Method: Data were collected and analysed according to Grounded Theory procedures, involving interviews with 24 participants, 17 weblogs, 17 autobiographical texts, and posts from 4 online forums.
Results: Prosthesis users are primarily concerned with being “just normal”: the condition of being and living in ways that persons variously perceive are “about right”; that are sufficient, fair, and generally how things “ought to be” for them. This concern is acted upon through: (i) “preserving”, where persons foresee and manage threats to being “just normal”, (ii) “redressing”, involving rectifying things judged not to be “just normal”, and (iii) “persevering”, where persons keep living “just normally” despite accompanying difficulties.
Conclusions: “Just normal” is a new means for rehabilitation practitioners to better understand a key concern of prosthesis users and the motivations underlying behaviours in their prosthesis use. It is also relevant and transferable to broader fields of assistive technology use and disability.
- Implications for Rehabilitation
The grounded theory of “just normal” invites practitioners to discover a key concern in prosthesis use, enabling a richer understanding of the needs and desires of service users.
Being “just normal” is presented as an important motivator underlying a range of diverse actions within prosthesis use.
The theory is relevant and transferable to broader areas of assistive technology use and disability.
Method: A systematic literature search was conducted in MEDLINE, Cochrane, EMBASE, CINAHL and Web of Science. Included studies compared QoL, function, activity and/or participation level in patients with bone-anchored or socket prostheses. A best-evidence synthesis was performed.
Results: Out of 226 studies, five cohort and two cross-sectional studies were eligible for inclusion, all had methodological shortcomings. These studies used 10 different measurement instruments and two separate questions to assess outcome. Bone-anchored prostheses were associated with better condition-specific QoL and better outcomes on several of the physical QoL subscales, outcomes on the physical bodily pain subscale were inconclusive. Outcomes on function and activity level increased, no change was found at participation level. The level of evidence was limited.
Conclusions: There is a need for a standard set of instruments. There was limited evidence that bone-anchored prostheses resulted in higher QoL, function and activity levels than socket prostheses, in patients with socket-related problems.
- Implications for Rehabilitation
Use of bone-anchored prostheses in combination with intensive outpatient rehabilitation may improve QoL, function and activity level compared with socket prosthesis use in patients with a transfemoral amputation and socket-related problems.
All clinicians and researchers involved with bone-anchored prostheses should use and publish data on QoL, function, activity and participation level.
There needs to be an agreement on a standard set of instruments so that interventions for patients with a lower extremity amputation are assessed consistently.
Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews.
Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels.
Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery.
- Implications for Rehabilitation
Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings.
The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users.
The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels.
As assistive products users’ perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.
Methods: A volunteer with motor complete T11 paraplegia repeatedly propelled his manual wheelchair over level ground and simulated destabilizing conditions including sudden stops, bumps and rough terrain. Wireless inertial measurement units attached to the wheelchair frame and his sternum recorded associated accelerations and angular velocities. Algorithms based on mean, standard deviation and minimum Mahalanobis distance between conditions were constructed and applied to the data off-line to discriminate between events. Classification accuracy was computed to assess effects of sensor position and potential for automatically selecting a dynamic intervention to best stabilize the wheelchair user.
Results: The decision algorithm based on acceleration signals successfully differentiated destabilizing conditions and level over-ground propulsion with classification accuracies of 95.8, 58.3 and 91.7% for the chest, wheelchair and both sensors, respectively.
Conclusion: Mahalanobis distance classification based on trunk accelerations is a feasible method for detecting destabilizing events encountered by wheelchair users and may serve as an effective trigger for protective interventions. Incorporating data from wheelchair-mounted sensors decreases the false negative rate.
- Implications for Rehabilitation
SCI has a significant impact on quality of life, compromising the ability to participate in social or leisure activities, and complete other activities of daily living for an independent lifestyle.
Using inertial measurement units to build an event classifier for control the actions of a neuroprosthetic device for maintaining seated posture in wheelchair users.
Varying muscle activation increases user stability reducing the risk of injury.
