Archives of Rehabilitation (Journal of Rehabilitation)
Year:1403 | Volume:25 | Issue:1|Papers Count:8

Objective According to the World Health Organization (WHO), more than 1 billion people (approximately 15% of world population) live with disability. Also, about half of these people lack access to healthcare facilities. Therefore, providing timely healthcare services, especially rehabilitation, is of great significance for these people. The goal of the study was to determine the objectives and policies in the field of rehabilitation in middle-and high-income countries and compare them with Iran. Materials & Methods Based on available databases, a comprehensive review of documents, papers, and books was performed in the field of rehabilitation related to high-and middle-income countries. Results Due to a lack of coordinated services, inappropriate access, unplanned distribution, unclear service delivery levels, neglect of health promotion and prevention levels, lack of a transparent referral system, unclear insurance system, and weak financial resources, the need for a national program with a service integration approach is strongly felt. The review of the rehabilitation programs and documents in other countries help us to design a conceptual framework of the rehabilitation service model, which is based on three principles: Removing barriers and developing access to healthcare services and programs,strengthening and developing rehabilitation using technology, community-based support, and rehabilitation services,and promoting comparable international data collection on disability and supporting research on disability and related rehabilitation services. Conclusion The national rehabilitation program, with a service integration approach, provides a good platform for fair access to rehabilitation services for all people with disability. In this program, the health system is the most important reference to meet these needs. Therefore, it is suggested that this program pursue three main objectives: Fair promotion of the healthcare services of rehabilitation for recipients, improving the response to the needs of rehabilitation service recipients, and reducing the financial and social risks of service recipients.

Objective The implementation of early rehabilitation programs based on evidence to improve the movement abilities of preterm infants is of particular importance. The evidence about rehabilitation interventions in improving the motor development of preterm infants is diverse and scattered and there is heterogeneity in the type, dose and time of therapeutic interventions. Therefore, the purpose of this review study is to identify the types of rehabilitation interventions (occupational therapy and physiotherapy) in improving the motor skills of infants hospitalized in the intensive care unit. Materials & Methods This is a scoping review study. Research studies and indexed in scientific databases including were available in PubMed/Web of Science/Scopus or retrieved by Google Scholar search engine were searched and reviewed. Inclusion criteria included the report of studies in English and Persian papers published from 2000 to 2023 that were mainly focused and the main subject of early rehabilitation intervention studies (occupational therapy and physiotherapy) on the development of neuromotor skills of preterm infants in the neonatal intensive care unit. After selecting the keywords and organized search, the found articles were matched with the entry criteria and finally considered studies were selected. Results Among the reviewed studies, 15 studies met the inclusion criteria. Among the available studies, 7 studies related to multi-modal interventions and 2 studies related to multi-sensory intervention. 2 studies related to neuro-developmental interventions. 2 studies related to interventions implemented by parents –administered. 2 studies related to interventions supporting play exploration and early developmental intervention. Conclusion Based on the findings of this research and the meetings held with experts in this field, we were able to organize early rehabilitation interventions for motor skills of preterm infants in 4 groups: 1) multimodal and multisensory interventions 2) neurodevelopmental interventions 3) parents-administered interventions 4) supporting play exploration and early developmental intervention to categorize. In this way, all types of therapeutic interventions in improving motor skills of infants were identified. Most of the studies included interventions that were performed in a short period of time and reported short-term effects on motor improvement. Only the supportive play exploration intervention continued after discharge and bridged the gap of early NICU-to-home interventions and reported improved motor development in the short-and long-term (6, 12 months).

