A comparison of a hospital-based and two home-based rehabilitation programmes

Purpose.?This paper compares the service models of three different types of rehabilitation programmes provided in Victoria, Australia: One hospital-based and two types of rehabilitation in the home (RITH).

Method.?Nine focus group interviews were conducted with multidisciplinary staff working in rehabilitation teams in one hospital-based and eight RITH programmes. Additional data were collected for 164 clients and 75 carers from eight of these programmes at admission, discharge and three months post discharge. Interviews were conducted with 32 clients and 14 carers.

Results.?The criteria for admission and model of rehabilitation adopted in the three programmes were similar. There were differences in programme aims, characteristics of the clients admitted and the type and level of therapy clients received, both between hospital and home-based programmes and between the three programmes. In general, staff and clients saw the home as providing a relevant context that enabled individualized, goal directed therapy for medically stable rehabilitation clients. The hospital offered an opportunity to socialize with others and specialized equipment.

Conclusions.?Results of this study suggest clients and carers require a mix of hospital and home-based rehabilitation that is able to respond to their needs and preferences at each phase of the rehabilitation continuum.     

家庭康复护理对脑卒中家庭护理者护理能力的影响

目的 研究家庭康复护理干预对脑卒中家庭护理者护理能力的影响。方法 采用以社区为基础的对照试验研究。将60名社区脑卒中家庭主要护理者按其患者随机分组分别进入干预组和对照组,各30人。培训社区护士根据“脑卒中家庭康复护理干预方案”实施干预,于1、3个月时对护理者进行各项护理能力评定。结果 干预组护理者各项护理能力提高较对照组显著,统计学检验差异有显著意义(P=0．00)。结论 家庭康复护理干预可有效提高脑卒中家庭护理者的护理能力。     

Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke

During the 1990s most western European and Organization of Economic Cooperation and Development (OECD) countries experienced financial difficulties and were forced to cut back on or restrain health care expenditures. Home rehabilitation has received attention in recent years because of its potential for cost containment. Often forgotten, however, is the redistribution of costs from one caregiver to another. The aim of this study was to analyse whether a redistribution of costs occurs between health care providers (the County councils) and social welfare providers (the municipalities) in a comparison of home-based rehabilitation and hospital-based rehabilitation after stroke. The study population included 123 patients, 53 in the home-based rehabilitation group and 68 in the hospital-based rehabilitation group. The patients were followed up at 6 and 12 months after onset of stroke. Resource use over a 12-month period included acute hospital care, in-hospital rehabilitation, home rehabilitation and use of home-help service as well as nursing home living. The hospital-based rehabilitation group had significantly fewer hospitalization days after a decision was made about rehabilitation at the acute care ward and consequently the cost for the acute care period was significantly lower. The cost for the rehabilitation period was significantly lower in the home-based rehabilitation group. However, the cost for home help service was significantly higher in the home-based rehabilitation group. The total costs for the care episode did not differ between the two groups. The main finding of this study is that there seems to occur a redistribution of costs between health care providers and social welfare providers in home rehabilitation after stroke in a group of patients with mixed degree of impairment.     

A novel method for designing and optimizing the layout of facilities in bathroom for the elderly in home-based rehabilitation

Purpose: The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships.

Methodology: A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs.

Findings: The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective.

Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly.

• Implications for Rehabilitation

• Develop a new approach to design and optimize the layout of facilities in bathroom.

• Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation.

• Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.

     

Encountering staff in the home: Three older adults' experience during six months of home-based rehabilitation

Purpose. The purpose of the present study was to explore and describe how older adults who received home-based rehabilitation perceived the staff during a period of 6 months when they received rehabilitation. Specifically, the study focused on how the participants collaborated with and made use of the services from the staff.

Method. In this case-oriented study, three older adults were interviewed continuously during the 6-month period they received home-based rehabilitation. The interviews were analysed continuously using a grounded theory approach.

Results. Five different modes of perceiving the staff were identified among the participants: as small talk persons, as discussions partners, as instructors and advisors, as teachers and as persons who carry out tasks efficiently. The three conditions that most came to influence the way the participants perceived collaborated with the staff were as follows: ‘experience and encounters with the staff’, ‘expectations for the future daily life’, and ‘the participants’ needs and tasks related to their disability’.

