The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: A randomized clinical trial

Background

Over the past three decades, research has been carried out on the effects of exercise on chronic kidney disease patients for improving their physical potential.

Objectives

The purpose of this study is to evaluate the effect of intradialytic leg ergometry exercise for improving fatigue and daily physical activity levels among chronic kidney disease patients.

Design

A quasi-experimental clinical trial.

Setting

Two hemodialysis units in a medical center in northern Taiwan.

Method

The leg ergometry exercise was performed within the first hour of each hemodialysis session for 30 min for 8 weeks. There were 36 subjects in the experimental group and 35 subjects in the control group who completed the study. Measurement on a fatigue scale and a physical activity log were done at the time of enrollment, and again on the fourth and eighth weeks.

Result

Active subjects demonstrated significantly less fatigue and higher physical activity levels than those with a sedentary lifestyle at baseline. During the 8 weeks of intervention, subjects in both the active and sedentary groups reduced their fatigue levels significantly, with the exception of sedentary subjects in the control group. Only active subjects in the experimental group demonstrated an increase in activity levels. The 36 subjects performed 3456 leg ergometry exercise sessions with three early terminations (<.01%) among the sedentary subjects.

Conclusions

Intradialytic leg ergometry is a safe exercise that is effective to reduce fatigue and improve physical fitness in already active chronic kidney disease patients and it also reduces fatigue in sedentary patients. Interventions to motivate sedentary patients to become active require further investigation.

Implication for nursing practice

Exercise during hemodialysis does not cost patients extra time and is effective in reducing fatigue and increasing physical activity potential as demonstrated by our study; 30 min of intradialytic leg ergometer exercise can be considered as routine care while delivering hemodialysis.     

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004;85:201-9.

Objective

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

Design

Qualitative research methodology comprising a series of semistructured interviews.

Setting

Community-based setting.

Participants

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

Interventions

Not applicable.

Main outcome measure

Accounts of personal experiences related to employment.

Results

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

Conclusions

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.     

Injurious falls among middle aged and older adults with multiple sclerosis

Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis.

Objective

To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS).

Design

Survey.

Setting

United States.

Participants

Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey.

Interventions

Not applicable.

Main Outcome Measures

Participant's self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never).

Results

More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27−2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62).

Conclusions

Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.     

Prediction of Postoperative Ambulatory Status 1 Year After Hip Fracture Surgery

Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery.

Objectives

To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status.

Design

Cohort study.

Setting

Twelve hospitals belonging to the regional network for hip fracture in Japan.

Participants

The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers.

Interventions

Not applicable.

Main Outcome Measures

We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status.

Results

In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (ρ=0.6, P<.001).

Conclusions

In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery.     

Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study

Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study.

Objective

To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin.

Design

A randomized, double-blind, placebo-controlled pilot study.

Setting

Outpatient physical medicine and rehabilitation clinic of a university-affiliated tertiary hospital.

Participants

A total of 29 subjects enrolled from among 45 screened patients. No subject withdrawal due to serious adverse events occurred.

Intervention

Subjects were evaluated at baseline, received a 1-time injection of either BTX-A (treatment group) or saline (control group), and were followed up at 2 weeks and at months 1, 2, 3, 4, and 6.

Main Outcome Measures

Visual analog scale (VAS) for pain, the Neck Disability Index (NDI), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36).

Results

Improvements in the VAS and NDI scores were seen in the treatment group but were not significant when compared with the controls. Statistically significant improvements for the treatment group were seen in the SF-36 bodily pain (at months 2 and 4) and mental health (at month 1) scales but not in the other scales, nor in the summary measures. No serious adverse events were reported.

Conclusions

Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic.     

A randomised controlled trial of lay-led self-management for Myocardial Infarction patients who have completed cardiac rehabilitation

Background

There are increasing opportunities for MI patients to attend lay-led, community based generic self-management programmes via self-referral.

Aims

To determine the effectiveness of the Expert Patient Programme (EPP) for MI patients who had completed CR using a randomised controlled, wait-list design, with a nested qualitative study.