Method: Two independent expert teams analyzed medical records on 299 consecutive patients admitted for CSS or DSS rehabilitation. One team provided a golden standard for the patient referrals, and the other team provided RCS-E scores. Models for predicting referrals from RCS-E scores were developed on data for 149 patients and tested on the remaining 150 patients.
Results: The optimal RCS-E sum score threshold for referral prediction was 11, predicting the golden standard for patient referral with sensitivity 88%, specificity 78% and correct classification rate 81%. Improved referral prediction performance was achieved by using RCS-E item-wise score thresholds (sensitivity 81%, specificity 89%, correct classification rate 87%). The RCS-E sum score range for patients referred CSS and DSS by the item-wise model was, respectively, 0–12 and 2–22 suggesting strong non-linear interaction of the RCS-E items.
Conclusions: We found excellent referral decision support in the RCS-E and the item specific threshold model, when patients with acquired brain injury are to be referred to CSS or DSS as their primary rehabilitation.
- Implications for Rehabilitation
Efficient rehabilitation after acquired brain injury requires rehabilitation settings that meet patient needs.
Validated tools for referral decision support make the process more transparent.
Patient rehabilitation complexity can be stratified by the RCS-E with high sensitivity, specificity and predictive value of positive test.
RCS-E is an excellent tool for referral decision support.
Objectives: To examine whether real time feedback can be used to influence manual wheelchair propulsion biomechanics.
Review methods: Clinical trials and case series comparing the use of real time feedback against no feedback were included. A general review was performed and methodological quality assessed by two independent practitioners using the Downs and Black checklist. The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines.
Results: Six papers met the inclusion criteria. Selected studies involved 123 participants and analysed the effect of visual and, in one case, haptic feedback. Across the studies it was shown that participants were able to achieve significant changes in propulsion biomechanics, when provided with real time feedback. However, the effect of targeting a single propulsion variable might lead to unwanted alterations in other parameters. Methodological assessment identified weaknesses in external validity.
Conclusions: Visual feedback could be used to consistently increase push arc and decrease push rate, and may be the best focus for feedback training. Further investigation is required to assess such intervention during outdoor propulsion.
- Implications for Rehabilitation
Upper limb pain and injuries are common secondary disorders that negatively affect wheelchair users’ physical activity and quality of life.
Clinical guidelines suggest that manual wheelchair users should aim to propel with a semi-circular pattern with low a push rate and large push arc in the range in order to minimise upper limbs’ loading.
Real time visual and haptic feedback are effective tools for improving propulsion biomechanics in both complete novices and experienced manual wheelchair users.
Purpose: The objective of this study was to validate the choice of simulated activities in a group of newly trained PW users.
Methods: We recruited 17 new PW users, who practiced with the miWe simulator at home for two weeks. They then related their experience through the Short Feedback Questionnaire, the perceived Ease of Use Questionnaire, and semi-structured interviews.
Results: Participants in general greatly appreciated their experience with the simulator. During the interviews, this group made similar comments about the activities as our previous group of expert PW users had done. They also insisted on the importance of realism in the miWe activities, for their use in training.
Discussion: A PW simulator may be helpful if it supports the practice of activities in specific contexts (such as a bathroom or supermarket), to complement the basic skills training received in the clinic (such as driving forward, backward, turning, and avoiding obstacles).
- Implications for Rehabilitation
New power wheelchair users appreciate practicing on a virtual reality simulator and find the experience useful when the simulated diving activities are realistic and ecologically valid.
User-centred development can lead to simulated power wheelchair activities that adequately capture everyday driving challenges experienced in various environmental contexts.
Materials and methods: Seventeen novice able-bodied subjects performed a 120-min uninstructed practice distributed over 4 weeks. During the initial and final sessions, upper limbs kinematics and hand-rim kinetics were continuously collected. Inverse kinematics and dynamics coupled to a three-dimensional linked-segment model were used to compute shoulder net moments.
Results: Participants increased the speed of the wheelchair with practice. In average, an increase of shoulder net moments and mechanical work during the push phase was observed. Conversely, during the recovery phase, participants slightly increased shoulder power but maintained a similar level of shoulder loading. However, individual evolutions allowed the definition of two groups defined as: “increasers”, who increased shoulder loading and mechanical work versus “decreasers”, who managed to limit shoulder loading while improving the wheelchair speed.
