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1.
Chien-Yu Huang Li-Chen Tung Yeh-Tai Chou Hing-Man Wu Kuan-Lin Chen Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(3):512-520
Objectives
To (1) develop a computerized adaptive test for gross motor skills (GM-CAT) as a diagnostic test and an outcome measure, using the gross motor skills subscale of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT-GM) as the candidate item bank; and (2) examine the psychometric properties and the efficiency of the GM-CAT.Design
Retrospective study.Setting
A developmental center of a medical center.Participants
Children with and without developmental delay (N=1738).Interventions
Not applicable.Main Outcome Measures
The CDIIT-GM contains 56 universal items on gross motor skills assessing children's antigravity control, locomotion, and body movement coordination.Results
The item bank of the GM-CAT had 44 items that met the dichotomous Rasch model's assumptions. High Rasch person reliabilities were found for each estimated gross motor skill for the GM-CAT (Rasch person reliabilities =.940-.995, SE=.68-2.43). For children aged 6 to 71 months, the GM-CAT had good concurrent validity (r values =.97-.98), adequate to excellent diagnostic accuracy (area under receiver operating characteristics curve =.80-.98), and moderate to large responsiveness (effect size =.65-5.82). The averages of items administered for the GM-CAT were 7 to 11, depending on the age group.Conclusions
The results of this study support the use of the GM-CAT as a diagnostic and outcome measure to estimate children's gross motor skills in both research and clinical settings. 相似文献2.
Chelsea A. Harris John-Michael Muller Melissa J. Shauver Kevin C. Chung 《Archives of physical medicine and rehabilitation》2018,99(3):459-467.e1
Objectives
To (1) characterize patients' medical experiences from initial injury until they become candidates for upper extremity reconstruction (UER); and (2) identify points in this medical context that may be most amenable to interventions designed to increase UER utilization.Design
A qualitative cross-sectional study using grounded theory methodology and constant comparative analysis of data collected through semistructured individual interviews.Setting
Community.Participants
A sample of individuals with C4 to C8 cervical spinal injuries (N=19) who sustained injuries at least 1 year before interview. Nine patients had undergone reconstruction, and 10 had not. The study sample was predominantly male (79%) and white (89%), and American Spinal Injury Association grades A through D were represented (A, 42%; B, 32%; C, 16%; D, 10%).Interventions
Not applicable.Main Outcome Measures
Participants' self-report of their medical experiences from the time of injury through the early recovery period.Results
We identified 3 domains that formed patients' medical context before UER candidacy: (1) their ability to achieve and maintain health; (2) their relationship with health care providers; and (3) their expectations regarding clinicians' tetraplegia-specific expertise. Trust emerged as a major theme driving potential intervention targets. Patients transferred to referral centers had higher trust in tertiary providers relative to local physicians. In the outpatient setting, patients' trust correlated with the tetraplegia-specific expertise level they perceived the specialty to have (high for physical medicine and rehabilitation, intermediate for urology, low for primary care).Conclusions
In appropriate candidates, UER produces substantial functional gains, but reconstruction remains underused in the tetraplegic population. By analyzing how patients achieve health and build trust in early recovery/injury, our study provides strategies to improve UER access. We propose that interventions targeting highly trusted points of care (transfer hospitals) and avoiding low-trust points (primary care physicians, home health) will be most effective. Urology may represent a novel entry point for UER interventions. 相似文献3.
Jerin Mathew Kavitha Raja Febin P. Baby Basima Barikkal 《Journal of bodywork and movement therapies》2018,22(3):622-626
Background
In most developing countries, accessibility for people using walking aids is limited due to architectural and environmental barriers. As observed from anecdotal accounts, even a minor orthopaedic injury/disorder may restrict a person's ambulation due to fatigue associated with using walking aids. Hence this study was undertaken with the following objective.Objective
to estimate the magnitude of energy consumption using energy expenditure index (EEI) during gait under different conditions.Design
Repeated measures design (within subjects study).Setting
School.Participants
Ten healthy, typical young adults between 17 and 25 years of age.Outcome measure
Energy Expenditure Index (EEI) was estimated for each of the conditions of the study using consistent measurement procedures.Results
Energy consumption with immobilization is greater (ankle-16.2%, knee-36.7% and ankle and knee-49.2%) than typical self-selected ambulation. During on ground ambulation the energy cost was greatest for an axillary crutches than a standard walker with ankle and knee immobilized being the highest in relation to typical ambulation (78.2% greater). Axillary crutches were more efficient than a walker during stair climbing.Conclusion
For young adults a standard walker may be the right option for over-ground ambulation, when a lower limb joint in immobilized; with an axillary crutch used during stair climbing. 相似文献4.
