共查询到20条相似文献,搜索用时 31 毫秒
1.
Sepideh Pooyania Karen Ethans Tony Szturm Alan Casey Daryl Perry 《Archives of physical medicine and rehabilitation》2010,91(5):703-707
Pooyania S, Ethans K, Szturm T, Casey A, Perry D. A randomized, double-blinded, crossover pilot study assessing the effect of nabilone on spasticity in persons with spinal cord injury.
Objectives
To determine whether nabilone, a synthetic cannabinoid, alleviates spasticity in people with spinal cord injury (SCI).Design
A double-blind, placebo-controlled crossover study.Setting
Outpatient rehabilitation clinics.Participants
We recruited volunteers (N=12) with SCI and spasticity. One subject, a paraplegic man, dropped out of the study because of an unrelated cause. Eleven subjects completed the study; all subjects were men with an average age of 42.36 years; 6 of them were persons with tetraplegia, and 5 were persons with paraplegia.Interventions
The subjects received either nabilone or placebo during the first 4-week period (0.5mg once a day with option to increase to 0.5mg twice a day), and then outcome measures were assessed. After a 2-week washout, subjects were crossed over to the opposite arm.Main Outcome Measures
The primary outcome was the Ashworth Scale for spasticity in the most involved muscle group, in either the upper or lower extremities, chosen by the subject and clinician. The secondary outcomes included the sum of the Ashworth Scale in 8 muscle groups of each side of the body measured by the clinician; Spasm Frequency Scale and visual analog scale, reported by the subject; Wartenberg Pendulum Test, in order to quantify severity of spasticity; and the Clinician's and Subject's Global Impression of Change.Results
One subject dropped out during the placebo arm because of an unrelated urinary stricture, and 11 subjects completed the study. There was a significant decrease on active treatment for the Ashworth in the most involved muscle (mean difference ± SD, .909±.85; P=.003), as well as the total Ashworth score (P=.001). There was no significant difference in other measures. Side effects were mild and tolerable.Conclusions
Nabilone may be beneficial to reduce spasticity in people with SCI. We recommend a larger trial with a more prolonged treatment period and an option to slowly increase the dosage further. 相似文献2.
Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain.
Objective
To investigate the changes in 2 electromyographic measures, flexion relaxation (FR) response and feed-forward activation of the deep abdominals, associated with low back pain (LBP) after different rehabilitation interventions.Design
A 2×2 factorial design with subjects' self-selecting treatment with randomization after 4 weeks to either the specific exercise group or exercise advice group for a further 12-week period.Setting
General community practitioners and university training center.Participants
Subjects with chronic nonspecific LBP were recruited for this study. A total of 112 people were initially screened, and 60 were recruited for the study, with 50 being available for long-term follow-up.Intervention
Four weeks of treatment (manipulative or nonmanipulation) and 12 weeks of subsequent exercise (supervised Swiss ball training or exercise advice).Main Outcome Measures
The Oswestry Disability Index, FR response measured at T12-L1 and L4-5, and feed-forward activation of the deep abdominal muscles.Results
More rapid improvements in disability were identified for subjects who received the supervised exercise program. The FR response at L4-5 also increased more for those who received directly supervised exercise. Long-term follow-up showed that there was still a between-group difference in the FR response, despite no difference in self-rated disability. Long-term changes were observed for the feed-forward activation of the deep abdominals; however, no exercise or treatment effects were identified.Conclusions
Supervised exercise rehabilitation leads to more rapid improvements in self-rated disability, which were associated with greater improvement in the low back FR response. 相似文献3.
