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Goal Setting with Head-injured Clients in a Multi-disciplinary Community-based Rehabilitation Team
Quality of Life in Rehabilitated Lower Limb Amputees S Sener F Uygur
Y Yakut A Karaduman ~~
There are only a few reports related to the life satisfaction of rehabilitated lower limb amputees and the effects of different fitting techniques on this satisfaction tOToole, 1985; Nissen, 1992; DeFretes, 1994). Thirty-nine above-knee amputees with a mean age of 31.46 years (range 19-44) were evaluated by means of t h e R e i n t e g r a t i o n of N o r m a l Living ( R N L i Questionnaire ( Wood-Dauphine, 1987 ). Eighteen of the amputees were given immediate post-operative prostheses (IPOP)while 21 were fitted after the stump had been stabilised in shape. The Mann-Whitney test was used for statistical analysis. Group differences in the overall RNL score were found to be statistically significant in favour of t h e 1PoP group ( P < 0.05,. Of t h e 11 statements i n t h e RNL index t h e difference between the two groups was most evident in statements regarding comfort in self-care needs, recreational activities, a n d self-confidence. Responses indicated t h a t while 77.784. 66.676 and
Rehabilitation Services and Physically Disabled Adults (16-65 years): A service users' perspective A G Crack ~~~~~
~
~
This research was initiated because changes were being proposed regarding rehabilitation services that could affect the quality of life for disabled people. On a larger scale, cultural and historical assumptions a b u t disabled people, and their needs and rights were being challenged. Rehabilitation and habilitation needs of young physically disabled people (aged 16-65 years) were sought from the perspective of service users, and the involvement of users in service planning and provision was discussed. Using grounded theory 30 disabled people, who within the past three years had received a health and social rehabilitation service, were interviewed. The interviews were recorded, transcribed and interpreted by the researcher. Social experiences and barriers such unsuitable transport systems, inadequate physical access, societal attitudes and employment difficulties as being the main problems. They also expressed difi-
66.67'k in the [POP p u p stated satisfaction (mre2 in survey scale); thew percentages were 28.57. 38.10 and 28.57 respectively in t h e aecond group. Both p u p s reported normal aatisfaction in indoor mobility, dissatisfaction in mohility on trips. and moderate impairment in social activities. We examined t h e impact of several variables on the RNL x o r e and found phantom limb as the only variable to reduce significantly the overall score in the Becond group tP < 0.06). We can conclude that achieving a physiologmd stump t h r o u g h e a r l y f i t t i n g is a n i m p o r t a n t factor i n improving t h e q u a l i t y of life a f t e r lower l i m b amputation. Rekmces DeFretes. A. Boorrstra, A M and Vos L D V (1994) 'FuncboMI outcome of rehabilitated bi-lateral lower limb amputees'. pmmrcs and m b c s ~ntemabonai.i 8 . i e - 2 4 Nissen. S J and Newman. W P (1992) Factors tnflueoctng reinlegrabon to normal living after amputam'. Archrves of Physrcal Medrnne and Rehablki+m 73 548-551 O ' T d e . D M. Gddberg, R T and Ryan, B ( 1 9 8 5 ) 'Fwctmnal changes in vascular amputee pabents Evaluatmn by Earthel Index. PULSES Prof& and ESCROW h k ' .68,508-51 1 Wood-Dauphin&S and Williams. J I (1987) Reintegration lo normal living as a proxy to quality of Me'. Journal ol C b m c Diseases. 40 491-499
culties in understanding the meaning of being disabled and personal problems associated with relationships, physical mobility and f u n h o n . Services were criticised for being introspective and lacking in coordination and participation of users in service planning and provision was considered little more than a public relations exercise. Disabled people showed interest in participating in service planning and provision but were unsure how they could become meanmgfdly involved.
