Rehabilitation medicine in countries of Central/Eastern Europe

Purpose.?To describe attributes of rehabilitation medicine common to the five countries of Central Eastern Europe (CEE) and their implications for future challenges.

Methods.?Critical collection and study of pertinent data on evolvement and present state of rehabilitation medicine in CEE countries by a coordinated team of rehabilitation experts from each of the relevant countries.

Results.?CEE countries are similar in their need for rehabilitation medicine, its evolvement, present state and current practice. Settings largely emerged without strategic planning on the national level and lagged behind those in Central and Western Europe both in time and content.

Conclusion.?The framework that evolved in all except Slovenia is not appropriate to needs. In order to meet future challenges all five CEE countries need the incorporation of inpatient, outpatient and community-based rehabilitation into one system.     

The system for medical rehabilitation in Croatia

Purpose.?To describe the framework for medical rehabilitation in Croatia and to discuss its influence on the practice of the specialty.

Methods.?Collection, analysis and interpretation of data pertaining to the need for medical rehabilitation in the country and to its elements of structure, process and outcome of care.

Results.?The practice of medical rehabilitation in Croatia has evolved without strategic planning on the national level and therefore without a designed system. This lack in the present framework causes shortcomings in all three elements of rehabilitation care and impedes the advancement of the specialty.

Conclusion.?Medical rehabilitation in Croatia needs a national strategic plan for a three-level system that incorporates inpatient, outpatient and community-based rehabilitation.     

Family Medicine in Egypt From Medical Students' Perspective: A Nationwide Survey

Phenomenon: Attitudes of medical students toward family medicine as a specialty choice can provide information on the future supply of family physicians. Due to the current worldwide shortage of family physicians, these attitudes, with their subsequent effects on the state and dynamics of the healthcare system, are important to investigate. Approach: A web-based questionnaire was sent to 600 medical students, selected by a systematic random sampling technique, in 7 Egyptian medical schools. Participants were surveyed to assess their perception of the family medicine specialty as a future career and explore the impact of different factors, including undergraduate family medicine clerkships, on their attitudes toward family medicine. Findings: We had a response rate of 75.2% (n = 451). Although 90.7% of students believed in the vital role that family medicine can play in Egypt's healthcare system, only 4.7% showed an intention to choose it as a future career. Students choosing family medicine as a first-career choice were more likely to have a prior contact with family physicians as consumers. Exposure to an undergraduate family medicine curriculum was associated with increased knowledge about family medicine but not the intentions to pursue it as a career. Insights: Medical students in Egypt have a positive perception of family medicine as an important specialty but low interest in its choice as a future career.     

标准化病人在康复评定学教学中的应用

目的:评价在康复评定学教学中采用标准化病人(SP)教学法的教学效果。方法:选择康复治疗专业二年级本科生为研究对象,2006级学生67人采用传统教学法(传统组),2007级学生(SP组)60例采用SP的教学法。课程结束后运用DREEM量表及考试成绩评价教学效果。结果:SP组学生DREEM量表的总分及各下位量表评分均明显高于传统组(P<0.05,0.01),且SP组学生应用知识解决问题的得分和操作考试得分显著高于传统组(P<0.01)。结论:SP教学法适用于本科康复治疗专业学生的康复评定学教学,值得推广应用。     

Application of virtual reality to the rehabilitation field to aid amputee rehabilitation: Findings from a systematic review

Purpose.?To determine the scope and use of virtual reality (VR) applications in the gait rehabilitation field and to review and characterise VR approaches for application in amputee rehabilitation.

Method.?A state-of-the-art research analysis was completed to review different approaches of VR to the gait rehabilitation field. Systematic research using Medline, EBSCOhost and Science Direct (ISI Web of Knowledge) was conducted to analyse various VR rehabilitation methods, and we developed a framework to characterise different research findings.

Results.?Framework for a research approach in the field of VR and rehabilitation was developed based on the literature review. On the basis of outcomes from gait rehabilitation using VR, trials for amputee rehabilitation using VR is warranted and an outline of this potential VR rehabilitation area was identified.

Conclusions.?Evidence supports the investigation of VR as applied to amputee rehabilitation based on general gait rehabilitation results. Research should be expanded to better understand the role and use of technology in community-based rehabilitation to enhance the quality of life of individuals.     

An analysis of disability models and the application of the ICF to obesity

Purpose.?Given the significant increase in obesity rates and associated health risks, understanding obesity treatment in the context of disability is important to rehabilitation practitioners.

Method.?Published literature in the area of obesity research and clinical practice was reviewed within the medical, social and biopsychosocial conceptual models of disability.