A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy 总被引:1,自引:0,他引:1
Marjorie Chown Lynne Whittamore Mark Rush Sally Allan David Stott Mark Archer 《Physiotherapy》2008,94(1):21-28
Objective
To investigate the difference in outcome between patients treated with group exercise, physiotherapy or osteopathy.Design
Prospective study of patients referred at random to one of three treatments, with follow-up 6 weeks after discharge and after 12 months.Setting
National Health Service physiotherapy department at St Albans City Hospital, part of the West Hertfordshire Musculoskeletal Therapy Service.Participants
Two hundred and thirty-nine patients aged 18-65 years recruited from referrals to the physiotherapy department with chronic low back pain.Interventions
Eligible patients were randomised to group exercises led by a physiotherapist, one-to-one predominantly manipulative physiotherapy, or osteopathy.Main outcomes
Oswestry Disability Index (ODI), EuroQol-5D, shuttle walking test and patients’ subjective responses to pain and treatment.Results
All three treatments indicated comparable reductions in mean (95% confidence intervals) ODI at 6-week follow-up: group exercise, −4.5 (−0.9 to −8.0); physiotherapy, −4.1 (−1.4 to −6.9); and osteopathy, −5.0 (−1.6 to −8.4). Attendance rates were significantly lower among the group exercise patients. One-to-one therapies provided evidence of greater patient satisfaction.Conclusion
The study supports the use of a variety of approaches for the treatment of chronic low back pain. Particular attention needs to be given to the problems of attracting enough participants for group sessions, as these can be difficult to schedule in ways that are convenient for different participants. 相似文献4.
Adam T. Hirsh Aaron P. Turner Dawn M. Ehde Jodie K. Haselkorn 《Archives of physical medicine and rehabilitation》2009,90(4):646-651
Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors.
Objective
To characterize the prevalence and impact of pain in veterans with multiple sclerosis (MS) and to assess their association with demographic, biologic, and psychologic variables.Design
Cross-sectional cohort study linking computerized medical record information to mailed survey data.Setting
Veterans Health Administration (VHA).Participants
Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires.Interventions
Not applicable.Main Outcome Measures
Items assessing pain intensity, pain interference, and physical and mental health functioning.Results
Ninety-two percent of participants reported bodily pain within the prior 4 weeks, with 69% of the total sample indicating pain of moderate or higher intensity. Eighty-five percent indicated that pain caused functional interference during the past 4 weeks, with 71% of the total sample reporting pain-related interference that was moderate or greater. No significant sex or race differences emerged for the pain indices. A significant but modest relationship between increasing age and pain interference emerged (r=.05, P<.01); however, age was not significantly related to pain intensity. Multivariate regression analyses identified pain intensity (β=.73), physical health functioning (β=-.07), and mental health functioning (β=-.13) variables as significant, unique contributors to the prediction of pain interference. The interaction of pain intensity and physical functioning was also significant but of minimal effect size (β=-.03).Conclusions
Pain is highly prevalent and causes substantial interference in the lives of veterans with MS. The functional impact of pain in veterans with MS is influenced by pain intensity, physical health, and emotional functioning. Clinical practice should take each of these domains into consideration and reflect a biopsychosocial conceptualization. 相似文献5.
Brose SW Boninger ML Fullerton B McCann T Collinger JL Impink BG Dyson-Hudson TA 《Archives of physical medicine and rehabilitation》2008,89(11):2086-2093
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. 相似文献6.
Mallinson TR Manheim LM Almagor O Demark HM Heinemann AW 《Archives of physical medicine and rehabilitation》2008,89(11):2066-2079
Mallinson TR, Manheim LM, Almagor O, DeMark HM, Heinemann AW. Trends in the supply of inpatient rehabilitation facilities services: 1996 to 2004.
