Factor Structure and Predictive Validity of Somatic and Nonsomatic Symptoms From the Patient Health Questionnaire-9: A Longitudinal Study After Spinal Cord Injury

Krause JS, Reed KS, McArdle JJ. Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: a longitudinal study after spinal cord injury.

Objective

To investigate the factor structure and predictive validity of somatic and nonsomatic depressive symptoms over the first 2.5 years after spinal cord injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9).

Design

Somatic and nonsomatic symptoms were assessed at baseline during inpatient hospitalization (average of 50 days after onset) and during 2 follow-ups (average of 498 and 874 days after onset).

Setting

Data were collected at a specialty hospital in the Southeastern United States and analyzed at a medical university. We performed time-lag regression between inpatient baseline and follow-up somatic and nonsomatic latent factors of the PHQ-9.

Participants

Adults with traumatic SCI (N=584) entered the study during inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measure

PHQ-9, a 9-item measure of depressive symptoms.

Results

The inpatient baseline nonsomatic latent factor was significantly predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient baseline did not significantly predict either factor. In contrast, when regressing latent factors between the 2 follow-ups, the nonsomatic factor predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor structure was not stable over time. Item analysis verified the instability of somatic items between inpatient baseline and follow-up and also indicated that self-harm at inpatient baseline was highly predictive of future self-harm.

Conclusions

Nonsomatic symptoms are better predictors of future depressive symptoms when first assessed during inpatient rehabilitation, whereas somatic symptoms become stable predictors only after inpatient rehabilitation. Self-harm (suicidal ideation) is the most stable symptom over time. Clinicians should routinely assess for suicidal ideation and use nonsomatic symptoms when performing assessments during inpatient rehabilitation.     

Prospective analysis of lipid profiles in persons with a spinal cord injury during and 1 year after inpatient rehabilitation

de Groot S, Dallmeijer AJ, Post MW, Angenot EL, van den Berg-Emons RJ, van der Woude LH. Prospective analysis of lipid profiles in persons with a spinal cord injury during and 1 year after inpatient rehabilitation.

Objectives

To investigate the course of lipid profiles during and 1 year after inpatient rehabilitation of persons with spinal cord injury, and to determine which personal, lesion, and lifestyle characteristics influence the changes in lipid profiles over time and among subjects.

Design

Multilevel regression analysis of measurement points during and after rehabilitation.

Setting

Eight rehabilitation centers in The Netherlands.

Participants

People with complete and incomplete paraplegia and tetraplegia (N=180).

Interventions

Not applicable.

Main Outcome Measures

Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and the TC/HDL ratio.

Results

We found a significant decrease in TG and TC/HDL during inpatient rehabilitation and a significant increase in HDL during and after inpatient rehabilitation. TC and LDL, however, showed unfavorable increases after clinical discharge. The changes in HDL and LDL over time differed between lesion groups. An increase in the body mass index (BMI) led to an unfavorable change in all lipid profiles. Older participants showed higher TC, LDL, and HDL concentrations. Women and participants who consumed some alcohol, or who were more active 1 year after discharge, had more favorable HDL levels.

Conclusions

Lipid profiles improved during inpatient rehabilitation but deteriorated somewhat after clinical discharge. Controlling one’s BMI seems important in diminishing the risk for unfavorable lipid profiles.     

Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation

Yokoyama O, Sakuma F, Itoh R, Sashika H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation.

Objective

To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI).

Design

Case-controlled study.

Setting

SCI unit in a rehabilitation center.

Participants

Seventeen patients with SCI-AA and 17 patients with traumatic SCI.

Intervention

Standard rehabilitation therapy for SCI.

Main Outcome Measures

Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge.

Results

No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community.

Conclusions

SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community.     

A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge

van den Berg-Emons RJ, Bussmann JB, Haisma JA, Sluis TA, van der Woude LH, Bergen MP, Stam HJ. A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge.

Objectives

To assess the change over time in the physical activity level after a spinal cord injury (SCI), to explore its determinants, and to compare the physical activity level 1 year after discharge from the rehabilitation center with the level in able-bodied persons.

