共查询到20条相似文献，搜索用时 500 毫秒
1.
Albert F. Moraska Robert C. Hickner Rachael Rzasa-Lynn Jay P. Shah Jonathan R. Hebert Wendy M. Kohrt 《Archives of physical medicine and rehabilitation》2018,99(11):2151-2159
Objective
To investigate changes in nutritive blood flow as well as interstitial glucose and lactate within an active myofascial trigger point (MTrP) following massage.Design
Randomized, placebo-controlled trial.Setting
Subjects were recruited from the general population; procedures were conducted at a research center affiliated with a university hospital.Participants
Adults (N=25) (18-49y old) with episodic or chronic tension-type headache and an active MTrP in the upper trapezius muscle.Interventions
Subjects were randomized to receive a single trigger point (TrP) release massage or sham ultrasound (US) treatment at an active MTrP in the upper trapezius muscle. Microdialysis was used to continuously sample interstitial fluid from the MTrP before, during, and for 60 minutes following intervention.Main Outcome Measures
The primary outcome measure was nutritive blood flow within the MTrP as measured by microdialysis ethanol clearance; secondary measures included dialysate glucose, dialysate lactate, and subject discomfort with the procedures. Pressure-pain threshold (PPT) was determined to assess treatment effectiveness.Results
There was no treatment effect of TrP release massage on nutritive blood flow (P=.663) or dialysate glucose (P=.766). The interaction for lactate was significant indicating that dialysate lactate increased for TrP release massage vs sham US (P=.04); maximum lactate increase over baseline was observed at 60 minutes after TrP release massage (P=.007, 0.128 μM, 95% confidence interval 0.045-0.212). Pain evoked by probe placement into an active MTrP was low. An interaction effect on PPT was significant (P=.005).Conclusion
TrP release massage of an active MTrP affected anaerobic metabolism as represented by an increase in dialysate lactate without change in nutritive blood flow or dialysate glucose. The lack of a treatment effect on blood flow is discussed. 相似文献2.
Ellie Cathcart Terence McSweeney Ross Johnston Hayley Young Darren J. Edwards 《Journal of bodywork and movement therapies》2019,23(1):74-81
Background
Myofascial release (MFR) is used to restore tissue extensibility of the fascia tissue and is considered to be useful in a number of clinical settings such as low back pain, ankle injuries, fibromyalgia, and headaches. There is, however, despite the popularity of MFR in manual therapy, little consensus on whether it leads to biomechanical, systemic or interoceptive outcomes.Aims
This study aimed to explore the immediate biomechanical (increased elasticity for increased range of motion), systemic (local vs. distal areas of pain threshold) and bodily awareness effects (interoception) of a myofascial release technique on the thoracic spine.Method
Twelve healthy participants took part in this triple-bind, repeated measures, cross-over design study, and were randomised into counterbalanced sequences of three conditions; a control, a sham, and the MFR condition. The outcome measures used were; range of motion (ROM), pain pressure thresholds (PPT), and interoceptive sensitivity (IS) to assess biomechanical, systemic, and interoceptive effects of MFR.Results
There were significant increases in ROM and PPT (both local and distal) post MFR intervention. There was also a positive correlation between baseline interoceptive sensitivity and post-MFR ROM and a negative correlation for baseline interoceptive sensitivity and post-MRF PPT. Interoceptive sensitivity did increase post-MFR but this was non-significant.Conclusions
The increase in ROM suggests that the MFR may have caused a biomechanical change in tissue elasticity creating an increase in tissue flexibility. The increase in both local and distal sites of the PPT suggest an overall systemic response to the therapy. The correlation between baseline IS and post-MFR ROM and PPT suggest that IS may be usefully applied as a predictor for ROM and PPT post-MFR. 相似文献3.
4.
Mahnaz Daman Farideh Shiravani Ladan Hemmati Shohreh Taghizadeh 《Journal of bodywork and movement therapies》2019,23(1):202-205
Objective
Proprioception, the perception of limb movements and spatial orientation derived from body stimuli, plays a critical role in maintaining joint stability. This study aimed to investigate the effect of combined exercise therapy (closed kinetic chain exercises and proprioception exercises) on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome.Design
Single-blind randomized clinical trial.Setting
Shiraz School of Rehabilitation Sciences.Participants
Twenty four patients with hypermobility syndrome.Interventions
The patients were assigned to the control (no intervention) or intervention group (exercise therapy) by random allocation.Measurements
Knee proprioception, pain intensity and quality of life were evaluated before and immediately after the intervention. Exercise sessions were held 3 days a week for 4 weeks.Results
The results showed that knee proprioception improved significantly in the intervention group compared to the control group. Quality of life increased, and knee pain intensity decreased significantly in the intervention group compared to the control group.Conclusion
Combined exercise therapy can reduce pain intensity and increase knee proprioception and quality of life in patients with hypermobility syndrome. 相似文献5.
