Disability and rehabilitation
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To explore how gender appears in the stories of self-told by men and women undergoing rehabilitation for chronic muscle pain. ⋯ Understanding the significance of gender in the construction of selves in stories of chronic pain may help to improve the health care offered to patients suffering from chronic pain. Implications for Rehabilitation Patients tell stories that powerfully communicate their particular illness experiences. Cultural expectations of femininity and masculinity play a significant role with regard to how the patients construct their stories, which may be important to health professionals' perceptions of the patients' problem. Health care professionals should listen carefully to the patient's own story and be sensitive to the significance of gender when trying to understand these people's health problem.
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Community-based rehabilitation (CBR) must prove that it is making a significant difference for people with disabilities in low- and middle-income countries. Yet, evaluation is not a common practice and the evidence for its effectiveness is fragmented and largely insufficient. The objective of this article was to review the literature on best practices in program evaluation in CBR in relation to the evaluative process, the frameworks, and the methods of data collection. ⋯ In order to facilitate and improve evaluations in CBR, there is an urgent need to agree on a common framework, such as the CBR matrix, and to develop best practice guidelines based on the literature available and consensus among a group of experts. These will need to demonstrate a good balance between community development and standards for effective evaluations. Implications for Rehabilitation In the quest for evidence of the effectiveness of community-based rehabilitation (CBR), a shared program evaluation framework would better enable the combination of findings from different studies. The evaluation of CBR programs should always include sharing findings and taking action for the sake of the local community. Although qualitative methodologies have dominated the scene in CBR and remain highly relevant, there is also a call for the inclusion of quantitative indicators in order to capture the progress made by people participating in CBR programs. The production of best practice guidelines for evaluation in CBR could foster accountable and empowering program evaluations that are congruent with the principles at the heart of CBR and the standards for effective evaluations.
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This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain. ⋯ The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety. Implications for Rehabilitation The prevalence of insomnia is high in patients with complex chronic pain conditions. Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects. Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia. One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.
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The aim of this study was to involve older people and physiotherapists in the development of acceptable strategies to promote uptake and adherence with an exercise-based falls prevention programme. ⋯ A focus on self-management support may provide the key to promoting uptake and adherence with an exercise-based falls prevention programme. Physiotherapists should move from being "experts" to "enablers" who use their professional knowledge and expertise to support older people at risk of falling to maintain optimum levels of health and independence. Implications for Rehabilitation Despite the established efficacy of exercise-based falls prevention programmes, their impact remains limited by low levels of uptake and adherence. Clinical encounters between physiotherapists and older people at risk of falling offer the opportunity for the exchange of new information to promote patient empowerment and shared decision-making. Physiotherapists need to move away from being experts who care for and do to their patients to enable us to use their professional knowledge and expertise to maintain optimum levels of health and independence for older people at risk of falling.
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Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study focused on the relationship between resilience and post-amputation outcomes, i.e. quality of life, pain and recurrence of CRPS-I and psychological distress. ⋯ The results confirmed our hypothesis that patients with an amputation because of CRPS-I who have a higher resilience also have a higher quality of life and experience lower psychological distress. The prognostic value of resilience in this patient group requires further research. Implications for Rehabilitation Until characteristics of patients with positive quality of life outcome have been further unraveled, amputation for CRPS-I should only be performed in expertise centers. Resilience, the process of adapting well in the face of adversity, should be further explored in Rehabilitation Medicine research in general. Measurement of resilience should be a standard procedure when patients with CRPS-I request an amputation. Improving resilience of patients in in- and outpatient rehabilitation clinics might be an additional treatment in rehabilitation care.