The Neuro-IFRAH Method: Its Contribution and Utilization by Graduates of Certification Courses
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1 MANPOWER EVALUATION AND SOCIAL PLANNING The Neuro-IFRAH Method: Its Contribution and Utilization by Graduates of Certification Courses Shiri Nir Malka Korazim The study was initiated and funded by Eshel, the Association for the Planning and Development of Services for the Aged in Israel RR
2 The Neuro-IFRAH Method: Its Contribution and Utilization by Graduates of Certification Courses Shiri Nir Malka Korazim The study was initiated and funded by Eshel, the Association for the Planning and Development of Services for the Aged in Israel Jerusalem July 2011
3 Editor: Raya Cohen English translation (executive summary): Evelyn Abel Layout and print production: Leslie Klineman Myers-JDC-Brookdale Institute P.O.B Jerusalem 91037, Israel Tel: (02) Fax: (02) Web site:
4 Executive Summary Neuro-IFRAH Neuro-Integrative Functional Rehabilitation and Habilitation is a unique rehabilitation method developed by the occupational therapist, Waleed Al-Oboudi. The method is a branch of the well-known Bobath method in the field of rehabilitation. It focuses on treating people who suffered a stroke or head injury and, as a result, their central nervous system was affected. For the past five years, Eshel s training center has been offering a certification course in the Neuro-IFRAH method for physiotherapists and occupational therapists. To date, five courses have been completed (from 2005 to 2009) with the participation of 109 physiotherapists and occupational therapists. In preparation for the continuation of the course, Eshel asked the Myers- JDC-Brookdale Institute to conduct a survey among graduates to examine their utilization of the method, their attitudes to it, their perception of its contribution to their therapeutic work, of the difficulties of implementation and of unmet needs. The data were collected in a telephone survey of 104 graduates out of a total of 109 graduates. The study findings show: a. Professional and Employment Characteristics of the Graduates Over half the graduates (60%) are physiotherapists while the remaining 40% are occupational therapists. The graduate population is heterogeneous in terms of professional seniority more than half (53%) have been working in the profession for up to 10 years, and about a quarter for over 20 years. Over half the graduates (56%) are employed in community clinics (private or health-plan clinics), 20% work in general hospitals, 16% work in rehabilitation hospitals and 8% in oldage homes. The graduate population is heterogeneous in terms of length of time in their current positions; approximately one third (30%) have been working up to 3 years, 39% 4r to 9 years, and an additional third (31%) for over 10 years. Some of the graduates (40%) had trained in the Bobath method (mainly physiotherapists); the others (60%) had not trained in this method (mainly occupational therapists). b. Utilization of the Method and Extent of Command Most of the graduates (91%) reported using the method in the half year preceding the interview: over half (54%) reported using it to a very great or great extent, 28% to a small extent and 9% to a very small extent. The rate of respondents reporting utilization of the method to a very great or great extent was higher among occupational therapists than physiotherapists (61% and 46%
5 respectively), and among graduates who had not received Bobath training than graduates who had (62% and 43% respectively). No correlation was found between the utilization of the Neuro-IFRAH method and a graduate s course cohort, professional seniority, type of organization in which s/he is employed or type of population being served (as regards age and the number of patients suffering from neurological problems). About half the graduates (54%) assessed that they have a very good or good command of the method; the rest (46%) assessed their command as not so good or not good. As expected, a correlation was found between extent of command and utilization of the method those who used the method to a very great or great extent reported a greater command than those who used it to a very small or small extent. c. Attitudes towards the Method Almost all the graduates assessed the method as contributing to them to a very great or great extent: new professional skills (90%), important treatment tools (88%), new professional knowledge (88%) and improved quality of care to patients (81%). In the overall evaluation of the method, a high percentage of graduates noted that it was effective/ useful/ beneficial (43%), or "brilliant/ amazing/ excellent (40%). The attitudes of the graduates towards the implementation of the method showed general agreement that the method was physically strenuous for the therapist (82%) and demanded ongoing review of the course material (81%). Opinions were divided over other aspects of the method s implementation: "it is easy to implement" (60%); "it does not require prolonged treatment" (60%); "it is easy to obtain the necessary equipment" (56%). A correlation was found between the attitudes towards implementing the method and the extent of utilization. d. Evaluation of the Certification Course, Participation in Refresher Courses and Training Needs Almost all the graduates (95% to 99%) expressed very great or great satisfaction with the certification course as regards the teaching method, the professional level, the connection between theoretical and practical parts and the quality of the material distributed in the course. About a third of the graduates (35%) reported that the course had too much material and too little time devoted to practice (28%). Two-thirds suggested improving the existing course, mainly by making it less intensive and increasing practice time. Over a third (36%) of the graduates had participated in at least one refresher course since completing the certification course. Most of these participants were among the respondents who had said they used the method to a very great or great extent.
