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Introduction/Background ACP is the process of planning of planning for future healthcare to guide clinical decision making when one is unable to communicate decisions due to lack of capacity. This study explored the perspectives of brain tumour (BT) patients in discussing ACP, symptom profile, physical and functional status, quality of life (QoL), level of coping and carer burden. Material and method A prospective cohort study with semi-structured interviews regarding ACP for BT patients in hospital and community was conducted. Validated assessment tools measured coping strategies, QoL and carer burden. Interview ACP transcripts were analyzed, coded and interpreted using qualitative analytic techniques for thematic analyses. Results Participants’ ( n = 36) mean age was 47 years (range 20–69 years), with median time since diagnosis of 3.9 years, and majority (70%) had glioblastoma multiforme (GBM). Fatigue was the most common symptom reported by 89% participants, followed by pain (53%) and cognitive impairment (39%). Overall, participants indicated good QoL and used more problem-focused coping strategies including ‘acceptance’ and ‘positive reframing’. There was a ‘moderate’ level of carer burden. Thematic analyses indicated participants had limited understanding of ACP, and lack of such discussions with healthcare professionals. Majority preferred dedicated sessions by trained healthcare professionals especially medical staff. Conclusion The low uptake of ACP amongst BT patients’ highlights need for increased awareness of ACP in clinical practice as it has an important role in enhancing patient autonomy and delivery of quality end-of-life care. The neuropalliative-rehabilitation model of care integrates care with treating teams and can provide timely ACP information to BT patients, with the need for multifaceted system-wide interventions in implementing ACP. [ABSTRACT FROM AUTHOR]

Introduction/Background Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews for effectiveness of non-pharmacological interventions for improved spasticity outcomes. Material and method A literature search was conducted using medical and health science electronic databases for published systematic reviews up to 15th June 2017. Two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Results Overall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is ‘moderate’ quality evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care in persons following stroke. ‘Low’ quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with multiple sclerosis, vibration therapy for spinal cord injury and stretching for other neurological condition. For other interventions, evidence was inconclusive. Conclusion Despite non-pharmacological interventions are used for various neurological conditions, there is still lack of high-quality evidence for many. Further research is needed to judge the effect with appropriate study designs and intensity and associate costs of these interventions. [ABSTRACT FROM AUTHOR]

Introduction/Background An estimated 80% of persons with disability (PwD) live in low- and middle-income countries (LMICs), with significant burden of disease and subsequent disability. The WHO Global Disability Action Plan 2014–2021 (GDAP), provides a list of specific actions and metrics for the empowerment of PwD, including strengthening/extending rehabilitation, assistive-technology, support services, and community-based rehabilitation. The aim of this study was to identify potential barriers for implementation of the GDAP in LMICs. Material and method The Flying Faculty rehabilitation team from the Royal Melbourne Hospital, Australia conducted intensive workshops at medical/academic institutions in LMICs for healthcare professionals from various local Physical Medicine and Rehabilitation (PM&R) facilities. A modified Delphi method identified challenges for future implementation to address gaps identified. Results Despite differences in the healthcare system and practices in LMICs, the challenges reported in four countries, at both macro (governmental/policy makers) and micro levels (community/social/individual) were similar. Common strategies were implemented to address challenges: limited knowledge of disability services, PM&R workforce, guidelines and accreditation standards; coordination amongst healthcare sectors; social issues; data and research; legislation and political commitment. Support of potential facilitators were: need for strong leadership; advocacy of disability-inclusive development; investment in infrastructure/human resources; coordination/partnerships in healthcare sector; and research. Conclusion Disability care and rehabilitation is an emerging priority in LMICs to address the needs of people with disability. The GDAP framework provides guidance to facilitate access and strengthen PM&R services. [ABSTRACT FROM AUTHOR]