Amy K. Fuhs Lacey N. LaGrone Miguel G. Moscoso Porras Manuel J. Rodríguez Castro Rosa Lizbeth Ecos Quispe Charles N. Mock 《Archives of physical medicine and rehabilitation》2018,99(6):1116-1123
Objective
To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks.Design
Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input.Setting
Large public hospitals and referral centers and an online survey platform.Participants
Convenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies.Interventions
Not applicable.Main Outcome Measures
Outcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems.Results
Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent.Conclusions
Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies. 相似文献5.
Objective
To investigate frequency, type, and characteristics of work anxieties in patients with somatic illness.Design
Cross-sectional observation study.Setting
Neurology, orthopedic, and cardiology rehabilitation clinics.Participants
Patients (N=1610; age, 18–65y) with work anxieties.Interventions
Not applicable.Main Outcome Measures
Patients who scored high on at least 2 of 9 items in the work-anxiety screening questionnaire and who reported impairment were investigated with a differential diagnostic interview on work anxieties and with the Mini-International Neuropsychiatric Interview on non–work-related common mental disorders. Patients also filled out a self-rating questionnaire on their subjective symptom load and sociodemographic data.Results
Approximately 20% to 27% of the investigated inpatients in somatic rehabilitation (altogether n=393) received a work-anxiety diagnosis. Patients with orthopedic illness report highest work anxiety and have previous longest sick leave (20.6wk in the past 12mo). Patients with orthopedic illness suffer from work-related adjustment disorder with anxiety, social anxieties, and workplace phobias, whereas patients with cardiac illness are more often affected by hypochondriac anxieties. Anxieties of insufficiency and worrying occur equally in all indications.Conclusions
About a quarter of patients in somatic rehabilitation are in need of additional diagnostic attention owing to work anxieties. Differential diagnostic of work anxiety is needed for initiating adequate therapeutic action. Somatic rehabilitation physicians should be aware of work anxieties in their patients, especially in patients with orthopedic illness with previous long-term sick leave. 相似文献6.
Meiqi Guo Gaetan Tardif Mark Bayley 《Archives of physical medicine and rehabilitation》2018,99(6):1217-1219
Objective
To describe the implementation process, outcomes, and lessons learned in the implementation of medical safety huddles, a novel patient safety monitoring strategy that promotes physician engagement with patient safety.Design
Single-center observational study.Setting
Brain and spinal cord injury rehabilitation program at an urban, academic adult rehabilitation hospital.Participants
Physicians associated with the program (N=18).Interventions
Weekly physicians' safety huddles were implemented to review, anticipate, and address patient safety issues.Main Outcome Measures
Main outcome measures were the number and nature of identified and anticipated patient safety incidents, actions taken, and physician attendance during huddles. The number of adverse events in the program before and after huddle implementation were secondary measures.Results
Over a 7-month period, average physician attendance at medical huddles was 76.0%. There were 1.0±0.8 patient safety incidents and 3.2±2.1 anticipated patient safety issues identified in each weekly huddle. Most patient safety incidents identified were clinical administrative and clinical process related, which differed from information gathered from the organization's preexisting patient safety monitoring strategies. A total of 79 actions, or 3.3±1.8 actions per huddle, were taken in response to improve patient safety for the program. Adverse events decreased from 31.2 (95% confidence interval [CI], 27.0–35.3) to 22.9 per month (95% CI, 19.3–26.5) after implementation.Conclusions
Medical safety huddles are a novel strategy to engage physicians in patient safety and organizational quality improvement. They have the potential to enhance organizational anticipation of safety risks by supplementing existing methods. Other rehabilitation settings may wish to consider implementing and evaluating similar huddles into their existing patient safety and quality improvement frameworks. 相似文献7.
