Program evaluation in rehabilitation

Increased accountability and more encompassing accreditation standards have heightened interest in the role that evaluation research plays in improving the quality of life and independence for people with disabilities. The field of Program Evaluation is a valuable resource for conducting studies that meet the standards and information needs in the field of rehabilitation. This article describes the nature of evaluation research and illustrates its contribution to contemporary rehabilitation practice.     

The Prison Cage as Home for African American Men

Through critical discourse analysis I describe the impact of incarceration as seen in narratives that underlie the overrepresentation of Blacks in American prisons. Much of my research illustrates how narratives can show the moral agency required for rehabilitation. This article shows the context into which that moral agency fits and calls for a critical literacy for communities to understand incarceration and its effects on family and society.     

A Counseling Plan for Randall

The “Case of Randall” illustrates many common issues that underlie the provision of career counseling to individuals with brain injury. Often, brain-injured individuals experience a diminished capacity to perform work-related functions, and require anywhere from 6 months to 5 years of rehabilitation before they are ready for job placement. As Kay, Ezrachi, and Cavallo (1986) have noted, the rate of return to work among brain-injured individuals is between 25% and 75%. Hence, the length of rehabilitation time required by Randall is not unusual. As is true with Randall, many individuals who have suffered brain injury have difficulty adjusting to changes in their cognitive and physical functioning. Frequently, these individuals experience anger and frustration, and have difficulty accepting and understanding their newfound limitations.     

The multi-disciplinary nature of low vision rehabilitation--a case report

This paper presents the case of a 47-year-old female with low vision secondary to high myopic macular degeneration who remains active in the work force as a spiritual and religious care coordinator for a large institution. An ophthalmologist with a specialty in low vision rehabilitation initially assessed the client. The ophthalmologist prescribed optical devices which used residual retinal vision available at preferred retinal loci. This availed better vision for viewing targets located at far, near and intermediate distances from the client. An optician provided and dispensed the devices prescribed to the client. Additionally, the ophthalmologist made a referral to an occupational therapist. The occupational therapist conducted a series of sessions to further enhance reading and writing skills and a work place assessment aimed at optimizing workplace conditions in order to achieve optimal functional vision. This case illustrates and emphasizes the multi-disciplinary nature of low vision rehabilitation, which involved in this case co-operation between ophthalmology, occupational therapy and opticianry.     

Towards Employment: What Research Says About Support-to-Work in Relation to Psychiatric and Intellectual Disabilities

This article presents an overview of research about support-to-work in relation to psychiatric and intellectual disabilities. The overview shows that support-to-work services are multifaceted, and that work can be seen as a tool for individual rehabilitation or as a set of goals to achieve. Providers are presented with specific components, which are characterized by systematic, targeted, and individualized interventions. The overview illustrates a need for long-term engagement and cooperation of and between welfare services and agents within the labor market to dissolve the Gordian knot that the transition from welfare interventions to employment seems to be.     

Assessment of workplace product accessibility: a human factors perspective

This paper illustrates the advantages of using human factors evaluation techniques as a method of informing rehabilitation service provider decisions about client care and assistive technology selection. Successful integration of accessibility evaluation techniques can strengthen an evidence based service program and offer service providers another tool for providing efficient, effective, and rapid services to individuals in need. With accessibility evaluation data showing the functional abilities required to operate a given product or set of products, it is possible to empirically demonstrate that an individual has the potential to successfully utilize the provided workplace equipment. Conversely, if the accessibility evaluation data reveal that the functional capabilities required to use a product exceed the capabilities of a given user, it would be possible to demonstrate the need for particular interventions or accommodations. With accessibility evaluation data, service providers can make better informed decisions about client care.     

Book Reviews

Critical appraisal of research studies forms a central role within the application and uptake of evidence‐based approaches within health and social care. While there are established checklists for evaluating quantitative research, this is not the case for qualitative research. This article outlines the process of developing an evaluative tool for qualitative studies, reflecting the uniqueness of the associated paradigm, and illustrates its use by reference to three qualitative research papers appraised within a systematic review of community‐based rehabilitation services. At its centre are concerns with the context of the study and the way the data are collected and analysed. Use of such an evaluative template opens the way for the quality of qualitative research to be judged in a systematic manner and for qualitative research to take its rightful place within debates over what works, where, when and how within health and social care policy and practice.     

Representations of Physical Disability in Colonial Zimbabwe: the Cyrene Mission and Pitaniko, the Film of Cyrene

Pitaniko, the Film of Cyrene is a unique short film, created in 1946 in part to popularize the work of Cyrene and its founder, the Reverend Edward George (Ned) Paterson. The film is the story of the mission, told through the transformation of the life of a disabled young man, Samuel Songo, who portrays Pitaniko, first through his experience of rejection at his village and then at the Cyrene mission. In Pitaniko , physical disability is viewed in two worlds, one African, the other the world of the Cyrene mission, befitting the colonial contrasts of the primitive and the civilized. The meaning of rehabilitation is derived from the transformation from the African world into the world of the Cyrene mission through the medium of art, and ultimately, through conversion into Christianity. Disability is first an opportunity and later a symbol that illustrates and enhances the mission of Cyrene.     

