Concomitant injuries and its influence on functional outcome after traumatic brain injury

Abstract

Purpose: This study aims to describe the presence and severity of extracranial concomitant injuries in traumatic brain injury (TBI) patients and to ascertain their effect on long-term functional outcome.

Method: A retrospective cohort study was performed in a single-center recruiting patients with first episode of TBI. The types and severity of extracranial concomitant injuries were documented for patients who fulfilled the inclusion criteria. Injuries with Abbreviated Injury Scale (AIS) grade 3–6 were considered to be high grade. A cross-sectional functional assessment was conducted at 18 months post-injury using Glasgow Outcome Scale.

Results: A total of 100 patients were included in the analysis. Extracranial concomitant injuries were seen in 78% of the patients. Three commonest injuries were facial (44%), lower extremity (20%) and upper extremity (12%) injuries. Among the AIS grade?≥?3, injury involving the chest was most common (41%). Presence of extracranial concomitant injuries AIS grade?≥?3 was significantly associated with disability in TBI patients at 18 months (OR 12.74, 95% CI 2.39–67.95, p?=?0.003).

Conclusion: Presence of extracranial concomitant injuries was high. In TBI survivors, extracranial concomitant injuries AIS grade?≥?3 influenced the long-term functional outcome at 18 months, causing moderate and severe disabilities.

• Implications for Rehabilitation

• Concomitant injuries should be suspected in patients with traumatic brain injury, especially in a high-speed trauma mechanisms as the incidence can be as high as 78% as in this study and may interfere with the long term rehabilitation and outcome.

• This study shows that severe extra cranial concomitant injuries are associated with a poor long term functional outcome even in the mild traumatic brain injury patients and therefore need to be addressed early in the rehabilitation of this group of patients.

• Early diagnosis and management of severe concomitant injuries is warranted and may improve the functional gains in the long term after traumatic brain injury.

     

Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction

Purpose: This study examined the role of anxiety and upper limb dysfunction, amongst other variables, as predictors of health related quality of life (HRQOL) 6 months after stroke. Method: Participants: Stroke survivors (n = 85) who had previously participated in a randomised controlled trial of a physiotherapy intervention. Dependent variable: HRQOL – Nottingham Health Profile (NHP). Predictor variables: Mood – Hospital Depression and Anxiety Scale; Upper Limb Functioning - Action Research Arm Test; Rivermead Motor Assessment; Activities of Daily Living – Modified Barthel Index; Clinical and demographic factors. Results: Anxiety and depression significantly predicted 49% of variance in overall HRQOL (p < 0.05), but only anxiety significantly predicted NHP pain (13% variance, p < 0.001), emotional reactions (41% variance, p < 0.001), sleep (19% variance, p = 0.02) and social isolation (23% variance, p = 0.02). Depression and anxiety together significantly predicted 30% variance in energy level (p < 0.001). UL motor impairment and activities of daily living predicted 36% of variance in NHP physical activity score (p < 0.001). Conclusions: This study indicates that where anxiety is assessed, it appears more important in determining HRQOL than depression. UL impairment and ADL independence predicted perceived physical activity. Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL.

Implications for Rehabilitation

• Anxiety is a major predictor of quality of life six months after stroke.

• Post-stroke anxiety should be routinely assessed in rehabilitation.

• Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period.

• Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke.

• Rehabilitation of the upper limb should continue into the chronic post-stroke period.

