The Importance of Adopting a Client Focus in Assessing Outcomes Following Inpatient Rehabilitation Treatment of Older People

Over the last few years, the German Pension Insurance has implemented a new method of quality assurance for inpatient rehabilitation of children and adolescents diagnosed with bronchial asthma, obesity, or atopic dermatitis: the so-called rehabilitation treatment standards (RTS). They aim at promoting a comprehensive and evidence-based care in rehabilitation. Furthermore, they are intended to make the therapeutic processes in medical rehabilitation as well as potential deficits more transparent. The development of RTS was composed of five phases during which current scientific evidence, expert knowledge, and patient expectations were included. Their core element is the specification of evidence-based treatment modules that describe a good rehabilitation standard for children diagnosed with bronchial asthma, obesity, or atopic dermatitis. Opportunities and limitations of the RTS as a tool for quality assurance are discussed.

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Behavior Problems in Children Requiring Inpatient Rehabilitation Treatment for Asthma

Journal of Asthma ◽

10.3109/02770908909073241 ◽

1989 ◽

Vol 26 (2) ◽

pp. 123-132 ◽

Cited By ~ 3

Author(s):

David Furrow ◽

Janice Hambley ◽

Kevin Brazil

Keyword(s):

Behavior Problems ◽

Inpatient Rehabilitation ◽

Rehabilitation Treatment

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Predictors of effectiveness of multidisciplinary rehabilitation treatment on motor dysfunction in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458513508834 ◽

2013 ◽

Vol 20 (7) ◽

pp. 862-870 ◽

Cited By ~ 6

Author(s):

G Liberatore ◽

F Clarelli ◽

A Nuara ◽

D Ungaro ◽

R Gatti ◽

...

Keyword(s):

Multiple Sclerosis ◽

Outcome Measures ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Program ◽

Activity Limitation ◽

Motor Dysfunction ◽

Short Term ◽

Rehabilitation Treatment ◽

Edss Score

Objectives: To identify clinical predictors of effectiveness of a motor rehabilitation treatment in a cohort of multiple sclerosis (MS) patients. Materials and methods: We analysed 212 consecutive patients who underwent a short-term (3–7 weeks) intensive (two hours per day, five days per week), individualised, goal-oriented inpatient rehabilitation program. Activity limitation and impairment were measured on admission and discharge of the rehabilitation trial using the motor sub-items of the Functional Independence Measure (mFIM) and the Expanded Disability Status Scale (EDSS) score. Multivariate logistic regression models have been tested to evaluate the role of clinical baseline features on rehabilitation effectiveness. Results: According to pre-defined outcome measures, 75.1% of MS patients improved in either activity limitation (≥5 points delta mFIM) or impairment (≥1.0 delta EDSS score if baseline EDSS was ≤5.5, or ≥0.5 if baseline EDSS was >5.5), and 35.4% of MS patients improved in both outcomes. A relapsing-remitting course of disease, a more severe baseline impairment and activity limitation level, a shorter disease duration and a less severe balance dysfunction were predictive of the effectiveness of rehabilitation. Discussion: These data confirm that an intensive inpatient rehabilitation program is able to produce a short-term relevant improvement on clinical and functional outcome measures and suggest some clinical features which can be considered as potential predictors of the outcome of rehabilitative intervention.

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The meanings older people give to their rehabilitation experience

Ageing and Society ◽

10.1017/s0144686x06005113 ◽

2006 ◽

Vol 27 (1) ◽

pp. 147-164 ◽

Cited By ~ 9

Author(s):

MARJO WALLIN ◽

ULLA TALVITIE ◽

MIMA CATTAN ◽

SIRKKA-LIISA KARPPI

Keyword(s):

Older Adults ◽

Older People ◽

Everyday Life ◽

Qualitative Method ◽

Inpatient Rehabilitation ◽

Heterogeneous Group ◽

Geriatric Rehabilitation ◽

Structured Interviews ◽

Everyday Living ◽

At Home

Promoting older people's ability to manage at home is important both for themselves and for society, but few studies have explored whether geriatric rehabilitation actually meets the needs of this heterogeneous group. The purpose of this study was to investigate the meanings that older adults attribute to their geriatric rehabilitation experiences. A group of 27 older adults in inpatient rehabilitation were interviewed during the programme and after returning home. Semi-structured interviews were analysed using a qualitative method, which identified three categories of meaning. In the category ‘sense of confidence with everyday life’, rehabilitation was perceived as facilitating everyday living at home; in the category ‘sense of vacation’, rehabilitation was seen as a means of getting away from normal life and enjoying oneself; and in the category ‘sense of disappointment in the rehabilitation programme’, the participants expressed frustration with the limited opportunities to participate in the planning of their rehabilitation, and with the mismatch between the offered programme and what was needed. To promote older people's autonomy and to enhance their ability to live at home, professionals must involve their clients to a greater extent in the planning of the rehabilitation than is currently the case, and also individualise the rehabilitation regimen.

