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1.
Prvu Bettger JA Coster WJ Latham NK Keysor JJ 《Archives of physical medicine and rehabilitation》2008,89(7):1267-1275
Prvu Bettger JA, Coster WJ, Latham NK, Keysor JJ. Analyzing change in recovery patterns in the year after acute hospitalization.
Objective
To examine trajectories of recovery and change in patterns of personal care and instrumental functional activity performance to determine whether different assessment interval designs within a 12-month period yield different estimates of improvement and decline after acute hospitalization and inpatient rehabilitation.Design
Secondary analysis of a 12-month prospective cohort study.Setting
Transition to the community.Participants
Adults (N=419) admitted to acute care and receiving inpatient rehabilitation for a neurologic, lower-extremity musculoskeletal, or medically complex condition.Interventions
Not applicable.Main Outcome Measures
Improvement, no change, and decline as measured by the personal care and instrumental scale of the Activity Measure for Post-Acute Care.Results
Assessment at the end of a single 12-month follow-up assessment interval showed that over 60% of the participants improved. In contrast, analysis of 2 fixed-length 6-month assessment intervals revealed an almost 40% decrease in the proportion who improved from 6 to 12 months. Fewer participants continued to improve in the time periods further from the acute hospitalization and the proportion of subjects who declined increased from 21.4% to 31.2% to 38.0% over the 3 consecutive assessment intervals (baseline to 1mo, 1−6mo, 6−12mo). Only 58 (19.7%) participants continued on the same path of recovery from baseline to 12 months (9.8% improved over all 3 consecutive time periods, 3.1% made no change, 6.8% declined).Conclusions
Examination of change over shorter compared with longer assessment intervals revealed considerable variability in the trajectories of recovery. Research is needed to determine the appropriate frequency and timing for measuring and monitoring function and recovery after an acute hospitalization. 相似文献2.
Hanks RA Millis SR Ricker JH Giacino JT Nakese-Richardson R Frol AB Novack TA Kalmar K Sherer M Gordon WA 《Archives of physical medicine and rehabilitation》2008,89(5):950-957
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. 相似文献3.
Timothy A. Reistetter James E. Graham Anne Deutsch Carl V. Granger Samuel Markello Kenneth J. Ottenbacher 《Archives of physical medicine and rehabilitation》2010,91(3):345-350
Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke.
Objective
To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke.Design
Retrospective cross-sectional design.Setting
Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation.Participants
Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007.Interventions
Not applicable.Main Outcome Measure
Discharge FIM rating and discharge setting (community vs institutional).Results
Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77).Conclusions
Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings. 相似文献4.
Pieter A. Struyf Caroline M. van Heugten Minou W. Hitters Rob J. Smeets 《Archives of physical medicine and rehabilitation》2009,90(3):440-446
Struyf PA, van Heugten CM, Hitters MW, Smeets RJ. The prevalence of osteoarthritis of the intact hip and knee among traumatic leg amputees.
Objective
To determine the prevalence of osteoarthritis (OA) in the knee and/or hip of the intact leg among traumatic leg amputees compared with the general population and its relationship with amputation level, time since amputation, age, and mobility.Design
Cross-sectional observational study.Setting
Outpatient population of 2 Dutch rehabilitation centers.Participants
Patients (N=78) with a unilateral traumatic transtibial amputation, knee disarticulation, or transfemoral amputation of at least 5 years ago; ability to walk with a prosthesis; older than 18 years of age; and able to understand Dutch. Patients were excluded if they had bilateral amputations, other pathologies of the knee or hip, or central neurologic pathologies.Interventions
Not applicable.Main Outcome Measure
The prevalence of OA.Results
The prevalence of knee OA was 27% (men 28.3%, women 22.2%) and hip OA was 14% (men 15.3%, women 11.1%). This was higher compared with the general population (knee OA men 1.58%, women 1.33%, hip OA men 1.13%, women 0.98%, age adjusted). No significant relationships between the prevalence of OA and level of amputation, time since amputation, mobility, and age were found.Conclusions
The prevalence of OA is significantly greater for both the knee and hip in the traumatic leg amputee population. No specific risk factors were identified. Although no specific risk factors in this specific population could be identified, it might be relevant to apply commonly known strategies to prevent OA as soon as possible after the amputation. 相似文献5.
Treger I Ring H Schwartz R Tsabari R Bornstein NM Tanne D;National Acute Stroke Israeli Survey Group 《Archives of physical medicine and rehabilitation》2008,89(3):435-440
Treger I, Ring H, Schwartz R, Tsabari R, Bornstein NM, Tanne D; for the National Acute Stroke Israeli Survey Group. Hospital disposition after stroke in a national survey of acute cerebrovascular diseases in Israel.
