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Rehabilitation Settings (rehabilitation + setting)
Selected AbstractsMini Nutritional Assessment in geriatric rehabilitation: Inter-rater reliability and relationship to body composition and nutritional biochemistryNUTRITION & DIETETICS, Issue 3 2007Sonja A. NEUMANN Abstract Aim:, To determine the inter-rater reliability of the Mini Nutritional Assessment (MNA) and relationship with body composition and nutritional biochemistry among older Australians undergoing rehabilitation. Methods:, Thirty-eight adults aged ,65 years were prospectively and consecutively recruited from an Australian rehabilitation ward. Two dietitians independently administered the 18-item MNA to determine inter-rater reliability. MNA classifications (well nourished, at risk of malnutrition, malnourished) were compared with body composition (using dual-energy X-ray absorptiometry) and serum albumin. These analyses were also performed for the short-form version of the MNA (six items). Results:, In this cross-sectional study, inter-rater reliability of the 18-item MNA score, estimated by the intraclass correlation coefficient, was 0.833, while inter-rater reliability estimated by the weighted kappa index was 0.53. The two raters reached agreement on MNA classification for 26 of 38 cases (68%). Women classified as malnourished/at risk of malnutrition using the 18-item MNA had lower total body fat (11 kg vs 29 kg, P < 0.01) and per cent body fat (25% vs 40%, P < 0.01), compared with women classified as well nourished. Similar findings were not apparent for men, although men classified as malnourished/at risk of malnutrition had lower serum albumin (32 g/L vs 36 g/L, P = 0.04) compared with men classified as well nourished. Similar findings were evident for the short-form version of the MNA. Conclusion:, The MNA was found to be useful for identifying older women with lower body fat in the Australian rehabilitation setting. The 18-item MNA score has substantial inter-rater reliability, and fair inter-rater reliability when used according to the classifications. Inclusion of subjective and self-reported items in surveys can be problematic for optimal reliability as can the use of such items in a subject population that is experiencing rapid progress in recovery. [source] Routine administration of the Canadian Occupational Performance Measure: Effect on functional outcomeAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2010Heather Colquhoun Background/aim:,Routinely using outcome measures as an integral component of practice has been encouraged for decades yet has not been widely adopted. There are many reasons to measure outcomes yet any positive effect of measurement on our programs or clients has not been substantiated. If the time-consuming nature of outcome measurement is to be encouraged, we need to begin addressing larger questions of the value of outcome measurement on care and outcomes. This cohort study evaluated the impact of routinely administering the Canadian Occupational Performance Measure on client outcomes on a geriatric rehabilitation unit. Methods:,Changes in Functional Independence MeasureÔ scores between an experimental group (n = 45) that received the routine use of the Canadian Occupational Performance Measure for evaluation/planning versus a historical comparison group (n = 58) that received ,usual' care were analysed using generalised linear modeling. Results:,Both groups had significant changes in Functional Independence MeasureÔ scores over time. Results for differences between groups were inconclusive with a significantly underpowered analysis; however, results suggest that a medium to large effect of this intervention cannot be expected. Conclusions:,Results are significant for the field of routine outcome measurement, suggesting that when adding the Canadian Occupational Performance Measure to routine assessment within an inpatient rehabilitation setting, substantially improved Functional Independence MeasureÔ score outcomes should not be expected. The value of routine outcome measurement on client outcomes remains largely unexplored. Routinely, using outcome measures requires additional research to determine the specific benefits to our programs and client outcomes. [source] Interrater reliability of the Personal Care Participation Assessment and Resource Tool (PC-PART) in a rehabilitation settingAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2009Christopher Turner Background:,The Personal Care Participation Assessment and Resource Tool (PC-PART), formerly the Handicap Assessment and Resource Tool (HART), assesses the domains of clothing, hygiene, nutrition, mobility, safety, residence and supports. Aim:,To examine the interrater reliability of the PC-PART in a rehabilitation setting. Methods:,Assessments made by the researcher were compared to the interdisciplinary rehabilitation team. The research and standard assessments occurred within three working days. Raters were blind to each other's scores. Sample participants were a consecutive case-series of rehabilitation clients with varied diagnoses, activity limitations and participation restrictions. Of 66 consecutive patients seen during the a priori determined enrolment period, 25 were included in the study (nine males and 16 females, aged 44,85 years). The remaining 41 patients did not meet the inclusion criteria. Conclusion:,The PC-PART has good interrater reliability. Clinicians, administrators and researchers can be reassured about this aspect of the validity of the tool. [source] Coaching patients to self-care: a primary responsibility of nursingINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2009Julie Pryor BA Aim., To explore the process nurses use to guide and