Postural Responses to Dynamic Perturbations in Amputee Fallers Versus Nonfallers: A Comparative Study With Able-Bodied Subjects

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.     

The association of functional oral intake and pneumonia in patients with severe traumatic brain injury

Hansen TS, Larsen K, Engberg AW. The association of functional oral intake and pneumonia in patients with severe traumatic brain injury.

Objectives

To investigate the incidence and onset time of pneumonia for patients with severe traumatic brain injury (TBI) in the early phase of rehabilitation and to identify parameters associated with the risk of pneumonia.

Design

Observational retrospective cohort study.

Setting

Subacute rehabilitation department in a university hospital in Denmark.

Participants

Patients (N=173) aged 16 to 65 years with severe TBI who were admitted during a 5-year period. Patients are transferred to the brain injury unit as soon as they ventilate spontaneously.

Interventions

Not applicable.

Main Outcome Measure

Pneumonia.

Results

Twenty-seven percent of the patients admitted to the brain injury unit were in treatment for pneumonia; pneumonia developed in 12% of the patients during rehabilitation; the condition occurred within 19 days of admission in all but 1 patient. Of these patients, 81% received nothing by mouth. Three factors identified patients at highest risk of pneumonia: Glasgow Coma Scale score less than 9 (1 day after cessation of sedation); Rancho Los Amigos Scale score less than 3 (on admission); and no oral intake on admission. Having a tracheotomy tube and/or feeding tube was also associated with a higher occurrence of pneumonia.

Conclusions

Among patients with severe TBI, 27% had pneumonia at transfer from the intensive care unit. Pneumonia developed in only 12% of the participants during rehabilitation. Patients with a low level of consciousness and patients with a tracheotomy tube or feeding tube had a higher likelihood of pneumonia.     

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis capture nursing practice? A Delphi survey

Background

The “Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)” is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA.

Objectives

The objective of this study was to validate this ICF Core Set from the perspective of nurses.

Method

Nurses experienced in RA treatment were asked about the patients’ problems, patients’ resources and aspects of environment that nurses take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF.

Results

57 nurses in 15 countries named 1170 concepts that covered all ICF components. 20 concepts were linked to the as yet undeveloped ICF component Personal Factors. 19 ICF categories are not represented in the Comprehensive ICF Core Set for RA.

Conclusion

The validity of the Comprehensive ICF Core Set for RA was largely supported by the nurses. However, a number of body functions which address side effects of drug therapies were not included in the Comprehensive ICF Core Set for RA. Furthermore, several issues arose which were not precisely covered by the ICF like “dry mucous”, “risk for decubitus ulcers” and “height” and need to be investigated further.     

The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system

Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system.

Objective

To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.

Design

An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.

Setting

Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.

Participants

A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004.

Interventions

Not applicable.

Main Outcome Measures

One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year.

Results

After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26-1.80) and home discharge (OR=2.58; 95% CI, 2.17-3.06). Prosthetic limb procurement did not differ significantly between groups.

Conclusions

The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation.     

Examining the Relationship Between Cognition and Driving Performance in Multiple Sclerosis

Schultheis MT, Weisser V, Ang J, Elovic E, Nead R, Sestito N, Fleksher C, Millis SR. Examining the relationship between cognition and driving performance in multiple sclerosis.

Objective

To identify cognitive predictors of driving performance after multiple sclerosis (MS).

Design

Prospective design examining predictive value of cognitive measures on driving performance.

Setting

All data were collected in an outpatient research setting and an outpatient driver rehabilitation program.

Participants

Participants were community-dwelling persons (N=66) with clinically defined MS (86% relapsing-remitting, 14% progressive) with a mean age of 43.47 years. All were active drivers who met vision requirements established by their respective states, and none required adaptive driving equipment.

Intervention

Not applicable.

Main Outcome Measures

Participants were administered a comprehensive neuropsychologic assessment and a clinical behind-the-wheel (BTW) driving evaluation. Additional measures of driving performance included history of traffic violations and collisions (since MS onset).

Results

Logistic regression indicated that information processing speed (Symbol Digit Modality Test [SDMT]) was the strongest predictor of BTW performance. A logistic regression revealed that the strongest predictors of collision and violation frequency were visuospatial learning and recall (7/24 Spatial Recall Test [SPART 7/24]).

