Appropriateness of admission to rehabilitation: definition of a set of criteria and rules through the application of the Delphi method

Merlo, Andrea; Rodà, Francesca; Carnevali, Davide; Principi, Niccolò; Grimoldi, Ludovico; Auxilia, F.; Lombardi, Francesco; Maini, M.; Brianti, Rodolfo; Castaldi, Silvana

doi:10.23736/s1973-9087.20.06148-1

Cited by 8 publications

(21 citation statements)

References 36 publications

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“…Comparators were also heterogeneous among studies, indicating a need for greater standardization. Scientific Societies could encourage discussions on these topics, even promoting the use of evidence-based methodologies in order to reach an agreement among experts, such as the Delphi Panels and the Consensus Conferences ( 71 , 72 ).…”

Section: Discussionmentioning

confidence: 99%

Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review

et al. 2022

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ObjectiveEquinus foot deformity (EFD) is the most common deformity following a stroke. Several approaches have been suggested for its correction, including pharmacological, surgical, and physical therapy (PT) interventions. This scoping review aims to map and synthesize the available evidence focusing on physical therapy treatments for EFD caused by triceps surae (TS) spasticity.MethodsScoping review methodological frameworks have been used. Pubmed, Cinahl, and Cochrane databases were searched for primary literature. Studies focusing on the treatment of EFD in adult stroke patients were included only when the intervention involved PT treatments and presented at least one outcome measure for the functional and/or structural condition of the TS. Data were systematically collected and reported in tables inclusive of type of intervention, sample characteristics, dosage, comparators, outcomes, follow-up timeline, and treatment efficacy. A narrative synthesis was also added.ResultsOf the 642 experimental or observational screened studies, 53 were included, focusing on stretching exercises, shock waves, electrical stimulation, dry needling, TENS, vibration therapy, ultrasounds, cryotherapy, and active physiotherapy. Patients with EFD benefited from specific physical therapy treatments. These usually resulted in Modified Ashworth Scale reduction, typically by 1 point, and an increase in ROM. Interventions consisting of shock waves, dry needling, and electrostimulation showed the best results in reducing EFD. Heterogeneous dosage and delivery mode generally limited conclusions.ConclusionsThis scoping review summarized available primary literature based on PT treatments for the correction of EFD. By highlighting the remaining gaps in knowledge, it provides a reference for future studies on this pathology. Further investigations are necessary to pinpoint the best dosage and delivery methods. Future studies should investigate whether early rehabilitation programs started during the acute phase might help prevent or limit the development of secondary deformities.

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Section: Discussionmentioning

confidence: 99%

Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review

et al. 2022

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“…A more recent paper published in 2020 by Merlo et al . 7 proposed new admission criteria for inpatient rehabilitation, based on expert advice by 53 healthcare professionals in the rehabilitation field in Italy. Three pillars mentioned as driving goals for appropriateness were: improvement in healthcare quality, cost saving and system sustainability.…”

Section: Discussionmentioning

confidence: 99%

Referrals for inpatient rehabilitation and the patient selection processes: Pre-pandemic challenges as a guide towards reforms moving forward

Anastasi

Zammit²

2022

Journal of Orthopaedics, Trauma and Rehabilitation

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Purpose: To analyse data related to the referral, selection and admission processes for inpatient rehabilitation at Karin Grech Hospital, Malta. Examining pre-pandemic challenges faced can guide reform towards a more sustainable use of inpatient rehabilitation services. Methods: Referrals and outcomes of all patients referred for inpatient rehabilitation between April and August, 2018 were analysed. Results: 47% of patients referred for inpatient rehabilitation were accepted, with an average time to transfer of 4.84 days. Of the 53% deemed unsuitable, the commonest reasons were: excessively high level of independence (22%), non-weight-bearing restriction (12%) and patient refusal (12%). 90% of inpatients in rehabilitation were discharged home, 7% were transferred back due to acute complications and 1 patient was transferred to a residential home. Out of all referrals, 14 passed away within 1 year, two of these within 8 days of referral. Conclusions: Identifying unsuitable referrals for inpatient rehabilitation can avoid inappropriate admissions that would otherwise decrease bed availability and increase waiting times. Basing patient selection on key principles can thence ensure efficient and sustainable rehabilitation services moving forward.

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“…The responses would be combined, analysed, and presented back to the panel of experts for further comment [ 13 , 14 ]. This process would be repeated until consensus was reached between most of the panel members, with the responses shifting towards the same ideas, thus suggesting stable results [ 11 ]. This Delphi study was completed over a total of four rounds.…”

Section: Methodsmentioning

confidence: 99%

“…Anonymity was crucial in ensuring an equal opportunity for each panellist to express their views, unconditioned by the identities or reactions of other panellists. Each panellist response had the same weighting score and was given equal importance at data analysis stage [ 11 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Although similarities could be noted across the existing literature, the particular healthcare service, culture, and other factors would cause local applicability of admission criteria to vary from one country to another [ 6 , 7 , 8 , 9 ]. Hence, the existence of pre-set admission criteria that could aid clinicians in selecting patients for inpatient rehabilitation, and admitting them to the correct ward, would be essential in ensuring that the most adequate level of care be provided to the patients [ 3 , 6 , 10 , 11 ]. A shared understanding of the best ways to serve the needs of these patient groups might encourage more international GR units to form a shared platform for learning to encourage the development of the service, globally.…”

Section: Introductionmentioning

confidence: 99%

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Inpatient Geriatric Rehabilitation: Definitions and Appropriate Admission Criteria, as Established by Maltese National Experts

Muscat

Camilleri

Attard

et al. 2022

JCM

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(1) Background: The importance of having an appropriate admissions system for geriatric rehabilitation is on the increase. However, the process of admitting patients to inpatient rehabilitation is a complex process. This is yet to be standardised across the European Union, as the approach to geriatric rehabilitation tends to vary from one Member State to another. (2) Objective: To discuss evidence-based practice with clinical experts, in order to define geriatric rehabilitation and admission criteria based on the Maltese population. (3) Method: The study entailed conducting four panel sessions using a purposive sample of thirteen local clinicians with extensive knowledge in clinical rehabilitation and healthcare management. A total of 48 items, based on the literature and clinical experience, were presented to the panel. Data analysis was done quantitatively and qualitatively, using IBM SPSS Statistics Version 24 and thematic analysis. (4) Results: The panel formulated a definition of rehabilitation, which shared common elements with the definition provided by the World Health Organization (WHO) and other sources/literature. The panel agreed on a list of eight criteria for appropriate inpatient geriatric rehabilitation admission in Malta. Consensus was also reached on: the need for a consultant-led multidisciplinary approach to assessment; the adoption of a standardised assessment processes for an equitable chance for all older adults assessed; the benefit of digital health in assessments; and the consideration that most patients would have some form of rehabilitation potential, depending on availability of resources. (5) Conclusion: Inpatient geriatric rehabilitation hospitals should have a unified strategy for rehabilitation services. The conclusions reached by the panel, could be useful in supporting the clinical evidence and establishing future rehabilitation guidelines and standards for inpatient rehabilitation.

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Appropriateness of admission to rehabilitation: definition of a set of criteria and rules through the application of the Delphi method

Cited by 8 publications

References 36 publications

Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review

Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review

Referrals for inpatient rehabilitation and the patient selection processes: Pre-pandemic challenges as a guide towards reforms moving forward

Inpatient Geriatric Rehabilitation: Definitions and Appropriate Admission Criteria, as Established by Maltese National Experts

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