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1.
Lee HM Chen JJ Wu YN Wang YL Huang SC Piotrkiewicz M 《Archives of physical medicine and rehabilitation》2008,89(4):692-699
Lee H-M, Chen J-JJ, Wu Y-N, Wang Y-L, Huang S-C, Piotrkiewicz M. Time course analysis of the effects of botulinum toxin type A on elbow spasticity based on biomechanic and electromyographic parameters.
Objective
To quantify changes of elbow spasticity over time after botulinum toxin type A (BTX-A) injection in the upper extremity of stroke patients.Design
Before-after trial in which the therapeutic effects were followed up at 2, 6, and 9 weeks after the BTX-A injection (Botox).Setting
Hospital.Participants
Chronic stroke patients (N=8) with upper-limb spasticity.Intervention
BTX-A was injected in upper-limb muscles, including the biceps brachii.Main Outcome Measures
Treatment effects were quantified as the changes in the velocity and the length dependence of hyperexcitable stretch reflexes. Manual sinusoid stretches of the elbow joint at 4 frequencies (1/3, 1/2, 1, 3/2Hz) over a movement range of 60° were performed on patients by using a portable device. The Modified Ashworth Scale (MAS), biomechanic viscosity, and the reflexive electromyography threshold (RET) of the biceps brachii were used to evaluate the degree of hypertonia.Results
The statistical analyses of the MAS score, biomechanic viscosity, and RET revealed a significant decrease in spasticity after the injection (all P<.05). Moreover, our quantitative parameters (biomechanic viscosity, RET) revealed small changes in spasticity after the BTX-A injection that could not be observed from clinical MAS evaluations. Five of 8 subjects showed a maximal reduction in spasticity (in terms of biomechanic viscosity value) within 6 weeks after the injection, whereas it was notable that all subjects exhibited peak RET values at either 2 or 6 weeks after the injection with variable degrees of relapse of spasticity.Conclusions
Early relapse of spasticity (within 9 weeks of the injection) can be detected from biomechanic and neurophysiologic assessments in a clinical setup. These quantitative indices provide valuable information for clinicians when making decisions to perform additional rehabilitation interventions or another BTX-A injection in the early stages of treatment. 相似文献2.
Éimear M. Smith Catherine M. Comiskey Áine M. Carroll 《Archives of physical medicine and rehabilitation》2009,90(7):1127-1135
Smith ÉM, Comiskey CM, Carroll ÁM. A study of bone mineral density in adults with disability.
Objectives
To examine prevalence of low bone mineral density (BMD) among adults with disability, using World Health Organization diagnostic categories.Design
Cross-sectional study.Setting
National Rehabilitation Hospital, Dublin, Ireland.Participants
Patients (N=255; 178 men, 77 women) who were disabled for at least 3 months because of acquired brain injury, spinal cord injury, other neurologic condition, or lower-limb amputation.Interventions
None.Main Outcome Measures
Laboratory investigations including intact parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and sex hormones; and BMD of lumbar spine and at least 1 hip, measured by dual-energy x-ray absorptiometry and expressed as T scores and z scores.Results
Mean age ± SD of participants was 48.7±15.6 years. Vitamin D deficiency, 25-OHD level 50nmol/L or less, occurred in 154 (62.9%); insufficiency, a level between 51 and 72nmol/L, occurred in 36 (14.7%). Based on T scores, 108 participants (42.4%) had osteopenia, and 60 (23.5%) had osteoporosis. A z score of −1 or less but more than −2 occurred in 76 (29.8%); a further 52 (20.4%) had a z score of −2 or less. On multiple linear regression analysis, ambulatory status and duration of disability were independent predictors of BMD at neck of femur (β=.152, P=.007; β=−.191, P=.001, respectively) and total proximal femur (β=.170, P=.001; β=−.216, P<.001, respectively).Conclusions
Osteopenia and osteoporosis are very common in adults with disability participating in rehabilitation, compared with the general young adult population. Duration since onset of disability and mobility status are independent predictors of BMD at the hip. Bone health monitoring should form part of the long-term follow-up in adults with newly acquired disabilities. 相似文献3.
Deutscher D Horn SD Smout RJ DeJong G Putman K 《Archives of physical medicine and rehabilitation》2010,91(11):1722-1730
Deutscher D, Horn SD, Smout RJ, DeJong G, Putman K. Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions.
