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Kathleen Beebe Kimberly J. Song Ellen Ross Benjamin Tuy Francis Patterson Joseph Benevenia 《Archives of physical medicine and rehabilitation》2009,90(6):1039-1047
Beebe K, Song KJ, Ross E, Tuy B, Patterson F, Benevenia J. Functional outcomes after limb-salvage surgery and endoprosthetic reconstruction with an expandable prosthesis: a report of 4 cases.
Objective
To determine the functional outcomes of skeletally immature patients after replacement of the femur and tibia performed by using noninvasive expandable endoprostheses.Design
Case series.Setting
A hospital-based ambulatory care center.Participants
Pediatric patients (N=4) with primary bone tumors of the distal femur and proximal tibia who underwent surgical replacement performed by using the Repiphysis noninvasive expandable endoprosthesis (Wright Medical Technology, Memphis, TN).Interventions
Wide resection of bone sarcoma and placement of expandable endoprosthesis.Main Outcome Measures
Musculoskeletal Tumor Society (MSTS) scores were assessed at the beginning of the study and at each follow-up visit. Medical Outcomes Study 36-Item Short-Form Health Survey, Version 2 (SF-36); gait; sit-to-stand transition; and range of motion (ROM) were assessed at an average follow-up of 31.5 months.Results
At an average of 31.5 months postoperative, the SF-36 physical component summary scores lagged behind the national mean, whereas the mental component summary scores were satisfactory. MSTS scores indicated low levels of pain and supports use with high emotional acceptance and walking ability but persisting difficulties with function and gait. Patients also showed altered patterns of sit-to-stand transition including decreased peak vertical force in the operated limb and increased center of mass momentum in a shorter amount of time. Parts of gait functioning were found to be decreased, including gait velocity, stride length, and cadence. Some patients displayed alternate weight-bearing strategies that accompanied increased double-limb support and stance phase during walking. ROM and strength were diminished at both the hip and knee joints in the operated limb and in the nonoperated limb.Conclusions
Reconstruction with a noninvasive expandable endoprosthesis produces satisfactory functional outcomes in pediatric patients with primary tumors of the bone. Patients in our study displayed some persisting physical difficulties including decreased ROM and strength and altered gait and sit-to-stand patterns, yet they maintained high levels of emotional acceptance and coping. 相似文献3.
Lang CE Edwards DF Birkenmeier RL Dromerick AW 《Archives of physical medicine and rehabilitation》2008,89(9):1693-1700
Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. Estimating minimal clinically important differences of upper-extremity measures early after stroke.
Objective
To estimate minimal clinically important difference (MCID) values of several upper-extremity measures early after stroke.Design
Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial, an acute, single-blind randomized controlled trial of constraint-induced movement therapy. Subjects were tested at the prerandomization baseline assessment (average days poststroke, 9.5d) and the first posttreatment assessment (average days poststroke, 25.9d). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests.Setting
Inpatient rehabilitation hospital.Participants
Fifty-two people with hemiparesis poststroke.Interventions
Not applicable.Main Outcome Measures
Estimated MCID values for grip strength, composite upper-extremity strength, Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and duration of upper-extremity use as measured with accelerometry.Results
MCID values for grip strength were 5.0 and 6.2kg for the affected dominant and nondominant sides, respectively. MCID values for the ARAT were 12 and 17 points, for the WMFT function score were 1.0 and 1.2 points, and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides, respectively. MCID values were indeterminate for the dominant (composite strength), the nondominant (WMFT time score), and both affected sides (duration of use) for the other measures.Conclusions
Our data provide some of the first estimates of MCID values for upper-extremity standardized measures early after stroke. Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke. 相似文献4.
Haley SM Gandek B Siebens H Black-Schaffer RM Sinclair SJ Tao W Coster WJ Ni P Jette AM 《Archives of physical medicine and rehabilitation》2008,89(2):275-283
Haley SM, Gandek B, Siebens H, Black-Schaffer RM, Sinclair SJ, Tao W, Coster WJ, Ni P, Jette AM. Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes.
