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Purpose:
The aim is to analyze rehabilitation services provided by a mobile rehabilitation clinic (MU) in nine regions of the State of São Paulo, demonstrating the distribution of orthoses, prostheses and other mobility aids for persons with physical disabilities according to age groups and impairments, as well as the number of persons with physic...
Citations
... (e.g., shared vision and values) [13,14], brazil [15][16][17][18], China [19][20][21][22], india [23,24], iran [25][26][27], Kenya [28], lebanon [29], Madagascar [30,31], Malaysia [32][33][34], Pakistan [35], Peru [36], Philippines [37,38], south africa [39][40][41][42], thailand [43,44], turkey [45], Uganda [46,47], Ukraine [48], Vietnam [49,50], Zambia [51], Zimbabwe [52]. studies from multiple countries: africa [53], (Cambodia, nepal, independent republic of somaliland) [54], (Pakistan, Morocco, nigeria and Malaysia) [56], (south arica, botswana, Malawi) [55] type of study Qualitative [13,21,22,25,27,33,39,42,47,51,55], mixed methods [14,19,40,41,44,45,49,52], cross-sectional [15][16][17]20 [15][16][17]19,20,22,25,27,28,30,33,36,41,47,49,50], Clinic-based [13,14,16,25,28,37,[39][40][41]46,54], iCU [19,21,22,29,45,49,52], home-based [15,24,41,51], community-based rehabilitation [23,42,43], University-based [46], mobile rehabilitation unit [18] type of service providers [15][16][17]19,20,23,29], mobilisation & strengthening [28,39,43,45,52], assistive devices [13,28,40,44,51,53], prevention, early identification & screening [16,23,37,42,55], surgery [15,16,19], home-based rehabilitation [15,24,27], pulmonary rehabilitation [15], geriatrics [15], burns [47] (n = 1, 2.2%). Personnel providing physical rehabilitation mentioned in the studies were physiotherapists (n = 28, 63.6%), physicians (n = 20, 45.4%), nurses (n = 17, 38.6%), occupational therapists (OTs) (n = 12, 27.2%), prosthetists and orthotists (n = 9, 20.4%), speech and language pathologists (n = 9, 20.4%), mental health care providers (n = 5, 11.3%), therapists (n = 4, 9%), medical practitioners (n = 5, 11.3%), village health volunteers or community health care workers (n = 5, 11.3%), social workers (n = 3, 6.8%), exercise specialists (n = 2, 4.5%), dieticians (n = 3, 6.8%), and audiologists (n = 2, 4.5%). ...
... Given people in need of physical rehabilitation have multiple needs, the presence of professionals providing coordinated care for users undergoing treatment at different levels can assist in the implementation of comprehensive care. This was evident from examples in the literature, including for users undergoing cardiac care in Brazil [16] and the Philippines [37], physical rehabilitation in Brazil [18], Kenya [28] and the Philippines [38], post-stroke care in China [21] and Vietnam [50], and early mobilisation in ICUs within Zimbabwean hospitals [52]. ...
... Integrated secondary care level for people in need of post-stroke care, post-surgical care, cardiology and assistive technology was identified in 20 studies. Examples included coordinated approaches between multidisciplinary care teams, such as physiotherapists, Family-centred multidisciplinary care plans with clear and accessible care pathways [13][14][15][16][17][18][19] Coordination of care for users with multiple needs [18,[20][21][22][23][24][25][26][27] Responsiveness of care plans as users transition through different levels of care [16,17,19,28,29] Continuity of care [17,26,29] Coordinated public health campaigns such as community education [16], raising awareness to address social stigma/dispel myths [24] or informing of services available [19,26] Professional (meso-level) agreements on interdisciplinary collaboration through service-delivery partnerships [16,22,25,[28][29][30][31][32][33][34] embedding allied health providers within multidisciplinary primary health care teams [16,22] awareness of the roles of rehabilitation specialists to improve referral pathways and knowledge sharing [22,31,32] stepwise implementation of rehabilitation for acute, post-acute and long-term rehabilitative care [32,33] Multidisciplinary guidelines and protocols can promote governance [14,19,22,27,35] shared vision, goal setting and collaboration between professionals [14,19,22,23,25,26,29,31,36] building collaborative multidisciplinary relationships through complimentary goal setting [29,31,36] interprofessional education [14,19,25,26,29,32,34,37,38]: interdisciplinary training of community healthcare workers improves community integration [19,29,34] training primary health care providers to assess rehabilitation needs and provide basic interventions strengthens referral pathways [25,26,34] organisational (meso-level) interorganisational strategy and relationship building [16,[39][40][41][42][43][44]: intersectoral collaboration [43,44] engagement with multi-disciplinary teams and management structures [40,44] Fostering value creation [26,40,44,45] Collective groups of users, professional associations and international stakeholders can rally government support to build stronger physical rehabilitation services [44] Creating interdependence through training [43,44] Physical Rehabilitation training can improve awareness of the role of physical rehabilitation practitioners, add value in their work, and enhance interorganisational collaboration [43] Windows of opportunity [26,44] in post-conflict or post-disaster contexts, close collaboration with local and non-local actors can strengthen physical rehabilitation by applying international standards in the absence of strong local policy regulation [26,44] system (macro-level) ...
