How to use the International Classification of Functioning, Disability and Health as a reference system for comparative evaluation and standardized reporting of rehabilitation interventions

Rehabilitation aims to optimize functioning of persons experiencing functioning limitations. As such the comparative evaluation of rehabilitation interventions relies on the analysis of the differences between the change in patient functioning after a specific rehabilitation intervention versus the change following another intervention. A robust health information reference system that can facilitate the comparative evaluation of changes in functioning in rehabilitation studies and the standardized reporting of rehabilitation interventions is the International Classification of Functioning, Disability and Health (ICF). The objective of this paper is to present recommendations that Cochrane Rehabilitation could adopt for using the ICF in rehabilitation studies by: 1) defining the functioning categories to be included in a rehabilitation study; 2) specifying selected functioning categories and selecting suitable data collection instruments; 3) examining aspects of functioning that have been documented in a study; 4) reporting functioning data collected with various data collection instruments; and 5) communicating results in an accessible, meaningful and easily understandable way. The authors provide examples of concrete studies that underscore these recommendations, whereby also em-phasizing the need for future research on the implementation of specific recommendations, e.g. in meta-analysis in systematic literature reviews. Furthermore, the paper outlines how the ICF can complement or be integrated in established Cochrane and rehabilitation research structures and methods, e.g. use of standard mean difference to compare cross-study data collected using different measures, in developing core outcome sets for rehabilitation, and the use of the PICO model. © 2019 EDIZIONI MINERVA MEDICA

Functional assessment for acute stroke trials: properties, analysis, and application

A measure of treatment effect is needed to assess the utility of any novel intervention in acute stroke. For a potentially disabling condition such as stroke, outcomes of interest should include some measure of functional recovery. There are many functional outcome assessments that can be used after stroke. In this narrative review, we discuss exemplars of assessments that describe impairment, activity, participation, and quality of life. We will consider the psychometric properties of assessment scales in the context of stroke trials, focusing on validity, reliability, responsiveness, and feasibility. We will consider approaches to the analysis of functional outcome measures, including novel statistical approaches. Finally, we will discuss how advances in audiovisual and information technology could further improve outcome assessment in trials

Coronary artery bypass surgery in the elderly : is it worthwhile?

Objectives: To evaluate the early outcomes after coronary surgery in the elderly. Methods: A retrospective analysis (April 1995- January 2012) of mortality, morbidity and hospital stay, derived from a single surgeon’s practice. Outcomes of patients over 70 (group A, n=785) were compared with those of controls under 70 (group B, n=2772). Results: Intervention rate was significantly higher (1502/106 vs 467/106, p<0.0001). There were significantly fewer single and quintuple grafts, and significantly more double grafts in group A. The use of an internal thoracic artery (ITA) was lower in group A (748/785, 95.3% vs 2695/2772, 97.2%, p=0.006). Mortality for the entire coronary surgical practice was 1.2%. The overall mortality was 2.7% in group A and 0.8% in group B (p<0.0001). Freedom from any post- operative complication occurred in 57.7% in group A and in 75.6% in group B (p<0.0001). Cardiac complications (except for perioperative MI and atrial flutter) were significantly higher in group A, as were major neurological, renal and respiratory complications, as well as minor wound complications. All complications resulted in patient morbidity but cerebrovascular accident had the worst impact, contributing to perioperative death in 8 of the 18 cases ingroupAandin4ofthe24casesingroupB (p=0.049). Average length of stay on intensive care was similar (1.19±1.84 days for group A and 1.13±1.48 days for group B, p=0.38). The average HDU stay was longer in group A (1.43±2.70 vs 0.95±3.68 days, p=0.006) as was the average ward stay (4.00±3.33 vs 3.25±2.23 days, p<0.0001). Conclusions: Although mortality and morbidity remain significantly higher, taken in the context of the overall clinical problem, cardiac surgery has much to offer in this select group of patients.peer-reviewe

Why audit?

Decision making in surgery is based on contemporary hard data describing outcomes in a particular patient population. As a professional body, with powers of self regulation and peer review, we need to be cognisant of the expected norm of practice. This can only be derived from information that is shared amongst our colleagues both locally and abroad. We have the responsibility to contribute to this database by way of audit in a rigourous and honest fashion and to utilise it routinely in the management of our patients.peer-reviewe

Predictors of Gains During Inpatient Rehabilitation in Patients with Stroke- A Review.

Stroke remains a major cause of disability. The cost of stroke rehabilitation is substantial. Understanding the factors that predict response to inpatient stroke rehabilitation may be useful, for example, to best individualize the content of therapy, or to maximize the efficiency with which resources are directed. This review reviewed the literature and found that numerous variables were associated with outcome after inpatient stroke rehabilitation. The strongest evidence exists for factors such as age, stroke subtype, nutritional status, psychosocial factors such as living with family prior to stroke or presence of a caregiver. Functional status on admission, urinary incontinence, post-stroke infection, and aphasia each can also impact prognosis. Strengths and weaknesses of cited studies are considered in an attempt to inform design of future studies examining the factors that predict response to inpatient rehabilitation after stroke

EURASIA: developing a framework to create a joint disaster management curricular to enhance European and Asian higher education capacities

Poor response capacities related to public and commercial infrastructure and facilities management have been identified as a major inhibit for successful post tsunami recovery attempts in Sri Lanka. Lack of proper knowledge related to disaster management has been identified as a main attribute of the above poor response capacities. Being more specific, none of the Sri Lankan higher education institutions possess a curricular with the ability to produce disaster management expertise within the country. Addressing this issue, European and Asian Infrastructure Advantage (EURASIA) research project has been initiated which aims at developing a mechanism to develop a joint curriculum for Built Environment education through an international collaboration between five European and Asian Built Environment educational institutions. It is anticipated that this international collaboration will enhance the capacities of both the European and Asian partner institutions in their teaching, training and research activities in the Built Environment related disciplines

Training and Employment of People with Disabilities: India 2002

[Excerpt] Training and Employment of People with Disabilities: India 2002 is descriptive in nature. When the ILO commissioned the researchers for the Country Study Series, each was asked to follow the comprehensive research protocol appended to this document. The resulting report therefore includes country background information, statistics about people with disabilities and their organizations, a description of relevant legislation and policies and their official implementing structures, as well as the education, training and employment options available to people with disabilities. While few countries have such information readily available, researchers were asked to note the existence or lack of specific data points and to report data when it did exist. Since the lack of information about people with disabilities contributes to their invisibility and social exclusion, the information itself is important. The protocol called for limited analysis and did not specifically ask for the researchers recommendations, however, researchers were asked to report on existing plans and recommendations of significant national stakeholders