The purpose of this study was to explore the challenges met by nursing staff in a rehabilitation ward. The overall design was qualitative: data were derived from focus interviews with groups of nurses and analyzed from a phenomenological-hermeneutic perspective. The main finding was that challenges emerge on two levels of ethics and rationality: an economic/administrative level and a level of care. An increase in work-load and the changing potential for patient rehabilitation influence the care that nurses can (...) provide in rehabilitating patients, and therefore also affect patients’ feelings of self-worth and dignity. Some patients wish to maintain their independence and autonomy, whereas others seem to ‘lose themselves’. Independence and autonomy are associated with dignity, but their lack is contrary to it. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have (...) effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

HLDING A‐G and HEGGDAL K. Nursing Inquiry 2012; 19: 345–356 Patients’ experiences of health transitions in pulmonary rehabilitationPeople who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and (...) after PR. The research was inspired by interpretive phenomenology. Thirty‐three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well‐being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time‐limited PR and support the current trends towards patient‐centred rehabilitation efforts that incorporate user involvement and self‐management education. (shrink)

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template (...) consisting of a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

With the world's population aging, hospitals are facing pressure to adequately meet the needs of a growing number of frail older patients. For this population, comorbidities combined with a limited ability to face stressful situations contribute to frailty whereby a small injury or illness can lead to significant loss of function. It is widely recognized that hospitalized older patients are more vulnerable to physical or cognitive functional decline and require increased assistance in activities of daily living (Creditor 1993; Sager et (...) al. 1996; Mahoney, Sager, and Jalaluddin 1998; Kortebein et al. 2008; English and PaddonJones 2010; Covinsky, Pierluissi, and Johnston 2011; Zisberg et al. 2011;... (shrink)

In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients’ autonomy was found to be helpful for restoration of their autonomy. Two patterns in health professionals’ approach appeared (...) to be facilitatory: (1) from full support on admission through moderate support and supervision, to reduced supervision at discharge; and (2) from paternalism on admission through partial paternalism (regarding treatment) to shared decision making at discharge. The approach experienced by the patients did not always match their desires regarding their autonomy. Support and supervision were reduced over time, but paternalism was often continued too long. Additionally, the patients experienced a lack of information. Tailoring interventions to patients’ progress in autonomy would stimulate their active participation in rehabilitation and in decision making, and would improve patients’ preparation for autonomous living after discharge. (shrink)

The objective of this paper is to describe the organization and modality of provision of clinical psychology services for those patients who had to be hospitalized due to COVID-19 during the pandemic in Northern Italy. The IRCCS Policlinico San Donato hospital in Milan was converted into a COVID-19 center in March 2020, and all the staff, including the Clinical Psychology Service Team, were diverted to assist these patients. A description is given of how the service was organized and the modalities (...) which were utilized to assist the patients. Following the pertinent ministerial decrees, guidelines, and relevant literature, the patients were followed up through telehealth. A COVID-19 rehabilitation unit was later opened in April 2020, where all patients were seen and followed up by the Clinical Psychology team, the last patient being discharged at the end of June. Details are given about the type of services provided during the hospitalization at the different points in time. At admittance and subsequent isolation, patients indicated by the medical and nursing staff, and those who specifically requested it, were given psychological support. Patients transferred to the COVID-19 rehabilitation unit were all evaluated for anxiety, depression, posttraumatic stress disorder, and sleep disorders both on admission and at discharge when possible. (shrink)

In interprofessional clinical teams, the patients have interpersonal relationships with several practitioners. The aim of this study was to explore patients’ and practitioners’ perceptions of how such relationships may contribute to promote the whole team’s respect for the patient’s autonomy, as interpersonal patient–provider relationships may contribute to enhance patient autonomy. Sixteen qualitative in-depth interviews were conducted with 12 informants, including patients, nurses, physiotherapists, and physicians from three rehabilitation teams. Data were analysed according to Grounded Theory procedures. (...) The informants discussed interpersonal relationships as an integral and significant part of the team work. The practitioners tried to adjust their professional approach to the patients’ genuine opinions and let patients decide the teams’ goals. Close relationships with patients could be important to accomplish this, particularly described by nurses and physiotherapists, who could facilitate the communication with the rest of the team. (shrink)

