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ObjectiveThe Society for Integrative Oncology (SIO) Online Task Force was created in response to the challenges facing continuity of integrative oncology care resulting from the COVID-19 pandemic. The Task Force set out to guide integrative oncology practitioners in providing effective and safe online consultations and treatments for quality-of-life-concerns and symptom management. Online treatments include manual, acupuncture, movement, mind-body, herbal, and expressive art therapies.MethodsThe SIO Online Practice Recommendations employed a four-phase consensus process: (1) literature review and discussion among an international panel of SIO members, identifying key elements essential in an integrative oncology visit; (2) development, testing, and refinement of a questionnaire defining challenges and strategies; (3) refinement input from integrative oncology experts from 19 countries; and (4) SIO Executive Committee review identifying the most high-priority challenges and strategies.ResultsThe SIO Online Practice Recommendations address ten challenges, providing practical suggestions for online treatment/consultation. These include overcoming unfamiliarity, addressing resistance among patients and healthcare practitioners to online consultation/treatment, exploring ethical and medical-legal aspects, solving technological issues, preparing the online treatment setting, starting the online treatment session, maintaining effective communication, promoting specific treatment effects, involving the caregiver, concluding the session, and ensuring continuity of care.ConclusionsThe SIO Online Practice Recommendations are relevant for ensuring continuity of care beyond the present pandemic. They can be implemented for patients with limited accessibility to integrative oncology treatments due to geographic constraints, financial difficulties, physical disability, or an unsupportive caregiver. These recommendations require further study in practice settings.

Background Stroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core components have been identified to guide the delivery of evidence-based ESD, however, service provision in England is of variable quality. The study sought to understand how and in what conditions the adoption of these components drives the delivery of responsive and intensive ESD services in real world settings. Methods This qualitative study was part of a wider multimethod realist evaluation project (WISE) conducted to inform large-scale ESD implementation. Overarching programme theories and related context–mechanism–outcome configurations were used as a framework to guide data collection and analysis. Six case study sites were purposively selected; interviews and focus groups with ESD staff members were conducted and analysed iteratively. Results We interviewed 117 ESD staff members including clinicians and service managers. Staff highlighted the role of certain core components including eligibility criteria, capacity, team composition and multidisciplinary team (MDT) coordination in achieving responsive and intensive ESD. Regardless of the geographical setting, adhering to evidence-based selection criteria, promoting an interdisciplinary skillset and supporting the role of rehabilitation assistants, allowed teams to manage capacity issues and maximise therapy time. Gaps in the stroke care pathway, however, meant that teams had to problem solve beyond their remit to cater for the complex needs of patients with severe disabilities. Adjusting MDT structures and processes was seen as key in addressing challenges posed by travel times and rural geography. Conclusions Despite variations in the wider service model of operation and geographical location, the adoption of core components of ESD helped teams manage the pressures and deliver services that met evidence-based standards. Findings point to a well-recognised gap in service provision in England for stroke survivors who do not meet the ESD criteria and emphasise the need for a more integrated and comprehensive stroke service provision. Transferable lessons could be drawn to inform improvement interventions aimed at promoting evidence-based service delivery in different settings. Trial registration ISRCTN: 15,568,163, registration date: 26 October 2018.

Within physical therapy, the disablement model has proven useful as a language to delineate the consequences of disease and injury. This perspective provides an update on the changing language of disablement, reviews selected contemporary disablement models, and discusses some challenges that need to be addressed to achieve a universal disablement language that can be used to discuss physical therapy research and clinical interventions. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework has the potential of becoming a standard for disablement language that looks beyond mortality and disease to focus on how people live with their conditions. If widely adopted, the ICF framework could provide the rehabilitation field with a common, international language with the potential to facilitate communication and scholarly discourse across disciplines and national boundaries, to stimulate interdisciplinary research, to improve clinical care, and ultimately to better inform health policy and management.

An estimated 20 million of the 135 million people who need humanitarian assistance globally are living with some form of disability and require access to rehabilitation services and assistive technology.1 This figure excludes the unknown number of people with conflict-caused impairment. However, physical disabilities and rehabilitation needs of populations in conflict-affected settings are rarely considered and very few international organizations specializing in rehabilitation are active in such contexts.

In 2018, the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research published a systematic evidence-based review and an associated practice guideline for improved assessment, treatment, and rehabilitation of patients with disorders of consciousness. Patients with disorders of consciousness include individuals in the vegetative and minimally conscious states, as well as others with covert consciousness and cognitive motor dissociation. These landmark publications (concurrently published in Neurology and Archives of Physical Medicine and Rehabilitation) supplant the 1994 New England Journal of Medicine Multi-Society Task Force report on the vegetative state and the 2002 criteria establishing minimally conscious states. The guideline re-designates the permanent vegetative state as chronic. In our article, we consider the legal and ethical implications of the practice guideline for clinical practice and explain the vulnerability of these patients who suffer from high rates of misdiagnosis, inadequate medical surveillance, undertreatment of pain, inadequate rehabilitation, and segregation in chronic care. We argue that these deficiencies in medical care are inconsistent with our growing appreciation of the dynamic nature of these brain states and an emerging standard of care as articulated by the national guideline. These deficiencies also violate domestic and international disability law. To substantiate this latter claim, we apply disability law to this population, focusing on key Americans with Disabilities Act mandates, the relevance of the 1999 Supreme Court, Olmstead v. L.C., and the utility of Olmstead enforcement actions to integrate the care of these individuals into the medical mainstream.

