Menopause Characteristics and Subjective Symptoms in Women With and Without Spinal Cord Injury

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.     

Relationship Between Ultrasonographic,Electromyographic, and Clinical Parameters in Adult Stroke Patients With Spastic Equinus: An Observational Study

Objective

To find more accurate indices that could affect decisions in spasticity treatment by investigating the relation between ultrasonographic, electromyographic, and clinical parameters of the gastrocnemius muscle in adults with spastic equinus after stroke.

Design

Observational study.

Setting

University hospitals.

Participants

Chronic patients with stroke with spastic equinus (N=43).

Interventions

Not applicable.

Main Outcome Measures

Ultrasonographic features were spastic gastrocnemius muscle echo intensity, muscle thickness, and posterior pennation angle of the gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) in both legs. Electromyographic evaluation included compound muscle action potentials (CMAPs) recorded from the GM and GL of both legs. Clinical assessment of the spastic gastrocnemius muscle was performed with the Modified Ashworth Scale (MAS) and by measuring ankle dorsiflexion passive range of motion (PROM).

Results

Spastic muscle echo intensity was inversely associated with proximal (GM and GL: P=.002) and distal (GM and GL: P=.001) muscle thickness, pennation angle (GM: P< .001; GL: P=.01), CMAP (GM: P=.014; GL: P=.026), and ankle PROM (GM: P=.038; GL: P=.024). The pennation angle was directly associated with the proximal (GM and GL: P< .001) and distal (GM: P=.001; GL: P< .001) muscle thickness of the spastic gastrocnemius muscle. The MAS score was directly associated with muscle echo intensity (GM: P=.039; GL: P=.027) and inversely related to the pennation angle (GM and GL: P=.001) and proximal (GM: P=.016; GL: P=.009) and distal (GL: P=.006) muscle thickness of the spastic gastrocnemius.

Conclusions

Increased spastic muscle echo intensity was associated with reduced muscle thickness, posterior pennation angle, and CMAP amplitude in the gastrocnemius muscle. Building on previous evidence that these instrumental features are related to botulinum toxin response, these new findings may usefully inform spasticity treatment decisions.     

Changes in Ankle Mechanical Stability in Those With Knee Osteoarthritis

Hubbard TJ, Hicks-Little C, Cordova M. Changes in ankle mechanical stability in those with knee osteoarthritis.

Objective

To examine ankle joint mechanical stability in patients who had mild to moderate knee osteoarthritis (OA).

Design

Case control study.

Setting

Biodynamics research laboratory.

Participants

Subjects with knee OA (n=15; 5 men and 10 women; mean age ± SD, 60.3±10.2y; mean mass ± SD, 93.9±18.3kg; mean height ± SD, 167.23±9.5cm) were matched to healthy controls (n=15; 5 men and 10 women; mean age ± SD, 59.6±12.6y; mean mass ± SD, 83.5±19.2kg; mean height ± SD, 169.7±12.6cm).

Interventions

Not applicable.

Main Outcome Measures

Mechanical ankle-subtalar joint stability was assessed with an instrumented arthrometer where ankle-subtalar joint motion for anterior/posterior displacement and inversion/eversion rotation was measured. Separate 2 × 2 mixed model analyses of variance were performed.

Results

Significant group × side interactions were observed for anterior and posterior displacement (P<.05) where patients with knee OA had significantly less anterior and posterior ankle displacement compared with the control group, as well as compared with their unaffected extremity. Additionally, patients with knee OA had significantly (P<.05) less inversion/eversion rotation than their respective controls.

Conclusions

These data suggest that altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. Compensatory changes in ankle joint mechanics must also be considered when addressing lower extremity functional deficits in patients with knee OA.     

Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.

Objectives

To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle.

Design

We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1β (IL-1β), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance.

Setting

A biomedical research facility.

Participants

Nine healthy volunteer subjects.

Interventions

Not applicable.

Main Outcome Measures

Preselected analyte concentrations.

Results

Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).

Conclusions

We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs.     

Higher Muscle Passive Stiffness in Parkinson's Disease Patients Than in Controls Measured by Myotonometry

Marusiak J, Kisiel-Sajewicz K, Jaskólska A, Jaskólski A. Higher muscle passive stiffness in Parkinson's disease patients than in controls measured by myotonometry.

Objective

To assess muscle passive stiffness in medicated Parkinson's disease patients using myotonometry.

Design

Case-control study.

Setting

Kinesiology laboratory.

