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Participation in Daily Life: Influence on Quality of Life in Ambulatory Children with Cerebral Palsy
Background
Cerebral palsy (CP) is a chronic condition that affects children and has an impact on social and physical activity, as well as participation in daily life. Participation and quality of life (QOL) are 2 important measures of successful rehabilitation that have not been well studied in children with CP.Objective
To report levels of participation and examine the relationship of participation to QOL in ambulatory children with CP.Design
Secondary analysis, cross-sectional cohort study.Setting
Regional pediatric specialty care center.Participants
A cohort of 128 ambulatory children with CP, Gross Motor Function Classification System levels I-III, age 2-9 years.Interventions
Not applicable.Main Outcome Measures
Pediatric Quality of Life Inventory; Assessment of Life Habits; and Children’s Assessment of Participation and Enjoyment and Assessment of Preschool Children’s Participation.Results
Participation was negatively associated with increasing Gross Motor Function Classification System but not age. Level of participation was associated with psychosocial QOL (2.97, P = .001) and total QOL (54.70, P = .03) but not physical QOL. There was a positive relationship between physical activity performance (0.63, P = .001), walking performance (0.002, P = .01), and communication level (7.23, P = .05) with physical QOL. Increasing age and decreased frequency of participation were negatively associated with all QOL domains.Conclusions
The results suggest that participation in daily life is negatively influenced by physical impairment and that levels of participation are positively associated with psychosocial and total QOL among ambulatory children with CP. This suggests that participation influences QOL and further studies are needed to determine the aspects of participation directly impacting QOL in ambulatory children with CP.Level of Evidence
III 相似文献3.
Christian Larivière Dany H. Gagnon Sharon M. Henry Richard Preuss Jean-Pierre Dumas 《PM & R》2018,10(5):483-493
Background
Lumbar stabilization exercise programs (LSEP) produce positive effects on clinical outcomes, but the underlying mechanisms remain relatively unexplored. Psychological and neuromuscular mechanisms can be involved, such as a better activation of the lumbar multifidus, which represents one possibility.Objectives
To determine the following: (1) the effect of an LSEP on lumbar multifidus muscle thickness and activation, as measured with rehabilitative ultrasound imaging (RUSI), in patients with low back pain (LBP); (2) the correlation between RUSI measures and any change in clinical outcomes following the LSEP; and (3) the reliability of RUSI measures in control subjects over 8 weeks.Design
One-arm clinical trial with healthy subjects as a control group; reliability study.Setting
LSEP delivered in a clinical setting; outcomes measured in a laboratory setting.Participants
A total of 34 patients with nonacute LBP and 28 healthy control subjects.Methods
Outcomes were measured before and after an 8-week LSEP in patients with LBP, and at the same time interval (without treatment, to assess reliability) in control subjects.Main Outcome Measurements
Pain numeric rating scale, Oswestry Disability Index (function), as well as RUSI measures for the lumbar multifidus (LM) muscles at 3 vertebral levels (L5-S1, L4-5, and L3-4) during rest (static) and dynamic contractions (percent thickness change).Results
Patients did not show systematic changes in RUSI measures relative to controls, even though RUSI impairments were observed at baseline (dynamic measure at L5-S1) and even though patients had significant improvements in pain and disability. Correlational analyses with these clinical outcomes suggested that patients had reduced muscle thickness at baseline that was associated with a greater reduction in disability following LSEP; however, LM activation measured at baseline showed the opposite. Static RUSI measures showed excellent reliability at the L4-5 and L3-4 levels, whereas dynamic measures were not reliable.Conclusions
Patients showed less muscle activation than controls at baseline (L5-S1 level), but the LSEP did not normalize this impairment. The links between RUSI measures and the change in clinical outcomes during LSEP should be further explored.This clinical trial has been recorded in the International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry (ID: ISRCTN94152969).Level of Evidence
II 相似文献4.