Objective Adolescents with visual impairments have less opportunity to adapt emotionally to the environment and, as a result, experience more social and academic problems. One of the most critical needs of adolescence is maintaining emotional balance while confronting the stressful factors of puberty and environmental expectations. As visual impairment adversely influences adolescents’ emotional maturity, helping teenagers adapt to challenging conditions is one of the main goals of a social and educational system. The purpose of the present study was to determine the effect of acceptance and commitment therapy (ACT) on the emotional maturity of female adolescents with visual impairment. Materials & Methods The current quasi-experimental study employed a pre-test and post-test and a follow-up design with a control group. A total of 82 females aged 14 to 18 from an educational community special for visually impaired individuals were assessed using the emotional maturity scale (EMS) in the academic year 2020-2021. Among the 33 volunteers who scored 180 and above in the EMS, 28 individuals were selected according to the inclusion criteria and matched based on their age and educational level via convenience sampling. All participants were randomly assigned to the experimental and control groups (14 individuals each). The experimental group attended 10 therapeutic sessions and received acceptance and commitment group therapy for two months (twice a week, 60 minutes per session). However, the control group only participated in the educational community’s make-up empowering programs (including lessons curriculum plans and music training). All participants completed the EMS after the last intervention session and then 8 weeks later as a follow-up. The data were analyzed using the Shapiro-Wilk test, Levene test, M. Box test, multivariate analysis of covariance, and dependent t-test by SPSS software, version 22. Results The results of the Shapiro-Wilk test, Levene test, and M. Box test confirmed the normality of the distribution of scores, the homogeneity of variances, and the homogeneity of line slope, respectively. The results of multivariate analysis of covariance indicated that attendance of the experimental group in the acceptance and commitment group therapy sessions has led to a significant increase (P<0. 05) in emotional maturity scores and its components: emotional stability, emotional progression, social adjustment, personality integration, and independence. Also, the ACT program changed the experimental group’s emotional maturity and components as follows: 90%, 69%, 59%, 55%, 92%, and 68% for emotional stability, emotional progression, social adjustment, personality integration, and independence, respectively. In addition, the results of the dependent t-test to compare the emotional maturity of the experimental group in post-test and follow-up stages indicated that the effect of the group therapy has remained on emotional maturity and its areas even 8 weeks later (P<0. 05). In addition, the results of the dependent t-test showed a significant difference between the emotional maturity of the experimental group in the post-test and follow-up stages. It means that the effect of group therapy has remained on emotional maturity and its components even 8 weeks later. Conclusion Since the acceptance and commitment group therapy has improved the emotional maturity and its components in adolescents with visual impairment, it seems that the ACT is important as a proper and complementary method in empowerment programs for adolescents. The ACT helps adolescents recognize, accept, and control negative feelings or thoughts by increasing their emotional maturity. Therefore, the ACT is a proper method for hindering the problems relating to emotional maturity and probably prevents the occurrence of future problems in adulthood.

Objective The escalating challenges of drug and alcohol abuse underscore the critical need to prioritize Addiction-Affected Family members (AAFs), who face diverse health consequences and complex challenges. This study focuses on Addiction-Affected Mothers (AAMs) and their coping strategies during their child’s substance abuse, aiming to explore their experiences during both the addiction and recovery periods. Materials & Methods Using interpretative phenomenological analysis (IPA), nine AAMs, whose children had completed recovery, participated in semi-structured interviews. Purposive sampling ensured firsthand insights, with data analysis following IPA principles, including coding, categorization, and interpretation. Trustworthiness was maintained through member checking, peer debriefing, and ethical considerations. Results The data analysis and the codes extracted from the interviews revealed four main themes and 14 subthemes. The four main themes extracted from the data included 1. Social Isolation, 2. The Swamp Trails, 3. The Continuum of Injuries, and 4. The Pursuit of Freedom. The first three main themes contained 11 sub-themes reflecting the mothers’ experiences caused by their child’s addiction, and the fourth theme, containing 3 sub-themes, comprised of countermeasures and effective mechanisms employed to overcome addiction-caused problems. Conclusion The study provides evidence-based insights for enhanced services and policies targeting Addiction-Affected Mothers, who often initiate responses within families. Specialized interventions are crucial to address their unique needs and those of their families, minimizing the direct and indirect effects of addiction. Encouraging AAMs’ participation in support sessions is vital for ongoing coping. Effective resources and strategies can facilitate long-term recovery for both individuals with substance abuse and their families, contributing to a deeper understanding of familial dynamics affected by addiction.

Objective Insurance deductions are among the most important causes of hospital resource waste. Insurance deductions cause financial problems for hospitals and create tension between insurance organizations and hospitals. This study, done by the University of Social Welfare and Rehabilitation Sciences, investigates the reasons for deductions of inpatient bills covered by Social Security Insurance in Rofeideh Rehabilitation Hospital Materials & Methods The study was conducted cross-sectionally on 776 cases admitted to Rofeidah Rehabilitation Hospital in 2021. All invoices for inpatient services sent to Social Security Insurance were reviewed using the census method. To collect data, invoices sent to Social Security, inpatient records and checklists, and a 31-question questionnaire of Mohammadkhani et al. were used. The collected data were analyzed by descriptive (frequency and percentage) and analytical statistics (the Spearman correlation coefficient) in SPSS software, version 23. Results According to the findings, the highest frequency of inpatient prescriptions was related to November 2021 (7. 48%). The most frequent deductions of inpatients’ bills were related to medicine and consumables to the amount of 310815448 Rails and surgeon’s fees in 187728448 Rails. Also, the most common reasons were requesting a surcharge and wrong coding. In this study, there was a significant relationship between the documentation of nurses and doctors and the amount of deductions (P<0. 0001). Conclusion Multiple causes affect the reduction of insurance deductions. By teaching insurance rules and the book on the relative value of health services to medical and nursing staff groups, electronic documents to Social Security Insurance and creating warning mechanisms in it, continuous interaction with Social Security Insurance to justify the managers of the organization regarding the way of providing services to rehabilitation patients and the reason for the prolonged hospitalization time of such patients could be the potential solutions for preventing patients records deductions and help hospitals achieve financial goals.

