Disability and Rehabilitation最新文献

Background: Children with disabilities (CWD) experience greater obstacles than those without disabilities, including increased poverty, reduced healthcare opportunities, minimal educational resources, and stigma. This research explored the impact of community interventions on reducing stigma and discrimination toward children with disabilities.

Methods: A repeated cross-sectional survey design (2019/2021) was implemented with community members in three low-resource compounds in Lusaka, Zambia, regarding stigma related to disability and participation in sensitization events via Kusumala+, a community-based intervention designed to improve quality of life for households with CWD. The analysis included descriptive statistics and linear regression assessing group mean change over time.

Results: Participants included N = 259 (2019) and N = 1037 (2021). Subscales of stigma were identified: attitudes (t = 9.7, p < 0.001) and discrimination (t = 4.1, p < 0.001), which both significantly changed from baseline to follow-up. The effect size for the change in discrimination was d = 0.28 (95% CI 0.15-0.42) (weak to moderate effect) and for attitudes was d = 0.67(95% CI 0.53-0.81) (strong effect). Attitudes improved if event attendance occurred and increased with each additional event. In contrast, discrimination improved only when one event attendance occurred, not with each additional event change, in adjusted or unadjusted models.

Conclusion: Sensitization activities and events show promise as targeted interventions to reduce stigma and discrimination and create supportive community environments for CWD and their families.

Purpose: Currently available methods may not reliably assess language comprehension in children with significant speech and motor limitations. The Computer-Based instrument for Low motor Language Testing (C-BiLLT) is a standardized assessment designed for children with cerebral palsy that allows them to participate using various alternative response methods. This study aimed to understand speech-language pathologists' and occupational therapists' perceived facilitators and barriers to implementing the Canadian C-BiLLT (C-BiLLT-CAN).

Materials and methods: Six focus groups were conducted with 30 clinicians. Transcripts were analyzed using a semi-deductive thematic analysis. The Consolidated Framework for Implementation Research was used to guide the identification of clinicians' perceived facilitators and barriers.

Results: Clinicians unanimously reported interest in implementing the C-BiLLT-CAN. Facilitators and barriers were classified into five primary themes. Key facilitators related to the test's evidence-based design, standardized nature, and potential flexibility. Key barriers related to Internet connectivity, the need to expand customization and response options to meet a greater breadth of needs, privacy policies, lack of resources, and perceived costs associated with equipment, training, and time.

Conclusions: Many perceived barriers aligned with previous European and Canadian C-BiLLT implementation research. However, findings elucidated unique considerations that will inform adaptations to the C-BiLLT-CAN and development of training/educational materials.

Purpose: This study aims to cross-culturally validate the Dutch version of the Lymphedema Symptom Intensity and Distress Survey-Head and Neck version 2.0 (LSIDS-H&N v2.0). This questionnaire assesses the impact of lymphedema and fibrosis symptoms in head and neck cancer (HNC) patients in terms of symptom intensity and related distress.

Materials and methods: The convergent validity, test-retest reliability, and internal consistency of the Dutch LSIDS-H&N v2.0 were investigated in 30 HNC patients. Convergent validity was examined by correlating LSIDS-H&N v2.0 scores with four other questionnaires: the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30 v3.0), Brief Pain Inventory Short Form (BPI-SF), Neck Disability Index (NDI), and Vanderbilt Head and Neck Symptom Survey version 2.0 (VHNSS v2.0). Eleven hypotheses were tested.

Results: Ten out of 11 hypotheses (91%) were accepted, confirming very strong convergent validity. The Dutch LSIDS-H&N v2.0 demonstrated strong to very strong test-retest reliability (ICCs of 0.792 to 0.963). Very strong internal consistency was demonstrated (Cronbach's α ranging from 0.883 to 0.981).

Conclusion: The Dutch LSIDS-H&N v2.0 proved to be a reliable and valid tool for assessing symptom burden and distress in HNC patients with potential lymphedema and/or fibrosis.

Trial registration: ClinicalTrials.gov, Identifier: NCT05256238 (S65549).

Purpose: To map the 3- and 6-month post-acute rehabilitation and healthcare networks from the perspective of people with Acquired Brain Injury and examine how these relate to funding provision and participation in a specialist transitional rehabilitation service.