     

Children’s contact with people with disabilities and their attitudes towards disability: a cross-sectional study

Purpose: To explore the association between children’s self-reported contact with people with disabilities and attitudes towards them, as well the potential mediating influence of anxiety about interacting with people with disabilities and empathy for them. Method: 1881 children, aged 7–16 years, from 20 schools in South West England completed a survey assessing their contact with people with disabilities and their attitudes towards them. Anxiety about interacting with people with disabilities and empathy towards them were examined as potential mediators. Gender, school year, perceived similarity between people with and without disabilities, proportion of children with additional needs at the school and socioeconomic status (SES) were assessed as moderators. A random effects (“multilevel”) regression model was used to test the contact–attitude association and moderation, and path analysis was used to test for mediation. Results: Participants with more self-reported contact reported more positive attitudes towards disability (p?Conclusions: Self-reported contact was observed to be associated with more positive attitudes towards disability, which was partially mediated by empathy and anxiety. Providing opportunities for contact with people with disabilities that reduces anxiety and increases empathy may improve attitudes to disability and merits evaluation in interventions.

• Implications for Rehabilitation

• Children who reported greater levels of contact with people with disabilities had more positive attitudes towards disability.

• Anxiety about interacting with people with disabilities and empathy towards them partially mediated the contact–attitude associations.

• Providing opportunities for contact with people with disabilities, reducing anxiety and increasing empathy may improve children’s attitudes to disability.

     

Clinical practice guidelines for the management of conditions related to traffic collisions: a systematic review by the OPTIMa Collaboration

Abstract

Objective: To evaluate the methodological quality and synthesize recommendations of evidence-based guidelines for the management of common traffic injuries. Study design: We conducted a systematic review and best evidence synthesis of guidelines on musculoskeletal injuries, psychological disorders and mild traumatic brain injuries (MTBI) from 1995 to 2012. Independent reviewers critically appraised eligible guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) criteria. Results: We retrieved 9863 citations. Of those, 16 guidelines were eligible for critical appraisal and eight were scientifically admissible (four targeting whiplash-associated disorders (WAD), one addressing anxiety and three addressing MTBI). The inadmissible guidelines had inadequate literature searches, inexplicit links between evidence and recommendations, and ambiguous recommendations. The literature used to develop most of the admissible guidelines was outdated. Major recommendations included: (1) Advice, education and reassurance for all conditions; (2) Exercise, return-to-activity, mobilization/manipulation, analgesics and avoiding collars for WAD; (3) Psychological first aid, pharmacotherapy and cognitive behavioral therapy as first-line interventions for anxiety; and (4) Monitoring for complications, discharge criteria, advice upon discharge from the emergency room and post-discharge care for MTBI. Conclusion: Fifty percent of appraised guidelines were scientifically admissible, but most need updating. Most guidelines focus on WAD and MTBI. Few guidelines make comprehensive recommendations on a wide range of consequences from traffic collisions.

• Implications for Rehabilitation

• The core components of a program of care designed to manage common traffic injuries (whiplash-associated disorders – WAD, anxiety and mild traumatic brain injuries) should include advice, education and reassurance.

• Depending on the condition, the following specific interventions should be considered: (1) WAD: exercise, early return to activity, mobilization/manipulation, analgesics and avoidance of collars; (2) Anxiety: psychological first aid, pharmacotherapy and cognitive behavioral therapy; and (3) Mild traumatic brain injuries: use of specific discharge criteria (including no factors warranting hospital admission and support structures for subsequent care), education upon discharge from emergency room and post-discharge care (e.g. monitoring for complications, gradual return to normal activity based on tolerance of individual).

• The methodological quality of guidelines varies greatly; therefore, guideline developers need to adhere to established methodological standards and conform to the evaluation criteria outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.

     

Assessing the impact of upper limb disability following stroke: a qualitative enquiry using internet-based personal accounts of stroke survivors

Purpose: Upper limb disability following stroke may have multiple effects on the individual. Existing assessment instruments tend to focus on impairment and function and may miss other changes that are personally important. This study aimed to identify personally significant impacts of upper limb disability following stroke. Methods: Accounts by stroke survivors, in the form of web-based diaries (blogs) and stories, were sought using a blog search engine and in stroke-related web-sites. Thematic analysis using the World Health Organisation’s International Classification of Functioning Disability and Health (ICF) was used to identify personal impacts of upper limb disability following stroke. Results: Ninety-nine sources from at least four countries were analysed. Many impacts were classifiable using the ICF, but a number of additional themes emerged, including emotional, cognitive and behavioural changes. Blogs and other web-based accounts were easily accessible and rich sources of data, although using them raised several methodological issues, including potential sample bias. Conclusions: A range of impacts was identified, some of which (such as use of information technology and alienation from the upper limb) are not addressed in current assessment instruments. They should be considered in post-stroke assessments. Blogs may help in the development of more comprehensive assessments.