Participants

Women with Parkinson's disease (PD) (n=8) and healthy matched elderly women (controls) (n=10) (mean age: PD, 77±3y; controls, 77±4y).

Interventions

Not applicable.

Main Outcome Measures

Passive stiffness of relaxed biceps brachii (BB) muscle was measured using myotonometry. Additionally, surface electromyographic and mechanomyographic signals were recorded from the muscle at rest, and amplitude of those signals was analyzed offline.

Results

The values of BB muscle passive stiffness were significantly (P=.004) higher in PD than in the controls, with a statistically significant influence of parkinsonian rigidity score (Unified Parkinson's Disease Rating Scale) on intergroup differences (P<.001). The Spearman correlation coefficient ρ value showed a significant (P=.005) positive relationship (ρ=.866) between the parkinsonian rigidity score and passive stiffness values of BB in PD. The groups did not differ significantly in the electromyogram amplitude (P=.631) and mechanomyogram amplitude (P=.593) of the BB muscle, and values of these parameters did not correlate significantly with rigidity score (P=.555, P=.745, respectively) in the patients.

Conclusions

Myotonometer is a sensitive enough tool to show that PD patients have higher muscle passive stiffness than healthy controls.     

Balance-Based Torso-Weighting May Enhance Balance in Persons With Multiple Sclerosis: Preliminary Evidence

Widener GL, Allen DD, Gibson-Horn C. Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence.

Objective

To determine whether weight placed on the trunk in response to directional balance loss would enhance function and stability in people with multiple sclerosis (MS).

Design

Quasi-experimental study in which subjects served as their own controls.

Setting

Research laboratory.

Participants

Subjects (N=16) age 20 to 65 years with MS recruited through the Northern California Chapter of the National Multiple Sclerosis Society.

Interventions

Balance-based torso-weighting where up to 1.5% body weight was placed in a garment on the trunk. Subjects were tested at baseline and then in randomly ordered balance-based torso-weighting and nonweighted garment conditions.

Main Outcome Measures

Sharpened Romberg, eyes open (SREO) and Sharpened Romberg, eyes closed, computerized dynamic platform posturography (CDPP), Timed Up & Go (TUG), and 25-foot timed walk.

Results

Significant improvement (P<.014) was found with SREO in the balance-based torso-weighting compared with nonweighted conditions. CDPP eyes open and TUG showed improvements (P<.03) from baseline to balance-based torso-weighting and nonweighted conditions.

Conclusions

Improved performance in a group of adults with MS was seen when light weights were placed on the torso to counteract balance loss. Placement of weights may have the potential to produce immediate improvements in balance in this population.     

Reliability of Center of Pressure Measures for Assessing the Development of Sitting Postural Control

Kyvelidou A, Harbourne RT, Stuberg WA, Sun J, Stergiou N. Reliability of center of pressure measures for assessing the development of sitting postural control.

Objectives

To determine the reliability of linear and nonlinear tools, including intrasession and intersession reliability, when used to analyze the center of pressure (COP) time series during the development of infant sitting postural control.

Design

Longitudinal study.

Setting

University hospital laboratory.

Participants

Typically developing infants (N=33; mean ± SD age at entry in the study, 152.4±17.6d).

Interventions

Not applicable.

Main Outcome Measures

Infants were tested twice in 1 week at each of the 4 months of the study. Sitting COP data were recorded for 3 trials at each session (2 each month within 1 week). The linear COP parameters of root mean square and range of sway for both the anterior-posterior and the medial-lateral directions, and the sway path, were calculated. The nonlinear parameters of approximate entropy, Lyapunov exponent, and correlation dimension for both directions were also calculated. Intrasession and intersession reliability was quantified by the intraclass correlation coefficient (ICC).

Results

The nonlinear tool of approximate entropy presented high intrasession and intersession ICC values compared with all other parameters evaluated. Generally, intrasession and intersession reliability increased in the last 2 months of the data collection and as sitting posture matured.

Conclusions

Our results showed that the evaluation of COP data is a reliable method of investigating the development of sitting postural control. The present study emphasizes the need for establishing COP reliability before using it as a method of examining intervention progress directed at improving the sitting postural abilities in infants with motor developmental delays.     

Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

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.     

A Systematic Review of Therapeutic Interventions for Pressure Ulcers After Spinal Cord Injury

Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JL, for the Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury.

Objective

To systematically review evidence on the prevention and treatment of pressure ulcers in those with a spinal cord injury (SCI).

Data Sources

For this evidence-based review, the following data sources were used: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO.