Hsiu-Yun Hsu Chia-Wen Ke Ta-Shen Kuan Hsiu-Ching Yang Ching-Liang Tsai Li-Chieh Kuo 《PM & R》2018,10(2):146-153
Background
The presence of subtle losses in hand dexterity after stroke affects the regaining of independence with regard to activities of daily living. Therefore, awareness of ipsilesional upper extremity (UE) function may be of importance when developing a comprehensive rehabilitation program. However, current hand function tests seem to be unable to identify asymptomatic UE impairments.Objectives
To assess the motor coordination as well as the sensory perception of an ipsilesional UE using biomechanical analysis of performance-oriented tasks and conducting a Manual Tactile Test (MTT).Design
Case-controlled study.Setting
A university hospital.Participants
A total of 21 patients with unilateral stroke, along with 21 matched healthy control subjects, were recruited.Methods
Each participant was requested to perform a pinch?holding-up activity (PHUA) test, object-transport task, and reach-to-grasp task via motion capture, as well as the MTT.Main Outcome Measurements
The kinetic data of the PHUA test, kinematics analysis of functional movements, and time requirement of MTT were analyzed.Results
Patients with ipsilesional UE had an inferior ability to scale and produce pinch force precisely when conducting the PHUA test compared to the healthy controls (P < .05). The movement time was statistically longer and peak velocity was significantly lower (P < .05) in the performance-oriented tasks for the ipsilesional UE patients. The longer time requirement in 3 MTT subtests showed that the ipsilesional UE patients experienced degradation in sensory perception (P < .001).Conclusion
Comprehensive sensorimotor assessments based on functional perspectives are valid tools to determine deficits in the sensation-perception-motor system in the ipsilesional UE. Integration of sensorimotor training programs for ipsilesional UE in future neuro-rehabilitation strategies may provide more beneficial effects to regain patients’ motor recovery and to promote daily living activity independence than focusing on paretic arm motor training alone.Level of Evidence
III 相似文献5.
Megan Sutter Laiene Olabarrieta Landa Amilkar Calderón Chagualá Helmer Chacón Peralta Gina Vergara Torres Paul B. Perrin Juan Carlos Arango-Lasprilla 《PM & R》2017,9(1):8-14
Background
Stroke is a primary cause of death and disability in upper-middle–income countries such as Colombia. Given the lack of comprehensive rehabilitation for stroke patients in Colombia, there is a need to assess longitudinal mental health problems poststroke in this region.Objective
To compare the course of mental health in stroke patients to healthy controls over the first year poststroke in Ibague, Colombia.Design
Cross-sectional study.Setting
The Psychological Attention Center of Antonio Nariño University in Ibague, Colombia.Participants
Stroke patients (n = 50) and age- and gender-matched healthy controls (n = 50).Methods
Patients and controls completed self-report Spanish versions of demographic information, injury-related characteristics, and mental health questionnairesMain Outcome Measurements
Outcomes assessed included mental health (depression, anxiety, and stress) at 3, 6, and 12 months poststroke.Results
Hierarchical linear models suggested that stroke patients had worse depression and anxiety over time than controls (P < .001). Among patients, depression and anxiety decreased over time (P < .001), whereas stress increased over time (P < .01). The findings suggest that although anxiety and depression improved over time in stroke patients, their mental health remained significantly lower than that of controls.Conclusions
This is the first study to examine the course of mental health over the first year poststroke in Latin America, specifically in Ibague, Colombia. Despite the improvements in anxiety and depression over the first year poststroke, patient anxiety and depression were still worse in comparison to those in healthy controls. The current findings indicate a need for rehabilitation services in Colombia, especially targeting mental health issues.Level of Evidence
I 相似文献6.
Yong-Taek Lee Kwang-Soo Chun Kyung Jae Yoon Hee-Jin Park So-Yeon Lee Eugene Kim Young Sook Park Kyoung-Ho Seo 《PM & R》2018,10(2):137-145
Background
No study has investigated the relationship between the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) and the joint volume of the shoulder, which has been considered the standard reference for diagnosis of adhesive capsulitis (AC).Objective
To investigate the relationships among the capsulo-synovial thickness measured by CE-MRI, joint volume, and passive range of motion (ROM) in patients with AC.Design
This was a retrospective study.Setting
The study took place at an institutional practice.Patients
Medical record of 103 patients (46 male and 57 female), who were treated with sonographically guided intra-articular injection with diagnosis of AC and underwent CE-MRI to rule out other concomitant shoulder disease, were retrospectively reviewed.Methods
Passive ROM and glenohumeral joint (GHJ) volume were measured before and during sonographically guided injection. The thickness of the enhancing portion of the capsulo-synovium was measured at the axillary recess and rotator interval on CE-MRI.Main Outcome Measurements
The relationship among the thickness of the enhancing portion on CE-MRI, GHJ volume, and passive ROM was analyzed using the Pearson correlation coefficient.Results
Capsulo-synovial thickness measured by CE-MRI at the enhancing portion of the axillary recess inversely correlated with GHJ volume (ρ = ?0.444, P < .001), whereas at the rotator interval, this finding was not observed. At the axillary recess, the capsulo-synovial thickness inversely correlated with abduction (ρ = ?0.400, P < .001), forward elevation (ρ = ?0.378, P < .001), and external rotation (ρ = ?0.297, P < .01), but at the rotator interval, such statistically significant correlations were not shown.Conclusion
The capsulo-synovial thickness measured by CE-MRI at the enhancing portion of the axillary recess could represent obliterated joint capacity and clinical impairment (restricted passive ROM), which could help in diagnosing AC and in differentiating other shoulder diseases that may mimic this condition.Level of Evidence
III 相似文献7.
