Prolonged exposure for pain and comorbid PTSD: a single-case experimental study of a treatment supplement to multiprofessional pain rehabilitation

Objectives It is unclear how to address PTSD in the context of chronic pain management. Here we examine the potential benefits of an addition of prolonged exposure (PE) therapy for PTSD for adults attending multidisciplinary CBT for chronic pain. Methods Four adults seeking treatment for chronic pain from a specialized pain rehabilitation service were offered PE for PTSD using a replicated, randomized, single-case experimental phase design, prior to commencing a 5-week multidisciplinary CBT program for chronic pain. Pre-, post-, follow-up, and daily measures allowed examination of PTSD and pain outcomes, potential mediators, and the trajectory of these outcomes and potential mediators during the subsequent pain-focused CBT program. Results Visual inspection of the daily data demonstrated changes in all outcome variables and potential mediators during the PE phase. Changes came at different times and at different rates for the four participants, highlighting the individual nature of putative change mechanisms. Consistent with expectation, PE produced reliable change in the severity of PTSD symptoms and trauma-related beliefs for all four participants, either by the end of the PE phase or the PE follow-up, with these gains maintained by the end of the 5-week pain-focused CBT program. However, few reductions in pain intensity or pain interference were seen either during the PE phase or after. Conclusions Although “disorder specific” approaches have dominated the conceptualising, study, and treatment of conditions like PTSD and chronic pain, such approaches may not be optimal. It may be better instead to approach cases in an individual and process-focused fashion. Ethical committee number 2013/381.

Harmonization of Rehabilitation Service Standards for Drug Abuse’s Addicts and Victims according to the Regulations

Narcotics addicts and victims of narcotics abuse must undergo medical and social rehabilitation, according to Article 54 of Indonesia's Narcotics Law. The government then issued a rehabilitation policy for them under the authority of three state institutions, namely the Ministry of Health, the Ministry of Social Affairs, and the National Narcotics Agency. This causes overlapping and tug-of-war among stakeholders when it comes to developing policies and implementing rehabilitation services for addicts and victims of narcotics abuse, resulting in no method that becomes a guideline for rehabilitation implementation, on the report of an Ombudsman study. The aim here is to investigate how the laws of Rehabilitation Service Standards for Addicts and Victims of Drug Abuse are harmonized. The approach used is normative juridical. According to the study's findings, the regulations are hierarchically aligned, but the implementation of each rehabilitation program has a Service Standard. There is a vertical disparity in the definitions of medical and social rehabilitation and service providers and service recipients. Horizontally, there are differences in the determination of the implementing agency, service standards such as service programs, human resources, infrastructure, and activity funding sources. As a result, medical and social rehabilitation implementation is separated, resulting in a lack of comprehensive services for service recipients.

Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

Early Occupational Therapy Intervention in the Hospital Discharge after Stroke

Stroke is the leading cause of acquired disability in adults which is a cerebrovascular disease of great impact in health and social terms, not only due to its prevalence and incidence but also because of its significant consequences in terms of patient dependence and its consequent impact on the patient and family lives. The general objective of this study is to determine whether an early occupational therapy intervention at hospital discharge after suffering a stroke has a positive effect on the functional independence of the patient three months after discharge—the patient’s level of independence being the main focus of this research. Data will be collected on readmissions to hospitals, mortality, returns to work and returns to driving, as well as an economic health analysis. This is a prospective, randomized, controlled clinical trial. The sample size will be made up of 60 patients who suffered a stroke and were discharged from the neurology unit of a second-level hospital in west Malaga (Spain), who were then referred to the rehabilitation service by the joint decision of the neurology and rehabilitation department. The patients and caregivers assigned to the experimental group were included in an early occupational therapy intervention program and compared with a control group that receives usual care.

Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries

ObjectivesLimb amputation incidence is particularly high in fragile contexts due to conflict, accidents and poorly managed diabetes. The study aim was to analyse (1) demographic and amputation characteristics of persons with any type of acquired amputation (PwA) and (2) time between amputation and first access to rehabilitation in five conflict and postconflict countries.DesignA retrospective, observational study analysing differences in demographic and clinical factors and time to access rehabilitation between users with traumatic and non-traumatic amputations.SettingFive countries with the highest numbers of PwA in the global International Committee of the Red Cross database (Afghanistan, Cambodia, Iraq, Myanmar, Sudan). Cleaned and merged data from 2009 to 2018 were aggregated by sex; age at amputation and registration; cause, combination and anatomical level of amputation(s); living environment.ParticipantsAll PwA newly attending rehabilitation.ResultsData for 28 446 individuals were included (4329 (15.2%) female). Most were traumatic amputations (73.4%, 208 90); of these, 48.6% (138 01) were conflict related. Average age at traumatic amputation for men and women was 26.9 and 24.1 years, respectively; for non-traumatic amputation it was 49.1 years and 45.9 years, respectively. Sex differences in age were statistically significant for traumatic and non-traumatic causes (p<0.001, p=0.003). Delay between amputation and rehabilitation was on average 8.2 years for those with traumatic amputation, significantly higher than an average 3 years for those with non-traumatic amputation (p<0.001).ConclusionsYoung age for traumatic and non-traumatic amputations indicates the devastating impact of war and fragile health systems on a society. Long delays between amputation and rehabilitation reveal the mismatch of needs and resources. For rehabilitation service providers in fragile settings, it is an enormous task to manage the diversity of PwA of various causes, age, sex and additional conditions. Improved collaboration between primary healthcare, surgical and rehabilitation services, a prioritisation of rehabilitation and increased resource provision are recommended to ensure adequate access to comprehensive rehabilitation care for PwA.

Investigation on the Operation Status of Community-Based Rehabilitation Station in a District of Chongqing

Objective. Investigate and analyze the current operation status of the community-based rehabilitation station in a district of Chongqing to provide some reference schemes for improving the construction of the community-based rehabilitation system for Chongqing. Methods. Self-designed questionnaires were issued to 36 community-based rehabilitation stations in a district of Chongqing to investigate the human resources status, service projects, service methods, and other aspects of the community-based rehabilitation stations. Results. The community-based rehabilitation station lacks the participation of medical rehabilitation personnel, and only 33.3% of the community-based rehabilitation stations are composed of multidisciplinary human resources of medical and community staff. Community-based rehabilitation services focus on supply education and publicity (86.11%), and rehabilitation treatment services are not fully involved in the community-based rehabilitation service (44.44%). The methods of community-based rehabilitation services are mainly posters and other publicity activities (94.44%), and the community-based rehabilitation service methods are not highly goal-oriented. Conclusion. The survey found some problems to be improved in the construction and operation of grass-roots community-based rehabilitation stations in Chongqing. Community-based rehabilitation stations should enrich the human resources and technology of medical rehabilitation, become an extension of the restoration of community health institutions, and promote the high-quality development of community-based rehabilitation.

Demonstrating the processes and outcomes of a rural Community Mental Health Rehabilitation Service: A realist evaluation

Background As part of significant mental health reform, the Community Mental Health Rehabilitation Service (CMHRS) was implemented in rural South Australia. The CMHRS is a 10-bed mental health residential program offering rehabilitative mental health support to rural residents. Aim To analyse the CMHRS service delivery model and its impact on recovery outcomes for consumers. Methods A mixed method, realist evaluation approach was utilised. A purposive sample of CMHRS staff (n = 6) and consumers (n = 8) were recruited. Consumer recovery was measured using the RAS-DS (on admission and discharge). Participants’ perspectives of the service were gained via one staff focus group (n = 6) and individual semi-structured interviews (consumers n = 6; staff n = 2). Pre-post RAS-DS scores were analysed using paired t-tests/Wilcoxon paired-signed rank test, with qualitative data analysed thematically. Results Significant positive increases in RAS-DS total scores were observed at discharge, supported by the qualitative themes of (re)building relationships and social connections and recovering health and wellbeing. Contextual factors (e.g. staffing) and program mechanisms (e.g. scheduling) impacting on service implementation were identified. Conclusion Maintaining a rehabilitation recovery-focused approach, balanced with an appropriately trained multi-disciplinary team, are vital for maximising positive consumer outcomes. Significance This realist evaluation identifies critical factors impacting rural mental health rehabilitation service delivery.