Rehabilitation Strategies in Multidisciplinary Teams
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Questions and Answers

What percentage of the total global burden of disease is attributable to disorders in people aged 60 years and older?

  • 40%
  • 15%
  • 30%
  • 23% (correct)

    • What is the term used to represent the loss of one year of full health?

  • Health-adjusted life expectancy (HALE)
  • Disease-free life year (DFLY)
  • Disability-adjusted life year (DALY) (correct)
  • Quality-adjusted life year (QALY)

    • What is the primary goal of rehabilitation strategies developed by an MDT?

  • To improve patient outcomes (correct)
  • To reduce hospital readmission rates
  • To help patients return to activities sooner
  • To minimize the use of primary care resources

    • What is a key aspect of rehabilitation and community-based care that can be evaluated?

    <p>All of the above</p> Signup and view all the answers

    What is a common presentation to the older person multidisciplinary team (MDT)?

    <p>Initial assessment and management of morbidities</p> Signup and view all the answers

    What is a challenge in goal setting within the sphere of rehabilitation services?

    <p>Conflicts in goal setting</p> Signup and view all the answers

    What is the purpose of evaluating a rehabilitation service's key performance indicators (KPIs)?

    <p>To identify areas for improvement</p> Signup and view all the answers

    What is an important consideration in understanding the global burden of disease?

    <p>All of the above</p> Signup and view all the answers

    What percentage of the total global burden of disease is attributable to disorders in people aged 60 years and older?

    <p>23%</p> Signup and view all the answers

    What is a DALY used to measure?

    <p>Both a and b</p> Signup and view all the answers

    Which of the following morbidities is a physical morbidity?

    <p>Pain</p> Signup and view all the answers

    What is the estimated percentage of older patients who have no medical reason for being on bed rest?

    <p>60%</p> Signup and view all the answers

    What is the name of the campaign promoted by healthcare organizations in the UK and Ireland to prevent deconditioning and promote independence?

    <p>End Pajama Paralysis</p> Signup and view all the answers

    What is the equivalent loss in muscle aging that 10 days of bed rest can result in for an 80-year-old person?

    <p>10 years</p> Signup and view all the answers

    What is deconditioning defined as?

    <p>A complex process of physiological change following a period of inactivity, bed rest, or sedentary lifestyle</p> Signup and view all the answers

    What is the estimated percentage of hospitalized older adults who experience a decline in ambulatory function?

    <p>65%</p> Signup and view all the answers

    What is the result of inactivity in hospital for older adults?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is NOT one of the top 10 global causes of DALYs?

    <p>Cancer</p> Signup and view all the answers

    What is the primary focus of rehabilitative care, according to the philosophies of rehabilitation?

    <p>Achieving optimal recovery of independence</p> Signup and view all the answers

    What is the primary element for consideration within the context of an 85-year-old in-patient's case, who is depressed and unwilling to engage in physical activity?

    <p>The patient's ability to progress with a period of rehabilitation</p> Signup and view all the answers

    What is the name of the commonly used ordinal scale that measures and scores activities of daily living (ADLs) and mobility?

    <p>Barthel Scale/Index</p> Signup and view all the answers

    What is the primary goal of rehabilitation, as outlined in Article 26 of the United Nations Convention on the Rights of Persons with Disabilities?

    <p>To provide multidisciplinary rehabilitation to regain independence</p> Signup and view all the answers

    What is a common psychosocial factor that patients undergoing rehabilitative care may experience?

    <p>All of the above</p> Signup and view all the answers

    What is a potential physiological consequence of prolonged bed rest in older adults?

    <p>Risk of falls</p> Signup and view all the answers

    What is the term for the loss of muscle mass and strength associated with aging?

    <p>Sarcopenia</p> Signup and view all the answers

    What is the focus of the 5Ms in rehabilitative care?

    <p>Mentation, mobility, medications, multi-complexity, and matters most</p> Signup and view all the answers

    What is the aim of rehabilitative care clinicians in terms of family support?

    <p>To support the family to help and cope</p> Signup and view all the answers

    What is the underlying philosophy of rehabilitative care, according to Cork University Hospital?

    <p>Person-centered and societal in perspective</p> Signup and view all the answers

    What is a critical period for frail older patients in terms of early intervention?

    <p>Within the first 72 hours after admission</p> Signup and view all the answers

    What is a potential consequence of inactivity in older patients?

    <p>Accelerated bone loss</p> Signup and view all the answers

    What is the primary purpose of the Barthel Index?

    <p>To assess the patient's ability to perform activities of daily living</p> Signup and view all the answers

    What is a key element of the assessment process in rehabilitation?

    <p>Conducting a Comprehensive Geriatric Assessment (CGA)</p> Signup and view all the answers

    What is the purpose of the 5Ms framework?

    <p>To adapt the Comprehensive Geriatric Assessment (CGA) to individual settings</p> Signup and view all the answers

    What is a characteristic of SMART goals in rehabilitation?

