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1.
Background
Mild traumatic brain injury (mTBI) can have long-term cognitive and functional consequences, and recent mTBI has been associated with impaired performance on measures related to driving ability. However, it remains unclear whether mTBI history is associated with poorer driving performance.Objective
To examine the longer-term effects of mTBI on self-reported driving ability.Design
Retrospective cross-sectional study.Setting
Online.Participants
Three hundred eighty-nine participants (169 who reported an mTBI history and 220 without an mTBI history).Intervention
Comparing participants who report a history of mTBI with those who do not report a history of mTBI.Outcomes
Self-report measures of mTBI history, frequency of aberrant driving behaviors, recent history of car accidents and citations, and previous psychological diagnoses and current symptoms.Results
Participants with a history of mTBI reported an overall higher frequency of aberrant driving behaviors and committing more driving violations that risked the safety of others than comparison participants. Participants with mTBI also were more likely to have been involved in a car accident within the past 6 months and the past 3 years. Of participants with mTBI, reports of driving violations decreased with longer time since the most recent injury. Driving violations and crash risk also decreased with increased age and years of driving experience.Conclusions
Individuals with a history of mTBI are more likely to deliberately drive in a manner that risks the safety of others and are at a heightened risk of being involved in a recent car crash. Future work should examine predictor variables in greater depth and incorporate performance-based measures of driving ability to further explore these topics.Level of Evidence
III 相似文献2.
Andrea R.S. Huebner Amy Cassedy Tanya M. Brown H. Gerry Taylor Terry Stancin Michael W. Kirkwood Shari L. Wade 《PM & R》2018,10(5):462-471
Background
Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.Objective
To examine adolescents’ use of mental health services after TBI.Design
Secondary analysis from multicenter prospective randomized controlled trial.Setting
Five level 1 U.S. trauma centers.Participants
Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).Methods
Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.Main Outcome Measurements
Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.Results
Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.Conclusions
Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.Level of Evidence
II 相似文献3.
4.
Background
Employment in those with disability is an important rehabilitation goal, along with achieving some measure of functional independence and is at the same time one of the most difficult goals to achieve. The number of people with disabilities participating in adaptive sports has been increasing steadily over the years. A few studies have looked at the relationship between physical fitness and employment status in those with disability, but there have been no studies that focused on the results of organized adaptive sports events affecting employment outcome.Objective
To determine whether participation in the National Veterans Wheelchair Games (NVWG) has a positive impact on employment in those with disability.Study Design
Prospective, cross-sectional survey.Setting
2015 NVWG in Dallas, Texas (nonclinic setting).Participants
A total of 338 survey participants; 36 surveys were excluded due to incompletion.Methods
Veterans who participated at the 2015 NVWG were given the opportunity to complete a 2-page survey. Survey participants received $5.00 gift card as compensation.Main Outcome Measurements
Percentage of those who perceived NVWG made a difference in attaining employment, risk ratio analyses.Results
A total of 50% of the participants stated that the NVWG made a difference in attaining employment. Those currently working were 1.5 times more likely to say that the NVWG had a positive effect on employment than those not currently working (P < .01). Those who felt that the NVWG had a positive effect on employment attended 3-4 more wheelchair games on average than those reporting that the NVWG did not have an impact on employment (P < .001). Positive responses were obtained from the Likert scale distribution.Conclusions
Our study suggests that participating in the NVWG provides psychosocial support to the veterans and may have a positive influence in employment outcomes.Level of Evidence
III 相似文献5.
6.
