Construction and validation of a logical model for specialized Rehabilitation Centers

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ABSTRACT

OBJECTIVE

To build and validate a logical model for health care in Specialized Rehabilitation Centers (CER) by analyzing the work process and organizational issues of centers in Rio Grande do Norte.

METHODS

This is a methodological study developed in three stages: 1) documentary research of legislation and ordinances concerning the healthcare service and the Disability Care Network (RCPD); 2) focus groups with a Census study of the CER in Rio Grande do Norte to understand and assess the daily activities of the service; and 3) systematization of the information collected and, finally, proposition and validation of the evaluative logical model.

RESULTS

The model encompassed five central categories of the work and organizational process: “demands”, “resources” (inputs, financial and workforce), “processes”, “products and results” and “mission, values and external factors”.

CONCLUSION

The logical model built was suitable for graphical representation of the work process and organizational issues of the SRC. The study showed that the functioning of the services is in line with the regulations. However, there are still organizational gaps that need to be addressed to improve the resolution capacity of the service and the articulation with other points of the network.

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A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

Tess Bright, Sarah Wallace, Hannah Kuper (2018)

Rehabilitation seeks to optimize functioning of people with impairments and includes a range of specific health services—diagnosis, treatment, surgery, assistive devices, and therapy. Evidence on access to rehabilitation services for people with disabilities in low- and middle-income countries (LMICs) is limited. A systematic review was conducted to examine this in depth. In February 2017, six databases were searched for studies measuring access to rehabilitation among people with disabilities in LMICs. Eligible measures of access to rehabilitation included: use of assistive devices, use of specialist health services, and adherence to treatment. Two reviewers independently screened titles, abstracts, and full texts. Data was extracted by one reviewer and checked by a second. Of 13,048 screened studies, 77 were eligible for inclusion. These covered a broad geographic area. 17% of studies measured access to hearing-specific services; 22% vision-specific; 31% physical impairment-specific; and 44% measured access to mental impairment-specific services. A further 35% measured access to services for any disability. A diverse range of measures of disability and access were used across studies making comparability difficult. However, there was some evidence that access to rehabilitation is low among people with disabilities. No clear patterns were seen in access by equity measures such as age, locality, socioeconomic status, or country income group due to the limited number of studies measuring these indicators, and the range of measures used. Access to rehabilitation services was highly variable and poorly measured within the studies in the review, but generally shown to be low. Far better metrics are needed, including through clinical assessment, before we have a true appreciation of the population level need for and coverage of these services.

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What is rehabilitation? An empirical investigation leading to an evidence-based description

Derick Wade (2020)

Background: There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. Method: This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition. Findings: The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated. Conclusion: Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient’s needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.

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Advancing complexity science in healthcare research: the logic of logic models

Thomas Mills, Rebecca Lawton, Laura Sheard (2019)

Background Logic models are commonly used in evaluations to represent the causal processes through which interventions produce outcomes, yet significant debate is currently taking place over whether they can describe complex interventions which adapt to context. This paper assesses the logic models used in healthcare research from a complexity perspective. A typology of existing logic models is proposed, as well as a formal methodology for deriving more flexible and dynamic logic models. Analysis Various logic model types were tested as part of an evaluation of a complex Patient Experience Toolkit (PET) intervention, developed and implemented through action research across six hospital wards/departments in the English NHS. Three dominant types of logic model were identified, each with certain strengths but ultimately unable to accurately capture the dynamics of PET. Hence, a fourth logic model type was developed to express how success hinges on the adaption of PET to its delivery settings. Aspects of the Promoting Action on Research Implementation in Health Services (PARIHS) model were incorporated into a traditional logic model structure to create a dynamic “type 4” logic model that can accommodate complex interventions taking on a different form in different settings. Conclusion Logic models can be used to model complex interventions that adapt to context but more flexible and dynamic models are required. An implication of this is that how logic models are used in healthcare research may have to change. Using logic models to forge consensus among stakeholders and/or provide precise guidance across different settings will be inappropriate in the case of complex interventions that adapt to context. Instead, logic models for complex interventions may be targeted at facilitators to enable them to prospectively assess the settings they will be working in and to develop context-sensitive facilitation strategies. Researchers should be clear as to why they are using a logic model and experiment with different models to ensure they have the correct type. Electronic supplementary material The online version of this article (10.1186/s12874-019-0701-4) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Saude Publica

Journal ID (iso-abbrev): Rev Saude Publica

Journal ID (publisher-id): rsp

Title: Revista de Saúde Pública

Publisher: Faculdade de Saúde Pública da Universidade de São Paulo

ISSN (Print): 0034-8910

ISSN (Electronic): 1518-8787

Publication date (Electronic, pub): 21 September 2021

Publication date (Electronic, collection): 2021

Volume: 55

Electronic Location Identifier: 54

Affiliations

[I ] orgnameUniversidade Federal do Rio Grande do Norte orgdiv1Faculdade de Ciências da Saúde do Trairi orgdiv2Programa de Pós-Graduação em Saúde Coletiva Santa Cruz RN Brasil originalUniversidade Federal do Rio Grande do Norte. Faculdade de Ciências da Saúde do Trairi. Programa de Pós-Graduação em Saúde Coletiva. Santa Cruz, RN, Brasil