Lydia L. Lytle Jennifer L. Dannenbring Matthew A. Kilgas Steven J. Elmer 《Archives of physical medicine and rehabilitation》2019,100(5):914-922
Objective
To compare metabolic, cardiorespiratory, and perceptual responses to acute eccentric and traditional concentric arm cycling in a cohort of wheelchair users.Design
Single-group repeated measures.Setting
Exercise physiology laboratory.Participants
A convenience sample of 7 manual wheelchair users (45±15 y; 87±21 kg; 1.8±0.1 m; time in wheelchair 17±14 y) volunteered.Interventions
Participants performed 5-minute trials of eccentric and concentric arm cycling at (1) isometabolic rate (35% of peak oxygen consumption) and (2) isopower output (80W). Exercise trials were performed on an eccentric/concentric arm cycle ergometer that integrated with a personal wheelchair.Main Outcome Measures
Primary measures included power output, oxygen consumption, heart rate, ventilation, blood lactate, and perceived exertion. Secondary measures assessed included perceived muscle soreness, likability, frequency of use, and duration of use.Results
At isometabolic rate, power production during eccentric arm cycling was ～3× greater than concentric arm cycling (80±36 vs 26±10 W; P<.01). When exercising at isopower output, oxygen consumption during eccentric arm cycling was ～1/2 that of concentric arm cycling (0.66±0.15 vs 1.30±0.65 L/min; P=.03). Heart rate and perceived exertion were also substantially lower during eccentric arm cycling (both P<.05). Muscle soreness assessed 24-72 hours postexercise was minimal (<1.0 cm). Preference scores and anticipated frequency and duration of use did not differ between eccentric arm cycling and concentric arm cycling (all P>.05).Conclusion
Eccentric arm cycling provided a metabolically efficient (high-force, low-energy cost) and usable (wheelchair accessible, safe, likable) exercise for wheelchair users. Implementation of eccentric arm cycling with this population is promising but additional research is needed to confirm this possibility. 相似文献6.
Bryan Spinelli Michael J. Kallan Xiaochen Zhang Andrea Cheville Andrea Troxel Joy Cohn Lorraine Dean Kathleen Sturgeon Margaret Evangelista Zi Zhang David Ebaugh Kathryn H. Schmitz 《Archives of physical medicine and rehabilitation》2019,100(2):315-326
Objective
The goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer–related lymphedema, for use in the context of outcome evaluation in clinical trials.Design
Blinded repeated measures observational study.Setting
Outpatient research laboratory.Participants
Breast cancer survivors with and without lymphedema (N=71).Interventions
Not applicable.Main Outcome Measure
The assessment of intraclass correlation coefficients (ICCs) for the Breast Cancer–Related Lymphedema of the Upper Extremity (CLUE) standardized clinical evaluation tool.Results
Intrarater reliability for the CLUE tool was ICC: 0.88 (95% confidence interval [95% CI], 0.71-0.96). Interrater reliability for the CLUE tool was ICC: 0.90 (95% CI, 0.79-0.95). Concurrent validity of the CLUE score (Pearson r) was 0.79 with perometric interlimb difference and 0.53 with the Norman lymphedema overall score.Conclusions
The CLUE tool shows excellent inter- and intrarater reliability. The overall CLUE score for the upper extremity also shows moderately strong concurrent validity with objective and subjective measures. This newly developed clinical, physical assessment of upper extremity lymphedema provides standardization and a single score that accounts for multiple constructs. Next steps include evaluation of sensitivity to change, which would establish usefulness to evaluate intervention efficacy. 相似文献7.
8.
