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Janet K. Freburger Dongmei Li Anna M. Johnson Erin P. Fraher 《Archives of physical medicine and rehabilitation》2018,99(6):1077-1089.e7
Objective
To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke.Design
Retrospective cohort analysis of Medicare claims (2010–2013) linked to hospital-level and county-level data.Setting
Acute care hospital and community.Participants
Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke.Interventions
Not applicable.Main Outcome Measures
Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics.Results
Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use.Conclusions
Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use. 相似文献3.
Background
The development of novel oral anticoagulants (NOACs) has revolutionized oral anticoagulation. Rapid incorporation of NOACs into general practice has heightened the demand for directed reversal agents. Idarucizumab is a targeted reversal agent that is approved for the urgent reversal of the anticoagulant effects of dabigatran. While it is a welcome addition to reversal strategies of dabigatran, a number of clinical questions exist regarding its place in therapy.Objective
We describe controversies regarding the use of idarucizumab therapy in patients with dabigatran-associated bleeding.Discussion
Although existing clinical studies show a rapid reversal of coagulation assays, these studies did not describe a corresponding improvement in mortality or rapid cessation of hemorrhage. It is questionable how heavily clinicians can rely upon the use of the surrogate endpoints in clinical studies, such as ecarin clotting time and dilute thrombin time. Another issue is whether patients exhibiting re-elevation of coagulation assays would benefit from an additional dose of idarucizumab, because this has not been studied. It is currently unclear if blood products must be given in addition to idarucizumab can be used as monotherapy.Conclusions
The initial data suggest a definite role for idarucizumab in treatment of bleeding associated with dabigatran. As more clinical practice experience is gained with the agent and the remaining data on its use are released, clinicians can better guide the clinical use of idarucizumab. At present, there is currently not enough evidence for idarucizumab to be used as monotherapy. 相似文献4.
Sean M. Phelan Lauren R. Bangerter Greta Friedemann-Sanchez Kandace A. Lackore Megan A. Morris Courtney H. Van Houtven Kathleen F. Carlson Michelle van Ryn Kristin J. Harden Joan M. Griffin 《Archives of physical medicine and rehabilitation》2018,99(11):2222-2229
Objective
To assess the association between perceived stigma and discrimination and caregiver strain, caregiver well-being, and patient community reintegration.Design
A cross-sectional survey study of 564 informal caregivers of U.S. military service veterans of wars in Iraq and Afghanistan who experienced traumatic brain injuries or polytrauma (TBI/PT).Setting
Care settings of community-dwelling former inpatients of U.S. Department of Veterans Affairs Polytrauma Rehabilitation Centers.Participants
Caregivers of former inpatients (N=564), identified through next-of-kin records and subsequent nominations.Interventions
Not applicable.Main Outcome Measures
Caregiver strain, depression, anxiety, loneliness, and self-esteem; as well as care recipient community reintegration, a key aspect of TBI/PT rehabilitation.Results
Family stigma was associated with strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration. Caregiver stigma-by-association was associated with strain, depression, anxiety, loneliness, and lower self-esteem. Care recipient stigma was associated with caregiver strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration.Conclusions
Perceived stigma may be a substantial source of stress for caregivers of U.S. military veterans with TBI/PT, and may contribute to poor outcomes for the health of caregivers and for the community reintegration of the veterans for whom they provide care. 相似文献5.
Hsin-Yu Chiang Wen-Shian Lu Wan-Hui Yu I-Ping Hsueh Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(8):1499-1506
Objective
To examine the interrater and intrarater reliability of the Balance Computerized Adaptive Test (Balance CAT) in patients with chronic stroke having a wide range of balance functions.Design
Repeated assessments design (1wk apart).Setting
Seven teaching hospitals.Participants
A pooled sample (N=102) including 2 independent groups of outpatients (n=50 for the interrater reliability study; n=52 for the intrarater reliability study) with chronic stroke.Interventions
Not applicable.Main Outcome Measures
Balance CAT.Results
For the interrater reliability study, the values of intraclass correlation coefficient, minimal detectable change (MDC), and percentage of MDC (MDC%) for the Balance CAT were .84, 1.90, and 31.0%, respectively. For the intrarater reliability study, the values of intraclass correlation coefficient, MDC, and MDC% ranged from .89 to .91, from 1.14 to 1.26, and from 17.1% to 18.6%, respectively.Conclusions
The Balance CAT showed sufficient intrarater reliability in patients with chronic stroke having balance functions ranging from sitting with support to independent walking. Although the Balance CAT may have good interrater reliability, we found substantial random measurement error between different raters. Accordingly, if the Balance CAT is used as an outcome measure in clinical or research settings, same raters are suggested over different time points to ensure reliable assessments. 相似文献6.
