Use of healthcare a long time after severe burn injury; relation to perceived health and personality characteristics

Purpose. The aim of the study was to evaluate which factors are associated with the use of healthcare a long time after severe burn injury.

Method. After a review process based on clinical reasoning, 69 former burn patients out of a consecutive group treated at the Uppsala Burn Unit from 1980 - 1995 were visited in their homes and their use of care and support was assessed in a semi-structured interview. Post-burn health was assessed with the Burn-Specific Health Scale-Brief (BSHS-B) and personality was assessed with the Swedish universities Scales of Personality (SSP).

Results. The participants were injured on average eight years previously. Thirty-four had current contact with healthcare due to their burn injury and had significantly lower scores on three BSHS-B-domains: Simple Abilities, Work and Hand function, and significantly higher scores for the SSP-domain Neuroticism and the SSP-scales Stress Susceptibility, Lack of Assertiveness, and lower scores for Social Desirability. There was no relation to age, gender, time since injury, length of stay, or to the surface area burned.

Conclusions. A routine screening of personality traits as a supplement to long-term follow-ups may help in identifying the patient's need for care.     

Two-year follow-up of outcomes related to scarring and distress in children with severe burns

Purpose: We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn.

Methods: Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p?Results: Responses of 167 children with a mean age of 7?±?5 years and burns covering an average 54?±?14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p?p?Conclusions: According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury.

• Implications for Rehabilitation

• According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p?

• Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation.

• Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.

     

Quasi-experimental evaluation of a home care model for patients with stroke in China

Purpose: To evaluate the effectiveness of a modified home care model in China.

Methods: First-time stroke survivors were recruited from a comprehensive teaching hospital in China. Subjects in the intervention group (n?=?168) received modified home care involving detailed pre-discharge preparation and post-discharge follow-up lasting one month. The following outcomes were assessed at the end of follow-up: length of hospital stay, satisfaction with acute hospitalisation, medication compliance, complications and stroke-related re-hospitalisation. The outcomes were compared for the intervention group and a historical control group (n?=?173) who received routine care.

Results: Modified home care was associated with shorter acute hospitalisation (11.29?±?2.18 vs. 12.36?±?4.33 d, p?=?0.03), higher compliance [161 (95.83%) vs. 92 (53.18%), p?=?0.004] and ability to perform daily activities (38.25?±?10.22 vs. 32.08?±?10.32, p?=?0.03), and a lower rate of re-hospitalisation [2 (1.19%) vs. 11 (6.36%), p?=?0.02].

Conclusions: Home care may be associated with higher quality of life and reduced dependency among stroke patients in China.

• Implications for Rehabilitation

• Home care can be effective method at improving the physical and psychological well-being of stroke survivors in China.

• The home care model in this study can improve health outcomes as well as reduce healthcare resources utilisation.

• Home care models for stroke survivors should be adapted to local healthcare policies and resources.

     

Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study

Abstract

Purpose: To examine whether Functional Independence Measure (FIM) scores on admission can predict the future care levels of patients after acute stroke. Methods: In this multicenter retrospective cohort study, we enrolled post-acute stroke patients and assessed stroke subtypes, self-care abilities using FIM scores, and discharge destination. Patients’ care levels were assessed according to the Long-Term Care Insurance (LTCI) system (0–5: slight impairment to bedridden), the national insurance plan for care in Japan, at discharge. We divided patients into two groups according to LTCI care levels (0–2 versus 3–5) to compare their clinical characteristics using multivariate logistic regression analysis. The trial was registered with the UMIN Clinical Trials Registry (UMIN000012653). Results: Of the 1261 patients (47% female, mean age 75 years), 492 (39%) fulfilled LTCI care levels 0–2. FIM scores on admission were significantly correlated with LTCI care levels (p?<?0.001). On multivariate analysis, age and FIM scores on admission were found to be independent predictors of LTCI care levels 0–2. Conclusions: FIM scores on admission after stroke can independently predict later care requirements. Early prediction of LTCI care levels may contribute to the early supported discharge and improve the efficiency of healthcare planning.

• Implications for Rehabilitation

• There is a clear relationship between Functional Independence Measure (FIM) scores and the care levels certified by the Long-Term Care Insurance (LTCI) system, a national healthcare and insurance system in Japan.