6 Almost all the graduates (95%) believed it very important or important to receive professional support for purposes of ongoing consultation during the implementation of the method. Most of the graduates (77%) indicated that they would be interested in additional training in the method. e. Topics for Discussion The findings yielded two main questions concerning continued training and practice of the method: Should the format of the certification course be changed in light of the recommendations of the graduates? What types of professional support should be developed for the graduates to help them implement and expand the use of the method?
7 Acknowledgments It is our pleasant duty to thank all those who took part in conducting the survey: We are grateful to Dror Rotem, Director of Planning, Development and Instruction at Eshel for his professional input and contribution through all the stages of implementation. Our thanks go to physiotherapist Dor Wadash and occupational therapist Eldad Greenberg, graduates of the certification course in the Neuro-IFRAH method for their professional contribution to developing the research tools. We would also like to thank Maayan Katz, Deputy-Director of the National Service for Occupational Therapy at the Ministry of Health, and Shula Han, Deputy-Chief Physiotherapist and head of Geriatrics at the Ministry of Health for their valuable comments on developing the research tools. Special thanks to the physiotherapists and occupational therapists, the graduates of the certification course in the Neuro-IFRAH method who participated in the survey for their cooperation and the time they invested to make the survey possible.
8 Table of Contents 1. Introduction 1 2. Survey Goals and Method of Data Collection 1 3. Demographic, Professional and Employment Characteristics of the Graduates 2 4. Utilization of the Method by Graduates 4 5. Graduates Assessment of the Method and its Contributions 7 6. Graduates Assessment of the Certification Course 8 7. Participation in Refresher Courses on the Method and Interest in Further Training Topics for Discussion 11 List of Tables Table 1: Participants of the Survey 2 Table 2: Demographic Characteristics of the Graduates 2 Table 3: Employment Characteristics of the Graduates 3 Table 4: Training in the Bobath Method, by Graduate's Profession 4 Table 5: Table 6: Table 7: Table 8: Utilization of the Method, the Graduates Assessment of their Command of the Method, and the Frequency of their Use of the Professional Course Material 5 Utilization of the Method, by Profession, Training in the Bobath Method and Seniority in Current Position 6 Utilization of the Method, by the Graduates Assessment of the Level of their Command of the Method and the Frequency of their Use of the Professional Course Material 6 Assessment of Graduates of the Neuro-IFRAH Method, regarding Several Aspects 7 Table 9: Expressions Used by Graduates to Describe the Method 7 Table 10: Table 11: Assessment of Graduates of the Neuro-IFRAH Method, by Aspects Related to Implementation 8 Number of Aspects of Implementation Rated Positively, by the Extent of Use of the Method. 8
9 Table 12: Graduates Assessment of the Quality of the Certification Course 9 Table 13: Graduates Assessment of Various Aspects of the Certification Course 9 Table 14: Table 15: Reports of Graduates on Participation in Refresher Courses, their Interest in Further Training and the Importance they Attributed to Professional Support for Course Graduates 10 Utilization of the Method by Graduates, by Participation in Refresher Courses and their Interest in Further Training 11
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