Expert Views on Evidence-Based Classification for Goalball: A Delphi Study.

Para sport classification aims to minimize the impact of impairments on the outcome of competition. The International Paralympic Committee requires classification systems to be evidence based and sport specific, yet the sport of goalball uses a structure that is not supported by evidence demonstrating its legitimacy for competition. This study aimed to establish expert opinions on how a sport-specific system of classification should be structured in the sport of goalball. Using a three-round Delphi survey, 30 international experts expressed their views across topics linked to goalball classification. Participants were divided as to whether the current system fulfills the aim to minimize the impact of impairment on competition. Most felt that less impairment should be required to compete but that the one-class structure should remain. Experts identified measures of visual function that should be considered and 15 core components of individual goalball performance. Findings constitute a crucial first step toward evidence-based classification in goalball.

The development of the International Classification of Functioning, Disability and Health Core Sets for deafblindness: A study protocol.

BACKGROUND: Individuals with deafblindness experience a combination of hearing and vision impairments. The World Health Organization has developed a global framework referred to as the International Classification of Functioning, Disability and Health (ICF) to describe health and functioning. From the full ICF classification, a selection of categories, referred to as ICF Core Sets, provide users with a tool to describe functioning and disability in specific health conditions. There has been no ICF Core Set created for deafblindness. Given that core sets are instrumental in improving clinical practice, research, and service delivery, the aim of this study is to develop an ICF Core Set for deafblindness. METHODS: As part of the preparatory phase in the ICF Core Set development, there are four studies that will be conducted. This includes the [1] systematic literature review that examines the researcher's perspective, [2] qualitative study focusing on the individuals with deafblindness experience, [3] experts survey that looks at health professional's perspective, and [4] empirical study that examines the clinical perspective. The studies will be conducted using the principles outlined by the ICF Research Branch for the development of ICF Core Sets. The systematic literature review protocol was submitted for registration on PROSPERO CRD42021247952. DISCUSSION: An ICF Core Set created for deafblindness will benefit individuals living with deafblindness who are often excluded from social participation, policies, and services. An ICF Core Set for deafblindness will have a significant impact on healthcare professionals, policymakers, researchers, service providers and individuals with deafblindness by facilitating communication among all stakeholder to support the functioning of those with deafblindness.

Distinguishing chronic low back pain in young adults with mild to moderate pain and disability using trunk compliance.

Chronic low back pain (cLBP) rates among younger individuals are rising. Although pain and disability are often less severe, underlying changes in trunk behavior may be responsible for recurrence. We examine the biomarker capacity of a simple Trunk Compliance Index (TCI) to distinguish individuals with and without cLBP. A random subset (n = 49) of the RELIEF RCT were matched to healthy controls for sex, age, height and weight. We measured TCI (as displacement/ weight-normalized perturbation force) using anthropometrically-matched, suddenly-applied pulling perturbations to the trunk segment, randomized across three planes of motion (antero-posterior, medio-lateral, and rotational). Mean differences between cLBP, sex and perturbation direction were assessed with repeated-measures analysis of variance. Discriminatory accuracy of TCI was assessed using Receiver Operator Characteristic (ROC) analysis. Baseline characteristics between groups were equivalent (x̅ [range]): sex (57% female / group), age (23.0 [18-45], 22.8 [18-45]), height, cm (173.0 [156.5-205], 171.3 [121.2-197], weight, kg (71.8 [44.5-116.6], 71.7 [46.8-117.5]) with cLBP associated with significantly lower TCI for 5 of 6 directions (range mean difference, - 5.35: - 1.49, range 95% CI [- 6.46: - 2.18 to - 4.35: - 0.30]. Classification via ROC showed that composite TCI had high discriminatory potential (area under curve [95% CI], 0.90 [0.84-0.96]), driven by TCI from antero-posterior perturbations (area under curve [95% CI], 0.99 [0.97-1.00]). Consistent reductions in TCI suggests global changes in trunk mechanics that may go undetected in classic clinical examination. Evaluation of TCI in younger adults with mild pain and disability may serve as a biomarker for chronicity, leading to improved preventative measures in cLBP.Trial Registration and Funding RELIEF is registered with clinicaltrials.gov (NCT01854892) and funded by the NIH National Center for Complementary & Integrative Health (R01AT006978).

