Disability and rehabilitation
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Purpose: To describe control of risk factors after stroke from the perspectives of the stroke survivor, the family, and healthcare professionals. Materials and methods: A mixed methods design was used, undertaken in two phases: i) qualitative study using focus group methodology to explore secondary stroke prevention and ii) survey of stroke survivors about use of technology and self-management of blood pressure (BP). Results: From the eight focus groups (n = 33), three themes were identified: i) stroke is a wake-up call to do the right things; ii) challenges to doing the right things; and iii) role of technology in helping you to do the right things. ⋯ BP continues to be poorly controlled after stroke and there is opportunity for improvement. Stroke survivors and their families are receptive to using health information technology to support their risk factor control. Rehabilitation clinicians have an opportunity to incorporate different aspects of health information technology into their practice to support self-management of risk factors.
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Purpose: What are the characteristics of people with lower limb amputation at admission to, and discharge from, subacute rehabilitation? Have these characteristics changed over time?Methods: A total of 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission characteristics, including aetiology, gender, age, amputation level, cognition (Mini-Mental State Examination (MMSE)), indoor mobility aid, motor function (Functional Independence Measure motor subscale) and number and type of comorbidities, and discharge characteristics, including prosthetic prescription, motor function, discharge mobility aid, and destination were compared by admission date and year. Results: Proportion of people with lower limb amputation with nonvascular aetiology increased over time (2004, 15% to 2011, 24%) (ß = -181.836, p < 0.001). ⋯ Implications for rehabilitationRehabilitation should account for the changing characteristics of people with lower limb amputation. Motor function should be addressed as part of rehabilitation to optimise the patient's ability to return home and to the community. Prescription rates for lower limb prostheses reduced across time, indicating more specific selection processes and refined clinical decision making; this decision is best informed by a multi-disciplinary approach.
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Background: Discharge decisions have significant implications for older adults and their involved family members. Evidence of older adult and family members' engagement in discharge decision-making, however, varies widely. Some recent work shows assumed associations between ageing, diminished participation in healthcare decision-making and increased reliance on family members. ⋯ To reconcile these tensions, the older adults' family members in these cases employed strategies to promote older adults' participation in decision-making that were consistent with relational autonomy theory. Conclusion and implications for practice: The analysis suggests that older adults' participation in discharge decision-making processes could be better promoted through relational approaches. Implications for rehabilitation • Adopting an approach guided by relational autonomy might better enable patients to participate in decision-making than would an approach guided by traditional conceptions of autonomy. • Rehabilitation professionals could seek assistance from family members and guide them toward collaborative partnerships. • A range of strategies may be employed to customize relational approaches to enhance autonomy: • having several different conversations with patients to enable multiple chances to contribute knowledge and views; • involving family members or taking the time to explain information several different times and in diverse manners; • showing patients videos or photos of discharge locations; • exploring a breadth of potential discharge options; • accompanying patients to visit different options in person; and • getting patients in touch with individuals who have made similar choices. • It is recognized that taking a relational approach might be time-consuming and that practice contexts may not be conducive to such practice.
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Aim: This study provides a descriptive epidemiological analysis stratified by age of deaths reported to Australian Coroners of residential aged care facility residents aged under 65 years. Method: A national population-based retrospective analysis was conducted of deaths of Australian residential aged care facility residents reported to Australian Coroners between 2000 and 2013. Descriptive statistics compared adult residents categorised using age by factors relating to the individual, incident and death investigation. ⋯ Better management of progressive neurological conditions with multidisciplinary team and re-ablement programs would reduce risk of choking and falls. Improving outcomes for young people in residential aged care requires a co-ordinated, multisector approach comprising relevant government departments, aged care providers, researchers and clinicians. Effective planning requires more information about the cause and nature of deaths, and due to the small event counts, this would ideally involve an international collaboration.
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Purpose: Workers who are injured or become ill on the job are best able to return-to-work when stakeholders involved in their case collaborate and communicate. This study examined health care providers' and case managers' engagement in rehabilitation and return-to-work following workplace injury or illness. Method: In-depth interviews were conducted with 97 health care providers and 34 case managers in four Canadian provinces about their experiences facilitating rehabilitation and return-to-work, and interacting with system stakeholders. ⋯ Injured workers may become conduits of incorrect information, resulting in adversarial relationships, overturned health care providers' recommendations, and their disengagement from rehabilitation and return-to-work. Stakeholders should clarify the role of health care providers during rehabilitation and return-to-work and the appropriateness of early return-to-work to mitigate recurring challenges. Communication procedures between health care specialists may disrupt these challenges, increasing the likelihood of timely and effective rehabilitation and return-to-work.