Results.?There is universal agreement that disability is experienced by obese persons. However, interventions for rehabilitation practitioners are not articulated clearly in the literature. No specific conceptual model to underpin rehabilitation treatment is recommended.

Conclusions.?This article provides a rationale for rehabilitation practitioners to use a biopsychosocial model (the International Classification of Functioning, Disability and Health) as a universal framework to classify disability related to the condition of obesity.     

Models of rehabilitation – commonalities of interventions that work and of those that do not

Purpose.?To review models of rehabilitation and to consider factors that influence a models effectiveness or ineffectiveness.

Methods.?Narrative review, with consultation with researchers.

Results.?Whether rehabilitation works is arguably best considered from the perspective of the person with disability. Rehabilitation models can generally be considered as ‘complex interventions’ for which specific research approaches have been defined. It is more likely to be accepted by the people involved, and be more likely to work, if the complex intervention paradigm is used and if rehabilitation operates at the level of activity and participation, as defined by the WHO International Classification of Functioning, Disability and Health. Reasons for apparent ‘non-effectiveness’ of rehabilitation models are protean and can range from inadequately conceptualised health conditions, or interventions, to interference from ‘active’ control interventions, inappropriate outcome measures and, inadequate sample sizes.

Conclusion.?Many opportunities remain for future research into the effectiveness of models of rehabilitation and detection of what constitutes the crucial components.     

Health of people with spinal cord injury in Singapore: implications for rehabilitation planning and implementation

Purpose.?This study aimed to provide a broad overview of the health of people with spinal cord injury (SCI) in Singapore, so as to highlight areas of potential need. These areas could then guide future research and rehabilitation programme development.

Methods.?Demographic data, injury information and information about SCI-related secondary impairments, chronic conditions and their associated risk factors, medical and hospital utilisation, participation (Craig Handicap Assessment and Reporting Technique) and life satisfaction (Satisfaction with Life Scale) were collected via interviews from people living with traumatic SCI.

Results.?On average, participants (50 men and 5 women) were aged 48.3 ± 16.54 years and had had their SCIs for 5 years. ?75%% with tetraplegia. The most prevalent SCI-related secondary impairments were pain, spasms, bladder problems, bowel problems and oedema. Chronic conditions and their associated risk factors were prevalent. Participation and life satisfaction scores were lower than those reported for similar populations cross-culturally.

Conclusion.?The study revealed several health areas that may be affecting the overall health of people with SCI in Singapore. By focusing on community reintegration and health promotion, physiotherapists and other rehabilitation professionals may augment health outcomes and improve the quality of life of this population in Singapore.     

Human rights and rehabilitation outcomes

Purpose.?The aim of this article is to introduce rehabilitation professionals to the rapidly growing literature on human rights particularly as it relates to health and rehabilitation. The article aims to stimulate further discussion and debate concerning the place of human rights in rehabilitation practice.

Method.?Some important milestones in the recent history of the human rights movement are briefly outlined, and some important terms in the rights literature are explained. The Ward and Birgden model of the structure of human rights is then described as an example of a rights perspective that might have particular relevance for health and social services and rehabilitation.

Results.?A rehabilitation case study is presented as an example of how the Ward and Birgden model could have practical relevance when deciding on the most important outcomes for an individual in rehabilitation.

Conclusion.?Human rights are playing an increasing role in the struggle to improve health and healthcare globally. They also have important implications for rehabilitation practitioners and researchers and should form the core of any ethical framework for rehabilitation. It might even be argued that rights and dignity are themselves valued outcomes for rehabilitation.     

Dignity,rights and capabilities in clinical rehabilitation

Purpose.?The purpose of this article is to explore three concepts namely dignity, human rights and capabilities and to argue for their relevance in advancing the theory and practice of rehabilitation.

Method.?A narrative review of selected academic writing on the three constructs is considered with respect to the rehabilitation literature.

Results.?Each concept is defined and technical terms are explained for readers unfamiliar with these topics. Salient aspects of academic or scientific writing on each of these three topics is summarised and attempts are made to integrate these with rehabilitation.

Conclusions.?Dignity, rights and capabilities are three concepts that have the potential to enhance theory development in rehabilitation.     

Between the ideal and the real: Reconsidering the International Classification of Functioning,Disability and Health

Purpose.?The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) is a disability classification and framework that was endorsed in 2001. Despite its endorsement from WHO member states, some rehabilitation researchers have argued that the ICF has been used and requires further inquiry. The purpose of this article is to examine the ICF critically using a feminist theoretical perspective.

Method.?In this commentary, I apply a feminist perspective to identify some of the assumptions that limit the ICF and to illustrate how the principles of feminist science could enhance the ICF.

