Clinical measures of seated postural control in adults are not standardized and most are derived from in-house tools. The purpose of this study is to adapt a pediatric instrument to evaluate seated postural control in adult wheelchair users.
The new instrument is called the Seated Postural Control Measure for Adults (SPCMA) 1.0. Five preliminary versions were pretested with some 20 adults by two raters and a group of experts.
This instrument comprises three sections: Section 1, level of sitting scale for adults (1 item, 7-point ordinal scale); Section 2, static postural alignment (22 items, 7-point ordinal scale); and Section 3, postural alignment after a dynamic activity, propulsion of the wheelchair on flat terrain and an incline (22 items, 7-point ordinal scale).
The SPCMA for Adults 1.0 improves the quality and uniformity of evaluations done by different raters, which facilitates more rigorous follow-up of clients over time, communication between professionals, and objective verification of the attainment of intervention objectives.
We studied the workings of a rehabilitation team in a videoconference setting to note the pros and cons of videoconferencing in the development of interprofessional care plans (ICPs). We recorded every videoconference held by the teams of the specialized centre and the regional centre for clients with traumatic brain injuries over an 18-month period. Thirteen recorded videoconferences, lasting for 30-98 min, were analysed through an observation grid. On the whole, efficient teamwork was observed: the mean productivity level was 96%, while the percentage of time dedicated to the resolution of technical issues was 2%. During the videoconferences, the clinical coordinator and the client addressed the group most often. One of the most commonly mentioned advantages was the good visual contact provided by videoconferencing. The most often quoted disadvantage was the poor sound quality. The findings from the study support the adoption of videoconferencing and suggest a few guidelines for the development of ICPs.
Only one telehealth readiness assessment tool, that of Jennett et al., covers all types of telehealth projects, regardless of health-care provision context. However, this instrument is only available in English and has not undergone psychometric evaluation. We developed a French-Canadian version of the Practitioner Telehealth Readiness Assessment Tool and the Organizational Telehealth Readiness Assessment Tool. Transcultural validity was assessed by nine practitioners and 12 clinical project co-ordinators or administrators. For practitioners and managers, there was no significant difference between the scores of the English and the French versions of the questionnaires. The results showed that the telehealth readiness of co-ordinators or administrators was greater than that of practitioners when the range in scores was taken into account. The French-Canadian versions of the two questionnaires make it possible to assess telehealth readiness among French speakers. However, other studies involving patients will be necessary to validate the Patient-Public Telehealth Readiness Assessment Tool.
In 1998, 11.8% of the Quebec population over 15 years showed mobility problems and 2.3% of that group revealed that their needs were not met. The same year, the Régie de l'assurance-maladie du Québec distributed more than 4,500 wheelchairs and repaired some 30,000 others, at a cost of over $20 million. The recycling of wheelchairs is seen as a solution for improving this situation. This paper presents an evaluation of a wheelchair recycling program.
Three groups of participants involved in the recycling of wheelchairs contributed to the gathering of information. These were: personnel (n = 9), occupational therapists in the community (n = 5) and users of refurbished wheelchairs (n = 20).
A participative and qualitative research approach was conducted with the 1st group. The results outline the inefficacy of the process on the structural level (e.g. not enough resources to collect unused wheelchairs), operational level (e.g. absence of norms to recycle), strategic level (e.g. absence of policy to encourage people to give back their unused wheelchair) and systemic level (e.g. the state is not imputable). A quantitative approach with the 2nd and 3rd groups revealed high satisfaction with regard to the efficacy, appearance, safety, durability and comfort as well as the delivery and follow-up services rendered.
The evaluation procedure herein proposed can be customized to fit other contexts and provides policy-makers with quick access to field data to help them choose the appropriate course of action.
