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1.
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2.
Hill K Jenkins SC Cecins N Philippe DL Hillman DR Eastwood PR 《Archives of physical medicine and rehabilitation》2008,89(9):1782-1787
Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR. Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease.
Objective
To develop a predictive equation to permit estimation of the maximum work rate (Wmax) achieved during an incremental cycle ergometry test from the measurement of 6-minute walk distance (6MWD) and its derivative, 6-minute walk work, which is the product of 6MWD and body weight.Design
Cross-sectional observational study.Setting
Outpatient physiotherapy and pulmonary physiology clinics in a tertiary hospital.Participants
Patients (N=50; 36 men) with chronic obstructive pulmonary disease (forced expiratory volume in 1 second [FEV1]=37%±11% of predicted).Interventions
Not applicable.Main Outcome Measures
Measurements were obtained of 6MWD and Wmax achieved during a laboratory-based, symptom-limited incremental cycle ergometry test. Linear regression analyses were performed using 6MWD, height, weight, and FEV1 and using 6-minute walk work, height, and FEV1 to determine their contribution to Wmax and to develop predictive equations for estimating Wmax.Results
The equations derived to estimate Wmax using 6MWD and 6-minute walk work, respectively, were as follows: Wmax (W)=(0.122×6MWD)+(72.683×height [m])-117.109 (r2=.67, standard error of the estimate [SEE]=10.8W) and Wmax (W)=17.393+(1.442×6-minute walk work) (r2=.60, SEE=11.8W).Conclusions
Wmax can be estimated from equations based on measurements of 6MWD or 6-minute walk work. The estimate of Wmax derived from either equation may provide a basis on which to prescribe cycle ergometry training work rates that comply with the current guidelines for pulmonary rehabilitation. 相似文献3.
4.
Sophie Mitra Patricia A. Findley Usha Sambamoorthi 《Archives of physical medicine and rehabilitation》2009,90(9):1532-1540
Mitra S, Findley PA, Sambamoorthi U. Health care expenditures of living with a disability: total expenditures, out-of-pocket expenses, and burden, 1996 to 2004.
Objective
To estimate the health care expenditures associated with a disability and their recent trends.Design
Retrospective analysis of survey data.Setting
Not applicable.Participants
Data from multiple years (1996-2004) of the Medical Expenditure Panel Survey (MEPS) for a nationally representative sample of civilian, noninstitutionalized U.S. population.Interventions
Not applicable.Main Outcome Measures
Health care expenditures consisted of total health care expenditures, total out-of-pocket (OOP) spending, and burden (the ratio of OOP to family income). All the analyses accounted for the complex survey design of the MEPS.Results
Between 1996 and 2004, 6% to 9% of persons in the working-age group (21-61y) were identified as having a disability. Persons with disabilities consistently had higher total health expenditures, OOP spending, and burden compared with their counterparts without disabilities. In 2004, the average total expenditures were estimated at $10,508 for persons with disabilities and at $2256 for those without disabilities. In a multiple regression framework, persons with disabilities were consistently found to have higher expenditures, OOP spending, and burden between 1996 and 2004. Although expenditures, OOP spending, and burden increased over time, after controlling for demographic, socioeconomic, and health status, these 3 health care costs were not found to change disproportionately for persons with disability.Conclusions
During the 1996 to 2004 period, persons with disabilities were consistently found to have significantly higher health expenditures, OOP spending, and burden compared with their counterparts without disabilities, which may adversely affect their health and standard of living. 相似文献5.
McCain KJ Pollo FE Baum BS Coleman SC Baker S Smith PS 《Archives of physical medicine and rehabilitation》2008,89(4):684-691
McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.
Objective
To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.Design
Parallel group, posttest only.Setting
Inpatient rehabilitation center.Participants
Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).Interventions
Locomotor treadmill training with partial BWS or traditional gait training methods.Main Outcome Measures
Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.Results
Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.Conclusions
Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation. 相似文献6.