Objective
To investigate predictive factors for disposition after acute stroke.Design
A nationwide survey (2004 National Acute Stroke Israeli Survey).Setting
All 28 primary general medical centers operating in Israel.Participants
Acute stroke patients (n=1583) admitted during February and March 2004 and discharged from the primary hospital.Interventions
Data collected on baseline characteristics, stroke presentation, type and severity, in-hospital investigation and complications, discharge disability, acute hospital disposition, and mortality follow-up.Main Outcome Measure
Hospital disposition to home, acute rehabilitation, or nursing facility.Results
Among patients, 58.9% (n=932) were discharged home, 33.7% (n=534) to rehabilitation departments, and only 7.4% (n=117) to nursing facilities. Admission neurologic status was a good predictor of hospital disposition. Patients with severe strokes were mostly discharged to rehabilitation facilities. Patients with significant functional decline before the index stroke, resulting from a previous stroke or another cause, were sent to inpatient rehabilitation less frequently. Disability level at discharge from acute hospitalization had high predictive value in hospital disposition after stroke. In the northern region of Israel, a higher proportion of patients were sent home and a lower proportion to rehabilitation and nursing facilities, probably because of lower availability of rehabilitation care in this region of Israel.Conclusions
This nationwide survey shows that most stroke survivors in Israel are discharged home from the acute primary hospital. Good functional status before the index stroke is an important predictor for being sent to acute inpatient rehabilitation. Severity of neurologic impairment and level of disability after the stroke at discharge from the primary hospital are strong predictors for disposition after stroke in Israel. Our data may be useful in discharge planning for stroke patients by policy-makers and health care providers in Israel. 相似文献6.
Yokoyama O Sakuma F Itoh R Sashika H 《Archives of physical medicine and rehabilitation》2006,87(9):1189-1194
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. 相似文献7.
Quality of Life of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up
Diana Zidarov Bonnie Swaine Christiane Gauthier-Gagnon 《Archives of physical medicine and rehabilitation》2009,90(4):634-645
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. 相似文献8.
Vanessa D. Sherk 《Archives of physical medicine and rehabilitation》2010,91(7):1077-1081
Sherk VD, Bemben MG, Bemben DA. Interlimb muscle and fat comparisons in persons with lower-limb amputation.
Objectives
To investigate differences in muscle and fat tissue between amputated and intact limbs in subjects with transfemoral and transtibial amputations and to determine the effect of amputation level on limb differences. We hypothesized that the amputated limb would have a higher relative amount of fat than the intact limb, and transfemoral amputees would have greater limb differences in muscle size than transtibial amputees.Design
Cross-sectional, repeated-measures design.Setting
Laboratory.Participants
Subjects included persons with unilateral transfemoral (TF) (n=5) and transtibial (TT) (n=7) amputations and age- and sex-matched nonamputation controls (n=12).Interventions
Not applicable.Main Outcome Measures
Muscle cross-sectional areas and fat cross-sectional areas of the end of residual limbs were compared with similar cross-sectional sites of the intact limb by using peripheral quantitative computed tomography scans. Thigh and lower-leg fat mass (FM) and bone-free lean body mass were measured by dual-energy x-ray absorptiometry.Results
There was a 93% to 117% difference between limbs in muscle cross-sectional areas for TF and TT. TT had a between-limb difference of 39% for fat cross-sectional areas. Thigh bone-free lean body masses and FM were significantly (P<.05) lower for the amputated limb for both TF and TT. Thigh percent fat was significantly (P<.05) higher in the amputated thigh for TF and TT, but limb differences were greater in TF.Conclusions
Muscle atrophy was prevalent in the residual limb with larger relative amounts of fat in the thighs, especially in TF subjects. 相似文献9.
Susan Magasi Elizabeth Durkin Michael S. Wolf Anne Deutsch 《Archives of physical medicine and rehabilitation》2009,90(2):206-212
Magasi S, Durkin E, Wolf MS, Deutsch A. Rehabilitation consumers' use and understanding of quality information: a health literacy perspective.
Objectives
To explore consumers' use and understanding of quality information about postacute rehabilitation facilities.Design
Thematic, semistructured interviews.Setting
Two skilled nursing facilities and 2 inpatient rehabilitation facilities in a large Midwestern city.Participants
Rehabilitation inpatients (n=17) with stroke, hip fractures, and joint replacements and care partners (n=12) of rehabilitation inpatients.Intervention
None.Main Outcome Measure
None.Results
Health literacy imposed barriers to participants' understanding of quality information. Using the Institute of Medicine's Health Literacy Framework, we identified specific barriers that limited participants' abilities to (1) obtain quality information, (2) process and understand quality information, and (3) make appropriate decisions about the quality of a rehabilitation facility. Participants tended to rely on informal and nonquality information when choosing a rehabilitation facility.Conclusions
Given the barriers imposed by low health literacy, rehabilitation providers have a responsibility to present quality information in a way that consumers, especially those with low health literacy, can use and understand. 相似文献10.
van Koppenhagen CF Post MW van der Woude LH de Witte LP van Asbeck FW de Groot S van den Heuvel W Lindeman E 《Archives of physical medicine and rehabilitation》2008,89(9):1733-1740
van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in The Netherlands.
