Improving the uptake of pulmonary rehabilitation in patients with COPD : qualitative study of experiences and attitudes

Background
Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status.

Aim
To identify a strategy for improving the uptake of pulmonary rehabilitation.

Design of study
Qualitative interviews with patients.

Setting
Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK.

Method
In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory.

Results
Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating.

Conclusion
A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake.

Resolving conflicts in fire management using decision theory: asset-protection versus biodiversity conservation

Agencies charged with nature conservation and protecting built-assets from fire face a policy dilemma because management that protects assets can have adverse impacts on biodiversity. Although conservation is often a policy goal, protecting built-assets usually takes precedence in fire management implementation. To make decisions that can better achieve both objectives, existing trade-offs must first be recognized, and then policies implemented to manage multiple objectives explicitly. We briefly review fire management actions that can conflict with biodiversity conservation. Through this review, we find that common management practices might not appreciably reduce the threat to built-assets but could have a large negative impact on biodiversity. We develop a framework based on decision theory that could be applied to minimize these conflicts. Critical to this approach is (1) the identification of the full range of management options and (2) obtaining data for evaluating the effectiveness of those options for achieving asset protection and conservation goals. This information can be used to compare explicitly the effectiveness of different management choices for conserving species and for protecting assets, given budget constraints. The challenge now is to gather data to quantify these trade-offs so that fire policy and practices can be better aligned with multiple objectives

The therapeutic alliance : a theoretical revision for offender rehabilitation

The desired outcome of psychotherapy is positive change. A substantial body of empirical research now supports the importance of the therapeutic alliance in predicting therapeutic change. Research on therapeutic process has also been increasing. Despite these achievements, there is little theoretical understanding of how the therapeutic alliance develops and is maintained. What are the key variables in the establishment of a collaborative relationship between therapist and client that can elicit positive change in the client? Recent interest in client responsivity and effective therapy process with offenders has shed light on how little relevant theory and research exists on process issues in offender rehabilitation, compared to conventional psychotherapy. Although the general ingredients of a therapeutic alliance may be similar across therapy contexts, difficulties in creating these alliances with offenders can prompt a more complete examination of these ingredients. This article examines and critiques the dominant model of the therapeutic alliance proposed by Bordin [Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.], and then integrates it with recent research, theory, and clinical observation from the field of offender rehabilitation, to propose a Revised Theory of the Therapeutic Alliance that is particularly relevant for therapists who work to reduce future risk of criminal behavior.

Dignity, rights and capabilities in clinical rehabilitation

Purpose. The purpose of this article is to explore three concepts namely dignity, human rights and capabilities and to argue for their relevance in advancing the theory and practice of rehabilitation.

Method. A narrative review of selected academic writing on the three constructs is considered with respect to the rehabilitation literature.

Results. Each concept is defined and technical terms are explained for readers unfamiliar with these topics. Salient aspects of academic or scientific writing on each of these three topics is summarised and attempts are made to integrate these with rehabilitation.

Conclusions. Dignity, rights and capabilities are three concepts that have the potential to enhance theory development in rehabilitation.

Is offender rehabilitation a form of punishment?

This paper examines the consequences of the overlap between punishment and rehabilitation practices, and inquires into the implications for individuals who assess and treat offenders. More specifically, I make three claims concerning the relationship between offender rehabilitation and punishment. First, rehabilitation as it is commonly understood in the offending arena contains some components that meet the criteria for punishment, in the ethical sense of that term. It is also true that there are aspects of rehabilitation that are focused directly on assisting offenders to live better lives (higher levels of well-being) and therefore which do not meet the criteria for punishment. Second, there are a number of significant practice implications that follow from the hybrid nature of offender rehabilitation. Third, Duff's communicative theory of punishment (Duff, 2001) offers clinicians a stronger justification for the punishment aspects of rehabilitation than its retributive and consequential rivals.

Rehabilitation, etiology, and self-regulation : the comprehensive good lives model of treatment for sexual offenders

In this paper, we draw upon two sets of theoretical resources to develop a comprehensive theory of sexual offender rehabilitation named the Good Lives Model-Comprehensive (GLM-C). The original Good Lives Model (GLM-O) forms the overarching values and principles guiding clinical practice in the GLM-C. In addition, the latest sexual offender theory (i.e., the Integrated Theory of Sexual Offending; ITSO) provides a clear etiological grounding for these principles. The result is a more substantial and improved rehabilitation model that is able to conceptually link latest etiological theory with clinical practice. Analysis of the GLM-C reveals that it also has the theoretical resources to secure currently used self-regulatory treatment practice within a meaningful structure.