• FIM scores on admission can predict future LTCI care levels required for patients after acute stroke.

• Early prediction of LTCI care levels may contribute to early supported discharge, improve the efficiency of stroke management and assist healthcare planning.

     

A prospective study examining balance confidence among individuals with lower limb amputation

Purpose:?In this study we assessed whether balance confidence scores changed over a 2-year follow up period, and identified predictors of balance confidence and predictors of change in balance confidence among lower limb amputees.

Method:?A prospective follow-up survey of 245 community living adults with unilateral below and above knee lower limb amputation who used their prosthetic limb daily was conducted. Balance confidence, assessed using the 16-item Activity-specific Balance Confidence (ABC) Scale, socio-demographic, health and amputation related variables were collected at baseline and 2 years later.

Results:?ABC scores were similar at baseline (mean?= 67.6; SD?=?25.7) and follow up (mean?=?68.0; SD?=?25.8). Lower balance confidence scores at follow up were predicted by older age, being female, use of a mobility device, poor perceived health, increased symptoms of depression, having to concentrate while walking, and fear of falling (all p?<?0.05). Predictors of change in balance confidence included gender and perceived health (all p?<?0.05).

Conclusion:?Balance confidence appears to be a persistent problem in the amputee population. Health professionals are encouraged to consider balance confidence as a potentially important variable that may influence function in this clinically unique group of individuals. The identified predictor variables may be useful to clinicians in targeting individuals who require attention to improve balance confidence.     

Does Modafinil improve the level of consciousness for people with a prolonged disorder of consciousness? a retrospective pilot study

Background and aim: Modafinil is best known as a sleep regulator among healthy individuals, but studies suggest that it reduces excessive daytime sleepiness in patients with brain injury. This retrospective pilot study evaluated the effectiveness of Modafinil for people with a prolonged disorder of consciousness and whether those with a traumatic brain injury did better than those with a non-traumatic brain injury.

Method: Twenty four prolonged disorder of consciousness patients who were prescribed Modafinil, were assessed at least four times both before and during treatment. The Coma Recovery Scale-Revised was used to determine if patients had a disorder of consciousness and the Wessex Head Injury Matrix was used to monitor behavior during baseline and treatment periods. Patients with a traumatic brain injury (N?=?12) were compared with those with non-traumatic brain injury (N?=?12). A chi-square test with significance at 0.05 was used and when frequencies were below 5 a Fisher’s Exact Test was used.

Results: Cognitive improvements were noted in domains of wakefulness, awareness, concentration, tracking and following commands. Significant differences were found for the whole group between baseline and Modafinil (x^2?=^?9.80; p?=?0.002). Eleven of the 12 traumatic brain injury patients had higher Wessex Head Injury Matrix scores when on Modafinil (x^2?=^?8.33, p?p?=?0.29).

Conclusion: Modafinil appears to be beneficial for enhancing cognition in prolonged disorder of consciousness patients. Traumatic brain injury patients benefited more than non-traumatic brain injury patients.

• Implications for Rehabilitation

• People with prolonged disorders of consciousness are those in coma, a vegetative state or a minimally conscious state.

• Sensorimotor and neuromodulations (pharmacological and brain stimulation) are the available treatment strategies to this group.

• Modafinil promotes attention, concentration and maintains wakefulness in a patient with narcolepsy, obstructive sleep apnea and shift work sleep disorders.

• In a relatively small sample, this retrospective pilot study shows the effectiveness of Modafinil in conjunction with good care, suitable medications and multidisciplinary rehabilitation in enhancing arousal in prolonged disorders of consciousness patients.

     

Clock drawing and rehabilitation outcome in hip fracture patients

Purpose.?To assess the relationship between the Clock Drawing Test (CDT) and rehabilitation outcome in hip fracture patients within normal range of the Mini Mental State Examination (MMSE).

Methods.?This retrospective study was performed in a post-acute geriatric rehabilitation centre. One hundred and forty-two patients with proximal hip fracture admitted from January 2006 to June 2008 whose MMSE scores was within normal range (>23) were enrolled in the study. The patients were divided into two groups according to CDT performance (impaired versus intact). The differences between the two groups in relation to age, gender, education level, living arrangement, pre fracture functional level, fracture type, and outcome measurements [Functional Independent Measure (FIM), motor FIM, Rate of in-hospital Improvement (RI) in FIM and motor FIM, and Length of Stay (LOS)] were assessed.

