Objective: To assess the physical therapist’s adherence to structured stroke clinical practice guidelines in an active inpatient rehabilitation center in Qatar.
Setting: Department of Physical therapy in the stroke rehabilitation tertiary referral hospital in Qatar.
Method: A retrospective chart audit was performed on the clinical records of 216 stroke patients discharged from the active inpatient stroke rehabilitation unit with a diagnosis of stroke in 2016. The audit check list was structured to record the adherence of the assessment, goal settings and the management domains as per the “Physical Therapy After Acute Stroke” (PAAS) guideline.
Result: Of the 216 case files identified during the initial search, 127 files were ultimately included in the audit. Overall adherence to the clinical practice guideline was 71%, a comparable rate with the studies analyzing the same in various international health care facilities. Domains which were shared by interdisciplinary teams than managed by physical therapy alone and treatments utilizing sophisticated technology had lower adherence with the guideline. A detailed strength and weakness breakdown were then conducted.
Conclusion: This audit provides an initial picture of the current adherence of physical therapy assessment and management with the stroke physical therapy guideline at a tertiary rehabilitation hospital in the state of Qatar. An evaluation of the guideline adherence and practice variations helps to fine tune the physical therapy care to a highest possible standard of practice.
- Implications for Rehabilitation
???An evaluation of the guideline adherence and practice variations helps to fine tune the rehabilitation care to the highest possible standard of practice.
??Proper assessments of the relationship between the process of rehabilitation care and outcomes with a comprehensive set of process indicators will improve the quality of the care.
??An agreement needs to be established between rehabilitation teams engage in interdisciplinary stroke care regarding the shared responsibilities and team functioning.
??It is recommendable to develop a specialty based clinical practice guidelines that can be aligned at a higher ‘comprehensive rehabilitation level’ to provide the best possible and evidence based stroke care.
Materials and methods: In a qualitative study, 10 interviews with stroke patients were conducted, transcribed, and analysed using qualitative content analysis.
Results: The patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions during hospitalisation were found to be related to one overall theme derived from 10 categories. As a recurring motif in the patients’ interviews, they experienced existential thoughts, and these thoughts unquestionably affected their experiences within the rehabilitation unit. These thoughts enhanced their need for human contact, thereby affecting their relationships with and perceptions of the nursing staff.
Conclusion: The findings deepen our understanding of how patients experience inpatient rehabilitation. The patients struggled with existential thoughts and concerns about the future and therefore called for human contact and support from the nursing staff. They perceived the nursing staff as mostly polite and helpful, but were unclear about the nursing staff’s function in rehabilitation which, in the patients’ perspective, equals physical training.
- Implications for Rehabilitation
Nursing staff need to pay attention to the patients’ needs, existential thoughts and concerns during inpatient rehabilitation.
Meaningful goals for the rehabilitation of stroke patients are crucial, and it is vital that the patients commit to the goals.
Patients expected polite and helpful nurses, but did not see them as therapeutic and active stakeholders, thus it is important that nursing staff present themselves as part of the interdisciplinary rehabilitation.
There is a need for training and education of nursing staff, both pre and post graduate.
Method: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines.
Results: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin “ultra”, beyond, to “habilitare”, make fit. The resulting term, “ultrabilitate”, commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning.
Conclusions: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas.
- Implications for rehabilitation
Despite significant progress, rehabilitation limits some people with disabilities.
Modern health systems still benchmark therapy for rehabilitation against “normal” or species-typical standards to aid recovery.
“Ultrabilitation”, meaning “beyond fitness”, promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery.
Biological, social and technological conditions are needed to support ultrabilitation.
Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth.
Methods: Stroke survivors receiving in-patient rehabilitation were randomised to receive eight art participation sessions (n?=?41) or usual care (n?=?40). Recruitment, retention, preference for art participation and change in selected outcomes were evaluated at end of intervention outcome assessment and three-month follow-up.
Results: Of 315 potentially eligible participants 81 (29%) were recruited. 88% (n?=?71) completed outcome and 77% (n?=?62) follow-up assessments. Of eight intervention group non-completers, six had no preference for art participation. Outcome completion varied between 97% and 77%. Running groups was difficult because of randomisation timing. Effectiveness cannot be determined from this feasibility study but effects sizes suggested art participation may benefit emotional wellbeing, measured on the positive and negative affect schedule, and self-efficacy for Art (d?=?0.24–0.42).