Purpose:
Integration is a concept that seeks to strengthen the delivery of services to ensure people receive a continuum of care across the health system. We conducted a scoping review to explore how rehabilitation services have been integrated into health systems in low- and middle- income countries (LMICs).
Materials and methods:
We conducted a scoping review using Valentijn's Rainbow Model of Integrated Care (RMIC) as an organising framework. The key enablers of integration of rehabilitation were extracted, charted and summarised according to the RMIC framework.
Results:
Of 4667 articles identified, 44 met inclusion criteria. Most studies focused on rehabilitation within secondary and tertiary level facilities, and described service models incorporating clinical, professional and functional integration characteristics. The geographical and clinical scope of rehabilitation models that demonstrate elements of integration from LMICs is limited.
Conclusion:
The key enablers identified highlight the important role of responsive multidisciplinary care plans, and interdisciplinary guidelines, protocols and interprofessional education to support an integrated rehabilitation service model in LMICs.
... 18 Also, given Brazil's continental dimensions, the populations of each region have different characteristics such as social behaviors, genetic and economic characteristics, demanding diverse medical and social controls in each region. 19 Facing such needs, specifically in the southeast region of the country, the Instituto 20 included, more recently, multidisciplinary interventions for patients with COVID-19 sequelae. 21 Understanding how much the institutional rehabilitation program can influence the recovery of these individuals becomes necessary. ...
A COVID-19 tem consequências sensório motoras, cognitivas, psíquicas e nutricionais que necessitam de reabilitação. Objetivo: Descrever o programa de reabilitação ambulatorial desenvolvido no Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, otimizado, intensivo e de curta duração. Método: Obtivemos informações sociodemográficas e clínicas de 12 adultos com diagnóstico laboratorial de COVID-19, grave e crítica, que necessitaram de hospitalização na fase aguda. Avaliações funcionais: Escala de Medida de Independência Funcional (MIF), EQ-5D-5L, World Health Organization Disability Assessment Schedule (WHODAS 2.0), Post-COVID-19 Functional Status scale, Medical Research Council (MRC) dyspnea scale, escala visual analógica (EVA) para dor, DN-4 (Douleur Neuropathique 4), escala de sonolência de Epworth, Índice de Gravidade da Insônia, Montreal Ontario Cognitive Assessment (MoCA), escala de Depressão, ansiedade e estresse (DASS-21), avaliação nutricional, Timed Up and Go, teste de caminhada de 10 metros, teste de preensão palmar, MRC sum score, ultrassonografia musculoesquelética da coxa antes, durante e após programa de reabilitação ambulatorial. Este incluiu estimulação magnética indutiva e elétrica musculoesquelética, tratamento por ondas de choque extracorpóreas, exercícios isocinéticos, abordagem emocional, estimulação cognitiva, estimulação do desempenho ocupacional, orientação nutricional e programa educacional por aplicativo COMVC. O tratamento foi realizado duas vezes por semana até atingir os critérios de alta pré-estabelecidos. Resultados: VAS e TUG proporcionaram melhora estatisticamente significante (p <0,001). PCFS, MIF, Handgrip, 10 MWT e DASS-21 domínio ansiedade apresentam tendências de melhora. Conclusão: O programa melhora a dor, mobilidade e ansiedade em pacientes com COVID longa.
... They are staffed with health professionals to increase health access to populations and enforce disease prevention, as well as improve access to chronic health management at reduced costs [1]. Mobile clinics have also been used to increase healthcare staff and provide specialty equipment such as orthoses and prostheses to disabled patients in Sao Paulo [2]. In situations such as flooding when building facilities were destroyed or individuals were unable to access stationary healthcare facilities, mobile clinics were alternatives to providing adequate medical services as was in the case in Malaysia [3]. ...
Mobile health clinics are critical avenues for reaching underserved populations. There are over 2,000 mobile clinics serving 7 million individuals annually. Costs per patient are low compared to stationary clinics. Further, they play a critical role in reducing healthcare access disparities by ensuring healthcare is delivered at the doorstep of patients. However, this model of healthcare delivery is a tool that has rarely been considered for dealing with emergencies such as a pandemic. The case of the COVID-19 pandemic illustrates several potential areas where mobile clinic programs can play a critical role. Apart from the role mobile clinics have played in improving COVID-19 testing for under-resourced populations, and the current efforts to play a role in expanding vaccination, there are other proposed initiatives these programs can play. Establishing a comprehensive approach to incorporate mobile clinics in our entire health system, would not only be effective for addressing health outcomes of under-resourced patient populations, but will also contribute to the success of a national pandemic response. Mobile healthcare clinics are a vital part of national healthcare solutions, and it is time to recognize their broader potential, and include them in preparation efforts for current and future health crises.