Objective Communication skills have a principal function and value in health and treatment. These skills are essential for child experts, resulting in the clients’ cooperation, satisfaction, and correct diagnosis. This study aims to design a scale to evaluate the communication skills of health center experts in children’s developmental tests. Materials & Methods The research community consisted of experts from health centers in Iran universities of medical sciences. The samples were recruited by purpose-based sampling. This group of experts was used in health centers due to the training of selected experts to perform the developmental Bayley test. First, the evaluation concepts were determined and discussed through a literature review and focused group discussion sessions with 10 experts,the experts were asked to express their opinions and suggestions regarding compiling communication items using the Delphi method. Suggested comments were collected and coded, and the study scale was designed. Then, the psychometric characteristics of the scale were determined with the participation of 16 experts through quantitative content validity and face validity. The scale’s reliability was determined through the test re-test with a 2-week interval, the agreement coefficient in observations was compared between raters and the reference rater, and internal consistency was done. Quantitative data analysis was done in SPSS software, version 22. Results In this study, the communication skills scale was designed with 30 items: 13 for communication with children, 6 for communication with parents, and 11 for general items. The lowest content validity index value was related to one item in the communication with the children section. The rest of the items had acceptable validity. The Cronbach α value was 0. 81 in communication with the children, 0. 82 in communication with the parents, and 0. 76 in the general section. The reliability level was 0. 83, and the intracluster correlation coefficient was 0. 77 in communication with a child, 0. 88 in communication with parents, and 0. 81 in general. The kappa coefficient for agreement between reference observer and other observers was above 0. 7 in 5 cases and less than 0. 4 in 2 cases. Conclusion The compiled evaluation scale has high validity and reliability and can be used as an evaluation scale of communication skills for child experts.

Objective This study aimed to investigate the validity and reliability of the Persian version of the “resilience assessment questionnaire” in patients with multiple sclerosis. Materials & Methods The statistical population of the present study included all multiple sclerosis patients living in Tehran City in 2022. Of them, 250 people were selected through available sampling. The participants completed the questionnaires of Gromis et al. resilience and the hospital anxiety and depression scales. The validity of the questionnaire was investigated using the formal, content, construct, and predictor methods. Also, the reliability of the test was checked through the Cronbach α method and retesting. Data analysis was done using SPSS software, version 26. Results The face validity was confirmed by checking the content and solving the appearance problems. The content validity of the questionnaire was confirmed after correcting the questions. The results of exploratory factor analysis showed that the resilience questionnaire includes 5 components: Emotional and cognitive strategies, physical activity and diet, family and friends support, peer support, and spirituality. Also, the Cronbach α values of these components were 0. 88, 0. 79, 0. 62, 0. 76, 0. 50, and 0. 89, respectively. The eigenvalues of these components explained 47. 49% of the variance. There was a significant relationship between the resilience and anxiety/depression questionnaire components. The correlation value between the first and second stages confirmed the retest validity of the resilience questionnaire. Conclusion The Persian version of the “multiple sclerosis resilience” scale is a valid and reliable tool for assessing resilience features in Iranian MS patients, which can be used in policymaking and research studies.

Objective Cerebral palsy (CP) is the most prevalent motor disability during childhood, characterized by a range of movement and posture disorders that result in activity limitations. In children with CP, abnormal walking patterns are observed due to spasticity and contractures in the lower limb muscles. Also, an excessive flexion gait pattern of the knee presents in 66% of spastic diplegic CP children aged from 5 to 21 years. Accordingly, reducing excessive knee flexion during walking may decrease secondary compensations and enhance walking performance and quality of life. This study aims to design and evaluate a novel dynamic orthosis along with its impact on functional parameters of walking and occupation performance in a child with spastic diplegia CP. Materials & Methods This research was a fundamental and applied study of the design and fabrication. The study plan is a single subject, interaction design, conducted in two stages and implemented as A-B-BC-A. After the initial orthosis design, a second and final iteration was developed to address the limitations observed in the preliminary design. The study participant included an 8-year-old boy with spastic diplegic CP, classified as level II (according to the gross motor function classification system expanded and revised), exhibiting a crouch gait pattern. Functional variables, such as speed, balance in walking, spasticity, and occupation performance, were assessed in the study phases. Results The advantages and disadvantages of the final design were identified. Changes were made regarding manufacturing in less time, the ability to adjust the circumferential measures, ease of wearing and removing, and issues related to toileting. In comparing the baseline with intervention phases one and two regarding balance, the intervention demonstrated effectiveness (percentage of non-overlapping data [PND]=70%). According to PND values, functional speed in the second intervention phase showed significant results (PND=75%). The hamstring muscle spasticity graph analysis during intervention phases exhibited a reduction of 1 or 2 units. The occupational performance score and satisfaction with the child’s performance increased significantly after the intervention phases. Conclusion According to the mechanism of dynamic movement orthoses, as long as they are worn during the day, they are effective in modulating the tonicity of spastic muscles by exerting pressure on hypertonic muscles. This modulation improves balance, movement speed, and overall task performance. Consequently, these findings suggest that dynamic orthotic interventions may enhance functional outcomes and occupational performance, and satisfaction in children with spastic diplegic CP.