Background
A variety of tests have been proposed to measure the performance of neck flexor muscles, but head-to-head comparisons hardly have been documented.Objective
To compare reliability indexes, construct validity, and ability to discriminate between individuals with and without neck pain of 4 muscle tests (deep neck flexors endurance test [DNFET]; 2 variations of the craniocervical flexion test [CCFT1 and CCFT2]; and dynamometry).Design
Reliability and validity study.Setting
General community.Participants
A total of 66 participants, 33 with chronic idiopathic neck pain (mean ± standard deviation pain intensity: 3.2 ± 1.9) and 33 without neck pain, from the general population.Methods/Main Outcome
Neck muscle functioning was assessed with the CCFT1, the CCFT2, the DNFET, and dynamometry on 2 separate sessions. Participants with neck pain also were assessed for pain intensity, disability, pain catastrophizing, and fear of movement.Results
Relative reliability of all tests was at least moderate (intraclass correlation coefficient ≥ 0.62), whereas measurement error was high, particularly for the DNFET (95% minimum detectable change ≥ 23.00 seconds). All tests showed moderate correlation (r ≥ 0.3) with at least 2 pain-related measures and moderate-to-strong correlations with each other. Principal component analysis retained 2 factors explaining 68%-73% of the variance of the 4 muscle tests. Significant differences between groups were found for the DNFET and dynamometry (P < .05).Conclusion
The reliability indexes suggest that the DNFET and the CCFT may be more appropriate for group comparisons than for individual comparisons. The 4 tests seem to have construct validity, but they also seem to measure slightly different constructs.Level of Evidence
III 相似文献7.
Adam G. Culvenor Brooke E. Patterson Ali Guermazi Hayden G. Morris Timothy S. Whitehead Kay M. Crossley 《PM & R》2018,10(4):349-356
Background
A timely return to competitive sport is a primary goal of anterior cruciate ligament reconstruction (ACLR). It is not known whether an accelerated return to sport increases the risk of early-onset knee osteoarthritis (KOA).Objective
To determine whether an accelerated return to sport post-ACLR (ie, <10 months) is associated with increased odds of early KOA features on magnetic resonance imaging (MRI) 1 year after surgery and to evaluate the relationship between an accelerated return to sport and early KOA features stratified by type of ACL injury (isolated or concurrent chondral/meniscal injury) and lower limb function (good or poor).Design
Cross-sectional study.Setting
Private radiology clinic and university laboratory.Participants
A total of 111 participants (71 male; mean age 30 ± 8 years) 1-year post-ACLR.Methods
Participants completed a self-report questionnaire regarding postoperative return-to-sport data (specific sport, postoperative month first returned), and isotropic 3-T MRI scans were obtained.Outcome Measures
Early KOA features (bone marrow, cartilage and meniscal lesions, and osteophytes) assessed with the MRI OA Knee Score. Logistic regression analyses evaluated the odds of early KOA features with an accelerated return to sport (<10 months post-ACLR versus ≥10 months or no return to sport) in the total cohort and stratified by type of ACL injury and lower limb function.Results
Forty-six (41%) participants returned to competitive sport <10 months post-ACLR. An early return to sport was associated with significantly increased odds of bone marrow lesions (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-6.0) but not cartilage (OR 1.2, 95% CI 0.5-2.6) or meniscal lesions (OR 0.8, 95% CI 0.4-1.8) or osteophytes (OR 0.6, 95% CI 0.3-1.4). In those with poor lower limb function, early return to sport exacerbated the odds of bone marrow lesions (OR 4.6, 95% CI 1.6-13.5), whereas stratified analyses for type of ACL injury did not reach statistical significance.Conclusion
An accelerated return to sport, particularly in the presence of poor lower limb function, may be implicated in posttraumatic KOA development.Level of evidence
IV 相似文献8.
Background
Several barriers exist in the recruitment of individuals with a history of mild traumatic brain injury (mTBI). The current study is the first to examine whether crowdsourcing, which has been used in other clinical populations, is useful in the recruitment of those with mTBI.Objective
To examine whether Amazon’s Mechanical Turk (MTurk), an online crowdsourcing platform, is a useful tool in the recruitment of individuals with a history of mTBI and to examine the injury and psychological characteristics of individuals who report a history of mTBI.Design
Retrospective, cross-sectional study.Setting
Online.Participants
A total of 468 MTurk workers (215 who reported mTBI history on the screener, 253 who did not).Methods
Comparison of MTurk participants (“workers”) who report a history of mTBI on a one-item screener and/or a more comprehensive mTBI assessment tool (ie, the Ohio State University Traumatic Brain Injury Identification Method [OSU TBI-ID]) with workers who do not report mTBI history.Main Outcome Measures
Prevalence rates of mTBI in the MTurk sample (one-item screener and/or OSU TBI-ID), associations between self-reported mTBI with history of psychological disorders and current psychological symptoms (ie, selected Patient-Reported Outcomes Measurement Information System scales).Results
Of workers who reported a history of mTBI on the screener, 169 (79%) met mTBI criteria on the OSU TBI-ID. Compared with those who denied history of mTBI on both the screener and OSU TBI-ID, workers who reported a history of mTBI on both measures were more likely to have a history of diagnosed depression (P = .008), anxiety (P = .007) or attention deficit-hyperactivity disorder (P = .04), and were more likely to currently experience cognitive (P = .01) and sleep disorder symptoms (P = .003).Conclusions
Workers recruited via MTurk with history of mTBI show similar rates of psychological disorder history and current symptoms to samples recruited via noncrowdsourcing methods in previous studies. MTurk may be a useful recruitment tool in the mTBI population and should be used in future studies of outcomes after mTBI.Level of Evidence
III 相似文献9.