Objectives
To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness.Design
Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later.Setting
Follow-up interviews conducted in patient’s home setting.Participants
Adults (N=94) with diagnoses of neurologic, orthopedic, or medically complex conditions.Interventions
Not applicable.Main Outcome Measures
Participation domains of mobility, domestic life, and community, social, & civic life, measured using a CAT version of the Participation Measure for Postacute Care (PM-PAC-CAT) and a 53-item fixed-length survey (PM-PAC-53).Results
The PM-PAC-CAT showed substantial agreement with PM-PAC-53 scores (intraclass correlation coefficient, model 3,1, .71-.81). On average, the PM-PAC-CAT was completed in 42% of the time and with only 48% of the items as compared with the PM-PAC-53. Both formats discriminated across functional severity groups. The PM-PAC-CAT had modest reductions in sensitivity and responsiveness to patient-reported change over a 3-month interval as compared with the PM-PAC-53.Conclusions
Although continued evaluation is warranted, accurate estimates of participation status and responsiveness to change for group-level analyses can be obtained from CAT administrations, with a sizeable reduction in respondent burden. 相似文献5.
Haley SM Raczek AE Coster WJ Dumas HM Fragala-Pinkham MA 《Archives of physical medicine and rehabilitation》2005,86(5):932-939
OBJECTIVE: To assess score agreement, validity, precision, and response burden of a prototype computerized adaptive testing (CAT) version of the Mobility Functional Skills Scale (Mob-CAT) of the Pediatric Evaluation of Disability Inventory (PEDI) as compared with the full 59-item version (Mob-59). DESIGN: Computer simulation analysis of cross-sectional and longitudinal retrospective data; and cross-sectional prospective study. SETTING: Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics, community-based day care, preschool, and children's homes. PARTICIPANTS: Four hundred sixty-nine children with disabilities and 412 children with no disabilities (analytic sample); 41 children without disabilities and 39 with disabilities (cross-validation sample). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from a prototype Mob-CAT application and versions using 15-, 10-, and 5-item stopping rules; scores from the Mob-59; and number of items and time (in seconds) to administer assessments. RESULTS: Mob-CAT scores from both computer simulations (intraclass correlation coefficient [ICC] range, .94-.99) and field administrations (ICC=.98) were in high agreement with scores from the Mob-59. Using computer simulations of retrospective data, discriminant validity, and sensitivity to change of the Mob-CAT closely approximated that of the Mob-59, especially when using the 15- and 10-item stopping rule versions of the Mob-CAT. The Mob-CAT used no more than 15% of the items for any single administration, and required 20% of the time needed to administer the Mob-59. CONCLUSIONS: Comparable score estimates for the PEDI mobility scale can be obtained from CAT administrations, with losses in validity and precision for shorter forms, but with a considerable reduction in administration time. 相似文献
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Coster WJ Haley SM Ni P Dumas HM Fragala-Pinkham MA 《Archives of physical medicine and rehabilitation》2008,89(4):622-629
Coster WJ, Haley SM, Ni P, Dumas HM, Fragala-Pinkham MA. Assessing self-care and social function using a computer adaptive testing version of the Pediatric Evaluation of Disability Inventory.
Objective
To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the self-care and social function scales of the Pediatric Evaluation of Disability Inventory compared with the full-length version of these scales.Design
Computer simulation analysis of cross-sectional and longitudinal retrospective data; cross-sectional prospective study.Setting
Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics; community-based day care, preschool, and children’s homes.Participants
Children with disabilities (n=469) and 412 children with no disabilities (analytic sample); 38 children with disabilities and 35 children without disabilities (cross-validation sample).Interventions
Not applicable.Main Outcome Measures
Summary scores from prototype CAT applications of each scale using 15-, 10-, and 5-item stopping rules; scores from the full-length self-care and social function scales; time (in seconds) to complete assessments and respondent ratings of burden.Results
Scores from both computer simulations and field administration of the prototype CATs were highly consistent with scores from full-length administration (r range, .94-.99). Using computer simulation of retrospective data, discriminant validity, and sensitivity to change of the CATs closely approximated that of the full-length scales, especially when the 15- and 10-item stopping rules were applied. In the cross-validation study the time to administer both CATs was 4 minutes, compared with over 16 minutes to complete the full-length scales.Conclusions
Self-care and social function score estimates from CAT administration are highly comparable with those obtained from full-length scale administration, with small losses in validity and precision and substantial decreases in administration time. 相似文献7.