Objective
To assess black-white differences in functional outcomes, controlling for patient characteristics, use of nontherapy ancillaries (NTAs), and use of physical (PT) and occupational therapy (OT) activities and interventions.Design
Multicenter prospective observational cohort study of poststroke rehabilitation.Setting
Six U.S. inpatient rehabilitation facilities.Participants
Patients (N=732) subdivided into case-mix subgroups (CMGs; CMGs 104-107 for moderate strokes [n=397], CMGs 108-114 for severe strokes [n=335]).Interventions
Not applicable.Main Outcome Measure
Discharge Motor FIM.Results
Taking into account patient characteristics, NTAs, and therapy activities, multivariate regressions explained (R2) 54% and 69% of variation in outcomes between patients with moderate and severe stroke, respectively. Black race was associated with lower outcomes than white race in the severe group. However, race was no longer associated with outcomes after including interventions used within PT and OT activities. Including interventions within therapy activities increased R2 to 64% and 74% for moderate and severe strokes, respectively. Some PT and OT activities were provided more to blacks than whites and vice versa. Greater intensity sometimes was associated with better and sometimes with poorer functional outcomes.Conclusions
After controlling for interventions within activities, no racial differences were found in functional outcomes at discharge despite racial differences in rehabilitation care, possibly because each racial group received a mixture of interventions that were negatively and positively associated with outcome. Clinicians should provide therapies associated with better outcomes with high and similar intensities for black and white patients poststroke. 相似文献4.
Susan Magasi Elizabeth Durkin Michael S. Wolf Anne Deutsch 《Archives of physical medicine and rehabilitation》2009,90(2):206-212
Magasi S, Durkin E, Wolf MS, Deutsch A. Rehabilitation consumers' use and understanding of quality information: a health literacy perspective.
Objectives
To explore consumers' use and understanding of quality information about postacute rehabilitation facilities.Design
Thematic, semistructured interviews.Setting
Two skilled nursing facilities and 2 inpatient rehabilitation facilities in a large Midwestern city.Participants
Rehabilitation inpatients (n=17) with stroke, hip fractures, and joint replacements and care partners (n=12) of rehabilitation inpatients.Intervention
None.Main Outcome Measure
None.Results
Health literacy imposed barriers to participants' understanding of quality information. Using the Institute of Medicine's Health Literacy Framework, we identified specific barriers that limited participants' abilities to (1) obtain quality information, (2) process and understand quality information, and (3) make appropriate decisions about the quality of a rehabilitation facility. Participants tended to rely on informal and nonquality information when choosing a rehabilitation facility.Conclusions
Given the barriers imposed by low health literacy, rehabilitation providers have a responsibility to present quality information in a way that consumers, especially those with low health literacy, can use and understand. 相似文献5.
Claire Z. Kalpakjian Elisabeth H. Quint Tamara Bushnik Gianna M. Rodriguez Melissa Sendroy Terrill 《Archives of physical medicine and rehabilitation》2010,91(4):562-569
Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury.
Objective
To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI).Design
Prospective cohort (4 data collection periods across 4 years).Setting
Community.Participants
Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed.Interventions
None.Main Outcome Measures
Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms).Results
The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness.Conclusions
Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition. 相似文献6.
Background
Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak.Objective
This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients.Design
Pretest-posttest within-and-between-groups design.Setting
A School of Nursing in Germany.Participants
Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n = 78, mean age = 22).Methods
In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results.Results
The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test p < .001). The trained students managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann-Whitney-U-test p < .001,). Similar results were found for scenario B (untrained 3.01, trained 3.61; Mann-Whitney-U-test p < .001). No significant differences were found in the pretest results irrespective the students’ age or duration of previous nursing education.Conclusions
Aggression management training is able to improve nursing students’ performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely. 相似文献7.
Kevin M. Takakuwa Ethan J. Halpern Frances S. Shofer 《The American journal of emergency medicine》2011,29(2):187-195
Study Objective
The study aimed to examine time and imaging costs of 2 different imaging strategies for low-risk emergency department (ED) observation patients with acute chest pain or symptoms suggestive of acute coronary syndrome. We compared a “triple rule-out” (TRO) 64-section multidetector computed tomography protocol with nuclear stress testing.Methods
This was a prospective observational cohort study of consecutive ED patients who were enrolled in our chest pain observation protocol during a 16-month period. Our standard observation protocol included a minimum of 2 sets of cardiac enzymes at least 6 hours apart followed by a nuclear stress test. Once a week, observation patients were offered a TRO (to evaluate for coronary artery disease, thoracic dissection, and pulmonary embolus) multidetector computed tomography with the option of further stress testing for those patients found to have evidence of coronary artery disease.Results
We analyzed 832 consecutive observation patients including 214 patients who underwent the TRO protocol. Mean total length of stay was 16.1 hours for TRO patients, 16.3 hours for TRO plus other imaging test, 22.6 hours for nuclear stress testing, 23.3 hours for nuclear stress testing plus other imaging tests, and 23.7 hours for nuclear stress testing plus TRO (P < .0001 for TRO and TRO + other test compared to stress test ± other test). Mean imaging times were 3.6, 4.4, 5.9, 7.5, and 6.6 hours, respectively (P < .05 for TRO and TRO + other test compared to stress test ± other test). Mean imaging costs were $1307 for TRO patients vs $945 for nuclear stress testing.Conclusion
Triple rule-out reduced total length of stay and imaging time but incurred higher imaging costs. A per-hospital analysis would be needed to determine if patient time savings justify the higher imaging costs. 相似文献8.