The good lives model of offender rehabilitation : clinical implications

The major aim of the current paper is to expand on the practice elements of the Good Lives Model-Comprehensive (GLM-C) of offender rehabilitation and to provide a detailed examination of its assessment and treatment implications. First we discuss the notion of rehabilitation and the qualities a good theory of rehabilitation should possess. Second, the principles, etiological assumptions, and general treatment implications of the GLM-C are briefly described. Third, we outline in considerable detail the application of this novel perspective to the assessment and treatment of sexual offenders. Finally, we conclude the paper with a summary of the major benefits we envisage the GLM-C bringing to the rehabilitation of sexual offenders.

Repairing the rupture : restorative justice and the rehabilitation of offenders

Restorative justice is a social justice movement that aims to deal with consequences of crime through repairing and restoring relationships of three key stakeholders: victims, offenders, and communities. Unfortunately, it is often unclear where offender rehabilitation fits within the constructs of repair and reintegration that drive this justice paradigm. An analysis of the relationship between restorative justice theory and offender rehabilitation principles reveals tensions between the two normative frameworks and a lack of appreciation that correctional treatment programs have a legitimate role alongside restorative practices. First, we outline the basic tenets of the Risk–Need–Responsivity Model and the Good Lives Model in order to provide a brief overview of two recent models of offender rehabilitation. We then consider the claims made by restorative justice proponents about correctional rehabilitation programs and their role in the criminal justice system. We conclude that restorative justice and rehabilitation models are distinct, although overlapping, normative frameworks and have different domains of application in the criminal justice system, and that it is a mistake to attempt to blend them in any robust sense.

Measurement of stable changes of self-management skills after rehabilitation: a latent state-trait analysis of the Health Education Impact Questionnaire (heiQ™)

To assess stable effects of self-management programs, measurement instruments should primarily capture the attributes of interest, for example, the self-management skills of the measured persons. However, measurements of psychological constructs are always influenced by both aspects of the situation (states) and aspects of the person (traits). This study tests whether the Health Education Impact Questionnaire (heiQ™), an instrument assessing a wide range of proximal outcomes of self-management programs, is primarily influenced by person factors instead of situational factors. Furthermore, measurement invariance over time, changes in traits and predictors of change for each heiQ™ scale were examined.

Measurement of stable changes of self-management skills after rehabilitation: a latent state–trait analysis of the Health Education Impact Questionnaire (heiQ™)

Methods: Subjects were N = 580 patients with rheumatism, asthma, orthopedic conditions or inflammatory bowel disease, who filled out the heiQ™ at the beginning, the end of and 3 months after a disease-specific inpatient rehabilitation program in Germany. Structural equation modeling techniques were used to estimate latent trait-change models and test for measurement invariance in each heiQ™ scale. Coefficients of consistency, occasion specificity and reliability were computed.

The Integrating Theory, Evidence and Action (ITEA) method: a procedure for helping practitioners translate theory and research into action

Introduction: The aim of this article is to describe and explain a new method for integrating theory and evidence that enables practitioners to translate evidence into action applied in their practice. Method: A new multiple methods procedure called the Integrating Theory, Evidence and Action method is described. It is a mixed method that progresses through seven distinct steps: clinical question, framework, identification, deconstruction, analysis, reconstruction, and transfer/utilization. An example of using this method to review evidence around occupational therapy with people recovering from alcohol misuse and/or abuse is provided. Findings: This method highlights the importance of theory, tests the empirical strength of theories, includes diverse forms of evidence, and encourages the integration of knowledge within clinical practice. Conclusion: The Integrating Theory, Evidence and Action method is accessible and useful to practitioners and will support their efforts to make their practice evidence based. Current methods of evidence-based practice focus mostly on research evidence (particularly quantitative evidence); however, research is only one of the ways of knowing that practitioners draw upon to guide their practice. This method enables occupational therapists to integrate theory, evidence, and practice in a coherent and translatable way.