Study Selection

To be selected for inclusion in the current review, there had to have been an intervention, studies had to have 3 or more subjects, and 50% or more of the participating group had to have an SCI.

Data Extraction

Data extracted included study design, subject demographics, inclusion and exclusion criteria, study type, sample size, outcome measures used, and study results.

Data Synthesis

Articles selected for this review were organized into 1 of 2 categories: prevention or treatment. Within each broad category, several smaller ones were created, and articles were grouped according to the prevention (direct or indirect) or treatment intervention discussed.

Conclusions

Of the 26 articles selected for inclusion in the systematic review, 7 were randomized controlled trials (RCTs) that dealt with treatment for pressure ulcers, and there was 1 RCT on prevention. Despite the cost-effectiveness of prevention, little research exists on preventative interventions, and what does exist is mostly level 4 evidence. More research is needed for both prevention and treatment, but especially the former.     

Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke

Celnik P, Hummel F, Harris-Love M, Wolk R, Cohen LG. Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke.

Objective

To test the hypothesis that somatosensory stimulation would enhance the effects of training functional hand tasks immediately after practice and 1 day later in chronic subcortical stroke patients.

Design

Single-blinded and randomized, crossover study.

Setting

Human research laboratory.

Participants

Nine chronic subcortical stroke patients.

Interventions

Three separate sessions of motor training preceded by (1) synchronous peripheral nerve stimulation (PNS), (2) no stimulation, or (3) asynchronous PNS.

Main Outcome Measures

Time to complete the Jebsen-Taylor Hand Function Test (JTHFT time) and corticomotor excitability tested with transcranial magnetic stimulation.

Results

After familiarization practice, during which all patients reached a performance plateau, training under the effects of PNS reduced JTHFT time by 10% beyond the post-familiarization plateau. This behavioral gain was accompanied by a specific reduction in GABAergically mediated intracortical inhibition in the motor cortex. These findings were not observed after similar practice under the influence of no stimulation or asynchronous PNS sessions.

Conclusions

Somatosensory stimulation may enhance the training of functional hand tasks in patients with chronic stroke, possibly through modulation of intracortical GABAergic pathways.     

Older fallers with poor working memory overestimate their postural limits

Liu-Ambrose T, Ahamed Y, Graf P, Feldman F, Robinovitch SN. Older fallers with poor working memory overestimate their postural limits.

Objective

To compare the accuracy of perceived postural limits between older fallers with good working memory and those with poor working memory.

Design

Cross-sectional study.

Setting

Research laboratory.

Participants

Thirty-three community-dwelling older adults with a history of falls.

Interventions

Not applicable.

Main Outcome Measures

We measured the accuracy of perceived postural limits by using the perceived reach test in 33 fallers. The difference between the verbal digits forward test score and the verbal digits backward test score was used to provide an index of the central executive component of working memory. Participants were then allocated into 2 groups: (1) good working memory or (2) poor working memory. Comparisons of group characteristics and scores were undertaken by using Student independent-sample t tests for differences in means between those with good working memory and those with poor memory. One hierarchical linear regression model was constructed to determine the independent association of the central executive component of working memory with the accuracy of older fallers' perceived reach capacity.

Results

There was a significant difference in the mean percentage error in perceived reach between older fallers with good working memory and those with poor working memory (P=.01). The verbal digit span difference score was independently associated with the percentage error in perceived reach. The verbal digit span difference score resulted in an R² change of 18.2% and significantly improved the regression model (F_1,26 change, 7.45; P=.01).

Conclusions

Our novel results suggest that impaired executive functioning may increase falls risk by impairing older adults' judgment in motor planning for daily activities. However, future studies with larger sample sizes are needed to confirm our current results.     

Diaphragm needle placement techniques evaluated in cadaveric specimens

Chiodo A, Goodmurphy C, Haig A. Diaphragm needle placement techniques evaluated in cadaveric specimens.

Objective

To evaluate the safest and most accurate method of diaphragm needle placement for electromyography.

Design

Single blinded study.

Setting

University anatomy laboratory.

Cadavers

Five cadavers.

Interventions

Needle placement in the diaphragm by an American Board of Electrodiagnostic Medicine physician, blinded dissection by a doctoral candidate anatomist.

Main Outcome Measures

Accurate needle placement in the diaphragm, proximity or penetration of organs, vessels, or nerves, defined as cautions (proximity) and dangers (penetration).

Results

The anterior axillary approach was most accurate at the above-the-seventh and eighth-rib locations. The risk of dangers of needle placement in the diaphragm was greater on the right than left side.