How can cooperation between rehabilitation professionals in rehabilitation planning be improved? A qualitative study from the employer's perspective

Research shows that there are often problems with cooperation between rehabilitation professionals within vocational rehabilitation. The aim of this study was to describe employers' experiences of how cooperation between different rehabilitation professionals can be improved in a vocational rehabilitation planning process. Ten employers who had sent their employees to vocational rehabilitation at a rehabilitation centre in the north of Sweden during 2000 and 2001 participated in the study. Qualitative interviews were performed and analysed by thematic content analysis. The employers' cooperation with clients could be improved by a focus on clients' needs and participation in the rehabilitation process. The employers cooperation with Social Insurance companies could be improved by, 1) early prevention and intervention, 2) knowledge of each other's roles, responsibilities and opportunities and 3) priority making. The employers' cooperation with rehabilitation professionals could be improved by, 1) early identification of rehabilitation needs and goals and early rehabilitation and, 2) increased focus on own responsibilities from each part in the process.     

Features of occupational rehabilitation systems in Australia: a map through the maze

This review contributes to the limited literature on systems of occupational rehabilitation in Australia. Occupational rehabilitation is defined and features of occupational rehabilitation systems within the workers' compensation framework are described. Common features include: (a) the trend to workplace management, (b) preferred rehabilitation program settings and (c) widespread acceptance of some identified principles of occupational rehabilitation. Other features such as roles of stakeholders and participants, relationship of rehabilitation providers and employers, and the services provided have a number of variations in the Australian systems. Similarities and differences between features of Australian and North American systems are noted. Implications for occupational rehabilitation providers are discussed, and recommendations for practice and future research are made.     

Proprietary rehabilitation: Challenges and opportunities in the new millennium

Proprietary rehabilitation has developed into a distinct professional sector with procedures, practices, and philosophy that differ from those in the public rehabilitation program. As the new millennium commences, proprietary rehabilitation will face a variety of challenges and opportunities that could affect the future of this sector of the rehabilitation profession. Among these issues are changes in occupational information upon which many proprietary rehabilitation practices are based; increased opportunities for early intervention and establishment of disability management programs within industry; adjustment to the movement to a managed health care system; and the necessity to demonstrate fiscal efficacy of rehabilitation services to workers with compensable injuries. This article discusses these issues and suggests some ways in which those involved in proprietary rehabilitation can properly position themselves to address and benefit from these challenges and opportunities.     

Summary report of action research on occupational rehabilitation and community re-integration of migrant workers with work injuries in Mainland China

This article is a summary of an action research exploring the strategies to initiate the occupational rehabilitation and community re-integration of migrant workers with work injuries in Guangdong Province, China. Using two cases of rehabilitation intervention for workers with work injury, a case management model of occupational rehabilitation and community re-integration was illustrated, in the different phases of rehabilitation. Finally, some key elements in supporting occupational rehabilitation and community re-integration for migrant workers with work injury in China were highlighted.     

Design considerations for a theory-driven exergame-based rehabilitation program to improve walking of persons with stroke

Virtual rehabilitation approaches for promoting motor recovery has attracted considerable attention in recent years. It appears to be a useful tool to provide beneficial and motivational rehabilitation conditions. Following a stroke, hemiparesis is one of the most disabling impairments and, therefore, many affected people often show substantial deficits in walking abilities. Hence, one of the major goals of stroke rehabilitation is to improve patients' gait characteristics and hence to regain their highest possible level of walking ability. Because previous studies indicate a relationship between walking and balance ability, this article proposes a stroke rehabilitation program that targets balance impairments to improve walking in stroke survivors. Most currently, available stroke rehabilitation programs lack a theory-driven, feasible template consistent with widely accepted motor learning principles and theories in rehabilitation. To address this hiatus, we explore the potential of a set of virtual reality games specifically developed for stroke rehabilitation and ordered according to an established two-dimensional motor skill classification taxonomy. We argue that the ensuing “exergame”-based rehabilitation program warrants individually tailored balance progression in a learning environment that allows variable practice and hence optimizes the recovery of walking ability.     

Intentions and realities in rehabilitation service in Denmark

We used Danish register data on rehabilitation benefits paid from 1994 to 2005. The purpose was to compare actual payments of rehabilitation benefits with intentions in the law. Legally, rehabilitation benefits should be used for providing living expenses during a planned rehabilitation period facilitating the recipients' return to the labor market. We found that one third of recipients were paid for less than 3 months, and half of remaining recipients had time gaps in their payments. The findings indicated that rehabilitation benefits were not paid only for planned rehabilitation periods, and that not all recipients followed the legally required plan.     