Goal Setting with Head-injured Clients in a Multidisciplinary Community-based Rehabilitation Team C McCann This paper will describe a n innovative approach to goal s e t t i n g , t h e C o n t r a c t u a l l y O r g a n i s e d Goal System, t h a t h a s been developed by t h e Outreach Team. T h e Regional Neurological R e h a b i l i t a t i o n U n i t O u t r e a c h Project, based a t Homerton Hospital,
London, ie a random-allocation controlled trial evaluating the effectiveness of community-based rehabilitation for head-injured clients and their carers. We are funded by the Department of Health and a r e one of t h e 12 projects being e v a l u a t e d i n t h e N a t i o n a l Traumatic Brain Injury Study carried out by t h e University of Warwick.
Following aseeasment by the multidisciplinary team, long- and short-term goals are defined within overall Outreach Pmject goals. Therapy intervention is then jointly planned with clients and carers; a treatment contract is devised with clearly defined goals and performance is reviewed a t a n agreed interval and further treatment planned as indicated. The approach is individually tailored and flexible, responsibility for rehabilitation is shared between client and therapist a n d continued intervention i s based on objective evidence.
x presenting data on a sample of discharged I will l clients with regard to goal setting using project aims, long- and short-term goal achievement, number of treatment contra&, length of interventions and direct uet-sus indirect therapy time.
However, the project still h a s 18 months to run and no interim results are available. Data on client flow are shown below. Client Row
No of Treatment C O R ~ Discharged ~O~ group group referrals Pilot Phase
From community From R N R U
26
17
5
4
80
34 11
1 0
17
20
9 6
3
Tnal Phase
From community From RNRU
30
17
Non-partlclpants
Ineligible Assessed No goals Assessed Withdrew Assessed Treatment delayed Other Total
7 12 7
2 6 34
In lookmg at effectiveness of rehabilitation the study is evaluating several areas including mobility, functional independence, social integration, carer burden, and neuropsychoiogical functioning. A n u m b e r of outcome measures are being used.
Treatment group
To Load or Not to Load?
Six trained female nurses and two wheelchair users who were able to take some weight through their legs during transfers volunteered to evaluate the products in a laboratory environment. The users were allocated to two groups of equipment each. A t each session one nurse transferred t h e users with and without each product. between bed a n d wheelchair a n d between wheelchair and commode.
That is the Question
S Jackson
R Allen
H Marsden D L Mckltan
S GOm The need to assess t h e risk to carers when moving people with disabilities has been highlighted by the European C o m m u n i t i e s D i r e c t i v e on M a n u a l Handling (90/269/EEC ). The Royal College of Nursing Code of practice for the handling of patients advises t h e use of hoists for patients weighing over eight stones. This figure is derived from equations deterniining safe weight limits when lifhng a load. However, people with disabilities are usually able to take some weight through their legs. There is very little research looking a t the division of the load between the carer and the patient or the effectiveness of equipment designed to reduce the load on the carer when transferring a patient.
A biomechanical study of 1%transferring products was undertaken by t h e DEAC with t h e [Jnivcrsity of Southampton Mechanical Engineering Department (funded by t h e Medical Devices Agency. Departmcnt of Health, U K ) . The projects included t h r r e belts. three slings, two turntables and four transfer boards.