Se realizó un estudio descriptivo para evaluar la influencia de la rehabilitación protésica en la calidad de vida de los pacientes desdentados totales tratados en las clínicas estomatológicas docentes "Ismael Clark Mascaró" y "La Vigía" en Camagüey, desde septiembre del 2009 a septiembre del 2013. El universo estuvo comprendido por 254 pacientes desdentados totales rehabilitados y una muestra de 43, a través de un muestreo probabilístico aleatorio. Se obtuvo un predominio del grupo de 50-69 años y el sexo femenino. Al (...) determinar los problemas mecánicos se apreció que los flancos sobreextendidos, seguido de las inserciones frénicas sin liberar y la presencia de puntos prematuros de contacto, fueron las principales dificultades encontradas en los pacientes portadores de prótesis totales. La rehabilitación influyó en la calidad de vida de estos pacientes. It was carried out a descriptive study with the objective to evaluate the influence of prosthetic rehabilitation in total toothless patients life quality treated in the teaching stomatological clinics ¨Ismael Clark Mascaró" and "La Vigía" in Camagüey, from September 2009 to September 2013, with a universe of study composed by 254 total toothless patients who were rehabilitated. The sample was of 43, through a random probabilistic sampling. There was a predominance of the female group aged from 50-69 years old, followed by the female group aged 70. While determining the mechanical problems it was appreciated that the flanks overextended, followed of phrenic insertions without being sustained and the presence of premature points of contact, and were the main difficulties found in the patient's carrier of total prostheses. Prosthetic rehabilitation influenced in the patients´ quality life. (shrink)

This paper describes how body regimes are effectuated in the prevailing treatment strategy of physiotherapy. The process of self‐mastering in the context of sports‐related injuries is highlighted. Through a Foucauldian perspective on body regimes the aim is to shed light on the process of individualization and self‐mastery in rehabilitation. The treatment of illness in the physiotherapy clinic does not characterize the patient as sick, and exempt the patient from daily duties and expectations. The empirical data include 17 (...) qualitative illness narratives and several years of fieldwork observing patients with anterior cruciate ligament (ACL) injuries in a physiotherapy clinic. The study demonstrates how the expectation that the patients be active and self‐mastering permeates the total process of treatment. The individual responsibility for personal well‐being is a recurrent phenomenon in public health services in general, and specifically prominent in the rehabilitation of sports injuries. (shrink)

Introduction Respecting the Patients’ Rights Charter leads to the demands of patients for their rights and the response of rehabilitation therapists by increasing their compliance. The present study aimed to compare the views of patients and rehabilitation therapists about the importance and extent of compliance with the Patients’ Rights Charter. Methods This cross-sectional study was conducted for 3 months on 114 patients and 55 therapists who were selected using the convenience sampling method. The data collection tools included a (...) demographic information form and the Justification and Practice of Patient Rights Questionnaire. The collected data were analyzed using descriptive statistics, independent t-test, paired t-test, and Pearson correlation coefficient. Results Mean scores of the importance of compliance with the Patients’ Rights Charter were 2.21 ± 0.40 and 2.31 ± 0.43 in the group of patients and therapists, respectively. Moreover, the mean scores of compliance with the Patients’ Rights Charter were 1.45 ± 0.48 and 1.53 ± 0.61 from the perspective of patients and therapists, respectively. There was no statistically significant difference between the views of patients and therapists on the importance and extent of compliance with the Patients’ Rights Charter. Discussion and Conclusion The importance of respecting the Patients’ Rights Charter from the perspective of patients and therapists was at a desirable level while the level of compliance with it from the perspective of both groups was moderate. It seems that more research is needed to explain the causes of this discrepancy and increase compliance with the Patients’ Rights Charter in rehabilitation clinics. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in (...) the context of rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