Objective
To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.Design
A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.Setting
Eight rehabilitation centers in The Netherlands.Participants
Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.Interventions
Not applicable.Main Outcome Measure
The Life Satisfaction Questionnaire.Results
Mean satisfaction with life ± SD as a whole was 5.3±0 before SCI and 4.3±1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (β=.31, P<.05), pain (β=.19, P<.05), and secondary impairments (β=.22, P<.05).Conclusions
Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation. 相似文献11.
Sayer NA Chiros CE Sigford B Scott S Clothier B Pickett T Lew HL 《Archives of physical medicine and rehabilitation》2008,89(1):163-170
Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, Lew HL. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror.
Objective
To describe characteristics and rehabilitation outcomes among patients who received inpatient rehabilitation for blast and other injuries sustained in Iraq and Afghanistan during the Global War on Terror.Design
Observational study based on chart review and Department of Veterans Affairs (VA) administrative data.Setting
The 4 VA polytrauma rehabilitation centers (PRCs).Participants
Service members (N=188) admitted to a PRC during the first 4 years of the Global War on Terror for injuries sustained during Operation Iraqi Freedom or Operation Enduring Freedom.Intervention
Multidisciplinary comprehensive rehabilitation program.Main Outcomes Measures
Cognitive and motor FIM instrument gain scores and length of stay (LOS).Results
Most war-injured patients had traumatic brain injury, injuries to several other body systems and organs, and associated pain. Fifty-six percent had blast-related injuries, and the pattern of injuries was unique among those with injuries secondary to blasts. Soft tissue, eye, oral and maxillofacial, otologic, penetrating brain injuries, symptoms of post-traumatic stress disorder, and auditory impairments were more common in blast-injured patients than in those with war injuries of other etiologies. The mechanism of the injury did not predict functional outcomes. LOS was variable, particularly for those with blast injuries. Patients with low levels of independence at admissions made the most progress but remained more dependent at discharge compared with other PRC patients. The rate of gain was slower in this low-functioning group.Conclusions
Blasts produce a unique constellation of injuries but do not make a unique contribution to functional gain scores. Findings underscore the need for assessment and treatment of pain and mental health problems among patients with polytrauma and blast-related injuries. Patients with polytrauma have lifelong needs, and future research should examine needs over time after community re-entry. 相似文献12.
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. 相似文献13.
Diana Zidarov Bonnie Swaine Christiane Gauthier-Gagnon 《Archives of physical medicine and rehabilitation》2009,90(11):1953-1959
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. 相似文献14.
Eric B. Larson Allen W. Heinemann PhD ABPP 《Archives of physical medicine and rehabilitation》2010,91(3):389-394
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. 相似文献15.
Jessica Sharac Ramon Sabes-Figuera Ann Wood 《International journal of nursing studies》2010,47(7):909-917
Background
Despite major developments in community mental health services, inpatient care remains an important yet costly part of the service system and patients who are admitted frequently spend a long period of time in hospital. It is, therefore, crucial to have a good understanding of activities that take place on inpatient wards.Objective
To review studies that have measured nursing and patient activity and interaction on psychiatric inpatient wards.Data sources and review methods
This literature review was performed by searching electronic databases and hand-checking reference lists.Results
The review identified 13 relevant studies. Most used observational methods and found that at best 50% of staff time is spent in contact with patients, and very little time is spent delivering therapeutic activities. Studies also showed that patients spend substantial time apart from staff or other patients.Conclusion
On inpatient psychiatric wards, evidence over 35 years has found little patient activity or patient social engagement. The reasons for this trend and recommendations for the future are discussed. 相似文献16.
Bussmann JB Schrauwen HJ Stam HJ 《Archives of physical medicine and rehabilitation》2008,89(3):430-434
Bussmann JB, Schrauwen HJ, Stam HJ. Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation.