Escala de triagem odontológica para pacientes com necessidades especiais / Dental screening scale for patients with special needs

Objetivo: elaborar e testar uma Escala de Triagem Odontológica para Pacientes com Necessidades Especiais (PNEs). Métodos: a escala foi elaborada a partir da experiência clínica de um centro de referência para aten-dimento odontológico a PNEs e de evidências científicas. Foi construída utilizando cinco critérios principais: comportamento, necessidade e possibilidade de estabilização protetora, urgência odontológica (dor), núme-ro e complexidade de procedimentos odontológicos e local do atendimento (acessibilidade). O instrumento foi testado em 14 PNEs, que participaram de uma triagem no Centro de Especialidades Odontológicas (CEO) Jequitibá, na Faculdade de Odontologia da Universidade Federal de Pelotas (UFPel). Estudantes de gradua-ção a partir do oitavo semestre fizeram a aplicação, e o resultado da escala foi comparado ao parecer clínico realizado pelos pesquisadores experientes no atendimento a esses pacientes. Resultados: foi observada uma concordância em 85% dos casos. Conclusão: o instrumento apresentou desempenho comparável à avalia-ção de profissionais com expertise, e a escala pode ser um instrumento útil para ser empregado em serviços odontológicos que oferecem atendimento aos PNEs. A sua utilização em meio acadêmico também pode pro-porcionar o empoderamento dos critérios de avaliação pelos estudantes, proporcionando maior segurança em acolher, atender ou encaminhar esse público no seu futuro profissional. (AU)

Objective: to develop and test a dental screening scale to be used of patients with special needs (PSN). Method: the scale was developed based on the clinical experience of a reference center for dental care for PSN and scientific evidence. It was built using 5 main criteria: behavior, need and possibility of protective stabilization (PE), dental urgency (pain), number and complexity of dental procedures and place of care (accessibility). The instrument was tested on 14 PSN who participated in a screening at the Center for Dental Specialties (CEO) Jequitibá, Faculty of Dentistry, UFPEL. Undergraduate students from the eighth semester onwards applied and the result of the scale was compared to the clinical opinion carried out by experienced researchers in the care of these patients. Results: agreement was observed in 85% of cases. Conclusion: the instrument presented performance comparable to the evaluation of professionals with expertise and the scale can be a useful instrument to be used in dental services that offer care to PSN. Its use in academia can also provide the empowerment of assessment criteria by students, providing greater security in welcoming, serving or referring this audience in their professional future.

Evidence-based Classification in Track Athletics for Athletes with a Vision Impairment: A Delphi Study.

SIGNIFICANCE: The Delphi analysis presented here highlights the need for a sport-specific evidence-based classification system for track athletics for athletes with a vision impairment (VI). This system may differ for different race distances. Further research is required to develop a useful test battery of vision tests for classification. The issue of intentional misrepresentation during classification needs particular attention. PURPOSE: At present, athletes with VI are placed into competition classes developed on the basis of legal definitions of VI. The International Paralympic Committee Athlete Classification Code states that all sports should have their own classification system designed to reflect the (visual) demands of that individual sport. This project gathered expert opinion on the specific requirements for an evidence-based sport-specific classification system for VI track athletics and to identify any particular issues within track athletics that require further research into their impact on sport performance. METHODS: A three-round Delphi review was conducted with a panel of 17 people with expertise in VI track athletics. RESULTS: The panel agreed that the current classification system in VI track athletics does not completely minimize the impact of impairment on competition outcome, highlighting the need for improvements. There was clear agreement that the existing measures of vision may fail to adequately reflect the type of vision loss that would impact running performance, with additional measures required. Intentional misrepresentation, where athletes "cheat" on classification tests, remains a serious concern. CONCLUSIONS: The panel has identified measures of vision and performance that will inform the development of an evidence-based classification system by better understanding the relationship between VI and performance in track athletics. Issues such as the use of guides and whether the current class system was equitable gave rise to differing opinions within the panel, with these varying across the different running distances.

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.

Estudio descriptivo sobre la Clasificación Internacional del Funcionamiento y el diagnóstico de fisioterapia / Descriptive study on the International Classification of Functioning and diagnosis of physiotherapy

