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1.
Dara Meldrum Anne-Marie Lydon Mary Loughnane Fiona Geary Laura Shanley Karen Sayers Elizabeth Shinnick Denise Filan 《Physiotherapy》2008,94(3):212-219
Objectives
To investigate the inter-rater reliability of physiotherapy educators in awarding clinical placement marks to undergraduate students using a standardised clinical placement assessment form.Design
Inter-rater reliability study performed over five undergraduate physiotherapy clinical placements.Setting
Five clinical sites associated with a BSc undergraduate physiotherapy programme.Participants
Second and final year physiotherapy students who were on clinical placements (n = 86 paired assessments). Two physiotherapy educators (a practice tutor and a practice educator), equally involved in supervising the students over the placement period, marked each student blindly at the end of the placement.Outcome measure
Marking was performed using a standardised clinical placement assessment form and guidelines. This form was developed by physiotherapy educators, and utilised previously published work in the area.Results
Eighty-six paired assessment marks were analysed. Practice educators and practice tutors agreed on grades on 74% of occasions. The mean difference in marks (maximum of 100) between educators was −0.5 (95% confidence interval −1.1 to 0.2), and using the limits of agreement method, the results suggested that where two raters mark a student at the end of a clinical placement, the raters will be within 6.2 marks of each other on 95% of occasions. The intraclass correlation coefficient (ICC) for the overall mark was 0.84, indicating almost perfect agreement. Subsections of the form also had substantial agreement (patient management ICC, 0.75; professional development ICC, 0.75; organisation and management ICC, 0.81).Conclusion
Physiotherapy educators demonstrated a high level of reliability in the assessment and marking of undergraduate physiotherapy student performance using a standardised clinical assessment form. This was evident over several sites and specialities. 相似文献2.
Objective
To validate the Rehabilitation Adherence Measure for Athletic Training (RAdMAT) for use in clinic-based physiotherapy.Design and procedure
Single group, prospective study conducted over the course of the participants’ rehabilitation. Clinic-based adherence was measured by participant attendance at physiotherapy appointments, the 16-item RAdMAT (three subscales) and the three-item SIRAS questionnaire. The SIRAS was evaluated after each physiotherapy treatment and the RAdMAT either at the completion of their treatment or at end of the eight week study period. Both questionnaires were completed by the physiotherapist.Participants
108 participants with soft tissue injuries of the shoulder.Results
The percentage of adherence for the three different adherence measures was high ranging from 89% to 95%. Large significant correlations were found between the SIRAS and the RAdMAT total score, and the RAdMAT factor 1; and amongst the RAdMAT total and its three subscales. Medium strength correlations existed between the SIRAS and the other two RAdMAT subscales. Small significant correlations occurred between percentage of attendance, and RAdMAT factors 2 and 3.Conclusion
The strength of the correlations between the RAdMAT and the SIRAS provide evidence for the RAdMAT and its three subscales comprising a valid and comprehensive assessment tool for measuring patient adherence to clinic-based physiotherapy.Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000611820). 相似文献3.
Shaun C. Spalding Paula H. Mayer Adit A. Ginde Steven R. Lowenstein Michael Yaron 《The American journal of emergency medicine》2011,29(2):207-211
Objectives
We evaluated whether implementation of computerized physician order entry (CPOE) reduces length of stay (LOS) for discharged emergency department (ED) patients.Methods
Emergency department LOS for discharged and admitted patients were analyzed in a university-affiliated ED before and after introduction of CPOE. Patient demographics and covariates that may affect LOS (mode of arrival, provider staffing, daily census, and admission rate) were measured.Results
The study included 71?188 patients; 49?175 (69%) were discharged from the ED (28?687 before and 20?488 after CPOE). Length of stay for discharged patients decreased from 198 to 168 minutes (difference of −30; 95% confidence interval [CI], −28 to −33), whereas LOS for admitted patients increased from 405 to 441 minutes (difference of +36; 95% CI, 26-46). After controlling for covariates, CPOE implementation was associated with a 23-minute decrease in LOS for discharged patients (β = −23 [95% CI, −26 to −19]).Conclusion
Implementation of CPOE was associated with a clinically significant (23-minute) decrease in LOS among patients who were discharged from the ED. 相似文献4.