• Implications for Rehabilitation

• A comprehensive assessment of the upper limb following stroke should include the impact of upper limb problems on social participation, as well as associated emotional, cognitive and behavioural changes.

• Using personalised assessment instruments alongside standardised measures may help ensure that these broader domains are considered in discussions between clinicians and patients.

• Rehabilitation researchers should investigate whether and how these domains could be addressed and operationalised in standard upper limb assessment instruments.

     

Hierarchy of higher-level physical functions: a longitudinal investigation on a nationally representative population of community-dwelling middle-aged and elderly persons

Purpose: Understanding the hierarchy of higher-level physical functions to infer disability level (mild, moderate or severe) is essential for the precise targeting of preventive interventions and has been examined previously in a cross-sectional study. Based on longitudinal data, this study evaluated the hierarchy of higher-level physical functions. Methods: Data from a cohort of 2729 community-dwelling persons aged over 50 with no initial disability were drawn from the “Survey of Health and Living Status of the Elderly in Taiwan” from 1996 through 2007. The three-level hierarchy of eight chosen activities was examined by the median ages to disability onset with survival analyses and by Cox regressions, which examined the effects of sex and age on the development of this hierarchy. Results: The progression of incident disability was as follows: mild level-running, carrying weight, and squatting; moderate level-climbing stairs, walking, and standing; and severe level-grasping and raising arms up. Women and older persons were at greater risk of developing more severe levels of disability. Another Cox regression with one index activity from each hierarchical level revealed similar results. Conclusions: The three-level hierarchy of higher-level physical functions has been validated longitudinally, suggesting rich research and clinical implications.

Implications for Rehabilitation

• Higher-level physical functions demand greater challenges than the activities of daily living.

• This longitudinal study, based on nationally representative data, has validated a three-level hierarchy of higher-level physical functions.

• This three-level hierarchy forms a basis of rapidscreening of high-risk people eligible for preventive interventions, which may help to reverse disability status or to prevent progression of disability.

• Future work could investigate the effects of focused targeting of people with different levels of disability to administer preventive interventions.

     

Documenting outdoor activity and travel behaviour in persons with neurological conditions using travel diaries and GPS tracking technology: a pilot study in multiple sclerosis

Abstract

Objective: Persons with multiple sclerosis (PwMS) experience several physical and cognitive problems which can influence their travel behaviour. This study aimed to document the number of activities, the activity type and the transport mode of the related trips that are daily made by PwMS. Their outdoor activity and travel behaviour was studied in relation to disease-related disability. Methods: Thirty six PwMS (Expanded Disability Status Scale, EDSS, 1.5–8.0, age 27–63) and 24 healthy controls (age 25–62) were studied, using activity-related travel diaries and GPS tracking devices. Information about overall disability characteristics was gained by standard clinical tests and questionnaires. PwMS were further divided in three subgroups based on EDSS cut-off scores 4.5 and 6.5. Results: Persons with mild ambulatory dysfunction (EDSS 1.5–4.0, n?=?17) showed similar travel characteristics to healthy controls, with few restrictions during travelling. Statistically significant changes in activity and travel behaviour were detected in the moderate (EDSS 4.5–6.5, n?=?8) and severe MS subgroups (EDSS?>?6.5–8.0, n?=?11) compared with healthy controls: driving independently became less frequent, significant more trips were made with company and the duration of performed activities had increased. Conclusion: The combination of self-reported travel diaries and objective GPS loggers offered detailed information about the actual outdoor travel behaviour of PwMS, which was significantly changed in PwMS with EDSS greater than 4.

