Sopeutumisvalmennuskursseille osallistuvien lasten vanhempien arvioita hyvinvoinnista, toimintakyvystä ja kurssiodotuksista

Sopeutumisvalmennus on psykososiaalista kuntoutusta, joka tarjoaa tietoa ja tukea sairaudesta tai vammasta, sen hoidosta ja selviytymiskeinoista. Lapset ja nuoret, joilla on pitkäaikaissairaus tai kehityksen häiriöitä, osallistuvat sopeutumisvalmennukseen useimmiten perheenjäsentensä kanssa. Tämän tutkimuksen tavoitteena oli 1) selvittää vanhempien käsityksiä lasten hyvinvoinnista ja toimintakyvystä, 2) arvioida vanhempien omaa hyvinvointia ja perheiden valtaistumista ja 3) selvittää kurssiodotuksia ja niihin yhteydessä olevia tekijöitä. Tutkimus kohdistui Kelan kuntoutuksena vuosina 2014–15 toteutettuihin diabeteskursseihin, oppimisen tai psyykkisen kehityksen häiriöiden kursseihin sekä moni- ja liikuntavammaisten lasten kursseihin. Lasten vanhemmat vastasivat kurssin alussa lomakekyselyyn (n = 357, vastausprosentti 59 %). Kaikissa kurssiryhmissä useimmat vanhemmat arvioivat lapsen terveydentilan hyväksi tai melko hyväksi. Vanhempien arviot niin omasta kuin lapsenkin hyvinvoinnista erosivat kurssiryhmittäin, mutta myös kurssiryhmien sisällä ilmeni vaihtelua. Vanhemmat, joiden lapsella oli diabetes, arvioivat hyvinvointia myönteisemmin kuin vanhemmat, joiden lapsella oli kehityksellinen häiriö. Vanhempien arviot omasta hyvinvoinnistaan korreloivat melko vahvasti lasta koskeviin hyvinvointiarvioihin. Sopeutumisvalmennukseen liittyvät odotukset ja tuen tarpeet koskivat erityisesti vertaistukea ja virkistäytymistä sekä tiedon saantia sairaudesta ja sen hoidosta ja kuntoutuksesta. Kurssiryhmä, lapsen toimintakyvyn rajoitteet, vanhempien hyvinvointi ja perheiden valtaistuminen olivat yhteydessä perheiden odotuksiin ja tuen tarpeisiin. Tutkimuksen keskeinen tulos koski perheen valtaistumisen ja kurssiodotusten välistä yhteyttä. Tarve ammatilliseen asiantuntijuuteen pohjautuvaan tietoon ja psykososiaaliseen tukeen oli vahvempaa niillä perheillä, joilla valtaistumisen tunne oli heikompaa. Sen sijaan ne perheet, joilla valtaistuminen oli voimakkaampaa, odottivat kursseilta vähemmän asiantuntijan tukea ja enemmän vertaistukea ja virkistäytymistä. Abstract Parents´ evaluations of their children´s wellbeing and functioning and identified expectations for psychosocial rehabilitation Finnish adaptation training represents psychosocial rehabilitation, which aims to offer information and guidance for living with an illness or disability as well as promoting coping skills. Children and adolescents with chronic illnesses or developmental disorders participate adaptation training mostly with their family members. The aim of this study was to 1) examine the parents´ perceptions of their child´s wellbeing and functioning, 2) depict their assessments on their own wellbeing and family empowerment, and 3) investigate their needs and expectations for the adaptation training as well as factors connected with different expectations. The study focused on three courses arranged for children either with diabetes, learning or psychological development disorders or multiple or mobility disabilities. The courses were organized in three rehabilitation centers. The parents answered the questionnaire at the beginning of the course (n=357, response rate 59 %). In all course groups most parents perceived their child’s health fairly good or good. The parents of children with diabetes evaluated their child’s wellbeing more positively than the parents of children with developmental disorders. The parents’ wellbeing correlated positively with the children´s wellbeing. Strongest rehabilitation needs and expectations were related to the domains of peer support and recreation, and information about illness or disability and its treatment. The course group, disability of the child, wellbeing of parents and children, and family empowerment were associated with the expectations and needs factors. The main finding of this study addressed the relationship ofthe family empowerment to the expectation domains. Families with weaker empowerment expressed more expectations and needs for professional information and support. More strongly empowered families expressed less needs for professional support and information but more expectations for peer support and recreation.