Josephine McMurray Heather McNeil Alicia Gordon Jacobi Elliott Paul Stolee 《Archives of physical medicine and rehabilitation》2019,100(1):39-44
Objective
To develop and test face and content validity, and user interface design of a rehabilitative care patient experience measure.Design
Mixed methods, cross-sectional validation study that included subject matter expert input. Cognitive interviewing tested user interface and design.Setting
Outpatient rehabilitative care settings.Participants
Subject matter experts (n=3), health care providers (n=137), and patients and caregivers (n=5) contributed to the question development. Convenience and snowball sampling were used to recruit rehabilitative care patients postdischarge (n=9) for cognitive interviews to optimize survey design and user interface (N=154).Interventions
Not applicable.Main Outcome Measure
This novel survey instrument measures 6 concepts previously identified as key to outpatient rehabilitative care patients’ experience: ecosystem issues, client and informal caregiver engagement, patient and health care provider relations, pain and functional status, group and individual identity, and open-ended feedback.Results
502 survey questions from psychometrically tested instruments, secondary data from a related ethnographic study, and consultations with health care providers, patients, caregivers, and subject matter experts, were analyzed to create a 10-item questionnaire representing 6 key constructs that influence patient experience quality. Cognitive interviewing with 9 patients (3 rounds of 3 participants each), produced 3 progressively edited versions of the survey instrument. A final version required no further modifications.Discussion
Rehabilitative care clients have characteristics that differentiate their experience from that of other sectors and patient groups, warranting a distinct experience measure. The survey instrument includes a parsimonious set of questions that address strategic issues in the ongoing improvement of care delivery and the patient experience in the rehabilitative care sector.Conclusion
The rehabilitative care patient experience survey instrument developed has an acceptable user interface, and content and face validity. Psychometric testing of the survey instrument is reported elsewhere. 相似文献9.
Ma José Ariza-Mateos Irene Cabrera-Martos Araceli Ortiz-Rubio Irene Torres-Sánchez Janet Rodríguez-Torres Marie Carmen Valenza 《Archives of physical medicine and rehabilitation》2019,100(1):9-16
Objective
To explore the effects of a 6-week patient-centered graded exposure intervention added to manual therapy in women with chronic pelvic pain (CPP) and fear of movement/(re)injury.Design
Prospective 3-armed randomized controlled trial.Setting
Faculty of Health Sciences.Participants
A total of 49 women with CPP and substantial fear of movement were randomly allocated to 1 of 3 groups: (1) patient-centered graded exposure intervention added to manual therapy; (2) manual therapy; (3) control group.Interventions
The 6-week intervention consisted of 12 sessions in the group receiving manual therapy and 6 additional sessions of graded exposure therapy in the group receiving both interventions.Main Outcome Measures
Primary outcomes were fear-avoidance behavior assessed using the Fear-Avoidance Beliefs Questionnaire and pain interference and severity evaluated with the Brief Pain Inventory. The secondary outcome was disability evaluated with the Oswestry Disability Index. All the variables were assessed in a blinded manner at baseline, after the treatment, and at 3-month follow-up.Results
Our results show interaction effects (P<.05) for all the outcomes. Graded exposure added to manual therapy is distinctly superior to manual therapy alone in maintaining improvements for long-term fear-avoidance behavior and physical functioning.Conclusions
Graded exposure added to manual therapy is a promising approach with long-term effects for women with CPP and fear of movement/(re)injury. 相似文献10.
Jayme S. Knutson Amy S. Friedl Kristine M. Hansen Terri Z. Hisel Mary Y. Harley 《Archives of physical medicine and rehabilitation》2019,100(1):140-143.e1
Objective
To evaluate the convergent validity and responsiveness of the Stroke Upper Limb Capacity Scale (SULCS) in comparison to the Arm Motor Ability Test (AMAT), the Box and Blocks Test (BBT), and the upper limb Fugl-Meyer Assessment (FMA). The SULCS is a relatively new measure that was designed to be easier to score and less time consuming than some existing measures.Design
Prospective repeated-measures design.Setting
Clinical research laboratory of a large public hospital.Participants
Patients (N=61) <2 years poststroke with moderate to severe upper limb hemiparesis.Intervention
Participants received 12 weeks of therapy that included neuromuscular electrical stimulation of the paretic finger and thumb extensors. The SULCS, AMAT, BBT, and FMA were administered at weeks 0, 6, 12 (end of therapy), 20, 28, and 36 (6mo post-therapy).Main Outcome Measures
Convergent validity was evaluated with Spearman’s correlation coefficients between pairs of measures at each time point. Responsiveness from 0 to 12 weeks and 0 to 36 weeks was evaluated with the standardized response mean (SRM).Results
The SULCS demonstrated strong correlation with the AMAT (ρ=0.81-0.93), BBT (ρ=0.73-0.92), and FMA (ρ=0.78-0.92), at all 6 time points. All 4 measures had moderate to large SRMs (SULCS, 0.71-0.77; AMAT, 0.83-0.97; BBT, 0.73-0.82; FMA, 0.75-0.76). There was no significant difference in responsiveness among the 4 measures.Conclusions
The results support the use of the SULCS to measure upper limb capacity in patients who are less than 2 years poststroke with moderate to severe hemiplegia. 相似文献11.