    <p>They are specific, measurable, achievable, relevant, and timebound</p> Signup and view all the answers

    Who should be involved in setting rehabilitation goals?

    <p>The patient and all members of the multidisciplinary team (MDT)</p> Signup and view all the answers

    What is the term used to describe the holistic process of assessment, formulation of a care plan, coordinated delivery of services, and monitoring?

    <p>Comprehensive Geriatric Assessment (CGA)</p> Signup and view all the answers

    What is a potential benefit of rehabilitation strategies developed by a multidisciplinary team (MDT)?

    <p>Improved patient outcomes and reduced hospital readmission rates</p> Signup and view all the answers

    What is a key consideration in developing rehabilitation strategies for older patients?

    <p>Considering the patient's individual needs and preferences</p> Signup and view all the answers

    What is the main purpose of the SMART framework in goal-setting?

    <p>To develop specific and achievable goals for an individual patient</p> Signup and view all the answers

    What does the 'capacity' construct refer to in the ICF?

    <p>What an individual can do in a standardized environment</p> Signup and view all the answers

    What is the primary purpose of the FIM+FAM measurement tool?

    <p>To measure disability in the brain-injured population</p> Signup and view all the answers

    What is the definition of 'performance' in the ICF?

    <p>What the person actually does in their current environment</p> Signup and view all the answers

    What does the RCS-E instrument evaluate?

    <p>Rehabilitation complexity in patients with severe brain injury</p> Signup and view all the answers

    What is the primary difference between 'capacity' and 'performance' in the ICF?

    <p>Capacity refers to what an individual can do in a standardized environment, while performance refers to what they do in their current environment</p> Signup and view all the answers

    What was Labibah's main concern?

    <p>Being able to get around her house independently using a stick</p> Signup and view all the answers

    What is the purpose of the FIM measurement tool?

    <p>To measure disability through an 18-item global measure</p> Signup and view all the answers

    What was the reason for Labibah's admission to the hospital?

    <p>Non-syncopal fall</p> Signup and view all the answers

    What is the level of assistance required for a patient rated as 'modified independence' on the FIM?

    <p>The patient uses an assistive device, takes longer than a reasonable amount of time, or has some concern for safety</p> Signup and view all the answers

    What was Labibah's diagnosis?

    <p>Right-sided pubic ramus fracture and pneumonia with a CURB-65 score of 3</p> Signup and view all the answers

    What is the purpose of measuring support needs in rehabilitation services?

    <p>To describe and measure the level of support needed by the patient</p> Signup and view all the answers

    What was the primary goal of Labibah's rehabilitation plan?

    <p>Preventing deconditioning</p> Signup and view all the answers

    What was the result of the multidisciplinary team's (MDT) assessment?

    <p>Labibah required standby assistance with a rollator Zimmer frame</p> Signup and view all the answers

    What is the benefit of using the SMART framework in goal-setting?

    <p>It helps to develop specific, measurable, achievable, relevant, and time-bound goals</p> Signup and view all the answers

    What is the level of assistance required for a patient rated as 'minimal assistance' on the FIM?

    <p>The patient receives incidental help only to complete the task, but does at least 75% of the task themselves</p> Signup and view all the answers

    What was the reason for Labibah's delirium?

    <p>The hospital environment</p> Signup and view all the answers

    What was the goal of the speech and language therapy review?

    <p>To assess Labibah's swallow function</p> Signup and view all the answers

    What was the outcome of the occupational therapy (OT) assessment?

    <p>Labibah's Barthel Index score decreased</p> Signup and view all the answers

    What was the priority for Labibah's pubic ramus fracture?

    <p>Early mobilization and adequate pain relief</p> Signup and view all the answers

    What is the primary concern for Labibah's rehabilitation?

    <p>Preventing deconditioning</p> Signup and view all the answers

    What is the purpose of the 4AT test in Labibah's case?

    <p>To detect possible cognitive impairment</p> Signup and view all the answers

    Which medication was targeted for deprescribing in Labibah's medication review?

    <p>Esomeprazole</p> Signup and view all the answers

    What is the impact of bed rest on older adults like Labibah?

    <p>Rapid deconditioning and loss of muscle mass</p> Signup and view all the answers

    What is the significance of Labibah's clinical frailty score of 4?

    <p>Suggests moderate frailty and high risk of falls</p> Signup and view all the answers

    What is the likely reason for Labibah's nocturnal restlessness?

    <p>Side effect of gabapentin</p> Signup and view all the answers

    What is the goal of Labibah's rehabilitation plan?

    <p>To restore her prior level of function</p> Signup and view all the answers

    What is the significance of Labibah's 4AT score of 2?