Background There is a gap in educational resources and knowledge translation for reactive balance training (RBT). This study aimed to examine current educational practices and training experiences related to balance control and RBT among Polish healthcare professionals. Methods A cross-sectional online survey was distributed among members of a Polish regulated healthcare profession. Participants were eligible if they were licensed healthcare professionals involved in treating clients with balance or mobility impairments. The questionnaire included 55 items across six sections, covering demographics, clinical practice, treatment approaches, and knowledge, attitudes, barriers, facilitators, and clinical use of RBT. Data were analyzed using descriptive statistics and chi-square tests for group comparisons. Results Of the 286 valid respondents, only 26.5% reported using RBT in clinical practice, while 54.2% either had not heard of it or did not use it. Non-users commonly reported first learning about RBT through the survey itself (44.0%). Conceptual confusion with other approaches such as Bobath concept and Proprioceptive Neuromuscular Facilitation was evident. Users demonstrated higher confidence, greater workplace support, and fewer safety concerns. All groups expressed strong interest in further training, particularly through hands-on workshops and instructional videos. Conclusion RBT remains underused in Poland, partly due to limited formal education and conceptual misunderstandings. Addressing these gaps through structured, hands-on training and institutional support may enhance implementation. These findings highlight the need for targeted educational strategies and broader knowledge translation efforts in underrepresented regions.

Adults with intellectual and developmental disabilities (I/DD) are increasingly presenting to their health care professionals with concerns related to growing older. One particularly challenging clinical question is related to the evaluation of suspected cognitive decline or dementia in older adults with I/DD, a question that most physicians feel ill-prepared to answer. The National Task Group on Intellectual Disabilities and Dementia Practices was convened to help formally address this topic, which remains largely underrepresented in the medical literature. The task group, comprising specialists who work extensively with adults with I/DD, has promulgated the following Consensus Recommendations for the Evaluation and Management of Dementia in Adults With Intellectual Disabilities as a framework for the practicing physician who seeks to approach this clinical question practically, thoughtfully, and comprehensively.

Up to 80% of wheelchair users are affected by shoulder pain. The Clinical Practice Guidelines for preservation of upper limb function following spinal cord injury suggest that using a proper wheelchair propulsion technique could minimize the shoulder injury risk. Yet, the exact relationship between the wheelchair propulsion technique and shoulder load is not well understood. This study aimed to examine the changes in shoulder loading accompanying the typical changes in propulsion technique following 80 min of low-intensity wheelchair practice distributed over 3 weeks. Seven able-bodied participants performed the pre- and the post-test and 56 min of visual feedback-based low-intensity wheelchair propulsion practice. Kinematics and kinetics of propulsion technique were recorded during the pre- and the post-test. A musculoskeletal model was used to calculate muscle force and glenohumeral reaction force. Participants decreased push frequency (51→36 pushes/min, p = 0.04) and increased contact angle (68→94°, p = 0.02) between the pre- and the post-test. The excursion of the upper arm increased, approaching significance (297→342 mm, p = 0.06). Range of motion of the hand, trunk and shoulder remained unchanged. The mean glenohumeral reaction force per cycle decreased by 13%, approaching significance (268→232 N, p = 0.06). Despite homogenous changes in propulsion technique, the kinematic solution to the task varied among the participants. Participants exhibited two glenohumeral reaction force distribution patterns: 1) Two individuals developed high force at the onset of the push, leading to increased peak and mean glenohumeral forces 2) Five individuals distributed the force more evenly over the cycle, lowering both peak and mean glenohumeral forces.

Background The large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building. Methods A qualitative descriptive national study was conducted to explore the perspectives of South African stakeholders in rehabilitation, regarding CPG capacity-building. Twenty rehabilitation professionals (physiotherapists, occupational therapists, speech language therapists, podiatrists, rehabilitation managers or directors) were interviewed. Transcribed interview data were analysed using a deductive content analysis approach, mapping findings to an international capacity-building framework to produce new knowledge. Results Capacity-building is required in content, purpose and construction of locally relevant CPGs, as well as personal, workforce and systems capacity. Principles and strategies were derived to underpin implementation of CPGs that are user friendly, context specific, relevant to the needs of end-users, and achievable within available resources. Collaboration, networks and communication are required at national, provincial and regional level, within and between sectors. A central agency for CPG methods, writing, implementation and evaluation is indicated. Conclusion South African rehabilitation can benefit from a multi-level CPG capacity-building focusing on performance, personal, workforce and systems issues.