term "rehabilitation." We also performed a content analysis classifying all CSRs by field and type of intervention and checked the internal coherence of the two databases in order to verify whether all CSRs on interventions in a specific rehabilitation field were included in the databases or not. RESULTS: Out of 14,816 PubMed entries, we analyzed 89 CSRs. We found four reviews that were judged by all classifications as not rehabilitation: they were related to mouth, nutritional, penile and schizophrenia rehabilitation. While CRDB and AJ included 94% and 91% of CSRs respectively, PubMed included only 50%. One CSR about cardiac rehabilitation was excluded only by CRDB and four by AJ. In the 50% CSRs excluded by PubMed, we found that all CSRs on cancer and vestibular rehabilitation, and those on cognitive and neuropsychological interventions, were always omitted, even if all other CSRs on neurological rehabilitation were included. CONCLUSIONS: Our results clearly highlight the need for a comprehensive rehabilitation definition that is able to point out what should be included and excluded from rehabilitation interventions. This will consequently inform all of Cochrane Rehabilitation's work and will serve the wider community of research and rehabilitation.

Toward a new definition of rehabilitation for research purposes: a comparative analysis of current definitions.

There is a need for a common, shared definition of rehabilitation to conduct systematic reviews and identify relevant systematic reviews for knowledge translation purposes, which is an important task of Cochrane Rehabilitation. The present paper aimed to introduce and compare existing health-related definitions of rehabilitation and to propose core aspects that should characterize a new and workable definition of rehabilitation that is able to serve both as the basis for internal communication and identity work and for external communication. We have conducted a PubMed literature search on current definitions that have been published since the launch of WHO's ICF in 2001. Definitions were analyzed by framing questions to which the definitions provide answers. Nine definitions were included in the analysis. Rehabilitation has been defined as a process, as a set or bundle of interventions, and as a health strategy. The main beneficiaries were mainly related to the presence of disability, however, no specific means or interventions in rehabilitation could be identified. The definitions provided varying answers to the questions "by whom…," "where…," and "when…" and additionally identified certain conditions for rehabilitation. The present analysis can serve as a valuable source of information for developing a Cochrane Rehabilitation definition of rehabilitation.

Expert opinions leave space for uncertainty when defining rehabilitation interventions: analysis of difficult decisions regarding categorization of rehabilitation reviews in the Cochrane library.

BACKGROUND: In 2017, Cochrane Rehabilitation created an online relational database to crowd-source the identification and categorization of Cochrane publications for relevance to rehabilitation. One of the challenges of this work has been the lack of an operational definition to determine what is or is not a rehabilitation intervention. As such, categorization decisions have been largely based on expert opinion, with two health professionals screening each review, and with disagreements in categorization decisions being adjudicated by the Cochrane Rehabilitation Review Committee. AIM: To analyze the rationale for resolving conflicts in the identification of rehabilitation reviews from all Cochrane reviews to contribute to future work on the scope and definition of rehabilitation interventions. METHODS: We extracted data on decisions made about all Cochrane titles (both protocols and reviews) published between 1 January, 1996, and 31 August, 2019, and identified all titles where there had been disagreement between any people categorizing the reviews. We used thematic analysis methods to classify the reasons for including or excluding reviews from a collection of reviews on rehabilitation interventions. We compared across groups to identify areas of conflict and errors in the initial categorization. RESULTS: Of the 9756 Cochrane titles screened, we identified 894 (9.2%) where some disagreement existed about whether a review was about rehabilitation interventions or not. Of these, 333 (37.2%) had met our original pragmatic criteria for being a "rehabilitation" review, while 561 (52.8%) had not. Seven hundred and nineteen of these reviews (80.4%) could be grouped by inductively created, reportable criteria to justify the initial categorization decisions. Fifty-seven reviews (6.4%) were on topics that were too idiosyncratic to easily group with others for the purposes of categorization. Conflicts in the rationale for categorization decisions were identified in 90 reviews (10.1%) and errors in the initial categorization for 28 reviews (3.1%). CONCLUSIONS: The challenges and conflicts identified in this study clearly indicate the need for better operational definition of rehabilitation interventions. This study provides a foundation for future work to check the utility of any new definition of rehabilitation interventions and to improve the trustworthiness of categorization decisions regarding the Cochrane Rehabilitation database.

International Classification of Service Organization in Rehabilitation: An updated set of categories (ICSO-R 2.0).