Results.?The analysis reveals that although the ICF is premised on the assumptions of biopsychosocial theory (BPS), there are aspects of the classification that contradict the tenets of BPS. Moreover, although the ICF is purported to represent a change in thinking about disability, the stated principles of rehabilitation medicine have the potential to limit the ICF in this regard.

Conclusion.?The ICF has the potential to be a powerful tool for changing the way that we think about disability and to improve the lives of individuals of all abilities. Bringing the ICF into closer alignment with BPS theory is an important step in moving the ICF forward.     

A research study into the requirements of disabled residents for rehabilitation services in Beijing

Purpose.?Rehabilitation services need strengthening further. This study explores a sample of the population in Beijing in order to establish the extent of medical impairments and disabilities. It describes the present utilization of rehabilitation by different economic groups of the population and also explores the attitudes of these same groups to the concepts inherent in rehabilitation. The conclusions are that a considerable information program is needed to help people with disabilities to access and utilize services appropriately. Finally, it concludes that the present Rehabilitation Services need to be professionally improved and expanded.

Background.?In China, the spectrum of disease is changing, along with the development of society, and progress in science and technology. The requirements of people for medical rehabilitation following major accidents, and acute or chronic disease, leading to disability and handicap, increase year by year. This is especially so now, with the added geriatric problems of an aging population. At present, rehabilitation services and resources within this country are limited. It is difficult to meet the immediate or long-term needs of disabled persons. Recently, there have been many national publications describing the requirements and discussing those factors which influence Rehabilitation Service provision, but much of this discussion has been theoretically based, rather than facing practical issues. We can find no studies describing the nature and extent of disabling disorders in the Beijing population and, in particular, few formal studies relating the provision of rehabilitation services to that population in need of this essential management process. We have therefore carried out a survey-based study to demonstrate the present rehabilitation service requirements for disabled residents in some typical Beijing urban districts. We have also looked at those factors which influence clients to accept the various services which are available to them at present. This will, we suggest, provide an epidemiological and demographic analysis with data on which to base future policies for government services to best meet these requirements.

Method.?A series of comprehensive questionnaires were designed, in order to investigate the demographic characters, health conditions, knowledge of rehabilitation services, and social status of the interviewees. Some 460 disabled residents from three districts in the city of Beijing were selected. They were randomized, with multi-stage cluster sampling for in-house survey.

Results.?Some 74.78% of interviewees expressed a need for rehabilitation, at different levels, but only 26.73% received any services. Factors influencing requests for community rehabilitation services for disabled residents in Beijing included income, nature of disability, awareness of rehabilitation services and the nature of services supplied. The expressed needs for rehabilitation services by disabled residents in communities in Beijing urban districts are real, and are largely unmet. Only a few of the disabled received any services. Factors influencing disabled residents' abilities to access rehabilitation service, included the nature and degree of disability, the economic status of the residents, the quality and nature of the rehabilitation programs and treatment available, and the knowledge by clients of the existence and availability of these services.

Conclusion.?More effective measures need to be taken to make the appropriate Rehabilitation Services more available to community residents with medical disabilities.     

A description and evaluation of an innovative rural rehabilitation programme in South Eastern Australia

Purpose.?To describe and evaluate the effectiveness of an innovative model of rehabilitation designed to meet the needs of a sparsely populated rural area in South Eastern Australia.

Method.?Five rural health services collaborated to establish a rehabilitation programme. Evaluation included comparing length of stay (LOS) and improvement in the Modified Barthel Index (BI) with the Victorian State average for Level 2 (non-specialist) rehabilitation. Surveys were conducted with staff, clients and carers in the programme.

Results.?An inpatient rehabilitation programme was successfully established through cooperation between five health services. Clients admitted to the programme improved functionally at least as well as the Victorian State average for similar client groups (BI change 26.5 compared with 22.3 points, p?<?0.001), with a shorter LOS (13.8 compared with 22.3 days) but more were discharged to residential aged care (16.1% compared with 6%).

Conclusions.?The programme was successful in meeting its stated aims. The model described could be adopted in rural areas sharing similar characteristics. Key enablers to the success of the programme included: collaboration between hospitals; a skilled and enthusiastic leader; recruitment of allied health staff; consistent medical leadership; access to training and support from a major regional rehabilitation centre; and access to funding to enable the programme to establish itself and demonstrate outcomes for clients.     

Psychological comorbidity in medical rehabilitation – the need for education

Purpose.?Prevalence of comorbid mental disorders in rehabilitation patients is high. In spite of the bio-psycho-social approach in rehabilitation, recognition and treatment rates of comorbid mental disorders during rehabilitation are low. The purpose of the study was to raise specific information about current clinical practice concerning comorbid mental disorders and training needs of rehabilitation personnel.