Objective
The purpose of this work was to design and evaluate an information leaflet for new patients attending a physiotherapy outpatient department. This formed part of a wider agenda of improving the patients’ experience and increasing adherence to the Chartered Society of Physiotherapy's core standards.Design
A needs analysis was undertaken with existing patients to determine the content of the new leaflet. This was then tested for readability, reviewed by physiotherapy staff and evaluated by patients via a questionnaire.Setting
The musculoskeletal outpatient physiotherapy department at Southampton General Hospital.Participants
Patients referred to the outpatient physiotherapy service, plus all clinical and support staff employed in the musculoskeletal outpatient team.Main outcome measures
Numerical Rating Scale and Gunning's Fog Index.Results
Thirty-seven of 50 patients completed the needs analysis (74%), generating 42 ideas for the leaflet content. The definitive leaflet addressed one core standard and 16 specific criteria, and had a readability of grade 8.3, which is below the recommended maximum limit of grade 9 for health education leaflets. Using an 11-point Numerical Rating Scale, where 0 = of no benefit and 10 = extremely helpful, the mean rating for the leaflet from 29 of 100 patients was 8.6.Conclusions
This work has produced a patient information leaflet for physiotherapy outpatients, a copy of which is freely available (electronically) from the author. The leaflet forms part of an ongoing commitment to improving the patients’ experience. 相似文献5.
Objectives
To investigate the difference in attitudes: (1) between first and fourth year physiotherapy students towards functioning in individuals with back pain; and (2) between physiotherapy students and non-healthcare students towards functioning in individuals with back pain.Design
Observational, cross-sectional study.Setting
Glasgow Caledonian University, Scotland, UK.Participants
First year physiotherapy (n = 61) and non-healthcare students (n = 61), and fourth year physiotherapy (n = 62) and non-healthcare students (n = 62).Main outcomes
All participants completed the Health Care Providers’ Pain and Impairment Relationship Scale (range 15 to 105). This questionnaire measures attitudes towards functioning in individuals with back pain.Results
Fourth year physiotherapy students had more positive attitudes towards functioning in individuals with back pain than first year physiotherapy students [57.4 vs 66.6 (mean difference −9.2, 95% confidence interval −12.2 to −6.1, P < 0.01)]. Similarly, fourth year non-healthcare students had more positive attitudes towards functioning in individuals with back pain compared with first year non-healthcare students [69.2 vs 65.3 (mean difference −3.9, 95% confidence interval −7.2 to −0.5, P = 0.03)]. Physiotherapy students had more positive attitudes than non-healthcare students in the first year [66.6 vs 69.2 (mean difference −2.6, 95% confidence interval −5.5 to 0.4, P = 0.08)] and the fourth year [57.4 vs 65.3 (mean difference −7.9, 95% confidence interval −11.4 to −4.4, P < 0.01)] of study.Conclusion
These findings suggest that physiotherapy education brings about positive student attitudes towards functioning in individuals with back pain. This may be partly attributable to receiving a university degree education, but would appear to be further enhanced by specifically receiving a physiotherapy degree. This may facilitate students to become more evidence-based practitioners following qualification. 相似文献6.