[II ] orgnameUniversidade Federal do Rio Grande do Norte orgdiv1Departamento de Odontologia orgdiv2Programa de Pós-Graduação em Saúde Coletiva Natal RN Brasil originalUniversidade Federal do Rio Grande do Norte. Departamento de Odontologia. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasil

[III ] orgnameUniversidade Federal do Rio Grande do Norte orgdiv1Departamento de Saúde Coletiva Natal RN Brasil originalUniversidade Federal do Rio Grande do Norte. Departamento de Saúde Coletiva. Natal, RN, Brasil

[IV ] orgnameUniversidade Federal de Pernambuco orgdiv1Departamento de Fisioterapia orgdiv2Programa de Pós-Graduação em Fisioterapia Recife PE Brasil originalUniversidade Federal de Pernambuco. Departamento de Fisioterapia. Programa de Pós-Graduação em Fisioterapia. Recife, PE, Brasil

[V ] orgnameSecretaria Estadual de Saúde do Rio Grande do Norte Natal RN Brasil originalSecretaria Estadual de Saúde do Rio Grande do Norte, Natal, RN, Brasil

[VI ] orgnameInstituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro Rio de janeiro RJ Brasil originalInstituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de janeiro, RJ, Brasil

[I ] Brasil originalUniversidade Federal do Rio Grande do Norte. Faculdade de Ciências da Saúde do Trairi. Programa de Pós-Graduação em Saúde Coletiva. Santa Cruz, RN, Brasil

[II ] originalUniversidade Federal do Rio Grande do Norte. Departamento de Odontologia. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasil

[III ] Brasil originalUniversidade Federal do Rio Grande do Norte. Departamento de Saúde Coletiva. Natal, RN, Brasil

[IV ] Brasil originalUniversidade Federal de Pernambuco. Departamento de Fisioterapia. Programa de Pós-Graduação em Fisioterapia. Recife, PE, Brasil

[V ] Brasil originalSecretaria Estadual de Saúde do Rio Grande do Norte, Natal, RN, Brasil

[VI ] Brasil original Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de janeiro, RJ, Brasil

Author notes

Correspondence: Diego Dantas Av. Jorn. Aníbal Fernandes, 173, sala 02 50740-560 Recife, PE, Brazil Email: diego.sdantas@ 123456ufpe.br

Authors’ Contribution: Study design and planning: RSV, THMD, LC, DD. Data collection, analysis and interpretation: RSV, THMD, FCAM, MSS, CMA, DD. Preparation or revision of the manuscript: RSV, THMD, FCAM, MSS, CMA, DD. Final version approval: RSV, THMD, FCAM, MSS, CMA, DD. Public responsibility for the content of the article: RSV, THMD, FCAM, MSS, CMA, DD.

Conflict of Interest: The authors declare no conflict of interest.

Correspondência: Diego Dantas Av. Jorn. Aníbal Fernandes, 173, sala 02 50740-560 Cidade Universitária, Recife, PE, Brasil E-mail: diego.sdantas@ufpe.br

Contribuição dos Autores: Concepção e planejamento do estudo: RSV, THMD, LC, DD. Coleta, análise e interpretação dos dados: RSV, THMD, FCAM, MSS, CMA, DD. Elaboração ou revisão do manuscrito: RSV, THMD, FCAM, MSS, CMA, DD. Aprovação da versão final: RSV, THMD, FCAM, MSS, CMA, DD Responsabilidade pública pelo conteúdo do artigo: RSV, THMD, FCAM, MSS, CMA, DD.

Conflito de Interesses: Os autores declaram não haver conflito de interesses.

Author information

Regis de Souza Valentim https://orcid.org/0000-0002-0865-8304

Thaissa Hamana de Macedo Dantas https://orcid.org/0000-0003-0509-8505

Flavia Christiane de Azevedo Machado https://orcid.org/0000-0003-1587-2664

Camilla Medeiros Araújo https://orcid.org/0000-0003-0492-5329

Marilene Soares da Silva https://orcid.org/0000-0001-8571-3664

Luciana Castaneda https://orcid.org/0000-0001-8573-342X

Diego Dantas https://orcid.org/0000-0002-1966-3352

Article

Other ID: 00247

DOI: 10.11606/s1518-8787.2021055002976

PMC ID: 8455145

PubMed ID: 34614117

SO-VID: 4396e9ea-1684-4261-a595-6e5cadeadf8a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 30 July 2020

Date accepted : 9 November 2020

Page count

Figures: 2, Tables: 4, Equations: 0, References: 30

Funding

Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico

Award ID: 44278/2018.7

Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Award ID: 001

Funding: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq - case 44278/2018.7). Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes - Funding 001).

Construction and validation of a logical model for specialized Rehabilitation Centers

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ABSTRACT

OBJECTIVE

METHODS

RESULTS

CONCLUSION

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Most cited references 40

A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries

What is rehabilitation? An empirical investigation leading to an evidence-based description

Advancing complexity science in healthcare research: the logic of logic models

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