Muscle lesion treatment in Brazilian soccer players: Theory vs. Practice

Background: In this study we evaluated the rehabilitation profile of Brazilian soccer players which underwent lower limb muscle lesions.Methods: This is a descriptive investigation. We evaluated 139 professional soccer players (1724 years old). We evaluated the following variables: muscle lesion diagnosis, symptoms, non steroidal anti-inflammatory used, physiotherapy treatment, which physiotherapy recourses was used if treated and train adaptation.Results: In great part of the athletes muscle lesion remained between 2 weeks and 1 month. Around 54% were diagnosed by a physician; the other part was diagnosed by a physical therapist. Non steroidal anti-inflammatory were prescribed by physicians in 42% of the cases; in 7% the physical therapist prescribed the medication while in 49% of the cases the masseur prescribed the drug. More than 1/4 of the athletes received physiotherapy treatement between 48 hours and 5 days. Isometric exercise therapy was applied in 15% of the cases. 63% were not accompanied by the physiotherapist on their return to the field. 48% received massages immediately after injury.Conclusion: We presented discrepancy between the recommended theory described by several researches and the practice. We indicate the necessity of recycling in a general context the rehabilitation of muscle injuries.

Muscle lesion treatment in Brazilian soccer players: theory vs. practice

Background: In this study we evaluated the rehabilitation profile of Brazilian soccer players which underwent lower limb muscle lesions. Methods: This is a descriptive investigation. We evaluated 139 professional soccer players (1724 years old). We evaluated the following variables: muscle lesion diagnosis, symptoms, non steroidal anti-inflammatory used, physiotherapy treatment, which physiotherapy recourses was used if treated and train adaptation. Results: In great part of the athletes muscle lesion remained between 2 weeks and 1 month. Around 54% were diagnosed by a physician; the other part was diagnosed by a physical therapist. Non steroidal anti-inflammatory were prescribed by physicians in 42% of the cases; in 7% the physical therapist prescribed the medication while in 49% of the cases the masseur prescribed the drug. More than 1/4 of the athletes received physiotherapy treatement between 48 hours and 5 days. Isometric exercise therapy was applied in 15% of the cases. 63% were not accompanied by the physiotherapist on their return to the field. 48% received massages immediately after injury. Conclusion: We presented discrepancy between the recommended theory described by several researches and the practice. We indicate the necessity of recycling in a general context the rehabilitation of muscle injuries.

Synthesis of Hand Exoskeletons for the Rehabilitation of Post-Stroke Patients

This dissertation presents the synthesis of a hand exoskeleton (HE) for the rehabilitation of post-stroke patients. Through the analysis of state-of-the-art, a topological classification was proposed. Based on the proposed classification principles, the rehabilitation HEs were systematically analyzed and classified. This classification is helpful to both understand the reason of proposing certain solutions for specific applications and provide some useful guidelines for the design of a new HE, that was actually the primary motivation of this study. Further to this classification, a novel rehabilitation HE was designed to support patients in cylindrical shape grasping tasks with the aim of recovering the basic functions of manipulation. The proposed device comprises five planar mechanisms, one per finger, globally actuated by two electric motors. Indeed, the thumb flexion/extension movement is controlled by one actuator whereas a second actuator is devoted to the control of the flexion/extension of the other four fingers. By focusing on the single finger mechanism, intended as the basic model of the targeted HE, the feasibility study of three different 1 DOF mechanisms are analyzed: a 6-link mechanism, that is connected to the human finger only at its tip, an 8-link and a 12-link mechanisms where phalanges and articulations are part of the kinematic chain. The advantages and drawbacks of each mechanism are deeply analyzed with respect to targeted requirements: the 12-link mechanism was selected as the most suitable solution. The dimensional synthesis based on the Burmester theory as well as kinematic and static analyses were separately done for all fingers in order to satisfy the desired specifications. The HE was finally designed and a prototype was built. The experimental results of the first tests are promising and demonstrate the potential for clinical applications of the proposed device in robot-assisted training of the human hand for grasping functions.

Referral to rehabilitation following traumatic brain injury: a model for understanding inequities in access

Identifying inequities in access to health care requires critical scrutiny of the patterns and processes of care decisions. This paper describes a conceptual model. derived from social problems theory. which is proposed as a useful framework for explaining patterns of post-acute care referral and in particular, individual variations in referral to rehabilitation after traumatic brain injury (TBI). The model is based on three main components: (1) characteristics of the individual with TBI, (2) activities of health care professionals and the processes of referral. and (3) the contexts of care. The central argument is that access to rehabilitation following TBI is a dynamic phenomenon concerning the interpretations and negotiations of health care professionals. which in turn are shaped by the organisational and broader health care contexts. The model developed in this paper provides opportunity to develop a complex analysis of post-acute care referral based on patient factors, contextual factors and decision-making processes. It is anticipated that this framework will have utility in other areas examining and understanding patterns of access to health care. (C) 2002 Elsevier Science Ltd. All rights reserved.