Conclusions: Undertaking a RCT of art participation within stroke rehabilitation was feasible. Art participation may enhance self-efficacy and positively influence emotional wellbeing. These should be outcomes in a future definitive trial. A cluster RCT would ensure art groups could be reliably convened. Fewer measures, and better retention strategies are required.
- Implications for Rehabilitation
This feasibility randomised controlled trial (RCT) showed that recruiting and retaining stroke survivors in an RCT of a visual arts participation intervention within stroke rehabilitation was feasible.
Preference to participate in art activities may influence recruitment and drop-out rates, and should be addressed and evaluated fully.
Art participation as part of rehabilitation may improve some aspects of post-stroke wellbeing, including positive affect and self-efficacy for art.
A future definitive cluster RCT would facilitate full evaluation of the value art participation can add to rehabilitation.
Design: Qualitative and semi-structured interviews.
Setting: Australian burn and rehabilitation units.
Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings.
Results: The data portrayed the health professionals’ perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care.
Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes.
- Implications for rehabilitation
Burn care and rehabilitation remains a complex and challenging area of care.
Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase.
Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.
Method: We included 20 acute stroke and back pain rehabilitees (mean age 66?y) who set goals with a multidisciplinary rehabilitation team. Data was collected by interviewing the rehabilitees after the goal setting situations. A qualitative analysis from a phenomenological perspective using Spiegelberg’s seven-phase meaning analysis was performed to reveal meanings.
Results: The five meanings were identified as: (i) “trust in the rehabilitation situation, professionals, oneself, and relatives;” (ii) “respectful presence;” (iii) “confusing awareness;” (iv) “disturbing pain;” and (v) “fear of unpredictability.” When professionals committed to working in a patient-centred manner, the rehabilitees felt respected and they trusted professionals and thus their self-efficacy was empowered. Moreover, relatives were an important support in the situation. However, disturbing pain and fear of the future limited patients level of participation in the situation.
Conclusion: Rehabilitee commitment to rehabilitation can be supported with equality in communication and presence of relatives, while pain and uncertainty because of changed health limit participation in a goal setting situation.
- Implications for Rehabilitation
Multidisciplinary rehabilitation professionals should be recommended to support the active role of a patient in the goal setting situation.
Relatives are recommended to participate in goal setting situation as they are an important support for rehabilitees.
Professionals should be recommended to remove obstacles that restrain patient’s participation in the goal setting situation.
Professionals should be recommended to recognize patients with changed health and offer psychosocial support for those in need to improve their participation in rehabilitation process.
Materials and methods: Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017.
Results: Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services.
Conclusions: There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level.
- Implications for rehabilitation
There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases.
This scoping review shows that the need for rehabilitation considerably outstrips the provision of services.
There are substantial unmet needs for rehabilitation and numerous barriers to accessing services.
Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries.
Method: A thematic network analysis-based approach was used to relate aural rehabilitation methods to the ecological model of tinnitus and the client-oriented scale of improvement in tinnitus.
Results: Aural rehabilitation methods were mapped to concepts of: (1) Context, (2) presence of sound and (3) reaction to sound. A global theme was: adaptation to sound. The framework is the result of an iterative and cumulative research program exploring tinnitus as the outcome of the relationship between individual psychoacoustics and psychosocial factors including context of perception.
Conclusions: The intent of this framework is to help guide audiologists managing tinnitus. The framework has been useful in our clinic as illustrated by a case study. The benefits of this approach relative to standard care needs to be independently ascertained.
- Implications for Rehabilitation
Tinnitus is a common oto-neurological complaint that when severe can be very disabling.
Tinnitus is very heterogeneous as a consequence of this no one treatment is suitable for everyone.
The sound therapy and aural rehabilitation for tinnitus framework is designed to assist audiologists in clinical planning that addresses individual needs.
The framework is the result of an iterative and cumulative research program exploring tinnitus as the outcome of the relationship between individual psychoacoustics and psychosocial factors including context of perception.
Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria.
Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The included studies used a variety of outcome measures encompassing domains within the ICF: body functions, activities, participation, and contextual factors across the time course of stroke recovery. We discovered disproportionate representation among racial/ethnic groups in the post-stroke disability disparities literature.
Conclusions: A wide variety of assessments are used to examine disparities in post-stroke disability across the time course of stroke recovery. Several studies have identified disparities through a variety of assessments; however, substantial problems abound from the assessments used including inconsistent use of assessments, lacking evidence on the validity of assessments among racial/ethnic groups, and inadequate representation among all racial/ethnic populations comprising the US.