Methods

The Intervention Group attends the EPP immediately after completing the baseline assessment; The Control Group had the opportunity to attend the EPP after completion of the 4-month follow-up. 192 MI patients (72% men) completed baseline assessment; 162 responded at follow-up. Telephone interviews were conducted with 10 male and 9 female Intervention group participants.

Results

Intention-to-treat analysis revealed no statistically significant differences between the groups although a pattern of small improvements among the Intervention Group was observed over time. Interviews revealed that Intervention Group participants viewed CR as being more about instruction whereas the EPP was viewed as being more about discussion, mutual support, and goal setting. A gender difference emerged whereby male participants valued information exchange whereas female participants expressed a preference for emotional support and social interaction within the EPP context.

Conclusion

The EPP appears to hold few benefits for MI patients who have attended CR.     

How Many Trials Are Needed to Achieve Performance Stability of the Timed Up & Go Test in Patients With Hip Fracture?

Kristensen MT, Ekdahl C, Kehlet H, Bandholm T. How many trials are needed to achieve performance stability of the Timed Up & Go test in patients with hip fracture?

Objective

To examine the number of trials needed to achieve performance stability of the Timed Up & Go (TUG) test using a standardized walking aid in patients with hip fracture who are allowed full weight bearing (FWB).

Design

Prospective methodologic study.

Setting

An acute 14-bed orthopedic hip fracture unit.

Participants

Patients (N=122; 89 women, 33 men) with hip fracture with a median age (25%-75%, quartiles) of 80 (67-85) years performed the TUG on hospital discharge to their own home (n=115) or further inpatient rehabilitation (n=7).

Interventions

Not applicable.

Main Outcome Measures

After a demonstration by a physical therapist how to perform the TUG with a standardized walking aid (a 4-wheeled rollator), the patients performed 6 timed TUG trials with up to 1-minute seated rest intervals. The participants were given a few minutes to familiarize with the rollator before commencing the timed trials. Repeated-measures analysis of variance (ANOVA) with Bonferroni corrections were used to examine the number of trials needed to ensure statistically stable TUG scores.

Results

A total of 106 (87%) patients performed all 6 TUG trials, while 120 patients performed a minimum of 3 timed trials. Repeated-measures ANOVAs of both groups showed that TUG scores improved significantly (P≤.007) up to and including the third TUG trial.

Conclusions

These results suggest that the original TUG manual, described as 1 practice trial followed by 1 timed trial, needs modification when used in patients with hip fracture who are allowed FWB. The best (fastest) of 3 timed TUG trials performed with a standardized walking aid is recommended.     

The effect of ice stimulation on sensory loss in chronic stroke patients—a feasibility study

Objectives

Ice stimulation has often been used in sensory bombardment programmes after stroke. This feasibility study explored the effects of ice as a single stimulus on disturbed wrist position sense, sensation of light touch and temperature discrimination of the affected hand.

Design

A multiple baseline single case study design across subjects.

Setting

Physiotherapy department at the Royal Star and Garter Home.

Participants

Four patients following cerebrovascular accident with left hemiparesis.

Methods

Eight baseline measurements were collected over a minimum of 8 days. The intervention phase was started for the first, second, third and fourth subjects staggered on the 8th, 11th, 13th and 15th days of the study, respectively.

Intervention

The intervention phase involved daily short, repeated ice-water immersions of each subject's affected hand.

Main outcome measure

Repeated measurements of wrist position sense, sensation of light touch and temperature discrimination.

Results

Visual and statistical analysis indicated that changes of wrist position error were neither significant nor consistent across subjects. Results for sensation of light touch were inconclusive: one subject improved and two subjects showed deterioration. Temperature discrimination of warm stimuli improved in one subject.

Conclusion

These observations suggest that ice-water immersions of the affected hand did not improve wrist position sense in three chronic stroke patients. Further exploration of the effects of ice stimulation on disturbed sensation of light touch and temperature after stroke is justified.     

Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome

Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil 2003;84:1637-41.

