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1.
Fan Gao Thomas H. Grant Elliot J. Roth Li-Qun Zhang 《Archives of physical medicine and rehabilitation》2009,90(5):819-2500
Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.
Objectives
To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle.Design
To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0°, 30°, 60°, and 90° knee flexion in a case-control manner.Setting
Research laboratory in a rehabilitation hospital.Participants
Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10).Interventions
Not applicable.Main Outcome Measurements
At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0° to 90° knee flexion.Results
At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P≤.048) and smaller pennation angle, especially for more extended knee positions (P≤.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P≤.044) and shorter fascicle length (P≤.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05).Conclusions
This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation. 相似文献2.
Objectives
Acquired brain injury (ABI) requires an extended recovery time and residual signs may be observed years after discharge. Supervised home-based motor training may present a viable option for continuing treatment of adult patients, but little information is available on home-based treatment in children. This study assessed the feasibility of home practice in children with ABI (1 or more years post-trauma). The efficacy of the programme was also evaluated.Design
A non-randomised, self-control study with control and intervention periods.Setting
Home-based exercise programme.Participants
Nineteen children (mean age 12.5 ± 3.1 years).Interventions
A 4-week daily training programme of step-up and sit-stand-sit exercises.Main outcome measures
Feasibility was assessed by the number of participants who completed the programme. Efficacy was evaluated at different stages using 10-metre walking and 2-minute walking tests, and the balance subitems of the Bruininks-Oseretsky Test of Motor Proficiency. An energy expenditure index was calculated for walking. Performance scores were used to assess balance.Results
Nine participants completed the study. The mean number of training sessions was 22 ± 8 of the 30 sessions originally scheduled. Major differences were noted between the experimental stages. Walking speed, endurance and balance improved significantly during the intervention period.Conclusions
Continuing exercising at home may be a feasible and efficient option for a considerable proportion of ABI children who are compliant with a simple but challenging exercise programme. A randomised controlled trial with a larger sample is now required. 相似文献3.
Distance measure error induced by displacement of the ulnar nerve when the elbow is flexed 总被引:1,自引:0,他引:1
Kim BJ Date ES Lee SH Yoon JS Hur SY Kim SJ 《Archives of physical medicine and rehabilitation》2005,86(4):809-812
Kim BJ, Date ES, Lee SH, Yoon JS, Hur SY, Kim SJ. Distance measure error induced by displacement of the ulnar nerve when the elbow is flexed. Arch Phys Med Rehabil 2005;86:809-12.
Objectives
To determine the presence of ulnar nerve displacement at the elbow when it is flexed and to determine its effect on distance measurements using the conventional measurement method for nerve conduction studies (NCSs).Design
Comparing the ultrasonography-assisted distance measurement method with the conventional measurement method.Setting
An electrodiagnostic laboratory at a university hospital.Participants
Seventy-eight elbows of 39 healthy volunteers.Interventions
We used high-resolution ultrasonography in real time. Based on sonographic searching, we marked 3 points on the skin through the course of the displaced ulnar nerve when the elbow is flexed: (1) point A, 7cm above the elbow (from the midpoint between the medial epicondyle tip and olecranon in the postcondylar groove [point M]); (2) point B, 3cm below the elbow; and (3) point C, the point closest to the medial epicondyle tip.Main outcome measures
Distance measurements between points A, B, and C were taken. These values were compared with measurements obtained through conventional measurement methods.Results
Ulnar nerve displacement occurred in 24.3% (19/78) of the elbows; approximately 20.5% (16/78) were subluxation, and 3.8% (3/78) were dislocation. In the ulnar nerve displacement group, the distance between points A and C was 5.84±0.33cm (range, 5.10-6.30cm), and the distance between points B and C in the flexed position was 3.35±0.19cm (range, 3.10-3.70cm). When the conventional distance measurement was used, the ulnar nerve conduction velocity across the elbow was overestimated by approximately 5.33±2.29m/s in the ulnar nerve displacement group.Conclusions
This distance measurement error may be responsible for the decreased sensitivity found in NCSs that test for ulnar neuropathy at the elbow. If the NCS results are normal in patients who have clear symptoms of ulnar neuropathy, the possibility of ulnar nerve displacement at the elbow should be considered, and further investigation with ultrasonography would be beneficial. 相似文献4.
