共查询到20条相似文献，搜索用时 31 毫秒
1.
Brittany N. Hand James S. Krause Kit N. Simpson 《Archives of physical medicine and rehabilitation》2018,99(5):855-861
Objectives
To (1) compare the opioid utilization patterns in opioid users with spinal cord injury (SCI) to a propensity score–matched general population of opioid users without SCI; and (2) identify characteristics of persons with SCI associated with long-term and/or high-dose use of opioids.Design
Quasi-experimental analysis of archival data.Setting
Data used for the analysis were derived from Thompson Reuters MarketScan Commercial Claims and Encounters Databases for the years 2012 to 2013.Participants
Participants (N=2908; aged 18–64y) included opioid users with SCI (n=1454) and propensity score–matched opioid users without SCI (n=1454). The cohorts were matched using demographics including comorbidities, hospital admissions, age, sex, and geographic region.Interventions
Not applicable.Main Outcome Measures
Medical and pharmacy claims from 2012 to 2013 MarketScan data were analyzed to characterize whether persons were short-term (<90d) or long-term (≥90d) opioid users, and whether persons had high (≥120mg) or low (<120mg) average daily morphine equivalents.Results
Persons with SCI were significantly more likely to be long-term users of low-dose, short-acting opioids (P<.0001) and more likely to be taking high morphine-equivalent doses of long-acting opioids (P<.0001) than matched controls. Among persons with SCI, those with lumbar/sacral injuries had more days' supply of high-dose, long-acting opioids than did persons with thoracic or cervical injuries.Conclusions
Persons with SCI are prescribed opioids for longer durations and at higher morphine-equivalent doses than controls, which may increase the risk of opioid dependence or adverse drug events. Findings should be considered in the development of practice guidelines for alternate pain management options or opioid dependence interventions for persons with SCI. 相似文献2.
Hui-Fen Mao Hsing-Po Huang Tung-Wu Lu Ting-Ming Wang Cheng-Hua Wu Jwu-Sheng Hu 《Archives of physical medicine and rehabilitation》2018,99(10):1982-1990
Objective
To quantify the effects of initial hip angle and angular hip velocity settings of a lower-limb wearable robotic exoskeleton (WRE) on the balance control and mechanical energy requirements in patients with paraplegic spinal cord injuries (SCIs) during WRE-assisted sit-to-stand (STS).Design
Observational, cross-sectional study.Setting
A university hospital gait laboratory with an 8-camera motion analysis system, 3 forceplates, a pair of instrumented crutches, and a WRE.Participants
Patients (N=12) with paraplegic SCI.Interventions
Not applicable.Main Outcome Measures
The inclination angle (IA) of the body’s center of mass (COM) relative to the center of pressure (COP), and the rate of change of IA (RCIA) for balance control, and the mechanical energy and forward COM momentum before and after seat-off for energetics during WRE-assisted STS were compared between conditions with 2 initial hip angles (105° and 115°) and 3 initial hip angular velocities (800, 1000, 1200 rpm).Results
No interactions between the main factors (ie, initial hip angle vs angular velocity) were found for any of the calculated variables. Greater initial hip angle helped the patients with SCI move the body forward with increased COM momentum but reduced RCIA (P<.05). With increasing initial angular hip velocity, the IA and RCIA after seat-off (P<.05) increased linearly while total mechanical energy reduced linearly (P<.05).Conclusions
The current results suggest that a greater initial hip angle with smaller initial angular velocity may provide a favorable compromise between momentum transfer and balance of the body for people with SCI during WRE-assisted STS. The current data will be helpful for improving the design and clinical use of the WRE. 相似文献3.
