Work-related hand injuries: Case analyses in a Brazilian rehabilitation service (original) (raw)
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Possible approaches to evaluating the effectiveness of rehabilitation services
Physical rehabilitation and recreational health technologies
Purpose: the article scientifically substantiates models for assessing the effectiveness of rehabilitation services to ensure the quality of provision of rehabilitation assistance in the healthcare sector at the individual level, at the level of a rehabilitation center/department/institution, and the state level. Material & Methods: an analysis of various approaches to assessing the effectiveness of rehabilitation services is presented, particularly in rehabilitation centers created, among other things, based on sanatorium-resort enterprises. Results: the general principle of evaluating the effectiveness of individual rehabilitation of patients based on the International Classification of Functioning (ICF) is considered. Generally accepted scales are presented that can be used to determine the corresponding category of ICF domains on patients` health status for the purpose of rehabilitation. If generally accepted scales do not match the ICF domains, it is suggested that subscales be...
Rehabits: A common language of functional assessment
Archives of Physical Medicine and Rehabilitation, 1995
Rehabit: a common language of functional assessment. Arch Phys Med Rehabil 1995;76:113-22. • Probabilistic measurement models offered by Rasch and others can be used to link different functional assessment instruments into a single measurement system. This study assessed 54 subjects (diagnoses: 8 brain injuries, 7 neuromuscular, 22 musculoskeletal, 7 spinal cord, 10 stroke) admitted to a free-standing rehabilitation hospital at admission and discharge using both the Functional Independenc e Measure (FIM) and the Patient Evaluation and Conference System (PECS). Thirteen FIM and 22 PECS motor skills items were scaled together into a 35item instrument, providing scale values for all items in the same unit of measurement. Separate FIM and PECS measures produced for each subject correlate .94 and .91 (p < .0001), respectively, with the cocalibration measures, and 0.91 (p < .0001) with each other. Either instrument's ratings are easily and quickly converted into the other's using the common unit of measurement, the rehabit (rehabilitation measuring unit). This article argues that the stability of the PECS and FIM item difficulty estimates over thousands of subjects, dozens of hospitals, hundreds of raters, and years of assessment is convincing evidence in support of the widespread use of their cocalibrated, common scale values as a functionometric ruler.
Functional outcomes and rehabilitation: an acute care field study
PubMed, 1989
The effectiveness of intervention including occupational therapy in combination with other rehabilitation services was investigated in 193 acute care patients with a variety of diagnostic conditions. The study was conducted in two phases. In both phases, patients who received occupational therapy in conjunction with other services were compared to patients who did not receive occupational therapy. In the first phase, patients (N = 77) were matched according to diagnostic category, age, sex, and severity of impairment. In both phases, outcome measures included length of hospital stay, Barthel Index change scores, and discharge destination. Results revealed statistically significant findings for the measure of discharge destination. Patients who received occupational therapy as part of their rehabilitation program were more likely to be discharged to home environments. This result occurred despite the fact that patients receiving occupational therapy were rated as more severely impaired than patients who did not receive occupational therapy as part of their rehabilitation program.
Journal of Rehabilitation Medicine, 2023
To investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation. Design: Prospective cohort. Participants: Patients, across diseases, living in western Norway, accepted for somatic spesialized interprofessional rehabilitation (n = 984). Methods: Physical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling. Results: In the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b =-0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/ mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years. Conclusion: Physical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation.
Pm&r, 2019
For rehabilitation clinicians to independently interpret the literature, they must understand evidence-based practice strategies for answering and interpreting clinical research questions. Summary measures, sometimes called measures of frequency or measures of occurrence, summarize the occurrence of outcomes within a group of people. Measures of effect, sometimes called measures of association, quantify the comparison of the outcomes between two groups and are used to inform interpretation of clinical significance. This feature introduces these concepts, building on concepts presented in previous Methodology Matters features. The mission of the Methodology Matters series is to educate rehabilitation clinicians, researchers, and peer reviewers in the principles and application of evidence-based practice using rehabilitation examples. We do not expect all rehabilitation clinicians to do research, but to have the vocabulary and knowledge base to understand and interpret rehabilitation research.