Objective
To assess whether robot-assisted reach training (RART) with an active assistant protocol can improve upper extremity function and kinematic performance in chronic stroke survivors.Design
This study was conducted as a randomized controlled trial.Setting
National rehabilitation center.Participants
Chronic stroke survivors (N=38) were randomized into 2 groups: a robot-assisted reach training with assist-as-needed (RT-AAN) group and a robot-assisted reach training with guidance force (RT-G) group.Intervention
The RT-AAN group received robot-assisted reach training with an assist-as-needed mode for 40 minutes per day, 3 times per week over a 6-week period, and the RT-G group participated in the RART with a guidance mode for 40 minutes per day, 3 times per week over a 6-week period.Main Outcome Measures
Upper extremity functions were measured with Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box and Block Test. In addition, movement velocities were measured as an index for upper extremity kinematic performances in 6 directions.Results
Both groups showed significant improvements in FMA, ARAT, and kinematics (movement velocity) in all directions (targets 1-6, P<.05). However, the RT-AAN group showed significantly more improvement than the RT-G group in FMA and ARAT (P<.05).Conclusions
RART with an active assistant protocol showed improvements of upper extremity function and kinematic performance in chronic stroke survivors. In particular, assist-as-needed robot control was effective for upper extremity rehabilitation. Therefore robot-assisted training may be suggested as an effective intervention to improve upper extremity function in chronic stroke survivors. 相似文献12.
David B. Matchar Kirsten Eom Pamela W. Duncan Mina Lee Rita Sim Nirmali R. Sivapragasam Christopher T. Lien Marcus Eng Hock Ong 《Archives of physical medicine and rehabilitation》2019,100(1):1-8
Objective
To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people.Design
Randomized control trial.Settings
Communities.Participants
Adults aged at least 65 years (N=354) seen at the emergency department (ED) for a fall or fall-related injury and discharged home.Interventions
The intervention group received a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. They also received screening and referrals for low vision, polypharmacy, and environmental hazards. The Short Physical Performance Battery (SPPB) test was assessed at regular intervals to allocate participants into either a home-based or group center-based program. The control group received usual care prescribed by a physician and educational materials on falls prevention.Main Outcome Measures
The incremental cost-effectiveness ratio (ICER) over the 9-month study period based on intervention costs and utility in terms of quality-adjusted life years (QALYs) calculated from EuroQol-5D scores.Results
The ICER was 120,667 Singapore dollars (S$) per QALY gained (S$362/0.003 QALYs), above benchmark values (S$70,000). However, the intervention was more effective and cost-saving among those with SPPB scores of greater than 6 at baseline, higher cognitive function, better vision and no more than 1 fall in the preceding 6 months. The intervention was also cost-effective among those with 0-1 critical comorbidities (S$22,646/QALY).Conclusion
The intervention was, overall, not cost-effective, compared to usual care. However, the program was cost-effective among healthier subgroups, and even potentially cost-saving among individuals with sufficient reserve to benefit. 相似文献13.
Samantha Backhaus Dawn Neumann Devan Parrott Flora M. Hammond Claire Brownson James Malec 《Archives of physical medicine and rehabilitation》2019,100(2):195-204.e1
Objectives
This study aimed to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention.Design
Randomized waitlist-controlled trial.Setting
Midwestern outpatient brain injury rehabilitation center.Participants
Participants (N=44; 22 persons with brain injury and their intimate partners) were randomized by couples to the intervention or waitlist-controlled group, with 11 couples in each group.Interventions
The Couples Caring and Relating with Empathy intervention is a 16-week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition, empathy training, cognitive-behavioral and dialectical-behavioral strategies, communication skills training, and Gottman’s theoretical framework for couples adjusted for individuals with brain injury.Main Outcome Measures
The Dyadic Adjustment Scale, Quality of Marriage Index (QMI), and the Four Horsemen of the Apocalypse communication questionnaire were implemented. Measures were completed by the person with brain injury and that person’s partner at 3 time points: baseline, immediate postintervention, 3-month follow-up.Results
The experimental group showed significant improvement at posttest and follow-up on the Dyadic Adjustment Scale and the Horsemen questionnaire compared to baseline and to the waitlist-controlled group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable.Conclusions
Results suggest this intervention can improve couples’ dyadic adjustment and communication after brain injury. High satisfaction ratings suggest this small group intervention is feasible with couples following brain injury. Future directions for this intervention are discussed. 相似文献14.