Objectives
Describe the supply of inpatient rehabilitation facilities (IRFs) services in 1996 and examine changes between 1996 and 2004, including the impact of the IRF prospective payment system (PPS) in 2002 on organizational trends.Design
Retrospective pre-post design.Setting
Freestanding and subprovider (distinct-part units) IRFs.Participants
IRFs (N=1424), including 257 freestanding IRFs and 1167 IRF units reported in the Healthcare Cost Report Information System database, from years 1996 to 2004.Interventions
Not applicable.Main Outcome Measures
Number of IRF openings, IRF closures, beds, and inpatient days.Results
The number of IRFs grew from 1037 to 1183 between 1996 and 2001 and grew to 1235 between 2001 and 2004. The likelihood of IRF closures trended lower after PPS, and there was a significant increase in the likelihood of openings when PPS was introduced. For-profit, rural, and small IRFs were more likely to open over the entire period. There was a 12.9% increase in the number of total inpatient days, somewhat less than the 15.7% growth in IRF beds over the period. There was no impact of PPS on beds available but a significant decline in total inpatient days after PPS.Conclusions
Inpatient days rose under the Tax Equity and Fiscal Responsibility Act and declined after 2002. Yet the likelihood of openings and closures did not appear to respond to these changes, perhaps because they were modest compared with changes in local IRF markets. The IRF PPS did little to affect service distribution in less well-served areas, although we did find growth in rural areas. Occupancy rates in 2004 were close to rates at the start of the period (70%). This observation implies that IRFs were implementing strategies to recruit a sufficient number of patients, even though bed numbers were increasing and length of stay was declining. Consequently, policy that limits the potential of IRFs to increase patient admissions, such as the limits on admissions to IRFs of patients with conditions other than those included in the 75% rule, is likely to produce substantial decreases in total inpatient days. 相似文献7.
8.
Yeh C-Y, Tsai K-H, Su F-C, Lo H-C. Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke.
Objectives
To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES.Design
Within-subject comparison.Setting
University hospital.Participants
Patients with stroke (N=16; age range, 42-72y; <8wk poststroke) with hypertonia in the affected leg.Interventions
Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session.Main Outcome Measures
Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity).Results
Modified Ashworth Scale scores were significantly lower (P<.05) and relaxation index and peak velocity values were significantly higher (P<.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P<.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling.Conclusions
The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia. 相似文献9.
Objectives
To compare the temporal recruitment of the vastus medialis obliquus (VMO) and vastus lateralis (VL) during voluntary ankle movements and perturbed standing in people with patellofemoral pain, and to determine the effects of different reflex and voluntary postural exercise tasks on VMO facilitation.Design
Repeated-measures design.Participants
Twenty-three subjects with patellofemoral pain.Interventions
Quadriceps reflex contraction in response to postero-anterior knee perturbations was measured with three crural muscle contraction conditions and three postural exercises (semi-squatting, tip-toeing and heel standing).Main outcome measures
The electromyographic (EMG) onset time of the VMO and VL during each task was measured and compared across the different tasks.Results
The mean EMG onset time of the VMO was later than that of the VL in the voluntary tasks such as tip-toeing (VMO 95.3 ms vs VL 36.4 ms, mean difference 58.9 ms, 95% confidence interval −33.7 to 151.5 ms), whereas earlier VMO activation was found in the perturbation tests such as toe standing (VMO 17.6 ms vs VL 22.9 ms, mean difference −5.3 ms, 95% confidence interval −25.3 to 14.7 ms).Conclusion
These findings suggest the potential benefits of unexpected perturbation activities for facilitating VMO activation. The clinical applications of perturbation tasks in rehabilitation exercise programmes and the underlying mechanisms warrant further investigation. 相似文献10.
Erica N. Johnson 《Archives of physical medicine and rehabilitation》2010,91(7):1140-1142
Johnson EN, Thomas JS. Effect of hamstring flexibility on hip and lumbar spine joint excursions during forward-reaching tasks in participants with and without low back pain.