Refining the Conceptual Basis for Rehabilitation Outcome Measurement
Medical Care, 2004
Background: Rehabilitation outcome measures routinely include content on performance of daily activities; however, the conceptual basis for item selection is rarely specified. These instruments differ significantly in format, number, and specificity of daily activity items and in the measurement dimensions and type of scale used to specify levels of performance. We propose that a requirement for upper limb and hand skills underlies many activities of daily living (ADL) and instrumental activities of daily living (IADL) items in current instruments, and that items selected based on this definition can be placed along a single functional continuum. Objective: To examine the dimensional structure and content coverage of a Personal Care and Instrumental Activities item set and to examine the comparability of items from existing instruments and a set of new items as measures of this domain. Methods: Participants (N ϭ 477) from 3 different disability groups and 4 settings representing the continuum of postacute rehabilitation care were administered the newly developed Activity Measure for Post-Acute Care (AM-PAC), the SF-8, and an additional settingspecific measure: FIM (in-patient rehabilitation); MDS (skilled nursing facility); MDS-PAC (postacute settings); OASIS (home care); or PF-10 (outpatient clinic). Rasch (partial-credit model) analyses were conducted on a set of 62 items covering the Personal Care and Instrumental domain to examine item fit, item functioning, and category difficulty estimates and unidimensionality. Results: After removing 6 misfitting items, the remaining 56 items fit acceptably along the hypothesized continuum. Analyses yielded different difficulty estimates for the maximum score (eg, "Independent performance") for items with comparable content from different instruments. Items showed little differential item functioning across age, diagnosis, or severity groups, and 92% of the participants fit the model. Conclusions: ADL and IADL items from existing rehabilitation outcomes instruments that depend on skilled upper limb and hand use can be located along a single continuum, along with the new personal care and instrumental items of the AM-PAC addressing gaps in content. Results support the validity of the proposed definition of the Personal Care and Instrumental Activities dimension of function as a guide for future development of rehabilitation outcome instruments, such as linked, setting-specific short forms and computerized adaptive testing approaches.
Rehabilitation Process and Persons with Physical Dysfunctions
IOSR Journal of Sports and Physical Education, 2014
The main purpose of this study is to determine rehabilitation process and persons with physical dysfunctions. To achieve the purpose of this study, three hypotheses were formulated. Ex-post facto research design was adopted for the study. A sample of one hundred persons with disabilities was randomly selected for the study. The selection was done through the simple random sampling technique. This was to give equal and independent opportunity to all the respondents to be selected for the study. The questionnaire was the major instrument used for data collection. The instrument was subjected to both face and content validation by expert in measurement and evaluation. The reliability estimate of the instrument was established through the test-retest reliability method Pearson product correlation analysis and independent t-test were employed were adopted to test the hypotheses at .05 level of significance. The result of the analysis reveals that rehabilitation significantly relates with...
Archives of Physical Medicine and Rehabilitation, 2007
Objective: To examine the relations among cognitive and emotional function and other patient impairment and demographic variables and the performance of daily activities. Design: Cohort. Setting: Acute inpatient rehabilitation, skilled nursing facilities, home care, and outpatient clinics. Participants: Adults (Nϭ534) receiving services for neurologic (32.3%), lower-extremity orthopedic (42.7%), or complex medical (24.9%) conditions. Mean age was 63.8 years; 55% were women; 88.6% were white; and the time since condition onset ranged from 0.2 to 3.9 years. Interventions: Not applicable. Main Outcome Measures: Activity Measure for Post-Acute Care: applied cognitive, personal care and instrumental, and physical and movement scales; Mental Health Inventory-5 (MHI-5); and patient-identified problems (vision, grasp). Results: Path analyses resulted in good model fit both for the total sample and 3 patient subgroups (2 test, PϾ.05; comparative fit index Ͼ.95). There was a significant (PϽ.05) direct relation between the applied cognitive, grasp, and personal care and instrumental variables in all patient groups. There were also significant indirect relations between the MHI-5, visual impairment, and grasp problems with the personal care and instrumental scale through an association with the applied cognitive scale. Strength and significance of associations between age, sex, and physical and movement and personal care and instrumental scales varied more across patient groups. The model R 2 for the personal care and instrumental scale for the total sample was .60, with R 2 values of .10, .72, and .62 for the lower-extremity orthopedic, neurologic, and complex medical groups, respectively. Conclusions: Results suggest that variations in cognitive function, along with visual impairment and lower perceived well-being are associated with a patient's ability to complete daily activities. Rehabilitation professionals should consider cognitive and emotional factors as well as physical performance when planning treatment programs to restore daily activity function.