Kanako Shimoura Hirotaka Iijima Yusuke Suzuki Tomoki Aoyama 《Archives of physical medicine and rehabilitation》2019,100(2):300-306.e1
Objective
To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and comprehensive physical function in preradiographic knee osteoarthritis.Design
A single, participant-blinded, randomized controlled trial (RCT) with pre-post design.Setting
University research laboratory.Participants
Patients with knee pain belonging to Kellgren–Lawrence grade 0 or 1 (N=50; aged 50-69y) were randomly assigned to the TENS (n=25) and sham-TENS groups (n=25).Interventions
All participants wore the TENS device under the patella of the symptomatic knee. After measurement, the TENS devices in the TENS group were turned on, and those in the sham-TENS group were not connected.Main Outcome Measures
The primary outcome measures included the stair climb test, timed Up and Go (TUG) test, 6-minute walk test (6MWT), and knee pain evaluated using the visual analog scale (VAS) for stair climb test, TUG test, and 6MWT. Secondary outcomes included knee extensor strengths and the 2-step test and stand-up test from the locomotive syndrome risk test.Results
Multiple regression analysis revealed that TENS intervention significantly improved the walk distance and VAS score of the 6MWT, after adjusting for premeasurement data (distance; P=.015, VAS; P=.030).Conclusions
Use of TENS improved the VAS score for pain and the distance walked in the 6MWT for individuals with Kellgren–Lawrence grade 0 or 1 of the knee. Thus, TENS may be effective for long-distance walking in patients with preradiographic knee osteoarthritis. 相似文献15.
Leonid Kalichman Inbar Levin Itzhak Bachar Elisha Vered 《Journal of bodywork and movement therapies》2018,22(3):700-706
Background
Kinesio taping is a possible therapeutic modality for myofascial pain, nevertheless, very scarce research has been performed on this subject.Objective
To evaluate the immediate and short-term effect of kinesio taping application on myofascial trigger points (MTrPs) and pressure pain thresholds (PPTs) in the upper trapezius and gastrocnemius muscles.Methods
Two randomized, single-blinded, controlled trials were simultaneously executed on the upper trapezius and gastrocnemius muscles. Different participants in each study were randomly assigned to an active intervention (N = 15) or control (N = 15) group. Kinesio taping was applied on the gastrocnemius or upper trapezius muscles by positioning three “I” strips in a star shape (tension on base) directly above the MTrPs in the active intervention group and a few centimeters away from the MTrPs in the controls.Results
The second evaluation on both sides showed lower PPT values than the first evaluation in the control group, denoting that the spots were more sensitive. The third evaluation showed even lower values. The active intervention group showed a contralateral side pattern similar to the controls. However, on the side of the kinesio taping application, the PPT values of the second evaluation were higher (the spots were less sensitive) and after 24 h returned to the original values. The difference between the PPT measurements on the MTrPs’ side of the active intervention group vs. the controls (time-group interaction) was significant (F (2,56) = 3.24, p = 0.047).Conclusions
We demonstrated that a kinesio taping application positioned directly above the MTrPs may prevent an increase in sensitivity (decrease in PPT) immediately after application and prevent further sensitization up to 24 h later. The fact that two different muscles were similarly affected by the kinesio taping application, confirmed that the results were not in error. Further studies are needed to directly test the effect of a kinesio taping application on post-treatment soreness. 相似文献16.
Christian J. Dameff Jordan A. Selzer Jonathan Fisher James P. Killeen Jeffrey L. Tully 《The Journal of emergency medicine》2019,56(2):233-238
Background
Cybersecurity risks in health care systems have traditionally been measured in data breaches of protected health information, but compromised medical devices and critical medical infrastructure present risks of disruptions to patient care. The ubiquitous prevalence of connected medical devices and systems may be associated with an increase in these risks.Objective
This article details the development and execution of three novel high-fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices.Methods
Clinical simulations were developed that incorporated patient-care scenarios featuring hacked medical devices based on previously researched security vulnerabilities.Results
Clinicians did not recognize the etiology of simulated patient pathology as being the result of a compromised device.Conclusions
Simulation can be a useful tool in educating clinicians in this new, critically important patient-safety space. 相似文献17.
