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Employment Rate Decreases For Patients With Traumatic Brain Injury After One Year.

Sunday 22 April 2012 - 17:41:05 | International Physiotherapy News

Most patients after traumatic brain injury tends to get rehired in the period of 3 months to 1 year afteremploymentsmall.jpg the injury, and that rate goes down after the initial year. The study conducted by Grauwmeijer. E of Netherland and his team also reveals that patients who develop cognitive impairements are at an increased risk of being unemployable.

The subjects of the study were patients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands. The Patient group was aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI. A total of ninety-four patients (83%) completed the 3-year follow-up.The main outcome measure of the study was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM).

According to the study, the employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff score of less than 65 to identify patients at risk of long-term unemployment had a good diagnostic value.

Patients with TBI with psychiatric symptoms and impaired cognitive functioning at hospital discharge are at the highest risk of long-term unemployment. The authors considers that these factors should be the focus of vocational rehabilitation for such patients.
Authors of the study: Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM.


Physiotherapists Not To Treat, But Advice Patients With Low Back Pain In Nottingham; Hint Of Things To Come?

Thursday 12 April 2012 - 14:19:44 | International Physiotherapy News

Another proof of insurance or a second hand funding becoming a hurdle at times in getting the right treatment for the insured.worry.jpg As long as a third party decides the duration of the treatment, or the number of sessions, or the treatment techniques, there would certainly be incidents like this happening. With the whole world facing serious financial woes and trying cost cutting measures, health industry will not be far behind in taking quick actions. In the end, more than the moneybaggers being affected, it will be the patients who will be.

Patients referred to physiotherapists for treatment in Nottingham will no longer receive hands-on treatment - but will be directed to websites where they can learn exercises for themselves. Patients in Rushcliffe are given "advice and guidance" and directed to websites and information leaflets where they can learn exercises for themselves.
Phil Gray, chief executive of the Chartered Society of Physiotherapy, said: "They seem to have invented a new form of physiotherapy that no one has heard of - do-not-touch physiotherapy. Physiotherapists can't actually physically touch you at all under this system. It is deeply unscientific, there is no research or evidence to back up hands-off physiotherapy. Patients have been reporting back to GPs a very strong disapointment, and the physiotherapists providing this service are saying that basically 'you are preventing us from doing a professional job. It is a completely barmy form of treating people, which means that the only solution will be to go to the private sector and pay for themselves."

Before January 1, 2011, the Principia clinical commissioning group, which plans and buys healthcare services in Rushcliffe, offered one assessment and up to four treatments for physiotherapy patients. This includes patients who are suffering from soft tissue injuries and pain in their back, neck or joints. But, following a review of services, it changed from a treatment service to an advice and guidance service.This means that physiotherapists are no longer allowed to touch patients, and instead give advice on what exercises they should be doing and information on how to manage their condition themselves.
The Chartered Society of Physiotherapy asked all primary care trusts in the country about their physiotherapy services and any budget cuts. Mr Gray said that Principia was the only group not to offer a hands-on treatment to physiotherapy patients. Patients in Rushcliffe are also capped to a maximum of two physiotherapy appointments a year and have to visit their GP twice, six weeks apart, to get a physiotherapy referral in the first place.

Mr Gray said this was too long to wait. He added: "Getting people quickly into early intervention services makes a real difference to their ability to go back to work. The less treatment they go on to have and the longer it is left, the more complex problems it causes for people."

Barbara Venes, of the Local Improvement Network, which represents patients in Notts, also raised concerns. She said: "I think it is just awful. If you need physiotherapy, you need the treatment, not just advice. They are pushing people into paying privately and some people cannot afford to pay for it and so won't get treatment." She added that older patients may struggle to access information online, and that people needed practical demonstrations of how physiotherapy exercises should be done - to ensure that they were doing them correctly. "If you need physiotherapy, it is painful when you start." she said. "If you are doing it with a physiotherapist, then they can reassure you that it is normal to get some pain. But if you are doing it yourself, then people are afraid that if it is painful then they are going to get more damage."

A spokesman for Principia said that the change in service had not been a cost-cutting measure, and that costs were broadly the same as before. She said that "more vulnerable" patients received treatment through other means, such as a hospital specialist. She said: "Following a review, the service was changed to one of advice and guidance to encourage patients to self-care prior to further review by the GP. In some parts of the county this is done by web-based advice or in group sessions, and is the important first step in patients with back and neck problems." She added: "Once a decision to refer to a specialist is made by a GP, patients are seen quickly by a physiotherapist. With the advice and guidance service, patients are given practical advice to help them self manage their condition. This includes exercises to alleviate and manage their symptoms. This service enables all patients to take control of their condition and get better quicker."

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