ANTECEDENTES/OBJETIVO: El diagnóstico de fisioterapia es uno de los eslabones menos desarrollados en la profesión y, aunque se reconoce a la Clasificación Internacional del Funcionamiento (CIF) como marco teórico, no se interpretan adecuadamente las propuestas y etiquetas diagnósticas. El objetivo de este estudio es describir los elementos clave que configuran el diagnóstico en fisioterapia integrando el contexto de la CIF. MÉTODO: Estudio descriptivo, observacional, transversal de corte cualitativo, basado en el modelo de análisis interpretativo de Grounded Theory. En primer lugar, se lleva a cabo una encuesta tipo Likert (n = 42) y, en segundo lugar, se realiza un análisis interpretativo de un grupo de discusión. RESULTADOS: El diagnóstico de fisioterapia es percibido por los participantes del grupo de discusión como un sello de identidad de la profesión, por su objetividad, su carácter científico y por favorecer la comunicación interdisciplinar. Se identificaron trece códigos organizados en cuatro categorías. Estas categorías son: las áreas de desarrollo del diagnóstico de fisioterapia, los perfiles de los fisioterapeutas, los conocimientos sobre la Clasificación, y las competencias de la Clasificación. Los códigos que definen estas categorías son, respectivamente: los roles académico, profesional e investigador; los perfiles clínico-asistencial, científico y afectivo-emocional; las definiciones, desventajas, mejoras y utilidad en el diagnóstico de fisioterapia; y los componentes de salud, conjuntos básicos y nivel internacional. CONCLUSIÓN: Los códigos obtenidos definen el diagnóstico de fisioterapia en el contexto actual de la CIF. Estos son aspectos para el estudio y elementos de referencia para desarrollar etiquetas diagnósticas acordes con las necesidades de la fisioterapia actual

BACKGROUND/OBJECTIVE: Physiotherapy assessment is one of the least developed elements of the profession. Diagnostic proposals and labels are not properly interpreted, although the International Classification of Functioning (ICF) is recognized as a theoretical framework. The objective of the study is to describe the key elements that make up the physiotherapy assessment within the context of the ICF. METHOD: A descriptive, observational, cross-sectional qualitative study based on the Grounded Theory interpretative analysis model. First, a Likert-type survey (n = 42) is carried out, and second, an interpretative analysis of a discussion group. RESULTS: Physiotherapy assessment is perceived by the discussion group respondents as a hallmark of the profession, due to its objectivity, its scientific nature and in promoting interdisciplinary communication. Thirteen codes organized into four categories were identified. These categories are areas of development of physiotherapy diagnosis, physiotherapist profiles, knowledge about the ICF, and domains of the classification. The codes that define these categories are: academic, professional and research roles; clinical, scientific and affective-emotional profiles; definitions, disadvantages, improvements and diagnostic suitability; and health-related domains, basic sets and international level. CONCLUSION: The codes obtained define the physiotherapy assessment in the current context of the ICF. These elements are essential for study and to develop diagnostic labels according to the needs of current physiotherapy

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.

Disability Severity and Home-Based Care Quality in Older Adults: The Mediating Effects of Social Support and Caregiver Competence.

BACKGROUND: The lack of adequate medical care, healthcare, and older adult care in remote, low-income, rural Kazakh areas of China is a particular concern that should be prioritized for improvement. PURPOSE: This study was designed to explore the relationship between the variables of disability severity, social support, and caregiver competence and the quality of home-based care in a population of Kazakh older adults with disabilities and to analyze the path between severity of disability and quality of home-based care in this population. METHODS: A cross-sectional survey was conducted on 335 Kazakh older adults with disabilities living in Xinjiang, China, and their primary informal caregivers. Disability severity was assessed using the Activities of Daily Living Scale, caregiver competence was assessed using the Family Caregiver Task Inventory, social support was assessed using the Social Support Rating Scale, and home-based care quality was assessed using the Family Caregiving Consequences Inventory Scale. Path analysis was used to check the effects of other variables on the quality of home-based care. RESULTS: Significant correlations were found among disability severity, caregiver competence, social support, and home-based care quality. Disability severity was shown to have a 29.28% direct effect on home-based care quality and a 70.72% indirect effect through social support and caregiver competence. CONCLUSIONS: The results of this study confirm that better social support and caregiver competence improves the quality of home-based care available to older adults with disabilities. Policymakers should give priority to improving the quality of care provided to community-dwelling older adults with severe disabilities. Furthermore, health management departments should provide informal caregiver training that teaches care and rehabilitation knowledge and skills to improve the competencies of caregivers.

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.

The Prevalence and Risk of Type 2 Diabetes in Adults with Disabilities in Korea.