Objectives

To detect the clinical and radiologic characteristics of posttraumatic hydrocephalus (PTH), to define its prognostic value, and to assess the effects of shunt surgery.

Design

Correlational study on a prospective cohort.

Setting

Brain injury rehabilitation center.

Participants

One hundred forty patients with severe traumatic brain injury (TBI) referred to an inpatient intensive rehabilitation unit of primary care in a university-based system.

Interventions

Not applicable.

Main outcome measures

The Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), FIM™ instrument, and Neurobehavioural Rating Scale (NRS), as well as single-photon emission computed tomography (SPECT) and magnetic resonance imaging.

Results

PTH was found in 45% of patients. Risk factors for PTH were as follows: age (P<.04), duration of coma (P<.0001), and decompressive craniectomy (P<.0001). PTH correlated with the degree of hypoperfusion in the temporal lobes (P<.001). Patients who showed clinical deterioration improved after surgery. PTH correlated significantly with GOS, DRS, FIM, and NRS (P<.0001) 1 year after the trauma, and it influenced the appearance of posttraumatic epilepsy (P<.02).

Conclusions

PTH concerns about 50% of patients with severe TBI. It influences functional and behavioral outcome and the appearance of posttraumatic epilepsy. The selection of patients for surgery can be defined principally on a clinical basis. SPECT may be helpful for differentiating ventricular enlargement due to cortical atrophy and hydrocephalus.     

Validation of the Charlson Comorbidity Index for predicting functional outcome of stroke

Tessier A, Finch L, Daskalopoulou SS, Mayo NE. Validation of the Charlson Comorbidity Index for predicting functional outcome of stroke.

Objective

To determine whether a separate comorbidity index is needed to predict functional outcome after stroke, we compared the predictability of the Charlson Comorbidity Index (CMI) and the Functional Comorbidity Index (FCI) to that of a stroke-specific comorbidity index with function quantified with a measure developed with a Rasch model as outcome.

Design

Two prospective inception cohort studies, in 1996 through 1998 and in 2002 through 2005, with up to 9 months of follow-up.

Setting

Participants enrolled in 2 studies were recruited from acute care hospitals in the Montreal area.

Participants

For study one, 1027 persons with a first stroke discharged into the community were eligible; the 437 who were interviewed a second time at 6 months were included in the analysis. In study two, 235 of 262 patients with stroke were enrolled.

Interventions

Not applicable.

Main Outcome Measures

To predict recovery, we developed 3 stroke-specific comorbidity algorithms based on the estimated strength of association between comorbidities and stroke function. The various indices were compared on the basis of their predictive ability with a c statistic.

Results

In study 1, the c statistics were .758, .763, .766, and .763 for the stroke-specific algorithms 1, 2, and 3 and the CMI, respectively. In study 2, the c statistics were .680, .700, .704, .714, and .714 for the algorithms 1, 2, and 3, the CMI, and the FCI, respectively.

Conclusions

For purposes of case-mix adjustment, the CMI seems to be more than adequate.     

Predictors of Extended Rehabilitation Length of Stay After Traumatic Brain Injury

Arango-Lasprilla JC, Ketchum JM, Cifu D, Hammond F, Castillo C, Nicholls E, Watanabe T, Lequerica A, Deng X. Predictors of extended rehabilitation length of stay after traumatic brain injury.

Objective

To develop a prediction rule for acutely identifying patients at risk for extended rehabilitation length of stay (LOS) after traumatic brain injury (TBI) by using demographic and injury characteristics.

Design

Retrospective cohort study.

Setting

Traumatic Brain Injury Model Systems.

Participants

Sample of TBI survivors (N=7284) with injuries occurring between 1999 and 2009.

Interventions

Not applicable.

Main Outcome Measures

Extended rehabilitation LOS defined as 67 days or longer.

Results

A multivariable model was built containing FIM motor and cognitive scores at admission, preinjury level of education, cause of injury, punctate/petechial hemorrhage, acute-care LOS, and primary payor source. The model had good calibration, excellent discrimination (area under the receiver operating characteristic curve = .875), and validated well. Based on this model, a formula for determining the probability of extended rehabilitation LOS and a prediction rule that classifies patients with predicted probabilities greater than 4.9% as at risk for extended rehabilitation LOS were developed.

