The use of classification models in the evaluation of CBR programmes

Classification models for community-based rehabilitation (CBR) create conceptual order in the many types of rehabilitation programmes that exist in developing countries. Several models have been developed but none of the models appears to be widely accepted or being used in the evaluation process.

Purpose. To review classification models and assess its usability.

Methods. Literature review.

Results. Sixteen documents were found describing 11 different models. These models vary from simply listing different types of CBR to multidimensional configurations encircling principles, methods and outcomes of CBR. The models are only incidentally used in the evaluation of CBR programmes. The more recent models have been used to develop, select and group indicators.

Conclusions. Classification models can indeed structure the evaluation and comparison of CBR programs that are, by nature, very different from each other. Indicators can be developed within a theoretical framework provided by the classification model. In order to be widely accepted the models should be made less complex and focus on outcomes that are meaningful for the people involved in the evaluation as well as for policymakers and researchers.     

A framework for evaluating community-based rehabilitation programmes in Chinese communities

Purpose.?The primary aim of this study was to develop an evaluation framework that could effectively describe the quality of community-based rehabilitation (CBR) practice in Chinese communities.

Method.?This study adopted a case study approach to build and validate a CBR evaluation framework. Core elements of CBR programmes were defined from the literature to form an Initial Framework. Domains and elements of the Initial Framework were then verified with examples of CBR programmes cited in published articles. The revised framework was then further tested for relevance and appropriateness in the real life context through testing in five Chinese CBR programmes.

Results.?A final framework for evaluating CBR programmes was developed. It consists of 5 domains, 25 categorised core elements and 72 indicators.

Conclusion.?A comprehensive CBR evaluation framework was built and initially verified with domains, elements and indicators, and is ready for use in Chinese CBR settings.     

An emancipatory research on CBR and the barriers faced by persons with disabilities

Abstract

Purpose: The aim of this research was to understand the barriers faced by persons with disabilities in their daily lives and the role of CBR projects in overcoming them. Method: A group of persons with disabilities involved in CBR activities was identified and trained in participatory research methodologies. Research was carried out, with support from a scientific advisory group, through sharing of life stories in residential meetings focusing on specific themes. These meetings were attended by 368 persons with disabilities. Results: The barriers identified ranged from isolation, neglect, abuse and violence to lack of access to social, health, education and livelihood opportunities. People faced their first barriers in their own families. Families also played an important role in overcoming some barriers at the individual level. CBR projects assisted people in overcoming barriers mainly by providing information, by facilitating access to existing support and by helping persons in communities to take collective action against the barriers. The research also stimulated DPOs and CBR projects to identify some gaps in tackling the barriers and to start action to overcome them. Conclusions: CBR projects can play a role in overcoming some barriers faced by persons with disabilities. Emancipatory research yields rich data, facilitates ownership and possibly future sustainability.

• Implications for Rehabilitation

• Community-based rehabilitation (CBR) programmes can promote mainstreaming and helping in overcoming some barriers faced by persons with disabilities in the communities.

• CBR programmes can facilitate collective action by persons with disabilities in overcoming barriers to inclusion and participation.

• Participatory research approaches such as emancipatory research can play a role in understanding disability issues and at the same time, help CBR programmes to identify gaps and strengthen activities.

     

Practice guidelines for program evaluation in community-based rehabilitation

Purpose: This paper proposes practice guidelines to evaluate community-based rehabilitation (CBR) programs.

Method: These were developed through a rigorous three-phase research process including a literature review on good practices in CBR program evaluation, a field study during which a South Africa CBR program was evaluated, and a Delphi study to generate consensus among a highly credible panel of CBR experts from a wide range of backgrounds and geographical areas.

Results: The 10 guidelines developed are summarized into a practice model highlighting key features of sound CBR program evaluation. They strongly indicate that sound CBR evaluations are those that give a voice and as much control as possible to the most affected groups, embrace the challenge of diversity, and foster use of evaluation processes and findings through a rigorous, collaborative and empowering approach.

Conclusions: The practice guidelines should facilitate CBR evaluation decisions in respect to facilitating an evaluation process, using frameworks and designing methods.

• Implications for rehabilitation

• Ten practice guidelines provide guidance to facilitate sound community-based rehabilitation (CBR) program evaluation decisions. Key indications of good practice include:

• ??being as participatory and empowering as possible;

• ??ensuring that all, including the most affected, have a real opportunity to share their thoughts;

• ??highly considering mixed methods and participatory tools;

• ??adapting to fit evaluation context, local culture and language(s);

• ??defining evaluation questions and reporting findings using shared CBR language when possible, which the framework offered may facilitate.