Kirby RL Corkum CG Smith C Rushton P MacLeod DA Webber A 《Archives of physical medicine and rehabilitation》2008,89(3):480-485
Kirby RL, Corkum CG, Smith C, Rushton P, MacLeod DA, Webber A. Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial.
Objective
To test the hypotheses that, compared with participants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely.Design
A randomized controlled study.Setting
A rehabilitation center.Participants
Participants (N=30) including 16 able-bodied and 14 wheelchair users.Intervention
Participants were provided with wheelchair skills training (up to 2.4h).Main Outcome Measures
Total percentage score on a set of 23 RAD-relevant skills of the Wheelchair Skills Test (WST, version 3.2) administered a minimum of 3 days after training.Results
For the C-RAD and Arc-RAD groups, the mean ± standard deviation RAD-relevant WST scores were 32.3%±8.5% and 85.1%±18.9% (Kruskal-Wallis, P<.001). Of the 23 RAD-relevant individual skills, the success rates for the Arc-RAD group were at least 20% higher (the criterion we set for clinical significance) in 17 (74%). For the C-RAD group, the success rate was 0% for the 12 wheelie-dependent skills, the 13-cm-high obstacle, and the 15-cm level change ascent. There were no serious adverse effects in either group.Conclusions
The new RAD design allows much better performance on relevant wheelchair skills than the conventional design without compromising safety. 相似文献5.
Gregory N. Kawchuk Rick Haugen Julie Fritz 《Archives of physical medicine and rehabilitation》2009,90(2):366-368
Kawchuk GN, Haugen R, Fritz J. A true blind for subjects who receive spinal manipulation therapy.
Objective
To determine if short-duration anesthesia (propofol and remifentanil) can blind subjects to the provision or withholding of spinal manipulative therapy (SMT).Design
Placebo control.Setting
Day-procedure ward, University of Alberta Hospital.Participants
Human subjects with uncomplicated low back pain (LBP) (n=6).Interventions
In each subject, propofol and remifentanil were administered intravenously. Once unconsciouness was achieved (3-5min), subjects were placed in a lateral recumbent position and then randomized to either a control group (n=3) or an experimental group (with SMT, n=3); subjects received a single SMT to the lumbar spine. Subjects were given a standardized auditory and visual cue and then allowed to recover from anesthesia in a supine position (3-5min).Main Outcome Measures
Before anesthesia and 30 minutes after recovery, a blinded evaluator asked each subject to quantify their LBP by using an 11-point scale. This same evaluator then assessed the ability of each subject to recall specific memories while under presumed anesthesia including events related to treatment and specific auditory and visual cues.Results
In either the experimental or control group, subjects could not recall any event while under anesthesia. Some SMT subjects reported pain reduction greater than the minimally important clinical difference and greater than control subjects. No adverse events were reported.Conclusions
Short-duration, low-risk general anesthesia can create effective blinding of subjects to the provision or withholding of SMT. An anesthetic blind for SMT subjects solves many, if not all, problems associated with prior SMT blinding strategies. Although further studies are needed to refine this technique, the potential now exists to conduct the first placebo-controlled randomized controlled trial to assess SMT efficacy. 相似文献6.
Willi Horner-Johnson Gloria L. Krahn Rie Suzuki Jana J. Peterson Gale Roid Trevor Hall RRTC Expert Panel on Health Measurement 《Archives of physical medicine and rehabilitation》2010,91(4):570-575
Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.
Objective
To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.Design
Survey responses were analyzed by using partial correlations.Setting
General community.Participants
Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.Interventions
Not applicable.Main Outcome Measure
SF-36.Results
Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.Conclusions
Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36. 相似文献7.
Objective
The purpose of this study was to evaluate the effect of augmented soft tissue mobilization (ASTM) on the treatment of lateral epicondylitis.Methods
This randomized clinical study assessed 27 subjects (12 men and 15 women) with lateral epicondylitis and were divided randomly into 2 groups. The experimental group (n = 15) received ASTM twice a week for 5 weeks. The subjects of the control group (n = 12) received advice on the natural evolution of lateral epicondylitis, computer ergonomics, and stretching exercises. Patient-rated outcome was assessed at baseline and after 6 weeks and 3 months using a visual analog scale and the Patient-Rated Tennis Elbow Evaluation. The function was assessed using the pain-free grip strength at baseline and after 6 weeks.Results
Both groups showed improvements in pain-free grip strength, visual analog scale, and Patient-Rated Tennis Elbow Evaluation. Sample size for larger future randomized clinical trial was 116 participants.Conclusion
A larger study investigating the same hypothesis is warranted to detect difference in the effects of these treatments strategies. The study design is feasible, and minor improvements will help to minimize the potential bias. 相似文献8.