Conclusions

The current predictor model for TBI survivors who require extended inpatient rehabilitation may allow for enhanced rehabilitation team planning, improved patient and family education, and better use of health care resources. Cross-validation of this model with other TBI populations is recommended.     

The effects of task complexity on brake response time before and after primary right total knee arthroplasty

Marques CJ, Cabri J, Barreiros J, Carita AI, Friesecke C, Loehr JF. The effects of task complexity on brake response time before and after primary right total knee arthroplasty.

Objective

To study the effects of an increase in task complexity on brake response time (BRT) in patients undergoing total knee arthroplasty (TKA).

Design

A prospective repeated-measures design was used. The measurements took place 1 day before and 10 and 30 days after surgery.

Setting

Clinic.

Participants

The data of patients (N=21) who were admitted for primary total arthroplasty of the right knee were pooled for analysis.

Interventions

On each measurement day patients performed 5 practice and 10 test trials for 2 tasks (1 simple, 1 complex) in a car simulator. Task complexity was increased by adding a second movement to the first task performed.

Main Outcome Measures

BRT, reaction time (RT), and movement time were assessed.

Results

An increase in task complexity increased BRT, RT, and movement time at all measurement times. Right TKA increased BRT by increasing movement time. Thirty days after surgery BRT was no longer increased compared with preoperative values in both tasks.

Conclusions

Task complexity consistently increased BRT and its components. The effects of task complexity remained constant throughout the 3 measurements. After right TKA, we suggest patients should be advised to wait 30 days after surgery before resuming driving.     

Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation

Background

Chronic obstructive pulmonary disease (COPD) is predominantly caused by cigarette smoking and is considered a worldwide preventable chronic illness. Smoking cessation is considered the primary intervention for disease management and nurses should play a major role in assisting patients to stop smoking. Currently there is a lack of professional consensus on how cessation interventions should be evaluated. The vast array of biochemical markers reported in the literature can be confusing and can make the comparisons of results difficult.

Objective

To validate self-report data on smoking with exhaled carbon monoxide in patients with chronic obstructive pulmonary disease over twelve months.

Design

We performed a secondary analysis of a previously published randomized controlled trial evaluating nursing interventions to assist respiratory patients to stop smoking.

Setting

Northern Ireland's Regional Respiratory Centre.

Participants

A total of 91 cigarette smokers attending secondary care for the treatment for COPD participated in the study.

Method

Self-reported smoking status and cigarettes smoked per day were compared to exhaled carbon monoxide readings at baseline, 2, 3, 6, 9 and 12 months. The cut-off value of ≤10 ppm was used to identify non-smokers. The p-values are based on Pearson's correlation coefficient and Kappa Coefficient as appropriate.

Results

Findings suggest self-reported smoking status and cigarette consumption amongst patients with chronic obstructive pulmonary disease was highly consistent with exhaled carbon monoxide results (p = 0.001-0.003).

Conclusion

The majority of patients with chronic obstructive pulmonary disease reliably report their cigarette consumption.     

Potential Clinical Impact of Compounded Versus Noncompounded Intrathecal Baclofen

Moberg-Wolff E. Potential clinical impact of compounded versus noncompounded intrathecal baclofen.

Objective

To assess the differences between commercial and pharmacy-compounded preparations of baclofen for intrathecal administration.

Design

Random sample.

Setting

Pharmacies in the United States advertising compounded intrathecal baclofen preparation.

Participants

Not applicable.

Interventions

Intrathecal baclofen (ITB) samples were collected from 1 Food and Drug Administration-approved commercial source and 6 compounding pharmacies. An independent analysis of drug concentration and density was conducted. Information regarding ordering process, manufacturing, packaging, storage, and expiration was collected.

Main Outcome Measure

Comparison of concentration and density variations.

