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Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 38052

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Prof. Dr. Christoph Gutenbrunner

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Guest Editor

Department of Rehabilitation Medicine, Hannover Medical School, 30625 Hanover, Germany
Interests: clincal rehabilitation; rehabilitation systems research; rehabilitation service assessment; pain; muscuoloskeletal conditions; rehabilitation outcomes research
Special Issues, Collections and Topics in MDPI journals

Dr. Boya Nugraha

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Assistant Guest Editor

Department of Rehabilitation Medicine, Hannover Medical School, 30625 Hanover, Germany
Interests: rehabilitation systems research; rehabilitation service assessment; pain mechanism; role of immune system in rehabilitation; rehabilitation outcomes research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Rehabilitation is one of five main health strategies, and at the same time is an integral part of, Universal Health Coverage. However, the World Report on Disability that was published by the World Health Organization in 2011 provided strong evidence that around the world a huge number of persons in need for rehabilitation do not have access to qualified rehabilitation services. Ten years later it is important to look at changes, new epidemiological data, rehabilitation concepts, their integration into health systems, and their impact on the outcomes of innovative rehabilitation concepts.

The Special Issue ‘’Rehabilitation in Health Systems, Rehabilitation Needs, and Innovative Rehabilitation Programs’’ will be open for scientific papers addressing these topics. New scientific information on the integration of rehabilitation in health systems; rehabilitation needs; as well as the outcomes of rehabilitation programs will be welcome. Methodological papers are also welcome. The Editors will be happy if rehabilitation concepts in low- and lower-middle-income countries including community-based rehabilitation can be included in the Special Issue. Papers on vulnerable groups and rare diseases are welcome too.

The papers of the Special Issue also can contribute to WHO’s initiative “Rehabilitation 2030—a Call for Action”.

Prof. Dr. Christoph Gutenbrunner
Dr. Boya Nugraha
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

rehabilitation services
health systems
rehabilitation needs
rehabilitation programs
outcome research

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Published Papers (10 papers)

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Research

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10 pages, 2761 KiB

Open AccessArticle

Screening of Patient Impairments in an Outpatient Clinic for Suspected Rare Diseases—A Cross-Sectional Study

by Christoph Gutenbrunner, Joerg Schiller, Vega Goedecke, Christina Lemhoefer and Andrea Boekel

Int. J. Environ. Res. Public Health 2022, 19(14), 8874; https://doi.org/10.3390/ijerph19148874 - 21 Jul 2022

Cited by 1 | Viewed by 1870

Abstract

Background: Most rare diseases are chronic conditions with variable impairment of functionality, which can result in a need for rehabilitation. To our knowledge, there are no systematic studies on the rehabilitation needs of patients in centres for rare diseases in the literature. Our hypothesis is that participation of these patients is so limited that there is an increased need for rehabilitation. For this reason, a survey on the need for rehabilitation was carried out in all patients presenting to the centre for rare diseases, in order to assess the need for rehabilitative measures to counteract disturbances in activity and participation. Methods: A cross-sectional study was performed to collect data using a written questionnaire from December 2020 to June 2021, including patients presenting personally in the center for rare diseases. Results: Nearly 70% of the participants assessed their own ability to work as critical. Of those surveyed, n = 30 (44.9%) had PDI total ≥ 33 points and, thus, a clear pain-related impairment. Conclusion: The results show functional restrictions in the areas of mental well-being and activity. As expected, the health-related quality of life is reduced as compared to healthy people. Almost half of the participants reported significant pain-related impairments, however, only 9% of all respondents stated that they had received appropriate pain therapy. The results show the need for rehabilitation-specific skills in the care and counseling of patients with rare diseases. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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16 pages, 1359 KiB

Open AccessArticle

Motor Functioning and Intelligence Quotient in Paediatric Survivors of a Fossa Posterior Tumor Following a Multidisciplinary Rehabilitation Program

by Mathieu Decock, Robin De Wilde, Ruth Van der Looven and Catharine Vander Linden

Int. J. Environ. Res. Public Health 2022, 19(12), 7083; https://doi.org/10.3390/ijerph19127083 - 9 Jun 2022

