Suchergebnisse

Introduction: Assistive technology is required to implement the Convention of Rights of Persons with Disabilities which asserts that all people with disabilities have the right to personal mobility and available and affordable assistive technologyAim: Investigate patients' satisfaction with their lower-limb prosthetic or orthotic device and related service delivery in Malawi and Sierra Leone and to compare groups of patients regarding type and level of device and demographics. Methods: Questionnaires, including QUEST 2.0, were used to collect self-reported data from 83 patients in Malawi and 139 patients in Sierra Leone.Results: Patients in both countries were quite satisfied (mean 3.7–3.9 of 5) with their assistive device. Patients were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone patients were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p<.001) and reported many problems (418 comments made in Malawi and 886 in Sierra Leone). About half of the patients did not, or sometimes did not, have the ability to access services (71% in Malawi and 40% in Sierra Leone). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were more dissatisfied with follow-up services (41%) than patients in Malawi were (22%). Patients using above-knee devices were less satisfied with the services received than patients with below-knee devices. Women in Sierra Leone had poorer results when compared to men in terms of satisfaction of assistive device and service. Conclusion: Lower-limb prosthetic and orthotic patients were quite satisfied with their assistive devices. The patients in Malawi were very satisfied with the service received, while patients in Sierra Leone were quite satisfied in spite of the fact that more than half of the assistive devices were in need of repair. Access to repairs and follow-up services were important to patients, and should be addressed by both professionals operating within the rehabilitation field and policymakers.References: Magnusson L, Ahlström G, Ramstrand N, Fransson EI. Malawian Prosthetic and Orthotic Users' Mobility and Satisfaction with their Lower-Limb Assistive Device. Journal of Rehabilitation Medicine 2013; 45:385–391Magnusson L, Ramstrand N, Fransson EI, Ahlström G. Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: a cross-sectional study. Journal of Rehabilitation Medicine 2014; 46:438-446Introduction : La technologie d'assistance est indispensable pour garantir la mise en œuvre de la Convention relative aux droits des personnes handicapées qui affirme le droit de ces dernières à la mobilité personnelle et à la technologie d'assistance à un coût abordable.Objectif : Étudier la satisfaction des patients porteurs d'un appareillage prothétique et orthétique pour membre inférieur et la prestation de service associée au Malawi, comparer le type et le degré d'appareillage des groupes de patients et données démographiques. Méthodes : Des questionnaires, notamment QUEST 2.0, ont été utilisés pour collecter les données rapportées par 83 patients au Malawi et 139 patients en Sierra Leone.Résultats : Dans les deux pays, les patients étaient assez satisfaits (moyenne 3,7–3,9 sur 5) de leur aide technique. Les principales causes d'insatisfaction des patients étaient le confort (46 %), les dimensions (39 %) et la sécurité (38 %) de leur aide technique. En Sierra Leone, les patients sont moins satisfaits qu'au Malawi de la prestation de service (moyenne 3,7 ; 4,4, p<0,001) et signalent de nombreux problèmes (418 commentaires au Malawi et 886 en Sierra Leone). Environ la moitié des patients n'ont pas ou pas toujours accès aux services (71 % au Malawi et 40 % en Sierra Leone). L'accès à la réparation et à l'entretien de leur aide technique est considéré comme l'aspect le plus important. En Sierra Leone, les patients sont plus insatisfaits des services de suivi (41 %) que les patients au Malawi (22 %). Les patients utilisant des aides techniques au-dessus du genou sont moins satisfaits des services que