Conclusions

These findings indicate that information processing and visuospatial skills are predictive of driving performance among persons with MS. These measures (SDMT and SPART 7/24) may serve as screening methods for identifying the potential impact of cognitive impairment on driving. Furthermore, the findings raise questions regarding the appropriateness of the BTW evaluation to evaluate driving difficulties accurately among individuals with MS.     

The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial

Bombardier CH, Cunniffe M, Wadhwani R, Gibbons LE, Blake KD, Kraft GH. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial.

Objective

To determine if motivational interviewing-based telephone counseling increases health promotion activities and improves other health outcomes in people with multiple sclerosis (MS).

Design

Randomized controlled trial with wait-list controls and single-blinded outcome assessments conducted at baseline and at 12 weeks.

Setting

MS research and training center in the Pacific Northwest.

Participants

Community-residing persons (N=130) with physician confirmed MS aged 18 or older who were able to walk unassisted at least 90m (300ft).

Intervention

A single in-person motivational interview followed by 5 scheduled telephone counseling sessions to facilitate improvement in 1 of 6 health promotion areas: exercise, fatigue management, communication and/or social support, anxiety and/or stress management, and reducing alcohol or other drug use.

Main Outcome Measures

Health Promotion Lifestyle Profile II plus fatigue impact, subjective health, and objective measures of strength, fitness, and cognition. Intent-to-treat analyses of change scores were analyzed using nonparametric tests.

Results

Seventy persons were randomized to treatment and 60 to the control condition. The treatment group reported significantly greater improvement in health promotion activities, including physical activity, spiritual growth, and stress management as well as in fatigue impact and mental health compared with controls. In addition, the exerciser subgroup showed greater improvement than controls in self-selected walking speed.

Conclusions

A less intensive, more accessible approach to health promotion based on telephone counseling and motivational interviewing shows promise and merits further study.     

A 1-Year Follow-Up After Shortened Constraint-Induced Movement Therapy With and Without Mitt Poststroke

Brogårdh C, Lexell J. A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke.

Objective

To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke.

Design

A 1-year follow-up after shortened CIMT (3h training/d for 2wk) where the participants had been randomized to a mitt group or a nonmitt group.

Setting

A university hospital rehabilitation department.

Participants

Poststroke patients (N=20, 15 men, 5 women; mean age 58.8y; on average 14.8mo poststroke) with mild to moderate impairments of hand function.

Interventions

Not applicable.

Main Outcome Measures

The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers.

Results

One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time.

Conclusions

Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.     

A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial

Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial.

Objective

To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.

Design

A single-blinded randomized controlled trial, with outcome assessments at baseline, postintervention (6wk), and follow-up (18wk).

Setting

Inpatient acute and rehabilitation hospitals.

Participants

Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.

Intervention

Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.

Main Outcome Measures

Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.

Results

No significant differences were found in short-term improvement (0−6wk) on any measure (P>.05). For overall improvement (0−18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0−0.1; P=.05) and ARAT pinch section (95% CI, 0.3−5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P<.05), but this was irrespective of the treatment group.

Conclusions

Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.     

Diagnostic value of ultrasonography for clinical medial epicondylitis

Park G-Y, Lee S-M, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis.

Objectives

To assess the ultrasonographic findings and to evaluate the value of ultrasonography as a diagnostic method for detecting clinical medial epicondylitis.

Design

A prospective, single-blind study.

Setting

An outpatient rehabilitation clinic in a tertiary university hospital.

Participants

Twenty-one elbows from 18 patients with clinical medial epicondylitis and 25 elbows without medial epicondylitis were evaluated.

Interventions

Not applicable.

Main Outcome Measures

The clinical diagnosis of medial epicondylitis was based on the patient’s symptoms and clinical signs in a physical examination performed by a physiatrist. An experienced radiologist made the real-time ultrasonographic diagnosis based on the detection of at least one of the following abnormal findings: a focal hypoechoic or anechoic area, tendon nonvisualization, intratendinous calcifications, and cortical irregularity.

Results

Ultrasonography revealed positive findings in 20 of 21 elbows with medial epicondylitis and was negative in 23 of 25 without medial epicondylitis. Ultrasonography showed sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for clinical medial epicondylitis of 95.2%, 92%, 93.5%, 90.9%, and 95.8%, respectively. Tendinosis was observed in 15 elbows, and a partial-thickness tear, including 1 intrasubstance tear, was detected in 5 elbows. The most common ultrasonographic abnormality was a focal echogenic abnormality (15 hypoechoic, 5 anechoic) of the tendons.