Roberto Schreiber Cristiane M. Souza Layde R. Paim Guilherme de Rossi José R. Matos-Souza Anselmo de A. Costa e Silva Fernando R. Faria Eliza R. Azevedo Karina C. Alonso Andrei C. Sposito Alberto Cliquet José I. Gorla Wilson Nadruz 《Archives of physical medicine and rehabilitation》2018,99(8):1561-1567.e1
Objective
To investigate the relationship of carotid artery intima-media thickness (IMT) and cardiac structure and function with adipocytokines in sedentary (S-SCI) and physically active (PA-SCI) subjects with spinal cord injury (SCI).Design
Cross-sectional observational study.Setting
Academic medical center.Participants
Men with chronic (>1y) SCI (N=41; 16 S-SCI, 25 PA-SCI) were evaluated. S-SCI subjects did not perform labor that required physical effort, recreational physical activity, or sports, while PA-SCI subjects included competing athletes who were regularly performing adapted sports.Interventions
Not applicable.Main Outcome Measures
Clinical, laboratory, carotid ultrasonography, and echocardiography analysis. Plasma leptin, adiponectin, and plasminogen activating inhibitor-1 (PAI-1) levels were determined.Results
PA-SCI subjects had similar levels of adipocytokines, but lower carotid IMT and carotid IMT/diameter, and better left ventricular diastolic function than S-SCI participants. Bivariate analysis showed that adiponectin was inversely correlated with triglycerides (r=–.85, P<.001), low-density lipoprotein cholesterol (r=–.57, P<.05), and carotid IMT/diameter (r=–.56, P<.05) in S-SCI but not in PA-SCI participants. Additionally, the leptin-adiponectin ratio showed a direct correlation with triglycerides (r=.84, P<.001) and low-density lipoprotein cholesterol (r=.53, P<.05) in S-SCI but not in PA-SCI individuals. By contrast, the studied adipocytokines did not correlate with cardiac structure and function in PA-SCI and S-SCI participants.Conclusions
Lower adiponectin levels and higher leptin-adiponectin ratio are related to adverse vascular and/or metabolic characteristics in individuals with SCI. This relationship, however, appears to be mitigated by regular physical activity. 相似文献4.
Marcalee Alexander Khurram Bashir Craig Alexander Lesley Marson Raymond Rosen 《Archives of physical medicine and rehabilitation》2018,99(2):299-305
Objective
To examine the safety and efficacy of using a clitoral vacuum suction device (CVSD) versus vibratory stimulation (V) to treat orgasmic dysfunction in women with multiple sclerosis (MS) or spinal cord injury (SCI).Design
Randomized clinical trial.Setting
Two academic medical centers.Participants
Women (N=31) including 20 with MS and 11 with SCI.Intervention
A 12-week trial of the use of a CVSD versus V.Main Outcome Measures
Female Sexual Function Inventory (FSFI) and Female Sexual Distress Scale (FSDS).Results
Twenty-three women (18 MS, 5 SCI) completed the study including 13 of 16 randomized to CVSD and 10 of 15 randomized to V. There was a statistically significant increase in total FSFI score (P=.011), desire (P=.009), arousal (P=.009), lubrication (P=.008), orgasm (P=.012), and satisfaction (P=.049), and a significant decrease in distress as measured by FSDS (P=.020) in subjects using the CVSD. In subjects who used V, there was a statistically significant increase in the orgasm subscale of the FSFI (P=.028). Subjects using the CVSD maintained improvements 4 weeks after treatment.Conclusions
CVSD is safe and overall efficacious to treat female neurogenic sexual dysfunction related to MS and SCI. V is also safe and efficacious for female neurogenic orgasmic dysfunction; however, results were limited to the active treatment period. Because of ease of access and cost, clinicians can consider use of V for women with MS or SCI with orgasmic dysfunction. CVSD is recommended for women with multiple sexual dysfunctions or for whom V is ineffective. 相似文献5.
