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1.
Objective
To investigate the effect of spectators on the performance of a physiotherapy exercise.Design
Observational study.Setting
Research laboratory, Trinity College Dublin.Participants
Forty adult volunteer subjects (36 females, four males). As there were only four males, these were excluded from the analysis.Interventions
Subjects were observed and timed while performing single leg stance in two conditions 48 hours apart; once with the investigator present (investigator condition) and once with the investigator and three spectators present (spectator condition).Main outcome measure
Duration of single leg stance in seconds.Results
The mean duration of single leg stance, for females, under the investigator condition was 173 seconds [95% confidence interval (CI) 131 to 214], while that of the spectator condition was 168 seconds (95%CI 128 to 208). The mean difference between the two conditions was 5 seconds (95%CI −21 to 31). This was not statistically significant using a paired t-test (P = 0.686).Conclusions
Female performance of a straightforward exercise such as single leg stance was not affected by the presence of three spectators. 相似文献2.
Background
Postpartum home visiting by nurses can benefit higher-risk families. Yet, little is known about the effects of universal services which provide care for all families including those at lowest risk (e.g. provision by health visitors-United Kingdom specialist community public health nurses).Objective
It was to determine the effect of frequency of health visitors’ home visits on ‘low-risk’ first-time families’ outcomes to 8 weeks postpartum and 7 months follow-up.Design
A cluster randomised controlled trial.Setting
Within one health and social care managerial area in Northern Ireland.Participants
First-time ‘low risk’ mothers who had given birth during 2002-2004 and were visited by a health visitor who had agreed to take part in the study, were invited to participate. In total, n = 39 health visitors were allocated to ‘intervention’ and n = 41 to ‘control’. Of n = 295 ‘low-risk’ first-time mothers who agreed to take part, n = 136 with intervention health visitors were offered six home visits 2-8 weeks postpartum and n = 159 within the control group were offered one planned visit.Methods
Self-completed measures of parenting, maternal wellbeing and service use were gathered pre-intervention, 8 weeks and 7 months postpartum. The main outcome was the Edinburgh Postnatal Depression Scale (EPDS). At 8 weeks and 7 months postpartum, n = 129 and n = 115 intervention mothers, also n = 151 and n = 141 control mothers completed outcome measures.Results
An intention to treat analysis was performed using multilevel modelling analysis which statistically controlled for pre-home visit outcomes, clinic attendance and antenatal contact. The intervention had no impact on most outcomes, however, it was associated with an increased EPDS score (after adjustment: 0.16, 2.36 95%CI) at 8 weeks (before accounting for outliers) but not at 7 months (−0.62,1.65 95%CI). Intervention mothers had higher service satisfaction (7.7, 21.28, 95%CI 8 weeks; 4.69, 22.71, 7 months) and were less likely to have used emergency medical services for their infants to 8 weeks (OR: 0.15, 0.85, 95%CI).Conclusion
Weekly postpartum visits to ‘low-risk’ mothers had variable effects, therefore, practitioners and researchers should consider further development and application of effective, evidence based home visiting content. 相似文献3.
Samuel J. Howarth Jan M. Polgar Clark R. Dickerson Jack P. Callaghan 《Archives of physical medicine and rehabilitation》2010,91(3):436-442
Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.
Objectives
To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.Design
Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.Setting
Biomechanics laboratory.Participants
Healthy novice wheelchair users (N=13; 6 men) from a university student population.Interventions
Not applicable.Main Outcome Measures
Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.Results
Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.Conclusions
Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition. 相似文献4.
Christine M. Comer Derrick White Philip G. Conaghan Howard A. Bird Anthony C. Redmond 《Archives of physical medicine and rehabilitation》2010,91(10):1602-1607
Comer CM, White D, Conaghan PG, Bird HA, Redmond AC. Effects of walking with a shopping trolley on spinal posture and loading in subjects with neurogenic claudication.