Introduction/Background Chronic pain is common and significantly impacts on the lives of persons with multiple sclerosis (MS). Various types of non-pharmacological interventions are used to improve pain control in persons with MS (pwMS), however the effectiveness and safety of many modalities is still unknown. This review evaluated the effectiveness of currently used non-pharmacological interventions for chronic pain in pwMS. Material and method A literature search was performed using the Cochrane MS Group Trials Register which contains Cochrane CENTRAL, Medline, EMBASE, CINAHL, LILACUS, Clinical trials.gov and World Health Organisation International Clinical Trials Registry Platform in April 2017. Manual searching in the relevant journals and screening of reference lists of studies was done. Randomised controlled trials (RCTs), crossover studies and clinical controlled trials were included. All authors independently selected studies, extracted data and assessed the methodological quality. Pooling data for meta-analysis was not possible due to methodological/statistical heterogeneity of included studies. Results Overall, 12 RCTs (610 participants), which investigated different non-pharmacological interventions for the management of chronic pain in MS fulfilled the review inclusion criteria. The non-pharmacological interventions evaluated included: transcutaneous electrical nerve stimulation (TENS), psychotherapy (telephone self-management, hypnosis and electroencephalogram biofeedback), transcranial random noise stimulation (tRNS), transcranial direct stimulation (tDCS), hydrotherapy (Ai Chi) and reflexology. The findings suggest that there is “low level” or limited evidence for the use of evaluated non-pharmacological management for chronic pain in MS. Though, there is improved changes in pain scores and secondary outcomes, these were not clinically or statistically significant for TENS for lower back pain and tRNS, hydrotherapy exercises, tDCS, reflexology and psychotherapy for overall pain. The evidence was limited for other interventions. Conclusion Despite the use of wide range of non-pharmacological interventions for the treatment of chronic pain in pwMS, the evidence for these interventions is still limited and/or insufficient. More robust studies are needed to justify the beneficial effect of these interventions. [ABSTRACT FROM AUTHOR]

Introduction/Background Sudden-onset disasters (SODs) result in increased number of survivors with complex and long-term disabling injuries, including traumatic brain injury (TBI) that warrants comprehensive specialist rehabilitation. This presentation highlights the minimum technical standards required for specialised TBI rehabilitation teams and their integration into WHO Emergency Medical Teams (EMTs) to facilitate comprehensive management of TBI survivors in disaster settings. Material and method A team of medical rehabilitation physicians from the Royal Melbourne Hospital conducted a comprehensive review of literature for TBI management, based on the WHO core-guidelines for ‘Minimum technical standards and recommendations for rehabilitation for EMTs’. These were endorsed by a specialist TBI expert panel in the Asia-Pacific region. Results Comprehensive rehabilitation programs improve functional outcomes and quality of life of TBI survivors. It is recommended that specialised TBI care teams need to be embedded into EMTs for disaster response and management for early diagnosis, management and social reintegration. This guidance documents the minimum standards for deployment of TBI specialist rehabilitation teams in the context of SODs, including: skill requirements, team configuration and profile, professional competencies for management of TBI and complications, list of required equipment and consumables, information management/dissemination. Conclusion TBI rehabilitation should commence from the early response phase in SODs by accredited rehabilitation professionals to minimise complications and disability. Integration of specialised TBI rehabilitation professionals into EMTs for disaster response will improve functional outcomes of survivors. [ABSTRACT FROM AUTHOR]

Introduction/Background Despite the prevalence of disability in low-and-middle income countries (LMICs), the clinical skills of rehabilitation workforce are not well described. We report health professionals’ perspectives on clinical skills in austere settings and identify context-specific gaps for workforce capacity. Material and method An exploratory-descriptive, cross-sectional, pilot survey of healthcare professionals working in rehabilitation in hospital and community settings conducted in Pakistan, Morocco, Nigeria and Malaysia. A situational-analysis survey-tool captured cross-sectional assessment of clinical skills required in various rehabilitation settings. Participant responses were coded in a line-by-line process, and clustered into common terms based on International Classification of Functioning, Disability and Health (ICF) framework to classify skill-categories in target domains. Results Survey respondents ( n = 532) from Pakistan 248, Nigeria 159, Morocco 93 and Malaysia 32 completed the survey. The participants were: physiotherapists (52.8%), nurses (8.8%), speech and occupational therapists (8.5%, 5.3%), other medical doctors (5.5%), rehabilitation physicians (3.8%), and prosthetist/orthotists (1.5%). The 10 most commonly used clinical skills reported were prescription of physical activity and medications, transfer-techniques, daily-living activities, allied health interventions, patient/carer education, comprehensive patient-care, diagnosis/screening, behaviour/cognitive interventions, referrals, assessments and collaboration. Most responses linked with ICF categories in activities/participation, and personal factors. Conclusion The survey tool identified task shifting amongst healthcare professionals. The core skills and gaps reflected general rehabilitation practice, rather than discipline-specific skills. [ABSTRACT FROM AUTHOR]