Felicia Skelton Larissa Grigoryan Sally Ann Holmes Ivy Oiyee Poon Barbara Trautner 《Archives of physical medicine and rehabilitation》2018,99(2):219-225
Objectives
To measure the prevalence of asymptomatic bacteriuria (ASB) in persons with spinal cord injury (SCI) at the time of their annual examination and to examine the effect on urine testing during the annual examination on subsequent antibiotic use.Design
Retrospective cohort study.Setting
A major SCI center.Participants
Veterans (N=393) with SCI seen for an outpatient annual evaluation in 2012 or 2013.Interventions
Not applicable.Main Outcome Measures
Antibiotic use for bacteriuria within 7 days of the annual evaluation encounter.Results
There were 327 clinic visits that met inclusion criteria; of these 327 veterans, 249 had a urine culture performed. A total of 171 urine cultures (69%) were positive for bacteria, of which 22 (13%) represented urinary tract infection (UTI) cases and 149 (87%) were ASB cases. More than a third of the ASB cases (n=53 [36%]) were treated with antibiotics. None of the 78 visits with negative urine cultures received antibiotics to treat the UTI; thus, a positive urine culture alone was associated with antibiotic use (P<.01). Factors predicting antibiotic use were higher age, nitrite presence on urinalysis, and urease-producing organism on culture media. When comparing bladder management strategies, indwelling catheterization was found to be associated with higher levels of pyuria and hematuria than did spontaneous voiding or intermittent catheterization (P<.01).Conclusions
Two-thirds of the urine cultures of persons with SCI presenting for their annual examination were positive. Most of the positive cultures represented ASB cases, and more than a third of these were treated with antibiotics. A better understanding of the mandate for urine testing at the annual examination and the outcomes of this practice is an important first step in developing antibiotic stewardship for UTI in persons with SCI. 相似文献6.
Stephanie Rigot Lynn Worobey Michael L. Boninger 《Archives of physical medicine and rehabilitation》2018,99(8):1591-1598
Objectives
To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI).Design
Prospective observational study using the SCIRehab database.Setting
Six IPR facilities.Participants
Patients with new SCI (N=1376) receiving initial rehabilitation.Interventions
Patients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM.Main Outcome Measures
Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART).Results
Nearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART.Conclusions
A significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR. 相似文献7.
Tamra Keeney Mary Slavin Pamela Kisala Pengsheng Ni Allen W. Heinemann Susan Charlifue Denise C. Fyffe Ralph J. Marino Leslie R. Morse Lynn A. Worobey Denise Tate David Rosenblum Ross Zafonte David Tulsky Alan M. Jette 《Archives of physical medicine and rehabilitation》2018,99(9):1783-1788
Objective
To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI).Design
Multisite longitudinal (12-mo follow-up) study.Setting
Nine SCI Model Systems programs.Participants
Adults (N=165) with SCI enrolled in the SCI Model Systems database.Interventions
Not applicable.Main Outcome Measures
SCI-FI/AT computerized adaptive test (CAT) (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation domains) completed at discharge from rehabilitation and 12 months after SCI. For each domain, effect size estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia.Results
The demographic characteristics of the sample were as follows: 46% (n=76) individuals with paraplegia, 76% (n=125) male participants, 57% (n=94) used a manual wheelchair, 38% (n=63) used a power wheelchair, 30% (n=50) were ambulatory. For individuals with paraplegia, the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significantly large amount of change; in contrast, the Fine Motor Function and Wheelchair Mobility domains detected only a small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor Function, and Self-Care domains detected a small amount of change whereas the Ambulation item domain detected a medium amount of change. The Wheelchair Mobility domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change.Conclusions
SCI-FI/AT CAT item banks detected an increase in function from discharge to 12 months after SCI. The effect size estimates for the SCI-FI/AT CAT vary by domain and level of lesion. Findings support the use of the SCI-FI/AT CAT in the population with SCI and highlight the importance of multidimensional functional measures. 相似文献8.