Results

Twenty-nine ITB samples in concentrations of 2000, 3000, 4000, 5000, and 6000μg/mL were analyzed. Over 40% of compounded samples were more than 5% above or below labeled concentration. Twenty-two percent of compounded samples were more than 10% above or below labeled concentration. The only samples with no concentration deviation and consistent drug density were the commercially available, noncompounded products.

Conclusions

Compounding pharmacies have variable practices in the provision of ITB. A high incidence of concentration inaccuracy existed. The use of compounded ITB may result in unintended dose alterations. Variable clinical efficacy, or life-threatening overdose or withdrawal may occur in patients who are sensitive to slight dose fluctuations. Given the variability of these compounded ITB samples, informed consent to use these products and understanding of potential side effects should be reviewed with patients.     

A European care bundle for management of ventilator-associated pneumonia

Background

Although there is a wealth of guidance concerning the management of patients with ventilator-associated pneumonia (VAP), compliance with recommendations concerning optimal treatment practices is highly variable.

Methods

This document presents a comprehensive care bundle package addressing all aspects of VAP diagnosis and treatment in an attempt to promote guideline-compliant practices. Uniquely, the development of these care bundles used a formalized method to assess the supporting data, based on multicriteria decision analysis.

Results

This system allowed the numerous VAP management parameters identified from recent European guidelines to be ranked according to defined criteria. The resulting VAP care bundles are (a) diagnosis: early chest x-rays within 1 hour, immediate reporting of respiratory secretions Gram staining, and (b) therapy: immediate treatment, empiric therapy based on local pathogens and risk factors, de-escalation, assessment of response within 72 hours, and short therapy duration if feasible.

Conclusion

Adoption of these care bundles should rationalize VAP management practices and facilitate the development of consistent and guideline-compliant care processes.     

Test position and hip strength in healthy adults and people with chronic stroke

Barbic S, Brouwer B. Test position and hip strength in healthy adults and people with chronic stroke.

Objective

To determine if peak torques generated by the hip flexors and extensors are dependent on test position in healthy adults and in people with chronic stroke.

Design

Cross-sectional study.

Setting

Motor performance laboratory.

Participants

Volunteers were 10 young (20.7±1.5y), 10 older adults (62.1±7y), and 10 stroke survivors (60.6±10y) who were an average of 5 years poststroke.

Interventions

Not applicable.

Main Outcome Measures

Isokinetic (60°/s) peak concentric hip flexor and extensor torques (in Nm/kg) generated in supine and standing positions.

Results

Peak flexor torques measured in standing were generally higher than in supine (P=.018); a pattern evident in all groups, but significant only in stroke. An interaction between test position and group for hip extensor strength (P=.016) reflected 2 distinct patterns in which torques were highest in standing among the young subjects and highest in supine after stroke.

Conclusions

Isokinetic hip flexor and extensor strength measured in standing and supine are comparable in young and older healthy people. In chronic stroke, the test position may over or underestimate maximum peak torque depending on the muscle group tested, particularly on the side ipsilateral to the lesion. These findings may have implications for predicting functional ability from strength measurements.     

Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury

Kalmar K, Novack TA, Nakase-Richardson R, Sherer M, Frol AB, Gordon WA, Hanks RA, Giacino JT, Ricker JH. Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury.

Objectives

To determine (1) if more than 50% of patients with moderate to severe traumatic brain injury (TBI) who met study criteria can complete a battery of neuropsychologic tests in less than 75 minutes 2 to 6 weeks after injury regardless of posttraumatic amnesia (PTA) status; (2) which tests are most likely to be completed; and (3) range of scores obtained.

Design

Prospective multicenter observational study.

Setting

Acute inpatient neurorehabilitation hospitals.

Participants

Screened 543 Traumatic Brain Injury Model System patients with moderate to severe TBI; 354 were tested at 2 to 6 weeks postinjury.

Interventions

Not applicable.

Main Outcome Measure

Percentage of patients able to complete the neuropsychologic tests in less than 75 minutes.