BACKGROUND: People with disabilities are at risk of secondary conditions such as diabetes. The aim of this study was to evaluate the prevalence and risk of type 2 diabetes in South Korea, especially among people with all types of disabilities. METHODS: We conducted a cross-sectional study using data from the Korean National Health Insurance Service, with two disabilityfree controls matched for each participant with disabilities by age and sex. Information regarding the type, severity and grade of disabilities was obtained based on the National Disability Registry. Diagnosis of type 2 diabetes was defined according to the following criteria: presence of International Classification of Diseases, Tenth Revision, Clinical Modification codes E11, E12, E13, or E14 and claims for at least one oral anti-diabetic agent or insulin at baseline, or fasting glucose level ≥126 mg/dL. RESULTS: We included 1,297,806 participants with disabilities and 2,943,719 control. Out of 4,241,525 participants, 841,990 (19.9%) were diagnosed with diabetes. The prevalence of diabetes was higher in the disability group compared with individuals without disabilities (23.1% vs. 18.4%). The odds of having diabetes was higher in the disability group compared with the control group (adjusted odds ratio, 1.34; 95% confidence interval, 1.33 to 1.34). The results showed higher prevalence of diabetes in the mildly disabled group (23.2%) than in the severely disabled group (22.7%). CONCLUSION: The prevalence and risk of diabetes were higher in people with disabilities compared with the general population. Physicians and public health authorities should focus on people with disabilities for proper diabetes management.

How do the particular characteristics of less-educated employees with disabilities impact survey implementation?

BACKGROUND: Employees with disabilities make up a significant share of the working population. The group of employees covered by this study is hard to include in research and yet must be researched due to the vulnerable position it holds in the labour market. The topic is quite complex. OBJECTIVE: The article's main goal is to demonstrate how to implement a survey and adapt a questionnaire for assessing competencies and motivation for training and career changes among older and less-educated employees who have disabilities. METHODS: In the paper, we discuss the approach to adapting a questionnaire and a survey by undertaking an extensive process of different testing and adaptation stages that is presented in the article. RESULTS: We highlight some obstacles that employees with disabilities face when participating in surveys due to their low literacy skills, as well as low self-esteem, accessibility issues and other general methodological issues in the context of our population. Potential solutions gathered from all phases of the adaptation process are discussed. CONCLUSIONS: Proper survey implementation and questionnaire modification must be ensured if researchers aim to increase the willingness of individuals with disabilities to participate in the survey and to gather quality results.

Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional / Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit

OBJETIVO: Evaluar la influencia del cambio en la gestión de ingresos en una unidad geriátrica de recuperación funcional (UGRF) sobre su actividad y resultados asistenciales. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo. Se recogieron datos registrados desde el año 2000 de la UGRF del Hospital Central Cruz Roja, agrupados en periodos de 4 años, salvo los ingresos centralizados (septiembre de 2016-diciembre de 2018). Los datos recogidos al ingreso fueron Escala Funcional y Mental de Cruz Roja, índice de Barthel, diagnóstico principal motivo del deterioro funcional (que se agrupó en ictus, patología ortopédica y cuadros de inmovilidad multifactorial) y comorbilidad evaluada por el índice de Charlson. Como variables de resultado se estudiaron la ganancia funcional al alta, tanto global como relativa, la estancia hospitalaria, la eficiencia funcional, las altas a residencia y los retraslados a unidad de agudos. Analizamos la relación entre los ingresos realizados de manera centralizada desde una unidad externa y el periodo previo (ingresos gestionados directamente desde la UGRF) en las variables resultados utilizando un análisis multivariante (regresión lineal para variables resultado continuas y regresión logística para las dicotómicas) ajustado por variables al ingreso. RESULTADOS: En el análisis multivariante los pacientes ingresados desde la unidad central presentaron una mayor ganancia funcional global y relativa (diferencia de medias de 3,49 puntos con IC 95%=1,65-5,33 y 12,41% con IC 95%=0,74-24,08, respectivamente), mayor estancia (12,92 días; IC 95%=11,54-14,30) y menor eficiencia (−0,36; IC 95%=−0,16 a −0,57), mayor riesgo de institucionalización (OR 1,61; IC 95%=1,19-2,16) y riesgo de retraslado a unidad de agudos (OR 3,16; IC 95%=2,24-4,47). CONCLUSIONES: El sistema centralizado de ingreso influyó en la mejora de parámetros funcionales, pero a costa de una mayor estancia y una menor eficiencia asistencial, objetivándose un incremento de la institucionalización al alta y de los retraslados a unidades de agudos

OBJECTIVE: To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS: A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS: Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (−0.36, 95% CI; −0.16 to −0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS: A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed

Development of a comprehensive core set from the international classification of functioning, disability and health for return to work among patients with stroke through Delphi-based consensus.