Michiel J. Vanfleteren Maud Koopman Martijn A. Spruit Herman-Jan Pennings Frank Smeenk Willem Pieters Jan J. van den Bergh Arent-Jan Michels Emiel F. Wouters Miriam T. Groenen Frits M. Franssen Lowie E. Vanfleteren 《Archives of physical medicine and rehabilitation》2018,99(11):2279-2286.e3
Objective
To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).Design
Retrospective cohort study.Setting
PR network.Participants
A cohort of 1981 patients with COPD (55% men; age: 66.8±9.3y; forced expiratory volume in the first second%: 50.7±19.5; residual volume [RV]%: 163.0±49.7).Intervention
An interdisciplinary PR program for patients with COPD consisting of 40 sessions.Main Outcome Measures
Participants were stratified into 5 quintiles according to baseline RV and were evaluated on the basis of pre- and post-PR 6-minute walk distance (6MWD), constant work rate test (CWRT), and Saint George’s Respiratory Questionnaire (SGRQ), among other clinical parameters.Results
With increasing RV quintile, patients were younger, more frequently women, had lower forced expiratory volume in the first second%, lower body mass index and fat-free mass index, shorter 6MWD, shorter CWRT, and worse SGRQ scores (P<.01). All RV strata improved after PR in all 3 outcomes (P<.001). Nevertheless, higher, compared to lower RV categories, had lower ΔCWRT (P<.01) but similar Δ6MWD (P=.948) and ΔSGRQ (P=.086) after PR.Conclusions
LH in COPD is related to younger age, female sex, lower body weight, worse exercise capacity and health status, but did not prevent patients from benefitting from PR. LH, however, influences walking and cycling response after PR differently. 相似文献9.
Jason S. Au Arjun Sithamparapillai Katharine D. Currie Andrei V. Krassioukov Maureen J. MacDonald Audrey L. Hicks 《Archives of physical medicine and rehabilitation》2018,99(10):1991-1997
Objective
To assess the feasibility of measuring ventilatory threshold (VT) in higher-level motor-complete spinal cord injury (SCI) using 4 different analysis methods based on noninvasive gas exchange.Design
Observational.Setting
Laboratory testing.Participants
Individuals with C4-T6 motor-complete SCI (16 paraplegia, 22 tetraplegia; American Spinal Injury Association Impairment Scale A/B; 42±10 years old).Interventions
Not applicable.Main Outcome
VT from a graded arm cycling test to volitional exhaustion using 4 methods: ventilatory equivalents, excess CO2, V-slope, and combined method.Results
VT could be identified in all individuals with paraplegia, but in only 68% of individuals with tetraplegia. Individuals without observable VT completed the graded exercise test with lower ventilatory rate, peak power output, and peak oxygen consumption (Vo2peak) (all P<.05), compared to those with a detectable VT. Bland-Altman plots indicate minimal bias between methods (range: 0.01-0.03 L/min), with 95% limits of agreement of the difference within 0.25 L/min. Absolute o2 at VT with individual methods were all correlated to peak power output (r>0.74; P<.01) and Vo2peak (r>0.91; P<.01), with negligible differences between methods.Conclusions
The assessment of VT is a feasible alternative to peak exercise testing for aerobic fitness in individuals with higher-level, motor-complete SCI, although care should be taken when interpreting VT in individuals with tetraplegia who have lower cardiorespiratory fitness and lower peak power outputs. 相似文献10.
Sarah A. Morrison Douglas Lorenz Carol P. Eskay Gail F. Forrest D. Michele Basso 《Archives of physical medicine and rehabilitation》2018,99(3):555-562
Objective
To determine the impact of long-term, body weight–supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers.Design
Prospective observational cohort with longitudinal follow-up.Setting
Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN).Participants
Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1–45y after SCI) who completed at least 120 NRN physical therapy sessions.Interventions
Manually assisted locomotor training (LT) in a body weight–supported treadmill environment, overground standing and stepping activities, and community integration tasks.Main Outcome Measures
International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy.Results
Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment.Conclusions
Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs. 相似文献11.