Alex R. Ward Wendy Lee Hung Chuen BSc 《Archives of physical medicine and rehabilitation》2009,90(9):1619-1627
Ward AR, Lee Hung Chuen WL. Lowering of sensory, motor, and pain-tolerance thresholds with burst duration using kilohertz-frequency alternating current electric stimulation: part II.
Objective
To determine the optimum burst duration for discrimination between sensory, motor, and pain tolerance thresholds using 20-Hz bursts of kilohertz-frequency sinusoidal alternating current (AC) applied transcutaneously to human participants.Design
A within-subject, repeated-measures trial.Setting
A research laboratory.Participants
Healthy young adults (N=20).Interventions
Bursts of AC electric stimulation at frequencies of 1 and 4kHz. The burst frequency was 20Hz. Burst durations ranged from 250 microseconds (for 1 cycle of 4-kHz AC) and 1 millisecond (for 1 cycle of 1-kHz AC) to 50 milliseconds (continuous AC).Main Outcome Measures
Measurement of sensory, motor, and pain-tolerance thresholds.Results
Thresholds decreased to a minimum with increasing burst duration. The minimum threshold identified the utilization time over which summation of subthreshold stimuli occurs. Utilization times were different for sensory (∼20ms), motor (∼30ms), and pain (>50ms) and were much higher than found in a previous study that used a higher burst frequency (50Hz). As with the previous study, relative thresholds were found to vary with burst duration. Despite the very different utilization times, maximum separation between sensory, motor, and pain thresholds was found to occur with bursts in the range of 1 to 4 milliseconds, the same range found in the previous study.Conclusions
Our conclusions concur with those reported previously and support the contention that short-duration kilohertz-frequency AC bursts (1-4ms) have a more useful role in rehabilitation than the long-duration kilohertz-frequency bursts that characterize Russian and interferential currents. 相似文献7.
Hanneke Bouwsema Corry K. van der Sluis Raoul M. Bongers 《Archives of physical medicine and rehabilitation》2010,91(9):1442-1446
Bouwsema H, van der Sluis CK, Bongers RM. Learning to control opening and closing a myoelectric hand.
Objective
To compare 3 different types of myoelectric signal training.Design
A cohort analytic study.Setting
University laboratory.Participants
Able-bodied right-handed participants (N=34) randomly assigned to 1 of 3 groups.Interventions
Participants trained hand opening and closing on 3 consecutive days. One group trained with a virtual myoelectric hand presented on a computer screen, 1 group trained with an isolated prosthetic hand, and 1 group trained with a prosthetic simulator. One half of the participants trained with their dominant side, and the other half trained with their nondominant side. Before and after the training period, a test was administered to determine the improvement in skill. Participants were asked to open and close the hand on 3 different velocities at command.Main Outcome Measures
Peak velocity, mean velocity, and number of peaks in the myoelectric signal of hand opening and closing.Results
No differences were found for the different types of training; all participants learned to control the myoelectric hand. However, differences in learning abilities were revealed. After learning, a subgroup of the participants could produce clearly distinct myoelectric signals, which resulted in the ability to open and close the hand at 3 different speeds, whereas others could not produce distinct myoelectric signals.Conclusions
Acquired control of a myoelectric hand is irrespective of the type of training. Prosthetic users may differ in learning capacity; this should be taken into account when choosing the appropriate type of control for each patient. 相似文献8.
Moriello C Mayo NE Feldman L Carli F 《Archives of physical medicine and rehabilitation》2008,89(6):1083-1089
Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of recovery after elective colon resection surgery.
Objective
To provide evidence for construct and longitudinal validity of the six-minute walk test (6MWT) as a measure of postsurgical recovery.Design
Data from a randomized clinical trial.Setting
A major teaching hospital in a Canadian urban city.Participants
Patients (N=63) undergoing elective colon resection.Interventions
Not applicable.Main Outcome Measures
Functional walking capacity was measured using the 6MWT at before surgery and at 3 and 6 weeks after surgery.Results
At 3 weeks, 26 (41%) patients recovered to baseline or greater on the 6MWT distance, and 37 (59%) were at baseline or better by 6 weeks postdischarge. At all time points, the 6MWT distance correlated with age, the American Society of Anesthesiologists (ASA) score of surgical risk, albumin, the physical function subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the physical component summary score of the SF-36. Baseline 6MWT distance correlated with postoperative 6MWT recovery, and baseline SF-36 and ASA were associated with postoperative recovery. Patients with intraoperative complications had a clinically relevant lower 6MWT than those without complications at all time points.Conclusions
This study provides evidence for construct validity and sensitivity to change for the 6MWT as a measure of surgical recovery. 相似文献9.