Generating comprehensive functioning and disability data worldwide: development process, data analyses strategy and reliability of the WHO and World Bank Model Disability Survey

Background Data on functioning and disability collected at population level is essential to complement mortality and morbidity, to estimate rehabilitation needs of countries and regions and to monitor the Convention on the Rights of Persons with Disabilities (CRPD) and the Sustainable Development Goals (SDGs). The objective of this paper is to briefly report the development process of the WHO Model Disability Survey, its data analysis strategy as well as its reliability and ability to measure low to high levels of functioning and disability across countries. Methods The development process is described in detail, and a secondary analysis using Rasch methods is conducted to report reliability and targeting using data from eight national and two regional implementations of the survey. Results The currently available versions of the Model Disability Survey are presented. The survey has good to very good internal reliability and good targeting in all included countries. Conclusion The participatory and evidence-based development, consideration of the expertise of stakeholders, the availability of previously developed ICF-based surveys, and WHO tools targeting functioning and disability are reflected in its good to very good psychometric properties. The survey has been implemented to date in Afghanistan, Cameroon, Chile, Costa Rica, India, Laos, Pakistan, Philippines, Sri Lanka, and Tajikistan, and is used to inform policy-making, to monitor the CRPD and SDGs and to plan the delivery of rehabilitation services.

Speech-in-Noise Audiometry in Adults: A Review of the Available Tests for French Speakers

<b><i>Background:</i></b> Difficulty understanding speech in background noise is the reason of consultation for most people who seek help for their hearing. With the increased use of speech-in-noise (SpIN) testing, audiologists and otologists are expected to evidence disabilities in a greater number of patients with sensorineural hearing loss. The purpose of this study is to list validated available SpIN tests for the French-speaking population. <b><i>Summary:</i></b> A review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus databases were searched. Search strategies used a combination of 4 keywords: speech, audiometry, noise, and French. There were 10 validated SpIN tests dedicated to the Francophone adult population at the time of the review. Some tests use digits triplets as speech stimuli and were originally designed for hearing screening. The others were given a broader range of indications covering diagnostic or research purposes, determination of functional capacities and fitness for duty, as well as assessment of hearing amplification benefit. <b><i>Key Messages:</i></b> As there is a SpIN test for almost any type of clinical or rehabilitation needs, both the accuracy and duration should be considered for choosing one or the other. In an effort to meet the needs of a rapidly aging population, fast adaptive procedures can be favored to screen large groups in order to limit the risk of ignoring the early signs of forthcoming presbycusis and to provide appropriate audiological counseling.

