End-of-life decisions and involvement of Physical and Rehabilitation Medicine Physicians in Europe

Objective: As Physical and Rehabilitation Medicine physicians are experts in functional prognoses of disabling health conditions, the aim of this study was to gain insight into their involvement in end-of-life decisions in patients with neurological or terminal diseases in European countries. Design: Exploratory cross-sectional survey. Subjects: Delegates of the Union of European Medical Specialists, Physical and Rehabilitation Medicine Section. Methods: In July 2020, a self-constructed survey was sent to 82 delegates from 38 European countries, who were asked to answer from the point of view of their country. Topics included the legal status of end-of-life decisions and the involvement of Physical and Rehabilitation Medicine physicians in these decisions. Results: Between July 2020 and December 2020, 32 delegates from 28 countries completed the survey (response rate country level of 74%). If legal frameworks allow for these specific end-of-life decisions, involvement of Physical and Rehabilitation Medicine physicians was reported in 2 of 3 countries in euthanasia cases, 10 of 17 countries in non-treatment decision cases, and 13 of 16 countries in cases of intensified symptom management by the administration of drugs using potentially life-shortening doses. Conclusion: Estimated involvement of Physical and Rehabilitation Medicine physicians in end-of-life decisions varied between European countries, even when legal frameworks allow for these decisions.</p

End-of-life decisions and involvement of Physical and Rehabilitation Medicine Physicians in Europe

Objective: As Physical and Rehabilitation Medicine physicians are experts in functional prognoses of disabling health conditions, the aim of this study was to gain insight into their involvement in end-of-life decisions in patients with neurological or terminal diseases in European countries. Design: Exploratory cross-sectional survey. Subjects: Delegates of the Union of European Medical Specialists, Physical and Rehabilitation Medicine Section. Methods: In July 2020, a self-constructed survey was sent to 82 delegates from 38 European countries, who were asked to answer from the point of view of their country. Topics included the legal status of end-of-life decisions and the involvement of Physical and Rehabilitation Medicine physicians in these decisions. Results: Between July 2020 and December 2020, 32 delegates from 28 countries completed the survey (response rate country level of 74%). If legal frameworks allow for these specific end-of-life decisions, involvement of Physical and Rehabilitation Medicine physicians was reported in 2 of 3 countries in euthanasia cases, 10 of 17 countries in non-treatment decision cases, and 13 of 16 countries in cases of intensified symptom management by the administration of drugs using potentially life-shortening doses. Conclusion: Estimated involvement of Physical and Rehabilitation Medicine physicians in end-of-life decisions varied between European countries, even when legal frameworks allow for these decisions.</p

Integrating rehabilitation services into primary health care:policy options for Iran

BACKGROUND: Providing rehabilitation services in primary health care (PHC) is associated with numerous health, social, and economic benefits. Therefore, low and middle-income countries, such as Iran, should benefit from the advantages of integrating rehabilitation services into PHC. We conducted a qualitative study to determine policy solutions that could facilitate the integration of rehabilitation services into Iran’s PHC network. METHODS: Semi-structured interviews were conducted with 38 participants, including health policymakers, rehabilitation managers, faculty members, and rehabilitation practitioners. Purposive and snowball sampling strategies were adopted to recruit participants. The WHO Health System building blocks framework analysis was applied to analyze the collected data. RESULTS: Participants’ perspectives and experiences outlined potential policy options including: (1) stewardship: increasing political support, strengthening the leadership of the rehabilitation sector, and promoting inter-sectoral collaborations; (2) service delivery: increasing the knowledge of healthcare professionals, using local volunteers, deploying mobile rehabilitation teams, using telerehabilitation, and improving referral pathways; (3) financing: increasing government funding, preparing a package of rehabilitation services, and using appropriate payment mechanisms; (4) human resources: expanding rehabilitation workforce, training rehabilitation assistants, and enhancing employment and social opportunities; (5) information systems: establishing a comprehensive information system and an effective surveillance system; and (6) technologies: facilitating access to a range of rehabilitation equipment and raw materials, especially for prosthetics and orthotics services. CONCLUSION: Based on the WHO six building blocks framework, this study identified several policy options for integrating rehabilitation services into the Iranian PHC Network. Some of the policy options include increasing political support, promoting inter-sectoral collaborations, increasing the skills and knowledge of healthcare workers, establishing effective referral pathways, strengthening team-working, and increasing government funding