Sarah L. Martindale Erica L. Epstein Katherine H. Taber 《Archives of physical medicine and rehabilitation》2018,99(12):2485-2495
Objective
To characterize behavioral and health outcomes in veterans with traumatic brain injury (TBI) acquired in nondeployment and deployment settings.Design
Cross-sectional assessment evaluating TBI acquired during and outside of deployment, mental and behavioral health symptoms, and diagnoses.Setting
Veterans Affairs Medical Centers.Participants
Iraq and Afghanistan veterans who were deployed to a warzone (N=1399).Interventions
Not applicable.Main Outcome Measures
Comprehensive lifetime TBI interview, Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, and behavioral and health measures.Results
There was a main effect of deployment TBI on depressive symptoms, posttraumatic stress symptoms, poor sleep quality, substance use, and pain. Veterans with deployment TBI were also more likely to have a diagnosis of bipolar, major depressive, alcohol use, and posttraumatic stress disorders than those who did not have a deployment TBI.Conclusions
TBIs acquired during deployment are associated with different behavioral and health outcomes than TBI acquired in nondeployment environments. The presence of TBI during deployment is associated with poorer behavioral outcomes, as well as a greater lifetime prevalence of behavioral and health problems in contrast to veterans without deployment TBI. These results indicate that problems may persist chronically after a deployment TBI and should be considered when providing care for veterans. Veterans with deployment TBI may require treatment alterations to improve engagement and outcomes. 相似文献7.
Nobushige Takahashi Hidetoshi Takahashi Osamu Takahashi Ryosuke Ushijima Rie Umebayashi Junji Nishikawa Yasutomo Okajima 《PM & R》2018,10(2):168-174
Background
Spasticity is a common sequela of upper motor neuron pathology, such as cerebrovascular diseases and cerebral palsy. Intervention for spasticity of the ankle plantarflexors in physical therapy may include tone-inhibiting casting and/or orthoses for the ankle and foot. However, the physiological mechanism of tone reduction by such orthoses remains unclarified.Objective
To investigate the electrophysiologic effects of tone-inhibiting insoles in stroke subjects with hemiparesis by measuring changes in reciprocal Ia inhibition (RI) in the ankle plantarflexor.Design
An interventional before–after study.Setting
Acute stroke unit or ambulatory rehabilitation clinic of a university hospital in Japan.Participants
Ten subjects (47-84 years) with hemiparesis and 10 healthy male control subjects (31-59 years) were recruited.Methods
RI of the spastic soleus in response to the electrical stimulation of the deep peroneal nerve was evaluated by stimulus-locked averaging of rectified electromyography (EMG) of the soleus while subjects were standing.Main Outcome Measurements
The magnitude of RI, defined as the ratio of the lowest to the baseline amplitude of the rectified EMG at approximately 40 milliseconds after stimulation, was measured while subjects were standing with and without the tone-inhibiting insole on the hemiparesis side.Results
Enhancement of EMG reduction with the tone-inhibiting insole was significant (P < .05) in the subjects with hemiparesis, whereas no significant changes were found in controls.Conclusion
Tone-inhibiting insoles enhanced RI of the soleus in subjects after stroke, which might enhance standing stability by reducing unfavorable ankle plantarflexion tone.Level of Evidence
III 相似文献8.
Hsiu-Yun Hsu Chia-Wen Ke Ta-Shen Kuan Hsiu-Ching Yang Ching-Liang Tsai Li-Chieh Kuo 《PM & R》2018,10(2):146-153
Background
The presence of subtle losses in hand dexterity after stroke affects the regaining of independence with regard to activities of daily living. Therefore, awareness of ipsilesional upper extremity (UE) function may be of importance when developing a comprehensive rehabilitation program. However, current hand function tests seem to be unable to identify asymptomatic UE impairments.Objectives
To assess the motor coordination as well as the sensory perception of an ipsilesional UE using biomechanical analysis of performance-oriented tasks and conducting a Manual Tactile Test (MTT).Design
Case-controlled study.Setting
A university hospital.Participants
A total of 21 patients with unilateral stroke, along with 21 matched healthy control subjects, were recruited.Methods
Each participant was requested to perform a pinch?holding-up activity (PHUA) test, object-transport task, and reach-to-grasp task via motion capture, as well as the MTT.Main Outcome Measurements
The kinetic data of the PHUA test, kinematics analysis of functional movements, and time requirement of MTT were analyzed.Results
Patients with ipsilesional UE had an inferior ability to scale and produce pinch force precisely when conducting the PHUA test compared to the healthy controls (P < .05). The movement time was statistically longer and peak velocity was significantly lower (P < .05) in the performance-oriented tasks for the ipsilesional UE patients. The longer time requirement in 3 MTT subtests showed that the ipsilesional UE patients experienced degradation in sensory perception (P < .001).Conclusion
Comprehensive sensorimotor assessments based on functional perspectives are valid tools to determine deficits in the sensation-perception-motor system in the ipsilesional UE. Integration of sensorimotor training programs for ipsilesional UE in future neuro-rehabilitation strategies may provide more beneficial effects to regain patients’ motor recovery and to promote daily living activity independence than focusing on paretic arm motor training alone.Level of Evidence
III 相似文献9.
