共查询到20条相似文献,搜索用时 15 毫秒
1.
Yue Cao James F. Massaro James S. Krause Yuying Chen Michael J. Devivo 《Archives of physical medicine and rehabilitation》2014
Objectives
To compare 12-year suicide-specific mortalities of 3 different injury cohorts, identify the risk factors for suicide mortality after spinal cord injury (SCI), and investigate whether suicide mortality is higher among those with SCI than in the general population.Design
Retrospective cohort study.Setting
United States hospitals (n=28) designated as SCI Model Systems.Participants
Participants (N=31,339) injured between January 1, 1973, and December 31, 1999.Interventions
Not applicable.Main Outcome Measure
Suicide death after SCI.Results
The crude annual suicide mortality rate during the first 12 years after SCI was 91 per 100,000 person-years for 1973 to 1979 injury cohort, 69 per 100,000 person-years for 1980 to 1989 injury cohort, and 46 per 100,000 person-years for 1990 to 1999 injury cohort. Suicide mortality was associated with race, injury severity, and years since injury. The standardized mortality ratios for the 3 cohorts were 5.2, 3.7, and 3.0, respectively.Conclusions
Suicide mortality among those with SCI decreased over 3 injury cohorts, but it still remained 3 times higher than that of the general population. 相似文献2.
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3.
Yuying Chen MD PhD Caroline J. Anderson PhD Lawrence C. Vogel MD Kathleen M. Chlan BA Randal R. Betz MD Craig M.McDonald MD 《Archives of physical medicine and rehabilitation》2008,89(12):2285-2292
Chen Y, Anderson CJ, Vogel LC, Chlan KM, Betz RR, McDonald CM. Change in life satisfaction of adults with pediatric-onset spinal cord injury.
Objectives
To examine the change in life satisfaction over time and potential contributing factors among adults with pediatric-onset spinal cord injury (SCI).Design
Prospective dynamic cohort study.Setting
Community.Participants
Individuals who sustained a SCI before age 19 years (N=278) were initially interviewed at age 24 years or older and followed on an annual basis between 1996 and 2006.Interventions
Not applicable.Main Outcome Measures
A structured telephone interview was conducted to obtain the measures of Satisfaction with Life Scale (SWLS), physical independence, participation, and psychologic functioning. The hierarchical linear modeling was performed to characterize individual person-specific time paths and estimate the average rate of change in SWLS over time.Results
A total of 1171 interviews were conducted among 184 men and 94 women (89% white; baseline age, 27.1±3.4y; baseline years since injury, 12.8±4.9). The initial SWLS score averaged 24.2 and was estimated to increase by 0.14 a year (P=.10). After adjusting for potential confounding factors, the overall life satisfaction was significantly higher for women and those who were married/living with a partner; were employed/students; did not use illicit drugs; and scored high in the FIM, the mental health component of the Short Form-12, and the social integration subscale of the Craig Handicap Assessment and Reporting Technique. The rate of change in life satisfaction did not differ significantly by any personal, medical, and psychosocial characteristics under investigation.Conclusions
The study findings suggest that people who feel unsatisfied with life initially are likely to stay unsatisfied over time if the critical determinant factors remain unchanged in their life. To minimize the risk of decreasing life satisfaction, several modifiable risk factors identified in the present study could be targeted for intervention. 相似文献4.
5.
Annemarie Relyea-Chew William Hollingworth Leighton Chan Bryan A. Comstock Karen A. Overstreet Jeffrey G. Jarvik 《Archives of physical medicine and rehabilitation》2009,90(3):413-419
Relyea-Chew A, Hollingworth W, Chan L, Comstock BA, Overstreet KA, Jarvik JG. Personal bankruptcy after traumatic brain or spinal cord injury: the role of medical debt.
