State of the science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy: an introduction

Background

Computer graphics and virtual reality techniques are useful to develop automatic and effective rehabilitation systems. However, a kind of virtual environment including unstable visual images presented to wide field screen or a head mounted display tends to induce motion sickness. The motion sickness induced in using a rehabilitation system not only inhibits effective training but also may harm patients' health. There are few studies that have objectively evaluated the effects of the repetitive exposures to these stimuli on humans. The purpose of this study is to investigate the adaptation to visually induced motion sickness by physiological data.

Methods

An experiment was carried out in which the same video image was presented to human subjects three times. We evaluated changes of the intensity of motion sickness they suffered from by a subjective score and the physiological index ρ _max, which is defined as the maximum cross-correlation coefficient between heart rate and pulse wave transmission time and is considered to reflect the autonomic nervous activity.

Results

The results showed adaptation to visually-induced motion sickness by the repetitive presentation of the same image both in the subjective and the objective indices. However, there were some subjects whose intensity of sickness increased. Thus, it was possible to know the part in the video image which related to motion sickness by analyzing changes in ρ _max with time.

Conclusion

The physiological index, ρ _max, will be a good index for assessing the adaptation process to visually induced motion sickness and may be useful in checking the safety of rehabilitation systems with new image technologies.     

State of the science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy. An introduction

The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness along with academic, professional, provider, accreditor, and other organizations sponsored a 2-day State of the Science of Post-Acute Rehabilitation Symposium in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on post-acute care (PAC) rehabilitation so that health policy is founded on a solid evidence base. The goals were to (1) describe the state of our knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (2) identify methodologic and measurement challenges to conducting research, (3) foster the exchange of ideas among researchers, policymakers, industry representatives, funding agency staff, consumers, and advocacy groups, and (4) identify critical issues related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around four themes: (1) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (2) factors that influence access to postacute rehabilitation care, (3) similarities and differences in quality and quantity of services across PAC settings, and (4) effectiveness of postacute rehabilitation services. The full set of symposium articles, including recommendations for future research, appear in Archives of Physical Medicine and Rehabilitation.     

State-of-the-science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy: an introduction

The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness along with academic, professional, provider, accreditor, and other organizations, sponsored a 2-day State-of-the-Science of Post-Acute Rehabilitation Symposium in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on postacute care (PAC) rehabilitation so that health policy is founded on a solid evidence base. The goals were to (1) describe the state of our knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (2) identify methodologic and measurement challenges to conducting research, (3) foster the exchange of ideas among researchers, policy makers, industry representatives, funding agency staff, consumers, and advocacy groups, and (4) identify critical issues related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around four themes: (1) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (2) factors that influence access to postacute rehabilitation care, (3) similarities and differences in quality and quantity of services across PAC settings, and (4) effectiveness of postacute rehabilitation services. The full set of symposium articles, including recommendations for future research, appear in Archives of Physical Medicine and Rehabilitation.     

State of the science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy--an introduction.

Postacute rehabilitation care is a key component of the health care delivery system, yet we know little about the active ingredients of the rehabilitation process that produce the best outcomes. Well-designed research is needed to develop better measures for case-mix adjustment and outcomes of care. To advance research into rehabilitation effectiveness and support the development of evidence-based policies, we must develop new and improve existing measures of patient characteristics, treatment contents, and long-term outcomes. Critical research needs to include --Developing validated measures of rehabilitation interventions and case mix; --Standardizing PAC measures and timing of routine measurement for payment and quality assurance purposes across sites of care; --Examining differences in content and processes of care both within facilities of the same type and across the different types of facilities; --Identifying patient characteristics that vary by region such as rural and urban mix, cultural characteristics, and provider referral patterns; and --Implementing a strategic plan for effectiveness research that is characterized by collaboration among CMS, federal research funders, researchers, and care sites.     

State of the science of postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy. An introduction.

