A good lives model of clinical and community rehabilitation

Aims of the paper. The aim of this paper was to introduce the Good Lives Model, originally developed for offender rehabilitation, to the clinical rehabilitation community. We argue that this model has considerable promise, both as a ‘thinking tool’ and as an integrative framework emphasizing the centrality of the person in clinical and community rehabilitation for complex and chronic health conditions.

Key findings and implications. The essential features of a good rehabilitation theory are first outlined. These are the general principles and assumptions that underpin a theory, the aetiological assumptions and the intervention implications. The Good Lives Model for clinical rehabilitation is then described in terms of these three components of a good rehabilitation theory.

Conclusions and recommendations. The Good Lives Model has considerable promise as a tool for integrating many diverse aspects of current best practice in rehabilitation while maintaining the individual client as the central focus. At the same time it is provisional and further theoretical development and empirical support is required.

Artificial metaplasticity prediction model for cognitive rehabilitation outcome in acquired brain injury patients

Objective The main purpose of this research is the novel use of artificial metaplasticity on multilayer perceptron (AMMLP) as a data mining tool for prediction the outcome of patients with acquired brain injury (ABI) after cognitive rehabilitation. The final goal aims at increasing knowledge in the field of rehabilitation theory based on cognitive affectation. Methods and materials The data set used in this study contains records belonging to 123 ABI patients with moderate to severe cognitive affectation (according to Glasgow Coma Scale) that underwent rehabilitation at Institut Guttmann Neurorehabilitation Hospital (IG) using the tele-rehabilitation platform PREVIRNEC©. The variables included in the analysis comprise the neuropsychological initial evaluation of the patient (cognitive affectation profile), the results of the rehabilitation tasks performed by the patient in PREVIRNEC© and the outcome of the patient after a 3–5 months treatment. To achieve the treatment outcome prediction, we apply and compare three different data mining techniques: the AMMLP model, a backpropagation neural network (BPNN) and a C4.5 decision tree. Results The prediction performance of the models was measured by ten-fold cross validation and several architectures were tested. The results obtained by the AMMLP model are clearly superior, with an average predictive performance of 91.56%. BPNN and C4.5 models have a prediction average accuracy of 80.18% and 89.91% respectively. The best single AMMLP model provided a specificity of 92.38%, a sensitivity of 91.76% and a prediction accuracy of 92.07%. Conclusions The proposed prediction model presented in this study allows to increase the knowledge about the contributing factors of an ABI patient recovery and to estimate treatment efficacy in individual patients. The ability to predict treatment outcomes may provide new insights toward improving effectiveness and creating personalized therapeutic interventions based on clinical evidence.

Treatment readiness in violent offenders : the influence of cognitive factors on engagement in violence programs

Advances in offender rehabilitation theory have led to the development of a clear framework of the factors that need consideration for an offender to be ready for therapy and thus gain maximum benefits. Here, we examine in greater detail the role of cognition in readiness for rehabilitation in violent offenders. We assess how cognitive processes and distortions common in violent offenders may affect and hamper rehabilitation readiness. Methods for remediation of cognitive factors that diminish readiness, including motivational interviewing, are discussed. We conclude that cognitive factors are critical in the assessment of readiness in violent offenders and therapeutic efforts to enhance engagement.

Desistance from sex offending : motivating change, enriching practice

In this article we draw from desistance research and a strength-based rehabilitation theory, the Good Lives Model (GLM), to present a richer way of intervening with sex offenders. First, we define the concept of desistance and outline some of the major research findings concerning the factors that help offenders to cease offending. Second we briefly describe current best practice sex offender treatment and discuss its efficacy. Third, we explore the relationship between desistance research and the GLM, arguing that the GLM provides a useful conduit for desistance ideas into sex offender treatment programs. Fourth, we briefly consider the treatment implications of an integrated desistance-GLM approach.

Reconstructing the Risk–Need–Responsivity model : a theoretical elaboration and evaluation

In this paper, we examine the theoretical strengths and weaknesses of the Risk–Need–Responsivity (RNR) model of offender rehabilitation. We briefly discuss the nature of rehabilitation theories and their core components and then review the three source theories associated with the RNR Model. Following this we set out to reconstruct the RNR model in light of this analysis, essentially arguing that there are at least three components to any rehabilitation theory: (a) primary aims, values and principles; (b) etiological and methodological assumptions; and (c) practice implications. We then evaluate the theoretical and empirical adequacy of the RNR model. Finally, we conclude the paper with a few comments on the policy, research, and clinical implications of our evaluation (and reconstruction) of this important rehabilitation model.

