Cancer rehabilitation

Cancer rehabilitation is a relatively new subspecialty. Its goal is to help patients who have been diagnosed with cancer minimize the physical effects of treatment and disease and regain control over many aspects of their life. This article introduces the concept of cancer rehabilitation and offers examples from a Minnesota clinic of how it can benefit patients at different stages of treatment.     

Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

ABSTRACT: BACKGROUND: In 2006, the Canadian Cardiovascular Society (CCS) Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR). The objectives of the current study were to: (1) describe cardiac patient perceptions of actual and ideal CR wait times, (2) describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3) investigate actual wait times and factors that CR programs perceive to affect these wait times. METHODS: Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared. RESULTS: Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate), and 92 CR programs (61.7% response rate). Patients reported that their wait time from hospital discharge to CR initiation was 65.6 [PLUS-MINUS SIGN] 88.4 days (median, 42 days), while their ideal median wait time was 28 days. Most patients (91.5%) considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p < 0.05). CR programs reported that feasible wait times were significantly longer than what was appropriate for all indications (p < 0.05). They perceived that patient travel and staff capacity were the main factors negatively affecting waits. The median wait time from referral to program initiation was 64 days (mean, 80.0 [PLUS-MINUS SIGN] 62.8 days), with no difference in wait by indication. CONCLUSIONS: Wait times for access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times for percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time benchmarks.     

Evaluation of medical rehabilitation in community based rehabilitation.

Almost all governments and non-governmental organisations in developing countries use a community-based rehabilitation (CBR) approach to work with disabled people. Although disabled people's organisations reject the categorisation of disability in individual terms, 'medical rehabilitation' is still regarded as an important but time limited process within rehabilitation. The paper lists measures and methods used in a comprehensive evaluation, and presents a practical method to examine the quality of medical rehabilitation. The method was developed and applied in an evaluation of service needs and service provision for disabled people in low-income communities, for the Ministry of Welfare, Government of India. The method described is a tracer approach. It assesses quality in three aspects of medical rehabilitation: (i) Technical quality, based on application of minimum technical standards for each impairment. (ii) Interpersonal quality, by observation of service sessions and interviews with service users. (iii) Management (structural) quality, by comparing the rehabilitation goals of service users and service providers. The method differs from most others in that it is process oriented, as opposed to output oriented. The method meets the challenges of providing low-cost assessment of a difficult outcome measure (the quality of medical rehabilitation), within a complex process (CBR). It is anticipated that the tracer method will be useful to the objective evaluation of disability services throughout the developing world.     

Inanspruchnahme medizinischer rehabilitation

In Germany, the Pension Insurers Institutions provide for medical rehabilitation measures of workmen and salaried employees. The measures intend to prevent early retirement caused by illhealth. It is questionable, if selection of rehabilitation participants is based on needs. Experts estimate the range of over-utilization close to 30 %. We tried to establish empirical evidence for the estimated range of over-utilization. Investigations were part of a demonstration project that developed and tested a screening process of early medical rehabilitation intervention in persons insured with a specific Pension Insurer Institution. For 53 persons participating in medical rehabilitation measures in the demonstration project a second evaluation at the beginning of treatment in the rehabilitation clinic was effectuated. Physicians of the rehabilitation clinics evaluated persons according to the same procedures the general pratitioners (GPs) had used. The Pension Insurer Institution uses evaluation of GPs as a basis for the accreditation of rehabilitation measures. The first and second evaluation were compared for diagnoses and assessments of work capacity either reduced or at risk. The second evaluation confirmed the GPs main diagnosis in 66 % of the cases. In contrary, no indication for rehabilitation measures existed in light of the second evaluations for 33 % of the participants in rehabilitation measures because their work capacity was neither substantially at risk nor reduced, and did not fulfill the existing requirements for the accreditation of rehabilitation measures. Investigations confirmed the thesis of overutilization of rehabilitation measures and its range. Criteria for the accreditation of rehabilitation measures must be improved     

产后康复操对产褥期妇女康复的影响研究

目的：探讨在分娩24h后行产后康复体操训练对产褥期妇女机体各器官康复的影响。方法：选择180例经阴道自然分娩且无并发症的初产妇,随机分为两组：实验组产后24h行产后康复操,对照组按传统方法实施产后护理;两组分别于产后5天、产褥期满（产后42天）和产后6个月进行对比评定。结果：实验组的产妇子宫脱垂的发生率明显低于对照组（P〈0.01）;子宫复旧不良、张力性尿失禁、膀胱膨出、腰骶痛的发生率均比对照组低（P〈0.05）;体重的恢复亦明显优于对照组（P〈0.05）。结论：产后康复操有利于妇女产后康复,可减少诸多并发症的发生,从而提高产后妇女的生存质量。