Poonam K. Pardasaney Anne Deutsch Jeniffer Iriondo-Perez Melvin J. Ingber Tara McMullen 《Archives of physical medicine and rehabilitation》2018,99(6):1035-1041
Objective
To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016.Design
Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF–Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability.Setting
IRFs.Participants
Medicare FFS patients aged ≥21 years (N=4769).Interventions
Not applicable.Main Outcome Measures
Facility-level discharge self-care quality measure performance score.Results
A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged <65 years. Stroke was the most common diagnosis (21.8%). The mean±SD performance score was 55.1%±16.6% (range, 25.8%–100%). About 54% of IRFs had scores significantly different from the percentage of stays that met or exceeded the expected discharge self-care score in the overall demonstration sample. The quality measure showed strong reliability, with intraclass correlation coefficients of .91.Conclusions
The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs. 相似文献8.
Communicating Caregivers' Challenges With Cancer Pain Management: An Analysis of Home Hospice Visits
Claire J. Han Nai-Ching Chi Soojeong Han George Demiris Debra Parker-Oliver Karla Washington Margaret F. Clayton Maija Reblin Lee Ellington 《Journal of pain and symptom management》2018,55(5):1296-1303
Context
Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs.Objectives
We identified ways in which FCGs of hospice cancer patients communicated their pain management challenges to nurses during home visits and explored nurses' responses when pain management concerns were raised.Methods
Using secondary data from audio recordings of hospice nurses' home visits, a deductive content analysis was conducted. We coded caregivers' pain management challenges and immediate nurses' responses to these challenges.Results
From 63 hospice nurse visits, 101 statements describing caregivers' pain management challenges were identified. Thirty percent of these statements pertained to communication and teamwork issues. Twenty-seven percent concerned caregivers' medication skills and knowledge. In 52% of the cases, nurses responded to caregivers' pain management challenges with a validating statement. They provided information in 42% of the cases. Nurses did not address 14% of the statements made by caregivers reflecting pain management challenges.Conclusion
To optimize hospice patients' comfort and reduce caregivers' anxiety and burden related to pain management, hospice nurses need to assess and address caregivers' pain management challenges during home visits. Communication and educational tools designed to reduce caregivers' barriers to pain management would likely improve clinical practice and both patient- and caregiver-related outcomes. 相似文献9.
Simon Décary Pierre Frémont Bruno Pelletier Michel Fallaha Sylvain Belzile Johanne Martel-Pelletier Jean-Pierre Pelletier Debbie Feldman Marie-Pierre Sylvestre Pascal-André Vendittoli François Desmeules 《Archives of physical medicine and rehabilitation》2018,99(4):607-614.e1
Objective
To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude patellofemoral pain (PFP).Design
Prospective diagnostic study.Settings
Orthopedic outpatient clinics, family medicine clinics, and community-dwelling.Participants
Consecutive patients (N=279) consulting one of the participating orthopedic surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint.Interventions
Not applicable.Main Outcome Measures
History elements and physical examination tests were obtained by a trained physiotherapist blinded to the reference standard: a composite diagnosis including both physical examination tests and imaging results interpretation performed by an expert physician. Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of PFP, and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios with associated 95% confidence intervals (CIs) were calculated.Results
Two hundred seventy-nine participants were evaluated, and 75 had a diagnosis of PFP (26.9%). Different combinations of history elements and physical examination tests including the age of participants, knee pain location, difficulty descending stairs, patellar facet palpation, and passive knee extension range of motion were associated with a diagnosis of PFP and used in clusters to accurately discriminate between individuals with PFP and individuals without PFP. Two diagnostic clusters developed to confirm the presence of PFP yielded a positive likelihood ratio of 8.7 (95% CI, 5.2–14.6) and 3 clusters to exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06–.27).Conclusions
Diagnostic clusters combining common history elements and physical examination tests that can accurately diagnose or exclude PFP compared to various knee disorders were developed. External validation is required before clinical use. 相似文献10.