Results.?Discharge FIM score and motor FIM scores were significantly lower for the impaired CDT group (89?±?13.7 vs. 94.9?±?11.6, p?=?0.007; 61.6?±?11.1 vs. 65.7?±?9.6, p?=?0.022 respectively); LOS was significantly longer (28.2?±?7.9 vs. 25.3?±?8.5, p?=?0.033) and rates of improvement in FIM and motor FIM were significantly slower (0.62?±?0.35 vs. 0.77?±?0.45, p?=?0.036; 0.61?±?0.34 vs. 0.75?±?0.42, p?=?0.033, respectively). Nevertheless, FIM and motor FIM scores changes were similar in both CDT groups. Following adjustment for age, LOS of patients with impaired CDT was significantly longer (p?=?.027).

Conclusions.?The CDT may assist the multidisciplinary team in identifying hip fracture patients whose MMSE scores are within the normal range, but yet need a longer training period to extract their rehabilitation potential.     

Service use and family-centred care in young people with severe cerebral palsy: a population-based,cross-sectional clinical survey

Abstract

Purpose: To assess healthcare use and family perception of family-centred care in children and young adults with severe cerebral palsy (CP) within a geographical region of the UK. Method: Young people (4–27years) with severe forms of CP; Gross Motor Function Classification System levels IV and V, were recruited via an established case register. Data were collected in the participant’s home using a standardised background proforma and validated questionnaires. The Measure of Processes of Care was used to assess the family’s perception of family-centred care. Results: One-hundred and twenty-three children, young people and their families/guardians participated. Results showed high accessing of specialist services in childhood with a considerable decrease in young adults. Use of generalist services remained relatively constant. The reported use of formal respite services and support groups/youth clubs was relatively poor. Family-centred care was poor in the area of “providing general information” (2.8?±?1.73) but more moderate in the areas of “providing specific information about the young person” (4.2?±?1.94), “enabling and partnership” (4.2?±?1.9), “co-ordinated and comprehensive care” (4.3?±?1.95) and “respectful and supportive care” (4.7?±?1.75). Conclusions: The accessing of specialist services and respite care notably decreases amongst adolescents with severe forms of CP and the perception of family-centred care amongst families was fair at best. In particular, the results highlight the need for families to be provided with more general information and advice.

• Implications for Rehabilitation

• In a quest to enhance the rehabilitation process in young people with severe forms of cerebral palsy:

• Commissioners and service providers need to a adopt a more rationalised, needs led approach to service provision across the lifespan of people with severe forms of cerebral palsy, to include an effective and efficient transitional period.

• Habilitation specialists working with young adults need to continue to recognise the importance of family-centred care in managing this complex and chronic condition.

• Professionals working within the healthcare system must provide better communication and improve their dissemination of information to the families of children and young people with complex needs.

     

Electronic aids to daily living and quality of life for persons with tetraplegia

Purpose.?To compare the satisfaction with quality of life (QOL) of adults with tetraplegia from spinal cord injury (SCI) who use and do not use electronic aids to daily living (EADLs).

Method.?This study used a cross-sectional design. Thirty-six persons with spinal cord injuries or conditions at or above C5/6 level participated. Fifteen participants used EADL at home and 21 formed the comparison group of non-users of EADL; all were living in the community. We used the Quality of Life Profile-Physical Disabilities (QOLP-PD) to examine participant's QOL.

Results.?Both groups rated the levels of importance of all aspects of QOL equally. The EADL users rated their satisfaction with QOL significantly higher for total QOLP-PD scores and for four of the nine domains, including all three domains of belonging. The groups did not differ in age, FIM scores, level of education, and hours of paid attendant care. The EADL user group had significantly more males than females, and had higher levels of SCI.

Conclusions.?EADLs appear to contribute to the experience of greater subjective QOL for persons with severe physical disability from high SCI. Prospective cohort studies designs that employ methods and analytic plans to study the causal effect of EADLs on QOL are recommended. The QOLP-PD was found to be a valid measure of QOL for this population.     

Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014

Objective: To explore the associations between general practitioners (GPs) characteristics such as gender, specialist status, country of birth and country of graduation and the quality of care for patients with type 2 diabetes (T2DM).

Design: Cross-sectional survey.

Setting and subjects: The 277 GPs provided care for 10082 patients with T2DM in Norway in 2014. The GPs characteristics were self-reported: 55% were male, 68% were specialists in General Practice, 82% born in Norway and 87% had graduated in Western Europe. Of patients, 81% were born in Norway and 8% in South Asia. Data regarding diabetes care were obtained from electronic medical records and manually verified.

Main outcome measures: Performance of recommended screening procedures, prescribed medication and level of HbA1c, blood pressure and LDL-cholesterol stratified according to GPs characteristics, adjusted for patient and GP characteristics.

Result: Female GPs, specialists, GPs born in Norway and GPs who graduated in Western Europe performed recommended procedures more frequently than their counterparts. Specialists achieved lower mean HbA1c (7.14% vs. 7.25%, p?p?=?0.018) and lower mean systolic blood pressure (133.0?mmHg vs. 134.7?mmHg, p?p?Conclusion: Several quality indicators for type 2 diabetes care were better if the GPs were specialists in General Practice.

• Key Points

• Research on associations between General Practitioners (GPs) characteristics and quality of care for patients with type 2 diabetes is limited.

• Specialists in General Practice performed recommended procedures more frequently, achieved better HbA1c and blood pressure levels than non-specialists.

• GPs who graduated in Western Europe performed screening procedures more frequently and achieved lower diastolic blood pressure compared with their counterparts.

• There were few significant differences in the quality of care between GP groups according to their gender and country of birth.

     

Evaluation of negative emotional care experiences in burn care

Aim and objective. To assess recollection of negative emotional experiences during burn care. Background. Patients in intensive care frequently report negative emotional experiences. Patients with severe burns who are treated in intensive care units undergo painful care procedures, but there have been no recent evaluations of their care experiences. Design. Former burn patients (n = 42) were randomly assigned to three groups: postal questionnaire, telephone interview and face‐to‐face interview. Methods. Assessments included negative care experiences (feelings of uncertainty, powerlessness, being afraid, insecure, being a nuisance, or neglected), severity of injury, patient satisfaction, personality traits and psychological symptoms. Results. Overall, the degree of recalled negative experiences was low and associated with greater severity of injury, more symptoms of post‐traumatic stress disorder and lower satisfaction with care. The feeling of powerlessness was the most common, as 67% of participants had such feelings to some extent. Conclusions. Overall, negative care experiences were uncommon and most prevalent among the severely injured. Such experiences were also associated with psychological symptoms and lower patient satisfaction. Relevance to clinical practice. Although relatively uncommon, negative emotional care experiences should be monitored more closely during care.     

The health-related quality of life of people living with HIV/AIDS

Purpose:?The prevalence of people living with HIV/AIDS (PLWA) in South Africa is estimated to be approximately 14.2% of the total population. In the absence of anti-retroviral therapy, PLWA are likely to experience a steady decline in function, as their immune systems become increasingly compromised. However, there is limited information available to determine the potential role of rehabilitation interventions in the management of PLWA in a resource-poor community.

Subjects:?Subjects were recruited from the population of beneficiaries of HIV/AIDS clinics run by Medecins Sans Frontières, which provides anti-retroviral therapy to PLWA within a resource poor community. The subjects, who were either in WHO Stage 3 or 4 of the disease and/or had a CD4 count of less than 200, were interviewed after enrolment on the anti-retroviral programme and before treatment was initiated. They were therefore not yet receiving anti-retroviral therapy. The control group consisted of a community sample randomly selected from the same area and who were in the same age range.

Methods:?As all participants were Xhosa speaking, the Xhosa version of the EQ-5D measure of HRQoL was utilized.

Analysis:?The Mann?–?Whitney U-test was used to determine whether there was a difference in the rank ordering of responses to the five different domains of the EQ-5D and the Visual Analogue Scale of Health Status scores.