les patients avec des aides techniques placées sous le genou. En Sierra Leone, les femmes ont des résultats inférieurs à ceux des hommes en termes de satisfaction par rapport aux aides et services techniques. Conclusion : Les patients porteurs d'un appareillage prothétique et orthétique pour membre inférieur sont plutôt satisfaits de leur aide technique. Au Malawi, les patients sont très satisfaits du service reçu alors qu'en Sierra Leone, ils sont assez satisfaits même si plus de la moitié des aides techniques nécessite une réparation. L'accès aux réparations et les services de suivi sont importants pour les patients et doivent être garantis par les professionnels de la réadaptation et les décideurs politiques.Références : Magnusson L, Ahlström G, Ramstrand N, Fransson EI. Mobilité des utilisateurs de prothèses et orthèses au Malawi et satisfaction par rapport à l'aide technique pour membre inférieur. Journal of Rehabilitation Medicine 2013; 45:385–391Magnusson L, Ramstrand N, Fransson EI, Ahlström G. Mobilité et satisfaction avec des prothèses et orthèses pour membres inférieurs en Sierra Leone : une étude transversale. Journal of Rehabilitation Medicine 2014; 46:438-446Introduction : La technologie d'assistance est indispensable pour garantir la mise en œuvre de la Convention relative aux droits des personnes handicapées qui affirme le droit de ces dernières à la mobilité personnelle et à la technologie d'assistance à un coût abordable. Objectif : Étudier la satisfaction des patients porteurs d'un appareillage prothétique et orthétique pour membre inférieur et la prestation de service associée au Malawi, comparer le type et le degré d'appareillage des groupes de patients et données démographiques. Méthodes : Des questionnaires, notamment QUEST 2.0, ont été utilisés pour collecter les données rapportées par 83 patients au Malawi et 139 patients en Sierra Leone. Résultats : Dans les deux pays, les patients étaient assez satisfaits (moyenne 3,7–3,9 sur 5) de leur aide technique. Les principales causes d'insatisfaction des patients étaient le confort (46 %), les dimensions (39 %) et la sécurité (38 %) de leur aide technique. En Sierra Leone, les patients sont moins satisfaits qu'au Malawi de la prestation de service (moyenne 3,7 ; 4,4, p<0,001) et signalent de nombreux problèmes (418 commentaires au Malawi et 886 en Sierra Leone). Environ la moitié des patients n'ont pas ou pas toujours accès aux services (71 % au Malawi et 40 % en Sierra Leone). L'accès à la réparation et à l'entretien de leur aide technique est considéré comme l'aspect le plus important. En Sierra Leone, les patients sont plus insatisfaits des services de suivi (41 %) que les patients au Malawi (22 %). Les patients utilisant des aides techniques au-dessus du genou sont moins satisfaits des services que les patients avec des aides techniques placées sous le genou. En Sierra Leone, les femmes ont des résultats inférieurs à ceux des hommes en termes de satisfaction par rapport aux aides et services techniques. Conclusion : Les patients porteurs d'un appareillage prothétique et orthétique pour membre inférieur sont plutôt satisfaits de leur aide technique. Au Malawi, les patients sont très satisfaits du service reçu alors qu'en Sierra Leone, ils sont assez satisfaits même si plus de la moitié des aides techniques nécessite une réparation. L'accès aux réparations et les services de suivi sont importants pour les patients et doivent être garantis par les professionnels de la réadaptation et les décideurs politiques. Références : Magnusson L, Ahlström G, Ramstrand N, Fransson EI. Mobilité des utilisateurs de prothèses et orthèses au Malawi et satisfaction par rapport à l'aide technique pour membre inférieur. Journal of Rehabilitation Medicine 2013; 45:385–391 Magnusson L, Ramstrand N, Fransson EI, Ahlström G. Mobilité et satisfaction avec des prothèses et orthèses pour membres inférieurs en Sierra Leone : une étude transversale. Journal of Rehabilitation Medicine 2014; 46:438-446