Conclusions

Needle placement in the diaphragm is safe and most accurate at the anterior axillary line superior to the eighth rib. If the side of needle placement does not matter for the study being done, the left side should be chosen because it leads to a lower risk of danger to the patient.     

Development and Validation of Participation and Positive Psychologic Function Measures for Stroke Survivors

Bode RK, Heinemann AW, Butt Z, Stallings J, Taylor C, Rowe M, Roth EJ. Development and validation of participation and positive psychologic function measures for stroke survivors.

Objective

To evaluate the reliability and validity of Neurologic Quality of Life (NeuroQOL) item banks that assess quality-of-life (QOL) domains not typically included in poststroke measures.

Design

Secondary analysis of item responses to selected NeuroQOL domains.

Setting

Community.

Participants

Community-dwelling stroke survivors (n=111) who were at least 12 months poststroke.

Interventions

Not applicable.

Main Outcome Measures

Five measures developed for 3 NeuroQoL domains: ability to participate in social activities, satisfaction with participation in social activities, and positive psychologic function.

Results

A single bank was developed for the positive psychologic function domain, but 2 banks each were developed for the ability-to-participate and satisfaction-with-participation domains. The resulting item banks showed good psychometric properties and external construct validity with correlations with the legacy instruments, ranging from .53 to .71. Using these measures, stroke survivors in this sample reported an overall high level of QOL.

Conclusions

The NeuroQoL-derived measures are promising and valid methods for assessing aspects of QOL not typically measured in this population.     

Changes in Passive Mechanical Properties of the Gastrocnemius Muscle at the Muscle Fascicle and Joint Levels in Stroke Survivors

Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.

Objectives

To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle.

Design

To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0°, 30°, 60°, and 90° knee flexion in a case-control manner.

Setting

Research laboratory in a rehabilitation hospital.

Participants

Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10).

Interventions

Not applicable.

Main Outcome Measurements

At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0° to 90° knee flexion.

Results

At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P≤.048) and smaller pennation angle, especially for more extended knee positions (P≤.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P≤.044) and shorter fascicle length (P≤.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05).

Conclusions

This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation.     

Nurses’ attitudes to mental illness: A comparison of a sample of nurses from five European countries

Background

Mental health problems are of serious concern across Europe. A major barrier to the realisation of good mental health and well-being is stigma and discrimination. To date there is limited knowledge or understanding of mental health nurses’ attitudes towards mental illness and individuals experiencing mental health problems.

Objectives

To describe and compare attitudes towards mental illness and those experiencing mental health problems across a sample of registered nurses working in mental health settings from five European countries and the factors associated with these attitudes.

Design

A questionnaire survey.

Settings

A total of 72 inpatient wards and units and five community facilities in Finland, Lithuania, Ireland, Italy and Portugal.

Participants

810 registered nurses working in mental health settings.

Methods

The data were collected using The Community Attitudes towards the Mentally Ill (CAMI) scale, which is a 40-item self-report questionnaire. The data were analysed using quantitative methods.

Results

Nurses’ attitudes were mainly positive. Attitudes differed across countries, with Portuguese nurses’ attitudes being significantly more positive and Lithuanian nurses’ attitudes being significantly more negative than others’. Positive attitudes were associated with being female and having a senior position.

Conclusions

Though European mental health nurses’ attitudes to mental illness and people with mental health problems differ significantly across some countries, they are largely similar. The differences observed could be related to wider social, cultural and organisational circumstances of nursing practice.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.     

Ethnic differences in discharge destination among older patients with traumatic brain injury

Chang P-F, Ostir GV, Kuo Y-F, Granger CV, Ottenbacher KJ. Ethnic differences in discharge destination among older patients with traumatic brain injury.

Objective

To estimate the association between ethnicity and discharge destination in older patients with traumatic brain injury (TBI).

Design

A retrospective analysis.

Setting

Nationally representative sample of older patients from the Uniform Data System for Medical Rehabilitation in 2002 and 2003.

Participants

Patients (N=9240) aged 65 years or older who received inpatient rehabilitation services for TBI.

Interventions

Not applicable.

Main Outcome Measures

Discharge destination (home, assisted living facility, institution) and ethnicity (white, black, Hispanic).

Results

Multinomial logit models showed that older Hispanics (odds ratio [OR]=2.24; 95% confidence interval [CI], 1.66-3.02) and older blacks (OR=2; 95% CI, 1.55-2.59) with TBI were significantly more likely to be discharged home than older whites with TBI, after adjusting for relevant risk factors. Older blacks were also 78% less likely (OR=.22; 95% CI, .08-.60) to be discharged to an assisted living facility than whites after adjusting for relevant risk factors.