Results:?There were 123 and 108 subjects in the experimental and control groups, respectively. In the domain of mobility 30.9% of the subjects reported some or severe problems, compared to 14.8% of the control group (p?<?0.001). The corresponding figures for the other domains were: self-care 14.8% and 4.6% (p?=?0.016), usual activity 31.7% and 10.2% (p?<?0.001), pain/discomfort 69.1% and 33.3% (p?<?0.001) and anxiety/depression 33.4% and 24.2% (p?=?0.123) for the experimental and control groups respectively. PLWA reported a VAS score of 60.4 (SD 22.1), which was significantly lower than that of the community sample (80.13, SD 20.4, p?<?0.001).

Conclusion:?Self-reporting indicates that Health Related Quality of Life is severely comprised in PLWA in Stages 3 and 4 and limitations in the four domains of mobility, usual activities, pain/discomfort and anxiety/depression constitute major problems for PLWA. There is an obvious need to provide a continuum of care, encompassing not only medical but also physical and mental rehabilitation services as well. In an area of high HIV prevalence, the provision of appropriate, multi-disciplinary health care services to PLWA presents a major challenge to the health services.     

Impairment and employment issues after nerve repair in the hand and forearm

Purpose.?To evaluate retrospectively subjective impairments, experienced disabilities, job and leisure restrictions and job changes in patients at least 2 years after repair of a peripheral nerve injury in the forearm, wrist or hand.

Methods.?Between January 1997 and January 2000, 125 patients were treated surgically for a peripheral nerve injury in the hand and forearm at the Department of Plastic Surgery of a University Hospital. Sixty-one patients met the inclusion criteria. Using a questionnaire the ability to return to work (RTW), the possible consequences on Activities of Daily Life (ADL) and Instrumental Activities of Daily Life (IADL), job, hobby and housekeeping related disabilities and subjective pain were assessed.

Results.?Forty of the 61 included patients returned the questionnaire. As a result of the injury, seven patients (19%) were not able to return to their own job and eight patients (20%) needed to quit or change their hobbies. Mean Time Off Work (TOW) was significantly longer (p?=?0.024) in non-digital nerve lesions (21.4 weeks) as compared to digital nerve lesions (9.5 weeks).

Conclusions.?From this study it was concluded that digital nerve lesions have little consequence on the ability to return to work and the time off work. However, the patients' hobbies are significantly affected. At least 2 years after the injury, the effects on ADL and IADL are minor.     

The value of the Rehabilitation Activities Profile (RAP) as a quality sub-system in rehabilitation medicine

Purpose:?To determine whether interdisciplinary team care, using the Rehabilitation Activities Profile (RAP) as a team tool, results in a better rehabilitation outcome.

Method:?A multilevel prospective cohort study, with a controlled before and after design. Eighteen rehabilitation teams in eight rehabilitation centres in the Netherlands and Belgium participated. Based on the level of implementation of the RAP, we compared three study groups. Consecutive adult patients (n?=?933) with stroke, amputation of the lower limb, spinal cord injury, multiple sclerosis, or other neuromuscular disorders, were followed during inpatient or outpatient rehabilitation. Main outcome measures were Barthel Index, RAP-CPM (sum score of the domains communication, personal care and mobility), Nottingham Health Profile (NHP), length of rehabilitation (LOR) and discharge destination (home vs elsewhere).

Results:?Overall results show that scores on the Barthel Index, the RAP-CPM and the NHP improved, on average, by 18.4%, 12.7%, and 6.7%, respectively. However, treatment from a rehabilitation team that uses the RAP was associated with a significantly lower Barthel score, and small, non-significant effects on the RAP-CPM and the NHP. Partial use of the RAP resulted in non-significant, lower scores on these measures. With respect to discharge destination and LOR, there were also no significant differences between the three study groups, with the exception of a shorter outpatient rehabilitation period for the group in which partial use was made of the RAP.

Conclusion:?The RAP, at the current level of implementation, does not improve rehabilitation outcome.     