Objective
To estimate the prevalence of medical debt among traumatic brain injury (TBI) and spinal cord injury (SCI) patients who discharged their debts through bankruptcy.Design
A cross-sectional comparison of bankruptcy filings of injured versus randomly selected bankruptcy petitioners.Setting
Patients hospitalized with SCI or TBI (1996-2002) and personal bankruptcy petitioners (2001-2004) in western Washington State.Participants
Subjects (N=186) who filed for bankruptcy, comprised of 93 patients with previous SCI or TBI and 93 randomly selected bankruptcy petitioners.Interventions
Not applicable.Main Outcome Measures
Medical and nonmedical debt, assets, income, expenses, and employment recorded in the bankruptcy petition.Results
Five percent of randomly selected petitioners and 26% of petitioners with TBI or SCI had substantial medical debt (debt that accounted for more than 20% of all unsecured debts). SCI and TBI petitioners had fewer assets and were more likely to be receiving government income assistance at the time of bankruptcy than controls. SCI and TBI patients with a higher blood alcohol content at injury were more likely to have substantial medical debts (odds ratio=2.70; 95% confidence interval, 1.04-7.00).Conclusions
Medical debt plays an important role in some bankruptcies after TBI or SCI. We discuss policy options for reducing financial distress after serious injury. 相似文献6.
7.
James W. Middleton Grahame K. Simpson Annelies De Wolf Ruth Quirk Joseph Descallar Ian D. Cameron 《Archives of physical medicine and rehabilitation》2014
Objectives
To examine relations between psychological distress, health-related quality of life (HR-QOL), and burden among caregivers of people with traumatic spinal cord injury (SCI) over time, and to determine whether the data are more consistent with a wear and tear or adaptation trajectory.Design
Prospective longitudinal cohort study with measurements at 4 time points (6wk prior to discharge from subacute inpatient rehabilitation and 6wk, 1y, and 2y postdischarge to community).Setting
Rehabilitation units.Participants
Participants (N=44; spouses, parents, others) nominated as a primary caregiver by the person with SCI.Interventions
Not applicable.Main Outcome Measures
General Health Questionnaire-28 (GHQ-28), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index (CSI) assessed the extent of psychological distress, HR-QOL, and burden, respectively, among caregivers. Functional status and community participation/care needs of the persons with SCI were assessed by the FIM and Craig Handicap Assessment and Reporting Technique, respectively.Results
Multilevel piecewise models showed that psychological distress (GHQ-28 score) decreased significantly after discharge (slope estimate =−.03, P<.008). At the predischarge time point, the caregivers’ mental component summary score on the SF-36 was significantly lower than Australian national norms. The scores improved from predischarge to 6 weeks postdischarge (slope estimate =.39, P<.001), but they did not change significantly across the following 2 time points (slope estimate =.02, P=.250). At all 3 postdischarge time points, the mental component summary scores were not significantly different to national norms. In contrast, the physical component summary score of the SF-36 did not significantly change across the predischarge and 6-week postdischarge time points (slope estimate =−.14, P=.121) and the 3 postdischarge time points (slope estimate <.01, P=.947). Scores at all 4 time points were not significantly different to the national norms. Caregiver burden showed no significant change over the study period (predischarge to 6wk postdischarge slope estimate =.02, P=.426; 3 postdischarge time point slope estimates <−.01, P=.334). Reflecting this, 42% of caregivers met CSI caseness criterion at the first time point, and 46% met the criterion at the fourth (2y) time point. Higher burden was significantly correlated with increased hours of care being provided by the caregiver and lower FIM scores and lower community participation (for the person with SCI) at each time point. Psychological distress correlated with caregiver burden at 6 weeks and 1 year postdischarge but not at 2 years postdischarge.Conclusions
The trajectory of scores for psychological distress and HR-QOL was consistent with caregiver adaptation to the challenge of providing support to a person with SCI in the early postdischarge period. Caregiver burden did not display similar reductions but did not worsen over the study period. 相似文献8.
Shane N. Sweet Emilie Michalovic Amy E. Latimer-Cheung Michelle Fortier Luc Noreau Walter Zelaya Kathleen A. Martin Ginis 《Archives of physical medicine and rehabilitation》2018,99(3):468-476.e12
Objectives
To investigate the role of spinal cord injury (SCI) peer mentorship on quality of life (QoL)/participation, and test a self-determination theory model that explains the role of SCI peer mentorship on these outcomes.Design
A static group comparison design.Setting
Community.Participants
A convenience sample of mentees (individuals receiving peer mentorship) (n=68) and nonmentees (n=63) who had an SCI, were older than 18 years, and spoke either English or French.Interventions
Mentees: at least 4 peer mentorship sessions over the past 5 years; nonpeer mentees: 0 or 1 brief introductory session.Main Outcome Measures
QoL (ie, life satisfaction and positive and negative affect), participation (eg, autonomous indoor; family role), and the psychological needs of autonomy, competence, and relatedness.Results
No group differences were found, but years since injury was a moderator indicating that, generally, peer mentees living with SCI for longer (~30y) appear to benefit more from peer mentorship interactions compared with nonmentees and mentees living with SCI for approximately 6 years. Competence and relatedness mediated the peer mentorship–outcome relationship for QoL and some participation variables, indicating that peer mentorship predicted competence and relatedness, which in turn were related to the outcomes.Conclusions
Satisfaction of competence and relatedness needs requires greater attention in SCI peer mentorship. Years since injury modified the relationship between peer mentorship and outcomes, which provided new insights on the role of SCI peer mentorship. Further studies are needed to determine SCI peer mentorship–specific outcomes that are important across the years-since-injury spectrum. 相似文献9.