Materials and methods: Fifteen adults with an Acquired Brain Injury (mean age 43; range 20-63) participated in semi-structured telephone interviews at 3- and 6-month post-discharge from inpatient rehabilitation with a total of 29 interviews conducted. The interview guide was based on a social network framework and data were obtained regarding the composition, size, density, and stability of networks.

Results: Results indicated that participants' networks ranged from 3-10 health professionals. Five typologies were apparent including cohesive, cluster, core, star, and kite network. Participants' networks generally decreased in size and density at 6-month post-discharge. The networks of participants were varied, and differences in network measures were observed when comparing those who were funded by National Injury Insurance Scheme-Queensland and National Disability Insurance Scheme and those that did or did not attend Transitional Rehabilitation Service.

Conclusions: The study highlighted the diversity of individuals' personal networks when assessing their composition and structural characteristics. Through the study, a deeper understanding of the networks and individuals' experiences of service provision under the existing funding and program frameworks was developed.

Purpose: To explore expectations and experiences of patients who have consulted a physiotherapist in primary healthcare for initial assessment and treatment of knee osteoarthritis (KOA), as well as exploring if this initial contact had affected patients' perceived health status and views of future self-management.

Material and methods: Fifteen participants seeking care for suspected KOA at five rehabilitation centres in Swedish primary healthcare were interviewed. An inductive approach was used. Data material was analysed using qualitative content analysis.

Results: The overall theme was "I want to be physically active as long as I live." Three categories emerged and resulted in eight sub-categories. Participants wanted to get back to their usual physical activities, and to feel free to move the way they wanted. The core treatment, including patient education and individual exercise programs, delivered by a physiotherapist gave patients increased knowledge concerning how to treat KOA on their own.

Conclusion: Participants saw the physiotherapist as a natural first option. It was believed that exercise was the primary treatment alternative to relieve symptoms and that self-management was necessary. The participants were optimistic and had hopes of being able to return to their usual physical activities again.

Clinical trial: Prospectively registered 2022-10-03 in clinicaltrials.gov, reference number: NCT05566925.

Purpose: Adolescents with developmental coordination disorder (DCD) face daily challenges that affect their well-being. Existing interventions for individuals with DCD target younger children. This study explored adolescents' perspectives on coping resources and professional support, to inform age-appropriate intervention protocol development.

Materials and methods: Informed by the interpretive phenomenological approach, semi-structured interviews were conducted with 11 adolescents with DCD.

Findings: Three themes emerged: (1) "How I help myself get rid of the monster" - perceived coping resources for daily functioning, including external sources, self-utilised strategies (planning, task breakdown), and adaptive mindsets focused on persistence and capabilities; (2) "I'm not sitting in a wheelchair" - varying attitudes toward professional support; some avoid it due to stigma or aspiration for self-reliance, while others value it despite practical barriers; and (3) "What I want it to be like" - the priorities and needs in professional support, which emphasized practical skills and emotional aspects, knowledge of DCD and how to explain it to others, and preferences for individualized or combined group settings.

Conclusions: The findings indicate that interventions for adolescents with DCD should focus on function-oriented approaches, combined with psycho-educational knowledge about the disorder and enhancement of their psychosocial resources, while respecting their independence and need for self-reliance.

Purpose: Older adults with hearing and/or vision impairment often face challenges in accessing appropriate support within home care services. This study investigated the hearing and/or vision support care needs of older Australians receiving home care, and assessed whether these needs were met.

Methods: Semi-structured interviews were conducted with 13 home care recipients (mean age 81.2 years, range 71-94) reporting hearing (n = 3), vision (n = 4) or dual sensory impairments (n = 6), and three family members. Interviews explored physical, psychological, and communication needs, healthcare system interactions, and support requirements. Data were analysed using Braun and Clarke's thematic analysis.

Results: Four themes were identified: (1) understanding individual circumstances is fundamental to personalised hearing and vision care, (2) importance of support networks, (3) enhancing device use and communication, and (4) maintaining home life and connection to community. Participants reported difficulties with device management, communication, and accessing appropriate care. The study revealed poor coordination between hearing/vision specialists and home care providers, alongside inadequate assessment and response to sensory needs within existing services.