Natalie Vanicek Siobhan Strike Lars McNaughton Remco Polman 《Archives of physical medicine and rehabilitation》2009,90(6):1018-1025
Vanicek N, Strike S, McNaughton L, Polman R. Postural responses to dynamic perturbations in amputee fallers versus nonfallers: a comparative study with able-bodied subjects.
Objectives
To quantify postural responses in amputee fallers versus nonfallers by using computerized dynamic posturography.Design
All participants completed standard protocols on the Sensory Organization Test (SOT) and Motor Control Test (MCT) of the NeuroCom Equitest.Setting
Human performance laboratory in a university in the United Kingdom.Participants
Transtibial amputees (n=9) and able-bodied subjects (n=9) (all categorized into fallers and nonfallers according to their falls history in the previous 9mo).Interventions
Not applicable.Main Outcome Measures
Equilibrium and strategy scores on the SOT. Postural response latency and weight distribution on the MCT.Results
Equilibrium scores were highest when somatosensory information was accurate, but there were no differences between the groups. Strategy scores were lower when visual cues and somatosensory information were inaccurate, and the fallers and nonfallers used a combination of ankle and hip strategies to prevent a loss of balance. The amputee nonfallers indicated they had a greater reliance on visual input even when it was inaccurate compared with the amputee fallers, whereas the control fallers used the hip strategy significantly more compared with the control nonfallers (SOT condition 6: 56±22 vs 72±10, P=.01). Weight distribution symmetry showed that the amputee nonfallers bore significantly more weight through their intact limb compared with the amputee fallers during backward and forward translations (P<.05).Conclusions
The SOT and MCT appeared to be population specific and therefore did not reliably identify fallers among transtibial amputees or distinguish between community-dwelling control fallers and nonfallers. Amputee and control fallers can prevent a fall during challenging static and dynamic conditions by adapting their neuromuscular responses. The results from this study have important implications for amputee gait rehabilitation, falls prevention, and treatment programs. 相似文献10.
Stéphane Doutreleau Paola Di Marco MD Samy Talha MD Anne Charloux MD PhD François Piquard PhD Bernard Geny MD PhD 《Archives of physical medicine and rehabilitation》2009,90(1):51-2613
Doutreleau S, Di Marco P, Talha S, Charloux A, Piquard F, Geny B. Can the six-minute walk test predict peak oxygen uptake in men with heart transplant?
Objective
To determine whether the six-minute walk test (6MWT) might predict peak oxygen consumption (Vo2peak) after heart transplantation.Design
Case-control prospective study.Setting
Public hospital.Participants
Patients with heart transplant (n=22) and age-matched sedentary male subjects (n=13).Interventions
Not applicable.Main Outcome Measures
Exercise performance using a maximal exercise test, distance walked using the 6MWT, heart rate, and Vo2peak.Results
Compared with controls, exercise performance was decreased in patients with heart transplant with less distance ambulated (516±13m vs 592±13m; P<.001) and a decrease in mean Vo2peak (23.3±1.3 vs 29.6±1mL·min−1·kg−1; P<.001). Patients with heart transplant showed an increased resting heart rate, a response delayed both at the onset of exercise and during recovery. However, the patient's heart rate at the end of the 6MWT was similar to that obtained at the ventilatory threshold. The formula did not predict measured V?o2, with a weak correlation observed between the six-minute walk distance and both Vo2peak (r=.53; P<.01) and ventilatory threshold (r=.53; P<.01) after heart transplantation. Interestingly, when body weight was considered, correlations coefficient increased to .74 and .77, respectively (P<.001).Conclusions
In heart transplant recipients, the 6MWT is a safe, practical, and submaximal functional test. The distance-weight product can be used as an alternative method for assessing the functional capacity after heart transplantation but cannot totally replace maximal V?o2 determination. 相似文献11.