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10.
Kimberley R. Monden Mitch Sevigny Jessica M. Ketchum Susan Charlifue Ellen Severe Candy Tefertiller Jeff Berliner Jennifer Coker Heather B. Taylor Stephanie A. Kolakowsky-Hayner Leslie R. Morse 《Archives of physical medicine and rehabilitation》2019,100(12):2260-2266
ObjectiveTo investigate the association between insurance provider and reported assistive technology (AT) use to access computers and electronic devices 1 year after sustaining tetraplegia.DesignMulticenter cross-sectional study.SettingParticipants enrolled in the Spinal Cord Injury Model Systems (SCIMS) National Database.InterventionsNot applicable.ParticipantsMen and women with tetraplegia (N=498) enrolled in the SCIMS National Database were included in the analysis.Main Outcome MeasuresThe primary study outcome was the use of AT when operating a computer or other mobile electronic device. The primary predictor was the subject’s principal health insurance provider, which was grouped into the 3 categories: government (Medicare, Medicaid, and other government), private (private insurance, private funds, and other), and workers’ compensation.ResultsOverall, 34.7% of participants reported using AT to access computers and electronic devices. Results of logistic regression analysis revealed sex, injury level, injury completeness, self-perceived health status, and 12-month history of pressure ulcer were all significantly associated with AT use. After adjusting for these factors, participants with workers’ compensation were more likely to report AT use than individuals with either government or private insurance.ConclusionsDespite significant technological advances, AT is not readily available to the people who might benefit most from its use. Findings from the present study are the first to shed light on AT funding sources and reveal that individuals with workers’ compensation are more likely use AT than individuals with either government or private insurance. Additional work focused on AT use and functional outcomes is needed to assess the effect of barriers to use. Collectively, this work may inform insurers of the importance of having AT available for this unique population to potentially improve quality of life and participation. 相似文献
11.
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12.
Karin Postma Janneke A. Haisma Sonja de Groot Maria T. Hopman Michael P. Bergen Henk J. Stam Johannes B. Bussmann 《Archives of physical medicine and rehabilitation》2013
Objective
To describe changes in pulmonary function (PF) during the 5 years after inpatient rehabilitation in persons with spinal cord injury (SCI) and to study potential determinants of change.Design
Prospective cohort study.Setting
Eight rehabilitation centers with specialized SCI units.Participants
Persons with SCI (N=180).Interventions
Not applicable.Main Outcome Measures
PF was determined by forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) as a percentage of the predicted value, at the start of rehabilitation, at discharge, and 1 and 5 years after discharge from inpatient rehabilitation. The population was divided into 3 subgroups on the basis of whether their PF declined, stabilized, or improved.Results
FVC improved on average 5.1% over the whole period between discharge of inpatient rehabilitation and 5 years thereafter, but changes differed largely between persons. FVC declined in 14.9% of the population during the first year after discharge. During this year, body mass index, inspiratory muscle strength, change in peak power output, and change in peak oxygen uptake differed significantly between subgroups. FVC declined in 28.3% of the population during the following 4 years, but no differences were found between the subgroups for this period. Subgroups based on changes in FEV1 differed only with respect to change in peak oxygen uptake the first year after discharge.Conclusions
In our study, many persons with SCI showed a decline in PF, larger than the normal age-related decline, during the 5 years after inpatient rehabilitation. Results suggest that a decline in PF during the first year after inpatient rehabilitation is associated with higher body mass index, lower inspiratory muscle strength, and declined physical fitness. 相似文献13.