• Implications for Rehabilitation

• Activity and travel behaviour changes significantly in persons with multiple sclerosis (MS) with moderate to severe disability (EDSS greater than 4).

• Behavioural therapy could help to develop better coping and problem-solving skills to overcome anxiety in the making of trips by persons with MS with a mild severity.

• Enhancing community environments could serve as a promising approach to increase the outdoor participation of persons with (more severe) impairments.

     

Targeted rehabilitation reduces visual dependency and improves balance in severe traumatic brain injury: a case study

Purpose: To further understand the mechanisms underlying gait impairment following traumatic brain injury.

Case report: A 58-year-old man presented with marked unsteadiness and motion sensitivity following a severe traumatic brain injury. He underwent a 6-week inpatient rehabilitation program focused on re-weighting and subsequently re-integrating ascending interoceptive information, by gradual reduction of maladaptive visual fixation techniques. We report clinical neurological outcomes and measures of functional outcome, as well as an objective assessment of visual dependency (the rod and disk test) at baseline and after the rehabilitation.

Results: Clinically, the patient had gait unsteadiness exacerbated by visual motion. A significant reduction in visual dependency occurred with tailored multi-disciplinary rehabilitation via gradual removal of visual fixation strategies that the patient had developed to maintain balance (t-test; p?Conclusions: We highlight the importance of visual dependency in the generation of maladaptive gait strategies following brain injury. Our data suggest assessing and treating visual dependency to be an important component of gait rehabilitation after traumatic brain injury.

• Implications for rehabilitation

• Whilst gait disturbance in TBI is multifactorial, abnormal visual dependency may be important but under-recognised component of the disorder.

• Visual dependency can be easily and objectively assessed by the bedside in patients using a dynamic rod and disc test.

• Tailored rehabilitation with gradual reduction of maladaptive visual fixation can reduce visual dependency and contribute to improved gait and balance following TBI.

     

Mediators of disability and hope for people with spinal cord injury

Purpose: To test potential strength-based mediators of functional disability and hope in adults with spinal cord injury. Method: Two hundred and forty-two participants with spinal cord injury were recruited for this study. The mean age of participants was 44.6 years (standard deviation?=?13.2), and 66.1% were men. Participants completed a survey containing a demographic questionnaire, as well as measures of functional disability, hope, self-esteem, proactive coping, perceived social support and disability acceptance. Mediation analysis was conducted using a bootstrap test for multiple mediators. Results: Proactive coping, self-esteem and perceived social support significantly mediated the relationship between functional disability and hope, while disability acceptance did not. The combination of mediators resulted in functional disability no longer being a significant predictor of hope. Conclusions: The strength-based constructs of proactive coping, self-esteem and social support appear effective in predicting hope regardless of severity of spinal cord injury. Functional disability was no longer predictive of hope after controlling for these strength-based constructs. Disability acceptance did not significantly add to the mediation model. These results provide further evidence for strength-based interventions in rehabilitation.

• Implications for Rehabilitation

• Strength-based constructs of proactive coping, self-esteem and social support are important factors for addressing hope following spinal cord injury, regardless of level of severity.

• Rehabilitation services providers should focus efforts on supporting clients in the accurate appraisal of predictable stressors and then generate means for addressing them as a form of proactive coping.

• Rehabilitation services providers must be cautious when addressing self-esteem to focus on perceived competence and learning processes rather than self-esteem directly or through the accomplishment of goals that may not be achieved.

• Knowing that social supports are related to hope post-spinal cord injury, it is important for rehabilitation services providers to recognize potential social supports early in the rehabilitation process and involve those social supports in the rehabilitation process when possible.