Conclusions. To achieve collaboration and user involvement, the staffs have to encounter each client differently in accordance with the various tasks that must be carried out during rehabilitation. Our findings indicate that this is particularly important for older adults during home-based rehabilitation, since older adults often have changing needs because of comorbidity.     

居家康复锻炼对乳腺癌患者术后淋巴水肿治疗的作用

目的探讨居家康复锻炼对乳腺癌患者术后淋巴水肿的治疗效果。 方法选取2019年10月至2021年4月期间在中南大学湘雅医学院附属海口医院肿瘤化疗科治疗的乳腺癌术后淋巴水肿患者80例,采用随机分组将患者平均分为2组,对照组保持通常的自我护理,锻炼组在对照组的基础上给予患者居家康复训练指导,并通过检测患者淋巴水肿手臂周径大小、患肢间体积差异、肩部关节运动范围、手臂肌肉力量、生活质量等方面评估康复锻炼对淋巴水肿治疗的作用。 结果2组患者在经过为期至少6周的干预康复后,与对照组相比,锻炼组的淋巴水肿手臂周径大小有所下降（P＜0.05）,手臂体积也随之变小（P＜0.05）;锻炼组的肩关节运动范围恢复情况相比对照组显著提高（P＜0.05）。此外,在锻炼组中患者的手臂屈曲肌、外展肌、外旋肌、内旋肌和水平内收肌的肌力水平都显著增强（P＜0.05）;最后通过乳腺癌患者生命质量测定量表（FACT-B表）对患者生活质量进行评估之后发现,锻炼组患者各方面的生活质量都有所改善。 结论康复锻炼对于乳腺癌患者术后淋巴水肿的治疗是安全有效的,在一定程度上,有益于淋巴水肿的康复和预后,这为居家康复锻炼治疗乳腺癌术后淋巴水肿治疗提供了参考依据。     

Effect of life-space mobility on subjective well-being in aged home-based rehabilitation users with different levels of independence in activities of daily living

[Purpose] The relationship between quality of life and life-space mobility in community-dwelling older adults has recently been reported. The present study aimed to elucidate this relationship in home-based rehabilitation users with limited life-space mobility and loss of independence in activities of daily living. [Participants and Methods] The study population comprised 33 home-based rehabilitation users. The participants were expected to have a wide range of the level of independence in activities of daily living; therefore, they were categorized into three groups according to the Barthel Index score: independent (95–100 points), moderately disabled (90–65 points), and severely disabled (60–0 points) groups. We examined the relationships among the Philadelphia Geriatric Center Morale Scale, Life-Space Assessment, and Barthel Index scores and age. [Results] We detected a strong positive correlation between the Philadelphia Geriatric Center Morale Scale and Life-Space Assessment scores in the independent group; however, no significant correlations were observed in the moderately and severely disabled groups. [Conclusion] Our findings suggest a relationship between subjective well-being and life-space mobility in home-based rehabilitation users who are mostly independent in activities of daily living. However, owing to the small sample size and characteristics of the scales used in this study, further studies are warranted to verify these results.     

Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series

Purpose: The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation.

Method: A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation.

Results: The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement.

Conclusions: Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program.

• Implications for rehabilitation

• A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities.

• For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement.

• For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.

     

家庭康复护理入户干预对脑卒中患者自理能力的影响

目的:研究家庭康复护理干预对社区脑卒中患者自理能力的影响。方法:60例社区脑卒中患者随机分为干预组和对照组,各30例。在家庭康复现状基线调查的基础上结合专业知识制定“脑卒中家庭康复护理干预方案”,根据方案对社区护士进行脑卒中家庭康复护理知识和技能培训,考核合格后以“Orem自理模式”对干预组实施家庭整体康复护理干预,对照组不进行干预,于研究1,3个月时对两组患者进行自理能力评定。结果:干预组各项得分显著高于对照组(P均=0.00),综合性自理能力:1个月时(20.67±3.09比11.87±3.81,F=207.22)、3个月时(22.63±2.09比12.77±3.88,F=180.40);知识性自理能力:1个月时(8.60±1.19比5.67±1.45,F=157.45)、3个月时(9.20±0.71比6.00±1.44,F=142.07,P=0.00);决策性自理能力:1个月时(5.17±1.77比2.53±1.53,F=116.13)、3个月时(6.57±0.77比2.93±1.55,F=156.79);行为性自理能力:1个月时(6.30±1.09比3.67±1.60,F=98.35)、3个月时(6.87±0.97比3.83±1.62,F=69.69)。结论:培训社区护士开展家庭康复护理干预可有效提高脑卒中患者的自理能力。     

Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study

Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes.     