Design

Prospective cohort study. Measurements were obtained at the start of active rehabilitation, 3 months later, at discharge, 2 months after discharge, and 1 year after discharge.

Setting

Rehabilitation center in The Netherlands and the participant's home.

Participants

Persons (n=40) with SCI.

Interventions

Not applicable.

Main Outcome Measures

The physical activity level, as indicated by the duration of dynamic activities (ie, wheelchair driving, walking, cycling, noncyclic movement) per day, and the intensity of everyday activity; both were measured with an accelerometry-based activity monitor during 2 consecutive weekdays.

Results

Random coefficient analyses showed that the duration of dynamic activities and the intensity of everyday activity increased during inpatient rehabilitation at rates of 41% and 19%, respectively (P<.01). Shortly after discharge, there was a strong decline (33%; P<.001) in the duration of dynamic activities. One year after discharge, this decline was restored to the discharge level but was low in comparison with levels in able-bodied persons. The level of lesion and completeness of lesion were determinants of the change in the physical activity level after discharge.

Conclusions

The physical activity level increased during inpatient rehabilitation, but this increase did not continue after discharge, and the level 1 year after discharge was distinctly lower than the level in able-bodied persons. Subpopulations had a different change over time in the physical activity level after discharge.     

Quality of Life of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To describe and compare the quality of life (QOL) of persons with lower-limb amputation (LLA) at admission (T1), discharge (T2), and 3 months after rehabilitation discharge (T3) and to explore the relationships between QOL and demographic and clinical variables including body image.

Design

Longitudinal case series.

Setting

Inpatient rehabilitation facility.

Participants

Consecutive sample of 19 unilateral persons with LLA (14 men, mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Generic and specific QOL measures and perception of body image at T1, T2, and T3.

Results

Subjective QOL was relatively high at T1, T2, and T3 (0.87/2, 1.1/2, and 1.0/2, respectively) except for items related to physical functioning. There was no significant change over time for all but 1 QOL satisfaction measure (ability to go outside, P=.024). Prosthesis-related QOL was high at discharge and follow-up. Body-image disturbances were absent over the study period. QOL satisfaction and prosthesis satisfaction were strongly related to lower-limb pain and psychosocial factors (eg, body image).

Conclusions

QOL of persons with LLA was high and remained relatively stable during inpatient rehabilitation and 3 months after discharge.     

The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke

Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.

Objective

To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.

Design

Comparative gait analysis.

Setting

University-based aquatic therapy center.

Participants

Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal and kinematic gait parameters.

Results

The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.

Conclusions

The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking.     

The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system

Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system.

Objective

To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.

Design

An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.

Setting

Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.

Participants

A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004.

Interventions

Not applicable.

Main Outcome Measures

One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year.

Results

After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26-1.80) and home discharge (OR=2.58; 95% CI, 2.17-3.06). Prosthetic limb procurement did not differ significantly between groups.

Conclusions

The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation.     

Sleep-Disordered Breathing in Patients Enrolled in an Inpatient Stroke Rehabilitation Program

Brooks D, Davis L, Vujovic-Zotovic N, Boulias C, Ismail F, Richardson D, Goldstein RS. Sleep-disordered breathing in patients enrolled in an inpatient stroke rehabilitation program.

Objective

To report the prevalence of sleep-disordered breathing in an inpatient stroke rehabilitation unit and to explore correlations with functional status and health-related quality of life.

Design

Cross-sectional study.

Setting

Rehabilitation center.

Participants

Consecutive patients (N=45; mean age, 67±12y) (28 men) enrolled in inpatient rehabilitation after ischemic (84%) or hemorrhagic stroke (16%).

Interventions

Not applicable.

Main Outcome Measures

Overnight respiratory polysomnography was performed on all subjects. Interviewer-administered scales of sleepiness (Epworth Sleepiness Scale) and functional status (FIM, Barthel Index) were completed. Health-related quality of life was assessed by using a general questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]).

Results

Of the 45 subjects tested, only 4 (9%) had an apnea-hypopnea index of less than 10 per hour. The mean apnea-hypopnea index was 32.2 (19.4) per hour; most events were obstructive. There was no relationship between the respiratory index and the components of SF-36 (P values>.2).