Work rehabilitation programs: a 1997 survey

By adapting to the changing health care environment, legislative reforms, and consumer needs, work rehabilitation programs have experienced a metamorphosis. This study surveyed occupational therapists currently employed in work programs to ascertain a current demographic profile of work rehabilitation programs. Respondents indicated the delivery of services in the areas of prevention, assessment and rehabilitation. The majority of work rehabilitation programs in this study provide services in the form of ergonomics, education and training, and job analyses at the worksite. The area of work injury prevention services is forecasted for increased growth among work rehabilitation programs.     

Rehabilitation Contexts: A Holistic Approach

Psychosocial rehabilitation involves a gamut of activities that need to be personalized to suit an individual's needs. The context in which rehabilitation occurs greatly influences the range and availability of rehabilitation services and their utilization. This study attempts to highlight the contextual factors, with specific reference to globalization and development, the scope of rehabilitation, and the continuum of rehabilitation services that have a bearing on an individual's recovery. The relevance and effectiveness of the bio-psycho-social-spiritual approach in making services more pertinent and applicable are discussed. Implications for program development and policy interventions are suggested. It is hoped that this study will draw attention to the need for openness to a broad range of services even while using specific interventions.     

Work injury rehabilitation and the tendency to return to work of workers with injuries in Mainland China

This paper aims to describe the current situation of the work injury rehabilitation system in China with its drawbacks, especially relating to the employment services for workers with injuries and bringing up the topic of the need for more work to attempt to construct a modern work injury occupational rehabilitation system: perfecting the administration mechanism of policy, establishing an occupational rehabilitation pattern with Chinese characteristics, establishing the socialization service network as the core of occupational rehabilitation and establishing a practical professional team and academic communication platform. These creative thoughts may shed light on the development of the work injury rehabilitation system as well as the return to work for workers with injuries in China.     

Work injury rehabilitation in Guangzhou: 380 case cohort study

Work injury rehabilitation is a new concept in Mainland China. In 2001, the first work injury rehabilitation centre was established in Guangzhou under the management of the Guanghzhou Bureau of Labour and Security. This paper reviews the profile of a cohort of workers with injuries who received rehabilitation services at this centre. The changes in the physical capacity, daily function, and quality of life of the workers with injuries before and after the treatment services were also reviewed. A total of 380 were extracted from the database which occupied 79% of the total patient population admitted to the centre between 2003 to 2004. The assessment results suggested that workers with injuries showed increases in physical capacity in terms of the range of motion, muscle strength and walking tolerance. The daily functioning by using Barthel Index was also improved. Quality of life assessed with the WHOQOL also demonstrated an increase in the physical and psychological domains. Work injury rehabilitation in Guangzhou is at its infancy stage. The cooperation between the rehabilitation centre, employers and workers is of the utmost importance for a successful return to work outcome. The workers' compensation and rehabilitation policy also dictates the future of success of the rehabilitation services.     

Intervention options: Participation in work activities for people with schizophrenia

Vocational rehabilitation is a method by which people with disabilities are able to learn skills and receive supports that are necessary to take part in work activities. Vocational rehabilitation interventions can be used in a wide variety of settings with many different populations of people with disabilities, including those with schizophrenia. However, there is little available research to help guide clinicians to identify which vocational rehabilitation intervention methods may be the most effective for their clients. OBJECTIVES: The purpose of this paper is to identify what is the best practice for obtaining and maintaining participation in work activities for people with schizophrenia. STUDY DESIGN: This paper reviewed sixteen previously conducted studies (seven specific solely to schizophrenia) to identify which vocational rehabilitation method is the best practice to aid those with schizophrenia to obtain and maintain participation in work activities. RESULTS: The reviewed literature suggests that there are a variety of vocational rehabilitation intervention methods that may be effective treatment interventions. The effective interventions were those programs that had a client-centered approach and enabled the client to play an active role in his/her vocational rehabilitation. CONCLUSION: With this study review, clinicians will be able to examine a variety of successful client-centered vocational rehabilitation methods that may aid in helping their clients with schizophrenia to obtain and maintain participation in work activities.     

Multi-professional vocational rehabilitation group meetings with female clients: a qualitative study

Many women require vocational rehabilitation before they can return to work. The objective with the present study was to describe female clients' situation during the rehabilitation process, as it became apparent during the rehabilitation meetings with the various actors involved. The clients' diagnoses varied, but the majority was affected with musculoskeletal disorders. The meetings were audio-taped and transcribed verbatim, after which they were analysed by qualitative content analysis. The following themes emerged: Adaptation to the rehabilitation group; client's health status; the workplace's significance for rehabilitation; and the client's decision-point. Conflict between health and work was immensely important for rehabilitation. Differences in attitude were apparent during the rehabilitation meetings, as some clients were passive and exercised less influence on the planning, than the other more active clients did.