Cited by 3 | Viewed by 1956

Abstract

Background: Short- and long-term consequences after treatment for childhood fossa posterior tumors are extensively reported in the literature; however, papers highlighting physical function throughout rehabilitation and its correlation with Intelligence Quotient (IQ) are sparse. This study aims to describe the physical functioning and IQ of these survivors, their progression during rehabilitation, and the association with histopathological tumor classification. Additionally, the correlation between gross motor functioning and cognitive functioning was investigated. Methods: This retrospective single-center cohort study included 56 children (35 (62.5%) males and 21 (37.5%) females, with an average age of 6.51 years (SD 4.13)) who followed a multidisciplinary program at the Child Rehabilitation Centre, Ghent University Hospital in the period from 2005 to 2020. Descriptive statistical analysis was performed with the use of non-parametric tests and linear regression to determine the relationship between gross motor functioning and IQ. Results: This report shows impaired motor and intelligence performance in children with a fossa posterior tumor. Although multidisciplinary rehabilitation is beneficial, it is not able to counteract the further decline of several motor skills and intelligence during oncological treatment, more specifically in children with a medulloblastoma. A correlation between gross motor function and total IQ was found. Conclusion: Pediatric survivors of a fossa posterior tumor experience impaired physical and intellectual functions, with more decline during oncological treatment despite simultaneous multidisciplinary rehabilitation. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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11 pages, 827 KiB

Open AccessArticle

Rehabilitation of Difficult-to-Wean, Tracheostomized Patients Admitted to Specialized Unit: Retrospective Analyses over 10-Years

by Stefania Costi, Antonio Brogneri, Chiara Bagni, Giulia Pennacchi, Claudio Beneventi, Luca Tabbì, Daniela Dell’Orso, Riccardo Fantini, Roberto Tonelli, Gianfranco Maria Beghi and Enrico Clini

Int. J. Environ. Res. Public Health 2022, 19(5), 2982; https://doi.org/10.3390/ijerph19052982 - 3 Mar 2022

Cited by 6 | Viewed by 3305

Abstract

Rehabilitation outcomes of difficult-to-wean tracheostomized patients have been reported in relatively small case studies and described for a limited time span. This study describes the characteristics and clinical outcomes of a large cohort of tracheostomized patients admitted to a specialized weaning unit over 10 years. We retrospectively analyzed data collected from January 2010 to December 2019 on difficult-to-wean tracheostomized patients who underwent comprehensive rehabilitation. Clinical characteristics collected at admission were the level of comorbidity (by the Cumulative Illness Rating Scale—CIRS) and the clinical severity (by the Simplified Acute Physiology Score—SAPS II). The proportions of patients weaned, decannulated, and able to walk; the change in autonomy level according to the Bristol Activities of Daily Living (BADL) Scale; and the setting of hospital discharge was assessed and compared in a consecutive 5-year time period (2010–2014 and 2015–2019) subgroup analysis. A total of 180 patients were included in the analysis. Patient anthropometry and preadmission clinical management in acute care hospitals were similar across years, but the categories of underlying diagnosis changed (p < 0.001) (e.g., chronic obstructive pulmonary disease—COPD—decreased), while the level of comorbidities increased (p = 0.003). The decannulation rate was 45.6%. CIRS and SAPS II at admission were both significant predictors of clinical outcomes. The proportion of patients whose gain in BADL score increased ≥ 2 points decreased over time. This study confirms the importance of rehabilitation in weaning units for the severely disabled subset of tracheostomized patients. Comorbidities and severity at admission are significantly associated with rehabilitation outcomes at discharge. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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18 pages, 1298 KiB

Open AccessArticle

A Focus Group Study to Understand the Perspectives of Physiotherapists on Barriers and Facilitators to Advancing Rehabilitation in Low-Resource and Conflict Settings

by Cornelia Anne Barth, Maggie Donovan-Hall, Catherine Blake, Noor Jahan Akhtar, Joseph Martial Capo-Chichi and Cliona O’Sullivan

Int. J. Environ. Res. Public Health 2021, 18(22), 12020; https://doi.org/10.3390/ijerph182212020 - 16 Nov 2021

Cited by 10 | Viewed by 7149

Abstract

Physiotherapy as a health profession is continuously evolving in high-income countries (HIC). The highest burden of disease globally, however, is in low-resource and conflict contexts (LR-CC), resulting in unmet rehabilitation needs. Rehabilitation service models from HIC often face challenges when applied to the fragile health systems of LR-CC. It is important to engage rehabilitation experts living and working in LR-CC to guide service development. This study aims to understand physiotherapists’ views and perspectives of current rehabilitation services, of how these services can be strengthened over the next 10 years and of the role of physiotherapy within this development. Focus group discussions (FGDs) were conducted with 31 physiotherapists from 18 LR-CC using English as a common language. Audio recordings were transcribed verbatim. Data analysis was guided by thematic analysis. Participants provided deep insights into the complexity of developing rehabilitation services within fragile health systems. Participants agreed that physiotherapy lacked recognition and resources to be utilised effectively. Interacting themes as crucial prerequisites for strengthening the sector included (1) significance of context, (2) professional identity, and (3) professionalisation supported by workforce development and advocacy. These results are an important evidence base for informing the development of rehabilitation programmes in LR-CC and for future research. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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14 pages, 534 KiB