家庭康复护理干预对脑梗死偏瘫患者功能恢复的影响

目的 探讨家庭康复护理干预对脑梗死偏瘫患者运动功能及日常生活能力(ADL)的影响.方法 将80例脑梗死偏瘫患者随机分为观察组和对照组各40例,对照组给常规出院康复指导,出院后不给任何护理干预.观察组在此基础上,给予系统的家庭康复护理干预,于出院时和8周后对两组患者的康复效果进行比较.结果 出院8周后观察组上下肢肌力和生活能力(ADL)与对照组、与出院时比较均有显著提高(P＜0.01).结论 系统化的家庭康复护理干预能最大限度地恢复瘫痪肢体运动功能及日常生活自理能力.     

Patients' experience of home and hospital based cardiac rehabilitation: A focus group study

Background

New cardiac rehabilitation (CR) programmes, such as home programmes using the Heart Manual, are being introduced but little is known about patients' experiences of these.

Aims

To compare the views of patients who had completed a home or hospital-based CR programme and explore the benefits and problems of each programme.

Methods

16 patients from 4 hospital programmes attended one of 3 focus groups; 10 home programme patients attended one of 2 focus groups.

Results

Some themes were common to all focus groups: loss of confidence; continuing to exercise and lifestyle changes; understanding of heart disease. Hospital programme patients particularly enjoyed exercising in a group and mixing with other people, and gained motivation and support from others. Home programme patients spoke very highly of the Heart Manual and valued the one-to-one support of the nurse facilitators. They described the home programme as a lifestyle change compared to the hospital programme which they suggested was more like a treatment.

Conclusions

Patients in the hospital programme enjoyed the camaraderie of group exercise and patients in the home programme valued the wealth of information and advice in the Heart Manual and this gave them a feeling of being in control of their health.     

家庭心脏康复训练对冠心病患者康复疗效影响的Meta分析

目的系统评价家庭心脏康复训练对冠心病患者血压、体质量指数、心功能及运动耐力的影响。方法计算机检索国内外关于冠心病患者进行家庭心脏康复训练对患者血压、体质量指数、心功能及运动耐力影响的随机对照试验。对文献进行筛选、资料提取及质量评价后,采用Revman 5.3软件对资料进行Meta分析。结果共纳入12篇文献,Meta分析显示,与常规治疗组相比,家庭心脏康复训练能有效改善患者的心功能[MD=1.81,95%CI(0.68,2.95),P=0.002]及运动耐力[MD=21.97,95%CI(1.80,42.14),P=0.03],但在改善血压及体重指数方面未见明显优势(P>0.05)。敏感性分析显示,总体研究结果较为稳定,单个研究未对总体结果造成明显影响。结论家庭心脏康复训练能显著改善患者的心功能及运动耐力,但在改善患者的血压及体质量指数方面尚需要开展更多大样本、多中心的长期研究予以验证。     

A comparison of behaviour in two differing psychiatric long-stay rehabilitation environments

This study compares aspects of behaviour in two long-stay resident groups with residual psychiatric difficulties. One group was residing on traditional psychiatric hospital wards and the other group was based in a newly built bungalow complex set within the hospital grounds. This study compares behavioural profiles between these two resident groups. Results indicate that bungalow residents showed significantly lower levels of psychiatric difficulty than their 'ward-based' counterparts. To explore this result further we conducted an examination of possible selection bias at the time of initial assessment. Historical data on both groups were obtained from case notes and analysed to seek possible explanations for this result. These results are discussed with respect to the provision of mental health care in smaller retained hospital facilities and nursing practice, which emphasizes the provision of effective philosophies of care accentuating choice, a sense of autonomy and involvement in care.     

Rehab@home: a tool for home-based motor function rehabilitation

Purpose: This paper presents the Rehab@home system, a tool specifically developed for helping neurological patients performing rehabilitation exercises at home, without the presence of a physiotherapist. It is centred on the rehabilitation of balance and on the sit-to-stand (STS) movement. Method: Rehab@home is composed of two Wii balance boards, a webcam and a computer, and it has two main software applications: one for patients to perform rehabilitation exercises and another one for therapists to visualize the data of the exercises. During the exercises, data from the boards and the webcam are processed in order to automatically assess the correctness of movements. Results: Rehab@home provides exercises for the rehabilitation of balance (in sitting and in standing positions), and for the execution of the STS movement. It gives automatic feedback to the patient and data are saved for future analysis. The therapist is able to adapt the difficulty of the exercises to match with each patient's needs. A preliminary study with seven patients was conducted for evaluating their feedback. They appreciated using the system and felt the exercises more engaging than conventional therapy. Conclusions: Feedback from patients gives the hope that Rehab@home can become a great tool for complementing their rehabilitation process.

