Background: while hip fractures are an important cause of disability, dependency and death in older adults, the benefit of multi-disciplinary rehabilitation for people who have sustained hip fracture has not been demonstrated. Methods: Systematic review of randomized controlled trials which compare co-ordinated multi-disciplinary rehabilitation with usual orthopaedic care in older people who had sustained a hip fracture. Outcome measures included: mortality, return home, "poor outcome", total length of hospital stay, readmissions and level of function. Results: We identified 11 trials including 2177 patients. Patients who received multi-disciplinary rehabilitation were at a lower risk (Risk Ratio 0.84, 95% CI 0.73-0.96) of a "poor outcome" -that is dying or admission to a nursing home at discharge from the programme, and showed a trend towards higher levels of return home (Risk Ratio 1.07, 95% CI 1.00-1.15). Pooled data for mortality did not demonstrate any difference between multi-disciplinary rehabilitation and usual orthopaedic care. Conclusion: This is the first review of randomized trials to demonstrate a benefit from multi-disciplinary rehabilitation; a 16% reduction in the pooled outcome combining death or admission to a nursing home. this result supports the routine provision of organized care for patients following hip fracture, as is current practice for patients after stroke.
A survey, which achieved a 54% response rate, was completed to assess the availability and type of rehabilitation health services in Australia. 1044 surveys were sent out and 561 were returned. The details of a total of 346 rehabilitation services were obtained. There were more services in metropolitan compared with rural areas, more services in New South Wales and Victoria than in the other states, and a higher proportion of services led by health care workers other than rehabilitation physicians in rural compared with metropolitan areas.
Background: Following her review of health systems and structures Dwyer [1] suggested that there is a need to evaluate models of care for individuals with chronic diseases. Rehabilitation services aim to optimise the activity and participation of individuals with restrictions due to both acute and chronic conditions. Assessing and optimising the standard of these services is one method of assuring the quality of service delivered to these individuals. Knowledge of baseline standards allows evaluation of the impact of health care reforms in this area of need. The aim of this article is to compare the currently available rehabilitation service standards in Australia with those used in the USA and the UK.
Rehabilitation medicine is considered relevant by clinicians and academics at the SOM. The most effective way of filling identified gaps in coverage of rehabilitation medicine at the SOM will be via engagement across a number of medical and surgical disciplines. Implications for Rehabilitation Rehabilitation-related knowledge and skills are relevant to medical education. Many of these issues are already partially addressed in existing educational resources. The design and delivery of medical school curricula should include a trans-disciplinary and inter-year approach to the inclusion of rehabilitation concepts and aptitudes. This could be done by introducing relevant concepts early, making resources available online, and embedding rehabilitation items across different disciplines, courses and assessments.
Although individuals in rural and remote (R&R) parts of Australia have high levels of disability, 1 they generally have access to fewer rehabilitation services. 2 Little work has been done to ascertain methods of improving access to rehabilitation services in R&R regions. The aim of this workshop was to discuss the provision of rehabilitation services in Australia, the current models of service delivery and to suggest solutions for meeting rehabilitation service needs. ParticipantsA total of 30 attendees of the 2006 Australasian Faculty of Rehabilitation Medicine Scientific Meeting participated. Participants had a total of 637 (mean 24.5) years of experience in a variety of rehabilitation-related aspects of the health care industry. MethodsAs suggested by Quine, 3 a semistructured focus group style workshop was designed to discuss the availability of rehabilitation services in Australia and recommend solutions for R&R rehabilitation service needs. See Box 1 for the questions asked during the workshop. The workshop was facilitated by the authors.The narrative of the workshop was transcribed from video and subjected to content analysis as suggested by Chapman, 4 under headings provided by the workshop questions and other questions and themes brought up during the workshop. ResultsThe south eastern states have more developed rehabilitation services than other states. Metropolitan centres have more services than R&R areas. A number of population subgroups with probable special rehabilitation needs were identified.The advantages of network approaches were discussed. Concerns were expressed about the costeffectiveness and sustainability of fly-in-fly-out services. It was suggested that development and evaluation of telerehabilitation models are needed. R&R workforce development was identified as a priority. CommentIdentified areas of need for the provision of rehabilitation services in R&R regions include indigenous individuals, older people, children and young adults, amputees, those in rural fringes and outer metropolitan areas, individuals with vocational rehabilitation needs and individuals separated from support networks during inpatient treatment. Current models of service delivery include specialised outreach services, community-based services, telemedicine and fly-in-flyout services. Methods of meeting rehabilitation needs in R&R areas include the formation of cooperative clinical networks and the local recruitment and retention of health care providers.Given the current distribution of rehabilitation services in Australia, a hub and spoke clinical network model is likely to be most feasible, with metropolitan hubs supporting smaller R&R services. The hub and spoke model advocates the development of large metropolitan centres (hubs) providing support to smaller R&R centres (spokes). The implication is that the support provision is unidirectional, with advice being sent from the hub to the spoke, not from R&R centres to metropolitan centres. At present, in the majority of regions in Australia, large metropolitan...
Aims Rehabilitation services provide multidisciplinary management of complex clients and therefore require a multifactorial assessment tool to assess standards, discriminate between services and clients, and suggest areas requiring improvement. The World Health Organization International Classifi cation of Functioning Disability and Health (ICF) provides a structure based on impairment, activity, participation and environment that may be a useful basis for assessing rehabilitation outcomes. The authors developed a set of clinical indicators including the Australian Faculty of Rehabilitation Medicine (AFRM) clinical indicators (which largely concern the rehabilitation process) and additional outcome measures based on the ICF domains, and undertook this pilot study to assess its usefulness. Method In July and August 2004 a clinical reviewer assessed 30 client records from an inpatient and a community-based rehabilitation service respectively, using a proforma which included the AFRM clinical indicators and additional indicators relating to goal attainment and the ICF domains. The reviewer ascertained which ICF domains were relevant for each client and if the relevant domains were addressed in the records. Findings After practice, the pro forma was easy to use but time consuming. Items based on the AFRM clinical indicators tended to be complied with 100% (i.e. for most clients, all of the AFRM clinical indicators were fulfi lled). Scores based on improvement in activity and participation, and goal attainment had means of 0.23-0.43 (medians 0.0-0.6) with a range between clients of 0 (improvement in all areas assessed) and 1 (no improvement), suggesting that these scores are potentially more discriminatory than the AFRM clinical indicators. Conclusions The high level of compliance with the AFRM clinical indicators suggests that these indicators may not be useful for discriminating between services, but are likely to provide a useful measure of minimum standards. Items based on activity, participation and goal attainment, or a previously published instrument such as the Goal Attainment Scaling Tool, may be more appropriate methods for assessing outcomes in different settings. Further work is needed to appropriately assess potential confounding factors via use of the ICF concept of environmental facilitators and barriers.
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