Open AccessArticle

Functioning Problems in Persons with Schizophrenia in the Russian Context

by Manuel Rojas, Maite Barrios, Juana Gómez-Benito, Nadezhda Mikheenkova and Sergey Mosolov

Int. J. Environ. Res. Public Health 2021, 18(19), 10276; https://doi.org/10.3390/ijerph181910276 - 29 Sep 2021

Cited by 1 | Viewed by 2457

Abstract

Assessing functionality in schizophrenia from a biopsychosocial perspective is essential to generate treatments that respond to the needs of the individual in his/her context. This research aims to assess the prevalence of functioning problems and their association with socio-demographic and clinical variables in a sample of Russian individuals with schizophrenia, using the International Classification of Functioning, Disability, and Health as a framework. An empirical cross-sectional study assessed the functioning of 40 individuals with schizophrenia using the International Classification of Functioning, Disability, and Health Core Set for schizophrenia. For the Body functions component, the highest prevalence of problems was found in b144 Memory functions (75%) and b140 Attention functions (70%). In the Activities and participation component, the greatest limitations were in d770 Intimate relationships (79.3%) and d240 Handling stress and other psychological demands (82.5%). In the Environmental factors, the most frequent problems were in e110 Products or substances for personal consumption (25%) and e460 Societal attitudes (22.5%); when scored as facilitators, the highest rated categories were e125 Products and technology for communication (100%) and e165 Assets (100%). These results may guide the design of specific treatments for these individuals and serve as a starting point for further studies in similar contexts and in other regions in Russia. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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13 pages, 1412 KiB

Open AccessArticle

Development International Classification of Functioning, Disability and Health Core Set for Post Total Knee Replacement Rehabilitation Program: Delphi-Based Consensus Study in Taiwan

by Shih-Wei Huang, Yi-Wen Chen, Reuben Escorpizo, Chun-De Liao and Tsan-Hon Liou

Int. J. Environ. Res. Public Health 2021, 18(4), 1630; https://doi.org/10.3390/ijerph18041630 - 9 Feb 2021

Cited by 5 | Viewed by 3432

Abstract

Osteoarthritis is one of the leading causes of disability. Total knee arthroplasty (TKA) is a surgical intervention for patients with severe osteoarthritis. Post TKA rehabilitation is crucial for improving patient’s quality of life. However, traditional rehabilitation has only focused on physical function; a systemic analysis of other dimensions such as social participation and environmental factors of post TKA rehabilitation is lacking. The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) to create a comprehensive rehabilitation program for patients with osteoarthritis post TKA. Before the Delphi-based consensus process, a literature review process was performed for related ICF categories selection. We used a three-round Delphi-based consensus among 20 physical therapists with orthopedic rehabilitation expertise in a university-based hospital. A five-point Likert scale was used to rate the importance of each item. The consensus of ratings was analyzed using Spearman’s rho and semi-interquartile range indices. The ICF core set for post TKA rehabilitation was determined based on a high level of consensus and a mean score of ≥4.0 in the third Delphi-based consensus round. The ICF core set comprised 32 categories, with 13 regarding body function, four regarding body structures, nine regarding activities and participation, four regarding environmental factors, and two regarding personal factors. Our ICF core set for post TKA rehabilitation can provide information on effective rehabilitation strategies and goal setting for patients post TKA. However, further validation and feasibility assessments are warranted. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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13 pages, 1095 KiB

Open AccessArticle

Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability

by Isabella Campanini, Annalisa Bargellini, Stefano Mastrangelo, Francesco Lombardi, Stefano Tolomelli, Mirco Lusuardi and Andrea Merlo

Int. J. Environ. Res. Public Health 2021, 18(4), 1444; https://doi.org/10.3390/ijerph18041444 - 4 Feb 2021

Cited by 2 | Viewed by 3013

Abstract

(1) Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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Review

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19 pages, 1377 KiB

Open AccessReview

The Unmet Needs of Community-Dwelling Stroke Survivors: A Systematic Review of Qualitative Studies

by Yunfei Guo, Zhenxiang Zhang, Beilei Lin, Yongxia Mei, Qingxuan Liu, Leyun Zhang, Wenna Wang, Yuan Li and Zhongrong Fu

Int. J. Environ. Res. Public Health 2021, 18(4), 2140; https://doi.org/10.3390/ijerph18042140 - 22 Feb 2021