Heidi Prather Andrew Creighton Chris Sorenson Scott Simpson Maria Reese Devyani Hunt Monica Rho 《PM & R》2018,10(5):455-461
Background
In young and middle-aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety.Objective
The objective of this study was to compare assessments of insomnia and anxiety in young and middle-aged adults presenting with hip pain with no greater than minimal osteoarthritis (OA) compared to asymptomatic healthy controls. Comparisons between types of hip deformity and no hip deformity in hip pain patients were performed to assess whether patients with specific hip deformities were likely to have insomnia or anxiety as a cofounding disorder to their hip pain.Design
Prospective case series with control comparison.Setting
Two tertiary university physiatry outpatient clinics.Participants
A total of 50 hip pain patients aged 18-40 years and 50 gender- and age-matched healthy controls.Methods
Patients were enrolled if 2 provocative hip tests were found on physical examination and hip radiographs had no or minimal OA. Radiographic hip deformity measurements were completed by an independent examiner. Comparisons of insomnia and anxiety were completed between 50 hip pain patients and 50 controls and between patients with different types of hip deformity.Main Outcome Measures
Insomnia Severity Index (ISI) and Pain Anxiety Symptoms Scale (PASS).Results
A total of 50 hip pain patients (11 male and 39 female) with mean age of 31.2 ± 8.31 years enrolled. Hip pain patients slept significantly less (P = .001) per night than controls. Patients experienced significantly greater insomnia (P = .0001) and anxiety (P = .0001) compared to controls. No differences were found in insomnia and anxiety scores between hip pain patients with and without hip deformity or between different types of hip deformity.Conclusion
Hip pain patients with radiographs demonstrating minimal to no hip arthritis with and without hip deformity experience significant cofounding yet modifiable disorders of sleep and anxiety. If recognized early in presentation, treatment of insomnia and anxiety ultimately will improve outcomes for hip patients treated either conservatively or surgically for their hip disorder.Level of Evidence
II 相似文献8.
Xue-Cheng Liu David Embrey Channing Tassone Kim Zvara Brenna Brandsma Roger Lyon Karin Goodfriend Sergey Tarima John Thometz 《PM & R》2018,10(3):269-275
Background
Orthoses commonly are prescribed to children with cerebral palsy (CP) to provide foot correction and to improve ambulatory function. Immediate effects of ankle foot orthosis (AFOs) have been investigated, but long-term kinematic effects are lacking clinical evidence.Objective
To determine changes in 3-dimensional ankle and foot segment motion in pediatric patients with CP between initial and follow-up visits (18-month average time differences) in both barefoot gait and gait with their AFO. We also investigated intravisit changes between barefoot and AFO gait.Design
A prospective cohort study.Setting
Children’s Hospital of Wisconsin, Department of Orthopaedic Surgery, Medical College of Wisconsin.Patients
A total of 23 children with CP, mean age 10.5 years (6.2-18.1 years) were clinically prescribed either a solid ankle foot orthotic (SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic.Methods
Holes were cut in the study orthoses so that electromagnetic markers could be directly placed on the skin. A 6-foot segment model was used.Outcome Measurements
Kinematic and kinetic data were recorded for each patient’s initial and follow-up visit (18-month follow-up average, 15-20 months range).Results
For the SAFO group (gait with AFO), a significant decrease in dorsiflexion was found between the initial and third visit (P = .008). Furthermore, the SAFO group (barefoot gait) had an increased eversion at the midfoot for most of the gait cycle (P < .008). Sagittal forefoot range of motion was reduced for all 3 groups between the barefoot and AFO groups.Conclusion
The use of AFOs long term either maintained or improved foot deformities or dysfunction.Level of Evidence
Level II. 相似文献9.