Objectives
To explore whether compliance with a prescribed home exercise program in elderly people with knee and/or hip osteoarthritis was influenced by mode of exercise instruction.Design
Participants were randomised to one of three groups who received different modes of exercise instruction. Exercise performance was assessed at baseline and after 4 weeks and 8 weeks of home exercises.Setting
Eighteen physiotherapy clinics in rural Victoria, Australia.Participants
One hundred and fifteen males and females (mean age 70.5 years) with osteoarthritis of the knees and/or hips.Interventions
Participants were randomised to receive verbal instructions on a home exercise program in addition to: (i) a home exercise brochure; (ii) a brochure together with an audiotape; or (iii) a brochure together with a videotape.Main outcome measures
The Correctness of Exercise Performance scale and exercise log-sheets.Results
Compliance with the home exercise program was good for all modes of exercise instruction where between 79% and 91% of exercises were performed correctly. Once provided with verbal instructions together with illustrated brochures, the provision of additional videotapes or audiotapes did not further enhance outcome.Conclusions
Older people with osteoarthritis who received face-to-face instructions and a brochure on how to perform and comply with an 8-week home exercise program did not show additional benefits from other modes of instruction.Key messages
- •
- Brochures can be as effective as additional audiotapes or videotapes to enhance correctness of exercise performance in older people with osteoarthritis of the knees and/or hips when given together with verbal instructions.
- •
- Audiotapes and videotapes may provide additional cues to maintain correctness of performance of exercises that are difficult to perform.
7.
Background
The clinical learning environment and supervision scale (CLES) is a valid and reliable tool that was developed to assess the quality of nursing students’ clinical placements.Objectives
To obtain a reliable and valid Dutch version of the CLES that is in line with the Flemish culture and educational context.Design
Scale validation study on data provided by a cross-sectional survey.Settings
190 wards in 31 institutions for healthcare in Flanders, Belgium.Participants
768 student nurses enrolled in the 3 year bachelor programme at University College Ghent, Faculty of Healthcare Vesalius.Methods
Face and content validation was followed by data collection. Factor analysis was performed using varimax rotation. Subsequently, internal consistency reliability was tested on the total scale and its subdimensions using Cronbach's alpha.Results
We gathered 768 questionnaires. Factor analysis revealed 5 subdimensions with an eigenvalue greater than 1, explaining 71.281% of the variance. The overall internal consistency and the consistency of the five subdimensions is high. Our data supports face, content and construct validity of the CLES + NL.Conclusions
The CLES + NL is a valid and reliable instrument that can be used to evaluate the quality of nursing wards as learning environments in Flanders. 相似文献8.
Gross DP, Battié MC, Asante AK. The Patient-Specific Functional Scale: validity in workers' compensation claimants.
Objective
To examine the construct and predictive validity of the Patient-Specific Functional Scale (PSFS) in workers' compensation claimants.Design
Prospective cohort study with 1-year follow-up.Setting
A workers' compensation rehabilitation facility.Participants
Subjects included 294 claimants with a variety of musculoskeletal disorders. The sample was predominantly male (70%), with a mean age of 44 years. Subjects completed a battery of measures at baseline including the PSFS, the Pain Disability Index (PDI), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).Interventions
Not applicable.Main Outcome Measures
Outcomes for determining predictive validity included administrative indicators of timely return to work and recovery during the 1-year follow-up. Analysis included Pearson correlation and multivariable Cox and logistic regression.Results
At baseline, the PSFS correlated moderately (r range, 0.3−0.5) with other indicators of functional limitation (PDI, SF-36 role−physical subscale) but negligibly with the SF-36 mental health and role−emotional subscales. The PSFS was associated with timely recovery (adjusted hazard ratio, 1.16; 95% confidence interval, 1.07-1.27) with increasing functional limitation related to delayed recovery.Conclusions
Results provide construct and predictive validity evidence for the PSFS as an indicator of functional limitation in workers' compensation claimants. 相似文献9.
Blank R von Kries R Hesse S von Voss H 《Archives of physical medicine and rehabilitation》2008,89(2):251-259
Blank R, von Kries R, Hesse S, von Voss H. Conductive education for children with cerebral palsy: effects on hand motor functions relevant to activities of daily living.