OBJECTIVE: To develop a revised version of the International Classification of Service Organization in Rehabilitation (ICSO-R). DESIGN: Qualitative study. SUBJECTS: Not applicable Methods: The revision was based on testing the first version of the ICSO-R; 2 discussion rounds invited by the ICSO-R working group of the Standardized Rehabilitation Reporting Subcommittee of the World Health Organization Liaison committee of the International Society of Physical and Rehabilitation Medicine, and a call for corrections from a group of international experts. RESULTS: The resulting ICSO-R 2.0 version is composed of 2 dimensions (formerly 3); the Provider dimension and the Service delivery dimension. The categories of the Funding dimension from the first version of ICSO-R were incorporated into each of the other dimensions. The Provider dimension now consists of 9 categories and the Service delivery dimension consists of 14 categories. Subcategories have been added to 7 categories: governance/leadership, funding of provider, target groups, location of service delivery, setting, rehabilitation team, and funding of service delivery. CONCLUSION: This updated version of ICSO-R provides a prerequisite for rehabilitation service organization assessment and implementation projects, reporting of contextual influences in clinical trials and many other aspects. In addition, ICSO-R 2.0 can be used for several purposes, e.g. to analyse and compare the provision of rehabilitation services in health systems and to support the quality management of rehabilitation services. However, the development of value sets for each (sub)category and further validation studies are still needed.

Quality management in medical rehabilitative care by the German statutory pension insurance scheme.

This paper aims to provide an insight into the quality management approach for medical rehabilitation services of the German statutory pension insurance scheme. In the 1990s, the German statutory pension insurance scheme initiated a quality management programme in rehabilitation, which is subject to continuous development. The main objective of implementing quality management in rehabilitative care was quality control and quality improvement. To achieve these goals, five main tools for quality measurements were applied: a classification of therapeutic services, standards of rehabilitative interventions, patient surveys, peer review, and surveys that address structure of care. These tools enable the assessment of the structural and process quality of rehabilitative care, as well as aspects of rehabilitation outcome. As a result, quality of rehabilitation care becomes more measurable, transparent, and hence can be improved on well-founded grounds. These measurements allow implementing comparisons and benchmarking of rehabilitation facilities, thereby creating incentives for quality improvements. Therefore, the development and implementation of quality management measures in facilities of inpatient and outpatient medical rehabilitation is an ongoing process and expands to other areas of rehabilitation.

Physical Medicine Devices; Reclassification of Shortwave Diathermy for All Other Uses, Henceforth To Be Known as Nonthermal Shortwave Therapy. Final order; technical correction.

The Food and Drug Administration (FDA) is issuing a final order to reclassify shortwave diathermy (SWD) for all other uses, a preamendments class III device, into class II (special controls), and to rename the device "nonthermal shortwave therapy'' (SWT). FDA is also making a technical correction in the regulation for the carrier frequency for SWD and SWT devices.

Medical devices; physical medicine devices; classification of the powered lower extremity exoskeleton; republication. Final order; republication.

The Food and Drug Administration (FDA or the Agency) is republishing in its entirety a final order entitled ``Medical Devices; Physical Medicine Devices; Classification of the Powered Lower Extremity Exoskeleton'' that published in the Federal Register on February 24, 2015. FDA is republishing to correct an inadvertent omission of information. FDA is classifying the powered lower extremity exoskeleton into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the powered lower extremity exoskeleton's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Medical devices; physical medicine devices; classification of the powered exoskeleton. Final order.

: The Food and Drug Administration (FDA) is classifying the powered exoskeleton into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the powered exoskeleton's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

The International Classification of Functioning, Disability and Health: a unifying model for the conceptual description of physical and rehabilitation medicine.

There is a need to develop a contemporary and internationally accepted conceptual description of physical and rehabilitation medicine (PRM). The process of evolving such a definition can now rely on the unifying conceptual model and taxonomy of the International Classification of Functioning, Disability and Health (ICF) and an ICF-based conceptual description of rehabilitation understood as a health strategy. The PRM section of the European Union of Medical Specialists (UEMS) has endorsed the application of the ICF as a unifying conceptual model for PRM and supports the process of moving towards an "ICF-based conceptual description and according definitions of PRM". With this goal in mind, the authors have developed a first tentative conceptual description in co-operation with the professional practice committee of the UEMS-PRM-section. A respective brief definition describes PRM as the medical specialty that, based on the assessment of functioning and including the diagnosis and treatment of health conditions, performs, applies and co-ordinates biomedical and engineering and a wide range of other interventions with the goal of optimizing functioning of people experiencing or likely to experience disability. Readers of the Journal of Rehabilitation Medicine are invited to contribute to the process of achieving an internationally accepted ICF-based conceptual description of PRM by submitting commentaries to the Editor of this journal.

Case-mix measurement in medical rehabilitation.

Case-mix measurement offers a way to take patient characteristics into account in the determination of payment rates. This article begins with an overview of major case-mix measures across inpatient hospital and other institutional settings and describes ways to measure the suitability and relative strengths of these measures. It then briefly discusses issues of payment and the appropriateness of alternative case-mix measures to inpatient rehabilitation. The literature review extends back to the 1970s, thus preceding advent of the Diagnosis-Related Groups, which was the first major case-mix measure developed and implemented in a hospital setting.

Medicina fisica e reabilitacao - fisiatria: um pouco sobre sua historia / Physiatry: a historical briefing

Afim de trabalhar um pouco mais para o esclarecimento da especialidade, e proposito deste artigo fazer um breve historico das formas de tratamento fisiatrico mais utilizadas ao longo da historia, bem como procurar demonstrar um espaco de atuacao especifico, mas que ao mesmo tempo e necessariamente multidisciplinar.