    <p>Suggests mild cognitive impairment</p> Signup and view all the answers

    Study Notes

    Rehabilitation Strategies

    • Developed by a multidisciplinary team (MDT) to improve patient outcomes, reduce hospital readmission rates, and minimize the use of primary care resources
    • Help patients return to activities sooner and reduce the length of stay in critical care
    • Key elements of rehabilitation strategies include:
      • Evaluation of physical, psychological, social, and environmental aspects of rehabilitation and community-based care
      • Identification of realistic goals and common conflicts in goal setting
      • Use of systems of classification, frameworks, tools, and other resources for measuring disease severity, independence, performance, capacity, and functionality
      • Setting rehabilitation goals that center on "what matters most" to the patient

    Global Burden of Disease

    • Close to a quarter of the total global burden of disease is attributable to disorders in people aged 60 years and older
    • Global burden of disease is calculated using the disability-adjusted life year (DALY)
    • DALY represents the loss of the equivalent of one year of full health
    • Top 10 causes of DALYs include:
      • Neonatal conditions
      • Ischemic heart disease
      • Stroke
      • Lower respiratory infections
      • Diarrheal diseases
      • Road injury
      • Chronic obstructive pulmonary disease
      • Diabetes mellitus
      • Tuberculosis
      • Congenital anomalies

    Morbidities Requiring Rehabilitation Strategies

    • Morbidities can be physical (e.g., weakness, pain, incontinence) or non-physical (e.g., anxiety, depression, hallucinations)
    • Morbidities can be caused by events such as stroke, falls, dementia, and trauma
    • Rehabilitation strategies must take into account the individual's physical and non-physical morbidities

    Preventing Deconditioning

    • Deconditioning is a complex process of physiological change following a period of inactivity, bed rest, or sedentary lifestyle
    • Deconditioning can result in functional losses in areas such as mental status, continence, and ability to accomplish activities of daily living
    • Strategies to prevent deconditioning include:
      • Early mobilization and ambulation
      • Promotion of independence and autonomy
      • Minimization of bed rest and sedentary behavior
      • Encouragement of physical activity and exercise

    5Ms Framework

    • The 5Ms framework includes:
      • Mind: mentation, dementia, delirium, depression
      • Mobility: impaired gait and balance, fall injury rehabilitation, physical activity, resistance exercises
      • Medications: polypharmacy, deprescribing, adverse medication effects, medication burden
      • Multi-complexity: multi-morbidity, complex bio-psychosocial situations
      • Matters most: each patient having meaningful rehabilitative outcome goals and care preferences

    Rehabilitation Potential

    • Rehabilitation potential is a complex determination based on factors such as:
      • The experience of the clinician
      • Knowledge of the patient's medical conditions
      • The patient's ability to progress with a period of rehabilitation
      • Initiative and motivation on the part of the patient
    • All patients should be offered rehabilitative care, regardless of their rehabilitation potential

    Assessments and Measurements

    • The Comprehensive Geriatric Assessment (CGA) is an organized approach to assessment that includes:
      • Holistic process of assessment
      • Formulation of a care plan
      • Coordinated delivery of services according to the plan
      • Monitoring
    • The 5Ms framework can be used to adapt the CGA to individual settings
    • The Barthel Index measures and scores the individual's ability to perform activities of daily living
    • The Functional Independence Measure (FIM) carries an 18-item global measure of disability
    • The Functional Assessment Measure (FAM) adds 12 items to FIM, addressing cognitive and psychosocial function among individuals with brain injuries### Rehabilitation and Care Model
    • Labibah's rehabilitation goals include progressing to independence with a walking stick and transitioning to a normal diet.
    • The physiotherapist aims to improve Labibah's mobility and independence, despite her unsteady gait and pain on mobilization.
    • Bladder retraining is necessary to address Labibah's urinary incontinence.

    Medication Management

    • Labibah is on multiple medications, including ramipril, gabapentin, zopiclone, bumetanide, atorvastatin, l-thyroxine, escitalopram, and esomeprazole.
    • The 7 Steps medication review method is used to wean Labibah off gabapentin, SSRI, and zopiclone.
    • Polypharmacy is a concern, and the goal is to complete weaning of these medications as tolerated.

    Health Status

    • Labibah has a pubic ramus fracture, pneumonia, and chronic hyponatremia.
    • She has a clinical frailty score of 4 and a 4AT of 2, indicating mild frailty and cognitive impairment.
    • Labibah developed a delirium during her hospital stay, triggered by the hospital environment, which resulted in deconditioning.

    Mobility and Function

    • Labibah's mobility is impaired, and she requires assistance with a rollator Zimmer frame.
    • Her Barthel Index score decreased from 16 to 10 on day 7 of her admission, indicating a decline in her level of function.

    Social History and Priorities

    • Labibah is recently widowed and active in her community, with a strong support system from her extended family.
    • What matters most to Labibah is being able to get around her house independently using a stick, and preventing deconditioning is a priority.

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    Description

    Learn about rehabilitation strategies developed by multidisciplinary teams to improve patient outcomes, reduce hospital readmission rates, and promote community-based care. Evaluate the physical, psychological, social, and environmental aspects of rehabilitation.

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