Determination of the relationship between cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study

Abstract

Background: Hand dexterity is important for daily living activities and can be related to cognitive functions in patients with chronic obstructive pulmonary disease (COPD). Objective: The aim of this study was to investigate the relationship between cognitive dysfunction and hand dexterity in patients with COPD. Methods: 35 COPD patients and 36 healthy individuals were assessed. The Minnesota Hand Dexterity Test and Mini Mental State Examination (MMSE) were used for assessment of cognitive function and hand dexterity. Results: Hand dexterity test scores and cognitive function of COPD patients’ were significantly lower than the healthy group (p?<?0.01). The MMSE scores were negatively correlated with hand dexterity scores in the COPD group (p?<?0.05). Conclusions: There was a relationship between cognitive function and hand dexterity in the patients with COPD; however, hand dexterity did not alter according to hypoxemia severity. Hand dexterity which is important in daily living activities should be evaluated in greater detail with further studies in COPD patients.     

Autonomic cardiovascular control and sports classification in Paralympic athletes with spinal cord injury

Purpose To investigate the relationship between the classification systems used in wheelchair sports and cardiovascular function in Paralympic athletes with spinal cord injury (SCI). Methods 26 wheelchair rugby (C3–C8) and 14 wheelchair basketball (T3‐L1) were assessed for their International Wheelchair Rugby and Basketball Federation sports classification. Next, athletes were assessed for resting and reflex cardiovascular and autonomic function via the change (delta) in systolic blood pressure (SBP) and heart rate (HR) in response to sit-up, and sympathetic skin responses (SSRs), respectively. Results There were no differences in supine, seated, or delta SBP and HR between different sport classes in rugby or basketball (all p?>?0.23). Athletes with autonomically complete injuries (SSR score 0‐1) exhibited a lower supine SBP, seated SBP and delta SBP compared to those with autonomically incomplete injuries (SSR score?>1; all p?2?=^?1.63, p?=?0.20). Conclusion We provide definitive evidence that sports specific classification is not related to the degree of remaining autonomic cardiovascular control in Paralympic athletes with SCI. We suggest that testing for remaining autonomic function, which is closely related to the degree of cardiovascular control, should be incorporated into sporting classification.

• Implications for Rehabilitation

• Spinal cord injury is a debilitating condition that affects the function of almost every physiological system.

• It is becoming increasingly apparent that spinal cord injury induced changes in autonomic and cardiovascular function are important determinants of sports performance in athletes with spinal cord injury.

• This study shows that the current sports classification systems used in wheelchair rugby and basketball do not accurately reflect autonomic and cardiovascular function and thus are placing some athletes at a distinct disadvantage/advantage within their respective sport.

     

Life satisfaction and strain among informal caregivers of patients with traumatic brain injury in Malaysia

Purpose: This study aims to determine the life satisfaction and strain on informal caregivers when caring for traumatic brain injury (TBI) patients and to examine the factors predicting the level of strain among the informal caregivers.

Method: A cross-sectional survey on a purposive sampling was performed in a single centre in Malaysia recruiting caregivers of patients with TBI. Life Satisfaction Questionnaire-9 and Caregiver Strain Index questionnaires were used to ascertain the life satisfaction and strain of caregivers respectively. Relationship between life satisfaction and strain was analysed, together with factors significantly associated with strain.

Results: A total of 141 caregivers (77.3% women, average age of 46.1 years?±12.8 and mean duration of caregiving of 24.8 months?±?14.3) were included in the analysis. Most caregivers (75%) were satisfied with their lives but more than half claimed to have strain (57%). There was a significant relationship between life satisfaction and strain among the caregivers (p?p?=?0.04), presence of patient’s neurobehavioural disturbances (OR 4.48, 95% CI 1.60–12.55, p?=?0.004) and cognitive dysfunctions (OR 31.72, 95% CI 10.27–97.96, p?Conclusion: Caregivers with lower monthly income and caring for TBI patients with cognitive and neurobehavioural disturbances are at higher risk of developing strain. Rehabilitation interventions post-discharge should aim at supporting the caregivers at risk.

• Implications for Rehabilitation

• Informal caregivers of patients with traumatic brain injury who are not satisfied with their lives are most likely experiencing strain.

• Caregivers in Malaysia who are at high risk of experiencing strain are those with lower monthly income and care for patients with significant cognitive and neurobehavioural disturbances.

• Efforts to reduce strain in caregivers at risk should be included in the post-discharge rehabilitation programme in Malaysia.