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10.
Introduction
Osteopathic Manipulative Treatment (OMT) is effective in improving function, movement and restoring pain conditions. Despite clinical results, the mechanisms of how OMT achieves its' effects remain unclear. The fascial system is described as a tensional network that envelops the human body. Direct or indirect manipulations of the fascial system are a distinctive part of OMT.Objective
This review describes the biological effects of direct and indirect manipulation of the fascial system.Material and methods
Literature search was performed in February 2016 in the electronic databases: Cochrane, Medline, Scopus, Ostmed, Pedro and authors' publications relative to Fascia Research Congress Website.Results
Manipulation of the fascial system seems to interfere with some cellular processes providing various pro-inflammatory and anti-inflammatory cells and molecules.Discussion
Despite growing research in the osteopathic field, biological effects of direct or indirect manipulation of the fascial system are not conclusive.Conclusion
To elevate manual medicine as a primary intervention in clinical settings, it's necessary to clarify how OMT modalities work in order to underpin their clinical efficacies. 相似文献11.
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12.
Anthony H. Lequerica Christian Lucca Nancy D. Chiaravalloti Irene Ward John D. Corrigan 《Archives of physical medicine and rehabilitation》2018,99(9):1811-1817
Objective
To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).Design
Cross-sectional.Setting
General community.Participants
A volunteer sample of individuals (N= 265) from the general population across the United States.Interventions
Not applicable.Main Outcome Measure(s)
Online version of the Ohio State University Traumatic Brain Injury Identification Method, Rivermead Postconcussion Symptoms Questionnaire (RPQ), Patient-Reported Outcomes Measurement Information System Cognitive Concerns Scale.Results
The measure was completed by 89.4% of the sample with most participants completing the measure in <8 minutes. After controlling for age, sex, psychiatric history, drug or alcohol history, and history of developmental disability, worst TBI severity was significantly associated with scores on the RPQ, F(2,230)=4.56, P=.011, and having a TBI within the past 2 years was associated with higher scores on the cognitive factor subscale of the RPQ, F(1,75)=7.7, P=.007.Conclusions
The online administration of the Ohio State University Traumatic Brain Injury Identification Method appears to be feasible in the general population. Preliminary validity was demonstrated for the indices of worst TBI severity and time since most recent TBI. 相似文献13.
Shih-Chieh Lee Yi-Jing Huang Gong-Hong Lin Yeh-Tai Chou Chia-Yeh Chou Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(2):306-313
Objective
To develop a computerized adaptive test of social functioning (Social-CAT) for patients with stroke.Design
This study contained 2 phases. First, a unidimensional item bank was formed using social-related items with sufficient item fit (ie, infit and outfit mean square [MNSQ]). The social-related items were selected from 3 commonly used patient-reported quality-of-life measures. Items with differential item functioning (DIF) of sex were deleted. Second, we performed simulations to determine the best set of stopping rules with both high reliability and efficiency. The participants' responses to the items were extracted from a previous study.Setting
Rehabilitation wards and departments of rehabilitation/neurology of 5 general hospitals.Participants
Patients (N=263) with stroke (47.1% were inpatients).Interventions
Not applicable.Main Outcome Measure
Social-CAT.Results
The unidimensionality of the 24 selected items was supported (infit and outfit MNSQs =0.8–1.2). One item had DIF of sex and was deleted. The item bank was composed of the remaining 23 items. With the best set of stopping rules (person reliability ≥.90 or limited reliability increased ≤.001), the Social-CAT used on average 10 items to achieve sufficient reliability (average person reliability =.88; 81.0% of the patients with reliability ≥.90).Conclusions
The Social-CAT appears to be a unidimensional measure with acceptable reliability and efficiency, and it could be useful for both clinicians and patients in time-pressed clinical settings. 相似文献14.