Arango-Lasprilla JC Ketchum JM Williams K Kreutzer JS Marquez de la Plata CD O'Neil-Pirozzi TM Wehman P 《Archives of physical medicine and rehabilitation》2008,89(5):988-995
Arango-Lasprilla JC, Ketchum JM, Williams K, Kreutzer JS, Marquez de la Plata CD, O'Neil-Pirozzi TM, Wehman P. Racial differences in employment outcomes after traumatic brain injury.
Objective
To examine racial differences in employment status and occupational status 1 year after a traumatic brain injury (TBI).Design
Retrospective study.Setting
Longitudinal dataset of the Traumatic Brain Injury Model Systems national database.Participants
Subjects with primarily moderate to severe TBI (3468 whites vs 1791 minorities) hospitalized between 1989 and 2005.Interventions
Not applicable.Main Outcome Measures
Employment status (competitively employed or unemployed) and occupational status (professional/managerial, skilled, or manual labor) at 1 year postinjury.Results
Race and/or ethnicity has a significant effect on employment status at 1 year postinjury (=58.23, P<.001), after adjusting for preinjury employment status, sex, Disability Rating Scale at discharge, marital status, cause of injury, age, and education. The adjusted odds of being unemployed versus competitively employed are 2.17 times (95% confidence interval, 1.78-2.65) greater for minorities than for whites. Race and ethnicity does not have a significant effect on occupational status at 1 year postinjury.Conclusions
With this empirical evidence supporting racial differences in employment outcomes between minorities and whites at 1 year postinjury, priority should be given to tailoring interventions to maximize minority survivors' work-related productivity. 相似文献9.
Parcell DL Ponsford JL Redman JR Rajaratnam SM 《Archives of physical medicine and rehabilitation》2008,89(5):843-850
Parcell DL, Ponsford JL, Redman JR, Rajaratnam SM. Poor sleep quality and changes in objectively recorded sleep after traumatic brain injury: a preliminary study.
Objectives
To evaluate changes in sleep quality and objectively assessed sleep parameters after traumatic brain injury (TBI) and to investigate the relationship between such changes and mood state and injury characteristics.Design
Survey and laboratory-based nocturnal polysomnography.Setting
Sleep laboratory.Participants
Ten community-based subjects with moderate to very severe TBI and 10 age- and sex-matched controls from the general community.Interventions
Not applicable.Main Outcome Measures
Pittsburgh Sleep Quality Index for self-report sleep quality, nocturnal polysomnography for objective sleep recording, and Hospital Anxiety and Depression Scales.Results
Compared with controls, TBI patients reported significantly poorer sleep quality and higher levels of anxiety and depression. Objective sleep recording showed that TBI patients showed an increase in deep (slow wave) sleep, a reduction in rapid eye movement sleep, and more frequent nighttime awakenings. No significant relationship was observed between these changes in sleep and injury severity or time since injury. Anxiety and depression covaried with the observed changes in sleep.Conclusions
The findings contribute to the growing body of evidence that sleep is involved in the physiologic processes underlying neural recovery. The association between anxiety and depression and the observed changes in sleep in TBI patients warrants further examination to determine whether a causative relationship exists. 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.
Susan B. Williams Caroline A. Brand Keith D. Hill Susan B. Hunt Helen Moran 《Archives of physical medicine and rehabilitation》2010,91(1):106-114
Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.
Objective
To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.Design
Pre-post interventional study.Setting
General community.Participants
Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.Intervention
After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.Main Outcome Measures
Falls risk (Falls Risk of Older People—Community Setting) and balance measures.Results
Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).Conclusions
An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities. 相似文献12.
Jennifer M. Srygley Talia Herman Nir Giladi Jeffrey M. Hausdorff 《Archives of physical medicine and rehabilitation》2009,90(5):786-792
Srygley JM, Herman T, Giladi N, Hausdorff JM. Self-report of missteps in older adults: a valid proxy of fall risk?