Christopher L. Smyre Hyo Jung Tak Augustine P. Dang Farr A. Curlin John D. Yoon 《Journal of pain and symptom management》2018,55(3):897-905
Context
There has been a sustained debate in the medical literature over whether physicians should engage with patients' religious and spiritual concerns.Objectives
This study explores what physicians believe about the relative importance and appropriateness of engaging with patients' spiritual concerns and physicians' choices of interventions.Methods
In 2010, a questionnaire was mailed to 2016 U.S. physicians with survey items querying about the relative importance of addressing patients' spiritual concerns at the end of life and the appropriateness of interventions in addressing those concerns. The survey also contained an experimental vignette to assess physicians' willingness, if asked by patients, to participate in prayer.Results
Adjusted response rate was 62% (1156/1878). The majority of physicians (65%) believe that it is essential to good practice for physicians to address patients' spiritual concerns at the end of life. Physicians who were more religious were more likely to believe that spiritual care is essential to good medical practice (odds ratio: 2.76, 95% CI 1.12–6.81) and believe that it is appropriate to always encourage patients to talk to a chaplain (odds ratio: 5.71, 95% CI: 2.28–14.3). A majority of the physicians (55%) stated that, if asked, they would join the family and patient in prayer. Physicians' willingness to join ranged from 67% when there was concordance between the physician's and the patient's religious affiliation to 51% when there was discordance.Conclusion
The majority of U.S. physicians endorse a limited role in the provision of spiritual care, although opinions varied based on physicians' religious characteristics. 相似文献11.
Laura Coots Daras Melvin J. Ingber Anne Deutsch Jennifer Gaudet Hefele Jennifer Perloff 《Archives of physical medicine and rehabilitation》2018,99(6):1060-1066
Objective
To examine whether there are differences in inpatient rehabilitation facilities' (IRFs') all-cause 30-day postdischarge hospital readmission rates vary by organizational characteristics and geographic regions.Design
Observational study.Setting
IRFs.Participants
Medicare fee-for-service beneficiaries discharged from all IRFs nationally in 2013 and 2014 (N = 1166 IRFs).Interventions
Not applicable.Main Outcome Measures
We applied specifications for an existing quality measure adopted by Centers for Medicare & Medicaid Services for public reporting that assesses all-cause unplanned hospital readmission measure for 30 days postdischarge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, state).Results
IRFs’ mean risk-standardized hospital readmission rate was 13.00%±0.77%. After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates than did not-for-profit IRFs (P<.001). We also found geographic variation: IRFs in the South Atlantic and South Central census regions had the highest hospital readmission rates than did IRFs in New England that had the lowest rates.Conclusions
Our findings point to variation in quality of care as measured by risk-standardized hospital readmission rates after IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions, and follow-up. 相似文献12.
Introduction
Osteopathic Manipulative Treatment (OMT) is effective in improving function, movement and restoring pain conditions. Despite clinical results, the mechanisms of how OMT achieves its' effects remain unclear. The fascial system is described as a tensional network that envelops the human body. Direct or indirect manipulations of the fascial system are a distinctive part of OMT.Objective
This review describes the biological effects of direct and indirect manipulation of the fascial system.Material and methods
Literature search was performed in February 2016 in the electronic databases: Cochrane, Medline, Scopus, Ostmed, Pedro and authors' publications relative to Fascia Research Congress Website.Results
Manipulation of the fascial system seems to interfere with some cellular processes providing various pro-inflammatory and anti-inflammatory cells and molecules.Discussion
Despite growing research in the osteopathic field, biological effects of direct or indirect manipulation of the fascial system are not conclusive.Conclusion
To elevate manual medicine as a primary intervention in clinical settings, it's necessary to clarify how OMT modalities work in order to underpin their clinical efficacies. 相似文献13.