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Domiciliary therapy during inpatient rehabilitation treatment for patients with an acquired brain injury: a preliminary study

International Journal of Rehabilitation Research ◽

10.1097/00004356-200509000-00003 ◽

2005 ◽

Vol 28 (3) ◽

pp. 211-218

Author(s):

Anne M. Boonstra ◽

Wilma Wijbrandi ◽

Jacoba M. Spikman

Keyword(s):

Brain Injury ◽

Acquired Brain Injury ◽

Inpatient Rehabilitation ◽

Rehabilitation Treatment ◽

Preliminary Study

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Impact of a Pharmacy-Led Fall Prevention Program for Institutionalized Older People

The Senior Care Pharmacist ◽

10.4140/tcp.n.2021.217 ◽

2021 ◽

Vol 36 (4) ◽

pp. 217-222

Author(s):

Kylee Gross ◽

Ashley N. King ◽

Elizabeth Steadman

Keyword(s):

Older People ◽

Behavioral Health ◽

Older Adult ◽

Health Care Providers ◽

Fall Risk ◽

Inpatient Rehabilitation ◽

Acceptance Rate ◽

Care Providers ◽

Recurrent Falls ◽

The Impact

OBJECTIVE: To evaluate the impact of pharmacy interventions on recurrence of falls in older people. DESIGN: Prospective case-crossover study. SETTING: LECOM Health Nursing and Rehabilitation (LNR) and Senior Living Center (SLC) and Millcreek Community Hospital older adult behavioral health and inpatient rehabilitation units (IRU). PARTICIPANTS: Twenty and 15 residents of the SLC and LNR, respectively, and 5 and 2 patients of the older adult behavioral health unit and IRU, respectively, experienced a fall during the 8-week study period. INTERVENTIONS: Medication reviews were conducted by a pharmacist assessing for fall risk-increasing drugs (FRIDs). Adverse effects, drug interactions, and nonpharmacologic causes were evaluated, and recommendations were made to reduce future fall risk. MAIN OUTCOME MEASURES: Recommendation acceptance rate, FRID use, and incidence of recurrent falls. RESULTS: Eighty percent of fall risk-reduction recommendations were accepted and implemented by the medical team. The mean number of potential FRIDs prescribed per participant was reduced from 3.71 to 3.38. There was a 12.4% reduction in recurrent falls after pharmacy intervention (P = 0.0336; odds ratio [95% confidence interval] = 1.783 [1.045-3.112]). CONCLUSION: Pharmacist interventions for older people who experience a fall were associated with a high acceptance rate by health care providers, a reduction in FRID use, and decreased rate of recurrent falls.

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Chronic Functional Tremor: Positive Signs in the Management, Including Mirror Therapy

Case Reports in Neurology ◽

10.1159/000507567 ◽

2020 ◽

Vol 12 (2) ◽

pp. 175-179

Author(s):

Andreas Joos ◽

Ramona Halmer

Keyword(s):

Neurological Symptom ◽

Inpatient Rehabilitation ◽

Neurological Symptoms ◽

Diagnosis And Treatment ◽

Mirror Therapy ◽

Chronic Case ◽

Rehabilitation Treatment ◽

Future Studies ◽

Functional Neurological Symptom Disorder

Functional tremor (FT) is a common functional neurological symptom disorder (FNSD) and difficult to treat. Diagnosis is often delayed in FNSD, which reinforces maladaptation and chronicity. The presented case, who had suffered from FT for 2 years, demonstrates the value of positive neurological symptoms in the diagnosis and treatment of FNSD, even in a chronic case. The patient improved well during integrated inpatient rehabilitation, which included mirror therapy (MT). He had complete suppressibility of the tremor during distraction, which was shown to him, and reversibility of the FT was emphasized. Due do the suppressibility when focusing on the contralateral arm, we installed MT as part of a combined inpatient neurological-psychotherapeutic rehabilitation treatment lasting 8 weeks. During treatment, some strong emotional themes came up. At the end of rehabilitation, the tremor almost completely subsided. Possible pathomechanisms are discussed. Future studies are recommended for determining the effectiveness of MT in FNSD with one-sided symptoms.

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