Objectives
To explore possible mechanisms underpinning symptom relief and improved walking tolerance in patients with neurogenic claudication (NC) when pushing a shopping trolley by evaluating the effects of a shopping trolley on spinal posture and loading patterns.Design
An exploratory study of kinematic and kinetic changes in walking with and without pushing a shopping trolley in persons with NC symptoms and a comparison with asymptomatic control subjects.Setting
A primary care-based musculoskeletal service.Participants
Participants (n=8) with NC symptoms who have anecdotally reported symptomatic improvement when walking with a shopping trolley and a control group of asymptomatic persons (n=8).Interventions
Shopping trolley.Main Outcome Measures
Changes in lumbar spinal sagittal posture and ground reaction force.Results
Subjects with NC and asymptomatic controls walked with significantly more flexed spinal posture (increase in flexion, 3.40°; z=3.516; P<.001) and reduced mean ground reaction forces (−6.9% of body weight; z=−3.46; P=.001) when walking with a shopping trolley. However, at the midstance point of the gait cycle, controls showed minimal reliance on the trolley, whereas, people with NC showed continued offloading.Conclusions
Both posture and loading are affected by pushing a shopping trolley; however, patients with NC were found to offload the spine throughout the stance phase of gait, whereas asymptomatic controls did not. 相似文献5.
Barker AL Nitz JC Low Choy NL Haines TP 《Archives of physical medicine and rehabilitation》2008,89(11):2140-2145
Barker AL, Nitz JC, Low Choy NL, Haines TP. Clinimetric evaluation of the Physical Mobility Scale supports clinicians and researchers in residential aged care.
Objective
To investigate the interrater agreement and the internal construct validity of the Physical Mobility Scale, a tool routinely used to assess mobility of people living in residential aged care.Design
Prospective, multicenter, external validation study.Setting
Nine residential aged care facilities in Australia.Participants
Residents (N=186). Phase 1 cohort (99 residents; mean age, 85.22±5.1y); phase 2 cohort (87 residents; mean age, 81.59±10.69y).Interventions
Not applicable.Main Outcome Measures
Kappa statistics, minimal detectable change (MDC90) scores, and Bland-Altman plots were used to assess interrater agreement. Scale unidimensionality, item hierarchy, and person separation were examined with Rasch analysis for both cohorts.Results
Agreement between raters on 6 of the 9 Physical Mobility Scale items was high (κ>.60). The MDC90 value was 4.39 points, and no systematic differences in scores between raters were found. The Physical Mobility Scale showed a unidimensional structure demonstrated by fit to the Rasch model in both cohorts (phase 1: χ2=23.90, P=.16, person separation index=0.96; phase 2: χ2=22.00, P=.23, person separation index=0.96). Standing balance was the most difficult item in both cohorts (phase 1: logit=2.48, SE, 0.16; phase 2: logit=2.53, SE, 0.15). The person-item threshold map indicated no floor or ceiling effects in either cohort.Conclusions
The Physical Mobility Scale demonstrated good interrater agreement and internal construct validity with good fit to the Rasch model in both cohorts. The comparative results across the 2 cohorts indicate generality of the findings. The Physical Mobility Scale total raw scores can be converted to Rasch transformed scores, providing an interval measure of mobility. The Physical Mobility Scale may be suited to a range of clinical and research applications in residential aged care. 相似文献6.
Terry S. Horn 《Archives of physical medicine and rehabilitation》2010,91(1):30-34
Horn TS, Yablon SA, Chow JW, Lee JE, Stokic DS. Effect of intrathecal baclofen bolus injection on lower extremity joint range of motion during gait in patients with acquired brain injury.
Objectives
To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia.Design
Case series.Setting
Tertiary care rehabilitation center.Participants
Adults (N=28) with muscle hypertonia due to stroke, trauma, or anoxia.Interventions
50-μg ITB bolus injection via lumbar puncture (75 and 100μg in 2 cases).Main Outcome Measures
Ashworth score, self-selected gait speed, and sagittal plane ROMs in hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.Results
A significant decrease in the mean Ashworth score on the more involved side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at different intervals after ITB bolus injection. Ankle ROM significantly increased on the more involved (13° to 15°, P<.01) and less involved (22° to 24°, P<.05) sides. ROM significantly improved, significantly worsened, or showed no significant change in 42%, 34%, and 24% of individual joints, respectively. The peak change in ROM did not coincide with the peak decrease in Ashworth score. Peak changes in ROM and speed coincided more often (P<.001) in participants who increased gait speed after ITB bolus compared with those who decreased speed. The absolute change in ROM after ITB bolus injection correlated better with the concurrent changes in speed (r=.41, P<.001) than with the baseline speed (r=.18, P<.05).Conclusions
ITB bolus injection produces variable changes in joint ROM during gait, with significant improvements in the ankles only. Timing and magnitude of peak changes in ROM are associated with concurrent changes in speed but not muscle hypertonia. 相似文献7.
Won Hyuk Chang Sang Hee Im Jeong Ah Ryu Sang Chul Lee Ji Sung Kim 《Archives of physical medicine and rehabilitation》2009,90(2):279-284
Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.