support patients to actively re-establish self-care. Background., The movement of hospitalized patients from less to more independence is primarily a nursing responsibility. Studies of nursing practice in inpatient rehabilitation settings have begun to shed some light on this, but as yet there is limited understanding of the actual skills nurses use to support patients to re-establish self-care. Method., This study used grounded theory. Microanalysis and constant comparative analysis of data collected during interviews with, and observation of, registered and enrolled nurses during everyday nursing practice in five inpatient rehabilitation units facilitated open, axial and selective coding. Relevant literature was woven into the final theory. Findings., To facilitate patient transition from the role of acute care patient to rehabilitation patient actively reclaiming self-care, nurses engaged in a three-phase process known as coaching patients to self-care. The three phases were: easing patients into rehabilitation, maximizing patient effort and providing graduated assistance. Conclusion., Coaching patients to self-care is a primary activity and technology of rehabilitation nursing. Relevance to clinical practice., Patients in a variety of settings would benefit from nurses incorporating coaching skills into their nurse,patient interactions. [source] Evaluating the context within which continence care is provided in rehabilitation units for older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2007Jayne Wright Aim., This paper presents the first phase of an all Ireland 2-year study between the University of Ulster and University College Cork, to determine the contextual indicators that enable or hinder person centred continence care and management in rehabilitation settings for older people. The primary outcome of the study was the development of a tool to enable practitioners to assess the practice context within which continence care is provided. The main focus of this paper is the value of understanding practice ,context' (culture, leadership and evaluation) and its impact to the provision of person centred continence care. Background., The literature highlights the effect of continence problems on the quality of life of older people. Incontinence is often seen by health care professionals and older people as an inevitable consequence of ageing and difficult to treat. Furthermore, health care professionals do not always have the necessary skills and knowledge of best practice in continence care and treatments. The Promoting Action on Research Implementation in Health Services (PARIHS) framework utilized in the study proposes that successful implementation of evidence in practice is dependent on the inter-relationship of three key elements; the nature of the evidence, the quality of the context and expert facilitation. Kitson et al. propose that for successful implementation, evidence needs to be robust, the context receptive to change and appropriate facilitation is needed. Consequently understanding practice ,context' and its impact on the provision of person centred continence care is of value. Methods., Case study methodology with several data collection methods was utilized to measure all aspects of ,context' as identified by the PARIHS framework. Methods include: Royal College of Physicians Audit Scheme, Staff Knowledge questionnaire, semi-structured observation of practice and multidisciplinary focus groups. Findings., The data were analysed in two stages. Stage 1 using both qualitative and quantitative (SPSS 12) methods. Stage 2 analysed all the data utilizing the characteristics of context from the PARIHS framework in order to identify the strong and weak characteristics of the context within which continence care was provided. Continence care and management in this study was found to be focused on continence containment rather than proactive management. The evidence suggests that the context (leadership, culture and evaluation) was weak and not conducive to person centred continence care and management. Conclusion., An analysis of the data using the context framework provided a picture of the context within the units and the identification of the specific contextual issues hindering and enabling the delivery of person centred continence care. This process has thus, added to our understanding of the importance of context to the provision of person-centred care. [source] Efficient assessment of social problem-solving abilities in medical and rehabilitation settings: a rasch analysis of the social problem-solving inventory-revisedJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2009Laura E. Dreer Abstract The Social Problem Solving Inventory-Revised Scale (SPSI-R) has been shown to be a reliable and valid self-report measure of social problem-solving abilities. In busy medical and rehabilitation settings, a brief and efficient screening version with psychometric properties similar to the SPSI-R would have numerous benefits including decreased patient and caregiver assessment burden and administration/scoring time. Thus, the aim of the current study was to identify items from the SPSI-R that would provide for a more efficient assessment of global social problem-solving abilities. This study consisted of three independent samples: 121 persons in low-vision rehabilitation (M age=71 years old, SD=15.53), 301 persons living with diabetes mellitus (M age=58, and SD=14.85), and 131 family caregivers of persons with severe disabilities (M age=56 years old, SD=12.15). All persons completed a version of the SPSI-R, Center for Epidemiological Studies Depression Scale (CES-D), and the Satisfaction with Life Scale (SWLS). Using Rasch scaling of the SPSI-R short-form, we identified