     

Fit-for purpose use of mouse models to improve predictivity of cancer therapeutics evaluation

Preclinical animal models are useful tools to better understand tumor initiation and progression and to predict the activity of an anticancer agent in the clinic. Ideally, these models should recapitulate the biological characteristics of the tumor and of the related tumor microenvironment (e.g. vasculature, immune cells) in patients. Even if several examples of translational success have been reported it is a matter of fact that clinical trials in oncology often fail to meet their primary endpoints despite encouraging preclinical data. For this reason, there is an increasing need of improved and more predictive models.     

Notes on the Landmark Development of CBR in China

Community-based rehabilitation has a history of 22 years in China.In spite of the preliminary achievement and experiences obtained by the pioneering and trial projects,it was not until the beginning of the new century that CBR in China experienced a landmark development.This iS characterized by a number of favorable pohcy by the government for CBR;the mechanism facilitating primary health care with CBR,a new work-force system of CBR reorganized with better motivation and efficiency,99 demonstration projects of CBR bringing about benchmark promotion effect and the active involvement in CBR by social resources agents.     

Expert consensus on best evaluative practices in community-based rehabilitation

Purpose: The objective of this study was to generate expert consensus on best evaluative practices for community-based rehabilitation (CBR). This consensus includes key features of the evaluation process and methods, and discussion of whether a shared framework should be used to report findings and, if so, which framework should play this role. Method: A Delphi study with two predefined rounds was conducted. Experts in CBR from a wide range of geographical areas and disciplinary backgrounds were recruited to complete the questionnaires. Both quantitative and qualitative analyses were performed to generate the recommendations for best practices in CBR evaluation. Results: A panel of 42 experts reached consensus on 13 recommendations for best evaluative practices in CBR. In regard to the critical qualities of sound CBR evaluation processes, panellists emphasized that these processes should be inclusive, participatory, empowering and respectful of local cultures and languages. The group agreed that evaluators should consider the use of mixed methods and participatory tools, and should combine indicators from a universal list of CBR indicators with locally generated ones. The group also agreed that a common framework should guide CBR evaluations, and that this framework should be a flexible combination between the CBR Matrix and the CBR Principles. Conclusions: An expert panel reached consensus on key features of best evaluative practices in CBR. Knowledge transfer initiatives are now required to develop guidelines, tools and training opportunities to facilitate CBR program evaluations.

• Implications for Rehabilitation

• CBR evaluation processes should strive to be inclusive, participatory, empowering and respectful of local cultures and languages.

• CBR evaluators should strongly consider using mixed methods, participatory tools, a combination of indicators generated with the local community and with others from a bank of CBR indicators.

• CBR evaluations should be situated within a shared, but flexible, framework. This shared framework could combine the CBR Matrix and the CBR Principles.

     

Community-based rehabilitation and health professional practice: developmental opportunities and challenges in the global North and South

Purpose.?This article examines the politically-charged and hotly contested issue of the role of professionals can and should play in the provision of disability services in both the global North and South, with specific reference to Community-Based Rehabilitation (CBR).

Method.?A discursive theoretical discussion of the issues regarding the current and normative power relations that exist between disabled people and professionals working in the health sector is undertaken, by drawing upon contemporary debates in disability studies, rehabilitation, development studies and political science. This article provides an historical analysis of the development and subsequent critique of the underlying principles of CBR. Reference is then to the social model of disability and how it relates to client–professional relationships and subsequently analyses what impact and implications this has for professional practice.

Results.?The normative relationships that exist between disabled people and health professionals remains a contested area. Political imperatives for increased user involvement and public sector reform necessitate the reconfiguration of client–professional relationships. However, there is scant agreement on precisely how this should take place.

Conclusion.?The article concludes by suggesting practical strategies on how health and care services can be provided in a manner that embraces the positive characteristics of the social model of disability, and which enables professionals, such as occupational therapists, rehabilitation professionals and physicians to act as facilitators in extending the human rights and responsibilities of disabled people.     

Outcomes and impact of community-based rehabilitation programmes in Chinese communities

Purpose: To identify the most common and most valued outcomes of community-based rehabilitation (CBR) in Chinese communities and to map these to the CBR evaluation framework.

Method: A multiple, embedded case study design was used. Four CBR programmes in China met the criteria for inclusion and participated. Data collection, via participant “story telling”, followed the procedures of the most significant change technique (MSC) over a period for five months. Content analysis with thematic coding was used to detect the common significant changes described in “top-rated” stories and in the entire pool of stories. Meta-analysis using the CBR framework was carried out to enrich the understanding of programme outcomes.