Audrey L. Nelson Shirley Groer Polly Palacios Douglas Mitchell Sunil Sabharwal R. Lee Kirby Deborah Gavin-Dreschnack Gail Powell-Cope 《Archives of physical medicine and rehabilitation》2010,91(8):1166-1173
Nelson AL, Groer S, Palacios P, Mitchell D, Sabharwal S, Kirby RL, Gavin-Dreschnack D, Powell-Cope G. Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.
Objectives
(1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment.Design
This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records.Setting
Three Veterans' Administration hospitals.Participants
Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702).Interventions
Not applicable.Main Outcome Measures
Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment.Results
Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls.Conclusions
This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment. 相似文献12.
Taeyou Jung DoKyeong Lee Charalambos Charalambous Konstantinos Vrongistinos 《Archives of physical medicine and rehabilitation》2010,91(1):129-136
Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.
Objective
To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.Design
Comparative gait analysis.Setting
University-based aquatic therapy center.Participants
Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.Interventions
Not applicable.Main Outcome Measures
Spatiotemporal and kinematic gait parameters.Results
The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.Conclusions
The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking. 相似文献13.
Laffont I Guillon B Fermanian C Pouillot S Even-Schneider A Boyer F Ruquet M Aegerter P Dizien O Lofaso F 《Archives of physical medicine and rehabilitation》2008,89(10):1958-1964
Laffont I, Guillon B, Fermanian C, Pouillot S, Even-Schneider A, Boyer F, Ruquet M, Aegerter P, Dizien O, Lofaso F. Evaluation of a stair-climbing power wheelchair in 25 people with tetraplegia.
Objective
To compare the performance of a power wheelchair with stair-climbing capability (TopChair) and a conventional power wheelchair (Storm3).Design
A single-center, open-label study.Setting
A physical medicine and rehabilitation hospital.Participants
Patients (N=25) who required power wheelchairs because of severe impairments affecting the upper and lower limbs.Interventions
Indoor and outdoor driving trials with both devices. Curb-clearing and stair-climbing with TopChair.Main Outcome Measures
Trial duration and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) tool; number of failures during driving trials and ability to climb curbs and stairs.Results
All 25 participants successfully completed the outdoor and indoor trials with both wheelchairs. Although differences in times to trial completion were statistically significant, they were less than 10%. QUEST scores were significantly better with the Storm3 than the TopChair for weight (P=.001), dimension (P=.006), and effectiveness (P=.04). Of the 25 participants, 23 cleared a 20-cm curb without help, and 20 climbed up and down 6 steps. Most participants felt these specific capabilities of the TopChair—for example, curb clearing and stair climbing—were easy to use (22/25 for curb, 21/25 for stairs) and helpful (24/25 and 23/25). A few participants felt insecure (4/25 and 6/25, respectively).Conclusions
The TopChair is a promising mobility device that enables stair and curb climbing and warrants further study. 相似文献14.
Liang HW Wang YH Pan SL Wang TG Huang TS 《Archives of physical medicine and rehabilitation》2007,88(9):1193-1197
Liang H-W, Wang Y-H, Pan S-L, Wang TG, Huang T-S. Asymptomatic median mononeuropathy among men with chronic paraplegia.