Nobushige Takahashi Hidetoshi Takahashi Osamu Takahashi Ryosuke Ushijima Rie Umebayashi Junji Nishikawa Yasutomo Okajima 《PM & R》2018,10(2):168-174
Background
Spasticity is a common sequela of upper motor neuron pathology, such as cerebrovascular diseases and cerebral palsy. Intervention for spasticity of the ankle plantarflexors in physical therapy may include tone-inhibiting casting and/or orthoses for the ankle and foot. However, the physiological mechanism of tone reduction by such orthoses remains unclarified.Objective
To investigate the electrophysiologic effects of tone-inhibiting insoles in stroke subjects with hemiparesis by measuring changes in reciprocal Ia inhibition (RI) in the ankle plantarflexor.Design
An interventional before–after study.Setting
Acute stroke unit or ambulatory rehabilitation clinic of a university hospital in Japan.Participants
Ten subjects (47-84 years) with hemiparesis and 10 healthy male control subjects (31-59 years) were recruited.Methods
RI of the spastic soleus in response to the electrical stimulation of the deep peroneal nerve was evaluated by stimulus-locked averaging of rectified electromyography (EMG) of the soleus while subjects were standing.Main Outcome Measurements
The magnitude of RI, defined as the ratio of the lowest to the baseline amplitude of the rectified EMG at approximately 40 milliseconds after stimulation, was measured while subjects were standing with and without the tone-inhibiting insole on the hemiparesis side.Results
Enhancement of EMG reduction with the tone-inhibiting insole was significant (P < .05) in the subjects with hemiparesis, whereas no significant changes were found in controls.Conclusion
Tone-inhibiting insoles enhanced RI of the soleus in subjects after stroke, which might enhance standing stability by reducing unfavorable ankle plantarflexion tone.Level of Evidence
III 相似文献10.
11.
Adam G. Culvenor Brooke E. Patterson Ali Guermazi Hayden G. Morris Timothy S. Whitehead Kay M. Crossley 《PM & R》2018,10(4):349-356
Background
A timely return to competitive sport is a primary goal of anterior cruciate ligament reconstruction (ACLR). It is not known whether an accelerated return to sport increases the risk of early-onset knee osteoarthritis (KOA).Objective
To determine whether an accelerated return to sport post-ACLR (ie, <10 months) is associated with increased odds of early KOA features on magnetic resonance imaging (MRI) 1 year after surgery and to evaluate the relationship between an accelerated return to sport and early KOA features stratified by type of ACL injury (isolated or concurrent chondral/meniscal injury) and lower limb function (good or poor).Design
Cross-sectional study.Setting
Private radiology clinic and university laboratory.Participants
A total of 111 participants (71 male; mean age 30 ± 8 years) 1-year post-ACLR.Methods
Participants completed a self-report questionnaire regarding postoperative return-to-sport data (specific sport, postoperative month first returned), and isotropic 3-T MRI scans were obtained.Outcome Measures
Early KOA features (bone marrow, cartilage and meniscal lesions, and osteophytes) assessed with the MRI OA Knee Score. Logistic regression analyses evaluated the odds of early KOA features with an accelerated return to sport (<10 months post-ACLR versus ≥10 months or no return to sport) in the total cohort and stratified by type of ACL injury and lower limb function.Results
Forty-six (41%) participants returned to competitive sport <10 months post-ACLR. An early return to sport was associated with significantly increased odds of bone marrow lesions (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-6.0) but not cartilage (OR 1.2, 95% CI 0.5-2.6) or meniscal lesions (OR 0.8, 95% CI 0.4-1.8) or osteophytes (OR 0.6, 95% CI 0.3-1.4). In those with poor lower limb function, early return to sport exacerbated the odds of bone marrow lesions (OR 4.6, 95% CI 1.6-13.5), whereas stratified analyses for type of ACL injury did not reach statistical significance.Conclusion
An accelerated return to sport, particularly in the presence of poor lower limb function, may be implicated in posttraumatic KOA development.Level of evidence
IV 相似文献12.
13.