Sairauskäsitykset, elämänhallinta ja sopeutumisvalmennusta koskevat odotukset

Sopeutumisvalmennus on kuntoutusmuoto, jonka avulla pyritään tukemaan kuntoutujaa vamman tai pitkäaikaisen sairauden hallinnassa. Tutkimuksen tavoitteena oli selvittää sopeutumisvalmennukseen saapuvien aikuisten kuntoutujien elämäntilannetta, sairauskäsityksiä, hallinnan tunnetta, terveyteen liittyvää valtaistumista ja sopeutumisvalmennukseen kohdistuvia odotuksia. Kurssimuotoja oli kolme: syöpää, fibromyalgiaa ja diabetesta sairastavien kurssit. Neljän kuntoutuslaitoksen toteuttamille kursseille osallistui vuosina 2014–15 toteutetun tiedonkeruun aikana 581 kuntoutujaa, joista 377 (65 %) antoi kirjallisen suostumuksen osallistua tutkimukseen ja vastasi alkukyselylomakkeeseen. Kurssiryhmät erosivat sairauskäsitystensä suhteen toisistaan. Kuntoutujien elämäntilanne, sosiaalinen ja institutionaalinen luottamus sekä sairauden rajoitukset olivat yhteydessä hallinnan tunteeseen. Sopeutumisvalmennukseen kohdistuvat odotukset muodostivat neljä ulottuvuutta: palvelutietoja, sairautta ja sen hoitoa koskevia tietoja, psykososiaalista asiantuntijatukea sekä vertaistukea koskevat odotukset. Odotukset vaihtelivat kurssiryhmittäin. Sairauskäsityksiin liittyvät sairauden oireet, huolestuneisuus, tunnereaktiot ja käsitys hoidon vaikutuksista ja omista vaikutusmahdollisuuksista selittivät odotusten vaihtelua. Tietoihin ja psykososiaaliseen asiantuntija-apuun kohdistuvien odotusten todennäköisyyttä lisäsi terveyteen liittyvän valtaistumisen osalta tiedollisen hallinnan vähäisyys, kun taas vertaistukeen liittyvien odotusten todennäköisyyttä lisäsi vahva tiedollinen ja psykososiaalinen hallinta. Abstract Illness perceptions, empowerment and rehabilitation expectations of persons attending psychosocial rehabilitation Adaptation training is a form of psychosocial rehabilitation that aims to empower the client in coping with his or her illness or disability. The aim of the study was to examine the life situation, sense of mastery, illness perceptions, health-related empowerment and rehabilitation needs and expectations of clients attending adaptation training courses for adults with cancer, fibromyalgia or diabetes. In 2014–15, 581 clients attended these courses in four rehabilitation centers; 377 of them gave their informed consent to participate the study and answered the questionnaire at the beginning of the course. The three groups differed according to their illness perceptions and rehabilitation expectations, but there was also much variance between group members. Life situation, perceived disability, and social and institutional trust were associated with sense of mastery. Rehabilitation expectations were grouped into four main dimensions, i.e., information about services and support, information about the illness and treatment and rehabilitation options, psychosocial professional support, and peer support. Illness perceptions, i.e. perceived symptoms, worry, emotional reactions, experienced outcomes of treatment, and perceptions of one’s own possibilities to influence the illness were associated with different dimensions. Health-related empowerment was also connected with expectations. Expectations for information and professional help were stronger in those with weak informational mastery, whereas expectations for peer support were stronger with those whose informational and psychosocial mastery was better than average.

Stroke Rehabilitation and Occupational Therapy in Low Resource Settings

The long-term complications of stroke interfere with function, and the level of disability varies based on the type of stroke, location, and the extent of damage. Rehabilitation services are important in the recovery of stroke patients, but not all survivors have access to the services especially in low resourced settings where accessibility and economic challenges are the major barriers. Inadequate fulfilment of stroke survivors’ rehabilitation needs contribute to poor functional outcomes and slow recovery. The objectives of this chapter is therefore to give an overview of stroke and stroke rehabilitation with specific emphasis on occupational therapy, discuss the activities and areas of participation considered important by stroke patients, stroke patients’ needs and perceived fulfilment of these needs in order to provide targeted interventions. Data to inform the chapter is based on research done in a low resource setting. The perceived important activities and participation areas, and the needs of stroke patients are discussed in light of literature on the subject and findings from the studies done in Zimbabwe.

The role of rehabilitation in the management of diabetic foot wounds.

Diabetes is one of the most common health problems worldwide. Diabetic foot wounds (DFWs) are hazardous complications of the disease. Patients are often referred to rehabilitation facilities at later stages of the diabetic complications, particularly after amputation surgery. There are potential benefits of rehabilitation practices in preventing and managing DFWs. Therefore, rehabilitation needs to be more involved in the management of DFWs and should be in all stages of diabetic care. In this review, we discuss literature data to bring rehabilitation perspective to the multidisciplinary management of DFWs.

Gefühlte und reale Arbeitsfähigkeit von Patient*innen mit Post-COVID Symptomatik nach mildem Akutverlauf: eine Analyse des Rehabilitation Needs Questionnaire (RehabNeQ)