The aim of this study was to examine the application of new Environmental Control Systems (ECSs) in the homes of users and caregivers. The research questions were: (1) Can new ECS applications improve the activities of daily living (ADL) of people with significant functional limitations who require personal assistance? (2) Can new ECS applications replace home services and lessen caregiver burden? To answer these questions, user satisfaction regarding ECS applications, impact on ADL, technical performance, and caregiver burden were examined. This collaborative investigation involving a local community health care center, a telephone monitoring service, an industrial partner, and a university research team used a case study approach. Five users with moderate cognitive problems or significant functional limitations who required personal assistance were chosen, along with their caregivers, for a 3-month in-home trial to test new ECS alternatives. The ECS in the study featured remote control functions (e.g., door lock release, outside intercom), specific verbal reminders (e.g., reminders to turn off stove elements), and automatic functions (e.g., night-lights in the bathroom and hallway). Information was collected in the users' homes with three standardized questionnaires and a company-designed questionnaire. The overall technical performance of the ECS was found to be in most cases moderately efficient. Participant satisfaction revealed that ECS alternatives needed improvement with respect to the service aspects such as follow-up services and repair/servicing. Caregiver burden was lessened for psychological aspects but not for physical tasks. Users seemed to have a positive perception of the impact of the ECS on many of their ADL. We learned six lessons from this 15-month case study, namely: (1) the use of remote control by people with moderate cognitive impairments was difficult; (2) verbal reminders were greatly appreciated; (3) the automatic ECS applications needed more adjustment; (4) reactions varied depending on the participant's perspective; (5) other assessment tools might have been better suited to mild cognitive problems; and (6) removal of a beneficial product at the conclusion of the evaluation phase raised ethical considerations.
Services to meet adequate rehabilitation needs of elderly stroke survivors are not always provided. Indeed, since 1995, in the wake of the Quebec shift to ambulatory care, home care services, mainly those related to rehabilitation of the elderly, are either unavailable or incomplete. The aim of this study was to examine the rehabilitation needs of this clientele from their hospitalization to their reintegration into the community.
The "Handicap Production Process" conceptual approach was chosen to help identify the rehabilitation needs of persons affected by physical or cognitive disabilities due to the interactions between personal and environmental factors, and (activities of daily living, social roles). This qualitative exploratory study was performed in 2003. Data were collected among four groups of experts: patients, caregivers, health care providers and administrators. Data triangulation was used to ensure a rigorous analysis and validity of the results.
Unfulfilled needs could be found in the categories of pertaining to residence, community living, psychological and emotional needs. Indeed, it appears that a psychological follow-up to discuss acceptance and consequences of non-acceptance would facilitate mid-to long-term rehabilitation.
Improving accessibility to healthcare services, respecting priority parking spaces for the disabled as well as promoting public awareness would enable a better social reintegration and recovery of social roles, thus limiting the onset of handicap situations.
We conducted a survey to document the rehabilitation services available to clients aged 65 years and older who had suffered a stroke. In all, respondents - gleaned from 295 resources located in three health regions in the province of Québec - completed a postal questionnaire describing the services that they offer, in terms of type of intervention (related to nine capabilities and seven areas of social participation) and type of services (evaluation, rehabilitation, and support). The results show that most rehabilitation services offered to older people with stroke address motor skills and mobility. Somewhat unexpectedly, for four capability-related interventions and two social-participation-related interventions, there appear to be more active rehabilitation services offered in regions with rural areas than in metropolitan regions.
Telesurveillance is a technologically based modality that allows the surveillance of patients in the natural setting, mainly home. It is based on communication technologies to relay information between a patient and a central call center where services are coordinated. Different types of telesurveillance systems have been implemented, some being staffed with non-health professionals and others with health professional, mainly nurses. Up to now, only telesurveillance services staffed with non-health professionals have been shown to be effective and efficient. The objective of this study was to document outcomes and cost evolution of a nurse-staffed telesurveillance system for frail elderly living at home.