Completed treatment Active intervention On reviewipendingfurther treatment Total
35
27 7 66
Comprehensive force a t the L5/S1 disc at the time of maximum load was calculated from force measurem e n t s a n d video footage of t h e t r a n s f e r s using a biomechanical model detailed by Wax et a1 ( 1987). The results were well below t h e biomechanical critical value of 3.45 kN included in the National Institute of Occupational Safety a n d Health equation for t h e design and evaluation of manual lifting tasks. The study d a t a showed t h a t no potentially harmful movement patterns were employed when using the specified equipment. F u r t h e r work is indicated t o clarify the difference between lfting and transferring in order to determine safe limits which enable health professionals to encourage rehabilitation when transfrhrring people who are able to partially weight-bear. References Wax C Flenghi D and Meyer J P (1987) comparison de deux techniques de lever de charge Analyse biomecanique et couts physiologiques Le Travail Human 50 4
Y Yakut A Karaduman ~~
There are only a few reports related to the life satisfaction of rehabilitated lower limb amputees and the effects of different fitting techniques on this satisfaction tOToole, 1985; Nissen, 1992; DeFretes, 1994). Thirty-nine above-knee amputees with a mean age of 31.46 years (range 19-44) were evaluated by means of t h e R e i n t e g r a t i o n of N o r m a l Living ( R N L i Questionnaire ( Wood-Dauphine, 1987 ). Eighteen of the amputees were given immediate post-operative prostheses (IPOP)while 21 were fitted after the stump had been stabilised in shape. The Mann-Whitney test was used for statistical analysis. Group differences in the overall RNL score were found to be statistically significant in favour of t h e 1PoP group ( P < 0.05,. Of t h e 11 statements i n t h e RNL index t h e difference between the two groups was most evident in statements regarding comfort in self-care needs, recreational activities, a n d self-confidence. Responses indicated t h a t while 77.784. 66.676 and
Rehabilitation Services and Physically Disabled Adults (16-65 years): A service users' perspective A G Crack ~~~~~
~
~
This research was initiated because changes were being proposed regarding rehabilitation services that could affect the quality of life for disabled people. On a larger scale, cultural and historical assumptions a b u t disabled people, and their needs and rights were being challenged. Rehabilitation and habilitation needs of young physically disabled people (aged 16-65 years) were sought from the perspective of service users, and the involvement of users in service planning and provision was discussed. Using grounded theory 30 disabled people, who within the past three years had received a health and social rehabilitation service, were interviewed. The interviews were recorded, transcribed and interpreted by the researcher. Social experiences and barriers such unsuitable transport systems, inadequate physical access, societal attitudes and employment difficulties as being the main problems. They also expressed difi-
66.67'k in the [POP p u p stated satisfaction (mre2 in survey scale); thew percentages were 28.57. 38.10 and 28.57 respectively in t h e aecond group. Both p u p s reported normal aatisfaction in indoor mobility, dissatisfaction in mohility on trips. and moderate impairment in social activities. We examined t h e impact of several variables on the RNL x o r e and found phantom limb as the only variable to reduce significantly the overall score in the Becond group tP < 0.06). We can conclude that achieving a physiologmd stump t h r o u g h e a r l y f i t t i n g is a n i m p o r t a n t factor i n improving t h e q u a l i t y of life a f t e r lower l i m b amputation. Rekmces DeFretes. A. Boorrstra, A M and Vos L D V (1994) 'FuncboMI outcome of rehabilitated bi-lateral lower limb amputees'. pmmrcs and m b c s ~ntemabonai.i 8 . i e - 2 4 Nissen. S J and Newman. W P (1992) Factors tnflueoctng reinlegrabon to normal living after amputam'. Archrves of Physrcal Medrnne and Rehablki+m 73 548-551 O ' T d e . D M. Gddberg, R T and Ryan, B ( 1 9 8 5 ) 'Fwctmnal changes in vascular amputee pabents Evaluatmn by Earthel Index. PULSES Prof& and ESCROW h k ' .68,508-51 1 Wood-Dauphin&S and Williams. J I (1987) Reintegration lo normal living as a proxy to quality of Me'. Journal ol C b m c Diseases. 40 491-499
culties in understanding the meaning of being disabled and personal problems associated with relationships, physical mobility and f u n h o n . Services were criticised for being introspective and lacking in coordination and participation of users in service planning and provision was considered little more than a public relations exercise. Disabled people showed interest in participating in service planning and provision but were unsure how they could become meanmgfdly involved.