     

The accuracy of adult recall for early mild traumatic brain injury

Background: Childhood mild traumatic brain injury (mTBI) has been associated with negative adult outcomes. Effective interventions require identification of the injury event. There is currently little information regarding the accuracy of adult recall of childhood mTBI.

Method: Prospectively collected information from a large birth cohort was used to examine adult recall accuracy at age 25 for 161 childhood mTBI events occurring before age 10.

Results: At age 25 cohort members recalled 11 outpatient injuries and 16 inpatient injuries. Recall accuracy increased with age. Logistic regression analysis distinguished between respondents who reported and did not report a childhood mTBI event correctly classifying 84.5% of cases. Age at injury, injury severity and loss of consciousness (LoC) made a unique statistically significant contribution to the model.

Conclusions: Most childhood mTBI events are not recalled in adulthood. Age at injury, injury severity and LoC significantly increase likelihood of recall and should be used in measures that evaluate whether injury has occurred.

• Implications for rehabilitation

• Traumatic brain injury occurs frequently and often results in ongoing deficits in attention, concentration, executive function and later mental health problems.

• Identification of a history of traumatic brain injury is essential to ensure that appropriate rehabilitative input is provided.

• Rehabilitation professionals need to be aware that mental health problems may be secondary to a prior traumatic brain injury.

• It is important for rehabilitation professionals elicit an accurate history of traumatic brain injury to ensure that their treatment plans are tailored to the needs of this group.

     

Young adults with intellectual disability transitioning from school to post-school: A literature review framed within the ICF

Purpose: The purpose of this review was to describe literature relating to transition for young people with an intellectual disability and identify gaps within the current knowledge base. Method: A narrative literature review was undertaken. Searches of databases Medline, CINAHL, PsycINFO, ERIC, ISI Web of Science and ProQuest 500 International provided relevant research articles. The search terms used were intellectual disability, transition, employment, and ICF as well as other terms derived from the ICF. Manual searches of reference lists identified additional studies. Furthermore, government websites were searched for relevant reports and policies. Results: Transition literature was explored by ICF domains; body functions and structures, activity and participation and contextual factors. Studies were identified in some but not all areas and included literature describing self-determination and participation in leisure activities for those with mild intellectual disability. However, significant gaps were found particularly for those with severe intellectual disability. Conclusions: The ICF is a useful tool in framing a review of transition literature for young people with intellectual disability due to the complexity and multi-faceted nature of transition. The important influence of environmental factors including family systems, post-school services and access to transport were highlighted as having considerable impacts on transition outcomes.

Implications for Rehabilitation

• The ICF is a useful tool in framing transition research to identify gaps.

• The current body of literature in transition from school for young adults with intellectual disabilities is too singularly focused and rarely considers those with moderate to severe intellectual disability.

• There has been little research on this topic in low and middle income countries.

• The scale of the impact of environmental factors on young people transitioning from school to post-school is currently under-represented.

• A holistic approach to post-school outcomes needs to be undertaken in future research.

     

The applicability of four clinical methods to evaluate arm and hand function in all stages of spinal muscular atrophy type II

Abstract

Aim: To evaluate the ability of four clinical methods to reflect arm and hand function at impairment and activity level and to determine their ability to discriminate among SMA II patients of all ages and in all stages of the disease. Methods: Fifty-two patients with SMA II (age range: 8–73 years) were assessed by means of the Egen Klassifikation 2 (EK2 scale), the Motor Function Measure Scale (MFM D3), the Manual Muscle Test (MMT) and Hand-Held Dynamometry (HHD) in full fist grip and lateral pinch grip. Patients were classified into six levels of upper limb function by means of the Brooke Upper Limb Scale, and the four methods’ ability to differentiate among patients within these levels was calculated. Modified versions of the EK2 scale (EK Upper Limb) and the MFM D3 (MFM D3 Upper Limb) were assessed in the same manner. Results: The patients’ physical abilities were best described by the MMT and EK2 while the “EK Upper Limb”, MFM D3 and MMT were best at discriminating among patients across the range of upper limb function. Quantitative muscle tests as measured by Citec? HHD were less applicable to weak patients; full fist grip could discriminate among patients at Brooke levels 3–5, and lateral pinch grip among the strongest patients. Conclusion: At the impairment level, MMT is the superior measure of muscle function in very weak patients in whom HHD cannot reflect capacity. At the activity level, the EK 2 represents daily activities whereas the MFM D3 measures motor functions. In differentiating among SMA II patients of all ages and in all stages of the disease, the ability of abbreviated versions of scales targeting upper limb function is superior to unabridged versions of these scales.