Conclusions

There was a dramatically high prevalence of respiratory events in patients after stroke enrolled in an inpatient stroke rehabilitation unit. The awareness of this will influence patient evaluation and management.     

Rehabilitation setting and associated mortality and medical stability among persons with amputations

Dillingham TR, Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations.

Objective

To estimate the differences in outcomes across postacute care settings—inpatient rehabilitation, skilled nursing facility (SNF), or home—for dysvascular lower-limb amputees.

Design

Medicare claims data for 1996 were used to identify a cohort of elderly persons with major lower-limb dysvascular amputations. One-year outcomes were derived by analyzing claims for this cohort in 1996 and 1997.

Setting

Postacute care after amputation.

Participants

Dysvascular lower-limb elderly amputees (N=2468).

Interventions

Not applicable.

Main Outcome Measures

Mortality, medical stability, reamputations, and prosthetic device acquisition.

Results

The 1-year mortality for the elderly amputees was 41%. Multivariate probit models controlling for patient characteristics indicated that patients discharged to inpatient rehabilitation were significantly (P<.001) more likely to have survived 12 months postamputation (75%) than those discharged to an SNF (63%) or those sent home (51%). Acquisition of a prosthesis was significantly (P<.001) more frequent for persons going to inpatient rehabilitation (73%) compared with SNF (58%) and home (49%) dispositions. The number of nonamputee-related hospital admissions was significantly less for persons sent to a rehabilitation service than for those sent home or to an SNF. Subsequent amputations were significantly (P<.025) less likely for amputees receiving inpatient rehabilitation (18%) than for those sent home (25%).

Conclusions

Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers.     

Life Habits and Prosthetic Profile of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Life habits and prosthetic profile of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To assess performance of life habits among persons with lower-limb amputation at admission, at discharge, and 3 months after rehabilitation discharge and describe their prosthetic profile at discharge and follow-up.

Design

Case series.

Setting

Inpatient rehabilitation.

Participants

Unilateral persons with lower-limb amputation (N=19; 14 men; mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Life habits performance and prosthetic profile.

Results

In the daily activities subdomain, the lowest performances were observed for mobility and housing at all evaluation times. Within the social role subdomain, employment, recreation, and community life scores were the lowest for the 3 evaluations. Mean scores for all activities of daily living subdomain categories significantly increased (P<.05) during rehabilitation except for personal care and communication. Only community life (social roles subdomain) significantly increased during rehabilitation; life habits remained unchanged after discharge. Fifty-eight percent of patients at discharge versus 68.4% at follow-up used their prosthesis for more than 9 hours a day, and this increased significantly postdischarge (P=.017). Locomotor capability with prosthesis was similarly high at discharge and follow-up.

Conclusions

Among persons with lower-limb amputation, social role life habits appear to be more disturbed than those associated with activities of daily living. At discharge, prosthetic wear and locomotor capabilities with prosthesis were high and tended to improve on return to the community.     

Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury

Davies AL, Hayes KC, Dekaban GA. Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury.

Objective

To determine the serum cytokine profiles of patients with spinal cord injury (SCI) and varying clinical presentations relative to healthy, able-bodied, age-matched control subjects.

Design

Cross-sectional study.

Setting

Clinical research unit.

Participants

People with SCI (N=56) and different clinical presentations, and healthy, able-bodied, age-matched control subjects (N=35).

Interventions

Not applicable.

Main Outcome Measures

Serum levels of the proinflammatory cytokines interleukin (IL) 1β, IL-6, tumor necrosis factor alpha (TNF-α), the anti-inflammatory cytokines IL-4 and IL-10, the regulatory cytokine IL-2, the IL-1 receptor antagonist (IL-1RA), and autoantibodies against myelin-associated glycoprotein and GM₁ ganglioside (anti-GM₁) immunoglobulin (IgG and IgM), as determined by enzyme-linked immunosorbent assay. The relationship between elevated serum cytokine levels and clinical variables was also studied.