Goal Setting with Head-injured Clients in a Multidisciplinary Community-based Rehabilitation Team C McCann This paper will describe a n innovative approach to goal s e t t i n g , t h e C o n t r a c t u a l l y O r g a n i s e d Goal System, t h a t h a s been developed by t h e Outreach Team. T h e Regional Neurological R e h a b i l i t a t i o n U n i t O u t r e a c h Project, based a t Homerton Hospital,
London, ie a random-allocation controlled trial evaluating the effectiveness of community-based rehabilitation for head-injured clients and their carers. We are funded by the Department of Health and a r e one of t h e 12 projects being e v a l u a t e d i n t h e N a t i o n a l Traumatic Brain Injury Study carried out by t h e University of Warwick.
Following aseeasment by the multidisciplinary team, long- and short-term goals are defined within overall Outreach Pmject goals. Therapy intervention is then jointly planned with clients and carers; a treatment contract is devised with clearly defined goals and performance is reviewed a t a n agreed interval and further treatment planned as indicated. The approach is individually tailored and flexible, responsibility for rehabilitation is shared between client and therapist a n d continued intervention i s based on objective evidence.
x presenting data on a sample of discharged I will l clients with regard to goal setting using project aims, long- and short-term goal achievement, number of treatment contra&, length of interventions and direct uet-sus indirect therapy time.
However, the project still h a s 18 months to run and no interim results are available. Data on client flow are shown below. Client Row
No of Treatment C O R ~ Discharged ~O~ group group referrals Pilot Phase
From community From R N R U
26
17
5
4
80
34 11
1 0
17
20
9 6
3
Tnal Phase
From community From RNRU
30
17
Non-partlclpants
Ineligible Assessed No goals Assessed Withdrew Assessed Treatment delayed Other Total
7 12 7
2 6 34
In lookmg at effectiveness of rehabilitation the study is evaluating several areas including mobility, functional independence, social integration, carer burden, and neuropsychoiogical functioning. A n u m b e r of outcome measures are being used.
Treatment group
To Load or Not to Load?
Six trained female nurses and two wheelchair users who were able to take some weight through their legs during transfers volunteered to evaluate the products in a laboratory environment. The users were allocated to two groups of equipment each. A t each session one nurse transferred t h e users with and without each product. between bed a n d wheelchair a n d between wheelchair and commode.
That is the Question
S Jackson
R Allen
H Marsden D L Mckltan
S GOm The need to assess t h e risk to carers when moving people with disabilities has been highlighted by the European C o m m u n i t i e s D i r e c t i v e on M a n u a l Handling (90/269/EEC ). The Royal College of Nursing Code of practice for the handling of patients advises t h e use of hoists for patients weighing over eight stones. This figure is derived from equations deterniining safe weight limits when lifhng a load. However, people with disabilities are usually able to take some weight through their legs. There is very little research looking a t the division of the load between the carer and the patient or the effectiveness of equipment designed to reduce the load on the carer when transferring a patient.
A biomechanical study of 1%transferring products was undertaken by t h e DEAC with t h e [Jnivcrsity of Southampton Mechanical Engineering Department (funded by t h e Medical Devices Agency. Departmcnt of Health, U K ) . The projects included t h r r e belts. three slings, two turntables and four transfer boards.
Completed treatment Active intervention On reviewipendingfurther treatment Total
35
27 7 66
Comprehensive force a t the L5/S1 disc at the time of maximum load was calculated from force measurem e n t s a n d video footage of t h e t r a n s f e r s using a biomechanical model detailed by Wax et a1 ( 1987). The results were well below t h e biomechanical critical value of 3.45 kN included in the National Institute of Occupational Safety a n d Health equation for t h e design and evaluation of manual lifting tasks. The study d a t a showed t h a t no potentially harmful movement patterns were employed when using the specified equipment. F u r t h e r work is indicated t o clarify the difference between lfting and transferring in order to determine safe limits which enable health professionals to encourage rehabilitation when transfrhrring people who are able to partially weight-bear. References Wax C Flenghi D and Meyer J P (1987) comparison de deux techniques de lever de charge Analyse biomecanique et couts physiologiques Le Travail Human 50 4