- Implications for Rehabilitation
An enhanced understanding of racial/ethnic disparities in post-stroke disability outcomes is inherently important among rehabilitation practitioners who frequently engage with racial/ethnic minority populations across the time course of stroke recovery.
Clinicians should carefully consider the psychometric properties of assessment tools to counter potential racial bias.
Clinicians should be aware that many assessments used in stroke rehabilitation lack cultural sensitivity and could result in inaccurate assessment findings.
Methods: A 54-year-old GBM survivor completed a supervised six-week exercise intervention during irradiation treatment beginning 42?d after resection. Exercise modalities of cardiorespiratory, resistance, and balance training were designed on generic recommendations of various cancer populations and literature review.
Results: Our case attended all possible sessions without experiencing adverse effects, and improved in aerobe power (24%), muscle strength (0–38%), standing balance (71%), walking ability (9%), and QOL domains of “Global Health Status/QoL” and “Physical functioning.”
Conclusions: Based on this single case, exercise rehabilitation has the ability to maintain or improve functional performance and QOL domains even during heavy treatments. It also implies that patients with GBM are capable and may be willing to participate in exercise rehabilitation if supervised by physical therapists.
- Implications for rehabilitation
The use of exercise as part of rehabilitation still needs attention in strong methodology studies of patients with gliomas.
Exercise rehabilitation may maintain or even improve functional performance and QOL domains during medical treatment regimens.
Functional independent patients with GBM are capable to comply with generic exercise recommendations and may be willing to participate in exercise rehabilitation if supervised by physical therapists.
Materials and methods: The study group consisted of 88 patients, including 48 people with dementia and 40 people without dementia. Before and after physiotherapy, the Mini Mental State Examination and Barthel Index were used.
Results: Elderly patients without dementia achieved a greater improvement in functional status. The level of cognitive functioning at the time of admission to a nursing home, but not the patient’s functional status, had a significant impact on physiotherapy efficacy.
Conclusion: Understanding the role of dementia in the rehabilitation process is important for care planning. More research is required to ascertain the efficacy of physiotherapy in people with moderate to severe dementia, including the best strategies to improve their functional status.
- Implications for Rehabilitation
The level of cognitive function is important in the rehabilitation process, and it influences effectiveness of physiotherapy.
Physiotherapy efficacy in the group of patients with coexisting dementia is lower than that in patients without dementia.
Regular physiotherapy can also improve functional status in patients with coexisting dementia.
The results of the study may have utilitarian implications, leading to a change in therapy regimens at physiotherapy centres treating disabled chronically ill people with coexisting dementia.
Purpose: To describe self-efficacy in relation to Activities of daily living and symptom management in people with dizziness.
Material and methods: Thirteen women and three men, aged 45–82?years, with persistent dizziness (duration 4?months to 30?years) were recruited from an outpatient physiotherapy unit. A qualitative study was conducted using four focus groups and one individual interview and was then analysed with qualitative content analysis.
Results: The participants conveyed, in-depth information concerning two predefined main categories. Self-efficacy in Activities of daily living was related to challenging body positions and motions, environments, social activities, work tasks, and complex cognitive behaviours. Self-efficacy in symptom management was related to distress and aggravated symptoms, unfamiliar environment, and unknown people.
Conclusions: People with dizziness describe how self-efficacy for specific activities varies according to the perceived difficulty of the task, the context of the activity, and day-to-day variations in general wellbeing. The results underscore the importance of targeting self-efficacy in the rehabilitation of people with dizziness. Our findings can guide the rehabilitation process by providing a deeper understanding of self-efficacy judgements in relation to Activities of daily living and symptom management in people with dizziness.
- Implication for rehabilitation
This study adds important in-depth knowledge to the rehabilitation area on self-efficacy beliefs in relation to Activities of daily living and symptom management in people with dizziness.
Self-efficacy for specific activities varies according to the perceived difficulty of the task, the context in which the activity takes place and day-to-day variations in perceived general well-being.
The results can be used as a topic list to guide rehabilitation efforts in exploring and intervening aspects of people’s everyday activities that are affected by low self-efficacy judgements.
Activities perceived to be crucial to everyday life and important for well-being should be targeted in rehabilitation to increase self-efficacy and thereby activity performance and participation in people with dizziness.