Conclusions

Our findings indicate that older minority patients with TBI were significantly more likely to be discharged home than white patients with TBI. Studies are needed to investigate underlying factors associated with this ethnic difference.     

Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests

Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests.

Objective

To examine the interobserver reliability, internal consistency, and clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain.

Design

Prospective repeated-measures design.

Setting

Private practices for physical therapy and hospital outpatient physical therapy divisions.

Participants

Twenty-nine patients with shoulder pain who were diagnosed by a physician as having a shoulder disorder.

Interventions

Not applicable.

Main Outcome Measures

Study participants filled in a visual analog scale for pain and the Shoulder Disability Questionnaire. Next, 2 assessors performed the following tests: measurement of the distance between the posterior border of the acromion and the table, measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and the lateral scapular slide test.

Results

The interobserver reliability coefficients were greater than .88 (intraclass correlation coefficients) for the measurement of the distance between the posterior border of the acromion and the table, were greater than .50 for the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and were greater than .70 for the lateral scapular slide test. The Cronbach α coefficient for internal consistency for all tests was .88. No associations between the outcome of the tests and self-reported pain severity or disability were found.

Conclusions

These data provide evidence favoring the interobserver reliability of 2 of 3 tests for the assessment of scapular positioning in patients with shoulder pain. The clinical importance of the tests’ outcomes, however, is questionable.     

Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients

Background

Diagnosis of acute myocardial infarction (AMI) in out-of-hospital cardiac arrest (OHCA) patients is important because immediate coronary angiography with coronary angioplasty could improve outcome in this setting. However, the value of acute post-resuscitation electrocardiographic (ECG) data for the detection of AMI is debatable.

Methods

We assessed the diagnostic characteristics of post-resuscitation ECG changes in a retrospective single centre study evaluating several ECG criteria of selection of patients undergoing AMI, in order to improve sensitivity, even at the expense of specificity. Immediate post resuscitation coronary angiogram was performed in all patients. AMI was defined angiographically using coronary flow and plaque morphology criteria.

Results

We included 165 consecutive patients aged 56 (IQR 48-67) with sustained return of spontaneous circulation after OHCA between 2002 and 2008. 84 patients had shockable, 73 non-shockable and 8 unknown initial rhythm; 36% of the patients had an AMI. ST-segment elevation predicted AMI with 88% sensitivity and 84% specificity. The criterion including ST-segment elevation and/or depression had 95% sensitivity and 62% specificity. The combined criterion including ST-segment elevation and/or depression, and/or non-specific wide QRS complex and/or left bundle branch block provided a sensitivity and negative predictive value of 100%, a specificity of 46% and a positive predictive value of 52%.

Conclusion

In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion would detect all AMI and avoid the performance of the procedure in 30% of the patients, in whom coronary angiogram did not have a therapeutic role.     

Older people's and relatives’ experiences in acute care settings: Systematic review and synthesis of qualitative studies

Objective

To explore older people's and their relatives’ views on and experiences of acute health care.

Design

Systematic procedures were used for study selection and data extraction and analysis. A comparative thematic approach to synthesis was taken with a number of features adopted from the literature on meta-ethnography.

Data sources

Worldwide grey and published literature written in English between January 1999 and June 2008 identified from databases: CINAHL, Medline, British Nursing Index, EMBASE Psychiatry, International Bibliography of the Social Sciences, PsychINFO, and AgeInfo.

Review methods

We conducted a systematic review and synthesis of qualitative studies describing older patients’ and/or their relatives’ experiences of care in acute hospital settings. 42 primary studies and 1 systematic review met the inclusion criteria.

Results

A number of themes emerged. The quality of technical care is often taken for granted by older patients, and good or bad experiences are described more in terms of relational aspects of care. Older patients in hospital may feel worthless, fearful or not in control of what happens, especially if they have impaired cognition, or communication difficulties. Three key features of care consistently mediated these negative feelings and were linked to more positive experiences: “creating communities: connect with me”, “maintaining identity: see who I am” and “sharing decision-making: include me”.

Conclusion

These findings highlight the perspectives of older people and their relatives on the delivery of personalized and dignified care in acute settings. They lend support to previous calls for relationship-centred approaches to care and provide a useful experience-based framework for practice for those involved in care for older people.