Rehabilitation for Multiple Sclerosis in Adults (I); Impairment and Impact on Functioning and Quality of Life: An Overview

Multiple sclerosis (MS) is a chronic, central nervous system, disabling disease. International Classification of Functioning and relevant generic and specific outcome measures are reported. Problems perceived by people with MS (PwMS) affect mobility, sight, continence, feeding, or cognitive impairment, depending on whether acute, chronic, or long-term disability was involved. The most common body function and structure impairments leading to disability and reported by health care professionals are fatigue, weakness, decreased fitness, sensory disorders, pain, upper motor neuron syndromes, ataxia and tremor, balance and postural control problems, gait pattern disorders, visual problems, and neurogenic lower urinary tract and bowel dysfunction; sexual, autonomic, neuropsychological, and neuropsychiatric impairment; dysarthrophonia, dysphagia, and respiratory and sleep disorders. The most frequently affected activities and relationships include mobility, domestic life, community and social activities, remunerative employment, interpersonal relationships, self-care, learning and applying knowledge, and economic life. Limitations in activities of daily life because of fatigue, pain, visual problems, incontinence, sexual and cognitive impairment, depressive disorders, sleep disorders, economic pressure, employment status, and lack of information have an impact on quality of life (QoL). Increased caregiving tasks, psychological burden, limitation in activities and participation, and reduced QoL have a profound influence on caregivers. This paper summarizes the perception of problems and needs, the disease's impact on functioning and QoL of PwMS, and the impact on their significant others and caregivers, according to health and social research.Martinez-Assucena, A.; Marnetoft, S.; Roig Rovira, T.; Hernandez-San-Miguel, J.; Bernabeu, M.; Martinell-Gispert-Sauch, M. (2010). Rehabilitation for Multiple Sclerosis in Adults (I); Impairment and Impact on Functioning and Quality of Life: An Overview. Critical Reviews in Physical and Rehabilitation Medicine. 22(1-4):103-178. doi:10.1615/CritRevPhysRehabilMed.v22.i1-4.90103178221-

Rehabilitation for Multiple Sclerosis, in Adults (II); Management and Impact on Impairment, Functioning, and Quality of Life: An Overview

Multiple sclerosis (MS) often leads to different levels of severity and progression of impairment and disability and to dissimilar levels of limitation in activities and participation in different social domains, with varying impacts on quality of life (QoL) among people with MS (PwMS). Results have shown that, for PwMS, prioritizing goal setting may enhance adherence to treatment. Interdisciplinary rehabilitation may prolong the functional status level of PwMS, may result in transient improvement in the aspects of impairment features, may increase their participation in activities, and may improve their QoL, even when disease progression is not modified. Single rehabilitation packages of comprehensive care have proven beneficial, such as physiotherapy, which enhances aerobic capacity, strength, pain, mood, mobility, and QoL. Occupational therapy can help reduce the impact of impairment on QoL, especially fatigue. Neuropsychological interventions, such as learning and memory remediation, psychological intervention for depressive disorders, and acquistion of coping skills and self-management techniques help PwMS to adjust to disease and disability. Speech therapy can improve intelligibility of communication. Learning swallowing techniques can help prevent material from entering the airway. Clean intermittent self-catheterization can help prevent urinary tract infections. Power wheelchairs enhance occupational performance and energy conservation. Further vocational rehabilitation settings and research are required for more appropriate interventions due to high unemployment rates among PwMS. Comprehensive care for PwMS should include planning for future independent living and long-term care needs.Martinez-Assucena, A.; Marnetoft, S.; Roig Rovira, T.; Hernandez-San-Miguel, J.; Bernabeu, M.; Martinell-Gispert-Sauch, M. (2010). Rehabilitation for Multiple Sclerosis, in Adults (II); Management and Impact on Impairment, Functioning, and Quality of Life: An Overview. 22(1-4):179-239. doi:10.1615/CritRevPhysRehabilMed.v22.i1-4.100179239221-

A Conceptual Definition of Vocational Rehabilitation Based on the ICF: Building a Shared Global Model

Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participatio

Vocational rehabilitation of unemployed sick-listed people in a Swedish rural area : an individual-level study based on social insurance data

The long trend of low unemployment and increasing economical growth in Sweden was broken in the early 1990 s. In a short time the rate of unemployment had risen from 1.3% in 1990 to 8.2% in 1993. A previous study made in Stockholm showed that among the long-term sick-listed 20% were unemployed. The sparsely populated areas in the furthermost northern counties of Sweden have had a high rate of unemployment and incapacity rates (sick days per insured and year) during many years. The primary aim of this study was therefore to investigate the unemployed long-term sick-listed and their vocational rehabilitation in a rural area of the county of Jämtland, Sweden. The study is based on a sample of 4 394 long-term sick-leave cases reported sick at all seven rural social insurance offices in Jämtland. Surprisingly, the study showed that the proportion of unemployed among the long-term sick-listed was lower in the rural area of Jämtland (15%) than in Stockholm (20%). However, as in Stockholm, the unemployed were over-represented among the long-term sick. This was especially true for men. Mental problems were more frequent among the unemployed (16%), than among the employed (6%), especially among the men. Unemployed people s potential need for rehabilitation was not investigated to the same extent (15%) as employed people s (37%). The unemployed had also to wait longer for a rehabilitation investigation to be drawn up by the social insurance office (168 days) compared with the employed (78 days). The study partly supports the hypothesis that the unemployed people are disregarded in vocational rehabilitation. A more important finding, however, was that vocational rehabilitation in general, regardless of employment status, seems beset with problems. Neither employers nor the social insurance offices seem to live up to the responsibilities that was given them according to the Rehabilitation Reform of 1992. For both employed and unemployed long-term sick-listed people with musculoskeletal problems, the time before start of vocational rehabilitation does not seem to be the determining factor that it so often is stated. However, when investigating all types of diagnoses the time before start of vocational rehabilitation does seem to be important. The results indicated that women had less chance than men in succeeding with their vocational rehabilitation. Women obtain more on-the-job training while men undergo vocational programmes containing education. Education has been shown to be an effective measure for successful vocational rehabilitation, so therefore it may be concluded that women are more or less unfairly treated with regards to vocational rehabilitation. The study also showed that an unemployed sick-listed person has much less chance of returning to the Labour Market after rehabilitation than an employed person. The short, limited and low-cost vocational rehabilitation that the unemployed are offered may not be adequate to sufficiently affect future sick-leave. They may need more individually adjusted measures. A multidisciplinary vocational rehabilitation programme, with work training and case management was shown, twelve months after the end of the programme, to be more effective regarding lowered benefit levels for unemployed sick-listed people, than a conventional rehabilitation programme