Dynamic stability of the knee and weakness of the extensor muscles are considered to be the most important functional limitations after anterior cruciate ligament injury, probably due to changes at the central level of motor control rather than at the peripheral level. Despite general technological advances, fewer contraindicative surgical procedures, and extensive postoperative rehabilitation, up to 65% of patients fail to return to their preinjury level of sports, and only half were able to return to competitive sport. Later, it (...) becomes clear that current rehabilitation after knee surgery is not sufficient to address the functional limitations after ACL reconstruction even years after surgery. Therefore, new therapeutic tools targeting the central neural system, i.e., the higher centers of motor control, should be investigated and integrated into current rehabilitation practice. To improve motor performance when overt movement cannot be fully performed, several techniques have been developed to increase physical and mental activation without the need to perform overt movements. Among the most popular cognitive techniques used to increase physical performance are motor imagery and action observation practices. This review, which examines the available evidence, presents the underlying mechanisms of the efficacy of cognitive interventions and provides guidelines for their use at home. (shrink)

Based on action research as a practitioner‐involving approach, this article communicates the findings of a two‐year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and (...) reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice‐oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in (...) the context of rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

El objetivo del presente trabajo es realizar una revisión bibliográfica sobre los aspectos teórico-metodológicos para la evaluación de la calidad de vida de los pacientes que han sido rehabilitados con prótesis dentales. En primer lugar, se muestra la definición de calidad de vida que ha sido asumida en el trabajo; se contextualiza lacomprensión de calidad de vida en pacientes rehabilitados con prótesis dentales en segundo lugar, posteriormente se presentan algunos de los instrumentos y escalas de medición que están siendo utilizados (...) en la evaluación de la calidad en los procesos de la rehabilitación de pacientes con prótesis dentales;por último, se analiza el indicador satisfacción de los pacientes. The aim of this paper is to carry out a bibliographic review about the theoretical -methodological aspects to be included when assessing the quality of life of patients rehabilitated with dental prosthesis. In the first place, the concept of quality life stated in this paper is given, then, the understanding of the quality of life of patients rehabilitated with dental prosthesis is contextualized and later some of the instruments and measure scales used to assess the quality in the process of rehabilitation of patients with dental prosthesis are shown, and finally the index of patients satisfaction is analysed. (shrink)

BackgroundThe high incidence of post-stroke depression during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation (...) stage.MethodsThe research team created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals, Delphi experts, and patients with stroke in the rehabilitation stage.ResultsThe literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall’s W were 0.152 and 0.408, and the coefficient of variation were 0.05–0.32 and 0.00–0.18, respectively. The item-level content validity index was 0.53–1.00, the scale-level CVI/universal agreement was 0.26, and the S-CVI/average was 0.85 for the first found Delphi consultation; the I-CVI was 0.67–1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions was finally formed after two rounds. The patients with stroke made no further revisions after evaluation.ConclusionThe research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage. (shrink)

Traditional rehabilitation strategies become difficult in the chronic phase stage of stroke prognosis. Brain–computer interface combined with external devices may improve motor function in chronic stroke patients, but it lacks comprehensive assessments of neurological changes regarding functional rehabilitation. This study aimed to comprehensively and quantitatively investigate the changes in brain activity induced by BCI–FES training in patients with chronic stroke. We analyzed the EEG of two groups of patients with chronic stroke, one group received functional electrical stimulation (...) class='Hi'>rehabilitation training and the other group received BCI combined with FES training. We constructed functional networks in both groups of patients based on direct directed transfer function and assessed the changes in brain activity using graph theory analysis. The results of this study can be summarized as follows: after rehabilitation training, the Fugl–Meyer assessment scale score was significantly improved in the BCI–FES group, and there was no significant difference in the FES group. Both the global and local graph theory measures of the brain network of patients with chronic stroke in the BCI–FES group were improved after rehabilitation training. The node strength in the contralesional hemisphere and central region of patients in the BCI–FES group was significantly higher than that in the FES group after the intervention, and a significant increase in the node strength of C4 in the contralesional sensorimotor cortex region could be observed in the BCI–FES group. These results suggest that BCI–FES rehabilitation training can induce clinically significant improvements in motor function of patients with chronic stroke. It can improve the functional integration and functional separation of brain networks and boost compensatory activity in the contralesional hemisphere to a certain extent. The findings of our study may provide new insights into understanding the plastic changes of brain activity in patients with chronic stroke induced by BCI–FES rehabilitation training. (shrink)