The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness, along with academic, professional, provider, accreditor, and other organizations, sponsored a 2-day symposium on the state of the science of postacute rehabilitation in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on postacute care (PAC) rehabilitation so that health policy could be founded on a solid evidence base. The goals were to (1) describe the state of our knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (2) identify methodologic and measurement challenges to conducting research, (3) foster the exchange of ideas among researchers, policymakers, industry representatives, funding agency staff, consumers, and advocacy groups, and (4) identify critical issues related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around four themes: (1) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (2) factors that influence access to postacute rehabilitation care, (3) similarities and differences in quality and quantity of services across PAC settings, and (4) effectiveness ofpostacute rehabilitation services. The full set of symposium articles, including recommendations for future research,     

State-of-the-science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy. an introduction

Heinemann AW. State-of-the-science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy. An introduction.The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness along with academic, professional, provider, accreditor, and other organizations, sponsored a 2-day State-of-the-Science of Post-Acute Rehabilitation Symposium in February 2007. Its purpose was to serve as a catalyst for expanded research into rehabilitation postacute care (PAC) so that policy for such care is founded on a solid base of evidence. The goals were to: (1) describe the extent of current knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (2) identify methodologic and measurement challenges to conducting research, (3) foster the exchange of ideas among researchers, policy-makers, industry representatives, funding agency staffs, consumers, and advocacy groups, and (4) identify critical issues related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentations and state-of-the-science summaries were organized around 4 themes: (1) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (2) factors that influence access to postacute rehabilitation care, (3) similarities and differences in quality and quantity of services across PAC settings, and (4) effectiveness of postacute rehabilitation services. The full set of symposium articles, including recommendations for future research, appears in this issue of the Archives of Physical Medicine and Rehabilitation.     

State-of-the-Science on Postacute Rehabilitation: setting a research agenda and developing an evidence base for practice and public policy--an introduction

The Rehabilitation Research and Training Center on Measuring Rehabilitation OUTCOMES: and Effectiveness, along with academic, professional, provider, accreditor, and other organizations, sponsored a 2-day State-of-the-Science of Post-Acute Rehabilitation Symposium in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on postacute care (PAC) rehabilitation so that health policy is founded on a solid evidence base. The goals were: (1) to describe the state of our knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (2) to identify methodologic and measurement challenges to conducting research, (3) to foster the exchange of ideas among researchers, policymakers, industry representatives, funding agency staff, consumers, and advocacy groups, and (4) to identify critical issues related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around 4 themes: (1) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (2) factors that influence access to postacute rehabilitation care, (3) similarities and differences in quality and quantity of services across PAC settings, and (4) effectiveness of postacute rehabilitation services. The full set of symposium articles, including recommendations for future research, appear in Archives of Physical Medicine and Rehabilitation.     

Infant massage: developing an evidence base for health visiting practice

In common with most complementary interventions, infant massage has not received a great deal of attention from evaluative research, and what little research has been done has been quite equivocal. Its use as an intervention within Health Visiting practice has received even less attention. This modest study sought to evaluate the process and impact of one Health Visitor’s use of infant massage. Data were collected in three forms. Firstly, a postal questionnaire was distributed to those who had accessed the infant massage programme and to a ‘non-intervention’ group (94 and 60 were returned from each group, respectively). This questionnaire included the previously validated Self-Esteem Scale and the Parenting Sense of Competence Scale in addition to biographical and infant massage related questions that were designed for this study. Secondly, those parents attending the programme were invited to complete a programme evaluation questionnaire (n=100). Thirdly, three focus group interviews were held with one group of programme participants—at the start and end of the five-week programme and three months later. This study did not demonstrate any statistically significant impact of infant massage on the selected outcome measures. However, the more qualitative data provided considerable support for the intervention, both in relation to the perceived direct benefits of infant massage and in relation to the health promotion and social benefits of attending the infant massage programme. Indeed, the need to disaggregate the intervention from the mode of delivery in order to demonstrate effectiveness, together with the diffuse effects of massage, render such a study methodologically challenging.     