Introduction/Background To provide an overview of recommendations and quality of existing clinical practice guidelines (CPGs) for management of traumatic brain injury (TBI) focusing on rehabilitation medicine; and synthesise recommendations from these for applicability in disaster settings. Material and method Comprehensive literature search including health databases, CPG clearinghouse/developer websites, and grey literature using Internet search engines to September 2017. All TBI CPGs published in the last decade were selected if their scope included: management of TBI, systematic methods for evidence search, clear defined recommendations and supporting evidence for rehabilitation interventions. Three authors independently critically appraised the quality of included CPGs using the Appraisal of Guidelines, Research and Evaluation (AGREE) Instrument. All recommendations were extracted, compared and categorized for applicability in disaster settings. Results Only 4 of the 14 potential identified CPGs met the inclusion criteria. Despite variation in scope, target population, size, and guideline development processes, all four CPGs were assessed as of good quality (AGREE Global score of 5–7 out of 7). The recommendations included: patient/carer education, general physical therapy, practice in daily living activities and safe equipment use, direct cognitive/behavioural feedback, basic compensatory memory/visual strategies, basic swallowing/communication and psychological input for TBI survivors in disaster settings. More advanced interventions are generally not applicable following disasters due to limited access to services, trained staff/resources, equipment, funding and operational issues. Conclusion Although CPGs in this study were of high quality, many recommendations for TBI care are challenging to implement in disaster settings and need further research to identify and address barriers for implementation. [ABSTRACT FROM AUTHOR]

Introduction/Background Pain can be a significant long-term problem for a substantial proportion of persons with multiple sclerosis (pwMS). The aim of this study was to examine the course and impact of chronic pain over a span of 10-years. Material and method A longitudinal, cross-sectional study assessed pwMS residing in the community at seven and ten years using validated measures: Visual Analogue Scale; Numerical Rating Scale; Chronic Pain Grade (CPG); Assessment of Quality of Life and the Carer Strain Index (CSI). Results Mean age of the participants ( n = 70) was 59.8 ± 9 years (range: 39–74 years) and majority (70%) were female. The findings show that over 10-year period, majority report bilateral lower limb dysesthesia (40%), mixed pain (35.2%) and widespread pain (17.1%). There was a significant deterioration in quality of life (QoL) in those with more severe CPG. Almost half of the participants (44%) required care either from a private carer/family or institution. The carers ( n = 13) reported higher carer strain (mean CSI = 5.2), with over half reporting sleep disturbance, inconvenience, physical strains, family and personal constraints. Although fear of taking medications and side effects were common barriers to treatment for pain, there was an increase in the use of pharmacological treatment and healthcare services, mainly neurologists and general practitioners over time. Conclusion This study demonstrates that persistent chronic pain is a significant issue over time in pwMS, with clinical and health implications, poorer QoL, and increased healthcare utilisation. Greater awareness of chronic pain in pwMS and interdisciplinary approach is required to improve long-term patient outcomes and well-being. [ABSTRACT FROM AUTHOR]

Introduction/Background Various studies were completed in the developing countries however this is the first one to be carried out in a developed country with a universal healthcare system. Material and Method Study design: community based descriptive study. Settings: community dwelling in the greater Melbourne region, catchment area of Royal Melbourne Hospital. Participants: 100 consecutive recruited community residents has been interviewed. Procedure: After an informed consent was obtained, participants will be were required to fill and answer the standard MDS questionnaire. The Alpha version of the MDS comprises two questionnaires: –Household questionnaire (answered by the head of the household) with two modules: household roster: targeting a short description of the household and all household members and, the children module: targeting disability and health conditions in children; –Individual questionnaire (answered by a randomly-selected adult member of the household) with eight sections: socio-demographic characteristics, work history and benefits, environmental factors, functioning, health conditions and capacity, health-care utilisation, and satisfaction, personality and well-being. The WHO coding system for the individual questionnaires of the MDS will be used to quantitatively measure each participant's response. Results Many people with disability have less access to healthcare system, improved access to transport means and recreation facilities. Vocational opportunities are presented to individual with disabilities less than expected. Household with a person with a disability have greater difficulties and less freedom because of the caring responsibilities. Conclusion Although Australia has an equitable universal healthcare system, people with disability were still disadvantaged and inferior to the persons without disability in their access to work, education and healthcare system. Household with a person with a disability have a negative impact on the other family members in their educational and vocational interest. [ABSTRACT FROM AUTHOR]