Ripley DL Harrison-Felix C Sendroy-Terrill M Cusick CP Dannels-McClure A Morey C 《Archives of physical medicine and rehabilitation》2008,89(6):1090-1096
Ripley DL, Harrison-Felix C, Sendroy-Terrill M, Cusick CP, Dannels-McClure A, Morey C. The impact of female reproductive function on outcomes after traumatic brain injury.
Objectives
To determine the impact of traumatic brain injury (TBI) on female menstrual and reproductive functioning and to examine the relationships between severity of injury, duration of amenorrhea, and TBI outcomes.Design
Retrospective cohort survey.Setting
Telephone interview.Participants
Women (N=30; age range, 18-45y), between 1 and 3 years postinjury, who had completed inpatient rehabilitation for TBI.Interventions
Not applicable.Main Outcome Measures
Data collected included menstrual and reproductive functioning pre- and postinjury, demographic, and injury characteristics. Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), the Mayo-Portland Adaptability Inventory-4 (MPAI-4), and the Medical Outcome Study 12-Item Short-Form Health Survey, Version 2 (SF-12v2).Results
The median duration of amenorrhea was 61 days (range, 20-344d). Many subjects' menstrual function changed after TBI, reporting a significant increase in skipped menses postinjury (P<.001) and a trend toward more painful menses (P=.061). More severe TBI, as measured by the duration of posttraumatic amnesia, was significantly predictive of a longer duration of amenorrhea (P=.004). Subjects with a shorter duration of amenorrhea scored significantly better on the SF-12 physical component subscale (P=.004), the GOS-E (P=.05), and the MPAI-4 participation subscale (P=.05) after controlling for age, injury severity, and time postinjury.Conclusions
The severity of TBI was predictive of duration of amenorrhea and a shorter duration of amenorrhea was predictive of better ratings of global outcome, community participation, and health-related quality of life postinjury. 相似文献8.
OBJECTIVES: To describe the patterns of depression in patients with traumatic brain injury (TBI), to evaluate the psychometric properties of the Neurobehavioral Functioning Inventory (NFI) Depression Scale, and to classify empirically NFI Depression Scale scores. DESIGN: Depressive symptoms were characterized by using the NFI Depression Scale, the Beck Depression Inventory (BDI), and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Depression Scale. SETTING: An outpatient clinic within a Traumatic Brain Injury Model Systems center. PARTICIPANTS: A demographically diverse sample of 172 outpatients with TBI, evaluated between 1996 and 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The NFI, BDI, and MMPI-2 Depression Scale. The Cronbach alpha, analysis of variance, Pearson correlations, and canonical discriminant function analysis were used to examine the psychometric properties of the NFI Depression Scale. RESULTS: Patients with TBI most frequently reported problems with frustration (81%), restlessness (73%), rumination (69%), boredom (66%), and sadness (66%) with the NFI Depression Scale. The percentages of patients classified as depressed with the BDI and the NFI Depression Scale were 37% and 30%, respectively. The Cronbach alpha for the NFI Depression Scale was.93, indicating a high degree of internal consistency. As hypothesized, NFI Depression Scale scores correlated highly with BDI (r=.765) and MMPI-2 Depression Scale T scores (r=.752). The NFI Depression Scale did not correlate significantly with the MMPI-2 Hypomania Scale, thus showing discriminant validity. Normal and clinically depressed BDI scores were most likely to be accurately predicted by the NFI Depression Scale, with 81% and 87% of grouped cases, respectively, correctly classified. Normal and depressed MMPI-2 Depression Scale scores were accurately predicted by the NFI Depression Scale, with 75% and 83% of grouped cases correctly classified, respectively. Patients' NFI Depression Scale scores were mapped to the corresponding BDI categories, and 3 NFI score classifications emerged: minimally depressed (13-28), borderline depressed (29-42), and clinically depressed (43-65). CONCLUSIONS: Our study provided further evidence that screening for depression should be a standard component of TBI assessment protocols. Between 30% and 38% of patients with TBI were classified as depressed with the NFI Depression Scale and the BDI, respectively. Our findings also provided empirical evidence that the NFI Depression Scale is a useful tool for classifying postinjury depression. 相似文献
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New PW 《Archives of physical medicine and rehabilitation》2005,86(2):250-261