BACKGROUND: Young patients with stroke are typically the economic support of their families and societies, and their return to work (RTW) is crucial to maintaining their quality of life. However, the identification of RTW-related factors of different aspects is complicated and a systematic analysis of these factors is lacking. AIM: The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) for return to work (RTW) among patients with stroke. DESIGN: Three-round Delphi-based consensus. SETTING: University-based hospital. POPULATION: Thirty experts in stroke-related domains from different institutions. METHODS: A five-point Likert Scale was used to rate the importance of each item. Consensus of ratings was analyzed using Spearman's rho and semi-interquartile range indices. The International Classification of Functioning, Disability and Health core set for return to work among patients with stroke was based on a high level of consensus and a mean score of ≥4.0 in the third round of the Delphi. RESULTS: The ICF core set comprised 58 categories distributed as follows: 16 body function, 30 activities and participation, 10 environmental factor, and 2 personal factors. CONCLUSIONS: Our ICF core set for RTW among patients with stroke can inform effective rehabilitation strategies and goal setting for RTW among patients with stroke. However, further validation is warranted. CLINICAL REHABILITATION IMPACT: ICF core set could provide information on rehabilitation strategies setting for RTW of stroke patients.

Decision support system for designing and assigning ergonomic workplaces to workers with disabilities.

Workers with disabilities are still lagging in employment rates compared to the healthy workforce. Those workers are also more sensitive for stress at work and possible injuries that are usually connected with non-adequate workplace design. Generally, absenteeism presents high costs for companies and costs can be even higher if injuries at work occur. Therefore, companies face the problem of identifying a suitable workplace for workers with disabilities and supplying the needed requirements. The purpose of our research was to develop a decision support system that would aid in the process of identifying and categorising disabilities of workers, and assigning the most suitable workplace with needed requirements in an integrated work environment to ensure high safety, productivity and satisfaction. The developed decision support system is also a step toward prevention of injuries at work. The usefulness of the system has been shown in a case study of a large-sized production company. Practitioner summary: The purpose of our research was to develop a decision support system that would aid companies to identify a suitable workplace for workers with disabilities with needed requirements in an integrated work environment to ensure high safety, productivity and satisfaction with lower costs. Abbreviations: OSHA: occupational safety and health act; UN Convention: The United Nations Convention; EU Directive 89/654/EEC: European Union directive concerning the minimum safety and health requirements for the workplace; ICF: The International Classification of Functioning, Disability and Health; ICD: The International Statistical Classification of Diseases and Related Health Problems; RULA: rapid upper limb assessment; OWAS: ovaco working analysing system.

Examination of the dependency and complexity of patients admitted to in-patient rehabilitation in Australia.

Objective The aim of this study was to determine whether there has been a measurable change in the dependency and complexity of patients admitted to in-patient rehabilitation in Australia between 2007 and 2016. Methods A retrospective cohort study design was used to examine in-patient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database for the period 2007-16. Epidemiological descriptive analysis was used to examine datasets for difference between four discrete years (2007, 2010, 2013 and 2016). Datasets included patient demographics, length of stay (LOS), comorbidities, complications and the Functional Independence Measure (FIM™). Results Between 2007 and 2016, rehabilitation in-patients as a whole: (1) had a mean decrease in total admission FIM score; (2) became more complex, as evidenced by the increased proportion of particular comorbidities impacting on rehabilitation, namely cardiac and respiratory disease, dementia, diabetes and morbid obesity; and (3) had a mean decrease in total discharge FIM score. However, there was an increase in the proportion of patients discharged home from rehabilitation (from 86.5% to 92%) and decreases in onset and rehabilitation LOS of 2.2 and 2.5 days respectively. Conclusion The dependency and complexity of patients admitted to in-patient rehabilitation in Australia has increased between 2007 and 2016. What is known about the topic? Anecdotal reports suggest that rehabilitation patients in Australia have become more complex, necessitating increased active management of their presenting health condition and comorbid health conditions. However, to date, no systematic investigation has been undertaken to examine trends in rehabilitation in-patient dependency and complexity over time. What does this paper add? This study provides measurable evidence of increased dependency and complexity in patients admitted to rehabilitation in Australia. Further, compared with 2007, rehabilitation in-patients as a whole had an increased burden of care on discharge from rehabilitation in 2016. What are the implications for practitioners? The changes in patient dependency and complexity reported in this study have implications for rehabilitation service delivery. This is because the increased need for illness or injury and comorbidity management may result in increased potential for acute complications and health deterioration, and compensatory care for patients during rehabilitation. Clinicians may need to widen their skill set to include more acute and chronic illness management.