A quasi experimental design over a nine-month period was done. Patients (n = 38) and caregivers (n = 38) were selected by health professionals from two local community health centers. To be eligible, elders had to be over 65, live at home with a permanent physical, slight cognitive or motor disability or both and have a close relative (the caregiver) willing to participate to the study. These disabilities had to hinder the accomplishment of daily life activities deemed essential to continue living at home safely. Three data sources were used: patient files, telesurveillance center's quarterly reports and personal questionnaires (Modified Mini-Mental State, Functional Autonomy Measurement System, Life Event Checklist, SF-12, Life-H, Quebec User Evaluation of Satisfaction with Assistive Technology, Caregiver Burden). The telesurveillance technology permitted, among various functionalities, bi-directional communication (speaker-receiver) between the patient and the response center.
A total of 957 calls for 38 registered clients over a 6-month period was recorded. Only 48 (5.0%) of the calls were health-related. No change was reported in the elders' quality of life and daily activity abilities. Satisfaction was very high. Caregivers' psychological burden decreased substantially. On a 3 months period, length of hospital stays dropped from 13 to 4 days, and home care services decreased from 18 to 10 visits/client. Total cost of health and social public services used per client dropped by 17% after the first 3 months and by 39% in the second 3 months.
The ratio of 0.50 calls per client to the call center for health events is three times higher than that reported in the literature. This difference is probably attributable to the fact that nurses rather than non-health professional personnel were available to answer the clients' questions about their health and medications. Cost evolution showed that registering older adults at a telesurveillance center staffed by nurses, upon a health professional recommendation, costs the health care system less and does not have any negative effects on the well-being of the individuals and their families. Telesurveillance for the elderly is effective and efficient.
Cites: Fam Community Health. 2002 Oct;25(3):31-4012802140
Cites: Manag Care Q. 2000 Winter;8(1):38-4311009732
Cites: Care Manag J. 2001-2002 Winter;3(2):91-812455220
Cites: J Telemed Telecare. 2003;9(1):23-912641889
Cites: Arch Fam Med. 2000 Jan;9(1):40-510664641
Cites: Dimens Health Serv. 1984 Nov;61(11):30-16510587
Cites: Health Serv Res. 1981 Spring;16(1):65-806453110
Cites: Age Ageing. 1988 Sep;17(5):293-3022976575
Cites: Int J Geriatr Psychiatry. 1997 Oct;12(10):1008-189395933
Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, 525, Wilfrid-Hamel Blvd East, Québec (Québec), G1M 2S8, Canada. email@example.com
Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases utilization of health services, number of hospitalizations and early institutionalization, leading to a significant psychological and financial burden on the patients, their families and the health care system. The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke and who live in the community. The emphasis was put on needs that act as obstacles to social participation in terms of personal factors, environmental factors and life habits, from the point of view of four target populations.
Using the focus group technique, we met four types of experts living in three geographic areas of the province of Québec (Canada): older people with stroke, caregivers, health professionals and health care managers, for a total of 12 groups and 72 participants. The audio recordings of the meetings were transcribed and NVivo software was used to manage the data. The process of reducing, categorizing and analyzing the data was conducted using themes from the Disability Creation Process model.
Rehabilitation needs persist for nine capabilities (e.g. related to behaviour or motor activities), nine factors related to the environment (e.g. type of teaching, adaptation and rehabilitation) and 11 life habits (e.g. nutrition, interpersonal relationships). The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation. Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources.
Better knowledge of partially met or unmet rehabilitation needs expressed by the different types of people involved should lead to increased attention being paid to education for caregivers, orientation of caregivers towards resources in the community, and follow-up of patients' needs in terms of adjustment and rehabilitation, whether for improving their skills or for carrying out their activities of daily living.
Cites: Health Qual Life Outcomes. 2004;2:5315383147
Cites: BMJ. 1992 Apr 25;304(6834):1085-91586821
Cites: Arch Phys Med Rehabil. 1982 Jun;63(6):276-77082155