OBJECTIVE: To describe, in a group of patients undergoing initial inpatient rehabilitation after nontraumatic spinal cord injury (SCI), the demographic characteristics, clinical features, and outcomes, with a focus on the functional status and disability. DESIGN: Retrospective data analysis, 3-year case series. SETTING: Tertiary medical unit specializing in nontraumatic SCI rehabilitation. PARTICIPANTS: Consecutive sample of 70 adult inpatient referrals with nontraumatic SCI undergoing initial inpatient rehabilitation. INTERVENTION: Chart review. MAIN OUTCOME MEASURES: Primary outcomes were demographic characteristics, clinical features, mortality, length of stay (LOS), neurologic classification, accommodation setting, support services, mobility, bladder and bowel continence, and FIM instrument scores. RESULTS: Forty-one patients (58.6%) were paraplegic incomplete, 23 (32.9%) were tetraplegic incomplete, and 6 (8.6%) were paraplegic complete. Eight patients (11.4%) died before hospital discharge. Of those who survived, 47 (75.8%) were discharged home, 11 (17.7%) were transferred to a nursing home, and 4 (6.4%) went elsewhere in the community. The geometric mean LOS was 55.8 days. Nine patients (14.5%) were discharged walking unaided, 27 (43.5%) were walking at least 10 m with a gait aid, and 26 (41.9%) were wheelchair dependent for mobility. Thirty patients (48.4%) were voiding on sensation, 7 (11.1%) used intermittent catheterization, 23 (37.2%) had an indwelling catheter, and 2 (2.8%) used reflex voiding. Eleven patients (17.7%) were fecally continent on sensation and 47 (75.8%) were fecally continent with a bowel program, 1 patient (1.6%) had a colostomy, and 3 patients (4.8%) were discharged fecally incontinent. The mean Rasch FIM motor score was 39.6 on admission and 58.7 at discharge (paired t test, t=-11.2; P<.000). CONCLUSIONS: Most nontraumatic SCI patients returned home with a good level of functioning regarding mobility, bladder, and bowel status, in comparison to other studies of patients with SCI. Patients' disability was usually significantly reduced during rehabilitation. 相似文献
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Environmental factors and their role in participation and life satisfaction after spinal cord injury 总被引:7,自引:0,他引:7
Whiteneck G Meade MA Dijkers M Tate DG Bushnik T Forchheimer MB 《Archives of physical medicine and rehabilitation》2004,85(11):1793-1803
OBJECTIVES: To investigate environmental barriers reported by people with spinal cord injury (SCI), and to determine the relative impact of environmental barriers compared with demographic and injury characteristics and activity limitations in predicting variation in participation and life satisfaction. DESIGN: Cross-sectional, follow-up survey. SETTING: Individuals rehabilitated at 16 federally designated Model Spinal Cord Injury Systems of care, now living in the community. PARTICIPANTS: People with SCI (N=2726) who completed routine follow-up research interviews between 2000 and 2002. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), the Craig Handicap Assessment and Reporting Technique-Short Form, and the Satisfaction With Life Scale. RESULTS: The top 5 environmental barriers reported by subjects with SCI, in descending order of importance, were the natural environment, transportation, need for help in the home, availability of health care, and governmental policies. The CHIEF-SF subscales accounted for only 4% or less of the variation in participation; they accounted for 10% of the variation in life satisfaction. CONCLUSIONS: The inclusion of environmental factors in models of disability was supported, but were found to be more strongly related to life satisfaction than to societal participation. 相似文献
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Haley SM Siebens H Coster WJ Tao W Black-Schaffer RM Gandek B Sinclair SJ Ni P 《Archives of physical medicine and rehabilitation》2006,87(8):1033-1042
OBJECTIVE: To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home. DESIGN: Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit. SETTING: Follow-up visits conducted in patients' home setting. PARTICIPANTS: Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66). RESULTS: AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77-.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients' own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval. CONCLUSIONS: Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time. 相似文献
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Haley SM Ni P Ludlow LH Fragala-Pinkham MA 《Archives of physical medicine and rehabilitation》2006,87(9):1223-1229
OBJECTIVE: To compare the measurement efficiency and precision of a multidimensional computer adaptive testing (M-CAT) application to a unidimensional CAT (U-CAT) comparison using item bank data from 2 of the functional skills scales of the Pediatric Evaluation of Disability Inventory (PEDI). DESIGN: Using existing PEDI mobility and self-care item banks, we compared the stability of item calibrations and model fit between unidimensional and multidimensional Rasch models and compared the efficiency and precision of the U-CAT- and M-CAT-simulated assessments to a random draw of items. SETTING: Pediatric rehabilitation hospital and clinics. PARTICIPANTS: Clinical and normative samples. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: The M-CAT had greater levels of precision and efficiency than the separate mobility and self-care U-CAT versions when using a similar number of items for each PEDI subdomain. Equivalent estimation of mobility and self-care scores can be achieved with a 25% to 40% item reduction with the M-CAT compared with the U-CAT. CONCLUSIONS: M-CAT applications appear to have both precision and efficiency advantages compared with separate U-CAT assessments when content subdomains have a high correlation. Practitioners may also realize interpretive advantages of reporting test score information for each subdomain when separate clinical inferences are desired. 相似文献
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Tao W Haley SM Coster WJ Ni P Jette AM 《Archives of physical medicine and rehabilitation》2008,89(6):1046-1053
Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach.