State-of-the-science on postacute rehabilitation: measurement and methodologies for assessing quality and establishing policy for postacute care

Duncan PW, Velozo CA. State-of-the-science on postacute rehabilitation: measurement and methodologies for assessing quality and establishing policy for postacute care.We present an overview of commonly used postacute outcome measures and review new methodologies for postacute assessment. We question the impact that current measurement has had on improvement of quality of postacute care (PAC) and its utility in informing health policy. We suggest that Donabedian’s model of health care quality should be endorsed for measurement. Specifically, measurement of outcomes and process should be used jointly in assessment of PAC.     

Nursing, medication education and the new policy agenda: the evidence base

Current social and demographic trends, combined with ‘the new policy agenda’, highlight the importance of nurses’ role in educating patients about medication. In the absence of previous research investigation, this study set out to explore nurses’ current contribution to medication education and the clinical contextual factors that influence current practice. The evidence base for effective medication education was established from reviews of literature and focus groups with key informants. Nurses’ practice was investigated using a case study approach in seven clinical areas representing adult, care of the older person, mental health and community nursing contexts. Methods used to collect data were: audio-recordings (n=37) and observation (n=48) of nurse–patient interactions about medication, post-interaction interviews with nurses (n=29), post-interaction interviews with patients (n=39), analysis of relevant written documentation and researcher observation and field notes. Data sources within each case were subjected to systematic content analysis in order to identify current practice and contextual influences within each case. Cross-case analysis was also employed in order to identify explanations for any differentiation in practice. Findings indicate that nurses’ contribution to medication education is commonly limited to simple information giving about medicines, involving the name, purpose, colour, number of tablets and the time and frequency that medications should be administered. Nurses’ practice in two of the seven clinical areas was characterised by interactions that more closely demonstrated features of what is known to constitute more comprehensive and effective medication education. Analysis of contextual influences within and between cases allowed explanations to be derived for the types of medication education interactions observed. These concerned: patient characteristics, perceived and expressed preferences of patients for information, characteristics of the nurse-patient relationship, lack of time and high workload, and the philosophy of care within the clinical area. In all clinical areas, nurses were not explicitly and judiciously using available evidence to inform their medication-related interactions. The paper concludes with discussion and implications of the findings.     

Systematic reviews for informing rehabilitation practice: an introduction

The research literature that rehabilitation clinicians need to be familiar with has become too large for anyone to read, and numerous published studies are too complex for many practitioners to understand and fruitfully use. One method to keep up with new findings is through systematic reviews. Systematic reviews can be effective tools that help guide rehabilitation practice by identifying the best research that provides the evidence for enhanced clinical decision-making. This article describes how systematic reviews are created, indicates where rehabilitation clinicians may find them, and refers to a resource that may be of use in evaluating their quality and applicability.     

Creating the evidence base: the journey from practice to research

The ability to deliver accurate, evidence-based information when helping patients make decisions about their care is fundamental to the role of the clinical nurse specialist. For patients with ulcerative colitis who are considering surgery to form an ileo-anal pouch, it is essential to give them information about the psychosocial, as well as the physical, effects of such surgery. As many of these patients are of working age, understanding the likely consequences for paid employment is a priority. However, very little evidence is available on this subject. The authors therefore decided to develop a research study aimed at filling this gap. A proposal to conduct a phenomenological study into the subsequent employment experiences of patients who have undergone ileo-anal pouch formation has been developed. This article seeks to explore how the research idea and its methodology stemmed from practice and highlights the importance of seeing research and practice as complementary components of good nursing care.     

Evaluation of the research agenda for rehabilitation nursing.

From 1993 to 1995, under the direction of the board of directors of the Association of Rehabilitation Nurses (ARN), the Rehabilitation Nursing Foundation (RNF) created a research agenda for the field, which was published in 1996. The goal of the agenda was to identify a broad range of issues in rehabilitation practice that could be examined to advance the scientific knowledge base. Ten years later, the board of directors of ARN directed RNF to evaluate and update the agenda. A committee of three ARN members was formed to undertake this task. This article reports the committee's evaluation of the 1996 Rehabilitation Nursing Research Agenda. A separate article reports on the process of revising the agenda.