Objective
To examine the correlation between hamstring flexibility and hip and lumbar spine joint excursions during standardized reaching and forward-bending tasks.Design
Retrospective analysis of data obtained during 2 previous prospective studies that examined kinematics and kinetics during forward-reaching tasks in participants with and without low back pain (LBP).Setting
The 2 previous studies were conducted in the Motor Control Lab at Ohio University and the Orthopaedic Ergonomics Laboratory at The Ohio State University.Participants
Data from a total of 122 subjects from 2 previous studies: study 1: 86 subjects recovered from an episode of acute LBP (recovered) and study 2 (A.I. McCallum, unpublished data): 18 chronic LBP subjects and 18 healthy-matched controls (healthy).Interventions
Not applicable.Main Outcome Measure
Correlation values between hamstring flexibility as measured by straight leg raise (SLR) and amount of hip and lumbar spine joint excursions used during standardized reaching and forward-bending tasks.Results
No significant correlation was found between hamstring flexibility and hip and lumbar joint excursions during forward-bending tasks in the LBP or recovered groups. The SLR had a significant negative correlation with lumbar spine excursions during reaching tasks to a low target in the healthy group (right SLR: P=.011, left SLR: P=.004).Conclusions
Hamstring flexibility is not strongly related to the amount of lumbar flexion used to perform forward-reaching tasks in participants who have chronic LBP or who have recovered from LBP. More research needs to be conducted to examine the influence of hamstring flexibility on observed movement patterns to further evaluate the efficacy of flexibility training in the rehabilitation of patients with LBP. 相似文献11.
Bürge E Kupper D Finckh A Ryerson S Schnider A Leemann B 《Archives of physical medicine and rehabilitation》2008,89(10):1857-1862
Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.
Objective
To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.Design
Randomized trial.Setting
Rehabilitation center.Participants
Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.Intervention
The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.Main Outcome Measures
Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.Results
At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.Conclusions
Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery. 相似文献12.
Objectives
Patellar taping is used by clinicians to reduce pain, increase strength and enhance neuromuscular recruitment in patients with patellofemoral pain. This study explored the effect of medial patellar taping on these parameters in physically active subjects with and without patellofemoral pain.Study design
A placebo-controlled clinical trial with randomised interventions.Setting
Sport Science Institute of South Africa.Participants
Fifteen subjects with patellofemoral pain (experimental group) and 20 subjects without patellofemoral pain (healthy cohort).Methods
Pain perception, quadriceps force output and electromyographic (EMG) data were collected during maximal quadriceps strength testing and submaximal step testing for each intervention.Intervention
Subjects were tested during three different knee taping conditions: (1) no tape; (2) placebo tape; and (3) medial tape, in a randomised order.Main outcome measures
Visual analogue scale (VAS), isokinetic and isometric force output, and EMG analysis.Results
Medial patellar tape did not result in a significant reduction in pain during the step testing (step-up) in the group with patellofemoral pain (no tape condition: mean VAS 1.0, 95% confidence interval 0.30-1.70; taped condition: mean VAS 1.07, 95% confidence interval 0.22-1.91) or an increase in quadriceps force output. However, there was a significant decrease in EMG activity of the vastus medialis oblique in both groups during the closed chain step test (e.g. group with patellofemoral pain, no tape condition: mean 77%, 95% confidence interval 62-92%; taped condition: mean 64%, 95% confidence interval 53-75%, P < 0.05).Conclusion
Although taping did not reduce pain in the patellofemoral pain group, it did enhance the efficiency of the vastus medialus oblique. Future studies should determine whether there are clinical benefits to these findings. 相似文献13.
Objectives
To identify the extent to which an adapted pain management programme is successful in modifying pain beliefs, psychological distress, locus of control and self-efficacy using both qualitative and quantitative approaches.Design
Prospective, observational study with questionnaires at baseline and following completion of a pain management programme.Setting
Outpatient pain management programme in a district general hospital.Participants
Fifteen participants experiencing chronic pain, referred from pain and rheumatology clinics within the hospital.Outcome measures
Pain beliefs, self-efficacy, locus of control and psychological distress.Results
Wilcoxon signed ranks tests demonstrated significant improvements in pain beliefs, self-efficacy and psychological distress. However, changes in locus of control were not found to be significant. The qualitative data supported these findings.Conclusions
The pilot study suggested that the pain management programme successfully modified three out of four of the psychosocial risk factors (Yellow Flags) in a population with established pain and disability. A larger scale project replicating this pilot study including a comparison group, and further research to assess the extent to which modifying Yellow Flags generalises to affect quality of life and disability, are underway. 相似文献14.