Results

Two hundred eighteen (62%) patients completed the battery in 66 minutes on average. Mean interval from injury to testing was 28.3±7.1 days. Tests completed with the highest frequency were California Verbal Learning Test−II, FAS, and animal naming. Performance was less impaired (P<.001) on all measures for patients who had emerged from PTA.

Conclusions

Approximately two thirds of screened patients were able to complete a brief neuropsychologic test battery at 2 to 6 weeks postinjury, regardless of PTA status. Although patients out of PTA were less impaired on all test measures, confusion did not preclude participation in the test battery or prohibit assignment of test scores. Early neuropsychologic assessment after TBI is feasible even for many patients who are still in PTA.     

Wheelchair Ramp Navigation in Snow and Ice-Grit Conditions

Lemaire ED, O'Neill PA, Desrosiers MM, Robertson DG. Wheelchair ramp navigation in snow and ice-grit conditions.

Objective

To explore manual wheelchair propulsion strategies for ramp ascent and descent in snow and snow-ice-grit conditions.

Design

Cross-sectional study.

Setting

Climatic Engineering and Testing Chamber (Ottawa, Canada).

Participants

Manual wheelchair users (N=11) who typically self-propel their wheelchair in winter.

Interventions

Ramp ascent and descent at 3 grades (1:10, 1:12, 1:16) and 2 winter conditions (packed snow, packed snow with a freezing rain cover, and traction grit).

Main Outcomes Measures

Type of ascent and descent strategy, success rate, number and severity of obstructions, average speed, and perceived ramp navigation rating. A questionnaire regarding the subject's past experiences with wheelchair propulsion in winter.

Results

Snow accumulation on ramps at 1:10 grade will render the ramp inaccessible for many wheelchair users who do not have external assistance. For snow conditions, the transition area from the level group to the first 2m of ramp incline were the most difficult to traverse for both ascent and descent. All subjects were able to ascend and descend the ramp for the ice-grit condition. Two-railing propulsion is a preferred strategy for ice-grit ramp navigation because of enhanced trajectory control and reducing the potential for wheel-slip problems. Backwards ramp ascent was a successful strategy for ascent in soft-snow conditions.

Conclusions

The 1:16 grade is preferred for winter ramp navigation. Backwards ramp ascent for snow conditions should be considered for people with sufficient shoulder and trunk range of motion. Two handrails are recommended for exterior ramps for both propulsion and wheelchair extraction from ruts and other snow-related obstacles. For ice ramp navigation, the amount of grit required and the effective time (ie, time to when grit becomes embedded in snow-ice, becoming much less effective) should be addressed in further research. Front wheels typically available with manual wheelchairs are not appropriate for soft-snow conditions.     

The influence of psychologic factors on diskography in patients with chronic axial low back pain

Derby R, Lee S-H, Chen Y, Kim B-J, Lee C-H, Hong Y-K, Lee J-E, Seo K-S. The influence of psychologic factors on diskography in patients with chronic axial low back pain.

Objective

To determine whether a patient's presenting psychometric scores affect the findings of a pressure and injection speed-controlled manometric lumbar diskography in patients with chronic low back pain (CLBP).

Design

A prospective, correlation-based, investigative study.

Setting

Free-standing ambulatory spine surgery center.

Participants

Two hundred sixty-three disks from 81 patients (54 men, 27 women).

Intervention

Diskography was performed using pressure and injection speed-controlled techniques. The patients were divided into psychometric subgroups (normal, at risk, abnormal) according to the Distress and Risk Assessment Method (DRAM).

Main Outcome Measures

The diskography findings on each psychometric DRAM subgroup were evaluated.

Results

Across the individual psychometric categories, the positive rates of diskography in the normal, at-risk, and abnormal subgroups were 75.0% (9/12), 59.5% (25/42), and 70.4% (19/27), respectively (P>.05). The mean numeric rating scores of pain at 15 and 50psi above the opening pressure were similar in the 3 psychometric subgroups. There was no correlation between the diskography results and the psychometric subgroupings.

Conclusions

In patients with CLBP, there is no correlation between the presenting psychometric DRAM score and the findings from pressure and injection speed-controlled manometric lumbar diskography.