Cameron J.B. Cunningham Heather C. Finlayson William R. Henderson Russell J. O’Connor Andrew Travlos 《PM & R》2018,10(5):494-500
Background
Critical illness polyneuromyopathy (CIPNM) increasingly is recognized as a source of disability in patients requiring intensive care unit (ICU) admission. The prevalence and impact of CIPNM on patients in the rehabilitation setting has not been established.Objectives
To determine the proportion of at-risk rehabilitation inpatients with evidence of CIPNM and the functional sequelae of this disorder.Design
Prospective observational study.Setting
Tertiary academic rehabilitation hospital.Patients
Rehabilitation inpatients with a history of ICU admission for at least 72 hours.Methods
Electrodiagnostic studies were performed to evaluate for axonal neuropathy and/or myopathy in at least one upper and one lower limb.Main Outcome Measurements
The primary outcome was prevalence of CIPNM. Secondary outcomes included Functional Independence Measure (FIM) scores, rehabilitation length of stay (RLOS), and discharge disposition.Results
A total of 33 participants were enrolled; 70% had evidence of CIPNM. Admission FIM score, discharge FIM, FIM gain, and FIM efficiency were 64.1, 89.9, 25.5, and 0.31 in those with CIPNM versus 78.4, 94.6, 16.1, and 0.33 in those without CIPNM, respectively. Average RLOS was 123 days versus 76 days and discharge to home was 57% versus 90% in the CIPNM and non-CIPNM groups, respectively.Conclusions
CIPNM is very common in rehabilitation inpatients with a history of ICU admission. It was associated with a lower functional status at rehabilitation admission, but functional improvement was at a similar rate to those without CIPNM. Longer RLOS stay may be required to achieve the same functional level.Level of Evidence
III 相似文献15.
Penny Goldberg Giorgio Zeppieri Joel Bialosky Charlotte Bocchino Jon van den Boogaard Susan Tillman Terese L. Chmielewski 《Archives of physical medicine and rehabilitation》2018,99(1):43-48
Objective
To compare baseline kinesiophobia levels and their association with health-related quality of life across injury locations.Design
Retrospective cross-sectional study.Setting
Single, large outpatient physical therapy clinic within an academic medical center.Participants
Patients (N=1233) who underwent an initial evaluation for a diagnosis related to musculoskeletal pain and completed the 11-item version of the Tampa Scale for Kinesiophobia (TSK-11) and the Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8) questionnaires within 7 days of their first visit were eligible for inclusion. Three hundred eighty patients were excluded because of missing data or because they were younger than 18 years. A total of 853 patients (mean age, 43.55y; range, 18–94y) were included.Interventions
Not applicable.Main Outcome Measures
Comparison of baseline kinesiophobia levels and their association with health-related quality of life across injury locations in an outpatient physical therapy setting.Results
Separate analysis of variance models compared TSK-11 scores based on involved body region, and Pearson correlation coefficients were used to examine the association between TSK-11 scores and the SF-8 subscales at each body region. TSK-11 scores did not differ by body region (range, 23.9–26.1). Weak to moderate negative correlations existed between kinesiophobia and the SF-8 subscales.Conclusions
Kinesiophobia levels appear elevated and negatively associated with health-related quality of life at initial physical therapy evaluation regardless of injury location. These findings suggest that physical therapists in outpatient orthopedic settings should implement routine kinesiophobia assessment and provide stratified care based on kinesiophobia levels across musculoskeletal conditions. 相似文献16.
Moriah J. Brier Rhonda M. Williams Aaron P. Turner Alison W. Henderson Ann Marie Roepke Daniel C. Norvell Helene Henson Joseph M. Czerniecki 《Archives of physical medicine and rehabilitation》2018,99(3):452-458
Objective
To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first dysvascular lower extremity amputation (LEA).Design
Cross-sectional cohort study using self-report surveys.Setting
Department of Veterans Affairs, academic medical center, and level I trauma center.Participants
Individuals undergoing their first major LEA because of complications of peripheral arterial disease (PAD) or diabetes who have a caregiver and completed measures of caregiver support and conflict (N=137; 94.9% men).Interventions
Not applicable.Main Outcome Measures
The Patient Health Questionnaire-9 to assess depression and the Satisfaction With Life Scale to assess life satisfaction.Results
In multiple regression analyses, controlling for global levels of perceived support, self-rated health, age, and mobility, caregiver-specific support was found to be associated with higher levels of life satisfaction and caregiver-specific conflict was found to be associated with lower levels of life satisfaction and higher levels of depressive symptoms.Conclusions
The specific relationship between individuals with limb loss and their caregivers may be an important determinant of well-being. Conflict with caregivers, which has received little attention thus far in the limb loss literature, appears to play a particularly important role. Individuals with limb loss may benefit from interventions with their caregivers that both enhance support and reduce conflict. 相似文献17.