Nussbaum EL, Locke M. Heat shock protein expression in rat skeletal muscle after repeated applications of pulsed and continuous ultrasound.
Objective
To determine whether repeated ultrasound treatments are capable of increasing the expression of heat shock protein (HSP) 72 and HSP 25 in rat skeletal muscles.Design
In vivo, experimental, controlled study.Setting
Animal laboratory.Animals
Male Sprague-Dawley rats (n=9).Interventions
Ultrasound (1MHz, 15min, 2.0cm2 transducer) continuous at 1.0W/cm2 spatial average temporal average intensity (CONTUS) or pulsed at 2.0W/cm2 spatial average temporal peak intensity 50% duty cycle (PULS50) was applied on 4 consecutive days to the lower leg muscles of 1 hindlimb in each rat (n=9).Main Outcome Measures
Twenty-four hours after the final ultrasound application, hindlimb muscles were removed, weighed, and assessed for HSP 72 and HSP 25 content by Western blotting. Bands from blots were quantified and data were assessed using t tests (α=.05).Results
Ultrasound did not affect core or contralateral hindlimb muscle temperature. Average muscle temperatures during the final day ultrasound treatments were 38.71°±0.30°C when using PULS50 and 38.16°±0.57°C when using CONTUS. PULS50 significantly increased HSP 25 content in the plantaris and soleus muscles and HSP 72 content in the plantaris muscles. CONTUS significantly increased HSP 72 content in the white gastrocnemius muscle.Conclusions
HSPs can be induced in skeletal muscle when ultrasound is used on a repeated basis to treat soft tissue. 相似文献15.
Objectives
To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.Design
Cross-sectional, correlation study.Setting
Orthopaedic outpatient setting in a tertiary hospital.Participants
One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.Measures
Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.Results
The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.Conclusions
This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes. 相似文献16.
Background
Humour is a complex phenomenon, incorporating cognitive, emotional, behavioural, physiological and social aspects. Research to date has concentrated on reviewing (rehearsed) humour and ‘healthy’ individuals via correlation studies using personality-trait based measurements, principally on psychology students in laboratory conditions. Nurses are key participants in modern healthcare interactions however, little is known about their (spontaneous) humour use.Aims
A middle-range theory that accounted for humour use in CNS-patient interactions was the aim of the study. The study reviewed the antecedents of humour exploring the use of humour in relation to (motivational) humour theories.Participants and setting
Twenty Clinical Nurse Specialist-patient interactions and their respective peer groups in a country of the United Kingdom.Method
An evolved constructivist grounded theory approach investigated a complex and dynamic phenomenon in situated contexts. Naturally occurring interactions provided the basis of the data corpus with follow-up interviews, focus groups, observation and field notes. A constant comparative approach to data collection and analysis was applied until theoretical sufficiency incorporating an innovative interpretative and illustrative framework. This paper reports the grounded theory and is principally based upon 20 CNS-patient interactions and follow-up data. The negative case analysis and peer group interactions will be reported in separate publications.Findings
The theory purports that patients’ use humour to reconcile a good patient persona. The core category of the good patient persona, two of its constituent elements (compliance, sycophancy), conditions under which it emerges and how this relates to the use of humour are outlined and discussed. In seeking to establish and maintain a meaningful and therapeutic interaction with the CNS, patients enact a good patient persona to varying degrees depending upon the situated context. The good patient persona needs to be maintained within the interaction and is therefore reconciled with potentially problematic or non-problematic humour use. Humour is therefore used to deferentially package concerns (potentially problematic humour) or affiliate (potentially non-problematic humour). This paper reviews the good patient persona (compliance, sycophancy), potentially problematic humour (self-disparaging, gallows) and briefly, non-problematic humour (incongruity).Conclusions
The middle-range theory differentiates potentially problematic humour from non-problematic humour and notes that how humour is identified and addressed is central to whether patients concerns are resolved or not. The study provides a robust review of humour in healthcare interactions with important implications for practice. Further, this study develops and extends humour research and contributes to an evolved application of constructivist grounded theory. 相似文献17.