Objective
To study the effects of conductive education, a combined educational and therapeutic task-oriented approach for children with cerebral palsy (CP), on their hand motor functions and activities of daily living (ADLs).Design
Individual cohort study (B-A-B design).Setting
Ambulatory, referral center.Participants
Sixty-four children with CP, severity Gross Motor Function Classification System levels II through IV, ages 3 to 6 years.Interventions
Phases B: a 4.5-month period of special education, including 2 hours of individual physiotherapy or occupational therapy per week (special education). Phase A: during a 9-month period, conductive education was administered in 3 blocks of 4 weeks (7 hours daily from Monday through Friday); between the blocks, special education was applied as in the B phases.Main Outcome Measures
Transformed sum scores (0.00-1.00) for coordinative (eg, force-movement synergy during object manipulation, aiming) and for elementary hand functions (eg, maximum grip force, tapping), based on kinetic and kinematic measures; standardized parent questionnaire to measure ADL competence scores from 0.00 (dependence) to 1.00 (independence). Outcome parameters were changes in these parameters during phase A (intervention) compared with average changes during the B phases (pre- and postintervention). Student t tests were used for dependent samples.Results
Conductive education improved coordinative hand functions by 20% to 25% from baseline, compared with no improvement during special education; the preferred hand improved from .38 to .48 (mean, .10; 95% confidence interval [CI], .086−.114) and the nonpreferred hand improved from .39 to .47 (mean, .08; 95% CI, .034-.116). There were no changes in elementary hand motor functions. ADL competence improved by .11 (95% CI, .070-.149), from .50 to .61 (≈20%), compared with no significant improvement under special education.Conclusions
Conductive education improved coordinative hand functions and ADLs in children with CP. There was no effect on elementary hand functions. 相似文献10.
Sherer M Yablon SA Nakase-Richardson R Nick TG 《Archives of physical medicine and rehabilitation》2008,89(1):42-47
Sherer M, Yablon SA, Nakase-Richardson R, Nick TG. Effect of severity of post-traumatic confusion and its constituent symptoms on outcome after traumatic brain injury.
Objective
To investigate the prognostic significance of severity of post-traumatic confusion (PTC) and its constituent symptoms for early and late outcome after traumatic brain injury (TBI).Design
Prospective cohort study.Setting
Inpatient brain injury rehabilitation program.Participants
A total of 168 patients meeting study criteria from 195 consecutive Traumatic Brain Injury Model Systems neurorehabilitation admissions.Interventions
Not applicable.Main Outcome Measures
Employability at neurorehabilitation discharge and productivity status at 1 year postinjury.Results
More severely confused patients had poorer outcomes for both employability and productivity. Multivariable logistic regression revealed that after adjustment for all other predictors, time to follow commands, and confusion severity predicted employability at discharge and age and confusion severity predicted productivity status at 1 year. Each symptom showed an unadjusted effect on discharge employability. All symptoms except nighttime sleep disturbance or daytime decreased arousal had effects on productivity at 1 year. Presence of psychotic-type symptoms was associated with especially poor productivity outcomes.Conclusions
PTC constituent symptoms and severity predict outcome after TBI. Presence or absence of psychotic-type symptoms on a single evaluation at approximately 21 days postinjury may have particular prognostic significance for productivity outcome. 相似文献11.
Jae Chul Lee Allen W. Heinemann 《Archives of physical medicine and rehabilitation》2010,91(9):1319-1326
Lee JC, Heinemann AW. Forgoing physician visits because of cost: a source of health disparities for elderly people with disabilities?