Surfaces and depths : evaluating the theoretical assumptions of cognitive skills programmes

Cognitive skills programmes for offenders such as Reasoning and Rehabilitation (R & R) have been around now for over 20 years and were developed in part to address their poor reasoning and decision-making skills. In this paper we critically examine the theoretical underpinnings of the R & R programme in light of current theoretical developments and research from cognitive neuroscience, philosophy, biology, and psychology. After considering recent theoretical and empirical research on rationality, emotions, distributed cognition, and embodiment we conclude with some thoughts about how to fine-tune cognitive skills programmes such as R & R in light of this research.

Análise dos antecedentes das intenções empreendedoras nos estudantes de Reabilitação Psicomotora : estudo com alunos dos primeiro e segundo ciclos do ensino superior

Este estudo pretende (1) analisar os antecedentes das Intenções Empreendedoras (IE) dos estudantes de Reabilitação Psicomotora da Faculdade de Motricidade Humana de ambos os ciclos de ensino e (2) as Intenções Empreendedoras dos estudantes em função das suas características sociodemográficas. A amostra compreendeu um total de 130 alunos, aos quais foi aplicado uma versão adaptada do Questionário das Intenções Empreendedoras (EIQ: Liñán & Chen, 2009) que se baseia na Teoria do Comportamento Planeado (TCP: Ajzen, 1991) e inclui os seguintes fatores: Intenções Empreendedoras (IE), Atitude Percebida (AP), Controlo Comportamental Percebido (CCP) e Normas Subjetivas (NS). Foram realizados testes de regressão linear para identificar quais os fatores da TCP que influenciam as IE. Posteriormente, foram conduzidos testes t-student para comparar os valores médios dos quatro fatores da TCP em função do género, conhecimento de Empreendedores, pática desportiva, experiência profissional, participação na Associação de Estudantes e ciclo de ensino. Os resultados permitiram constatar que os antecedentes mais significativos das IE são a AP e o CCP e que existem maiores IE nos alunos que têm experiência profissional, que praticam/praticaram desporto e nos que conhecem um empreendedor. Estes resultados sugerem que, influenciando alguns destes aspetos, é possível aumentar as Intenções Empreendedoras dos estudantes.

Reconnection : a contemporary development in cultural landscape theory contributing to rehabilitation strategies for Australian open-cut coal mining landscapes

A value-shift began to influence global political thinking in the late 20th century, characterised by recognition of the need for environmentally, socially and culturally sustainable resource development. This shift entailed a move away from thinking of ‘nature’ and ‘culture’ as separate entities – the former existing to serve the latter – toward the possibility of embracing the intrinsic worth of the nonhuman world. Cultural landscape theory recognises ‘nature’ as at once both ‘natural’, and a ‘cultural’ construct. As such, it may offer a framework through which to progress in the quest for ‘sustainable development’. This study makes a contribution to this quest by asking whether contemporary developments in cultural landscape theory can contribute to rehabilitation strategies for Australian open-cut coal mining landscapes. The answer is ‘yes’. To answer the research question, a flexible, ‘emergent’ methodological approach has been used, resulting in the following outcomes. A thematic historical overview of landscape values and resource development in Australia post-1788, and a review of cultural landscape theory literature, contribute to the formation of a new theoretical framework: Reconnecting the Interrupted Landscape. This framework establishes a positive answer to the research question. It also suggests a method of application within the Australian open-cut coal mining landscape, a highly visible exemplar of the resource development landscape. This method is speculatively tested against the rehabilitation strategy of an operating open-cut coal mine, concluding with positive recommendations to the industry, and to government.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Opting in and opting out: a grounded theory of nursings contribution to inpatient rehabilitation

Aim: To develop a grounded theory of nursing’s contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation.

Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory.

Setting: Five inpatient rehabilitation units in Australia.

Participants: Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice.

Findings: The analysis revealed a situation whereby nurses made decisions about when to ‘opt in’ and when to ‘opt out’ of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about ‘opting in’ and ‘opting out’ were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, ‘opting out’ of addressing them. They did this not to make their working lives easier, but more manageable.

Conclusion: System-based problems impacted negatively on the nurses’ ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.

Grounded theory of nursing's contribution to inpatient rehabilitation

There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution. Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory. The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity. From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.

Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation

The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival. In this position paper, we provide practical advice for the application of exercise in heart failure and how to overcome traditional barriers, based on the current scientific and clinical knowledge supporting the beneficial effect of this intervention.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Unifying rehabilitation through theory development

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