Results: A total of 101 stories were collected in the two rounds of story collection from the four programmes. Aggregated results demonstrated that, across all programmes, 78.21% of stories focused on changes in people with disabilities, 9.9% described aspects of programme development, 8.91% reported on outcomes related to CBR workers, and only 2.97% were focused on advocacy. When mapped against the elements of the CBR framework the MSCs among these four programmes were (1) psychosocial changes, (2) increased family participation and (3) improved physical functioning.

Conclusions: CBR practice in Chinese communities remains orientated towards an approach of functional rehabilitation rather than community-based inclusive development.

• Implications for rehabilitation

• Community-based rehabilitation is a strategy for community-based inclusive development.

• Commonly reported significant outcomes of community-based rehabilitation programmes in China focus on changes in psychosocial and physical status of people with disabilities and family participation.

• Community-based rehabilitation in China continues to focus on traditional rehabilitation. New efforts and directions are needed to also include goals of equity and community inclusion.

• Further efforts to promote the use of CBR guideline with the goal of facilitating inclusion and equal participation are strongly recommended.

     

基于膀胱功能分类评估的儿童神经源性膀胱患者个体化护理的效果研究

目的探讨儿童神经源性膀胱的分类评估及个体化护理方法的效果。方法将164例神经源性膀胱患儿分为观察组和对照组各82例,对照组采取常规护理,观察组在对照组的基础上,根据膀胱功能分类评估结果,针对协调性痉挛性膀胱、失协调性痉挛性膀胱、协调性驰缓性膀胱、失协调性弛缓性膀胱、近似生理性膀胱采取个体化护理措施。结果观察组患儿尿动力学指标改善,尿路感染阳性率降低,生命质量评分降低(P0.01),且均优于对照组(P0.01)。结论对神经源性膀胱患儿,根据膀胱功能分类评估结果,采取个体化护理措施,能够明显改善患儿尿动力学指标,减少尿路感染发生率,提高患儿生命质量。     

护理质量评价关键环节解析及案例分析

护理质量评价是质量持续改进的重要方法及措施，本文阐述了护理质量评价的关键环节。护理质量评价应遵循“以目标为导向”“用比较判高低”“循证据下结论”“从事实到价值”的原则；将质量问题分解转化为可测量的指标，合理设计护理质量指标，制订切实可行、可测量的质量目标，以专业知识为基础，全面设计评价；注重评价对后续改进工作的指导性。     

脑卒中评估方法的最新进展

介绍一种脑卒中病人的评估的新方法:脑卒中评估新方法(SIAS)。SIAS主要是对病损进行评估,功能评估的等级在0～5或者0～3的范围。评估的项目包括运动功能、肌张力、感觉、关节活动范围、疼痛、躯干控制、空间视觉、失语以及健侧的功能。每一项的得分绘制在一个雷达图上,问题可一目了然。用Rasch分析法证实了SIAS结构的量值,并且验证了SIAS的总分数能够预测脑卒中结果,SIAS得分的内部变异性是可以接受的,而且评估可以作为常规临床检查的一部分。     

脊髓损伤病人神经源性膀胱功能评估及分类研究进展

对脊髓损伤病人神经源性膀胱功能评估及分类方法研究现状进行综述,护理人员根据检查结果对脊髓损伤神经源性膀胱功能进行分类,才能对脊髓损伤病人膀胱功能进行针对性个性化的康复护理。     

脑血管意外后遗症的康复治疗与评价

目的：观察ＰＴ、ＯＴ技术对脑血管意外后遗症（ＣＶＡ）功能恢复影响。方法：疗程前、中、后运用上田敏法及相关机能障碍评定方法对３０ 例ＣＶＡ病人进行了三期评价。结果： 统计表明, 治疗后残疾障碍改善率平均达９１．２％ 。结论：ＰＴ、ＯＴ技术是治疗ＣＶＡ恢复期病人行之有效的方法。     

老年慢性阻塞性肺疾病患者社区康复过程中的负性情绪及自我管理研究

目的 探讨社区老年慢性阻塞性肺疾病(COPD)患者社区康复过程中的负性情绪以及自我管理方法.方法 采用质性研究的现象学研究方法,对12例康复期的社区老年COPD患者进行深入访谈.结果 社区老年COPD患者康复过程中负性情绪有3个主题:孤独和自卑感、自责和罪恶感、无助感.负性情绪的自我管理有三个主题:感恩情绪、顺应疾病、转移注意力.结论 重视康复期老年COPD患者的负性情绪,社区医疗单位要主动承担起COPD患者康复的重任.积极探索适于老年COPD康复的可操作性干预模式,调动一切社会资源,做好社区老年COPD患者的社会支持工作.