Results

SCI subjects exhibited serum concentrations of IL-6, TNF-α, IL-1RA, and anti-GM₁ (IgG) that were greater (P<.05) than control group values. Elevated cytokine concentrations were not associated with high white blood cell counts, level of injury, or American Spinal Injury Association classification; they were evident in SCI subjects who were asymptomatic for medical complications, but were further elevated in subjects with pain, urinary tract infection (UTI), and pressure ulcers.

Conclusions

Elevated levels of circulating proinflammatory cytokines and autoantibodies are present in the serum of SCI subjects without medical complications, and are further elevated in SCI subjects with neuropathic pain, UTI, or pressure ulcers, relative to healthy, able-bodied control subjects. These findings may be indicative of a protective autoimmunity, simply a consequence of occult or evident infection, or evidence of cytokine dysregulation that may contribute to an immune-mediated impairment of axonal conduction.     

Effects of obesity on inpatient rehabilitation outcomes following total knee arthroplasty

Objective

To investigate the effects of obesity on inpatient rehabilitation outcomes following total knee arthroplasty.

Participants

Two hundred and thirty-nine total knee arthroplasty patients (12 men and 227 women).

Interventions

Patients were divided in two groups (non-obese and obese) according to pre-operative body mass index (BMI). After surgery, all patients received standard post-operative treatment from a physiotherapist, including continuous passive motion, active-assistive and active range of motion exercises, isometric and isotonic strengthening exercises, gait training and transfer training.

Main outcome measures

Patients were evaluated pre-operatively and at discharge using BMI, knee function score [Hospital for Special Surgery (HSS) score], pain and range of motion of knee flexion. Functional activities were evaluated using the Iowa Level of Assistance Scale, and walking speed was evaluated using the Iowa Ambulation Velocity Scale.

Results

There were no statistically or clinically significant differences between the two groups of patients at discharge, with obese patients recording a mean HSS score of 62.6 points (95% confidence interval 61.3 to 63.9) and non-obese patients recording a mean HSS score of 62.6 (95% confidence interval 61.6 to 63.7, P = 0.950). Both groups improved in all parameters at the time of discharge compared with pre-operative values, with the exception of walking speed and the range of knee flexion. There was no significant difference in length of hospital stay between obese (median 9 days, interquartile range 4-22) and non-obese (median 9 days, interquartile range 4-23) patients.

Conclusions

Obesity had no negative effects on inpatient rehabilitation outcomes following total knee arthroplasty. This finding is significant given implementation of the prospective payment system in rehabilitation hospitals in parts of Turkey, and the effect that this will have on length of hospital stay for patients who have undergone total knee arthroplasty.     

The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury

Hanks RA, Millis SR, Ricker JH, Giacino JT, Nakese-Richardson R, Frol AB, Novack TA, Kalmar K, Sherer M, Gordon WA. The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury.

Objective

To examine the predictive validity of a brief neuropsychologic test battery consisting of the Galveston Orientation and Amnesia Test, the California Verbal Learning Test-II, Trail-Making Test (TMT), Symbol Digit Modalities Test, grooved pegboard, phonemic and categorical word generation tasks, the Wechsler Test of Adult Reading (WTAR), and the Wisconsin Card Sorting Test-64 relative to functional outcome at 1 year in persons with traumatic brain injury.

Design

Inception cohort study. Follow-up period of 12 months.

Setting

Seven Traumatic Brain Injury Model System centers. Neuropsychologic testing was conducted during the acute inpatient rehabilitation stay and functional outcome measures were obtained at 1-year outpatient follow-up.

Participants

Adults (N=174) who met criteria for admission to inpatient brain injury rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

FIM instrument, Disability Rating Scale, Supervision Rating Scale, Satisfaction With Life Scale (SWLS), and Glasgow Outcome Scale−Extended.

Results

Multiple regression analyses revealed that performance on the neuropsychologic test battery was predictive of outcome at 1 year postinjury for all outcome measures, except FIM motor scores and the SWLS. Cognitive performance using this battery was found to predict 1-year outcomes above and beyond functional variables and injury severity variables collected during inpatient rehabilitation, thereby indicating incremental validity for this test battery. Individual tests that were found to be significant predictors of 1-year outcomes included the WTAR and TMT part B.