Jung Hwan Ahn Doo-Hyung Lee Hyuncheol Kang Michael Y. Lee Dae Ryong Kang Seung-Hyun Yoon 《PM & R》2018,10(1):19-27
Background
Intra-articular corticosteroid injection is a commonly used therapy for adhesive capsulitis, but not enough studies exist on the optimal timing of the injection.Objective
To determine whether intra-articular corticosteroid injection has better outcomes in patients with earlier stage than later stage of adhesive capsulitis.Study Design
Retrospective longitudinal studySetting
University-affiliated tertiary care hospital.Participants
Primary adhesive capsulitis patients (n=339) who were unresponsive to at least 1 month of conservative treatment and who had ultrasound-guided corticosteroid injection.Interventions
Not applicable.Main Outcome Measurements
Visual analogue scale, Shoulder Pain and Disability Index, and passive range of motion (flexion, abduction, external rotation, and internal rotation and extension) were evaluated at pretreatment, month 1 and 12 after the first injection.Results
The result of the multiple regressions, which considered the main and the interaction effect of confounding variables, showed that the differences of all outcomes in both short-term effect at month 1 and long-term effect at month 12 are greater when the duration of pain prior to injection is shorter. Among the confounders, the injection number in the difference of internal rotation and extension between month 0 and 12 (IRE Δ(0-12)) was statistically significant. IRE Δ(0-12) was also greater when the pain duration was shorter, though the decrease in IRE Δ(0-12) differed depending on the number of injections.Conclusions
Early injection improves outcomes of adhesive capsulitis at both short- and long-term follow-ups. If pain persists despite non-invasive and conservative treatments, early injection may be considered to shorten its natural history.Level of Evidence
III 相似文献14.
Background
Depression and traumatic brain injury (TBI) substantially contribute to the U.S. health care burden. Depression is a known risk factor for prolonged recovery after TBI. However, the effect of depression treatment on health care utilization has yet to be studied.Objective
To examine whether an association exists between pharmacologic treatment of depression at the time of mild or concussive TBI and the number of subsequent clinician visits for persistent injury-related symptoms.Design
Retrospective medical record review.Setting
Tertiary care medical center.Participants
A total of 120 patients (mean age 45.6 years) with a history of depression who subsequently experienced a mild or concussive TBI were included.Methods
Individuals were identified with co-occurring diagnoses of depression and mild or concussive TBI by retrospective electronic medical record review. The diagnosis of depression must have preceded the diagnosis of TBI.Main Outcome
The number of clinician visits for postinjury symptoms were counted at 3, 6, and 12 months postinjury.Results
Clinician visits for persistent injury-related symptoms were significantly fewer at all 3 time points for the group treated for depression at time of injury.Conclusions
Depressed individuals who were pharmacologically treated for depression at the time of TBI had significantly fewer clinician visits for persistent postinjury symptoms than those not pharmacologically treated for depression at the time of injury. Routine depression screening in patients with a high risk for TBI may identify a mood disorder that could contribute to persistent symptoms if left untreated, with its effective management potentially reducing health-related costs.Level of Evidence
III 相似文献15.
16.
Background
Women are at greater risk for knee osteoarthritis and numerous other lower limb musculoskeletal disorders. Arch drop during pregnancy and the resultant excessive pronation of the feet may alter loading patterns and contribute to the greater prevalence of knee osteoarthritis in women.Objective
To determine the effect of arch drop on tibial rotation and tibiofemoral contact stress.Design
Interventional study with internal control.Setting
Biomechanics laboratory.Participants
Eleven postpartum women (age 33.4 ± 5.3 years, body mass 76.1 ± 13.5 kg) who had lost arch height with pregnancy in a previous study.Methods
Subjects underwent standing computed tomography (SCT) with their knees in a 20° fixed-flexed position with and without semirigid arch supports to reconstitute prepregnancy arch height. Magnetic resonance imaging of the knee was acquired at a flexion angle equivalent to that of SCT. Bone and cartilage were manually segmented on the magnetic resonance images and segmented surfaces were registered to the 3-dimensional SCT image sets for the arch-supported and -unsupported conditions. These models were used to measure changes in tibial rotation, as well as to estimate contact stress in the medial and lateral tibiofemoral compartments, using computational methods.Main Outcome Measures
Change in tibial rotation and tibiofemoral contact stress with arch drop.Results
Arch drop resulted in a mean tibial internal rotation of 0.75 ± 1.33° (P = .02). Changes in mean or peak contact stress were not detected.Conclusions
Arch drop causes internal tibial rotation, resulting in a shift in the tibiofemoral articulation. An associated increase in contact stress was not detected. Internal rotation of the tibia increases stress on the anterior cruciate ligament and menisci, potentially explaining the greater prevalence of knee disorders in postpartum women.Level of Evidence
NA 相似文献17.