Jun Hamano Tatsuya Morita Masayuki Ikenaga Hirofumi Abo Yoshiyuki Kizawa Satoru Tunetou 《Journal of pain and symptom management》2018,55(3):785-791
Context
Although there has long been debate about physicians' intentions and what physicians consider to be proportionally appropriate when performing palliative sedation, few large studies have been performed.Objectives
To identify physicians' intentions when starting continuous deep sedation and to clarify what factors determine whether physicians regard sedation as proportionally appropriate in relation to expected survival, the patients' wishes, and refractoriness.Methods
A nationwide questionnaire survey of Japanese palliative care specialists was performed from August to December 2016. We defined continuous deep sedation as the continuous use of sedatives to relieve intolerable and refractory symptoms with the loss of consciousness until death.Results
Of the 695 palliative care specialists enrolled, 440 were analyzed (response rate, 69%). A total of 95% and 87% of the physicians reported that they explicitly intended to perform symptom palliation and decrease consciousness levels, respectively. Moreover, 38% answered that they explicitly intended to maintain unconsciousness until death, and 11% reported that they intended to shorten survival to some extent. The respondents considered that continuous deep sedation is more appropriate when the predicted survival is shorter, the patients' wishes are consistent and clear, and confidence in the refractoriness of symptoms is higher.Conclusions
Japanese palliative care specialists explicitly intend to control symptoms and reduce the level of consciousness when performing continuous deep sedation, but there are differences in their intentions with regard to maintaining unconsciousness until death. Predicted survival, patients' wishes, and confidence in refractoriness are associated with physicians' judgment that sedation is proportionally appropriate. 相似文献14.
Vicki A. Freedman Judith D. Kasper Alan Jette 《Archives of physical medicine and rehabilitation》2018,99(8):1507-1513
Objective
To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home).Design
Longitudinal observational study.Setting
Participants' homes.Participants
Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview.Interventions
Not applicable.Main Outcome Measures
Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service.Results
Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels.Conclusions
Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans. 相似文献15.
Susan Magasi Alex Wong Ana Miskovic David Tulsky Allen W. Heinemann 《Archives of physical medicine and rehabilitation》2018,99(1):1-8
Objective
To test the effect that indicators of mobility device quality have on participation outcomes in community-dwelling adults with spinal cord injury, traumatic brain injury, and stroke by using structural equation modeling.Design
Survey, cross-sectional study, and model testing.Setting
Clinical research space at 2 academic medical centers and 1 free-standing rehabilitation hospital.Participants
Community-dwelling adults (N=250; mean age, 48±14.3y) with spinal cord injury, traumatic brain injury, and stroke.Interventions
Not applicable.Main Outcomes Measures
The Mobility Device Impact Scale, Patient-Reported Outcomes Measurement Information System Social Function (version 2.0) scale, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities, and the 2 Community Participation Indicators' enfranchisement scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected.Results
Respondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating effect on participation outcomes, with 3 device quality variables (repairability, ease of maintenance, device reliability) accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than did ambulation aid users.Conclusions
Mobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable. 相似文献16.
Cheng-Yang Hsieh Hsiu-Chen Huang Darren Philbert Wu Chung-Yi Li Meng-Jun Chiu Sheng-Feng Sung 《Archives of physical medicine and rehabilitation》2018,99(6):1042-1048.e6
Objective
To determine the relation between rehabilitation intensity and poststroke mortality.Design
Retrospective cohort study.Setting
Nationwide claims data.Participants
From Taiwan's National Health Insurance claims databases, patients (N=6737; mean age, 66.9y; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled.Interventions
The intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the number of rehabilitation sessions.Main Outcome Measures
Long-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates.Results
Patients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR], .73; 95% confidence interval [CI], .63–.84) of mortality than the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR, 0.94; 95% CI, 0.84–1.06) compared with the low-intensity group. This association was not modified by stroke severity.Conclusions
Among patients with mild to moderate stroke severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk than low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of patients with stroke should be encouraged. 相似文献17.