10.
Alejandro Gómez-Bruton Alejandro González-Agüero Angel Matute-Llorente Cristina Julián Gabriel Lozano-Berges Alba Gómez-Cabello Nuria Garatachea Jose A. Casajús German Vicente-Rodríguez 《PM & R》2018,10(9):889-897
Background
Swimming has no effect on bone mass or structure. Therefore, adolescent swimmers present similar bone strength values when compared to normo-active controls, and lower values when compared to weight-bearing athletes. It thus seems necessary to try to improve bone structure and strength of adolescent swimmers through a weight-bearing intervention in order to reduce the risk of suffering osteoporosis later in life.Objective
To evaluate the effects of a 6-month whole body vibration (WBV) intervention on bone strength and structure of adolescent swimmers.Design
Randomized controlled trial.Setting
Research center.Participants
A total of 51 swimmers (14.4 ± 2.0 years) participated in the study.Methods
Swimmers were randomly allocated into 2 groups: 20 swimmers (9 females) who only performed their swimming training, and 31 swimmers (15 females) who performed their swimming training and received a WBV intervention (3.6-11.6 g) 3 times per week during 6 months (VIB).Outcome measurements
Peripheral quantitative computed tomography was performed in the nondominant tibia of all swimmers at 4%, 38%, and 66% of the tibia length before and after the intervention.Results
No differences between groups in any bone structure variable were found at pre- or postintervention. Both groups presented similar improvements in time, and no group by time interactions were found, suggesting that the WBV intervention was not intense enough to achieve positive changes in bone strength or structure.Conclusion
WBV, at the chosen intensities and durations, had no effect on adolescent swimmers’ bone strength or structure. Future studies should test other weight-bearing interventions aiming to improve bone strength and structure of adolescent swimmers.Level of Evidence
II 相似文献11.
Daniel L. Riddle 《Archives of physical medicine and rehabilitation》2018,99(5):887-892
Objectives
To determine the prevalence of a 1- to 2-year postsurgical pain-free state and pain plus symptom-free state as well as functional restoration after knee arthroplasty (KA) and to identify predictors of these outcomes.Design
Cohort study.Setting
Communities of 4 sites.Participants
Consecutive participants (N=383) who underwent KA on at least 1 knee during the first 8 years of the study (mean age, 67.95±8.5y; 61.4% women; n=235).Interventions
Not applicable.Main Outcome Measures
A composite pain score included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale and 2 generic pain rating scales. Composite pain plus other symptoms scores included 3 pain scales, a stiffness scale, and, in addition, the Knee injury and Osteoarthritis Outcome Score Symptoms scale. The WOMAC Function scale was used to quantify functional status. Prevalence estimates and predictors of a pain-free state, symptom-free state, and a fully functioning state were determined.Results
A sample of 383 participants with KA was studied, and of these, 34.1% (95% confidence interval [CI], 29.3%–39.2%; n=131) had a composite score of 0 for pain. A total of 14.1% (95% CI, 10.8%–18.1%; n=54) had a composite score of 0, indicating a symptom-free state, whereas 29.0% (95% CI, 24.4%–34.0%; n=111) achieved a score of 0 on the WOMAC Function scale.Conclusions
The prevalence of complete pain relief was 34%, the prevalence of complete pain and symptom relief was 14%, and the prevalence of complete functional restoration was 29% after KA. Participants who are older and with lower (better) WOMAC Pain scores were more likely to be pain-free after surgery. These data collected from a community-based sample have the potential to inform clinicians screening patients for KA consultation in a shared decision-making discussion to better align patient expectations with the most likely outcome. 相似文献12.