Conclusion: These findings underline that individual adaptation strategies are essential to take into account when designing a rehabilitation protocol for wheelchair users.
- Implications for Rehabilitation
The learning process of manual wheelchair locomotion is essential for the assimilation of motor tasks leading individuals to select their propulsion technique.
Novice users display different learning strategies: some people increase shoulder loading very early but others spontaneously manage to increase the wheelchair speed while maintaining a constant level of shoulder loading.
Wheelchair rehabilitation programs should be individualized to take into account the subject-specific learning strategy.
Method: We performed a secondary analysis of cross-sectional self-report data from a volunteer sample of people with LLL due to dysvascular and non-dysvacular causes. Perceived cognitive difficulties were assessed using the Quality of Life in Neurological Disorders Applied Cognition – General Concerns (Neuro-QoL ACGC). Mobility was measured with the Activities-Specific Balance Confidence Scale (ABC) and the Prosthetic Limb Users Survey of Mobility (PLUS-M). Simple linear regressions examined univariate relationships between cognitive concerns and mobility. Multiple linear regression analyses included demographic and amputation-related variables that could influence this relationship.
Results: Analysis of data from 1291 people with LLL demonstrated that greater cognitive concerns, measured by the Neuro-QoL ACGC, were associated with poorer perceived mobility, measured by both ABC and PLUS-M instruments. This relationship remained statistically significant after adjusting for demographic and amputation-related factors.
Conclusions: These results suggest that greater cognitive concerns are associated with worse mobility among a broad range of people with LLL. An improved understanding of this relationship is critical for optimizing rehabilitation outcomes for this population.
- Implications for rehabilitation
Rehabilitation for people with lower limb loss (LLL) typically focuses on physical impairments and mobility limitations, but cognition is increasingly recognized to have an impact on functional outcomes.
Greater perceived cognitive concerns are associated with poorer mobility among a broad range of people with LLL, even when adjusting for demographic and amputation-related factors.
Cognitive status can impact relevant rehabilitative outcomes, including mobility, and should be considered when planning prosthetic and therapeutic interventions.
Design: We conducted focus groups (FGs) with 17 GPs.
Setting: Norwegian primary health care.
Subjects: 17 GPs who attended a 5 d course on leadership in primary health care.
Results: Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement.
Conclusions: GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance.
- KEY POINTS
Little is known about doctors’ experiences and views about leadership in general practice and primary health care. Our study suggests that:
There is a lack of preparation and formal training for the leadership role.
GPs experience tensions between the clinical and leadership role.
GPs recognize leadership challenges at a system level and that doctors should take on leadership roles in primary health care.
Methods: Grounded Theory methodology was employed to collect and analyse data from 24 interviewees, 17 weblogs, 17 autobiographies, and posts from four internet discussion forums.
Results: Individuals that use prostheses are faced with a number of challenges and manage these through preservation strategies that ensure they stay “just normal”. These acts of preserving include “black-spotting”, “protective avoidance”, “vigilant risk-reducing”, “fail-safing”, “conserving” and “sufficing” through “playing it safe” and “resisting the recommended”.
Conclusion: Prosthesis users manage a range of threats that are related to the limitations of prostheses. Knowledge of these issues and how they may be resolved can empower and support individuals coming to prosthesis use as well as ongoing users. The findings of this study also have implications for developing the consultation experience through discussing applicable threats and strategies for managing these.
- Implications for Rehabilitation
Specific threats faced by prosthesis users along with the varied ways that these are resolved enable a greater insight into life with a prosthesis.
The consultation experience can be enhanced through a discussion of potential threats relevant to the person, their prosthesis, and the way they live or wish to live “just normally” with a prosthesis.
Insights into how persons manage threats associated with prosthesis use can help professionals to recognize and suggest strategies that may further enable their clients
Objective: To examine the associations between patients’ self-rated health and their sleep problems, somatic health complaints, and unmet needs in interpersonal relationships.
Design: We collected data via questionnaires for this cross-sectional study from general practice.
Setting: Primary health care in Norway.
Subjects: 1302 consecutive patients participated.