Conclusions

Our results indicate that ultrasonography is informative and accurate for the detection of clinical medial epicondylitis. Therefore, ultrasonography should be considered as an initial imaging method for evaluating medial epicondylitis.     

Association of Dynamic Joint Power With Functional Limitations in Older Adults With Symptomatic Knee Osteoarthritis

Segal NA, Yack HJ, Brubaker M, Torner JC, Wallace R. Association of dynamic joint power with functional limitations in older adults with symptomatic knee osteoarthritis.

Objectives

To determine which lower-limb joint moments and powers characterize the level of gait performance of older adults with symptomatic knee osteoarthritis (OA).

Design

Cross-sectional observational study.

Setting

University motion analysis laboratory.

Participants

Community-dwelling adults (N=60; 27 men, 33 women; age 50-79y) with symptomatic knee OA.

Interventions

Not applicable.

Main Outcome Measures

Physical function was measured using the long-distance corridor walk, the Short Physical Performance Battery, and the Late Life Function and Disability Instrument (LLFDI Function). Joint moments and power were estimated using an inverse dynamics solution after 3-dimensional computerized motion analysis.

Results

Subjects aged 64.2±7.4 years were recruited. Ranges (mean ± SD) for the 400-m walk time and the LLFDI Advanced Lower-Limb Function score were 215.3 to 536.8 (304.1±62.3) seconds and 31.5 to 100 (57.0±14.9) points, respectively. In women, hip abductor moment (loading response), hip abductor power (midstance), eccentric hamstring moment (terminal stance), and power (terminal swing) accounted for 41%, 31%, 14%, and 48% of the variance in the 400-m walk time, respectively (model R²=.61, P<.003). In men, plantar flexor and hip flexor power (preswing) accounted for 19% and 24% of the variance in the 400-m walk time, respectively (model R²=.32, P=.025).

Conclusions

There is evidence that men and women with higher mobility function tend to rely more on an ankle strategy rather than a hip strategy for gait. In higher functioning men, higher knee extensor and flexor strength may contribute to an ankle strategy, whereas hip abductor weakness may bias women with lower mobility function to minimize loading across the knee via use of a hip strategy. These parameters may serve as foci for rehabilitation interventions aimed at reducing mobility limitations.     

Life Habits and Prosthetic Profile of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Life habits and prosthetic profile of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To assess performance of life habits among persons with lower-limb amputation at admission, at discharge, and 3 months after rehabilitation discharge and describe their prosthetic profile at discharge and follow-up.

Design

Case series.

Setting

Inpatient rehabilitation.

Participants

Unilateral persons with lower-limb amputation (N=19; 14 men; mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Life habits performance and prosthetic profile.

Results

In the daily activities subdomain, the lowest performances were observed for mobility and housing at all evaluation times. Within the social role subdomain, employment, recreation, and community life scores were the lowest for the 3 evaluations. Mean scores for all activities of daily living subdomain categories significantly increased (P<.05) during rehabilitation except for personal care and communication. Only community life (social roles subdomain) significantly increased during rehabilitation; life habits remained unchanged after discharge. Fifty-eight percent of patients at discharge versus 68.4% at follow-up used their prosthesis for more than 9 hours a day, and this increased significantly postdischarge (P=.017). Locomotor capability with prosthesis was similarly high at discharge and follow-up.

Conclusions

Among persons with lower-limb amputation, social role life habits appear to be more disturbed than those associated with activities of daily living. At discharge, prosthetic wear and locomotor capabilities with prosthesis were high and tended to improve on return to the community.     

Prospective analysis of lipid profiles in persons with a spinal cord injury during and 1 year after inpatient rehabilitation

de Groot S, Dallmeijer AJ, Post MW, Angenot EL, van den Berg-Emons RJ, van der Woude LH. Prospective analysis of lipid profiles in persons with a spinal cord injury during and 1 year after inpatient rehabilitation.

Objectives

To investigate the course of lipid profiles during and 1 year after inpatient rehabilitation of persons with spinal cord injury, and to determine which personal, lesion, and lifestyle characteristics influence the changes in lipid profiles over time and among subjects.

Design

Multilevel regression analysis of measurement points during and after rehabilitation.

Setting

Eight rehabilitation centers in The Netherlands.

Participants

People with complete and incomplete paraplegia and tetraplegia (N=180).

Interventions

Not applicable.

Main Outcome Measures

Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and the TC/HDL ratio.