... The Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital (IMREA-HCFMUSP) is a reference for secondary and tertiary levels of rehabilitation care for people with physical disabilities through the Brazilian Public Healthcare System in the State of Sao Paulo. In 2014, it was the first Brazilian institution to be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and is commited to improve the quality of services provided [9,10]. Hence, assessing the outcomes of the assistive products is important to improve the use of public resources. ...
Purpose: To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center.
Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews.
Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels.
Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery.
• Implications for Rehabilitation
• Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings.
• The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users.
• The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels.
• As assistive products users’ perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.
... Mobile clinics have also been used to increase skilled specialty healthcare personnel and provide orthoses and prostheses to disabled patients in Sao Paulo (Battistella et al., 2015). In natural disasters such as flooding where building facilities were destroyed or individuals were unable to access stationary healthcare facilities, mobile clinics were an excellent alternative to providing adequate medical services as was in the case in Malaysia in 2006 (Ahmad et al., 2008). ...
The issue of access in rural areas, defined as the ability to afford healthcare services and have availability, is a concern amidst efforts to reduce the number of uninsured individuals in the United States. Mobile clinics can be used to provide efficient healthcare services in rural areas in states facing rural hospital closures and in those which have a large percentage of uninsured individuals who could be insured if the states expanded Medicaid. However, the use of mobile clinics in healthcare services delivery has not been studied well enough to warrant the implementation of policies to encourage their wider adoption. The study goals are to understand the costs, utilizations and geographic distributions of preventative, primary, mammography and dental mobile clinics and to determine whether they were being utilized in rural areas. ^ A descriptive analysis of the utilization and costs of a sample of mobile clinics identified in Texas, North Carolina, Georgia and Florida was conducted. The states identified in the study have not expanded Medicaid and have a large proportion of individuals that are uninsured. In addition they currently have 26 rural hospital closures. A graphical distribution of the rural or urban locations of the mobile clinics was also described in the study. Finally, a geographic measure of the influence of mobile clinics in primary healthcare delivery in rural areas was ascertained via a rural primary care provider mobile clinic index and stakeholder interview. ^ Most of the clinics were owned by for-profit organizations (37%) and 39% were privately funded. Demographic data showed clinics saw an equal distribution of males and females and African Americans, Caucasians, and Hispanics were the highest percent of race and ethnicities reported by clinics in the study (53%). Most individuals were reported by the clinics as having some type of insurance, with only 2% of the clinics having a population of patients that were solely uninsured. Dental healthcare delivery had the lowest median cost per patient, had the highest annual number of patients in the study sample, and was mostly in urban areas. The overall costs of all delivery types for a population with various insurance types in the mobile clinics in Texas, Florida, North Carolina, and Texas were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers. Most of the mobile clinics were located in urban areas although both the rural primary care mobile clinic index and narrative findings support the important role of mobile clinics in rural areas in the delivery of healthcare.
Background
Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion.
Methods
We conducted a scoping review following the methodological framework proposed by Arksey and O’Malley, Int J Soc Res Methodol 8:19–32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article.
Results
Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities.
Conclusion
Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations’ needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
Introduction
Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations.
Materials and Methods
This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t -test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution.
Results
Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology.
Conclusions
This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase.
Clinical Relevance
Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.
The Brazilian government launched the National Health Policy for People with Disabilities (PNSPD) in 2002 to address this inequality. PNSPD has six areas of focus: quality of life, impairment prevention, comprehensive health care, organization and functioning of health services, information mechanisms, and training of human resources. The aim of this article was to undertake a scoping review to assess the evidence on the experience of people with disabilities in Brazil with respect to the six themes of the PNSPD. The scoping review included articles published between 2002 and 2019, from four electronic databases: PUBMED/MEDLINE, LILACS, Science Direct, and Scielo. In total, 8076 articles were identified, and after review of titles, abstracts, and full texts by two independent reviewers, 98 were deemed eligible for inclusion.
This special issue addresses access to and service delivery of assistive technology (AT) in resource-limited environments (RLEs). Access to AT is complicated not simply by limited funds to purchase AT, but by larger ecosystem weaknesses in RLEs related to legislation and policy, supply, distribution, human resources, consumer demand and accessible design. We present eight diverse articles that address various aspects of the AT ecosystem. These articles represent a wide range of AT, many different countries and different research methods. Our goal is to highlight a topic that has received scant research investigation and limited investment in international development efforts, and offer an insight into how different countries and programs are promoting access to AT. We encourage researchers, funders and non-profit organizations to invest additional effort and resources in this area.