Carly S. Rivers Nader Fallah Vanessa K. Noonan David G. Whitehurst Carolyn E. Schwartz Joel A. Finkelstein B. Catharine Craven Karen Ethans Colleen OConnell B. Catherine Truchon Chester Ho A. Gary Linassi Christine Short Eve Tsai Brian Drew Henry Ahn Marcel F. Dvorak Jér?me Paquet Luc Noreau 《Archives of physical medicine and rehabilitation》2018,99(3):443-451
Objective
To analyze relations among injury, demographic, and environmental factors on function, health-related quality of life (HRQoL), and life satisfaction in individuals with traumatic spinal cord injury (SCI).Design
Prospective observational registry cohort study.Setting
Specialized acute and rehabilitation SCI centers.Participants
Participants (N=340) from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) who were prospectively recruited from 2004 to 2014 were included. The model cohort participants were 79.1% men, with a mean age of 41.6±17.3 years. Of the participants, 34.7% were motor/sensory complete (ASIA Impairment Scale [AIS] grade A).Interventions
None.Main Outcome Measures
Path analysis was used to determine relations among SCI severity (AIS grade and anatomic level [cervical/thoracolumbar]), age at injury, education, number of health conditions, functional independence (FIM motor score), HRQoL (Medical Outcomes Study 36-Item Short-Form Health Survey [Version 2] Physical Component Score [PCS] and Mental Component Score [MCS]), and life satisfaction (Life Satisfaction-11 [LiSat-11]). Model fit was assessed using recommended published indices.Results
Goodness of fit of the model was supported by all indices, indicating the model results closely matched the RHSCIR data. Higher age, higher severity injuries, cervical injuries, and more health conditions negatively affected FIM motor score, whereas employment had a positive effect. Higher age, less education, more severe injuries (AIS grades A–C), and more health conditions negatively correlated with PCS (worse physical health). More health conditions were negatively correlated with a lower MCS (worse mental health), however were positively associated with reduced function. Being married and having higher function positively affected Lisat-11, but more health conditions had a negative effect.Conclusions
Complex interactions and enduring effects of health conditions after SCI have a negative effect on function, HRQoL, and life satisfaction. Modeling relations among these types of concepts will inform clinicians how to positively effect outcomes after SCI (eg, development of screening tools and protocols for managing individuals with traumatic SCI who have multiple health conditions). 相似文献14.
Adam Stein Arti Panjwani Cristina Sison Lisa Rosen Radhika Chugh Christine Metz Matthew Bank Ona Bloom 《Archives of physical medicine and rehabilitation》2013
Objective
To test the hypothesis that the proinflammatory cytokine macrophage migration inhibitory factor (MIF) is elevated in the circulation of patients with chronic spinal cord injury (SCI) relative to uninjured subjects, and secondarily to identify additional immune mediators that are elevated in subjects with chronic SCI.Design
Prospective, observational pilot study.Setting
Outpatient clinic of a department of physical medicine and rehabilitation and research institute in an academic medical center.Participants
Individuals with chronic (>1y from initial injury) SCI (n=22) and age- and sex-matched uninjured subjects (n=19).Interventions
Not applicable.Main Outcome Measures
Plasma levels of MIF, as determined by a commercially available multiplex suspension immunoassay. The relationship between MIF levels and clinical/demographic variables was also examined. As a secondary outcome, we evaluated other cytokines, chemokines, and growth factors.Results
Plasma MIF levels were significantly higher in subjects with chronic SCI than in control subjects (P<.001). Elevated MIF levels were not correlated significantly with any one clinical or demographic characteristic. Subjects with SCI also exhibited significantly higher plasma levels of monokine induced by interferon-gamma/chemokine C-X-C motif ligand 9 (P<.03), macrophage colony stimulating factor (P<.035), interleukin-3 (P<.044), and stem cell growth factor beta (SCGF-β) (P<.016). Among subjects with SCI, the levels of SCGF-β increased with the time from initial injury.Conclusions
These data confirm the hypothesis that MIF is elevated in subjects with chronic SCI and identify additional novel immune mediators that are also elevated in these subjects. This study suggests the importance of examining the potential functional roles of MIF and other immune factors in subjects with chronic SCI. 相似文献15.
