Purpose: Literature regarding the WHO’s International Classification of Function, Disability and Health (ICF) has called for research into psychosocial adjustment processes. This project aims to establish the relevance of the Integrative Model of Adjustment to Chronic Conditions (IMACC) as a framework for research and a clinical tool in rehabilitation by linking it with the ICF. Methods: The study employed secondary analysis of data from the original IMACC grounded theory study, where 8 women and 2 men with type 2 diabetes mellitus participated. IMACC consists of 3 interconnected parts comprising a total of 13 components. Datasets used for the study consisted of the qualitative data underpinning each IMACC component. Meaningful concepts from each dataset were linked to ICF categories using the updated ICF linking rules. Results: Results showed that all 13 IMACC components accommodate ICF category codes from all health and health related ICF components in patterns consistent with the theoretical conceptualisation of each separate IMACC component. Conclusion: IMACC maps comprehensively to the ICF framework and provides a framework that may be useful for future ICF related research into biopsychosocial processes in psychosocial adjustment. IMACC provides a clinically applicable intervention for people with psychosocial adjustment difficulties consistent with the ICF framework.
The workforce of the medical specialty of Rehabilitation Medicine (RM) in the UK is 10 times less than the European average for the specialty of Physical and Rehabilitation Medicine (PRM). This can be explained partly by the difference in the scope of practice within the specialty between the UK and other European countries and USA. This opinion paper aims to compare the rehabilitation needs in chronic medical conditions and compare the scope of practice between countries within Europe and other regions of the world. The potential advantages of a broader remit specialty to improve rehabilitation care for patients by involving rehabilitation physicians in various medical conditions is explored. Recommendations have been put forward in the Rehabilitation Medicine Expansion Proposal (RMEP), which is likely to make the medical specialty of RM/ PRM more satisfying for the doctors working in the specialty and a more attractive career choice for those entering training in the specialty. There is a need for an international universal framework for the scope of the specialty to have a greater impact on improving the lives of those with chronic medical conditions.
BACKGROUND: Spinal Cord Injury (SCI) or Acquired Brain Injury (ABI) leads to disability, unemployment, loss of income, decreased quality of life and increased mortality. The impact is worse in Low-and Middle-Income Countries (LMICs) due to a lack of efficient long-term rehabilitative care. This study aims to explore the feasibility and acceptability of a telerehabilitation programme in Nepal. METHODS: Prospective cohort feasibility study in a community setting following discharge from a specialist rehabilitation centre in Nepal. Patients with SCI or ABI who had previously accessed specialist rehabilitation were connected to a specialist Multidisciplinary Team (MDT) in the centre through a video conference system for comprehensive remote assessments and virtual individualised interventions. Data were captured on recruitment, non-participation rates, retention, acceptability (via end-of-study in-depth interviews with a subset of participants) and outcome measures including the Modified Barthel Index (MBI), Depression Anxiety Stress Scale (DASS) and EuroQol-5D (EQ-5D), completed pre- and post-programme. RESULTS: 97 participants with SCI (n = 82) or ABI (n = 15) discharged from the centre during an 18-month period were approached and enrolled on the study. The telerehabilitation programme facilitated the delivery of support around multiple aspects of rehabilitation care, such as spasticity treatments and pain management. Outcome measures indicated a significant improvement in functional independence ( P < .001), depression, anxiety and stress ( P < .001) and quality of life ( P < .001). Qualitative interviews (n = 18) revealed participants found the programme acceptable, valuing regular contact and input from MDT professionals and avoiding expensive and lengthy travel. CONCLUSION: This is the first study in Nepal to identify telerehabilitation as a feasible and acceptable approach to augment the provision of specialist rehabilitation. Future research is needed to assess the suitability of the programme for other conditions requiring specialist rehabilitation and determine the mechanisms underpinning improved outcomes for people with SCI or ABI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04914650
Background:Telehealth has been declared an accepted method of occupational therapy (OT) service delivery and has been shown to be effective. However, studies done before the outbreak of coronavirus disease (COVID-19) show that most occupational therapists didn't use it.Aim:The aim of this exploratory study was to examine the perceptions of occupational therapists regarding remote delivery of service following the COVID-19 outbreak.Material and methods:An online survey, including 11-item five-point Likert scale, and 2 open-ended questions were distributed to occupational therapists.Results:Responses were received from 245 Israeli occupational therapists. The majority of the participants (60%) strongly agreed that remote delivery allows an ecological and effective intervention, while 76% strongly agreed that an ideal treatment is one that would combine telehealth with in-person intervention. Qualitative findings indicated that the most significant advantage was providing care in the natural environment and improving accessibility to the service. The most salient barriers were limitations of the therapeutic relationship and threats on clinical reasoning.Conclusion:The study results highlight the complexity of telehealth. Findings indicate that overall occupational therapists perceive remote care as an effective and legitimate service delivery method that cannot be used as an alternative to in-person treatment. These findings can help in developing intervention programs for remote treatment, and their implementation.