a subset of 10 items that reflected the five-component model of social problem solving. The 10 items were separately validated on the sample of persons living with diabetes mellitus and the sample of family caregivers of persons with severe disabilities. Results indicate that the efficient 10-item version, analyzed separately for all three samples, demonstrated good reliability and validity characteristics similar to the established SPSI-R short form. The 10-item version of the SPSI-R represents a brief, effective way in which clinicians and researchers in busy health care settings can quickly assess global problem-solving abilities and identify those persons at-risk for complicated adjustment. Implications for the assessment of social problem-solving abilities are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1,15, 2009. [source] Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patientsACTA NEUROLOGICA SCANDINAVICA, Issue 5 2006S. K. Saxena Background,,, Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. Aim,,, The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Methodology,,, Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. Results,,, The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index , 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01,12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32,14.98). Conclusion,,, Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed. [source] Towards integrated paediatric services in the Netherlands: a survey of views and policies on collaboration in the care for children with cerebral palsyCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2007B. J. G. Nijhuis Abstract Aim, Worldwide, family-centred and co-ordinated care are seen as the two most desirable and effective methods of paediatric care delivery. This study outlines current views on how team collaboration comprising professionals in paediatric rehabilitation and special education and the parents of children with disabilities should be organized, and analyses the policies of five paediatric rehabilitation settings associated with the care of 44 children with cerebral palsy (CP) in the Netherlands. Methods, For an overview of current ideas on collaboration, written statements of professional associations in Dutch paediatric rehabilitation were examined. The policy statements of the five participating settings were derived from their institutional files. Documents detailing the collaborative arrangements involving the various professionals and parents were evaluated at the institutional level and at the child level. Involvement of the stakeholders was analysed based on team conferences. Results, Also in the Netherlands collaboration between rehabilitation and education professionals and parents is endorsed as the key principle in paediatric rehabilitation, with at its core the team conference in which the various priorities and goals are formulated and integrated into a personalized treatment plan. As to their collaborative approaches between rehabilitation centre and school, the five paediatric settings rarely differed, but at the child level approaches varied. Teams were large (averaging 10.5 members), and all three stakeholder groups were represented, but involvement differed per setting, as did the roles and contributions of the individual team members. Conclusion, Collaboration between rehabilitation and education professionals and parents is supported and encouraged nationwide. Views on collaboration have been formulated, and general guidelines on family-centred and co-ordinated care are available. Yet, collaborative practices in Dutch paediatric care are still developing. Protocols that carefully delineate the commitments to collaborate and that translate the policies into practical, detailed guidelines are needed, as they are a prerequisite for successful teamwork. [source] Parent participation in paediatric rehabilitation treatment centres in the Netherlands: a parents' viewpointCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2007R. C. Siebes Abstract Aim, The importance of family-centred care and services has been increasingly emphasized in paediatric rehabilitation. One aspect of family-centred care is parent involvement in their child's treatment. The aims of this study were (1) to describe how, and to what extent parents are involved in the paediatric rehabilitation treatment process in the Netherlands; (2) to determine the level of parents' satisfaction about the services they and their child have received; and (3) to describe what ideas parents have to enhance their involvement in the treatment process. Methods, A total of 679 parents of children aged 1,20 years who participated in our longitudinal study on family centred care in the Netherlands. The children had various diagnoses and were treated in nine out of 23 Dutch paediatric rehabilitation centres. A random sample of 75 parents was interviewed within 4 weeks after completion of the Measure of Processes of Care and the Client Satisfaction Questionnaire. A Quality of Care cycle with six stages was used to structure the evaluation. Results, The data showed that parents are involved in all stages of their child's rehabilitation process in various ways. The average level of parent satisfaction about the services received was high. According to the interviewed parents, the communication between professionals and parents, parents' involvement in goal setting, and parents' involvement in treatment could be improved upon. Conclusion, Parents are to a large extent involved in all stages of the treatment process in Dutch paediatric rehabilitation settings. Although parents valued the services received, they suggested various ways to enhance parent participation. [source] | ||||||||||