Building Medical Rehabilitation System with Safety and Without Interruption for the Patients with Coronavirus Disease 2019 Using the Functional Resonance Analysis Method (FRAM)

  1. Naoki Sasanuma
  2. Keiko Takahashi
  3. Ai Yanagida
  4. Yohei Miyagi
  5. Seiya Yamakawa
  6. Tetsu Seo
  7. Yuki Uchiyama
  8. Norihiko Kodama
  9. Kazuhisa Domen

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Introduction

Coronavirus disease 2019 (COVID-19) is an indication for rehabilitation medicine, especially in severe cases. However, there has been no systematic development of a safe and uninterrupted provision system of medical rehabilitation for patients and medical staff with COVID-19. The Functional Resonance Analysis method (FRAM) is used to analyze performance in a socio-technical system. In FRAM, each “Function” is viewed from six aspects : Input, Output, Preconditions, Resources, Control, and Time. These aspects define each Function and reveal connections between Functions. In this study, we analyzed a safe and uninterrupted provision system for medical rehabilitation—for severely ill COVID-19 patients using FRAM to prepare for possible problems in the future.

Methods

The subject of analysis was the provision system for medical rehabilitation for patients with COVID-19 at the Rehabilitation Center of Hyogo College of Medicine College Hospital. The analysis was conducted by dividing a 21-month rehabilitation period beginning April 2020 into 5 phases, and analyzing each phase using FRAM. The first four phases were retrospective analyses, and the fifth phase was a prospective analysis.

Results

Our results showed that the number of rehabilitation physicians, consultation systems, and full-time therapists was adjusted and the system providing rehabilitation was modified during each phase.

Discussion

Elements of Function, such as preconditions, control, and resources, require modification in each phase. In the process of adding and deleting these elements, it became clear that it was necessary to deal with new characteristics of SARS-CoV-2 infection. Retrospective system analysis using FRAM may contribute to the planning of measures necessary for the implementation of rehabilitation medicine prospectively.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2022.05.18.22275242: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study was approved by the Ethics Committee of Hyogo Medical College (registration number 3866) and was described in line with the SQIURE (Quality Improvement Reporting Excellence) 2.0 checklist[15].
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are some limitations to this study. The setting and description of each “Function” has a high degree of freedom, and the reproducibility and universality of the model may be poor. In addition, since the scope of each function acting on the entire system is infinitely broad and can be infinitely subdivided, it is essential to examine the validity of the breadth and fineness of the descriptions in this report. Although we have attempted to formulate some prospective functions, the analysis of disturbances that occur suddenly and without warning must be performed retrospectively. The usefulness of FRAM from a predictive perspective is an important issue for the future. In this study, we conducted FRAM system analysis of the process of establishing a safe and uninterrupted system to provide rehabilitation for COVID-19 patients and attempted to develop a strategy to deal with foreseeable problems. The presentation of “Functions” and the analysis of the elements of each “Function” are useful for constructing a system can be modified from time to time, and may be applied to the operation of different systems in different situations. From our results, we conclude that the analysis of our medical rehabilitation provision system by FRAM allows the prediction of necessary measures in the future and contributes to the establishment of a safe and uninterrupted system for providing rehabilitation.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.05.18.22275242v1 on medRxiv