Objectives
To compare electrophysiologic abnormalities of the median nerve in asymptomatic paraplegic subjects and able-bodied controls and to examine the influence of personal factors on these parameters.Design
Cross-sectional survey.Setting
University hospital.Participants
Forty-seven men with paraplegia and 36 able-bodied controls underwent nerve conduction studies on both upper limbs. All were free of hand numbness in the past month, diabetic mellitus, or neuromusculoskeletal injuries to the upper limbs.Interventions
Not applicable.Main Outcome Measure
Nerve conduction studies of the bilateral median and ulnar nerves.Results
Although the 2 groups were of comparable age and had a similar body mass index (BMI), the subjects with paraplegia had a significantly higher proportion of asymptomatic median mononeuropathy than the controls (25.5% vs 5.6%, P=.02). The spinal cord injury (SCI) group had a prolonged median distal latency and a slowed digit-wrist sensory nerve conduction velocity. Multivariate general linear model analysis showed that prolonged motor and sensory latencies of the median nerve were associated with the SCI group and with greater BMI.Conclusions
The asymptomatic subjects with paraplegia had a significantly higher frequency of median mononeuropathy than the able-bodied controls. There was also an association between BMI and distal latency of the median nerve. 相似文献15.
Sumiko Shiba Hiroyuki Okawa Hiroyasu Uenishi Yumi Koike Katuya Yamauchi Ko Asayama Taro Nakamura Fumihiro Tajima 《Archives of physical medicine and rehabilitation》2010,91(8):1262-1266
Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.
Objective
To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).Design
Longitudinal study (20-y follow-up).Setting
Laboratory setting.Participants
Persons with SCI (N=7).Interventions
Not applicable.Main Outcome Measures
Maximum oxygen consumption V?o2max) measured in 1986-1988 and in 2006.Results
Subjects with SCI maintained stable V?o2max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o2max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o2max by 43% and 45% after 20 years.Conclusion
The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities. 相似文献16.
Rodger A. Weddell 《Archives of physical medicine and rehabilitation》2010,91(6):897-299
Weddell RA. Relatives' criticism influences adjustment and outcome after traumatic brain injury.
Objectives
To apply some of the methods developed to study the effects of relatives' expressed emotion (EE) on psychiatric relapse rates and to test the prediction that relatives' criticism and psychiatric distress would be associated with outcome and emotional distress after traumatic brain injury (TBI).Design
Retrospective cohort design with correlational analyses of quantitative and qualitative measures of TBI outcomes.Setting
The author interviewed participants in the hospital. The research assistant interviewed close relatives at home.Participants
Participants and relatives (N=78) were interviewed 34.3±15.2 months (mean ± SD) after a severe TBI.Interventions
None.Main Outcome Measures
Dependent variables in a series of hierarchical linear regression models were participants' scores on the Zung Depression Scale, Spielberger Trait Anxiety Inventory, State-Trait Anger Expression Inventory, an Anger Towards Relative questionnaire constructed for this study, and Extended Glasgow Outcome Scores. Participant-independent variables were social class, posttraumatic amnesia, Wechsler Memory Scale-Delayed Recall score, WAIS-R intelligence quotient, and a short version of the Smell Identification Test. Relative independent variables were the number of critical comments directed toward participants in the interview and psychiatric distress as measured by the General Health Questionnaire.Results
The contributions of variance associated with relative independent variables (predominantly criticism) were significant in stage 2 of most hierarchical regression analyses after the adjustments for variance associated with participant independent variables made in stage 1.Conclusions
Future application of EE research methods is warranted. If the present results are replicated, then evidence-based family interventions developed by EE researchers to reduce criticism might also improve TBI outcomes. 相似文献17.
Murray G. Tucker Justin J. Kavanagh Steven Morrison Rod S. Barrett 《Archives of physical medicine and rehabilitation》2010,91(5):750-758
Tucker MG, Kavanagh JJ, Morrison S, Barrett RS. What are the relations between voluntary postural sway measures and falls-history status in community-dwelling older adults?