Method.?435 questionnaires were sent out to medical personnel in 54 rehabilitation hospitals in south-west Germany.

Results.?Psychologists in rehabilitation spend most of their time on counselling (45%) and group interventions (29%). Physicians and psychologists both feel highly responsible for recognizing mental disorders and motivating patients to seek aftercare. Screeners are rarely used by psychologists and physicians. Seventy-six percent of the participants would take part in specific training sessions. High training needs were stated for affective, anxiety and somatoform disorders. A specific training session for mental health in rehabilitation should last at least half a day and cover affective, anxiety and somatoform disorders.

Conclusions.?Taking these results into account, it is possible to put together a training program in diagnostics of comorbid mental disorders, which fits the needs of the professionals.     

Theory development and a science of rehabilitation

Purpose.?This article considers the role of theory and theory building in science and specifically in rehabilitation. It is argued that rehabilitation has tended to value theory testing over theory building and some evidence is presented for this.

Method.?Some general questions concerning the role of theory in scientific progress are discussed including: What is a theory? What is the role of theory in science? What makes a good scientific theory? How does theoretical change occur in science? Where relevant these questions are discussed in terms of examples from clinical rehabilitation research.

Results.?Two important issues arising from the preceding discussion are then considered. First is the question of whether a general or unifying theory of rehabilitation is a desirable goal. The second concerns how we might begin to develop a coherent programme of theory building in rehabilitation.

Conclusion.?More time spent on rehabilitation theory building may enhance the fruits of empirical theory testing.     

Attitudes of doctors toward community medicine: Differences between graduates from innovative and traditional medical schools

Background: As the importance of community medicine in undergraduate medical curricula is increasingly emphasized, it is important to measure the long‐term impact of these courses on graduates’ attitudes towards community medicine.

Purpose: To compare the attitudes of general practitioners from a community‐oriented medical school with those from a traditional undergraduate background.

Methods: We developed a valid and reliable 35 item questionnaire assessing six key areas of community medicine.

Results: We found general practitioners from the community‐oriented medical school had more positive attitudes towards community medicine overall, and towards holistic and collaborative care. General practitioners, who were younger and female, had more positive attitudes on some dimensions.

Conclusions: This study provides some evidence to support the notion that medical educators have the potential to reinforce, or shape, the attitudes that students bring to medical school.     

Integrating physical medicine and rehabilitation into the curriculum of Iranian medical students

Purpose. To evaluate the attitude of interns toward Physical Medicine and Rehabilitation (PM&R) and design a PM&R curriculum for medical students with continued medical education programmes and workshops based on the needs and interest of Iranian medical community.

Method. Eighty questionnaires were distributed to the medical interns on the last day after attendance in the PM&R ward after participating in a one-month outpatient and inpatient course including 12 lectures.

Results. Out of 80 participants, 34 (42.5%) were female and 46 (57.5%) were male. All the participants believed

participating in a rehabilitation course was necessary; 52 (65%) believed that participating in a separate course of PM&R was necessary, and 28 (35%) believed that rehabilitation of each field of medicine should be presented in its course. A significant percentage (31.4%) of the participants were interested in continuing their education in PM&R specialty.

Conclusion. The enthusiasm of the medical students towards PM&R is a promising sign toward progress of PM&R in Iran which must be directed through a strong effort of physiatrists through setting up appropriate educational programmes for medical students and continued medical education programme s in the universities.     

The International Classification of Functioning,Disability and Health (ICF) in vocational rehabilitation and disability assessment in Slovenia: state of law and users' perspective

Objective. This study illustrates the use of the ICF in vocational rehabilitation and disability assessment in Slovenia.

Method.?A review of the Slovenian law about vocational rehabilitation was performed. A survey was developed and group and individual interviews were conducted with professionals involved in vocational rehabilitation who use the ICF.

Results.?The vast majority of the respondents believe that ICF helps to create a common language for multidisciplinary communication. The main advantages of the ICF identified by the respondents are that it provides a holistic view of the person, assesses complexities of functioning, provides a unified language and offers a quick and easy insight into functioning. The disadvantages of ICF are complicated terminology and subjectivity of the assessor. A difficulty encountered by the users is that by law, only body functions of the ICF are assessed. Additional qualitative analysis of the users' understanding of ICF and its purpose revealed heterogeneity. Significant differences between public and private organisations were found.

Conclusion.?ICF is a promising tool for use in vocational rehabilitation and disability assessment in Slovenia. A major challenge is the lack of interface between ICF and policies on vocational rehabilitation in Slovenia.