Zusammenfassung Hintergrund Das Beschwerdebild der Folgeerscheinungen, die nach einer COVID-19-Erkrankung auch nach Monaten existieren können, wird immer deutlicher: das Post-COVID-Syndrom. Neben verschiedenen Symptomen können auch funktionellen Zusammenhänge bestehen, die die Arbeitsfähigkeit einschränken. Derzeitige Untersuchungen gehen von 10% der Infizierten aus, die dies betrifft. In Deutschland würde dies nach aktuellen Zahlen 380 000 Menschen betreffen. Das Ziel dieser Analyse war es zu zeigen, wie sich die reale und gefühlte Arbeitsfähigkeit bei Patient*innen mit Post-COVID Syndrom darstellt. Methode Der Rehabilitation Needs Questionnaire wird routinemäßig bei Patient*innen mit Post-COVID-Symptomatik bei Vorstellungen in der Medizinischen Hochschule Hannover bzw. dem Universitätsklinikum Jena ausgefüllt. Es erfolgte eine deskriptive Analyse der Fragebögen ab April 2021 unter besonderer Berücksichtigung der Arbeitsfähigkeit. Ausgeschlossen wurden Patient*innen, die nicht im arbeitsfähigen Alter waren, oder bereits vor der COVID-19-Infektion arbeitsunfähig. Ergebnisse 75 von 81 Fragebögen wurden im entsprechenden Zeitraum von einer Stichprobe im arbeitsfähigen Alter in die Auswertung mit einbezogen (68% von Frauen, 32% von Männern). Das Durchschnittsalter lag bei 42,5 Jahren, die Zeit seit der Infektion im Mittel bei 3 Monaten. 44 der 75 Personen (58,7%) waren zum Zeitpunkt der Befragung arbeitsfähig. Die empfundene Arbeitsfähigkeit wurde im Schnitt mit 5,1 von 10 möglichen Punkten angegeben. Frauen zeigten hier durchschnittlich 6,2 Punkte und Männer 4,7 Punkte. 59,1% (n=26) der Befragten gaben Schwierigkeiten beim Erhalt von notwendigen Therapien an. 31 (41,3%) Personen waren zum Zeitpunkt der Befragung aufgrund der POST-COVID-19-Erkrankung arbeitsunfähig. Das mittlere Alter der Gruppe lag bei 46,6 Jahren. 16 (51,6%) der 31 Proband*innen gaben an ununterbrochen seit der Infektion arbeitsunfähig zu sein. Schwierigkeiten beim Erhalt von notwendigen Therapien hatten in dieser Gruppe 64,5% (n=20). Diskussion Die Rate derer, die nach einer COVID-19-Erkrankung auch nach Monaten noch arbeitsunfähig sind, ist hoch. Notwendige therapeutische Maßnahmen stehen entweder in nicht genügender Anzahl zur Verfügung oder werden trotz entsprechender Indikation nicht ausreichend verordnet. Weitere Untersuchungen sind notwendig, um die Wirksamkeit von Therapien zu belegen und welche Barrieren zur Rückkehr an den Arbeitsplatz bestehen. Die Auswirkungen können bei weiter steigenden Fallzahlen noch über Jahre hinweg Einfluss auf die Wirtschaftskraft des Landes haben.

Satisfying medical and rehabilitation needs positively influences returning to work after a work-related injury: an analysis of national panel data from 2018 to 2019

Background This study examined how meeting the medical needs of injured workers after initial treatment may affect their return to work, using data from the Panel Study of Workers’ Compensation Insurance. Methods This study was designed as a longitudinal study, which used data from the second-year, follow-up survey conducted in the secondary cohort of the Panel Study of Workers’ Compensation Insurance. The odds ratio (OR) and 95% confidence interval were estimated through binomial and multinomial logistic regression analyses to examine the effects of unmet medical needs on workers’ return to original work and return to work overall (including reemployment). Results The returned to original work OR of workers whose rehabilitation needs were met was 1.35 (1.12–1.63) while the return to work OR was 1.20 (1.03–1.41). The returned to original work OR of workers whose medical needs were met was 1.64 (1.18–2.27) while the return to work OR was 1.39 (1.07–1.80). In terms of disability rating, the return to work ORs of workers with mild disabilities whose medical/rehabilitation needs were not met and those of workers without disabilities were 1.71 (1.17–2.49) and 1.97 (1.27–3.08), respectively. In the case of regular/temporary workers, the returned-to-work ORs of workers whose medical/rehabilitation needs were not met were 1.54 (1.12–2.13) and 1.27 (1.03–1.56), respectively. Conclusions For workers who sustained work-related injuries, providing medical accessibility and meeting rehabilitation needs were found to be important predictors of return to work after initial treatment.