Objective
To examine disparities in having a usual source of care and forgoing physician visits because of cost between elderly people (age ≥65y) with and without disabilities after consecutively controlling for predisposing, enabling, and perceived and evaluated health need factors using the Andersen behavioral model, and to identify the determinants of such disparities.Design
Cross-sectional analysis.Setting
Community.Participants
Nationally representative sample of community-dwelling adults age 65 years or greater in the United States from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) (N=93,933).Interventions
Not applicable.Main Outcome Measures
Responses to 2 BRFSS questions: (1) whether the respondent had a health care provider, and (2) whether the respondent had forgone seeing a physician because of cost in the past 12 months.Results
After controlling for the aforementioned factors, elderly persons with disabilities were more likely than their counterparts without disabilities to have a usual source of care (adjusted odds ratio [AOR]=1.33; 95% confidence interval [CI], 1.08-1.64), and those with disabilities were more likely to forgo physician visits because of cost (AOR=1.64; 95% CI, 1.31-2.04). The unadjusted odds of forgoing physician visits (odds ratio [OR]=2.13; 95% CI, 1.87-2.43) did not decrease after controlling for predisposing factors (AOR=2.32; 95% CI, 1.96-2.75), whereas the odds were attenuated after controlling for enabling factors (AOR=2.18; 95% CI, 1.84-2.59), perceived health need (AOR=1.70; 95% CI, 1.37-2.12), and evaluated health need (AOR=1.64; 95% CI, 1.31-2.04).Conclusions
Although elderly people with disabilities were more likely than their counterparts without disabilities to have a usual source of care, those with disabilities were more likely to forgo physician visits because of cost. Elderly persons with greater perceived health needs were most likely to experience the disparity. 相似文献12.
Objectives
To compare the effect of the abdominal draw-in manoeuvre with the abdominal draw-in manoeuvre in combination with ankle dorsiflexion on changes in muscle thickness and associated muscle activity in abdominal muscles.Design
A preliminary, randomised, controlled study.Setting
University laboratory.Participants
Forty healthy adults (18 males, 22 females) were allocated at random to the experimental group [mean age (SD) 24 (1.6) years, n = 20] or the control group [mean age (SD) 24 (1.9) years, n = 20]. The experimental group performed the abdominal draw-in manoeuvre in combination with ankle dorsiflexion, and the control group performed the abdominal draw-in manoeuvre alone, five times a day.Main outcome measures
Ultrasonography and electromyography were used to determine the intervention-related changes in muscle activity and the thickness of abdominal muscles during the abdominal draw-in manoeuvre or the abdominal draw-in manoeuvre in combination with ankle dorsiflexion.Results
A significant difference was found in the thickness of the transverse abdominal muscle between the groups [mean difference 0.24 cm, 95% confidence interval (CI) 0.08 to 0.40, P =0.005. On electromyography, a significant difference was demonstrated in the amplitude of the transverse abdominal muscle contraction between the two techniques in the experimental group (mean difference 68.76 mV, 95% CI 53.16 to 84.36, P =0.000. The intra-class correlation coefficient (ICC2,1) showed excellent test-retest reliability of ultrasound measurement of the abdominal muscles: 0.96 (95% CI 0.85 to 0.99) for the transverse abdominal muscle, 0.87 (95% CI 0.62 to 0.98) for the internal oblique muscle and 0.77 (95% CI 0.44 to 0.96) for the external oblique muscle.Conclusions
This is the first study to demonstrate the additive effect of ankle dorsiflexion on deep core muscle thickness and activity, thus contributing to existing knowledge about therapeutic exercise for the effective management of low back pain. 相似文献13.
Bionka M. Huisstede Marienke van Middelkoop Manon S. Randsdorp Suzanne Glerum Bart W. Koes 《Archives of physical medicine and rehabilitation》2010,91(2):298-314
Huisstede BM, van Middelkoop M, Randsdorp MS, Glerum S, Koes BW. Effectiveness of interventions of specific complaints of the arm, neck, and/or shoulder: 3 musculoskeletal disorders of the hand. An update.
Objectives
To provide an evidence-based overview of the effectiveness of conservative and surgical interventions for trigger finger, Dupuytren's, and De Quervain's diseases.Data Sources
The Cochrane Library, PEDro, PubMed, Embase, and CINAHL were searched to identify relevant studies.Study Selection
Two reviewers independently applied the inclusion criteria to select potential relevant studies from the title and abstracts of the references retrieved by the literature search. Relevant (Cochrane) reviews and randomized controlled trials (RCTs) were included.Data Extraction
Two reviewers independently extracted the data and performed a methodologic quality assessment.Data Synthesis
A best-evidence synthesis was performed to summarize the results of the included trials. One Cochrane review (trigger finger) and 13 RCTs (trigger finger [6], Dupuytren's [4], De Quervain's [3]) were included. The trials reported on physiotherapy (De Quervain's), steroid injections (trigger finger, De Quervain's), surgical treatment (trigger finger, De Quervain's), and a postsurgical treatment (Dupuytren's). For trigger finger, moderate evidence was found for the effectiveness of steroid injections in the short-term (1-4wk) but not for long-term outcomes. Limited evidence was found for the effectiveness of staples compared with sutures in skin closure and for intermittent compression after surgery to treat Dupuytren's disease. For other interventions, no evidence was found.Conclusions
Indications for effectiveness of some interventions for trigger finger, Dupuytren's, and De Quervain's diseases were found. Because only a few RCTs were identified, it is difficult to draw firm conclusions. High-quality RCTs are clearly needed in this field. 相似文献14.