Ashraf S. Gorgey Gary J. Farkas David R. Dolbow Refka E. Khalil David R. Gater 《PM & R》2018,10(4):338-348
Background
Increase in visceral adipose tissue (VAT) is an independent risk for mortality and other health-related comorbidities.Objective
To examine the gender differences in VAT and subcutaneous adipose tissue (SAT) cross-sectional areas (CSA) between men and women with chronic spinal cord injury (SCI). The differences in the distribution of central adiposity were used to determine the association of VAT and SAT to metabolic dysfunction after SCI.Design
Cross-sectional design.Setting
Hospital-based study.Participants
Sixteen individuals (8 men and 8 women) with motor complete SCI were matched based on age, time since injury, and level of injury.Methods
Anthropometrics, dual x-ray absorptiometry (DXA), and magnetic resonance imaging were captured to measure lean mass, fat mass (FM), percentage FM, VAT, and SAT CSAs. Basal metabolic rate was measured, and intravenous glucose tolerance test and lipid panel were performed.Main Outcome Measurements
VAT, SAT, and metabolic profile.Results
SAT CSA was 1.6 -1.75 times greater in the upper and lower trunks in women compared to men with SCI (P < .05). VAT CSA was 1.8-2.6 times greater in the upper and lower trunks in men compared to women with SCI (P < .05). VAT adjusted to body weight was greater in men compared to women with SCI. High-density lipoprotein cholesterol (HDL-C) was positively related to SAT and negatively related to VAT. Glucose effectiveness was negatively related to lower trunk SAT (r = ?0.60, P = .02). HDL-C ratio and triglycerides were positively related to upper VAT, lower VAT, and VAT:SAT ratio.Conclusion
Magnetic resonance imaging demonstrated that there is a gender dimorphism in central adiposity in persons with chronic SCI. This gender dimorphism in central adipose tissue distribution may explain the higher prevalence of metabolic dysfunction in men with SCI, especially, the decrease in the HDL-C profile.Level of Evidence
IV 相似文献12.
Tom E. Nightingale Peter C. Rouse Jean-Philippe Walhin Dylan Thompson James L.J. Bilzon 《Archives of physical medicine and rehabilitation》2018,99(10):1998-2006.e1
Objective
To assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI).Design
This was a randomized controlled trial (HOMEX-SCI; ISRCTN57096451). After baseline laboratory testing and a week of free-living physical activity monitoring, eligible participants were randomly assigned (2:1 allocation ratio) to a home-based moderate-intensity upper-body exercise intervention group (INT, n=13), or a lifestyle maintenance control group (CON, n=8), for 6 weeks.Setting
Home-based with short laboratory visits immediately before and after the intervention/control period.Participants
Inactive participants (N=21) with chronic (>1yr) SCI (injury level <T4).Intervention
Participants assigned to the INT completed 4, 45-minute moderate-intensity (60%-65% peak oxygen uptake) arm-crank exercise sessions per week for 6 weeks. Participants assigned to the control group (CON) were asked to maintain their habitual physical activity behavior.Main Outcome Measures
Secondary outcome measures were assessed, including physical and mental component scores (PCS and MCS) of health-related quality of life (HRQOL), fatigue, global fatigue (FSS), and shoulder pain index (WUSPI). Cardiorespiratory fitness (CRF), objectively measured habitual moderate-to-vigorous physical activity (MVPA), and exercise self-efficacy (ESE) were also assessed at baseline and follow-up.Results
Changes in the PCS (P=.017) of the Short Form 36 Health Survey (SF-36), ESE (P=.011), and FSS (P=.036) were significantly different between the 2 groups, with moderate to large effect sizes (d=0.75-1.37). Various HRQOL outcomes demonstrated likely to very likely positive inferences in favor of the INT group following the 6-week exercise intervention. Changes in ESE were significantly (P<.01) associated with changes in PCS (r=0.62), MCS (r=0.71), FSS (r=-0.71), and global fatigue (r=0.57).Conclusions
A 6-week upper-body exercise intervention improved indices of HRQOL in persons with SCI. Improvements were associated with increases in ESE. While this intervention demonstrated a positive effect on perceived physical functioning, future interventions should aim to support social and mental functioning and exercise maintenance. 相似文献13.