Nicholas V. Karayannis Gwendolen A. Jull Michael K. Nicholas Paul W. Hodges 《Archives of physical medicine and rehabilitation》2018,99(1):121-128
Objective
To determine the distribution of higher psychological risk features within movement-based subgroups for people with low back pain (LBP).Design
Cross-sectional observational study.Setting
Participants were recruited from physiotherapy clinics and community advertisements. Measures were collected at a university outpatient-based physiotherapy clinic.Participants
People (N=102) seeking treatment for LBP.Interventions
Participants were subgrouped according to 3 classification schemes: Mechanical Diagnosis and Treatment (MDT), Treatment-Based Classification (TBC), and O'Sullivan Classification (OSC).Main Outcome Measures
Questionnaires were used to categorize low-, medium-, and high-risk features based on depression, anxiety, and stress (Depression, Anxiety, and Stress Scale–21 Items); fear avoidance (Fear-Avoidance Beliefs Questionnaire); catastrophizing and coping (Pain-Related Self-Symptoms Scale); and self-efficacy (Pain Self-Efficacy Questionnaire). Psychological risk profiles were compared between movement-based subgroups within each scheme.Results
Scores across all questionnaires revealed that most patients had low psychological risk profiles, but there were instances of higher (range, 1%–25%) risk profiles within questionnaire components. The small proportion of individuals with higher psychological risk scores were distributed between subgroups across TBC, MDT, and OSC schemes.Conclusions
Movement-based subgrouping alone cannot inform on individuals with higher psychological risk features. 相似文献18.
Jane L. Givens Rebecca L. Sudore Gad A. Marshall Alyssa B. Dufour Ilona Kopits Susan L. Mitchell 《Journal of pain and symptom management》2018,55(4):1105-1112
Context
Little is known about advance care planning (ACP) among community-dwelling patients with dementia.Objectives
To describe aspects of ACP among patients with dementia and examine the association between ACP and health care proxy (HCP) acceptance of patients' illness.Methods
Cross-sectional observational survey of 62 HCPs of patients with dementia (N = 14 mild, N = 48 moderate/severe), from seven outpatient geriatric and memory disorder clinics in Boston. Aspects of ACP included HCP's report of patients' preferences for level of future care, communication with HCP and physician regarding care preferences, and proxy preparedness for shared decision making. The association between ACP and HCP acceptance with patients' illness was examined using the Peace, Equanimity, and Acceptance subscale of the Cancer Experience Scale.Results
Eleven percent of proxies believed that the patient would want life-prolonging treatment, 31% a time-limited trial of curative treatment, and 47% comfort-focused care. Thirty-one percent reported that the patient had communicated with their physician regarding preferences for care, and 77% had communicated with the HCP. Forty-four percent of HCPs wanted more discussion with the patient regarding care preferences. The HCP having discussed care preferences with the patient was associated with greater acceptance of the patient's illness (P = 0.004).Conclusion
Our findings support need for greater ACP discussions between patients and proxies. Discussions regarding goals of care are likely to benefit patients through delivery of care congruent with their wishes and HCPs in terms of greater acceptance of patients' illness. 相似文献19.
Ana Torres-Costoso Vicente Martínez-Vizcaíno Celia Álvarez-Bueno Asunción Ferri-Morales Iván Cavero-Redondo 《Archives of physical medicine and rehabilitation》2018,99(4):758-765.e10
Objective
To evaluate the accuracy of inlet and outlet ultrasonography measurements for the diagnosis of carpal tunnel syndrome (CTS).Data Sources
MEDLINE, EMBASE, the Cochrane Library, and the Web of Science databases were systematically searched from inception to February 2017.Study Selection
Observational studies comparing the diagnostic accuracy of inlet and outlet ultrasonography measurements were selected.Data Extraction
Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves were used to summarize overall test performance.Data Synthesis
Twenty-eight published studies were included in the meta-analysis. The pooled dOR values for the diagnosis of CTS were 31.11 (95% CI, 20.42–47.40) for inlet-level and 16.94 (95% CI, 7.58–37.86) for outlet-level measurements. The 95% confidence region for the point that summarizes overall test performance of the included studies occurred where the cutoffs ranged from 9.0 to 12.6mm2 for inlet-level measurements and from 9.5 to 10.0mm2 for outlet-level measurements.Conclusions
Both ultrasonography measurements for the diagnosis of CTS showed sufficient accuracy for their use in clinical settings, although the overall accuracy was slightly higher for inlet-level than for outlet-level measurements. The addition of outlet and inlet measurements does not increase the accuracy for the diagnosis. Therefore, the inlet-level ultrasonography measurement appears to be an appropriate method for the diagnosis of CTS. 相似文献20.
Andrew C. Smith Kenneth A. Weber Denise R. O&#x;Dell Todd B. Parrish Marie Wasielewski James M. Elliott 《Archives of physical medicine and rehabilitation》2018,99(4):660-666