Reliability of a Road Test After Stroke

Background: Despite physical, perceptual and cognitive impairments, amongst others, which might affect driving after stroke, some patients have demonstrated the ability to resume safe driving. Such patients are identified following strictly administered predriving evaluations. The road test is generally acclaimed to be the most valid test of driving performance. Aim: The purpose of this study was to determine the reliability of the road test when performed by stroke patients in Belgium. Method: This was a prospective study of a predriving evaluation at the Belgian Road Safety Institute. Thirty subjects with sequelae of stroke were included. Subjects were accompanied and evaluated during the road test by one of two assessors (A or B) from the road safety institute in an automatic car fitted with a video camera for recording driving performance. Inter-rater reliability was evaluated by comparing results from (1) real-life performance and video recording and (2) between-video judgements. Results: Most sub-items of the road test showed >80% scoring agreement between the various evaluations. Intraclass correlation coefficient (ICC) of the items varied from -0.08 to 1.0. ICC of the overall performance was 0.62 when real-life scores were compared with video evaluations and 0.80 in video versus video comparison. Conclusion: Driving is important for optimal participation in daily and social activities. The reliability of assessing overall performance of the on-road test is moderately high and better when assessed using same evidence. Yet, the reliability of some items needs further attention

Reliability of a Road Test After Stroke

Background: Despite physical, perceptual and cognitive impairments, amongst others, which might affect driving after stroke, some patients have demonstrated the ability to resume safe driving. Such patients are identified following strictly administered predriving evaluations. The road test is generally acclaimed to be the most valid test of driving performance. Aim: The purpose of this study was to determine the reliability of the road test when performed by stroke patients in Belgium. Method: This was a prospective study of a predriving evaluation at the Belgian Road Safety Institute. Thirty subjects with sequelae of stroke were included. Subjects were accompanied and evaluated during the road test by one of two assessors (A or B) from the road safety institute in an automatic car fitted with a video camera for recording driving performance. Inter-rater reliability was evaluated by comparing results from (1) real-life performance and video recording and (2) between-video judgements. Results: Most sub-items of the road test showed \u3e80% scoring agreement between the various evaluations. Intraclass correlation coefficient (ICC) of the items varied from -0.08 to 1.0. ICC of the overall performance was 0.62 when real-life scores were compared with video evaluations and 0.80 in video versus video comparison. Conclusion: Driving is important for optimal participation in daily and social activities. The reliability of assessing overall performance of the on-road test is moderately high and better when assessed using same evidence. Yet, the reliability of some items needs further attention

Effect of Simulator Training on Driving After Stroke: A Randomized Controlled Trial

Neurologically impaired persons seem to benefit from drivingtraining programs, but there is no convincing evidence to support this notion. Wetherefore investigated the effect of simulator-based training on driving afterstroke. Eighty-three first ever sub-acute stroke patients entered a 5-week, 15-hourtraining program in which they were randomly allocated to either an experimental(simulator-based training) or control (driving-related cognitive tasks) group.Performance in off-road evaluations and an on-road test were used to assess thedriving ability of subjects pre- and post-training. Outcome of an official predrivingassessment administered 6 to 9 months post stroke were also considered.Both groups significantly improved in a visual and many neuropsychologicalevaluations and in the on-road test after training. There were no significantdifferences between both groups in improvements from pre- to post-trainingexcept in the “road sign recognition test,” in which the experimental subjectsimproved more. Statistically significant improvements in the three-class decision(“fit to drive,” “temporarily unfit to drive” and “unfit to drive”) were found infavor of the experimental group. Academic qualification and overall disabilitytogether determined subjects who benefited most from the simulator-baseddriving training. Significantly more experimental subjects (73%) than controls(42%) passed the follow-up official pre-driving assessment and were legallyallowed to resume driving. We concluded that simulator-based driving trainingwas a better method, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a resultof the large number of dropouts and the possibility of some neurological recoveryunrelated to training

Evidence-based position paper of the UEMS PR M on the role of Physical and Rehabilitation Medicine (PR M) physician in the management of children and adults with spinal dysraphism

Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (PR M) physician and PR M practice for children and adults with spinal dysraphism. A systematic literature review and a consensus procedure involved all European countries delegates represented in the UEMS PR M section through a Delphi process. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.Peer reviewe

ISPRM discussion paper: Proposing a conceptual description of health-related rehabilitation services.