Materials and methods: The peer-reviewed literature was searched across seven databases and identified abstracts were independently screened by two reviewers. A thematic synthesis methodology was used to code and synthesise the results from the included studies.
Results: In total, 7233 abstracts were identified; 31 articles were selected for inclusion, representing 26 physical rehabilitation interventions. The methodological quality of studies was moderate (Standards for Reporting Qualitative Research mean?±?standard deviation?=?14.39?±?3.61). The four main themes developed were: (1) Benefits of physical rehabilitation, (2) Challenges of physical rehabilitation, (3) Need for support, and (4) Issue of control.
Conclusions: This qualitative thematic synthesis provides key insights into the experiences of individuals with spinal cord injuries who received physical rehabilitation. Recommendations for practice, based on the findings, include creating a diverse, encouraging, and educational physical rehabilitation experience with supportive staff who focus on communication and person-centred care.
- Implications for Rehabilitation
Physical rehabilitation provides psychological as well as physical benefits to people with spinal cord injuries, including motivation, hope, improved self-confidence, and acceptance.
Challenges identified during physical rehabilitation for people with spinal cord injuries, such as comparisons, negative emotions, recovery expectations, and slow progress, should be addressed by healthcare professionals to ensure person-centred care.
People with spinal cord injuries identified a need for support from health care professionals, family, and friends, as well other people with spinal cord injuries.
There is an issue of control in physical rehabilitation for people with spinal cord injuries, which can result in a fight with oneself or with healthcare professionals to regain the control that has been lost.
Method: Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14–25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl–Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.
Results: Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p?<?0.05 for all measures).
Conclusions: Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability.
- Implications for rehabilitation
To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need.
Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation.
Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment.
Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.
Methods: Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n?=?9), family caregivers (n?=?4), and domestic helpers (n?=?4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software.
Results: All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor’s safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process.
Conclusions: Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore.
- Implications for rehabilitation
Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities.
Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors.
Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers.
A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.
Materials and methods: Semi structured individual interviews were conducted with seven partners to persons who had had stroke. The interviews were recorded and then transcribed verbatim. The participants comprised two men and five women aged 60–82 years. The data were collected and analysed using a grounded theory approach.
Results: One core category Living in strained everyday circumstances and three categories Feelings of anxiety, Living a demanding day to day life, and Adjusting to a changed role emerged from the analysis. The participants had developed strategies and new ways to boost their energy level in order to find the strength needed for their everyday life.
Conclusion: This study shows that the everyday lives of partners to people who have had a stroke are characterised by feelings of strain and anxiety and that they need possibilities for different kinds of long-term support. Our findings may contribute to increased knowledge among health workers and increased readiness to offer support or referral to other meeting places such as peer support groups.
- Implications for rehabilitation
The everyday lives of partners to people who have had a stroke are characterised by feelings of strain and anxiety.
Partners to people who have had a stroke need possibilities for different kinds of long-term support.
Possibilities for relief among partners to persons after stroke may be organised for example within the municipality or by patient organisations and other voluntary networks such as peer support groups.
Methods: An electronic search was conducted from 1987 to 24 October 2017. Studies were included if they met the following criteria: (1) full text, peer reviewed, and written in English, (2) original research, (3) diagnosed concussion or mild traumatic brain injury, (4) described the evaluation of an intervention, (5) the outcome was a concussion impairment, and (6) the mean/median age was under 19. Quality assessment using the Down’s and Black criteria was conducted.
Results: Twenty-six studies published between 2001 and 2017 were identified. Interventions included rest, active rehabilitation, exercise, vestibular, oculomotor, cervicospinal therapy, education, early intervention, telephone counselling, mobile health application, Web-based Self-Management program, multimodal physical therapy, cognitive behavioural therapy, transcranial direct current stimulation, and acupuncture. The quality assessments ranged from poor to good.
Conclusions: The literature describing interventions following concussion in children is scarce. While both positive and negative results were obtained, there were methodological concerns in most studies limiting the ability to draw conclusions. Interventions incorporating aerobic exercise show promise as a concussion management strategy.
- Implications for rehabilitation
Few studies have examined rehabilitation interventions for youth following concussion.
Research ranging from rest to exercise highlights the uncertainty of the field.
Low quality research limits the generalizability of results.
The use of physical activity appears to be an emerging area of interest.
Individualised, aerobic exercise should be used as part of clinical management.