• Implications for Rehabilitation

• Evaluation of upper limb function in spinal muscular atrophy II

• Even very weak patients with SMA II have some residual upper limb function that is measurable if the right method is chosen.

• The Manual muscle test is applicable to all patients with SMA II and is useful to determine possible interventions – such as methods to drive a wheelchair or operate a computer.

• Abbreviated versions of the EK2 scale and the MFM are useful as methods to evaluate subtle changes in upper limb function resulting from disease progression or interventions.

     

Conceptualisation and development of the arm activity measure (ArmA) for assessment of activity in the hemiparetic arm

Abstract

Purpose: To develop a patient reported outcome measure of active and passive function in the hemiparetic upper limb. Methods: Potential items for inclusion were identified through (a) systematic review and analysis of existing measures and (b) analysis of the primary goals for treatment in a spasticity service. Item reduction was achieved through consultation with a small, purposively selected multi-disciplinary group of experienced rehabilitation professionals (n?=?10) in a three-round Delphi process. This was followed by a confirmatory survey with a larger group of clinicians (n?=?36) and patients and carers (n?=?13 pairs). Results: From an initial shortlist of 75 items, 23 items were initially identified for inclusion in the arm activity measure (ArmA), and subsequently refined to a 20-item instrument comprising 7 passive and 13 active function. In common with the six measures identified in the systematic review, a five-point ordinal scaling structure was chosen, with ratings based on activity over the preceding 7?days. Conclusions: The ArmA is designed to measure passive and active function following focal interventions for the hemiparetic upper limb. Content and face validity have initially been addressed within the development process. The next phase of development has involved formal evaluation of psychometric properties.

• Implications for Rehabilitation

• In clinical practice or research, outcome measures in rehabilitation need to have face and content validity.

• Following stroke or brain injury, goals for rehabilitation of the hemiparetic upper limb may be: to restore active function, if there is return of motor control or to improve passive function making it easier to care for the limb (e.g. maintain hygiene) if no motor return is possible, measurement of both constructs should be considered.

• This study describes the systematic development of the ArmA, a measure of active and passive function in the hemiparetic upper limb.

     

Controlling a multi-degree of freedom upper limb prosthesis using foot controls: user experience

Abstract

Purpose: The DEKA Arm, a pre-commercial upper limb prosthesis, funded by the DARPA Revolutionizing Prosthetics Program, offers increased degrees of freedom while requiring a large number of user control inputs to operate. To address this challenge, DEKA developed prototype foot controls. Although the concept of utilizing foot controls to operate an upper limb prosthesis has been discussed for decades, only small-sized studies have been performed and no commercial product exists. The purpose of this paper is to report amputee user perspectives on using three different iterations of foot controls to operate the DEKA Arm. Method: Qualitative data was collected from 36 subjects as part of the Department of Veterans Affairs (VA) Study to Optimize the DEKA Arm through surveys, interviews, audio memos, and videotaped sessions. Three major, interrelated themes were identified using the constant comparative method: attitudes towards foot controls, psychomotor learning and physical experience of using foot controls. Results: Feedback about foot controls was generally positive for all iterations. The final version of foot controls was viewed most favorably. Conclusions: Our findings indicate that foot controls are a viable control option that can enable control of a multifunction upper limb prosthesis (the DEKA Arm).