Objectives
To develop and explore the feasibility of a functional staging system (defined as the process of assigning subjects, according to predetermined standards, into a set of hierarchic levels with regard to their functioning performance in mobility, daily activities, and cognitive skills) based on item response theory (IRT) methods using short forms of the Activity Measure for Post-Acute Care (AM-PAC) and to compare the criterion validity and sensitivity of the IRT-based staging system to a non-IRT-based staging system developed for the FIM instrument.Design
Prospective, longitudinal cohort study of patients interviewed at hospital discharge and 1, 6, and 12 months after inpatient rehabilitation.Setting
Follow-up interviews conducted in patients' homes.Participants
Convenience sample of 516 patients (47% men; sample mean age, 68.3y) at baseline (retention at the final follow-up, 65%) with neurologic, lower-extremity orthopedic, or complex medical conditions.Interventions
Not applicable.Main Outcome Measures
AM-PAC basic mobility, daily activity, and applied cognitive activity stages; FIM executive control, mobility, activities of daily living, and sphincter stages. Stages refer to the hierarchic levels assigned to patients' functioning performances.Results
We were able to define IRT-based staging definitions and create meaningful cut scores based on the 3 AM-PAC short forms. The IRT stages correlated as well or better to the criterion items than the FIM stages. Both the IRT-based stages and the FIM stages were sensitive to changes throughout the 6-month follow-up period. The FIM stages were more sensitive in detecting changes between baseline and 1-month follow-up visits. The AM-PAC stages were more discriminant in the follow-up visits.Conclusions
An IRT-based staging approach appeared feasible and effective in classifying patients throughout long-term follow-up. Although these stages were developed from short forms, this staging methodology could also be applied to improve the meaning of scores generated from IRT-based computerized adaptive testing in future work. 相似文献16.
Alex W.K. Wong Allen W. Heinemann Ana Miskovic Patrick Semik Thomas M. Snyder 《Archives of physical medicine and rehabilitation》2014
Objective
To evaluate the feasibility of computer adaptive testing (CAT) using an Internet or telephone interface to collect patient-reported outcomes after inpatient rehabilitation and to examine patient characteristics associated with completion of the CAT-administered measure and mode of administration.Design
Prospective cohort study of patients contacted approximately 4 weeks after discharge from inpatient rehabilitation. Patients selected an Internet or telephone interface.Setting
Rehabilitation hospital.Participants
Patients (N=674) with diagnoses of neurologic, orthopedic, or medically complex conditions.Interventions
None.Main Outcome Measure
CAT version of the Community Participation Indicators (CAT-CPI).Results
From an eligible pool of 3221 patients, 674 (21%) agreed to complete the CAT-CPI. Patients who agreed to complete the CAT-CPI were younger and reported slightly higher satisfaction with overall care than those who did not participate. Among these patients, 231 (34%) actually completed the CAT-CPI; 141 (61%) selected telephone administration, and 90 (39%) selected Internet administration. Decreased odds of completing the CAT-CPI were associated with black and other race; stroke, brain injury, or orthopedic and other impairments; and being a Medicaid beneficiary, whereas increased odds of completing the CAT-CPI were associated with longer length of stay and higher discharge FIM cognition measure. Decreased odds of choosing Internet administration were associated with younger age, retirement status, and being a woman, whereas increased odds of choosing Internet administration were associated with higher discharge FIM motor measure.Conclusions
CAT administration by Internet and telephone has limited feasibility for collecting postrehabilitation outcomes for most rehabilitation patients, but it is feasible for a subset of patients. Providing alternative ways of answering questions helps assure that a larger proportion of patients will respond. 相似文献17.