There is a need for a comprehensive classification system of health-related rehabilitation services. For conceptual clarity our aim is to provide a health-related conceptual description of the term rehabilitation service . First, we introduce a common understanding of the term rehabilitation , based on the current definition in the World Health Organization\u27s World Report on Disability, and a conceptual description of rehabilitation agreed upon by international Physical and Rehabilitation Medicine organizations. From a health perspective, rehabilitation can be regarded as a general health strategy with the aim of enabling persons with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning. Secondly, we distinguish different meanings of the term service , that have originated in management literature. It is important to distinguish between micro, meso and macro level uses of the term service . On a meso level, which is central for the classification of rehabilitation services, 2 aspects of a service, i.e. an offer of an intangible product and an organizational setting in which the offer is upheld, are both essential. The results of this conceptual analysis are used to develop a conceptual description of health-related rehabilitation, which is set out at the end of this paper. This conceptual description may provide the basis of a classification of health-related rehabilitation services, and is open for comments and discussion

Early csf biomarkers and late functional outcomes in spinal cord injury. A pilot study

open9noThis research was funded by the Italian Ministry of Health—call “Ricerca Finalizzata 2010” (project code RF-2010-2315118).Although, biomarkers are regarded as an important tool for monitoring injury severity and treatment efficacy, and for predicting clinical evolution in many neurological diseases and disorders including spinal cord injury, there is still a lack of reliable biomarkers for the assessment of clinical course and patient outcome. In this study, a biological dataset of 60 cytokines/chemokines, growth factorsm and intracellular and extracellular matrix proteins, analyzed in CSF within 24 h of injury, was used for correlation analysis with the clinical dataset of the same patients. A heat map was generated of positive and negative correlations between biomarkers and clinical rating scale scores at discharge, and between biomarkers and changes in clinical scores during the observation period. Using very stringent statistical criteria, we found 10 molecules which correlated with clinical scores at discharge, and five molecules, which correlated with changes in clinical scores. The proposed methodology may be useful for generating hypotheses regarding “predictive” and “treatment effectiveness” biomarkers, thereby suggesting potential candidates for disease‐modifying therapies using a “bed‐to‐bench” approach.openCapirossi R.; Piunti B.; Fernandez M.; Maietti E.; Rucci P.; Negrini S.; Giovannini T.; Kiekens C.; Calza' L.Capirossi R.; Piunti B.; Fernandez M.; Maietti E.; Rucci P.; Negrini S.; Giovannini T.; Kiekens C.; Calza' L

Training of Driving-Related Attentional Performance After Stroke Using a Driving Simulator

The objective of this study was to determine the effect of simulatorbased driving training on attentional performance after stroke. A further analysis of data was conducted from a randomized controlled trial in which the effect of simulator training and cognitive paper and pencil training to improve driving were compared. Performance in divided attention tasks before, during and after 15 hours of simulator-based training of general driving skills in 33 experimental participants were evaluated. Performance in divided attention tasks was assessed during navigation of a 5-km scenario with the divided attention tasks as the only event to respond to and another 13.5-km scenario that contained a good mixture of regular day to day traffic situations. There were significant improvements in mean response time to the divided attention tasks and time to complete the 5-km scenario. Significant decrease in mean response time, number of missed responses, collisions, pedestrians hit, total faults and run time and increase in number of correct responses were found in the 13.5-km scenario. Further analyses showed most improvements in the simulator assessments occurred between preand mid-training. Simulator-based training of driving skills positively impacted attentional performance. Findings in this study suggest that 10 hours of simulatorbased driving training after stroke is sufficient to realize meaningful benefits