     

Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale

Purpose:?We evaluated the Late-Life Function and Disability Instrument's (LLFDI) concurrent validity, comprehensiveness and precision by comparing it with the Short-Form-36 physical functioning (PF-10) and the London Handicap Scale (LHS).

Methods:?We administered the LLFDI, PF-10 and LHS to 75 community-dwelling adults (>?60 years of age). We used Pearson correlation coefficients to examine concurrent validity and Rasch analysis to compare the item hierarchies, content ranges and precision of the PF-10 and LLFDI function domains, and the LHS and the LLFDI disability domains.

Results:?LLFDI Function (lower extremity scales) and PF-10 scores were highly correlated (r?=?0.74???0.86, p?>?0.001); moderate correlations were found between the LHS and the LLFDI Disability limitation (r?=?0.66, p?<?0.0001) and Disability frequency (r?=?0.47, p?<?0.001) scores. The LLFDI had a wider range of content coverage, less ceiling effects and better relative precision across the spectrum of function and disability than the PF-10 and the LHS. The LHS had slightly more content range and precision in the lower end of the disability scale than the LLFDI.

Conclusions:?The LLFDI is a more comprehensive and precise instrument compared to the PF-10 and LHS for assessing function and disability in community-dwelling older adults.     

Comparison of subjective and objective assessments of outcome after traumatic brain injury using the International Classification of Functioning,Disability and Health (ICF)

Purpose.?The aim is to examine two aspects of outcome after traumatic brain injury (TBI). Functional outcome was assessed by the Glasgow Outcome Scale – Extended (GOSE) and by clinician ratings, while health-related quality of life (HRQoL) was assessed by the Quality of Life after Brain Injury (QOLIBRI).

Method.?The GOSE and the QOLIBRI were linked to the International Classification of Functioning, Disability and Health (ICF) to analyse their content. Functional outcome on ICF categories was assessed by rehabilitation clinicians in 55 participants with TBI and was compared to the participants' own judgements of their HRQoL.

Results.?The QOLIBRI was linked to 42 and the GOSE to 57 two-level ICF categories covering 78%% of the categories on the ICF brief core set for TBI. The closest agreement in the views of the professionals and the participants was found on the Physical Problems and Cognition scales of the QOLIBRI.

Conclusions.?The problems encountered after TBI are well covered by the QOLIBRI and the GOSE. They capture important domains that are not traditionally sufficiently documented, especially in the domains of interpersonal relationships, social and leisure activities, self and the environment. The findings indicate that they are useful and complementary outcome measures for TBI. In rehabilitation, they can serve as tools in assessment, setting meaningful goals and creating therapeutic alliance.     

Relationship between quality of life and functional status of young adults and adults with cerebral palsy

Purpose.?The aim of this study was investigate the relation between health related quality of life (HRQoL) and functional status in young adult or adult cerebral palsied individuals.

Methods.?The study included 45 cerebral palsied subjects who were divided into two groups as young adults (n?=?21, group 1) and adults (n?=?24, group 2), over the age 15 years. Gross Motor Function Classification System (GMFCS), Functional Independence Measurement (FIM), Physical Mobility Scale (PMS), Nottingham Health Profile (NHP), Visual Analogue Scale (VAS) were used as outcome measures.

Results.?In group 1, GMFCS and PMS scores were significantly correlated with total the total score of FIM (p?<?0.05). Although total FIM, PMS, LS and GMFCS scores were not correlated with the total NHP score (p?>?0.05), pain subscale of NHP was significantly correlated with self care and mobility subscales of FIM (p?<?0.05). Also, self care, mobility, locomotion subscales and total score of FIM were highly correlated with the physical activity subscale of NHP (p?<?0.05). In group 2, our findings were also similar to those of young adults when the relations between total NHP score and total FIM, PMS, LS and GMFCS were investigated (p?>?0.05) and also some subscales of FIM and NHP presented high correlations in between. In addition, there were significant differences between the groups in GMFCS, LS and locomotion and self care subscales of FIM (p?<?0.05).

Conclusion.?Although HRQoL in young cerebral palsied individuals seems to be more effected by parameters related to physical condition, in cerebral palsied adults psychological and emotional aspects may be more important indicators related to HRQoL. For that reasons, more population specific measures have to be developed for in-depth analysis of these factors.