Birgit Skoffer Ulrik Dalgas Thomas Maribo Kjeld Søballe Inger Mechlenburg 《PM & R》2018,10(7):687-692
Background
Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion.Objective
To examine whether preoperative PRT initiated 5 weeks prior to TKA would exacerbate pain and knee effusion, and would allow a progressively increased training load throughout the training period that would subsequently increase muscle strength.Design
Secondary analyses from a randomized controlled trial (NCT01647243).Setting
University Hospital and a Regional Hospital.Patients
A total of 30 patients who were scheduled for TKA due to osteoarthritis and assigned as the intervention group.Methods
Patients underwent unilateral PRT (3 sessions per week). Exercise loading was 12 repetitions maximum (RM) with progression toward 8 RM. The training program consisted of 6 exercises performed unilaterally.Main outcome measures
Before and after each training session, knee joint pain was rated on an 11-point scale, effusion was assessed by measuring the knee joint circumference, and training load was recorded. The first and last training sessions were initiated by 1 RM testing of unilateral leg press, unilateral knee extension, and unilateral knee flexion.Results
The median pain change score from before to after each training session was 0 at all training sessions. The average increase in knee joint effusion across the 12 training sessions was a mean 0.16 cm ± 0.23 cm. No consistent increase in knee joint effusion after training sessions during the training period was found (P = .21). Training load generally increased, and maximal muscle strength improved as follows: unilateral leg press: 18% ± 30% (P = .03); unilateral knee extension: 81% ± 156% (P < .001); and unilateral knee flexion: 53% ± 57% (P < .001).Conclusion
PRT of the affected leg initiated shortly before TKA does not exacerbate knee joint pain and effusion, despite a substantial progression in loading and increased muscle strength. Concerns for side effects such as pain and effusion after PRT seem unfounded.Level of Evidence
I 相似文献13.
Jung Hwan Ahn Doo-Hyung Lee Hyuncheol Kang Michael Y. Lee Dae Ryong Kang Seung-Hyun Yoon 《PM & R》2018,10(1):19-27
Background
Intra-articular corticosteroid injection is a commonly used therapy for adhesive capsulitis, but not enough studies exist on the optimal timing of the injection.Objective
To determine whether intra-articular corticosteroid injection has better outcomes in patients with earlier stage than later stage of adhesive capsulitis.Study Design
Retrospective longitudinal studySetting
University-affiliated tertiary care hospital.Participants
Primary adhesive capsulitis patients (n=339) who were unresponsive to at least 1 month of conservative treatment and who had ultrasound-guided corticosteroid injection.Interventions
Not applicable.Main Outcome Measurements
Visual analogue scale, Shoulder Pain and Disability Index, and passive range of motion (flexion, abduction, external rotation, and internal rotation and extension) were evaluated at pretreatment, month 1 and 12 after the first injection.Results
The result of the multiple regressions, which considered the main and the interaction effect of confounding variables, showed that the differences of all outcomes in both short-term effect at month 1 and long-term effect at month 12 are greater when the duration of pain prior to injection is shorter. Among the confounders, the injection number in the difference of internal rotation and extension between month 0 and 12 (IRE Δ(0-12)) was statistically significant. IRE Δ(0-12) was also greater when the pain duration was shorter, though the decrease in IRE Δ(0-12) differed depending on the number of injections.Conclusions
Early injection improves outcomes of adhesive capsulitis at both short- and long-term follow-ups. If pain persists despite non-invasive and conservative treatments, early injection may be considered to shorten its natural history.Level of Evidence
III 相似文献14.