Noelle E. Carlozzi Denise Fyffe Kel G. Morin Rachel Byrne David S. Tulsky David Victorson Jin-Shei Lai Jill M. Wecht 《Archives of physical medicine and rehabilitation》2013
Objectives
To identify medically relevant aspects of blood pressure dysregulation (BPD) related to quality of life in individuals with spinal cord injury (SCI), and to propose an integrated conceptual framework based on input from both individuals with SCI and their clinical providers. This framework will serve as a guide for the development of a patient-reported outcome (PRO) measure specifically related to BPD.Design
Three focus groups with individuals with SCI and 3 groups with SCI providers were analyzed using grounded-theory based qualitative analysis to ascertain how blood pressure impacts health-related quality of life (HRQOL) in individuals with SCI.Setting
Focus groups were conducted at 2 Veterans Affairs medical centers and a research center.Participants
Individuals with SCI (n=27) in 3 focus groups and clinical providers (n=25) in 3 focus groups.Interventions
Not applicable.Main Outcome Measures
Not applicable.Results
Qualitative analysis indicated that all focus groups spent the highest percentage of time discussing symptoms of BPD (39%), followed by precipitators/causes of BPD (16%), preventative actions (15%), corrective actions (12%), and the impact that BPD has on social or emotional functioning (8%). While patient/consumer focus groups and provider focus groups raised similar issues, providers spent more time discussing precipitators/causes of BPD and preventative actions (38%) than patient/consumer groups (24%).Conclusions
These results suggest that BPD uniquely and adversely impacts HRQOL in persons with SCI. While both individuals with SCI and their providers highlighted the relevant symptoms of BPD, the SCI providers offered additional detailed information regarding the precipitators/causes and what can be done to prevent/treat BPD. Further, the results suggest that persons with SCI are aware of how BPD impacts their HRQOL and are able to distinguish between subtle signs and symptoms. These findings exemplify the need for a validated and sensitive clinical measurement tool that can assess the extent to which BPD impacts HRQOL in patients with SCI. 相似文献16.
Anand V. Nene Alexandre Rainha Campos Klemen Grabljevec Arminda Lopes Bengt Skoog Anthony S. Burns 《Archives of physical medicine and rehabilitation》2018,99(9):1917-1926
A thorough assessment of the extent and severity of spasticity, and its effect on functioning, is central to the effective management of spasticity in persons with spinal cord damage (SCD). These individuals however do not always receive adequate assessment of their spasticity. Inadequate assessment compromises management when the effect of spasticity and/or need for intervention are not fully recognized. Assessment is also central to determining treatment efficacy. A barrier to spasticity assessment has been the lack of consensus on clinical and functional measures suitable for routine clinical practice. To extend on existing work, a working group of the Ability Network identified and consolidated information on possible measures, and then synthesized and formulated findings into practical recommendations for assessing spasticity and its effect on function in persons with SCD. Sixteen clinical and functional measures that have been used for this purpose were identified using a targeted literature review. These were mapped to the relevant domains of the International Classification of Functioning, Disability and Health to assess the breadth of their coverage; coverage of many domains was found to be lacking, suggesting a focus for future work. The advantages, disadvantages, and usefulness of the measures were assessed using a range of criteria, with a focus on usefulness and feasibility in routine clinical practice. Based on this evaluation, a selection of measures suitable for initial and follow-up assessments are recommended. The recommendations are intended to have broad applicability to a variety of health care settings where people with SCD are managed. 相似文献
17.
Laura C. Simko Liang Chen Dagmar Amtmann Nicole Gibran David Herndon Karen Kowalske A. Cate Miller Eileen Bulger Ryan Friedman Audrey Wolfe Kevin K. Chung Michael Mosier James Jeng Joseph Giacino Ross Zafonte Lewis E. Kazis Jeffrey C. Schneider Colleen M. Ryan 《Archives of physical medicine and rehabilitation》2019,100(5):891-898
Objective
Common data elements (CDEs) promote data sharing, standardization, and uniform data collection, which facilitate meta-analyses and comparisons of studies. Currently, there is no set of CDEs for all trauma populations, but their creation would allow researchers to leverage existing databases to maximize research on trauma outcomes. The purpose of this study is to assess the extent of common data collection among 5 trauma databases.Design
The data dictionaries of 5 trauma databases were examined to determine the extent of common data collection. Databases included 2 acute care databases (American Burn Association’s National Burn Data Standard and American College of Surgeons’ National Trauma Data Standard) and 3 longitudinal trauma databases (Burn, Traumatic Brain Injury, Spinal Cord Injury Model System National Databases). Data elements and data values were compared across the databases. Quantitative and qualitative variations in the data were identified to highlight meaningful differences between datasets.Setting
N/A.Participants
N/A.Interventions
N/A.Main Outcome Measures
N/A.Results
Of the 30 data elements examined, 14 (47%) were present in all 5 databases. Another 9 (30%) elements were present in 4 of the 5 databases. The number of elements present in each database ranged from 23 (77%) to 26 (86%). There were inconsistencies in the data values across the databases. Twelve of the 14 data elements present in all 5 databases exhibited differences in data values.Conclusions
This study demonstrates inconsistencies in the documentation of data elements in 5 common trauma databases. These discrepancies are a barrier to database harmonization and to maximizing the use of these databases through linking, pooling, and comparing data. A collaborative effort is required to develop a standardized set of elements for trauma research. 相似文献18.