Nam G. Lee Joshua H. You Chung H. Yi Hye S. Jeon Bong S. Choi Dong R. Lee Jae M. Park Tae H. Lee In T. Ryu Hyun S. Yoon 《Archives of physical medicine and rehabilitation》2018,99(11):2168-2174
Objectives
To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke.Design
Two-group randomized controlled trial with pretest-posttest design.Setting
Hospital rehabilitation center.Participants
Adults with chronic hemiparetic stroke (N=28).Interventions
Participants were randomly divided into either conventional core stabilization (n=14) or DNS (n=14) groups. Both groups received a total of 20 sessions of conventional core stabilization or DNS training for 30 minutes per session 5 times a week during the 4-week period.Main Outcome Measures
Electromyography was used to measure the APA time for bilateral external oblique (EO), transverse abdominis (TrA)/internal oblique (IO), and erector spinae (ES) activation during rapid shoulder flexion. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES) were used to measure trunk movement control, balance performance, and fear of falling.Results
Baseline APA times were delayed and fear of falling was moderately high in both the conventional core stabilization and DNS groups. After the interventions, the APA times for EO, TrA/IO, and ES were shorter in the DNS group than in the conventional core stabilization group (P<.008). The BBS and TIS scores (P<.008) and the FES score (P<.003) were improved compared with baseline in both groups, but FES remained stable through the 2-year follow-up period only in the DNS group (P<.003).Conclusions
This is the first clinical evidence highlighting the importance of core stabilization exercises for improving APA control, balance, and fear of falls in individuals with hemiparetic stroke. 相似文献14.
Huacong Wen Yuying Chen Yin He C. Scott Bickel Susan Robinson-Whelen Allen W. Heinemann 《Archives of physical medicine and rehabilitation》2018,99(10):1957-1964
Objective
To assess racial differences in body mass index (BMI) change over 5 years among people with spinal cord injury (SCI).Design
Multicenter longitudinal study.Setting
Spinal Cord Injury Model Systems centers.Participants
Individuals (N=437; 313 non-Hispanic white, 81 non-Hispanic black, and 43 Hispanic; 335 men; mean age, 41.3±13.5y) who incurred an SCI from 1974 to 2010 and completed 2 follow-up assessments within 5 years between October 1, 2006 and September 18, 2015 (mean duration of injury, 9.1±9.6y at the start of the 5-year follow-up).Interventions
Not applicable.Main Outcome Measures
BMI (in kilograms per meters squared).Results
The mean BMI of 437 participants increased from 26.4±6.3 to 27.0±6.4kg/m2 over 5 years (P=.002). The greatest increase was noted for Hispanics (2.0±5.7kg/m2; P=.02), followed by non-Hispanic whites (0.6±3.9kg/m2; P=.01) and non-Hispanic blacks (0.01±3.7kg/m2; P>.99). The differences in BMI increase across racial groups were significant (P=.03) in those with paraplegia (American Spinal Injury Association Impairment Scale A, B or C), those who were underweight or of normal weight at baseline, and those within 10 years of their injury. Such racial differences remained significant after taking into account demographic and injury characteristics.Conclusions
Our study findings provide a foundation for future research to explore risk and protective factors that contribute to racial differences in weight gain after SCI, which help alert health care professionals to a high-risk group for obesity prevention and management. 相似文献15.
Shannon D. Sullivan Mark S. Nash Eshetu Tefara Emily Tinsley Suzanne Groah 《PM & R》2018,10(4):373-381
Background
We reported previously that young men with chronic spinal cord injury (SCI) have a greater prevalence of testosterone deficiency compared with an age-matched, healthy control population. Young men with SCI also are at increased risk for developing cardiometabolic dysfunction after injury. It is unclear whether testosterone deficiency is associated with heightened cardiometabolic risk in men with SCI.Objective
To investigate associations among levels of testosterone in young men with chronic SCI and surrogate markers of cardiometabolic risk.Design
Secondary cross-sectional analysis.Setting
Rehabilitation research centers in Washington, DC, and Miami, Florida.Participants
Men (n = 58) aged 18-45 years with chronic (≥1 year), motor complete SCI without comorbidities or use of testosterone therapy.Methods
Plasma concentrations of testosterone, lipids, inflammatory markers (C-reactive protein and interleukin-6), percent hemoglobin A1c, glucose, and insulin were measured in a fasting state using standard assays. A 2-hour oral glucose tolerance test and Framingham Risk Score were assessed for each subject. Body composition was assessed by dual X-ray absorptiometry scan.Main Outcome Measurements
Surrogate markers of cardiometabolic risk among men based on the level of total testosterone (TT; ≤300, 301-500, or >500 ng/dL) and free testosterone (fT; ≤9 or >9 ng/dL). Comparisons were made between men with normal and low TT or fT.Results
Framingham Risk Score was significantly greater in men with low fT (P < .05). Percent body fat (P < .05) and waist-to-hip ratio (P < .05) but not body mass index (P > .08), were greater in men with low TT or low fT. Men with low TT or low fT had lower high-density lipoprotein cholesterol levels (P < .05) without differences in fasting triglycerides (P > .1) or low-density lipoprotein cholesterol (P > .07). Men with low TT had greater levels of inflammatory markers C-reactive protein (P < .05) and interleukin-6 (P < .05). Men with low TT or low fT had greater fasting glucose (P < .05) and greater insulin resistance (P < .04), without differences in percent hemoglobin A1c (P > .8).Conclusions
In young men with chronic SCI who undergo an accelerated aging process postinjury, hypogonadism is associated with an unfavorable cardiometabolic risk profile. Further research is needed to determine whether a causal relationship exists between hypogonadism and heightened cardiometabolic risk in men with SCI and whether routine screening for testosterone deficiency is warranted in this population.Level of Evidence
IV 相似文献16.