Mohammad A. Mohseni-Bandpei Jacqueline Critchley Thomas Staunton Barbara Richardson 《Physiotherapy》2006,92(1):34-42
Objectives
To assess the short- and long-term effectiveness of spinal manipulation therapy, and to identify the effect of manipulation on lumbar muscle endurance in patients with chronic low back pain (LBP).Design
A randomised controlled trial comparing manipulation and exercise treatment with ultrasound and exercise treatment.Setting
An outpatient physiotherapy department.Participants
One hundred and twenty patients with chronic LBP were allocated at random into the manipulation/exercise group or the ultrasound/exercise group.Interventions
Both groups were given a programme of exercises. In addition, one group received spinal manipulation therapy and the other group received therapeutic ultrasound.Main outcome measures
Pain intensity, functional disability, lumbar movements and muscle endurance were measured shortly before treatment, at the end of the treatment programme and 6 months after randomisation using surface electromyography.Results
Following treatment, the manipulation/exercise group showed a statistically significant improvement (P = 0.001) in pain intensity [mean 16.4 mm, 95% confidence interval (CI) 6.1-26.8], functional disability (mean 8%, 95% CI 2-13) and spinal mobility (flexion: mean 9.4 mm, 95% CI 5.5-13.4; extension: mean 3.4 mm, 95% CI 1.0-5.8). There was no significant difference (P = 0.068) between the two groups in the median frequency of surface electromyography (multifidus: mean 6.8 Hz, 95% CI 1.24-14.91; iliocostalis: mean 2.4 Hz, 95% CI 2.5-7.1), although a significant difference (P = 0.013) was found in the median frequency slope of surface electromyography in favour of spinal manipulation for multifidus alone (mean 0.3, 95% CI 0.1-0.5). A significant difference was also found between the two groups in favour of the manipulation/exercise group at 6-month follow-up.Conclusions
Although improvements were recorded in both groups, patients receiving manipulation/exercise showed a greater improvement compared with those receiving ultrasound/exercise at both the end of the treatment period and at 6-month follow-up. 相似文献15.
Shin-Liang Pan I.-Nan Lien Tony Hsiu-Hsi Chen 《Archives of physical medicine and rehabilitation》2010,91(6):913-918
Pan S-L, Lien I-N, Chen TH. Is higher serum total cholesterol level associated with better long-term functional outcomes after noncardioembolic ischemic stroke?
Objective
To investigate the prognostic effects of the serum total cholesterol (TC) levels on long-term functional outcomes in patients with first-time noncardioembolic ischemic stroke.Design
Cohort study.Setting
Referral center.Participants
Patients (N=109) with first-time ischemic stroke.Interventions
Not applicable.Main Outcome Measure
Serial Barthel Index (BI) scores at onset; 2 weeks; and 1, 2, 4, and 6 months after stroke. We analyzed the impact of the serum TC level and other clinical factors on the repeated measurements of BI scores at these 6 time points by using a linear mixed regression model.Results
Taking correlation across repeated measurement of BI scores, the TC level, baseline BI, follow-up time, and infarct size were identified as significant predictors for serial BI scores. Higher TC levels correlated with better functional outcomes. A 1-unit (mmol/L) increase in the TC caused a 3.12 (95% confidence interval [CI], .79-5.46) increase in the BI score after controlling for other clinical factors such as age, baseline functional status, and size of infarct. An elevation of 1 unit of baseline BI led to a .49 increase (95% CI, .38-.59) per unit in subsequent BI scores. A small infarct (<1cm) had higher BI scores than larger infarct by 9.09 (95% CI, 2.03-16.16).Conclusions
The serum TC level measured at the acute stage of noncardioembolic ischemic stroke is an independent predictor for long-term functional outcomes. 相似文献16.