This study examined the effects of computer-assisted cognitive rehabilitation in a group of 16 brain-damaged patients. Therapeutic effectiveness was assessed by improvement on computer tasks, the results of neuropsychological tests and quality of life ratings. Participants suffered from mild to moderate attention and memory problems or aphasia. The procedure involved baseline assessment, a 15-week course of therapy conducted twice a week and posttest. Neuropsychological tests assessing attention, memory and language problems and quality of life ratings were administered twice: in (...) pre- and posttests. Twelve healthy controls were also examined twice using the same battery of neuropsychological tests. The RehaCom program and the Polish computer therapy program for aphasics called Afa-System were used for rehabilitation. The computer-assisted rehabilitation tasks were selected individually for each patient. The results showed significant improvement on computer-assisted tasks in all braindamaged subjects. However, none or very little improvement was observed on neuropsychological tests and quality of life ratings. The results of the study confirm the importance of using different types of measures to estimate the effectiveness of computer-assisted neuropsychological rehabilitation as well as the necessity of applying various kinds of therapy to improve cognitive, emotional and social functioning in brain-damaged patients. (shrink)

Currently, the number of patients diagnosed with impaired self-awareness of their own deficits after brain injury—anosognosia— is increasing. One reason is a growing understanding of this multifaceted phenomenon. Another is the development and accessibility of alternative measurements that allow more detailed diagnoses. Anosognosia can adversely affect successful rehabilitation, as often patients lack confidence in the need for treatment. Planning such treatment can become a complex process full of ethical dilemmas.To date, there is no systematic way to deal with different (...) aspects of anosognosia rehabilitation planning. This is the first article to present a framework for ethical decision making in establishing rehabilitation plans that are focused on increasing patients’ self-awareness of their own deficits after brain injury. It concentrates especially on addressing the ethical dilemmas that may arise, and describes stepwise procedures that can be applied to distinct theoretical approaches, as well as diagnostic and rehabilitation methods. To show the flexibility of the use of this framework, alternative approaches are discussed. (shrink)

This article examines the storytelling aspect in philosophizing with rehabilitating cancer patients in small Socratic dialogue groups. Recounting an experience to illustrate a philosophical question chosen by the participants is the traditional point of departure for the dialogical exchange. However, narrating is much more than a beginning point or the skeletal framework of events and it deserves more scholarly attention than hitherto given. Storytelling pervades the whole Socratic process and impacts the conceptual analysis in a SDG. In this article we (...) show how the narrative aspect became a rich resource for the compassionate bond between participants and how their stories cultivated the abstract reflection in the group. In addition, the aim of the article is to reveal the different layers in the performance of storytelling, or of authoring experience. By picking, poking and dissecting an experience through a collaborative effort, most participants had their initial experience existentially refined and the chosen concept of which the experience served as an illustration transformed into a moral compass to be used in self-orientation post cancer. (shrink)

This paper presents an approach for monitoring exercises of hand rehabilitation for post stroke patients. The developed solution uses a leap motion controller as hand-tracking device and embeds a supervised machine learning. The K-nearest neighbor methodology is adopted for automatically characterizing the physiotherapist or helper hand movement resulting a unique movement pattern that constitutes the basis of the rehabilitation process. In the second stage, an evaluation of the patients rehabilitation exercises results is compared to the movement pattern (...) of the patient and results are presented, saved and statistically analyzed. Physicians and physiotherapists monitor and assess patients’ rehabilitation improvements through a web application, furthermore, offer medical assisted rehabilitation processes through low cost technology, which can be easily exploited at home. Recorded tracked motion data and results can be used for further medical study and evaluating rehabilitation trends according to patient’s rehabilitation practice and improvement. (shrink)