Timothy A. Reistetter James E. Graham Anne Deutsch Carl V. Granger Samuel Markello Kenneth J. Ottenbacher 《Archives of physical medicine and rehabilitation》2010,91(3):345-350
Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke.
Objective
To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke.Design
Retrospective cross-sectional design.Setting
Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation.Participants
Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007.Interventions
Not applicable.Main Outcome Measure
Discharge FIM rating and discharge setting (community vs institutional).Results
Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77).Conclusions
Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings. 相似文献18.
Patricia B. Burns H. Myra Kim R. Glenn Gaston Steven C. Haase Warren C. Hammert Jeffrey N. Lawton Greg A. Merrell Paul F. Nassab Lynda J. Yang Kevin C. Chung 《Archives of physical medicine and rehabilitation》2014
Objective
To identify predictors of surgical outcome for ulnar neuropathy at the elbow (UNE).Design
Prospective cohort followed for 1 year.Setting
Clinics.Participants
Patients diagnosed with UNE (N=55).Intervention
All subjects had simple decompression surgery.Main Outcome Measures
The primary outcome measure was patient-reported outcomes, such as overall hand function through the Michigan Hand Outcomes Questionnaire (MHQ). Predictors included age, duration of symptoms, disease severity, and motor conduction velocity across the elbow.Results
Multiple regression models with change in the overall MHQ score as the dependent variable showed that at 3 months postoperative time, patients with <3 months duration of symptoms showed 12 points (95% confidence interval [CI], 0.9–23.5) greater improvement in MHQ scores than those with ≥3 months symptom duration. Less than 3 months of symptoms was again associated with 13 points (95% CI, 2.9–24) greater improvement in MHQ scores at 6 months postoperative, but it was no longer associated with better outcomes at 12 months. A worse baseline MHQ score was associated with significant improvement in MHQ scores at 3 months (coefficient, −0.38; 95% CI, −.67 to −.09), and baseline MHQ score was the only significant predictor of 12 month MHQ scores (coefficient, −.40; 95% CI, −.79 to −.01).Conclusions
Subjects with <3 months of symptoms and worse baseline MHQ scores showed significantly greater improvement in functional outcomes as reported by the MHQ. However, duration of symptoms was only predictive at 3 or 6 months because most patients recovered within 3 to 6 months after surgery. 相似文献19.
Shana Harrington Lori A. Michener Tiffany Kendig Susan Miale Steven Z. George 《Archives of physical medicine and rehabilitation》2014
Objectives
(1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research.Data Sources
PubMed, Cumulative Index to Nursing and Allied Health Literature, and ProQuest MEDLINE databases were searched up to February 5, 2013.Study Selection
Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and the study was published in English.Data Extraction
A total of 865 articles were screened. Fifty-nine full text articles were assessed for eligibility. A total of 46 articles met the initial eligibility criteria for aim 1. Eleven of these articles reported means and SDs for the outcome scores and included a comparison group analysis for aim 2.Data Synthesis
Construct validity was evaluated by calculating effect sizes for known-group differences in 6 studies using the Disabilities of Arm, Shoulder and Hand (DASH), University of Pennsylvania Shoulder Score, Shoulder Disability Questionnaire-Dutch, and 10 Questions by Wingate. Responsiveness was analyzed comparing a treatment and control group by calculating the coefficient of responsiveness in 5 studies for the DASH and 10 Questions by Wingate.Conclusions
Eight different patient-reported upper extremity outcome measures have been reported in the peer-review literature for women with breast cancer; some that were specifically developed for breast cancer survivors (n=3) and others that were not (n=5). Based on the current evidence, we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH has the most consistently large effects sizes for construct validity and responsiveness. Future large studies are needed for more definitive recommendations. 相似文献20.
Robert S. Burnham Shelley Holitski Irina Dinu 《Archives of physical medicine and rehabilitation》2009,90(2):201-205
Burnham RS, Holitski S, Dinu I. A prospective outcome study on the effects of facet joint radiofrequency denervation on pain, analgesic intake, disability, satisfaction, cost, and employment.