Objective
To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.Design
Prospective open-label unicenter trial with a 3-month follow-up.Setting
University rehabilitation hospital.Participants
Twenty-two cases of suspected scapulothoracic bursitis.Intervention
Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.Main Outcome Measures
Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.Results
Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.Conclusions
Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis. 相似文献8.
Hart DL Wang YC Stratford PW Mioduski JE 《Archives of physical medicine and rehabilitation》2008,89(11):2129-2139
Hart DL, Wang Y-C, Stratford PW, Mioduski JE. A computerized adaptive test for patients with hip impairments produced valid and responsive measures of function.
Objectives
To describe the use of a computerized adaptive test (CAT) in routine clinical practice and evaluate content coverage and construct validity, sensitivity to change, and responsiveness of hip CAT functional status (FS) measures.Design
Longitudinal, prospective observational cohort study.Setting
Two hundred fifty-seven outpatient rehabilitation clinics in 31 states (United States).Participants
Two samples were examined: intake and discharge rehabilitation FS data from patients (N=8714) treated for hip impairments between January 2005 and June 2007 and data from patients (N=444) used to develop the hip CAT were examined for comparison (2002-2004).Interventions
Not applicable.Main Outcome Measures
Hip functional status and global rating of change.Results
The CAT used on average 7 items to produce precise estimates of FS that adequately covered the content range with negligible floor and slight ceiling effects. Test information functions and SEs supported FS measure precision. FS measures discriminated patients in clinically logical ways. Sixty-one percent of patients obtained discharge FS measures greater than or equal to minimal detectable change (95% confidence intervals). Change of 6 FS units (scale: 0-100) represented minimal clinically important improvement, which 64% of patients obtained.Conclusions
The hip CAT was efficient; produced valid, responsive measures of FS for patients receiving therapy for hip impairments; and functioned well in routine clinical application but would benefit from more difficult items. 相似文献9.
Perry J Weiss WB Burnfield JM Gronley JK 《Archives of physical medicine and rehabilitation》2004,85(8):1345-1350
Perry J, Weiss WB, Burnfield JM, Gronley JK. The supine hip extensor manual muscle test: a reliability and validity study. Arch Phys Med Rehabil 2004;85:1345-50.
Objectives
To define the relative hip extensor muscle strengths values identified by the 4 grades obtained with a supine manual muscle test (MMT) and to compare these values with those indicated by the traditional prone test.Design
Comparison of 4 manual supine strength grades with isometric hip extension joint torque; κ statistic-determined interrater reliability, and analyses of variance identified between grade differences in torque.Setting
Pathokinesiology laboratory.Participants
Adult volunteers recruited from local community and outpatient clinics. Reliability testing: 16 adults with postpolio (31 limbs). Validity testing (2 groups): 18 subjects without pathology (18 limbs), and 26 people with clinical signs of hip extensor weakness (51 limbs).Interventions
Not applicable.Main Outcome Measures
Supine hip extensor manual muscle grade and isometric hip extension torque.Results
Reliability testing showed excellent agreement (82%). Subjects with pathology had significant differences in mean torque (P<.01) for the assigned grade 5 (176Nm), grade 4 (103Nm), grade 3 (67Nm), and grade 2 (19Nm). Healthy adults showed significant differences between grade 5 (212Nm) and grade 4 (120Nm) in mean torque (P<.05).Conclusions
The supine MMT is a reliable and valid method with which to assess hip extension strength. 相似文献10.
Ana Cristina R. Camargos Luci F. Teixeira-Salmela PT PhD 《Archives of physical medicine and rehabilitation》2009,90(2):314-319
Camargos AC, Rodrigues-de-Paula-Goulart F, Teixeira-Salmela LF. The effects of foot position on the performance of the sit-to-stand movement with chronic stroke subjects.
Objective
To investigate the effects of different foot positions during the sit-to-stand (STS) movements with stroke subjects.Design
Cross-sectional.Setting
Research laboratory.Participants
Twelve chronic stroke subjects (N=12).Interventions
Not applicable.Main Outcome Measures
Differential latency and electromyography (EMG) activity of the tibialis anterior, soleus, quadriceps, and hamstring muscles of the affected leg as well as the movement time, time of seat-off, weight symmetry, and rising index were obtained while the subjects performed the STS movements by using 4 different strategies: spontaneous; symmetric; asymmetric-1, with the affected foot behind; and asymmetric-2, with the unaffected foot behind.Results
Compared with the spontaneous strategy, the soleus showed the greatest differential latency in the asymmetric-2 strategy, the hamstrings had lower EMG activity in the symmetric strategy, and the movement time was greater in the asymmetric strategies.Conclusions
The asymmetric 2 strategy appeared to be the least favorable, whereas the spontaneous and the symmetric strategies appeared to be more favorable in improving the STS performance. Based on these findings, allowing the subjects to adopt the spontaneous strategy or training of the symmetric strategy could result in greater benefits for subjects with higher chronicity and higher functional levels, such as those evaluated in the present study. 相似文献11.
