S-4-04-04
OUTCOMES AND PROGRAM PERFORMANCE IN REHABILITATION
Deborah L. Wilkerson (CARF - The Rehabilitation Accreditation Commission, Tucson, Arizona, USA)
Functional outcomes assessment begins at the individual person level of analysis, but is also important for evaluating the effectiveness of rehabilitation programs and provider organization performance. Purposes of such evaluation include quality improvement of the rehabilitation program, assurance of reaching the highest outcome goals, and meeting accreditation standards. Functional outcome measurement and management are used widely in program evaluation and performance indicator development in the United States. Outcomes data from clinical program monitoring data bases have contributed significantly to the outcomes research literature in rehabilitation. Baseline information from program trend data or from a pooled data system is essential to projecting program outcome goals (e.g., increase in function; discharge to community rates) for use in a program evaluation / quality improvement model. Key program performance indicators are being identified by several projects and accrediting bodies within the United States. While outcomes are more difficult to use than process measures in assessing program performance, increased function and return to community are most important issues to persons with disability and payers of care. Rehabilitation providers will be under growing pressure to maintain good outcomes data systems for these purposes.
EL-4-01-01
POST-POLIO SYNDROME: LATE BIOMECHANICAL EFFECTS
Walter C. Stolov (University of Washington, Seattle, Washington)
Abstract: Post-Polio syndrome has come to mean the development of muscle and joint pains, weakness, fatigue, loss of endurance, and increasing difficulty in performance of ordinary activities such as standing, walking, and upper extremity function. A large majority of patients present with these complaints 30-40 years after onset. In a subset of such patients the symptoms can be related to progressive alteration in body structure, function and biomechanics. Recognition of these structural changes permits their resolution through appropriate orthotic prescription and or surgery.
The key deformities to watch for include progressive unbalanced scoliosis, pelvic obliquities, hip abduction and flexion contractures, genu recurvatum, knee compartment syndromes, ankle plantar flexion contractures, calcaneus and heel walking, forefoot abnormalities, and reduced elbow flexion and shoulder flexion.
PL-5-01
REHABILITATION MEDICINE IN THE 21ST CENTURY
Martin Grabois (Baylor College of Medicine, Houston, Texas, USA)
The Sideny Licht Memorial Lectureship will address rehabilitation medicine today and towards the 21st century with a historical prospective of the field.
Today we are faced with the problem of attempting to maintain rehabilitation services in developed countries, build rehabilitation services in developing countries and establishing them within undeveloped countries. Guidelines will be presented that would implement and maintain rehabilitation programs in all developing countries. In developed countries with recognized rehabilitation programs, there is a need to reinvent ourselves in light of managed care and limited increased resources. To be able to provide appropriate services new strategies will need to be addressed.
It is hoped and expected that the International Society of Physical and Rehabilitation Medicine (ISPRM), a merge of the International Rehabilitation Medicine Association (IRMA) and International Federation of Physical Medicine and Rehabilitation (IFPMR) will provide the field worldwide with a well organized, well financed and action oriented program to help us move the agenda of improving function and quality of life for people with physical disabilities forward.
Hopefully, this summary of the past, challenges of the present, and my vision of the future, will provide you, challenge you and open opportunities for you to get involved and make a difference.