Conclusions

These findings support the clinical utility and ecological validity of this battery with respect to level of disability, functional independence, and supervision required.     

Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury

Hussain R, Cevallos ME, Darouiche RO, Trautner BW. Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury.

Objective

To determine whether the prevalence of gram-negative catheter-related bloodstream infection (CRBSI) is higher in patients with spinal cord injury (SCI) than in patients without SCI.

Design

Retrospective chart review from August 1998 to August 2006.

Setting

A Veterans Affairs medical center, which serves as a tertiary care medical center to over 500 veterans with SCI and is the primary source of health care for veterans in southeast Texas.

Participants

All hospitalized patients who had an International Classification of Diseases, Ninth Revision, code for bacteremia associated with their hospital stay.

Interventions

Not applicable.

Main Outcome Measure

The proportion of CRBSI caused by gram-negative organisms in the SCI patients to the proportion of CRBSI caused by gram-negative organisms in the non-SCI patients.

Results

Eight (42%) of 19 episodes of CRBSI in the SCI were caused by a gram-negative organism as compared with 4 (11%) of 36 infections in the non-SCI group (P<.01). Factors associated with having a gram-negative organism rather than a gram-positive organism as the causative agent of CRBSI were SCI, femoral catheter site, prolonged hospitalization, decubitus ulcer, and urinary catheter.

Conclusions

In our medical center, patients with SCI who develop CRBSI are more likely to have an infection with a gram-negative organism than are patients without SCI. This knowledge may guide initial empirical therapy of suspected bloodstream infection.     

Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury

Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury.

Objectives

To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight.

Design

Case series.

Setting

National Veterans' Wheelchair Games 2005 and 2006.

Participants

Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games.

Interventions

Not applicable.

Main Outcome Measures

Presence of relationships between US findings, PE findings, pain, and subject characteristics.

Results

The USPRS correlated with age, duration of SCI, and weight (all P<.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score (r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI (r=.679, P<.001) and duration of SCI (P<.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores (P=.002).

Conclusions

PE and US abnormalities are common in manual wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated.     

Are there meaningful longitudinal changes in health related quality of life — SF36, in cardiac rehabilitation patients?

Background

This study aimed to observe changes in quality of life and minimal clinical important differences of quality of life over time in cardiac rehabilitation patients and to compare these with published normal data.

Methods

In this non-randomised study, SF36 questionnaires were completed by 187 patients recruited to a Phase III cardiac rehabilitation multidisciplinary outpatient programme. Data was collected at beginning, end and six months after Phase III cardiac rehabilitation programme.

Results

There were significant improvements in physical functioning, role limitation due to physical function, pain and general health perception scales, over the above time frame, from both a statistically and a mean clinical important difference point of view. These improvements occurred mainly during the cardiac rehabilitation programme phase.

Conclusions

These improvements meant that patients six months post-cardiac rehabilitation were only 5% below the quality of life for an aged matched normal group. However patients still had significant deficits in physical role and emotional role limitations. Suitable measurement of quality of life on an individual basis, supported by normal values is needed. This would facilitate the identification of shortfalls in patient quality of life and the subsequent tailoring of care to address these individualised patient needs.     

A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial

Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial.

Objective

To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.

Design

A single-blinded randomized controlled trial, with outcome assessments at baseline, postintervention (6wk), and follow-up (18wk).

Setting

Inpatient acute and rehabilitation hospitals.

Participants

Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.

Intervention

Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.

Main Outcome Measures

Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.

Results

No significant differences were found in short-term improvement (0−6wk) on any measure (P>.05). For overall improvement (0−18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0−0.1; P=.05) and ARAT pinch section (95% CI, 0.3−5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P<.05), but this was irrespective of the treatment group.

Conclusions

Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.     

The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury

van Londen A, Herwegh M, van der Zee CH, Daffertshofer A, Smit CA, Niezen A, Janssen TW. The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury.

Objective

To study effects of surface electric stimulation of the gluteal muscles on the interface pressure in seated persons with spinal cord injury (SCI).