Deanna Devitt Yoichi Koike Geoffrey P. Doherty Nanthan Ramachandran Laurent Dinh Hans K. Uhthoff Martin Lecompte Guy Trudel 《Archives of physical medicine and rehabilitation》2009,90(5):756-760
Devitt D, Koike Y, Doherty GP, Ramachandran N, Dinh L, Uhthoff HK, Lecompte M, Trudel G. The ability of ultrasonography, magnetic resonance imaging and bone mineral densitometry to predict the strength of human Achilles' tendons.
Objective
To assess the value of ultrasonography (US), magnetic resonance imaging (MRI), and bone mineral densitometry (BMD) in evaluating human Achilles' tendon strength.Design
Cross-sectional observational study.Setting
Tertiary care hospital.Participants
Ninety-eight Achilles' tendons from 49 consecutive cadavers (26 men and 23 women with a mean age of 66.6 years) undergoing hospital autopsy were assessed.Interventions
Not applicable.Main Outcome Measures
Tendon dimensions on US and MRI, and T1-weighted optical density were measured. Areas of hypodensity, hyperdensity, calcification, and heterogeneity were identified on US. The BMD of each calcaneus was recorded. The tendons were mechanically tested to determine peak load at failure.Results
Sixteen patients (32.7%, 27 tendons) had abnormalities in 1 or both tendons on US and/or MRI (17 on US, 17 on MRI). Fifty-seven tendons (58%) ruptured in their midsubstance, at an average peak load of 4722±990N. Tendons with and without abnormalities on imaging had similar strengths (P>.05). Calcaneal BMD correlated weakly with peak load at failure (r=.21, P<.05).Conclusions
The prevalence of Achilles' tendons abnormalities on US or MRI was 32.7% in our study group. Abnormalities on clinical imaging (US or MRI) were not predictive of the load at failure. Therefore, tendons with imaging abnormalities are not necessarily weaker, and one cannot predict the likelihood of rupture based on imaging results. Further, higher-powered studies could explore the ability of BMD to detect minimal clinically important differences and to predict Achilles' tendon weakness. 相似文献9.
Lois E. Finch Johanne Higgins Sharon L. Wood-Dauphinee Nancy E. Mayo 《Archives of physical medicine and rehabilitation》2009,90(9):1584-1595
Finch LE, Higgins J, Wood-Dauphinee SL, Mayo NE. A measure of physical functioning to define stroke recovery at 3 months: preliminary results.
Objective
To develop a physical functioning measure through Rasch analysis conceptualized using the International Classification of Functioning, Disability and Health (ICF).Design
Observational cohort study.Setting
Acute-hospital and community-based study.Participants
Subjects (N=235) hospitalized with postacute stroke and reassessed in the community at 3-months (mean age, 71.6±12.9y).Interventions
None.Main Outcome Measures
Functional assessments 3 months poststroke included self-report and observational indices and tests commonly used to evaluate stroke survivors. Sociodemographic information was also collected. Rasch analysis assisted in combining the items across ICF components to develop the measure. Items were retained based on fit to the model and relationship to the construct; reliability and validity were assessed.Results
The best 44 items formed the Physical Functioning Measure at 3 months (F3m) measure of functioning evaluating limb movement, balance, activities of daily living, and participation. All Rasch model assumptions were met. Both item and person reliably (.96) indicated a stable hierarchy, while precision varied from .51 to 1.2 logits. Early evidence for construct validity is adequate.Conclusions
The F3m combines patient reported and observed ratings of performance items into a single measure quantifying functioning with good preliminary psychometric properties that with further testing can assist in directing and evaluating interventions and recovery. 相似文献10.
Chou LW Lee SC Johnston TE Binder-Macleod SA 《Archives of physical medicine and rehabilitation》2008,89(5):856-864
Chou L-W, Lee SC, Johnston TE, Binder-Macleod SA. The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury.
