Poster 5: Short-term effects of locomotor-oriented rehabilitation on postarthroplasty hip impairments and functional ability

Objective: To evaluate the effects of intensive rehabilitation offered 6 months after total hip arthroplasty (THA). Design: Intervention pilot study, before-after trial. Setting: Ambulatory care. Patients: 10 patients were evaluated 7.2±0.5 months after THA (pretest) and 2 months later (posttest). Intervention: 12 supervised sessions and unsupervised home exercises. Main Outcome Measures: Functional ability measured with Western Ontario and McMaster Universities Osteoarthritis Index (pain and disability scales), clinical locomotor tests, and laboratory gait evaluation. Hip strength and mobility impairments were also quantified. Comparisons were made with Wilcoxon signed-rank tests. Results: At posttest, patients had less pain (-56%) and less difficulty in performing daily activities (disability scale, −42%), and they performed better during the 10m walk (15%), 6-minute walk (16%), and timed stair (17%) tests, as compared with pretest. No differences were revealed in gait kinematics and kinetics or impairment measures on the operated limb. Significant changes were found in the movements of the sound limb. Conclusions: The intervention promoted better functional ability. Functional gains seem related to more efficient compensations with the sound limb and better locomotor endurance. These results stress the importance of measuring joint-specific outcomes and using bilateral measures to understand changes in global functional outcomes.     

Poster 29: Barriers to community integration treatment

Objective: To examine barriers to community integration treatment (CIT) among a consecutive sample of referrals. Design: A retrospective chart review of a consecutive series of referrals to CIT. Setting: CIT program for persons with brain injury. Participants: 138 consecutive referrals (n=72 nonadmitted) to CIT from January 1 to December 31, 2002. Interventions: All persons referred were evaluated by an admissions counselor and/or treatment team to determine appropriateness. Main Outcome Measures: Data comparing persons entering treatment with those not entering treatment were retrieved from summary admissions reports. Results: Persons entering treatment did not differ in age, gender, race, distance to the program, or time postinjury from persons who did not enter treatment. Common barriers to persons not entering treatment included: reliable transportation (14%), funding for treatment (8%), poor family support (6%), and awareness for relevance of treatment (14%). Conclusions: Among a sample of consecutive referrals not admitted to CIT, approximately 42% of cases were due to barriers such as reliable transportation, funding for treatment, poor family support, and education about the relevance of CIT. These data suggest points of intervention for policymakers and clinicians to decrease disability and handicap in states serving large rural populations.     

Poster 25: Intrathecal baclofen therapy in ambulatory patients with multiple sclerosis: effect on gait speed

Objective: To evaluate whether intrathecal baclofen (ITB) therapy causes a decrease in gait speed in ambulatory patients with multiple sclerosis (MS). Design: Longitudinal pre-post intervention study (24-wk follow-up). Setting: Spasticity clinic within a large outpatient comprehensive care center for MS. Participants: Patients with intractable lower-extremity spasticity, definitively diagnosed with MS and able to walk at least 25ft with or without support. Intervention: Implantation of a programmable ITB infusion system. All patients received inpatient and/or outpatient physical therapy after surgery. Main Outcomes Measure: Gait speed calculated from the Timed 25-Foot Walk. Results: 8 patients were analyzed (75% women; mean age, 37.4±6.1y; mean disease duration, 9.7±7.9y; median Expanded Disability Status Scale [EDSS] score, 6.5). There was no significant change in EDSS score during the study. There was statistically significant improvement of Modified Ashworth Scale scores between baseline and all follow-up visits. There was no statistically significant change in gait speed. Average gait speed was .48±.35m/s at baseline, .46±.41m/s at 4 weeks, .41±.37m/s at 12 weeks, and .48±.40m/s at 24 weeks. Conclusions: Our results suggest that ITB therapy improves severe spasticity, but does not affect gait speed measured on a short distance in ambulatory MS patients, up to 6 months after surgery. Further study is needed to assess the effect of ITB on gait endurance, gait quality, and patient quality of life.