Design

One session in which alternating and simultaneous surface electric stimulation protocols were applied in random order.

Setting

Research laboratory of a rehabilitation center.

Participants

Thirteen subjects with SCI.

Intervention

Surface electric stimulation of the gluteal muscles.

Main Outcome Measures

Interface pressure, maximum pressure, pressure spread, and pressure gradient for the stimulation measurement. Variables were compared using 2-tailed paired t tests.

Results

Alternating and simultaneous stimulation protocol caused a significant (P<.01) decrease in interface pressure (-17±12mmHg, -19±14mmHg) and pressure gradient (-12±11mmHg, -14±12mmHg) during stimulation periods compared with rest periods. There was no significant difference in effects between the 2 protocols.

Conclusions

Surface electric stimulation of the gluteal muscles in persons with SCI causes a decrease in interface pressure. This might restore blood flow in compressed tissue and help prevent pressure ulcers.     

Rasch Analysis of the Executive Interview (The EXIT-25) and Introduction of an Abridged Version (The Quick EXIT)

Larson EB, Heinemann AW. Rasch analysis of the Executive Interview (The EXIT-25) and introduction of an abridged version (The Quick Exit).

Objectives

To evaluate the psychometric properties of the Executive Interview (EXIT-25) and to propose modifications that will improve those properties.

Design

Rasch analysis of existing datasets contributed by 3 prior projects, all of which examined criterion-related validity of the EXIT-25.

Setting

A large, urban, academic free-standing rehabilitation facility.

Participants

The sample of 147 was comprised of 109 adults diagnosed with stroke evaluated during inpatient rehabilitation and 38 adults with traumatic brain injury evaluated during inpatient (n=11) or outpatient rehabilitation (n=27).

Interventions

Not applicable.

Main Outcome Measures

The EXIT-25, Repeatable Battery for the Assessment of Neuropsychological Status, and Trails A and B.

Results

Eleven of the 25 items correlated weakly with the total measure and misfit the rating scale model. Deleting these 11 items improved the internal consistency of the remaining 14 items and enhanced the measure's criterion-related validity.

Conclusions

The EXIT-25 can be reduced from 25 to 14 items without reducing internal consistency. Convergent validity of the abbreviated measure is supported by moderate-size correlations with standard measures of cognitive deficits.     

Pulmonary rehabilitation for chronic obstructive pulmonary disease: a pilot study evaluating a once-weekly versus twice-weekly supervised programme

Objectives

To compare the effectiveness of a once-weekly supervised pulmonary rehabilitation programme with a standard twice-weekly format.

Design

Randomised trial of equivalency.

Setting

Pulmonary rehabilitation service of a primary care trust delivered at two physiotherapy outpatient departments.

Participants

Thirty patients with chronic obstructive pulmonary disease.

Outcome measures

Primary outcomes were the Incremental Shuttle Walking Test (ISWT), Endurance Shuttle Walking Test (ESWT) and St George's Respiratory Questionnaire (SGRQ), assessed at baseline and at completion of the supervised programme. Secondary outcomes were home-exercise activity, attendance levels and patient satisfaction with the programme.

Interventions

The once-weekly group (n = 15) received one supervised rehabilitation session per week, and the twice-weekly group (n = 15) received two sessions per week, both for 8 weeks, together with a home-exercise plan.

Results

After pulmonary rehabilitation, the groups showed similar improvements in exercise tolerance (median values: ISWT once-weekly 60 metres, twice-weekly 50 metres; ESWT once-weekly 226 seconds, twice-weekly 109 seconds). However, for health-related quality-of-life, the once-weekly group's score did not change (SGRQ 0), whereas an improvement was seen for the twice-weekly group (SGRQ 3.7). The number of home-exercise sessions and attendance levels were similar between the groups. Patient satisfaction with both formats was high and almost identical between the groups.

Conclusions

This pilot provides data to inform a larger study and shows that the methodology is feasible. The findings suggest that once-weekly supervision may be capable of producing equivalent improvements in exercise tolerance as a twice-weekly programme, but the health-related quality-of-life outcome appeared to be poorer for once-weekly supervision.