Eric Garshick Palak Walia Rebekah L. Goldstein Merilee Teylan Antonio A. Lazzari Carlos G. Tun Jaime E. Hart 《PM & R》2018,10(3):276-285
Background
Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness.Objective
To assess the associations between leptin and adiponectin with pulmonary function in a chronic SCI cohort.Design
Cross-sectional study.Setting
Veterans Affairs Medical Center.Participants
A total of 285 participants (237 men and 48 women) with chronic SCI with mean (standard deviation) injury duration 17.8 (13.2) years from the VA Boston and the community participating in an epidemiologic study assessing factors associated with respiratory health.Methods
Participants (24.6% cervical American Spinal Injury Association Impairment Scale (AIS) level A, B, and C; 33.6% other AIS A, B, and C; 41.8% AIS D) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma leptin and adiponectin with spirometric measures of pulmonary function adjusted for age, race, gender, and height. Level and severity of SCI, mobility mode, body mass index, smoking, chronic obstructive pulmonary disease, asthma, chest injury history, laboratory batch, and other potential confounders were also considered.Main Outcome Measurements
forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC.Results
There was a statistically significant inverse relationship between plasma leptin assessed in quartiles or as a continuous covariate with FEV1 and FVC. In fully adjusted models, each interquartile range (16,214 pg/mL) increase in leptin was associated with a significant decrease in FEV1 (?93.1 mL; 95% confidence interval = ?166.2, ?20.0) and decrease in FVC (?130.7 mL; 95% confidence interval = ?219.4, ?42.0). There were no significant associations between leptin and FEV1/FVC or between plasma adiponectin with FEV1, FVC, or FEV1/FVC.Conclusion
Plasma leptin in individuals with chronic SCI is inversely associated with FEV1 and FVC, independently of SCI level and severity and other covariates. This finding suggests that plasma leptin may contribute to reduced pulmonary function in chronic SCI.Level of Evidence
II 相似文献15.
Brittany Bickelhaupt Sakiko Oyama Jonathan Benfield Keith Burau Shuko Lee Michelle Trbovich 《PM & R》2018,10(10):1004-1011
Background
Shoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion.Objective
To determine which arm stroke technique, pump (P) or semicircular (SC), is most energy efficient for long periods of propulsion.Design
A randomized study with repeated measures observations.Setting
The study was performed at an institutional gait analysis laboratory.Participants
18 able-bodied (AB) male participants were studied and randomized into one of 2 conditions, SC or P.Methods
Shoulder muscle fatigue was measured by changes in Borg CR10 Rate of Perceived Exertion (Borg RPE) and upper extremity strength via a handheld dynamometer. Participants were studied and assigned into one of 2 conditions of wheelchair arm propulsion patterns, SC or P group, and propelled on a wheelchair treadmill for 10 minutes.Main Outcome Measures
The primary outcomes included recordings of Borg RPE scale during continuous wheelchair propulsion and pre- and post-test dynamometer testing means for bilateral elbow and shoulder extension. Analysis of covariance, t-tests, and Kruskal-Wallis tests were used in analyzing data.Results
Although not significant (P = .23), the Borg RPE scores for the SC condition were consistently higher than the scores for the P condition. In addition, the dynamometer pre- and post-test readings demonstrated a larger decrease for the SC condition participants than for the P condition participants, but were not statistically significant.Conclusions
These data demonstrate that the SC wheelchair propulsion pattern appears to be more fatiguing to shoulder muscles than the P propulsion pattern. However, more data would need to be collected to find a significant difference.Level of Evidence
II 相似文献16.
Background
Depression and traumatic brain injury (TBI) substantially contribute to the U.S. health care burden. Depression is a known risk factor for prolonged recovery after TBI. However, the effect of depression treatment on health care utilization has yet to be studied.Objective
To examine whether an association exists between pharmacologic treatment of depression at the time of mild or concussive TBI and the number of subsequent clinician visits for persistent injury-related symptoms.Design
Retrospective medical record review.Setting
Tertiary care medical center.Participants
A total of 120 patients (mean age 45.6 years) with a history of depression who subsequently experienced a mild or concussive TBI were included.Methods
Individuals were identified with co-occurring diagnoses of depression and mild or concussive TBI by retrospective electronic medical record review. The diagnosis of depression must have preceded the diagnosis of TBI.Main Outcome
The number of clinician visits for postinjury symptoms were counted at 3, 6, and 12 months postinjury.Results
Clinician visits for persistent injury-related symptoms were significantly fewer at all 3 time points for the group treated for depression at time of injury.Conclusions
Depressed individuals who were pharmacologically treated for depression at the time of TBI had significantly fewer clinician visits for persistent postinjury symptoms than those not pharmacologically treated for depression at the time of injury. Routine depression screening in patients with a high risk for TBI may identify a mood disorder that could contribute to persistent symptoms if left untreated, with its effective management potentially reducing health-related costs.Level of Evidence
III 相似文献17.