Conclusions: Older Australians with hearing and/or vision impairment have distinct practical and psychosocial support needs that are not consistently addressed in current home care services. Findings suggest the need for integrated sensory care assessments and improved coordination between hearing/vision professionals and home care providers.

Purpose: This study aimed to develop a U.S.-specific reference equation for the 6-Minute Walk Test (6MWT) in individuals with Class III obesity and compare its performance with the Italian model by Capodaglio et al. The goal was to provide clinicians with a more accurate tool for assessing functional capacity.

Methods: A retrospective review was conducted on 307 adults with Class III obesity referred to outpatient physical therapy from 2017 to 2023. Of these, 295 completed the 6MWT. Multiple linear regression was used to build a predictive model using age, sex, and BMI as independent variables. The model was validated via internal cross-validation and compared with Capodaglio et al.'s equation. Subgroup analyses by age group were also conducted.

Results: The final model included age, BMI, and gender, explaining 41% of the variance in 6MWT distance. The mean absolute error was 53.2 meters, and the Spearman correlation was 0.67. Compared to Capodaglio's model, ours predicted 6.52% lower distances overall, with the largest differences in adults over 60.

Conclusion: The new U.S.-based model provides more accurate 6MWT predictions for individuals with Class III obesity, particularly older adults. It may help guide functional assessment and pre/post-metabolic and bariatric surgery care in this population.

Purpose: This knowledge translation (KT) descriptive study aimed to improve adherence to upper quadrant lymphedema clinical practice guideline (CPG) volume measurement recommendations.

Methods: Physical therapists and leaders from 3-outpatient clinics who receive referrals for surveillance and treatment of cancer-related upper quadrant lymphedema were included in this 2-year descriptive study. The Knowledge to Action and Consolidated Framework for Implementation Research were used to improve fidelity and adherence to CPG recommended practices.

Results: Clinicians and leaders scored highly on readiness for change questions at baseline. Chart audits (n = 176) showed improvement in all fidelity metrics: use of consistent increment of circumference measures improved from 0% to 94%, bilateral measures 43% to 94%, follow-up circumference measures 60% to 77%, and use of evidence-based volume difference metrics for appropriate referral 0% to 80%. Adherence decreased over time, ranging between 33% to 90% at the last chart audit. There was variability in the changes to clinician knowledge and beliefs about lymphedema measures documented at the end of the project.

Conclusions: This study demonstrated a feasible KT process to improve adherence to lymphedema measurement guidelines in outpatient clinics. Inconsistent adherence may impact clinical decision-making and limit patient access to appropriate care to manage this chronic condition.

Purpose: To understand the stroke recovery experience of Aboriginal Peoples living with stroke on Gamilaraay/Gomeroi country in New South Wales, Australia.

Materials and methods: Community participatory action research methods were undertaken incorporating individual and group yarn-ups with Aboriginal Peoples in the community living with stroke and their family. A non-Aboriginal qualitative researcher undertook inductive narrative analysis of the emergent themes in the yarns, with frequent review and input from Aboriginal and non-Aboriginal clinician researchers and the Aboriginal working group.

Results: Yarns were completed with (i) people living with stroke (n = 5, 60% female), (ii) family and carers of people living with stroke (n = 5, 80% female) and a (iii) well-established community group (n = 6, 100% female). The four themes were: (i) The role of family in stroke recovery, (ii) Trusted relationships with people aware of stroke and support options, (iii) Importance of culturally appropriate interactions with health service, and (iv) Disrespect and racism impacts stroke care access.

Conclusions: The role of family, trusted relationships, community connection, cultural safety and respect must be considered in improving the post-stroke quality of life for Aboriginal Peoples on Gamilaraay/Gomeroi country. These learnings can be used as a framework to inform future work with other Australian Aboriginal communities.*Our research group works with Aboriginal Peoples from Gamilaraay/Gomeroi country located in the North-western Plains of New South Wales Australia. We recognise the diversity of Aboriginal and Torres Strait Islander Peoples from across the many Countries of this place we now call Australia. Recognising this, throughout this text, we have used the preferred term "Aboriginal Peoples".