• Implications for Rehabilitation

• Multifunction upper limb prostheses require many user control inputs to operate. Foot controls offer additional control input options for such advanced devices, yet have had minimal study.

• This study found that foot controls were a viable option for controlling multifunction upper limb prostheses. Most of the 36 subjects in this study were willing to adopt foot controls to control the multiple degrees of freedom of the DEKA Arm.

• With training and practice, all users were able to develop the psychomotor skills needed to successfully operate food controls. Some had initial difficulty, but acclimated over time.

     

Self-report function and disability: a comparison between women with and without urgency urinary incontinence

Purpose: To compare self-reported function and disability between women with urgency urinary incontinence (UUI) and healthy controls. Method: Self-reported function and disability were evaluated using the Late Life Function and Disability Instrument (LLFDI) in 66 women with UUI (mean age 61.9 ± 5.6) and 66 age-matched control women without UUI in a cross-sectional study. The function component evaluates difficulty in performing physical activities in upper and lower extremities and the disability component evaluates limitations in life activities and frequency in taking part in life tasks. Body Mass Index (BMI), self-report incontinence quality of life questionnaire (I-QoL) and Visual Analog Scale (VAS) that indicate the degree to which the bladder problems limited the subject’s daily life activity were also evaluated. Results: The LLFDI scores in overall function, basic and advanced lower limb function, were significantly lower in women with UUI compared with continent women, while the upper extremity function and disability components were not. There was significant negative correlation between BMI and function scores in women with UUI. Conclusion: Our results support the assumptions that the women with UUI are likely to show poorer lower extremity physical functioning and that disability is a multifactorial combination of behavioral, psychological and environmental factors, and not functional limitations per se.

Implications for Rehabilitation

• Intervention targeting lower extremity physical functioning might increase physical ability; this may reduce the frequency of urgency urinary incontinence episodes in middle age women.

• Targeting weight loss is of importance when planning rehabilitation in urgency urinary incontinence women.

• Women with urgency urinary incontinence are less likely to show poorer disability scores.

     

Defining mild,moderate, and severe pain in young people with physical disabilities

Purpose: The purpose of this study is to identify the cutoffs that are most suitable for classifying average and worst pain intensity as being mild, moderate, or severe in young people with physical disabilities.

Method: Survey study using a convenience sample of 113 young people (mean age?=?14.19; SD?=?2.9; age range: 8–20) with physical disabilities (namely, spinal cord injury, cerebral palsy, spina bifida, limb deficiency (acquired or congenital), or neuromuscular disease).

Results: The findings support a non-linear association between pain intensity and pain interference. In addition, the optimal cutoffs for classifying average and worst pain as mild, moderate, or severe differed. For average pain, the best cutoffs were the following: 0–3 for mild, 4–6 for moderate, and 7–10 for severe pain, whereas the optimal classification for worst pain was 0–4 for mild, 5–6 for moderate, and 7–10 for severe pain.

Conclusions: The findings provide important information that may be used to help make decisions regarding pain treatment in young people with disabilities and also highlight the need to use different cutoffs for classifying pain intensity in young people with disabilities than those that have been suggested for adults with chronic pain.

• Implications for rehabilitation

• Most clinical guidelines make treatment recommendations based on classifications of pain intensity as being mild, moderate, and severe that do not have a clear cut association with pain intensity ratings.

• Cutoffs that are deemed to be the most appropriate for classifying pain intensity as mild, moderate, and severe appear to depend, at least in part, on the pain population that is being studied and pain domain that is being used.

• This work helps to advance our knowledge regarding the meaning of pain intensity ratings in young people with physical disabilities.

• Clinicians can use this information to make empirically guided decisions regarding when to intervene in young people with disabilities and chronic pain.