Iezzoni LI Ngo LH Li D Roetzheim RG Drews RE McCarthy EP 《Archives of physical medicine and rehabilitation》2008,89(4):595-601
Iezzoni LI, Ngo LH, Li D, Roetzheim RG, Drews RE, McCarthy EP. Treatment disparities for disabled Medicare beneficiaries with stage I non-small cell lung cancer.
Objective
To compare initial treatment and survival of nonelderly adults with and without disabilities newly diagnosed with non-small cell lung cancer.Design
Retrospective analyses; population-based cohorts.Setting
Eleven Surveillance, Epidemiology, and End Results cancer registries.Participants
Persons with disability Medicare entitlement (n=1016) and nondisabled persons (n=8425) ages 21 to 64 years when diagnosed with stage I, pathologically confirmed, first primary non-small cell lung cancer between January 1, 1988, and December 31, 1999.Interventions
Not applicable.Main Outcome Measures
Initial cancer treatments (surgery, radiotherapy), survival (through December 31, 2001). Multivariable logistic regression and Cox proportional hazards regression estimated adjusted associations of disability status with treatments and survival.Results
Persons with disabilities were much more likely to be male, non-Hispanic black, and not currently married. Although 82.2% of nondisabled persons had surgery, 68.5% of disabled persons received operations. Adjusted relative risks (RRs) of receiving surgery were especially low for persons with respiratory disabilities (adjusted RR=.76; 95% confidence interval [CI], .67-.85), nervous system conditions (adjusted RR=.86; 95% CI, .76-.98), and mental health and/or mental retardation disorders (adjusted RR=.92; 95% CI, .86-.99). Persons with disabilities had significantly higher cancer-specific mortality rates (hazard ratio [HR]=1.37; 95% CI, 1.24-1.51) than persons without disabilities. Observed differences in cancer mortality persisted after adjusting for demographic and tumor characteristics (adjusted relative HR=1.23; 95% CI, 1.10-1.39). Further adjustment for surgery use eliminated statistically significant differences in cancer mortality between persons with and without disabilities across disabling conditions.Conclusions
Persons with disabilities were much less likely than nondisabled Medicare beneficiaries to receive surgery; statistically significant cancer-specific mortality differences disappeared after accounting for these treatment differences. Future research must explore reasons for these findings and whether survival of disabled Medicare beneficiaries with early-stage, non-small cell lung cancer could improve if surgical treatment disparities were eliminated. 相似文献17.
Objectives
To translate the Patient Satisfaction Questionnaire (PSQ) from French to German, to undertake transcultural adaptation, and to test reliability and validity.Design
German translation according to sequential forward and backward translation approach, and transcultural adaptation by a consensus process. Validity testing was assessed in a cross-sectional study.Setting
Outpatient physiotherapy department of a multidisciplinary clinic.Participants
One hundred and twenty-three outpatients with musculoskeletal health disorders after completion of outpatient physiotherapy.Main outcome measures
Test-retest reliability was quantified using the intraclass correlation coefficient (ICC 2,1), and Chronbach's alpha was calculated to assess internal consistency of the questionnaire. A factor analysis was performed to investigate the factor structure of the questionnaire. No comparable gold-standard measurement of patient satisfaction was retrieved. The construct validity was assessed using Spearman's rank correlation coefficients between the most indicative item and the global scale excluding this item.Results
Translation and transcultural adaptation according to international guidelines did not produce any content or language problems. For 23 test-retest questionnaires, the ICC ranged from 0.74 (Item 10) to 0.92 (Item 11), corresponding to a Chronbach's alpha ranging from 0.85 to 0.96. On Item 12, correlations of 0.53-0.83 were obtained for the subscores and 0.79 for the total score. High values were obtained for content validity and face validity.Conclusions
The PSQ in German proved to be good in terms of practical application, comprehensibility, internal consistency, reliability and validity. It is suitable for use to record patient satisfaction after outpatient physiotherapy in German-speaking areas. 相似文献18.