Andrea R.S. Huebner Amy Cassedy Tanya M. Brown H. Gerry Taylor Terry Stancin Michael W. Kirkwood Shari L. Wade 《PM & R》2018,10(5):462-471
Background
Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.Objective
To examine adolescents’ use of mental health services after TBI.Design
Secondary analysis from multicenter prospective randomized controlled trial.Setting
Five level 1 U.S. trauma centers.Participants
Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).Methods
Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.Main Outcome Measurements
Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.Results
Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.Conclusions
Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.Level of Evidence
II 相似文献18.
Cameron J.B. Cunningham Heather C. Finlayson William R. Henderson Russell J. O’Connor Andrew Travlos 《PM & R》2018,10(5):494-500
Background
Critical illness polyneuromyopathy (CIPNM) increasingly is recognized as a source of disability in patients requiring intensive care unit (ICU) admission. The prevalence and impact of CIPNM on patients in the rehabilitation setting has not been established.Objectives
To determine the proportion of at-risk rehabilitation inpatients with evidence of CIPNM and the functional sequelae of this disorder.Design
Prospective observational study.Setting
Tertiary academic rehabilitation hospital.Patients
Rehabilitation inpatients with a history of ICU admission for at least 72 hours.Methods
Electrodiagnostic studies were performed to evaluate for axonal neuropathy and/or myopathy in at least one upper and one lower limb.Main Outcome Measurements
The primary outcome was prevalence of CIPNM. Secondary outcomes included Functional Independence Measure (FIM) scores, rehabilitation length of stay (RLOS), and discharge disposition.Results
A total of 33 participants were enrolled; 70% had evidence of CIPNM. Admission FIM score, discharge FIM, FIM gain, and FIM efficiency were 64.1, 89.9, 25.5, and 0.31 in those with CIPNM versus 78.4, 94.6, 16.1, and 0.33 in those without CIPNM, respectively. Average RLOS was 123 days versus 76 days and discharge to home was 57% versus 90% in the CIPNM and non-CIPNM groups, respectively.Conclusions
CIPNM is very common in rehabilitation inpatients with a history of ICU admission. It was associated with a lower functional status at rehabilitation admission, but functional improvement was at a similar rate to those without CIPNM. Longer RLOS stay may be required to achieve the same functional level.Level of Evidence
III 相似文献19.
Kelly L.D. Pham Kristie F. Bjornson Marisa Osorio Kathryn B. Whitlock Teresa L. Massagli 《PM & R》2018,10(6):594-600
Background
The incidence of contact isolation for multidrug-resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation.Objective
To determine whether the use of a modified contact isolation protocol (MCI) resulted in noninferior functional outcomes compared with children without contact isolation (NCI) on inpatient rehabilitation.Design
This is a retrospective noninferiority study.Setting
One academically affiliated pediatric inpatient rehabilitation unit located in a children’s hospital.Patients
All children with any diagnosis admitted to inpatient rehabilitation from January 1, 2007, to December 31, 2014.Methods or Interventions
We compared functional outcomes for 2 groups of children.Main Outcome Measurements
Primary outcome measures included the Functional Independence Measure for Children (WeeFIM) efficiency and the change in the Developmental Functional Quotient (DFQ) for the WeeFIM. Noninferiority margins of 0.63 for the WeeFIM efficiency and 0.092 for the change in DFQ for the WeeFIM were used.Results
There were a total of 949 patients of whom 899 were NCI, 48 MCI, and 2 excluded due to missing information. Patients with MCI had functional outcomes that were noninferior to those with NCI including the WeeFIM efficiency (mean difference 0.002, 95% CI –0.38 to 0.404) and the change in DFQ for the WeeFIM (mean difference –0.05, 95% CI –0.058 to 0.003).Conclusions
The modified contact isolation protocol, having resulted in noninferior functional outcomes in inpatient rehabilitation may provide adequate contact isolation while allowing for noninferior functional outcomes. This may be a guide in the face of an ever-increasing need for contact isolation.Level of Evidence
III 相似文献20.