Objective
To compare the effectiveness of progressively increasing stimulation intensity, progressively increasing frequency, or progressively increasing both frequency and intensity on paralyzed quadriceps femoris muscle force maintenance during repetitive activation.Design
Factorial design with different stimulation protocols as independent variables.Setting
A muscle performance laboratory.Participants
People (N=8) with spinal cord injury (SCI) (age, 14.63±1.77y).Interventions
Not applicable.Main Outcome Measure
Number of contractions when the peak force was 90% or more of a subject's maximal twitch force.Results
The protocol involving progressively increasing stimulation intensity and then frequency generated more successful contractions (189.88±53.33) than progressively increasing the frequency followed by intensity (122.75±26.56 contractions). Regardless of the order, progressively increasing both intensity and frequency generated more successful contractions than progressively increasing intensity (97 contractions) or frequency (62 contractions) alone.Conclusions
Our findings suggest that during repetitive electric activation, progressively increasing both stimulation frequency and intensity can produce more successful contractions than progressively increasing only frequency or intensity. These findings can help researchers and clinicians design more effective stimulation protocols for persons with SCI during functional electric stimulation applications. 相似文献11.
Background
Recent healthcare policies have encouraged increasing interest in the concept of patient self-referral, specifically with regard to physiotherapy. However, what has not been known until recently is the efficacy of this mode of access within the National Health Service (NHS), including the cost implications on which to reliably base the provision of future service models.Aim
To establish the costs to National Health Service (NHS) Scotland of differing modes of access to physiotherapy in primary care.Design
Cost-minimisation analysis, multi-centred national trial.Setting
Twenty-six general practices throughout Scotland.Participants
Three-thousand and ten patients.Method
Self-referral was introduced in each site in parallel with referral by a general practitioner (GP). NHS-associated cost data were collated over a full year by referral type, i.e. self-referral, GP-suggested and GP-referral groups. A cost-minimisation analysis was performed and the main outcome measures were the number of GP and physiotherapy contacts, prescribing of non-steroidal anti-inflammatory drugs and analgesics, and referral for X-ray, magnetic resonance imaging and/or secondary care. Costs were established for 2004.Results
The data from 3010 patients identified significant associations between referral group and prescribing, referral for X-ray and to secondary care, and GP and physiotherapy contacts (P < 0.001). The average cost of an episode of care was established as £66.31 for a self-referral, £79.50 for a GP-suggested referral and £88.99 for a GP referral. Extrapolated to identify national implications, the average cost benefit to NHS Scotland was identified as being approximately £2 million per annum.Conclusion
There are significant positive implications associated with self-referral to physiotherapy that represent added value for NHS Scotland. These implications are also of relevance to the rest of the NHS in the UK. 相似文献12.
Salbach NM Mayo NE Robichaud-Ekstrand S Hanley JA Richards CL Wood-Dauphinee S 《Archives of physical medicine and rehabilitation》2006,87(3):364-370
Salbach NM, Mayo NE, Robichaud-Ekstrand S, Hanley JA, Richards CL, Wood-Dauphinee S. Balance self-efficacy and its relevance to physical function and perceived health status after stroke.
Objectives
To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status.Design
Secondary analysis of baseline, postintervention, and 6-month follow-up data from a randomized trial.Setting
General community.Participants
Ninety-one subjects with a first or recurrent stroke, discharged from rehabilitation therapy with a residual walking deficit.Interventions
Not applicable.Main Outcome Measures
The Activities-Specific Balance Confidence (ABC) Scale, Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale, and the EQ-5D visual analog scale of perceived health status.Results
Average balance self-efficacy was 59 out of 100 points on the ABC scale (95% confidence interval, 55-64; n=89). After adjusting for age and sex, functional walking capacity explained 32% and 0% of the respective variability in physical function and perceived health status scores obtained 6 months later. After adjustment for age, sex, and functional walking capacity, balance self-efficacy explained 3% and 19% of variation in 6-month physical function and perceived health status scores, respectively.Conclusions
Subjects living in the community after stroke experience impaired balance self-efficacy. Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement, primarily in perceived health status, but also in physical function, than the enhancement of functional walking capacity alone. 相似文献13.