Results

We found a significant decrease in TG and TC/HDL during inpatient rehabilitation and a significant increase in HDL during and after inpatient rehabilitation. TC and LDL, however, showed unfavorable increases after clinical discharge. The changes in HDL and LDL over time differed between lesion groups. An increase in the body mass index (BMI) led to an unfavorable change in all lipid profiles. Older participants showed higher TC, LDL, and HDL concentrations. Women and participants who consumed some alcohol, or who were more active 1 year after discharge, had more favorable HDL levels.

Conclusions

Lipid profiles improved during inpatient rehabilitation but deteriorated somewhat after clinical discharge. Controlling one’s BMI seems important in diminishing the risk for unfavorable lipid profiles.     

Employment after traumatic brain injury: differences between men and women

Corrigan JD, Lineberry LA, Komaroff E, Langlois JA, Selassie AW, Wood KD. Employment after traumatic brain injury: differences between men and women.

Objective

To determine whether there are sex differences in employment 1 year after traumatic brain injury.

Design

Prospective cohort.

Setting

Acute care hospitals in South Carolina and Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers.

Participants

Subjects in the TBIMS national dataset and the South Carolina Traumatic Brain Injury Follow-up Registry who were expected to be working before injury and followed at 1 year postinjury.

Interventions

Not applicable.

Main Outcome Measure

Change in employment from preinjury to 1 year postinjury.

Results

When other measured influences on change in hours worked were held constant, there were significant interactions for sex by age and sex by marital status. Compared with men, women were more likely to decrease hours or stop working, except in the oldest age group (55−64y) in which men were more likely to stop working. For women, there was a pattern showing better employment outcomes as age increased. Decreased employment for women was most evident for married women, who were much more likely to reduce hours or stop working. There was also a tendency for divorced women to be more likely to stop working when compared with divorced men.

Conclusions

These findings run counter to the current literature. Although definitive explanations must await future studies, causal factors arising from differential societal behavior toward women as well as discriminatory attitudes about women and employment deserve further study.     

Interrater Reliability of Functional Status Scores for Patients Transferred From One Rehabilitation Setting to Another

Kohler F, Redmond H, Dickson H, Connolly C, Estell J. Interrater reliability of functional status scores for patients transferred from one rehabilitation setting to another.

Objective

To report the interrater reliability of FIM total score, FIM motor subscore, and FIM cognitive subscore from scoring that occurred in routine clinical practice in 2 closely linked inpatient rehabilitation services in Sydney, Australia.

Design

A natural-experiment blind clinical interrater reliability cohort study of the FIM across 2 rehabilitation units.

Setting

This study is set in 2 inpatient rehabilitation units immediately adjacent to each other in southwestern Sydney, New South Wales, Australia.

Participants

All patients (N=143) who were transferred between the 2 rehabilitation units between August 2006 and October 2007 were included in the study.

Intervention

Discharge FIMs were scored by the first unit and an admission FIM was scored independently by the second unit within a few days. The FIM scores were analyzed for agreement and systematic bias.

Main Outcome Measure

Intraclass correlation coefficients, kappa statistic, weighted kappa statistic, and Bland-Altman plots were used.

Results

There were 143 sets of scores identified. The range of differences between the 2 FIM totals was −32 to 50, between the FIM motor subscores was −22 to 43, and between the FIM cognitive subscores was −14 to 21. Bland-Altman plots demonstrated poor agreement. Few FIM totals were perfectly matched. The intraclass correlation coefficients ranged from .872 for the FIM total to .830 for the cognitive subscales. Values for kappa ranged from −.007 (FIM motor subscore) to .123 (FIM cognitive subscore). Values for weighted kappa ranged from .465 (FIM cognitive subscore) to .521 (FIM total).

Conclusions

There was no systematic scoring bias evident. Intraclass correlation coefficients were high, but tests of agreement demonstrated poor agreement. These findings have implications for the use of the FIM and any patient classification or funding system based on the FIM, especially if poor levels of agreement were found in the presence of all staff being FIM credentialed and standardization of methods of assessment. This study indicates that further investigation of agreement of both FIM totals and FIM item scores in the clinical setting is warranted.     

Caregivers' Well-Being After Traumatic Brain Injury: A Multicenter Prospective Investigation

Kreutzer JS, Rapport LJ, Marwitz JH, Harrison-Felix C, Hart T, Glenn M, Hammond F. Caregivers' well-being after traumatic brain injury: a multicenter prospective investigation.

Objective

To describe frequency and magnitude of caregivers' emotional distress and life satisfaction using standardized assessment procedures; compare distress levels among spouses, parents, and other caregivers; and identify risk factors.