Josephine McMurray Heather McNeil Alicia Gordon Jacobi Elliott Paul Stolee 《Archives of physical medicine and rehabilitation》2018,99(9):1840-1847
Objective
To evaluate the internal consistency and test-retest reliability, construct validity, and feasibility of the WatLX, a measure of the experience of patients in rehabilitative care.Design
Multisite, cross-sectional, and test-retest self-report study.Setting
Outpatient rehabilitative care settings.Participants
The WatLX was administered to English-speaking, cognitively intact outpatients (N=1174) over 18 years old who had completed a program of cardiac, musculoskeletal, neurologic, stroke, pulmonary, or speech language rehabilitative care, at 2 separate time points: (1) immediately following completion of their rehabilitation program, and (2) 2 weeks later (n=29). A subsequent feasibility study was conducted with 1013 patients from 19 clinics.Interventions
Not applicable.Main Outcome Measures
The WatLX measures 6 concepts, previously identified as key to outpatient rehabilitative care patients’ experience: (1) ecosystem issues, (2) client and informal caregiver engagement, (3) patient and health care provider relations, (4) pain and functional status, (5) group and individual identity, and (6) open-ended feedback.Results
Reliability analyses were conducted on 2 versions of the WatLX. Using a 7-point versus a 5-point Likert scale resulted in higher internal consistency and reliability scores. Cronbach’s alpha coefficients were .863 and .957 for the 5- and 7-point scale, respectively, and the ICC scores were .827 and .880, respectively. The proof of concept study recruited 1013 patients with little interruption of workflow; results displayed strong internal consistency (Cronbach’s alpha coefficient =.906). There is evidence of ceiling effects.Conclusions
The WatLX is a parsimonious question set that is feasible for administration in ambulatory rehabilitative care settings, and which shows promising psychometric properties. 相似文献18.
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19.
Bradley F. Thompson Matthew J. Pingree Wenchun Qu Naveen S. Murthy Nirusha Lachman Mark Friedrich Hurdle 《PM & R》2018,10(4):382-390
Background
Ultrasound is rarely used for guiding lumbosacral epidural steroid injections due to its technical limitations. For example, sonographic imaging lacks the ability to confirm epidural spread and identify vascular uptake. The perceived risk that these limitations pose to human subjects has precluded any large scale clinical trials to date.Objective
To compare the accuracy of ultrasound versus fluoroscopic guidance for first sacral transforaminal epidural injections.Design
Cadaveric comparative study using dichotomous outcomes.Setting
A fluoroscopy suite and anatomic laboratory at an academic medical center.Subjects
Four unembalmed adult human cadavers with no history of spinal surgery.Methods
Eight sites were injected twice by one interventionalist, using fluoroscopic and ultrasound guidance. In the fluoroscopy arm, contrast spread was assessed using computed tomography. In the ultrasound arm, latex spread was assessed using gross anatomic dissection. Any visible evidence of epidural spread constituted a positive result.Main Outcome Measurements
Comparison of the success of obtaining epidural contrast flow was the primary outcome measure. Secondary outcome measures included average duration, rate of intravascular uptake, and quantity of intravascular uptake.Results
All injections performed in both the ultrasound arm and the fluoroscopy arm had positive epidural spread. The average duration was 3.03 minutes with fluoroscopy and 4.76 minutes with ultrasound. The rate of intravascular uptake was 37.5% with fluoroscopy and 50% with ultrasound. Within the ultrasound arm, greater intravascular spread and duration variability were recorded.Conclusion
Although ultrasonography can provide reliable image guidance for cannulating the first sacral foramen in cadavers, it would have limited clinical utility due to its inability to visualize relevant neurovascular structures deep to the osseus roof and exclude intravascular uptake.Level of Evidence
IV 相似文献20.
James F. Malec Timothy E. Stump Patrick O. Monahan Jacob Kean Dawn Neumann Flora M. Hammond 《Archives of physical medicine and rehabilitation》2018,99(2):281-288.e2