Objective
To evaluate the relationship between missteps and falls and to identify factors associated with missteps, potentially to generate a broader picture of fall risk.Design
Prospective, observational cohort.Setting
General community.Participants
A sample of healthy, community-living older adults (N=266; age, 70-90y) who were cognitively intact and walked independently.Interventions
Not applicable.Main Outcome Measures
Baseline testing of gait, motor function, cognitive function, affect, and balance confidence was followed by a 12-month period in which subjects completed a daily log documenting the number of falls and missteps (defined as a trip, slip, or other loss of balance in which recovery occurred to prevent a fall).Results
Mean ± SD participant age was 76.4±4.3 years. Of all the participants, 20.7% reported at least 1 misstep, and 25.6% of the participants reported at least 1 fall during the 12 months. Among subjects who had multiple falls, missteps were more common than falls by a ratio of 3:1 (P<.001). Subjects who reported multiple missteps were more likely to fall prospectively (relative risk=3.89). Missteps were associated with higher scores on the Geriatric Depression Scale (P=.009) and increased anxiety (P=.014), but were not associated with other known risk factors for falls, including gait and cognitive function.Conclusions
The self-report of missteps may be a valuable tool in the research of falls and fall risk and may provide a way to identify patients at risk for falls before they fall. 相似文献13.
Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.
Objective
To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.Design
Case control.Setting
Sports medicine research laboratory.Participants
Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.Interventions
Not applicable.Main Outcome Measures
Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.Results
The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).Conclusions
The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat. 相似文献14.
Chetan P. Phadke Sheryl M. Flynn Floyd J. Thompson Andrea L. Behrman Mark H. Trimble Carl G. Kukulka 《Archives of physical medicine and rehabilitation》2009,90(7):1218-92
Phadke CP, Flynn SM, Thompson FJ, Behrman AL, Trimble MH, Kukulka CG. Comparison of single bout effects of bicycle training versus locomotor training on paired reflex depression of the soleus H-reflex after motor incomplete spinal cord injury.
Objective
To examine paired reflex depression changes post 20-minute bout each of 2 training environments: stationary bicycle ergometer training (bicycle training) and treadmill with body weight support and manual assistance (locomotor training).Design
Pretest-posttest repeated-measures.Setting
Locomotor laboratory.Participants
Motor incomplete SCI (n=12; mean, 44±16y); noninjured subjects (n=11; mean, 30.8±8.3y).Intervention
All subjects received each type of training on 2 separate days.Main Outcome Measure
Paired reflex depression at different interstimulus intervals (10s, 1s, 500ms, 200ms, and 100ms) was measured before and after both types of training.Results
(1) Depression was significantly less post-SCI compared with noninjured subjects at all interstimulus intervals and (2) post-SCI at 100-millisecond interstimulus interval: reflex depression significantly increased postbicycle training in all SCI subjects and in the chronic and spastic subgroups (P<.05).Conclusions
Phase-dependent regulation of reflex excitability, essential to normal locomotion, coordinated by pre- and postsynaptic inhibitory processes (convergent action of descending and segmental inputs onto spinal circuits) is impaired post-SCI. Paired reflex depression provides a quantitative assay of inhibitory processes contributing to phase-dependent changes in reflex excitability. Because bicycle training normalized reflex depression, we propose that bicycling may have a potential role in walking rehabilitation, and future studies should examine the long-term effects on subclinical measures of reflex activity and its relationship to functional outcomes. 相似文献15.
Lew HL Lee EH Castaneda A Klima R Date E 《Archives of physical medicine and rehabilitation》2008,89(1):75-80
Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study.
Objective
To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin.Design
A randomized, double-blind, placebo-controlled pilot study.Setting
Outpatient physical medicine and rehabilitation clinic of a university-affiliated tertiary hospital.Participants
A total of 29 subjects enrolled from among 45 screened patients. No subject withdrawal due to serious adverse events occurred.Intervention
Subjects were evaluated at baseline, received a 1-time injection of either BTX-A (treatment group) or saline (control group), and were followed up at 2 weeks and at months 1, 2, 3, 4, and 6.Main Outcome Measures
Visual analog scale (VAS) for pain, the Neck Disability Index (NDI), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36).Results
Improvements in the VAS and NDI scores were seen in the treatment group but were not significant when compared with the controls. Statistically significant improvements for the treatment group were seen in the SF-36 bodily pain (at months 2 and 4) and mental health (at month 1) scales but not in the other scales, nor in the summary measures. No serious adverse events were reported.Conclusions
Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic. 相似文献16.