Main outcome measures: The questionnaire included a single question about SRH, the Bergen Insomnia Scale (BIS), five questions on somatic health complaints, and three questions from the Basic Psychological Needs Scale (BPNS) pertaining to the relationships domain. We analyzed our data using ordinal logistic regression models.
Results: Our response rate was 74%. The prevalence of fair/poor SRH was 26%, with no gender differences. We revealed a significant association between increasing age and reduced SRH. The study showed that sleep problems and somatic health complaints were strongly associated with SRH, and unmet needs in relationships were also significantly and independently associated with reduced SRH in a full model analysis.
Conclusion: Sleep problems, somatic health complaints, and unmet needs in interpersonal relationships were all associated with reduced SRH. These factors are all modifiable and could be managed both within and outside a primary care setting in order to improve SRH.
- Key Points
There was a high prevalence of reduced SRH in clinical general practice
Sleep problems, somatic health complaints, and unmet needs in interpersonal relationships were all associated with reduced SRH
These predictors are all modifiable with a potential to improve SRH
Method: The paper uses vignettes to illustrate attention in patient-practitioner interaction.
Results: Attention is a precursor to understanding the patient as a unique individual and the problems the patient brings to the therapy experience.
Conclusions: The capacity of practitioners to attend to their patients has an impact on patient satisfaction and recovery.
- Implications for Rehabilitation
Attention is the precursor to establishing positive therapeutic alliances with patients.
It is essential to attend to the patient as a person with unique experiences, perspectives, and attitudes and to modify treatment based on the person’s priorities and desires.
Practitioners need to develop the interaction skills necessary to understand their patients as unique individuals.
Method: One hundred and sixty-six subjects with mild to moderate stroke were recruited and interviewed using the PS-SES. The principal axis factoring analysis was run to examine the factor structure, and internal consistency was assessed by computing Cronbach’s alpha coefficient.
Results: The final measure is a 35-item scale with six subscales: (1) managing home participation, (2) staying organized, (3) planning and managing community participation, (4) managing work/productivity, (5) managing communication, and (6) advocating for resources. The instrument demonstrated high internal consistency.
Conclusion: The PS-SES is a reliable measure offering unique information regarding self-efficacy in managing participation.
- Implications for Rehabilitation
Post-stroke participation requires complex management of resources, information, and strategies.
There is a gap in instruments that can assess self-efficacy in managing participation following a stroke.
The PS-SES is a valid tool measuring self-efficacy in using participation strategies in home, work, and community contexts.
Methods: Studies identified in a previous systematic review published on 2016 on the methodology of studies evaluating RRs by the user perspective were re-screened for eligibility based on the following inclusion criteria: evaluation of the human–robot interaction from the user perspective, use of standardized outcome measurements, and quantitative presentation of study results.
Results: Seventeen studies were eligible for inclusion. Due to the clinical and methodological heterogeneity across studies, a narrative synthesis of study results was conducted. We found conflicting results concerning the effectiveness of the robotic functionalities of the RRs. Only a few studies reported superior user performance or reduced physical demands with the RRs compared to unassisted conditions or conventional assistive mobility devices; however, without providing statistical evidence. The user perception of the RRs was found to be generally positive.
Conclusions: There is still no sufficient evidence on the effectiveness of RRs from the user perspective. More well-designed, high-quality studies with adequate study populations, larger sample sizes, appropriate assessment strategies with outcomes specifically tailored to the robotic functionalities, and statistical analyses of results are required to evaluate RRs at a higher level of evidence.
- Implications for Rehabilitation
RRs cover intelligent functionalities that focus on gait assistance, obstacle avoidance, navigation assistance, sit-to-stand transfer, body weight support or fall prevention.
The evaluation from the user perspective is essential to ensure that RRs effectively address users’ needs, requirements and preferences.
The evidence on the effectiveness of RRs is severely hampered by the low methodological quality of most of the available studies.
RRs seem generally to be perceived as positive by the users.
There is very limited evidence on the effectiveness and benefits of RRs compared to conventional assistive mobility devices.
Further research with high methodological quality needs to be conducted to reach more robust conclusions about the effectiveness of RRs.