Disability and rehabilitation
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Throughout the world, people with a disability who live in rural and remote areas experience difficulty accessing a range of community-based services including speech-, physio- and occupational therapy. This paper draws on information gathered from carers and adults with a disability living in a rural area in New South Wales (NSW), Australia to determine the extent to which people living in rural areas may receive a person-centred therapy service. ⋯ Therapy service delivery in rural and remote areas requires: Place-based and person centred strategies to build local capacity in communities. Responsive outreach programs working with individuals and local communities. Recognition of the need to support families who must travel to access remotely located specialist services. Innovative use of technology to supplement and enhance service delivery.
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To explore how patients construe bodily injury, examine how injury representations change over the course of a rehabilitation program and how injury representations influence adaptation and recovery trajectories. ⋯ Patient representations of pain and body injury are windows into the personal experience of individuals with chronic musculoskeletal pain. When patients enter programs, practitioners need to assess what the patient believes is wrong with their body and what will be helpful in rectifying the problem. Based on their initial assessment, practitioners need to direct education and activity toward shifting patient beliefs to include elements of soft tissue and a broader scope of pain sensitization and psychological impact. Activity-based intervention is essential for creating coherence between injury and pain representations and coping action. During rehabilitation, practitioners need to monitor patient beliefs about their injury. Shifting beliefs are signs that the patient is adopting a more adaptive cognitive stance toward their injury. Lack of movement indicates that the message is not getting through and the approach needs to be modified. When working with patients to transform beliefs, a collaborative approach might be best to increase trust and reduce reactance.
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Review Meta Analysis
The experience of amputation and prosthesis use for adults: a metasynthesis.
To identify and synthesize qualitative literature on the experience of amputation and prosthesis use for adults, and to make recommendations based on these findings for rehabilitation services. ⋯ The findings provide a base from which to make suggestions regarding the provision of health rehabilitation services for this population. It is recommended that such services make greater use of psychological interventions and education, include patients' social support networks, use psychotherapy to support and develop positive coping strategies, and facilitate peer support from those who have already made positive adjustments to amputation and prosthesis use.
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Randomized Controlled Trial
A pilot randomized controlled trial of an early multidisciplinary model to prevent disability following traumatic injury.
Chronic pain, posttraumatic stress disorder (PTSD), and depression are common outcomes following traumatic injury. Yet, screening and early intervention to prevent the onset of these disorders do not occur routinely in acute trauma settings. This pilot study examined the clinical utility of screening and early multidisciplinary intervention for reducing disability following traumatic injury. ⋯ Early findings point to the value of early screening to identify patients at risk of treatable pain, physical, and psychological impairments. Moreover, early multidisciplinary intervention models following traumatic injury show promise for protecting against the onset of posttraumatic psychological disorders.
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To examine the relationship between depression and pain severity during inpatient rehabilitation for those with new onset of spinal cord injury or spinal cord disease (SCI/D), along with patient characteristics, neurological function and etiology. ⋯ In general, depressive symptoms were not associated with pain severity in this sample. Etiology was associated with pain, those with traumatic SCI reporting more pain at admission. Among demographic characteristics, age was related to pain, with younger subjects reporting higher levels. These findings suggest that certain characteristics may predispose patients to pain and depression upon admission to rehabilitation. By determining who is at risk for these symptoms, clinicians can adopt treatments that prevent these from becoming chronic conditions.