Rehabilitation Phases

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Introduction

There is a growing need for healthcare rehabilitation systems as the worldwide population is increasing. In the near future, we will need rehabilitation system to cope with the increasing need.

• According to the World Health Organisation (WHO) there is more than 50% of people who need rehabilitation in low and middle-income countries don’t receive rehabilitation.
• The WHO states that globally today, 1 in 3 people need to receive rehabilitation.

• The WHO defines rehabilitation as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”.

The type of care and rehabilitation needs will depend on the 1. the acuity of the condition 2. the complexity of the patient. The type of care will vary to cover the individual's needs in all stages until full recovery is reached or they are able to incorporate within society. The care ranges from acute care in acute illness/ injury (in need of rapid intervention), through to the patient’s stable phase in which the medical condition is stable enough to transmit to the next step of care ie sub-acute care followed by long term care rehabilitation ( in rehabilitation centres, or at home).

• Initially we need to know the level of rehabilitation and care dependant on the acuity and complexity of the patient’s condition.
• Recording Measurements during rehabilitation process provide visual and document evidence for the patient and the doctor about improvement.

Acute Care

Definition

There isn’t a definite term for acute care, it is defined as a service provided to individuals/populations. It is time dependant and deal with urgent, unexpected, sudden injury or acute episodes of illness that it may be life-threatening condition or may lead to disability, and need rapid intervention. Patients during this phase usually have an unstable medical condition and they deal with a variety of care delivery platforms (see below).

Emergency Care

May be carried out by General Practitioners (GPs,) to prevent irreversible complications.

Occurs at a hospital‘s emergency department: they assess the airway, breathing, circulatory, and treat critically ill people to stabilize their condition.

Depending on the degree of severity, some cases can be managed at the emergency department while others will be referred to a specialist with appropriate referral and transport facilities. For example: severe wounds /injury (may cause internal bleeding); stroke; heart attack.

Urgent Care

Carried outside the emergency department of hospital and do not follow schedules, treat conditions that need immediate care but not life threatening ie not warranting urgent attention within 24 h. eg minor injury (sprain, strain, bone break), seasonal illness child fever, or following of chronic disease eg blood pressure, or UTI.

Acute Surgery

Acute surgical needs include intra- abdominal crises: eg, appendicitis, intestinal obstruction (the most common cause of hospital admission).

Short Term Stabilisation

From name stabilize the patient, directed toward decrease and control the symptoms until receiving the definite treatment. Prehospital care: care carried and provided before the patient arrived at the hospital, for example, delivery of a person with trauma. divided according to WHO into three steps:

1. First Responder Care
2. Basic Prehospital Care
3. Advanced Prehospital Care

Critical Care, for the patient who need ICU, usually with respiratory problems.

Services Provided at Acute Care

The patient is in need of a multidisciplinary approach to ensure they will return to functional daily life.

• Therapy usually lasts three hours or more per day.
• They receive therapy at least 5 days/ week, and daily assessment face-to-face and therapy plan is updated continuously.
• Patients will receive a combination of rehabilitative care (physical, occupational, respiratory, and speech therapy as needed) according to the patient’s condition and pre-requisites for each case.

Acute care helps patients to improve their quality of life and help them to improve till transferred to sub-acute care or next step of care (whatever it is). The selection of transfer of inpatient, from acute care to next rehabilitation phase, is an important decision impacting the quality care provided to the patient and their life.

Sub-acute Care

Sub-acute care is care provided for patients who are not severely ill, generally have a stable condition, but require ongoing support to manage a new or changing health condition. It helps them to regain their ability to carry out activities of daily life. It provides care for those no longer meeting the criteria of acute care but still in need of care at a hospital with more intense care than usual. There are many definitions for sub-acute care according to associations and literature as listed here.

Where it Occurs

It is carried out at hospitals, homes, health care centres, or specialist rehabilitation centres.

Benefits Sub-acute Care

• Decreases the time of hospitalization (if in hospital).
• Help to act independently as soon as possible and to understand next steps thus bringing the patient to the highest level of function as quickly as able.
• Help to return to normal life pre-injury/ illness, help to manage the changes that happened and manage their everyday tasks.

Services Provided at Sub-acute Care

Therapy lasts for 2 hours or less/ day. Patients’ family members are involved in the meeting with their care team to ensure everyone is working toward the same goals. The focus is on regaining strength, mobility, and long-term functionality over the course of therapy A combination of physical, occupational and speech therapy are used for best results if the patient needs it. Examples here

Criteria Sub-acute Care

The Inter Qual Level of Care Criteria:

• Contain criteria about patient admission, hospitalization time, and discharge review criteria that match with patient states at every phase of care acute, sub-acute, and discharge to home.
• According to IQC, to determine the patient at acute care availability to sub-acute care, should meet the criteria of pre-admission eligibility that tested via pre-admission review.
• The patient must fulfil criteria from one of the following (having an illness, injury, or surgery, impairments that require assistance, meeting clinical stability, a patient having an ability to endure a rehabilitation program, finally can’t be able to be managed in a lower level of care than he/she tested in.
• The patient should be medically stable to can include him/her in the rehabilitation programme and can co-operate, in other conditions some patients are in acute care, medically stable and can take part in.

Post Acute Care

While post-acute care also provides continued medical treatment after a hospital stay, it maintains an emphasis on recuperation, rehabilitation, and symptom management. Patients in recovery from cardiac or pulmonary disease, stroke or neurological disorders, or orthopaedic surgery often require rehabilitative therapies to help bridge the gap between hospital and home. The goal of post-acute rehabilitation is to maximize patient wellness and independence so they can get back to the business of living their best lives. Post-acute care services range from intensive short-term rehab to longer-term restorative care. Some patients will achieve full recovery, while others learn to manage the symptoms of a chronic illness.

Long Term Care

Long Term Care (LTC) is care provided for either a short or long period of time, to people with chronic illness or disability, who don’t need specialized medical care, they may be an adult or elder person, in order to improve their quality of life, and helping them to meet their needs over time.

Include assisting with medical needs and daily living activities eg, dressing, moving from bed to chair, bathing, etc. LTC need unspecialised, unskilled care and can be provided at home, nursing homes, LTC facilities. The focus is on services and interventions to increase the person’s independence.

Care communities provide a broad range of health care, personal care, and supportive services for adults who have limited self-care capabilities. In USA about 2.1 million reside in long-term care facilities.

Types

• Informal/ unpaid care, often provided by one’s relatives and friends. Nowadays, there is a decline in informal care especially in modern societies, where the tendency is to form small families and to be independent. According to the WHO the majority of informal LTC is provided by spouses and adult children especially daughters and two-thirds of primary caregivers are women

• Formal/ paid care, provided by health care institution, nursing, eg; LTC facilities