Nathan S. Hogaboom Lynn A. Worobey Bethlyn V. Houlihan Allen W. Heinemann Michael L. Boninger 《Archives of physical medicine and rehabilitation》2018,99(10):1949-1956
Objectives
To evaluate the relation between wheelchair breakdowns, their immediate consequences, and secondary health complications after spinal cord injury. “Immediate consequences” occur when part of a wheelchair breaks and leaves an individual stranded or injured, or causes him or her to miss medical appointments, work, or school.Design
Survey, cross-sectional.Setting
Spinal Cord Injury Model Systems Centers.Participants
Full-time wheelchair users (N=771) with SCI from 9 Spinal Cord Injury Model Systems Centers, with data collected between 2011 and 2016.Interventions
Not applicable.Main Outcome Measures
Incidence of self-reported wheelchair breakdowns within the past 6 months that did or did not result in immediate consequences (ie, injury, being stranded, missing a medical appointment, or an inability to attend school/work); self-perceived health status scale; pain severity numerical rating scale; rehospitalizations; and self-reported pressure injury development within the past 12 months.Results
A total of 610 participants with complete data sets were included in the analyses. When compared to those who reported no breakdowns, participants who reported 1 or more immediate consequences had worse secondary complications: higher self-perceived health status and pain scores (partial ?η2=.009-.012, P<.05), and higher odds of rehospitalization (odds ratio: 1.86, P<.05) and pressure injury development (odds ratio: 1.73, P<.05). Secondary health complications were not different in those who reported no immediate consequences compared to those who reported no breakdown.Conclusions
Wheelchair breakdowns that resulted in injury, being stranded, missing medical appointments, and/or an inability to attend work/school appear to have far-reaching impacts on health and secondary injury. Preventing wheelchair breakdowns, through either better maintenance or manufacturing, may be a means of decreasing secondary disability. 相似文献17.
Cristina Ehrmann Birgit Prodinger Hans Peter Gmünder Kerstin Hug Jerome E. Bickenbach Gerold Stucki 《Archives of physical medicine and rehabilitation》2018,99(10):1965-1981
Objective
To describe functioning in people living with spinal cord injuries (SCI) in Switzerland.Design
Secondary analysis of cross-sectional survey data.Setting
Community, Switzerland.Participants
Individuals (N=1549) 16 years of age or older with a history of traumatic or nontraumatic SCI and permanently residing in Switzerland.Interventions
Not applicable.Main Outcome Measures
Functioning was operationalized through 4 domains: (1) impairments in body functions; (2) impairments in mental functions; (3) independence in performing activities; and (4) performance problems in participation.Results
Univariate analysis indicated a high prevalence of problems in 5 areas: (1) housework; (2) climbing stairs; (3) tiredness; (4) spasticity; and (5) chronic pain. Graphical modeling showed a strong association among the four domains of functioning. Moreover, we found that the differences in the dependence structures were significant between the paraplegia SCI population and the tetraplegia SCI population.Conclusions
This study is a first study in the epidemiology of functioning of people living with SCI in Switzerland. Using univariate and graphical modeling approaches, we proposed an empirical foundation for developing hypotheses on functioning in each domain and category that could inform health systems on people’s health needs. 相似文献18.