Bruno Demont 《Physiotherapy》2007,93(1):12-16
Objectives
To evaluate the incidence of post-extubation atelectasia (PEA) and brain injury in newborns treated with the expiratory flow increase (EFI) method of chest physiotherapy, the most common chest physiotherapy technique in France.Design
Retrospective study.Setting
A large level-3 regional neonatal intensive care unit.Population
A cohort of all consecutive neonates admitted over a 17-month period who developed acute or chronic lung disease and required conventional mechanical ventilation.Intervention
Chest physiotherapy using the EFI technique, initiated early after birth, and performed three times daily until at least 24 hours after extubation.Outcome measures
PEA and brain lesions (intraventricular haemorrhage and cystic periventricular leukomalacia). Chest X-rays were taken 24 hours after extubation and routine head ultrasounds were performed during the course of hospitalization.Results
Among the 362 infants submitted to chest physiotherapy, nine developed PEA (2%; 95% CI = 1-4.0%). PEA was highly predictive of extubation failure since six of the nine infants with PEA were reintubated (67%), whereas only 33 among the 353 infants without PEA required reintubation (9%). Intraventricular haemorrhage and cystic periventricular leukomalacia were documented in 59 (16%) and 5 (1%) infants, respectively. In 54 of the 59 infants (92%) with intraventricular haemorrhage and all infants with periventricular leukomalacia, brain lesions existed prior to the initiation of chest physiotherapy.Conclusion
The incidence of PEA in babies treated with the EFI technique is low and chest physiotherapy does not appear to increase the incidence of brain lesions above the percentage normally seen in newborns with respiratory failure. A randomized controlled trial is urgently needed to further study the efficacy and safety of the EFI method in the prevention of neonatal post-extubation atelectasis and extubation failure. 相似文献19.
Selvaraj Samuelkamaleshkumar Somasundaram Radhika BOT Binu Cherian BPT Aarumugam Elango MA Windsor Winrose BPT Baby T. Suhany PhD M. Henry Prakash MD 《Archives of physical medicine and rehabilitation》2010,91(7):1117-1121
Samuelkamaleshkumar S, Radhika S, Cherian B, Elango A, Winrose W, Suhany BT, Prakash MH. Community reintegration in rehabilitated South Indian persons with spinal cord injury.
Objectives
To explore community reintegration in rehabilitated South Indian persons with spinal cord injury (SCI) and to compare the level of community reintegration based on demographic variables.Design
Survey.Setting
Rehabilitation center of a tertiary care university teaching hospital.Participants
Community-dwelling persons with SCI (N=104).Interventions
Not applicable.Main Outcome Measures
Craig Handicap Assessment and Reporting Technique (CHART).Results
The mean scores for each CHART domain were physical independence 98±5, social Integration 96±11, cognitive independence 92±17, occupation 70±34, mobility 65±18, and economic self sufficiency 53±40. Demographic variables showed no statistically significant difference with any of the CHART domains except for age and mobility, level of education, and social integration.Conclusions
Persons with SCI in rural South India who have completed comprehensive, mostly self-financed, rehabilitation with an emphasis on achieving functional ambulation, family support, and self-employment and who attend a regular annual follow-up show a high level of community reintegration in physical independence, social integration, and cognitive independence. CHART scores in the domains of occupation, mobility, and economic self-sufficiency showed lower levels of community reintegration. 相似文献20.
Mitterlechner T Wipp A Paal P Strasak AM Wenzel V Felbinger TW Schmittinger CA 《Resuscitation》2011,82(6):740-742