Herbert F. Jelinek Rowan McIntyre 《Archives of physical medicine and rehabilitation》2010,91(9):1378-1382
Jelinek HF, McIntyre R. Electric pulse frequency and magnitude of perceived sensation during electrocutaneous forearm stimulation.
Objectives
To investigate the effect that electric pulse frequency has on the perceived magnitude of sensation and to quantify the relationship between electric pulse frequency and perceived magnitude of sensation during low-intensity electrocutaneous stimulation.Design
A repeated-measures research design was applied to evaluate the effect of electric pulse frequency on the perceived magnitude of electrocutaneous stimulation.Setting
Electrocutaneous agents laboratory.Participants
University students (N=26) with normal hearing and normal sensation were recruited for the study.Interventions
Electrocutaneous stimulation was applied to the forearm at 10 electric pulse frequencies.Main Outcome Measures
A cross-modality matching procedure was used in which stimulation intensity was matched with the level of loudness. Pairwise comparisons with 2 degrees of freedom at a power of 80% was performed. Statistical significance was set at P equal to .05.Results
Electric pulse frequency had a significant effect on the perceived magnitude of sensation, with the perceived sensation growing between 0 and 120Hz (F=36.02; P<.001). The relationship between the 2 variables was strong (r2=.99; P<.01).Conclusions
Increasing the electric pulse frequency of electrocutaneous stimulation increases the perceived magnitude of the resulting sensation. This has implications for the use of electrocutaneous stimulation for both analgesia and muscle stimulation. 相似文献12.
Joe R. Nocera Thomas Buckley Dwight Waddell Michael S. Okun Chris J. Hass 《Archives of physical medicine and rehabilitation》2010,91(4):589-595
Nocera JR, Buckley T, Waddell D, Okun MS, Hass CJ. Knee extensor strength, dynamic stability, and functional ambulation: are they related in Parkinson's disease?
Objective
To evaluate the relationship between knee extensor strength, postural stability, functional ambulation, and disease severity in Parkinson's disease (PD).Design
A cohort study.Setting
University research laboratory.Participants
Patients (N=44) with idiopathic PD.Intervention
Not applicable.Main Outcome Measures
Participants were evaluated on their isokinetic knee extensor strength. Additionally, participants completed an assessment of their postural stability (Functional Reach Test for static stability and a dynamic postural stability assessment as measured by the center of pressure-center of mass moment arm during gait initiation). Participants also underwent an evaluation of their functional ambulation as measured by a 6-minute walk test. Lastly, participants were evaluated by a neurologist specially trained in movement disorders to assess neurologic status and disease severity using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr disability score.Results
Knee extensor strength positively correlated with dynamic postural stability and negatively correlated with disease severity. Further, dynamic postural stability was negatively correlated to disease severity and positively correlated with functional ambulation in this cohort of patients with PD (P<.05). The results also suggest that the Functional Reach Test may be a valuable assessment tool to examine postural stability in PD.Conclusions
These findings suggest a malleable relationship between knee extensor strength, dynamic stability, and disease severity in PD. Although strength is only one piece of the puzzle in the functional outcome of PD, these findings may assist clinicians in designing appropriate interventions aimed at increasing function and decreasing fall risk in PD. 相似文献13.