Background
Growing numbers of allogeneic stem cell transplants and improved posttransplant care have led to an increase of individuals with chronic graft-versus-host disease (cGVHD). Although cGVHD leads to functional impairment for many, there is limited literature regarding the benefits of acute inpatient rehabilitation for patients with cGVHD.Objective
To assess Functional Independence Measure (FIM) outcomes of patients with cGVHD during acute inpatient rehabilitation and to compare inpatient rehabilitation outcomes with patients with burn injuries, a rehabilitation patient population with similar comorbidities.Design
Retrospective chart review.Setting
Acute rehabilitation center at a large academic medical center.Patients (or Participants)
A total of 37 adult patients with cGVHD and 30 with burn injuries admitted to inpatient rehabilitation from 2010 to 2015.Methods or Interventions
Linear regression analysis to evaluate group (cGVHD versus burn) differences in functional gains. Effect size and minimal detectable change at the 90% confidence level (MDC90) were used to evaluate change in FIM outcomes.Main Outcome Measurements
Total FIM gain, motor FIM gain, and FIM efficiency.Results
Patients with cGVHD had statistically significant lower functional gains than patients with burn injuries, with an average of 11.66 fewer total FIM points (P ≤ .001), 10.54 fewer motor FIM points (P = .01), and 2.45 units less of FIM efficiency (P = .01). At the time of discharge, 7 (18%) patients with cGVHD exceeded the MDC90 values for total FIM gain versus 9 (30%) patients with burn injuries (P = .26). Eight (21%) patients with cGVHD exceeded the MDC90 for motor FIM gain versus 13 (43%) patients with burn injuries (P = .048). Effect sizes for patients with cGVHD and with burn injury were moderate to large, respectively, with patients with burn injuries having nearly twice the magnitude of gains as patients with cGVHD.Conclusions
Despite achieving more modest functional gains than patients with burn injuries, patients with cGVHD improved in function after acute inpatient rehabilitation. If replicated in larger studies, patients with functional impairment from cGVHD can be considered for inpatient rehabilitation. Future work should also determine minimal clinically important differences in function gain from inpatient rehabilitation for patients with cGVHD.Level of Evidence
II 相似文献18.
19.
Background
Understanding risk factors associated with readmission after lower extremity amputation may indicate targets for reducing readmission.Objective
To evaluate factors associated with all-cause 30-day readmission after lower extremity amputation procedures.Design
Retrospective cohort study.Setting
Inpatient.Patients
A total of 2480 patients who had lower extremity amputations between 2008 and 2014 were selected from national electronic medical record database, Cerner Health Facts.Methods
Univariate analysis of demographics, diagnoses, postoperative medications, and laboratory results were examined. Multivariate logistic regression models were used to identify characteristics independently associated with readmission overall and by amputation location—above the knee (AKA) or below the knee (BKA).Main Outcome Measurement
Readmission within 30 days of discharge.Results
More than one half of patients (1403, 57%) underwent BKA and 1077 (43%) underwent AKA. Readmission within 30 days was 22% (24.1% BKA versus 19.4% AKA, P = .005). In multivariable logistic regression, factors associated with 30-day readmission after any amputation included BKA (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.15-1.74, P = .001), hypertension (OR 1.70, 95% CI 1.33-2.16), surgical-site infections (OR 1.44, 95% CI 1.02-2.04), heart failure (OR 1.39, 95% CI 1.10-1.75), discharge to a skilled nursing facility (OR 1.88, 95% CI 1.41-2.51), and emergency/urgent procedures (OR 1.32, 95% CI 1.04-1.67). At readmission, 13.3% of patients with a BKA required an AKA revision, and 21.3% had a diagnosis of surgical-site infection.Conclusions
Risk factors for readmission after any amputation included cardiac comorbidities, associated postoperative medications, and discharge to a skilled nursing facility. The finding that acute arterial embolism or thrombosis and a BKA during the index admission was highly associated with readmission, combined with the high rates of 30-day conversion to an AKA when readmitted, suggests these patients more often develop stump complications or may be undertreated during the initial hospitalization.Level of Evidence
III 相似文献20.
Sherilyn W. Driscoll Carolyn C. Geis Mikaela M. Raddatz Carolyn L. Kinney Lawrence R. Robinson 《PM & R》2018,10(12):1361-1365