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
Objective
To investigate response shift effects in spinal cord injury (SCI) over 5 years postinjury.Design
Prospective cohort study observed at 1, 2, and 5 years post-SCI.Setting
Specialized SCI centers.Participants
Sample included 1125, 760, and 219 participants at 1, 2, and 5 years post-SCI (N = 2104). The study sample was 79% men; 39% were motor/sensory complete (mean age, 44.6±18.3y).Interventions
Not applicable.Main Outcome Measures
Patient-reported outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey version 2 and the Life Satisfaction-11 Questionnaire. Participant latent variable scores were adjusted for (1) potential attrition bias and (2) propensity scores reflecting risk of worse outcomes. The Oort structural equation modeling approach for detecting and accounting for response shift effects was used to test the hypothesis that people with SCI would undergo response shifts over follow-up.Results
The study data comprised the time after FIM scores, an objective measure of motor and cognitive function, had improved and stabilized. Three latent variables (Physical, Mental, and Symptoms) were modeled over time. The response shift model indicated uniform recalibration and reconceptualization response shift effects over time. When adjusted for these response shift effects, Physical showed small true change improvements at 2- and 5-year follow-up, despite FIM stability.Conclusions
We detected recalibration and reconceptualization response shift effects in 1- to 5-year follow-up of people with SCI. Despite stable motor and cognitive function, people with SCI are adapting to their condition. This adaptation reflects a progressive disconnection between symptoms and physical or mental health, and a real improvement in the Physical latent variable. 相似文献19.
Carol Y. Scovil Jude J. Delparte Saagar Walia Heather M. Flett Stacey D. Guy Michelle Wallace Anthony S. Burns Dalton L. Wolfe 《Archives of physical medicine and rehabilitation》2019,100(2):327-335
Objective
To use the theoretical frameworks of implementation science to implement pressure injury (PI) prevention best practices in spinal cord injury (SCI) rehabilitation.Design
Quality improvement.Setting
Six Canadian SCI rehabilitation centers.Participants
Inpatients (N=2371) admitted from 2011 to 2015.Interventions
The SCI Knowledge Mobilization Network (SCI KMN) selected and implemented 2 PI prevention best practices at 6 Canadian SCI rehabilitation centers: (1) completing a comprehensive PI risk assessment comprised of a structured risk assessment instrument followed by an individualized, interprofessional risk factor determination and prevention plan; and (2) providing structured and individualized PI prevention patient education. Active Implementation Frameworks provided a systematic approach to best practice implementation.Main Outcome Measures
Implementation indicators (completion rates) and patient outcomes (PI incidence, patient education survey).Results
After implementation, risk assessment completion rates improved from 46% to 94% (P<.05). Between initial (2012-2013) and full (2014-2015) implementation stages, completion rates improved for both interprofessional risk factor determination (67% to 96%) and prevention plans (67% to 94%). Documentation of patient education also increased to 86% (vs. 71% preimplementation). At rehabilitation admission 22% of patients had PIs, with 14% of individuals developing new PIs during rehabilitation. The overall PI prevalence was 30%. Considering only PIs of stage 2 or greater, prevalence was 21% and incidence 7%. There were no statistically significant differences in PI incidence between pre- and postimplementation. Patient education surveys indicated that PI education improved patients’ knowledge of prevention strategies.Conclusions
Active Implementation Frameworks supported successful implementation of PI prevention best practices across the 6 participating SCI KMN sites. Achieving a reduction in PI incidence will require additional measures, and there is an ongoing need to strengthen the evidence base underpinning PI prevention guidelines. 相似文献20.
Felicia Skelton Larissa Grigoryan Sally Ann Holmes Ivy Oiyee Poon Barbara Trautner 《Archives of physical medicine and rehabilitation》2018,99(2):219-225