Amer N. Al-Ani Lena Flodin Anita Söderqvist Paul Ackermann Eva Samnegård Nils Dalén Maria Sääf Tommy Cederholm Margareta Hedström 《Archives of physical medicine and rehabilitation》2010,91(1):51-57
Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.
Objective
To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.Design
Population-based cohort study.Setting
A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.Participants
Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture.Interventions
Not applicable.Main Outcome Measure
Walking ability and ADLs index at 4-month and 12-month follow-up.Results
Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44-19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8-3.5; P<.001), while type of surgery was not (P=.376).Conclusions
Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture. 相似文献17.
Shuldham C Parkin C Firouzi A Roughton M Lau-Walker M 《International journal of nursing studies》2009,46(7):986-992
Background
Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes.Objectives
To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis.Design
A case study using retrospective hospital data, at ward level.Setting
A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals.Participants
All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months.Methods
Data were extracted from corporate hospital systems. The clinical areas were categorised as lower dependency, i.e. wards, or critical care which included ICU and high dependency units. The relationship between nurse staffing characteristics and patient outcomes was assessed using either a Poisson or negative binomial regression model as appropriate. We sought to establish whether the outcomes were affected by the nurse hours per patient day, the permanent nurse hours worked as a percentage of the total hours, and the permanent nurse hours worked as a percentage of the permanent and bank hours combined.Results
In the lower dependency category wards there was only a weak association demonstrated between nurse staffing and the majority of the outcomes. The results from the high dependency critical care areas showed few significant results with only the rate of sepsis being significantly reduced as the ratio of permanent staff hours increased.Conclusions
The study demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes, however the associations found were weak and did not replicate reliably the findings from previous work. 相似文献18.
J. Derek Kingsley Victor McMillan Arturo Figueroa 《Archives of physical medicine and rehabilitation》2010,91(10):1551-364
Kingsley JD, McMillan V, Figueroa A. The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia.
Objective
To determine the effects of 12 weeks of resistance exercise training (RET) on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia (FM) and healthy controls (HCs).Design
Before-after trial.Setting
Testing and training occurred in a university setting.Participants
Women with FM (n=9; mean age ± SD, 42±5y) and HCs (n=15; mean age, 45±5y).Intervention
Both groups underwent testing before and after 12 weeks of whole-body RET consisting of 3 sets of 8 to 12 repetitions on 5 different exercises.Main Outcome Measures
Disease severity was assessed using the number of active tender points, myalgic score, and the Fibromyalgia Impact Questionnaire (FIQ). Heart rate and autonomic modulation using power spectral analysis of heart rate variability (HRV) were measured at rest and 20 minutes after 5 sets of leg-press exercise.Results
There was no group-by-time interaction for any variable. Women with FM and HCs had similar increases in maximal strength (P<.05) after RET. Number of active tender points, myalgic score, and FIQ score were decreased (P<.05) after RET in women with FM. Heart rate and natural log (Ln) high frequency (LnHF) were recovered, whereas Ln low frequency (LnLF) and LnLF/LnHF ratio were increased (P<.05) 20 minutes after acute leg resistance exercise. There were no significant effects of RET on HRV at rest or postexercise.Conclusions
These findings indicate that cardiovagal modulation of heart rate recovers early after leg resistance exercise in women with FM and HCs. It is concluded that RET reduces the severity of FM, but it has no impact on autonomic modulation of heart rate. 相似文献19.
Giuseppe Bellelli Giovanni Buccino Bruno Bernardini Alessandro Padovani Marco Trabucchi 《Archives of physical medicine and rehabilitation》2010,91(10):1489-1964
Bellelli G, Buccino G, Bernardini B, Padovani A, Trabucchi M. Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect?
Objective
To assess whether action observation treatment (AOT) may also improve motor recovery in postsurgical orthopedic patients, in addition to conventional physiotherapy.Design
Randomized controlled trial.Setting
Department of rehabilitation.Participants
Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure.Interventions
All participants underwent conventional physiotherapy. In addition, patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward. Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment.Main Outcomes Measures
Changes in FIM and Tinetti scale scores, and dependence on walking aids.Results
At baseline, groups did not differ in clinical and functional scale scores. After treatment, patients in the case group scored better than patients in the control group (FIM total score, P=.02; FIM motor subscore, P=.001; Tinetti scale score, P=.04); patients in the case group were assigned more frequently to 1 crutch (P=.01).Conclusions
In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients. 相似文献20.
Yiqin Mong Tilda W. Teo Shamay S. Ng 《Archives of physical medicine and rehabilitation》2010,91(3):407-307
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