In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long civil war. Purpose: The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery in Sierra Leone from the local staff's perspective. Method: Fifteen prosthetic and orthotic technicians working at all the rehabilitation centres providing prosthetic and orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content analysis. Results: One main theme emerged: sense of inability to deliver high-quality prosthetic and orthotic services. This main theme was generated from eight sub-themes: Desire for professional development; appraisals of work satisfaction and norms; patients neglected by family; limited access to the prosthetic and orthotic services available; problems with materials and machines; low public awareness concerning disabilities; marginalisation in society and low priority on the part of government. Conclusions: The findings illustrated traditional beliefs about the causes of disability and that the public's attitude needs to change to include and value people with disabilities. Support from international organisations was considered necessary as well as educating more prosthetic and orthotic staff to a higher level.

In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long civil war. Purpose: The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery in Sierra Leone from the local staff's perspective. Method: Fifteen prosthetic and orthotic technicians working at all the rehabilitation centres providing prosthetic and orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content analysis. Results: One main theme emerged: sense of inability to deliver high-quality prosthetic and orthotic services. This main theme was generated from eight sub-themes: Desire for professional development; appraisals of work satisfaction and norms; patients neglected by family; limited access to the prosthetic and orthotic services available; problems with materials and machines; low public awareness concerning disabilities; marginalisation in society and low priority on the part of government. Conclusions: The findings illustrated traditional beliefs about the causes of disability and that the public's attitude needs to change to include and value people with disabilities. Support from international organisations was considered necessary as well as educating more prosthetic and orthotic staff to a higher level.

BackgroundKnowledge about diagnoses patterns in older people with intellectual disabilities is limited.MethodsThe case group (n = 7936) comprised people with intellectual disabilities aged 55 years and older. The control group (n = 7936) was age matched and sex matched. Somatic inpatient diagnoses (2002–2012) were collected retrospectively.ResultsSeveral diagnoses were in several years significantly more common in the case group, particularly infections [odds ratio (OR) 1.78–4.08]; nervous system (OR 2.06–31.75); respiratory (OR 1.78–4.08) and genitourinary diseases (1.59–11.50); injuries, unspecified symptoms (OR 1.56–4.27); and external causes of morbidity (OR 1.53–4.08). The oldest in the case group had significantly less occurrence of tumours (OR 0.26–0.51), cardiovascular (OR 0.42–0.72), and musculoskeletal diseases (OR 0.32–0.53) than controls.ConclusionsOlder people with intellectual disabilities have higher numbers of some diagnoses, but lower numbers of others. Further research on the reasons for the unique pattern of diagnoses in this group is required.

BACKGROUND: Sweden has closed all institutions and imposed legislation to ensure service and support for individuals with intellectual disability (ID). Understanding mortality among older individuals with ID is essential to inform development of health promotion and disease control strategies. We investigated patterns and risk of mortality among older adults with ID in Sweden. METHODS: This retrospective cohort study compared older adults aged 55 years and older with ID with a control population. Participants were followed during 2002-2015 or death, and censored if they moved out of Sweden. Individuals with ID were identified from two national registers: one covering all specialist health-care visits (out-patient visits and hospitalisation) and the other covering people accessing social/support services. Individuals with ID (n = 15,289) were matched with a control population by sex, birth year, and year of first hospitalisation/out-patient visit/access to LSS services. Cause-of-death data were recorded using International Classification of Diseases, Tenth Revision. Cox proportional hazards regression were conducted to assess if overall and cause-specific mortality rate among individuals with ID was higher than in the Swedish population. RESULTS: The overall mortality rate among individuals with ID was 2483 per 100,000 people compared with 810 in the control population. Among those who died, more individuals with ID were younger than 75 years and unmarried. Leading causes of death among individuals with ID were circulatory diseases (34%), respiratory diseases (17%) and neoplasms (15%). Leading causes of death in a sub-sample with Down syndrome (DS) were respiratory diseases (37%), circulatory diseases (26%) and mental/behavioural disorders (11%). Epilepsy and pneumonitis were more common among individuals with ID than controls. Alzheimer's disease was common in the control population and individuals with DS, but not among those with ID when DS was excluded. Individuals with ID had a higher overall mortality risk (hazard ratio [HR] 4.1, 95% confidence interval [CI] 4.0-4.3) and respiratory disease death risk (HR 12.5, 95% CI 10.9-14.2) than controls. CONCLUSION: Older adults with ID in Sweden carry a higher mortality risk compared with the general population, mainly attributable to respiratory, nervous and circulatory diseases. Care for this group, particularly during the terminal stage of illness, needs to be tailored based on understanding of their main health problem.