Cited by 38 | Viewed by 5353

Abstract

The unmet needs perceived by community-dwelling stroke survivors may truly reflect the needs of patients, which is crucial for pleasant emotional experiences and a better quality of life for community-dwelling survivors not living in institutionalized organizations. The purpose of the study is to identify the scope of unmet needs from the perspectives of stroke patients in the community. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. Six electronic databases were searched from inception to February 2020. A total of 24 articles were involved, providing data on 378 stroke survivors. Eight categories were derived from 63 findings, and then summarized into four synthesized findings based on the framework of ICF: (1) unmet needs regarding with the disease-related information; (2) unmet physical recovery and activity/participation needs; (3) unmet needs for social environmental resources; (4) unmet psycho-emotional support needs. We found the framework of ICF mostly complete, but unmet information needs still remain. The needs that are mainly unsatisfied include physical, psychosocial and informational, as well as the practical support from professional or environment resources. The ever-present unmet needs perceived by community-dwelling stroke survivors who do not live in institutions are discoverable and mitigable. Future studies should focus on quantifying unmet needs comprehensively derived from experiential domains, assessing the rationality of the unmet needs expressed by patients’ perspectives and developing flexible strategies for long-term and changing needs. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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Other

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10 pages, 630 KiB

Open AccessBrief Report

Rehabilitation Outcomes among Frail Older Adults in the United States

by Jason R. Falvey, Joanna Z. Ye, Elizabeth A. Parker, Brock A. Beamer and Odessa Addison

Int. J. Environ. Res. Public Health 2022, 19(17), 11021; https://doi.org/10.3390/ijerph191711021 - 3 Sep 2022

Cited by 2 | Viewed by 3286

Abstract

Background: Current rehabilitation care paradigms are not well aligned with the needs of frail older adults, but the resultant impact on rehabilitation outcomes is unclear. Understanding how frailty may impact rehabilitation outcomes, and understanding some of the underlying mechanisms, may help inform payment policy changes. Design: This study was a cross-sectional analysis of data from Round 5 of the National Health and Aging and Trends Study (NHATS). We identified older adults who had completed one or more episodes of rehabilitation care and used a validated 5-item NHATS Fried Frailty scale to categorize patients as frail (3/5 or more) or non-frail (≤2/5). We then evaluated the association between frailty status and three key patient outcomes: (1) achievement of rehabilitation goals, (2) functional improvement during rehabilitation episodes, and (3) discontinuation of therapy after exhausting insurance benefits. Lastly, we used multivariable, survey-weighted logistic regression models to estimate adjusted relationships between frailty and rehabilitation outcomes. Results: An estimated 5.6 million survey-weighted older adults in the United States (95% CI 5.1 to 6.0 million) completed an episode of rehabilitation in the past year, an estimated 1,271,290 (95% CI 921,758 to 1,620,822; weighted: 22.8%) of whom were frail. Frail rehabilitation recipients were generally older, had a greater comorbidity burden, and had a higher prevalence of dementia. In adjusted models, frailty was associated with poorer functional outcomes, a lower probability of meeting rehabilitation goals and a greater likelihood of exhausting rehabilitation insurance benefits. Conclusions: Exercise is a well-supported intervention for the management of frailty, but our results suggest that frail older adults are not getting the volume or intensity of rehabilitation treatment needed to maximally improve outcomes—in part due to limited payer coverage of rehabilitation services in the United States. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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12 pages, 1476 KiB

Open AccessProtocol

Enhance Access to Pulmonary Rehabilitation with a Structured and Personalized Home-Based Program—reabilitAR: Protocol for Real-World Setting

by Sarah Bernard, Rui Vilarinho, Inês Pinto, Rosa Cantante, Ricardo Coxo, Rosa Fonseca, Sagrario Mayoralas-Alises, Salvador Diaz-Lobato, João Carvalho, Cátia Esteves and Cátia Caneiras

Int. J. Environ. Res. Public Health 2021, 18(11), 6132; https://doi.org/10.3390/ijerph18116132 - 6 Jun 2021

Cited by 4 | Viewed by 4332

Abstract

Home-based models represent one of the solutions to respond to the poor accessibility of pulmonary rehabilitation (PR) services in patients with chronic respiratory disease (CRD). The main goal of this protocol is to present the implementation of the first nationwide home-based PR program—reabilitAR—in Portugal and the strategies to assess its benefits in patients with CRD. The program consists of 2 phases: a 12-week intensive phase and a 40-week maintenance phase (total: 52 weeks, 1 year). The intervention in both phases is composed of presential home visits and phone-call follow ups, including exercise training and the self-management educational program Living Well with COPD. Dyspnea, impact of the disease, emotional status, and level of dyspnea during activities of daily living are used as patient-reported outcomes measures. A one-minute sit-to-stand test is used as a functional outcome, and the number of steps as a measure of physical activity. To ensure safety, fall risk and the cognitive function are assessed. Data are collected at baseline, at 12 weeks, at 26 weeks and at 52 weeks. This is the first nationwide protocol on enhancing access to PR, providing appropriate responses to CRD patients’ needs through a structured and personalized home-based program in Portugal. Full article

(This article belongs to the Special Issue Rehabilitation in Health Systems, Rehabilitation Needs and Innovative Rehabilitation Programs)

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