Objectives
To determine whether a series of voluntary postural sway tasks could differentiate and accurately identify the falls-history status of older adults, and to examine the relations between voluntary sway measures and falls risk.Design
Case-control study.Setting
University biomechanics laboratory.Participants
Healthy community-dwelling older adults (N=51) aged 65 to 94 years who were divided into nonfaller (n=36), single faller (n=10), and multiple faller (n=5) groups based on a 12-month history of falls.Interventions
Not applicable.Main Outcome Measures
Participants underwent a falls-risk assessment using the Physiological Profile Assessment (PPA) and then performed 6 voluntary postural sway tasks. The tasks included maximum static leans, maximum voluntary sway, continuous voluntary sway, rapid initiation of voluntary sway, rapid termination of voluntary sway, and rapid orthogonal switches of voluntary sway between the anterior-posterior and medial-lateral directions. Center of pressure amplitudes and reaction time measures were examined using analysis of covariance, Pearson's correlation, and discriminant function analyses.Results
Multiple fallers had increased age; increased falls risk; slower initiation, termination, and orthogonal switch reaction times; and reduced center of pressure amplitude during sway initiation and continuous voluntary sway compared with nonfallers. Few differences were observed between the nonfallers and single fallers. Voluntary sway measures were significantly correlated with each other and with PPA score. Two postural reaction time measures and age identified 80% of multiple fallers and 98% of nonmultiple fallers. Similarly, PPA score and age identified 80% of multiple fallers and 100% of nonmultiple fallers.Conclusions
The slower and less effective balance responses of multiple fallers compared with nonfallers and the comparable sensitivity and specificity of PPA score and reactive voluntary sway measures indicate that postural reaction time is a strong determinant of falls risk. 相似文献18.
Yu E Abe M Masani K Kawashima N Eto F Haga N Nakazawa K 《Archives of physical medicine and rehabilitation》2008,89(6):1133-1139
Yu E, Abe M, Masani K, Kawashima N, Eto F, Haga N, Nakazawa K. Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke.
Objective
To determine center of mass (COM) acceleration usefulness in the evaluation of postural control during quiet standing.Design
Three-group comparison design.Setting
A research laboratory.Participants
Poststroke subjects (n=12), healthy elderly subjects (n=22), and healthy young subjects (n=25).Interventions
Not applicable.Main Outcome Measures
With a force platform, postural sway was evaluated by using the standard deviations of COM acceleration and center of pressure (COP) and COM (COP-COM) in which COP-COM represents the distance between the COP and the COM.Results
COM acceleration and COP-COM variables were greater in the poststroke group than in the healthy groups (elderly and young) in the mediolateral (ML) direction. Both variables in the anteroposterior (AP) direction were greater in the poststroke group and the elderly group than in the young group. Furthermore, the correlations between COM acceleration and COP-COM in each group in each direction were shown to be significantly high (r range, .906-.979; P<.001).Conclusions
COM acceleration was useful in the evaluation of postural control during quiet standing when comparing the young, the elderly, and poststroke patients. Additionally, COM acceleration and COP-COM in both the AP and ML directions during quiet standing were significantly and highly correlated. Thus, we proposed that COM acceleration can be an alternative and convenient measure instead of COP-COM in the evaluation of postural control. 相似文献19.
Objective
To determine the need for a practice walk for the endurance shuttle walk test (ESWT) following the performance of two incremental shuttle walk tests (ISWTs) - one practice and one test - on the same day.Design
Retrospective data analysis of shuttle walk test measurements. All participants had performed two ISWTs and two ESWTs at a single visit, prior to commencing pulmonary rehabilitation.Setting
Outpatient physiotherapy department of a university hospital.Participants
Forty-four patients (33 males, 11 females) with a primary diagnosis of chronic obstructive pulmonary disease, referred for routine pulmonary rehabilitation.Measurements
Shuttle walk test distance and time, Borg breathlessness score, heart rate and pulsed oxygen saturation.Results
The mean age of the group was 67.6 years [standard deviation (SD) 9.0] and mean forced expiratory volume in 1 second was 37% predicted (SD 13). The mean times walked during ESWTs 1 and 2 were 195 and 207 seconds (SD 115 and 138), respectively. Using the analysis recommended by Bland and Altman, the mean of the individual differences (d) between Tests 1 and 2 was 12 seconds, with limits of agreement from −88 to +112 seconds.Conclusion
A practice endurance shuttle walk is unnecessary following performance of ISWTs on the same day. 相似文献20.
Stefania Fatone Steven A. Gard Bryan S. Malas 《Archives of physical medicine and rehabilitation》2009,90(5):810-818
Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.