Audrey L. Nelson Shirley Groer Polly Palacios Douglas Mitchell Sunil Sabharwal R. Lee Kirby Deborah Gavin-Dreschnack Gail Powell-Cope 《Archives of physical medicine and rehabilitation》2010,91(8):1166-1173
Nelson AL, Groer S, Palacios P, Mitchell D, Sabharwal S, Kirby RL, Gavin-Dreschnack D, Powell-Cope G. Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.
Objectives
(1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment.Design
This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records.Setting
Three Veterans' Administration hospitals.Participants
Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702).Interventions
Not applicable.Main Outcome Measures
Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment.Results
Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls.Conclusions
This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment. 相似文献18.
Marita B. de Leon Ned L. Kirsch Ronald F. Maio Cheribeth U. Tan-Schriner Scott R. Millis Shirley Frederiksen Clare L. Tanner M. Lynn Breer 《Archives of physical medicine and rehabilitation》2009,90(6):956-965
de Leon MB, Kirsch NL, Maio RF, Tan-Schriner CU, Millis SR, Frederiksen S, Tanner CL, Breer ML. Baseline predictors of fatigue 1 year after mild head injury.
Objective
To compare reports of fatigue 12 months after minor trauma by participants with mild head injury (MHI) with those with other injury, and identify injury and baseline predictors of fatigue.Design
An inception cohort study of participants with MHI and other nonhead injuries recruited from and interviewed at the emergency department (ED), with a follow-up telephone interview at 12 months.Setting
Level II community hospital ED.Participants
Participants (n=58) with MHI and loss of consciousness (LOC) of 30 minutes or less and/or posttraumatic amnesia (PTA) less than 24 hours, 173 with MHI but no PTA/LOC, and 128 with other mild nonhead injuries. Inclusion criteria: age 18 years or older, within 24 hours of injury, Glasgow Coma Scale score of 13 or higher, and discharge from the ED.Interventions
Not applicable.Main Outcome Measure
Medical Outcomes Study 36-Item Short-Form Health Survey Vitality subscale.Results
Significant predictors of fatigue severity at 12 months were baseline fatigue, having seen a counselor for a mental health issue, medical disability, marital status, and in some stage of litigation. Injury type was not a significant predictor.Conclusions
Fatigue severity 12 months after injury is associated with baseline characteristics and not MHI. Clinicians should be cautious about attributing persisting fatigue to MHI without comprehensive consideration of other possible etiologic factors. 相似文献19.
James E. Graham Cynthia M. Ripsin Anne Deutsch Yong-Fang Kuo Sam Markello Carl V. Granger Kenneth J. Ottenbacher 《Archives of physical medicine and rehabilitation》2009,90(7):1110-1116
Graham JE, Ripsin CM, Deutsch A, Kuo Y-F, Markello S, Granger CV, Ottenbacher KJ. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation.
Objectives
To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.Design
Secondary data analysis.Setting
Inpatient rehabilitation facilities (N=864) across the United States.Participants
Patients (N=135,097) who received medical rehabilitation for stroke in 2002-2003.Intervention
None.Main Outcome Measures
Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.Results
Mean ± standard deviation age of the sample was 70.4±13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.Conclusions
The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age. 相似文献20.
Won Hyuk Chang Sang Hee Im Jeong Ah Ryu Sang Chul Lee Ji Sung Kim 《Archives of physical medicine and rehabilitation》2009,90(2):279-284
Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.