Design

Prospective collaborative cohort study.

Setting

Six Traumatic Brain Injury Model System Centers providing neurotrauma care, rehabilitation, and outpatient follow-up.

Participants

Caregivers (N=273) of patients who were 1, 2, or 5 years postinjury.

Interventions

Acute neurotrauma care, inpatient interdisciplinary brain injury rehabilitation, and postacute services.

Main Outcome Measure

Brief Symptom Inventory-18 Depression, Anxiety, and Somatic dimensions.

Results

Levels of Depression, Anxiety, and Somatic symptoms were equally prevalent, with 1 in 5 caregivers scoring above the cutoff in each area. The proportion of participants with 1, 2, and 3 elevations was 17.9%, 5.5%, and 10.6%, respectively. Conversely, approximately two thirds (65.9%) had no scores exceeding cutoffs. Distress levels among spouses, parents, and other caregivers were comparable. Higher caregiver distress was associated with caring for survivors who had worse functional status, received more supervision, were less satisfied with life, and used alcohol excessively.

Conclusions

Depression, Anxiety, and Somatic symptoms are common among caregivers. Findings substantiate the importance of clinical care systems addressing the needs of caregivers in the long term as well as survivors.     

Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients

Treger I, Aidinof L, Lutsky L, Kalichman L. Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients.

Objective

To evaluate the association between mean flow velocity (MFV) in the middle cerebral artery (MCA) measured by using transcranial Doppler (TCD) and functional and neurologic impairment change during rehabilitation after acute stroke.

Design

Cross-sectional observational study.

Setting

Acute neurologic rehabilitation department.

Participants

Consecutive patients (N=67; 53 men, 14 women; mean ± SD age, 61.54±8.92y) referred to the rehabilitation center during the first 6 months of 2006 for a first ischemic stroke in the MCA area.

Interventions

Not applicable.

Main Outcome Measures

All subjects were evaluated on admission and at discharge by using the National Institutes of Health Stroke Scale (NIHSS) and the FIM. TCD measurements of MFV of the ipsilateral and contralateral MCA were performed on admission (during the first 20 days after stroke) and a few days before discharge.

Results

Contralateral MFV at admission was associated significantly with all indexes of functional rehabilitation success (FIM score at discharge [β=.169; P=.010], change in FIM score [β=.554; P=.010], relative improvement in FIM score [β=.783; P=.003]). No significant association was found between indexes of NIHSS change and ipsilateral or contralateral MFV.

Conclusions

Ipsilateral or contralateral MFV measured at admission did not change during the 2-month rehabilitation period. Our data showed a significant association between blood flow velocity in the contralateral MCA and functional rehabilitation parameters of patients after first ischemic stroke in the MCA area.     

Factor Structure and Predictive Validity of Somatic and Nonsomatic Symptoms From the Patient Health Questionnaire-9: A Longitudinal Study After Spinal Cord Injury

Krause JS, Reed KS, McArdle JJ. Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: a longitudinal study after spinal cord injury.

Objective

To investigate the factor structure and predictive validity of somatic and nonsomatic depressive symptoms over the first 2.5 years after spinal cord injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9).

Design

Somatic and nonsomatic symptoms were assessed at baseline during inpatient hospitalization (average of 50 days after onset) and during 2 follow-ups (average of 498 and 874 days after onset).

Setting

Data were collected at a specialty hospital in the Southeastern United States and analyzed at a medical university. We performed time-lag regression between inpatient baseline and follow-up somatic and nonsomatic latent factors of the PHQ-9.

Participants

Adults with traumatic SCI (N=584) entered the study during inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measure

PHQ-9, a 9-item measure of depressive symptoms.

Results

The inpatient baseline nonsomatic latent factor was significantly predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient baseline did not significantly predict either factor. In contrast, when regressing latent factors between the 2 follow-ups, the nonsomatic factor predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor structure was not stable over time. Item analysis verified the instability of somatic items between inpatient baseline and follow-up and also indicated that self-harm at inpatient baseline was highly predictive of future self-harm.

Conclusions

Nonsomatic symptoms are better predictors of future depressive symptoms when first assessed during inpatient rehabilitation, whereas somatic symptoms become stable predictors only after inpatient rehabilitation. Self-harm (suicidal ideation) is the most stable symptom over time. Clinicians should routinely assess for suicidal ideation and use nonsomatic symptoms when performing assessments during inpatient rehabilitation.