Lynn A. Worobey Stephanie K. Rigot Nathan S. Hogaboom Chris Venus Michael L. Boninger 《Archives of physical medicine and rehabilitation》2018,99(1):9-16.e10
Objectives
To determine the efficacy of a web-based transfer training module at improving transfer technique across 3 groups: web-based training, in-person training (current standard of practice), and a waitlist control group (WLCG); and secondarily, to determine subject factors that can be used to predict improvements in transfer ability after training.Design
Randomized controlled trials.Setting
Summer and winter sporting events for disabled veterans.Participants
A convenience sample (N=71) of manual and power wheelchair users who could transfer independently.Interventions
An individualized, in-person transfer training session or a web-based transfer training module. The WLCG received the web training at their follow-up visit.Main Outcome Measure
Transfer Assessment Instrument (TAI) part 1 score was used to assess transfers at baseline, skill acquisition immediately posttraining, and skill retention after a 1- to 2-day follow-up period.Results
The in-person and web-based training groups improved their median (interquartile range) TAI scores from 7.98 (7.18–8.46) to 9.13 (8.57–9.58; P<.01), and from 7.14 (6.15–7.86) to 9.23 (8.46–9.82; P<.01), respectively, compared with the WLCG that had a median score of 7.69 for both assessments (baseline, 6.15–8.46; follow-up control, 5.83–8.46). Participants retained improvements at follow-up (P>.05). A lower initial TAI score was found to be the only significant predictor of a larger percent change in TAI score after receiving training.Conclusions
Transfer training can improve technique with changes retained within a short follow-up window, even among experienced wheelchair users. Web-based transfer training demonstrated comparable improvements to in-person training. With almost half of the United States population consulting online resources before a health care professional, web-based training may be an effective method to increase knowledge translation. 相似文献19.
Kerstin Hug Caroline Stumm Isabelle Debecker Carolina Saskia Fellinghauer Claudio Peter Margret Hund-Georgiadis 《PM & R》2018,10(6):573-586
Background
Pressure ulcers (PUs) are a common and severe health condition in persons with spinal cord injury (SCI). Skin-care strategies for PU prevention are usually provided during initial rehabilitation. However, individuals with SCI often do not perform these strategies continuously, especially after discharge. The influence of psychological factors such as general self-efficacy (GSE) on the performance of PU prevention behavior has not yet been sufficiently explored.Objective
To investigate whether persons with greater levels of GSE are more likely to perform skin-care strategies for PU prevention regularly.Design
Nationwide cross-sectional survey within the Swiss Spinal Cord Injury Cohort Study.Setting
Community setting, data collection between 2011 and 2013.Participants
A total of 456 subjects with a traumatic or nontraumatic SCI living in Switzerland.Methods
Associations between GSE and PU prevention behavior were analyzed by multivariate proportional odds regression models, including potential sociodemographic, lesion-related, and lifestyle-related confounders without and with interaction terms between GSE and potential effect modifiers.Main Outcome Measurements
Self-efficacy was assessed by the GSE scale comprising 10 items. PU preventive behavior was operationalized using 5 items of an adapted version of the Spinal Cord Injury Lifestyle scale. Both measurements were components of a self-administered questionnaire.Results
Based on the regression model without interaction terms, GSE levels were not associated with skin-care PU prevention. After we included interaction terms, the final model showed statistically significant associations between GSE and 3 skin-care items with odds ratios ranging from 1.09 to 1.17 (all P < .001). The slightly positive effect of GSE on PU prevention behavior was restricted to persons who sustained their SCI at a younger age.Conclusions
GSE was generally not associated with skin-care PU prevention behavior among persons with SCI in this study. In further research, it might be of interest to assess SCI-specific concepts of self-efficacy.Level of Evidence
III 相似文献20.
Carolyn E. Schwartz Brian Stucky Carly S. Rivers Vanessa K. Noonan Joel A. Finkelstein 《Archives of physical medicine and rehabilitation》2018,99(8):1599-1608.e1