Fabrisia Ambrosio Ricardo J. Ferrari G. Kelley Fitzgerald George Carvell Michael L. Boninger Johnny Huard 《Archives of physical medicine and rehabilitation》2009,90(1):66-73
Ambrosio F, Ferrari RJ, Fitzgerald GK, Carvell G, Boninger ML, Huard J. Functional overloading of dystrophic mice enhances muscle-derived stem cell contribution to muscle contractile capacity. Arch Phys Med Rehabil
Objectives
To evaluate the effect of functional overloading on the transplantation of muscle derived stem cells (MDSCs) into dystrophic muscle and the ability of transplanted cells to increase dystrophic muscle's ability to resist overloading-induced weakness.Design
Cross-sectional.Setting
Laboratory.Animals
Male mice (N=10) with a dystrophin gene mutation.Interventions
MDSCs were intramuscularly transplanted into the extensor digitorum longus muscle (EDL). Functional overloading of the EDL was performed by surgical ablation of the EDL's synergist.Main Outcome Measures
The total number of dystrophin-positive fibers/cross-section (as a measure of stem cell engraftment), the average number of CD31+ cells (as a measure of capillarity), and in vitro EDL contractile strength. Independent t tests were used to investigate the effect of overloading on engraftment, capillarity, and strength. Paired t tests were used to investigate the effect of MDSC engraftment on strength and capillarity.Results
MDSC transplantation protects dystrophic muscles against overloading-induced weakness (specific twitch force: control 4.5N/cm2±2.3; MDSC treated 7.9N/cm2±1.4) (P=.02). This improved force production following overloading is concomitant with an increased regeneration by transplanted MDSCs (MDSC: 26.6±20.2 dystrophin-positive fibers/cross-section; overloading + MDSC: 170.6±130.9 dystrophin-positive fibers/cross-section [P=.03]). Overloading-induced increases in skeletal muscle capillarity is significantly correlated with increased MDSC engraftment (R2=.80, P=.01).Conclusions
These findings suggest that the functional contribution of transplanted MDSCs may rely on activity-dependent mechanisms, possibly mediated by skeletal muscle vascularity. Rehabilitation modalities may play an important role in the development of stem cell transplantation strategies for the treatment of muscular dystrophy. 相似文献14.
Michael I. Weintraub David N. Herrmann A. Gordon Smith Misha M. Backonja Steven P. Cole 《Archives of physical medicine and rehabilitation》2009,90(7):1102-1109
Weintraub MI, Herrmann DN, Smith AG, Backonja MM, Cole SP. Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial.
Objective
To determine whether repetitive and cumulative exposure to low-frequency pulsed electromagnetic fields (PEMF) targeting painful feet can reduce neuropathic pain (NP), influence sleep in symptomatic diabetic peripheral neuropathy (DPN), and influence nerve regeneration.Design
Randomized, double-blind, placebo-controlled parallel study.Setting
Sixteen academic and clinical sites in 13 states.Participants
Subjects (N=225) with DPN stage II or III were randomly assigned to use identical devices generating PEMF or sham (placebo) 2 h/d to feet for 3 months.Interventions
Nerve conduction testing was performed serially.Main Outcome Measures
Pain reduction scores using a visual analog scale (VAS), the Neuropathy Pain Scale (NPS), and the Patient's Global Impression of Change (PGIC). A subset of subjects underwent serial 3-mm punch skin biopsies from 3 standard lower limb sites for epidermal nerve fiber density (ENFD) quantification.Results
Subjects (N=225) were randomized with a dropout rate of 13.8%. There was a trend toward reductions in DPN symptoms on the PGIC, favoring the PEMF group (44% vs 31%; P=.04). There were no significant differences between PEMF and sham groups in the NP intensity on NPS or VAS. Twenty-seven subjects completed serial biopsies. Twenty-nine percent of PEMF subjects had an increase in distal leg ENFD of at least 0.5 SDs, while none did in the sham group (P=.04). Increases in distal thigh ENFD were significantly correlated with decreases in pain scores.Conclusions
PEMF at this dosimetry was noneffective in reducing NP. However neurobiological effects on ENFD, PGIC and reduced itching scores suggest future studies are indicated with higher dosimetry (3000-5000 G), longer duration of exposure, and larger biopsy cohort. 相似文献15.
Background
The personal use of and professional recommendation for complementary and alternative medicine (CAM) has been found to be related to nurses’ knowledge and type of training background. Little, however, is known about CAM usage among nurses from Hong Kong who while of Chinese origin, are educated in western medical principles while exhibiting both folk knowledge and lay use of CAM in their daily lives.Objective
The purpose of this study was to investigate the beliefs and attitudes towards CAM in a population of Hong Kong registered nurses. A particular focus was the sources of CAM information and the nurse's professional communication exchanges about CAM usage.Design
Cross-sectional survey.Setting and participants
The survey was conducted from March to June 2006 with registered nurses (N = 187) drawn form the Hong Kong College of Nursing.Results
Nearly three quarters (71.9%) of the nurses agreed that CAM should be integrated into mainstream Western medicine. The majority (89.8%) of participants did not agree that CAM should not be taken when using Western medicine. The most common sources for the nurses surveyed to obtain CAM information were, in order of frequency, newspapers and magazines (64.2%), friends (57.2%) and books (43.9%). Approximately one in three (28.0-35.3%) participants had either sometimes or frequently initiated a discussion about CAM or a discussion about the interaction between CAM and Western medicine with nursing colleague. Consistently, nurses who had previously received training on CAM (48.9%) were also more likely to initiate CAM discussions than those who had not received such training (30.7%, p < 0.05).Conclusion
More knowledge of CAM was in general, welcomed among nurses, with 93.6% of the nurses surveyed reporting an interest in further learning. A major recommendation is that HK registered nurses receive professional CAM training as a means to enhance patient care. 相似文献16.