Lianna Weissblum Peter Huckfeldt José Escarce Pinar Karaca-Mandic Neeraj Sood 《Archives of physical medicine and rehabilitation》2019,100(2):307-314
Objective
To investigate differences in facility characteristics, patient characteristics, and outcomes between skilled nursing facilities (SNFs) that participated in Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative and nonparticipants, prior to BPCI.Design
Retrospective, cross-sectional comparison of BPCI participants and nonparticipants.Setting
SNFs.Participants
All Medicare-certified SNFs (N=15,172) and their 2011-2012 episodes of care for chronic obstructive pulmonary disease, congestive heart failure, femur and hip/pelvis fracture, hip and femur procedures, lower extremity joint replacement, and pneumonia (N=873,739).Interventions
Participation in a bundled payment program that included taking financial responsibility for care within a 90-day episode.Main Outcome Measures
This study investigates the characteristics of bundled payment participants and their patient characteristics and outcomes relative to nonparticipants prior to BPCI, to understand the implications of a broader implementation of bundled payments.Results
SNFs participating in BPCI were more likely to be in urban areas (80.8%-98.4% vs 69.5%) and belong to a chain or system (73.8%-85.5% vs 55%), and were less likely to be located in the south (13.1%-20.2% vs 35.4%). Quality performance was similar or higher in most cases for SNFs participating in BPCI relative to nonparticipants. In addition, BPCI participants admitted higher socioeconomic status patients with similar clinical characteristics. Initial SNF length of stay was shorter and hospital readmission rates were lower for BPCI patients compared to nonparticipant patients.Conclusions
We found that SNFs participating in the second financial risk-bearing phase of BPCI represented a diversity of SNF types, regions, and levels of quality and the results may provide insight into a broader adoption of bundled payment for postacute providers. 相似文献18.
Rose Y. Hardy Richard C. Lindrooth Richard K. Peach Charles Ellis 《Archives of physical medicine and rehabilitation》2019,100(2):254-260
Objective
Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs urban) and race-ethnicity on service utilization and cost of care among PWA.Design
Cross-sectional.Setting
Administrative data from acute care hospitals in the state of North Carolina.Participants
Individuals (N=4381) with poststroke aphasia.Interventions
N/A.Main Outcome Measures
Length of stay (LOS), speech-language pathology (SLP) service utilization, costs of care.Methods
The 2011-2012 Healthcare Cost and Utilization Project State Inpatient Database data were analyzed to examine the effect of rural or urban residence on LOS, SLP service utilization, as well as total inpatient and SLP service costs. These outcomes were further analyzed across both residence and racial groups (non-Hispanic white and non-Hispanic black). Outcomes were analyzed using generalized linear model.Results
Both rural and urban black PWA experienced longer average LOS after controlling for demographics, illness severity, and the hospital where they received care. Rural blacks experienced longer LOS, received greater SLP services, and incurred greater average total hospital costs than their rural white counterparts after adjusting for differences in their demographics and stroke or illness severity. The differences were attenuated after controlling for the hospital where they received care.Conclusions
For PWA, race-ethnicity has a larger effect on average total medical costs, SLP service utilization, and LOS than residence. It is unclear how and why blacks with aphasia have greater service utilization and costs in acute care, yet their aphasia outcomes are worse. Future studies are required to explore potential factors such as quality of care. 相似文献19.
Richard Lombard-Vance Fiadhnait O’Keeffe Deirdre Desmond Robert Coen Nicola Ryall Pamela Gallagher 《Archives of physical medicine and rehabilitation》2019,100(2):278-288.e2
Objective
To establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation.Design
Cross-sectional study as part of a longitudinal prospective cohort.Setting
A national tertiary rehabilitation hospital.Participants
Adult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and nonvascular (n=18) LLA etiologies were included.Interventions
Not applicable.Main Outcome Measures
Demographic and health information and a battery of standardized neuropsychological assessments.Results
Compared to normative data, impairment was evident in overall cognitive functioning (P≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all P≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group compared with expected frequencies in normative data (P≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and nonvascular LLA etiology.Conclusions
Findings support the need for cognitive screening at rehabilitation admission regardless of etiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA, and further research is warranted in this area. 相似文献20.
Olivia A. Bernal Heather F. McClintock Jibby E. Kurichi Pui L. Kwong Dawei Xie Joel E. Streim Liliana E. Pezzin Hillary R. Bogner 《Archives of physical medicine and rehabilitation》2019,100(2):289-299