Background: Maintaining and improving the quality of prosthetics and orthotics education at the Tanzania Training Centre for Orthopaedic Technologists is essential for the provision of appropriate prosthetics and orthotics services in African countries.Objectives: To describe how Tanzanian and Malawian graduates' of the Diploma in Orthopaedic Technology perceive their education and how it could be improved or supplemented to facilitate clinical practice of graduates.Methods: Nineteen graduates from the diploma course in orthopaedic technology were interviewed and phenomenographic analysis was applied to the data.Results: Seven descriptive categories emerged, namely varied awareness of the profession before starting education, well-equipped teaching facilities, aspects lacking in the learning context, need for changes in the curriculum, enabling people to walk is motivating, obstacles in working conditions and the need for continuous professional development. All participants perceived possible improvements to the content and learning environment.Conclusions: Prosthetic and orthotic education can be better provided by modifying the content of the diploma programme by dedicating more time to the clinical management of different patient groups and applied biomechanics as well as reducing the programme content focusing on technical aspects of prosthetic and orthotic practice. Graduates were not prepared for the rural working conditions and the graduates desired continued training.Keywords: orthotic; prosthetic; education; Malawi; Tanzania; assistive device; assistive technology; developing countries; low-income country

AIM: To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons.BACKGROUND: Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care.METHOD: Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis.FINDINGS: A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance.CONCLUSION: The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice.IMPLICATIONS FOR NURSING MANAGEMENT: The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation

Aim To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons. Background Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care. Method Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis. Findings A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance. Conclusion The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice. Implications for nursing management The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation.

Objectives: To investigate patients' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery in Sierra Leone; to compare groups of patients regarding type and level of assistive device, gender, area of residence, income; and to identify factors associated with satisfaction with the assistive device and service. Methods: A total of 139 patients answered questionnaires, including the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire (QUEST 2.0). Results: Eighty-six percent of assistive devices were in use, but half needed repair. Thirty-three percent of patients reported pain when using their assistive device. Patients had difficulties or could not walk at all on: uneven ground (65%); hills (75%); and stairs (66%). Patients were quite satisfied with their assistive device and the service (mean 3.7 out of 5 in QUEST), but reported 886 problems. Approximately half of the patients could not access services. In relation to mobility and service delivery, women, orthotic patients and patients using above-knee assistive devices had the poorest results. The general condition of the assistive device and patients' ability to walk on uneven ground were associated with satisfaction with the assistive devices and service. Conclusion: Patients reported high levels of mobility while using their device although they experienced pain and difficulties walking on challenging surfaces. Limitations in the effectiveness of assistive devices and limited access to follow-up services and repairs were issues desired to be addressed.

AbstractBackgroundProblem behaviours are common among people with intellectual disabilities (ID), but psychometrically evaluated instruments for assessing such behaviours are scarce. The present study evaluated the psychometric properties of the Neuropsychiatric Inventory—Intellectual Disability (NPI‐ID).MethodWe assessed 108 residents with intellectual disabilities living in group‐homes using the NPI‐ID, which included the 12 symptoms of the original NPI‐Nursing Home and two supplementary symptoms: self‐injurious behaviour and impulsive risk‐taking behaviour.ResultsThe NPI‐ID showed adequate internal consistency (α = 0.76) and test–retest reliability (intraclass correlation coefficient = 0.88). Exploratory factor analysis revealed five factors accounting for 64.1% of the variance. Cluster analysis revealed that residents were clustered in three groups with distinctly different symptom profiles.ConclusionsThe psychometric properties were satisfactory, supporting the use of the NPI‐ID as a screening tool for people with intellectual disabilities. Additional research is needed to further evaluate the utility of the NPI‐ID among people with intellectual disabilities.