This paper presents an approach for monitoring exercises of hand rehabilitation for post stroke patients. The developed solution uses a leap motion controller as hand-tracking device and embeds a supervised machine learning. The K-nearest neighbor methodology is adopted for automatically characterizing the physiotherapist or helper hand movement resulting a unique movement pattern that constitutes the basis of the rehabilitation process. In the second stage, an evaluation of the patients rehabilitation exercises results is compared to the movement pattern (...) of the patient and results are presented, saved and statistically analyzed. Physicians and physiotherapists monitor and assess patients’ rehabilitation improvements through a web application, furthermore, offer medical assisted rehabilitation processes through low cost technology, which can be easily exploited at home. Recorded tracked motion data and results can be used for further medical study and evaluating rehabilitation trends according to patient’s rehabilitation practice and improvement. (shrink)

: When may a physician legitimately offer enrollment in a randomized clinical trial (RCT) to her patient? Two answers to this question have had a profound impact on the research ethics literature. Equipoise, as originated by Charles Fried, which we term Fried's equipoise (FE), stipulates that a physician may offer trial enrollment to her patient only when the physician is genuinely uncertain as to the preferred treatment. Clinical equipoise (CE), originated by Benjamin Freedman, requires that there exist a (...) state of honest, professional disagreement in the community of expert practitioners as to the preferred treatment. FE and CE are widely understood as competing concepts. We argue that FE and CE offer separable and, in themselves, incomplete justifications for the conduct of clinical trials. FE articulates conditions under which the fiduciary duties of physician to patient may be upheld in the conduct of research. CE sets out a standard for the social approval of research by institutional review boards. Viewed in this way, FE and CE are not necessarily competing notions, but rather address complementary moral concerns. (shrink)

ABSTRACTThe Norwegian government implemented a comprehensive welfare reform in 2012 to better manage an increasingly care-demanding patient demography while meeting budgetary constraints. This article discusses interdiscursive relationships between policy strategies and language use among rehabilitation professionals. It is based on a synthesis of textual analyses of policy documents and of transcribed interviews to produce complex insights into current rehabilitation discourse. The synthetic product is expressed in the form of two nodal discourses which subsume and articulate in particular (...) ways the constituent discourses of the policies and interviews. One nodal discourse approaches rehabilitation as a clinical practice; the other concerns rehabilitation as a management practice. These discourses serve different purposes. One is based in traditional medical science as a means for political action and relates to the body as an object of government policies and practices. The other relies on the individual... (shrink)

This case recounts the founding of HealthSouth Rehabilitation, its rapid growth, financial mishandlings and the struggle former CFO Aaron Beam had in dealing with a conscience that kept him awake at night. Beam had met HealthSouth founder Richard Scrushy when applying for a job with Lifemark Hospital Corporation in Texas in 1980. After Lifemark was bought by AMI in 1983, Scrushy invited Beam to join him in the launching of his new company in Birmingham, Alabama. The uniqueness of the (...) hospital was that it would provide inpatient surgery for those who had suffered an injury, but it would also provide outpatient services such as rehabilitation, nutrition guidance and psychological counseling. This type of structure was appealing to insurance companies because it would move the patient out of the hospital much quicker and save the cost of extended hospitalization. The company experienced rapid growth and went public within three years of launch. By 1996, the top executives of the company realized that they would not be able to meet Wall Street analysts’ forecasts which would affect the price of their stock and reduce their holdings. They decided to “cook the books” temporarily to meet quarterly expectations. However, once the financial mishandling had begun, the executives found it difficult to reverse their actions and report accurate numbers to the public. Beam decided to retire from the company in 1996; and after this action, he continued to find it difficult to sleep at night because of his involvement in the fraud. The issue in the case is whether Beam should consider coming forward and revealing to the Securities and Exchange Commission how the books had been doctored so that he could salvage his damaged conscience. (shrink)