Objectives
To test the hypothesis that people with a unilateral traumatic transtibial amputation are less active than people without an amputation, and to explore whether both groups have a similar heart rate response while walking.Design
A case-comparison study.Setting
General community.Participants
Nine subjects with a unilateral traumatic transtibial amputation and 9 matched subjects without known impairments.Interventions
Not applicable.Main Outcome Measures
Percentage of dynamic activities in 48 hours (expressing activity level). Additionally, we examined heart rate and percentage heart rate reserve during walking (expressing heart rate response) and body motility during walking (expressing walking speed). These parameters were objectively measured at participants’ homes on 2 consecutive days.Results
Subjects with an amputation showed a lower percentage of dynamic activities (6.0% vs 11.7% in a 48-h period, P=.02). No significant differences were found between the 2 groups in heart rate (91.1bpm vs 89.5bpm, P=.86) and percentage heart rate reserve during walking (28.2% vs 27.5%, P=1.0). Body motility during walking was lower in the amputation group (.14g vs .18g, P<.01).Conclusions
Our results support our hypothesis that persons with a unilateral traumatic transtibial amputation are considerably less active than persons without known impairments. The results indicate that heart rate response during walking is similar in both groups, and is probably regulated by adapting one’s walking speed. 相似文献17.
James S. Krause Karla S. Reed John J. McArdle 《Archives of physical medicine and rehabilitation》2010,91(8):1218-1224
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. 相似文献18.
Barker AL Nitz JC Low Choy NL Haines TP 《Archives of physical medicine and rehabilitation》2008,89(11):2140-2145
Barker AL, Nitz JC, Low Choy NL, Haines TP. Clinimetric evaluation of the Physical Mobility Scale supports clinicians and researchers in residential aged care.
Objective
To investigate the interrater agreement and the internal construct validity of the Physical Mobility Scale, a tool routinely used to assess mobility of people living in residential aged care.Design
Prospective, multicenter, external validation study.Setting
Nine residential aged care facilities in Australia.Participants
Residents (N=186). Phase 1 cohort (99 residents; mean age, 85.22±5.1y); phase 2 cohort (87 residents; mean age, 81.59±10.69y).Interventions
Not applicable.Main Outcome Measures
Kappa statistics, minimal detectable change (MDC90) scores, and Bland-Altman plots were used to assess interrater agreement. Scale unidimensionality, item hierarchy, and person separation were examined with Rasch analysis for both cohorts.Results
Agreement between raters on 6 of the 9 Physical Mobility Scale items was high (κ>.60). The MDC90 value was 4.39 points, and no systematic differences in scores between raters were found. The Physical Mobility Scale showed a unidimensional structure demonstrated by fit to the Rasch model in both cohorts (phase 1: χ2=23.90, P=.16, person separation index=0.96; phase 2: χ2=22.00, P=.23, person separation index=0.96). Standing balance was the most difficult item in both cohorts (phase 1: logit=2.48, SE, 0.16; phase 2: logit=2.53, SE, 0.15). The person-item threshold map indicated no floor or ceiling effects in either cohort.Conclusions
The Physical Mobility Scale demonstrated good interrater agreement and internal construct validity with good fit to the Rasch model in both cohorts. The comparative results across the 2 cohorts indicate generality of the findings. The Physical Mobility Scale total raw scores can be converted to Rasch transformed scores, providing an interval measure of mobility. The Physical Mobility Scale may be suited to a range of clinical and research applications in residential aged care. 相似文献19.
Background
Since the 1990s, several studies have shown that organizational culture is an important characteristic in long-term care. However, at the moment little is known about organizational culture and its relationship with quality of care.Objectives
In this study, the relationship between organizational culture and quality of care in long-term care was investigated using the competing values framework. Thereto, two independent measurements of quality of care were applied: the perceived quality of care by nursing staff of dementia units and the observed quality of care on the units by researchers.Design
The study used a cross-sectional design.Settings
Data were collected on 11 dementia units in 11 Dutch nursing homes.Participants
All nursing staff on the units were asked to complete a questionnaire, of whom 248 staff members responded. The average response rate on the 11 units was 63%.Methods
Data were collected during two days of field-work on each unit. Systematic observations were performed, and questionnaires were distributed among nursing staff. Data were analyzed using multilevel analyses.Results
Organizational culture was related to both perceived and observed quality of care on the units. Units that are characterized by a clan culture provide better quality of care, both in the eyes of the nursing staff as in the eyes of outsiders. Market culture, compared to clan culture, is negatively related to quality of care in this sample.Conclusions
The results indicate that organizational culture in long-term dementia care is important for organizational performance. 相似文献20.
Mary Ann McColl Samuel Shortt Marshall Godwin Karen Smith Kirby Rowe Patti O'Brien Catherine Donnelly 《Archives of physical medicine and rehabilitation》2009,90(9):1523-1531
McColl MA, Shortt S, Godwin M, Smith K, Rowe K, O'Brien P, Donnelly C. Models for integrating rehabilitation and primary care: a scoping study.