Background
Measurements from pressure biofeedback units (PBUs) can be used to evaluate the activity of the transversus abdominis (TrA) muscle indirectly. These measurements can classify patients or monitor the progress of treatment programmes for people with low back pain.Objective
To systematically review studies on the measurement properties of PBUs for the assessment of TrA activity.Data sources
Eligible studies were identified through searches of PUBMED, CINAHL and BIREME (1990 to 2009). In addition, hand searches of journals and citation tracking were performed.Study selection
Full-text studies involving any type of clinimetric tests of PBU measurement for the assessment of TrA activity were selected.Data extraction
Two independent reviewers selected the studies, extracted the data and assessed methodological quality.Data synthesis
Due to the heterogeneity of study designs and statistical analysis, it was not possible to pool the data for a meta-analysis.Results
Six studies met the inclusion criteria. These studies were typically of low quality and recruited healthy subjects rather than patients with low back pain. The studies found moderate to good reproducibility (intra-class correlation coefficients from 0.47 to 0.82) and acceptable construct validity (intra-class correlation coefficients from 0.48 to 0.90).Conclusions
The current evidence about the measurement properties of PBUs for the assessment of TrA activity is mainly based on studies with suboptimal designs, and the findings from these studies are likely to be overly optimistic. The most important clinical questions about the measurement properties of PBUs for the assessment of TrA activity are yet to be answered. 相似文献14.
Eun Joo Yang 《Archives of physical medicine and rehabilitation》2009,90(5):741-733
Yang EJ, Rha D, Yoo JK, Park ES. Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography.
Objective
To investigate the accuracy of manual needle placement into gastrocnemius muscle (GCM) for botulinum toxin type A (BTX-A) injection in children with spastic cerebral palsy (CP).Design
Prospective clinical study.Setting
University-affiliated hospital.Participants
A total of 272 injections in GCMs of 39 children with spastic CP who were scheduled to receive BTX-A injections in GCMs.Intervention
Not applicable.Main Outcome Measures
The accuracy of manual needle placement was checked against ultrasonography.Results
The needle was accurately inserted into GCM muscles in 78.7% of cases. Accuracy was 92.6% into gastrocnemius medialis (GM) and 64.7% into gastrocnemuis lateralis (GL). Muscle thickness at the needle insertion site was significantly thinner in GL than GM. Accuracy of GL in the younger age group (<4y, 57.6%) was lower than in the older age group (≥4y, 78.1%). For GM, accuracy in both younger and older age groups was good (>90%).Conclusions
Injection of the toxin into GCMs through the use of anatomic landmark was acceptable in GM, but not acceptable in GL, especially in young children. 相似文献15.
Chueh-Hung Wu Yi-Chiang Wang Hsing-Kuo Wang Wen-Shiang Chen Tyng-Guey Wang 《Archives of physical medicine and rehabilitation》2010,91(2):278-282
Wu C-H, Wang Y-C, Wang H-K, Chen W-S, Wang T-G. Evaluating displacement of the coracoacromial ligament in painful shoulders of overhead athletes through dynamic ultrasonographic examination.
Objective
To evaluate displacement of the coracoacromial ligament (CAL), using dynamic ultrasonography (US), for detecting instability-related impingement caused by overhead activities.Design
Between-group survey.Setting
Department of Physical Medicine and Rehabilitation in a tertiary care center.Participants
Volunteer high school volleyball players with unilateral shoulder pain (n=10) and volunteer asymptomatic high school volleyball players with identical training activities as control subjects (n=16).Interventions
Not applicable.Main Outcome Measure
The displacement of the CAL was measured during throwing simulation using dynamic US. Both shoulders of all subjects were evaluated.Results
During throwing simulation, the displacement of the CAL in the painful shoulders of overhead athletes increased significantly greater than the displacement in the asymptomatic shoulder (3.0±0.7mm and 2.2±0.4mm, respectively; P=.017). No difference was identified between the displacements of the CALs of bilateral shoulders of the control group subjects.Conclusions
Dynamic US, by measuring the displacement of the CAL during simulation of throwing, may be helpful in detecting abnormal humeral head upward migration in overhead athletes. 相似文献16.
17.
Anne E. Holland Catherine J. Hill Tshepo Rasekaba Annemarie Lee Matthew T. Naughton Christine F. McDonald 《Archives of physical medicine and rehabilitation》2010,91(2):221-1674
Holland AE, Hill CJ, Rasekaba T, Lee A, Naughton MT, McDonald CF. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease.