• Implications for Rehabilitation

• Rehab@home can be used at home by patients with motor deficits, without the presence of a therapist, as a complement to conventional therapy for accelerating the rehabilitation process.

• The system provides exercises for improving the balance and the STS movement capabilities of patients, gives automatic feedback, and saves video and load information from the movements for future analysis by the therapist.

• Its most important feature is adaptability: the therapist is able to tune the difficulty of the exercises for adapting them to the needs of each patient.

• Patients get more engaged for this type of exercises and think they can take profit from using it.

     

The impact of home-based physiotherapy interventions on breathlessness during activities of daily living in severe COPD: A systematic review

Objectives

To conduct a systematic review and meta-analysis to determine the impact of home-based physiotherapy interventions on breathlessness during activities of daily living (ADL) in severe chronic obstructive disease (COPD).

Data sources

The electronic databases AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Physiotherapy Evidence Database (PEDro) were searched from their inception to Week 20 2008. Bibliographies of all potentially relevant retrieved studies, identified relevant systematic reviews and international guidelines were searched by hand.

Review methods

Inclusion criteria consisted of individuals over 18 years of age with severe COPD (defined as forced expiratory volume in 1 second ≤50% predicted) without cardiovascular co-morbidities, home-based interventions and valid, reliable breathlessness ADL outcome measures. The PEDro scale assessed methodological quality. Data extraction included baseline characteristics, treatment intervention, frequency of training, level of supervision, breathlessness ADL outcome measure and results. Where possible, a random-effects meta-analysis was applied to appropriate trial data to produce overall quantitative results.

Results

Seven studies, providing nine data sets, met the inclusion criteria. Trial PEDro scores ranged from 4 to 7 out of 10. Studies were homogenous at baseline regarding age and COPD severity, although subjects were predominantly male. Five studies investigated inspiratory or expiratory muscle training, and two studies investigated exercises. Statistically significant breathlessness ADL outcome improvements were reported for all interventions except expiratory muscle training. Five studies demonstrated clinical significance (four for inspiratory muscle training and one for exercise). However, due to heterogeneity among study interventions and outcomes, meta-analysis was only considered clinically appropriate on one occasion to pool three inspiratory muscle training studies in relation to breathlessness score. The random-effects meta-analysis indicated that, on average, inspiratory muscle training improved the breathlessness score significantly by 2.36 (95% confidence interval 0.76 to 3.96) compared with controls.

Conclusion

Inspiratory muscle training and exercise are home-based physiotherapy interventions that may improve breathlessness during ADL in severe COPD. Administration can only be advocated tentatively in outpatient services and primary care at this stage because further higher quality, more homogeneous research with larger sample sizes is required to substantiate the current findings.     

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.     

Assessing the impact of a home-based stroke rehabilitation programme: a cost-effectiveness study

Background: Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRTs) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible. The objective of this study was to evaluate the cost-effectiveness of the CSRT programme compared with a “Usual Care” cohort.

Methods: We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35?years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year.

Results: Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost?=??$17,255; incremental effect?=?1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care.

Conclusions: The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods.

• Implications for Rehabilitation

• Ongoing rehabilitation following stroke is imperative for optimal recovery.

• Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.

• The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.

     

Between ideals and reality in home-based rehabilitation

Setting and objective The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway’s health authorities. Design and subjects In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees – service providers and managers – in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method. Results The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser–provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work. Conclusion and implications A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work.

• Key points

• Home-based rehabilitation is documented to be effective, and access to rehabilitation has been established in Norwegian law.

• The purchaser–provider organization, high rate of speed, and a scarcity of resources in home-based services hamper rehabilitation work.

• Healthcare providers find themselves squeezed between the health authorities’ overarching guidelines and requirements and the possibilities of achieving them.

• Rehabilitation must be placed on the agenda on the condition that authorities understand the clinical aspect of rehabilitation.