Yeh C-Y, Tsai K-H, Su F-C, Lo H-C. Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke.
Objectives
To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES.Design
Within-subject comparison.Setting
University hospital.Participants
Patients with stroke (N=16; age range, 42-72y; <8wk poststroke) with hypertonia in the affected leg.Interventions
Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session.Main Outcome Measures
Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity).Results
Modified Ashworth Scale scores were significantly lower (P<.05) and relaxation index and peak velocity values were significantly higher (P<.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P<.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling.Conclusions
The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia. 相似文献17.
Kimberly D. Fraser Carole Estabrooks Marion Allen 《International journal of nursing studies》2009,46(3):337-349
Background
Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care.Methods
Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis.Results
One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor.Conclusion
The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory. 相似文献18.
Andrew J. Teichtahl Anita E. Wluka Meg E. Morris Susan R. Davis Flavia M. Cicuttini 《Archives of physical medicine and rehabilitation》2009,90(2):320-324
Teichtahl AJ, Wluka AE, Morris ME, Davis SR, Cicuttini FM. The associations between the dominant and nondominant peak external knee adductor moments during gait in healthy subjects: evidence for symmetry.
Objectives
There is growing interest in the role of the knee adduction moment in the pathogenesis of knee pain and osteoarthritis. It is unclear whether the knee adduction moment is similar between the dominant and nondominant legs during locomotion. This study examined whether asymmetry exists in the peak knee adductor moments during gait in healthy adults.Design
Cross-sectional study.Setting
Musculoskeletal Research Centre, La Trobe University, Melbourne, Victoria, Australia.Participants
Three-dimensional Vicon gait analyses were performed for 17 healthy men and women.Interventions
Not applicable.Main Outcome Measures
The external dominant and nondominant peak knee adduction moments during early and late stance were analyzed to determine whether any significant differences occurred between limbs.Results
Peak knee adductor moments for dominant and nondominant limbs were significantly correlated during early (R=0.61, P=0.009) and late (R=0.72, P=0.001) stance. After adjustment for age and sex, there was an associated 0.58 (P=0.030) and 0.98 (P=0.009) unit increase in the peak knee adduction moment in the nondominant leg, for every 1 unit increase in the dominant leg during the early and late stance phases of gait, respectively. Further evidence for symmetry was provided by the symmetry index, which was 0.04% and 0.62% for early and late stance, respectively.Conclusions
In healthy subjects, the magnitude of the dominant limb peak external knee adduction moments during stance, and in particular late stance, appears representative of the magnitude of the moment in the nondominant limb. These findings imply symmetry between these moments and may have important implications when collecting data for limb analyses among healthy subjects. Whether gait symmetry protects against the onset of unilateral (or increases the risk for bilateral) pathological joint changes will need to be confirmed longitudinally. 相似文献19.
Anthony C. Waddimba Nitin B. Jain Kelly Stolzmann David R. Gagnon James F. Burgess Jr Lewis E. Kazis Eric Garshick 《Archives of physical medicine and rehabilitation》2009,90(2):193-200
Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury.
Objective
To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized.Design
Prospective cohort study.Setting
Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts.Participants/Data Sources
Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database.Interventions
Not applicable.Main Outcome Measures
Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression.Results
Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4kg/m2). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors.Conclusions
Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations. 相似文献20.
Chueh-Hung Wu Yi-Chiang Wang Hsing-Kuo Wang Wen-Shiang Chen Tyng-Guey Wang 《Archives of physical medicine and rehabilitation》2010,91(2):278-282
Wu C-H, Wang Y-C, Wang H-K, Chen W-S, Wang T-G. Evaluating displacement of the coracoacromial ligament in painful shoulders of overhead athletes through dynamic ultrasonographic examination.