Objective
To establish the minimal important difference (MID) for the six-minute walk distance (6MWD) in persons with chronic obstructive pulmonary disease (COPD).Design
Analysis of data from an observational study using distribution- and anchor-based methods to determine the MID in 6MWD.Setting
Outpatient pulmonary rehabilitation program at 2 teaching hospitals.Participants
Seventy-five patients with COPD (44 men) in a stable clinical state with mean age 70 years (SD 9y), forced expiratory volume in one second 52% (SD 21%) predicted and baseline walking distance 359 meters (SD 104m).Interventions
Not applicable.Main Outcome Measures
Participants completed the six-minute walk test before and after a 7-week pulmonary rehabilitation program. Participants and clinicians completed a global rating of change score while blinded to the change in 6MWD.Results
The mean change in 6MWD in participants who reported themselves to be unchanged was 17.7 meters, compared with 60.2 meters in those who reported small change and 78.4 meters in those who reported substantial change (P=.004). Anchor-based methods identified an MID of 25 meters (95% confidence interval 20-61m). There was excellent agreement with distribution-based methods (25.5-26.5m, κ=.95). A change in 6MWD of 14% compared with baseline also represented a clinically important effect; this threshold was less sensitive than for absolute change (sensitivity .70 vs .85).Conclusions
The MID for 6MWD in COPD is 25 meters. Absolute change in 6MWD is a more sensitive indicator than percentage change from baseline. These data support the use of 6MWD as a patient-important outcome in research and clinical practice. 相似文献18.
Dong-Wook Rha Sang Hee Im Sang Chul Lee Seong-Kyun Kim 《Archives of physical medicine and rehabilitation》2010,91(2):283-287
Rha D-W, Im SH, Lee SC, Kim S-K. Needle insertion into the tibialis posterior: ultrasonographic evaluation of an anterior approach.
Objective
To investigate the ultrasonographic anatomy of the lower leg for safe and accurate needle placement into the tibialis posterior using the anterior approach.Design
Cross-sectional study.Setting
University rehabilitation hospital.Participants
Healthy volunteers (N=62; 30 men, 32 women).Interventions
Not applicable.Main Outcome Measures
The safety window (the tibia to the neurovascular bundle) and the depth to the midpoint of the safety window (skin to the tibialis posterior) at the upper third and the midpoint of the tibia were measured with a transverse ultrasonographic scan.Results
The safety window at the upper third of the tibia was significantly larger than that at the midpoint (P<.01). The safety window ranged from .64cm to 2.13cm at the upper third tibialis point and from .32cm to 1.30cm at the midpoint. The depth to the tibialis posterior at the upper third of the tibia was significantly deeper than that in the midpoint (P<.01). The depth ranged from 2.47cm to 4.66cm at the upper third tibias point and from 2.35cm to 4.28cm at the midpoint.Conclusions
Ultrasonography is a useful tool in measuring the safety window and the depth to the tibialis posterior using the anterior approach. Considering the safety window, we suggest the needle placement at the upper third point of tibia rather than that at the midpoint. 相似文献19.
Li J Galatsch M Siegrist J Müller BH Hasselhorn HM;European NEXT Study group 《International journal of nursing studies》2011,48(5):628-635
Background
Many countries are facing a serious situation of nursing shortage, and retention of nurses is a challenge.Objectives
To examine whether reward frustration at work, as measured by the effort-reward imbalance model, predicts intention to leave the nursing profession, using data from the European longitudinal nurses’ early exit study.Design
A prospective study with one-year follow-up.Methods
6469 registered female nurses working in hospitals in seven European countries who did not have intention to leave the nursing profession at baseline were included in our analyses by multivariate Poisson regression.Results
8.24% nurses newly developed intention to leave during follow-up. High effort-reward imbalance at baseline predicted an elevated risk of intention to leave the profession (relative risk 1.33, 95% confidence interval 1.22-1.45), and reward frustration (poor salary and promotion prospects, lack of esteem) showed the strongest explanatory power. Findings were similar in a majority of the countries.Conclusions
Results suggest that improving the psychosocial work environment, and specifically occupational rewards, may be helpful in retaining nurses and consequently reducing nursing shortage in Europe. 相似文献20.
Sze PC Cheung WH Lam PS Lo HS Leung KS Chan T 《Archives of physical medicine and rehabilitation》2008,89(7):1329-1334
Sze P-C, Cheung W-H, Lam P-S, Lo HS-D, Leung K-S, Chan T. The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program.