Improving older adults' knowledge and practice of preventive measures through a telephone health education during the SARS epidemic in Hong Kong: a pilot study

Background

The outbreak of severe acute respiratory syndrome (SARS) in Hong Kong posed many challenges for health promotion activities among a group of older adults with low socio-economic status (SES). With concerns that this vulnerable group could be at higher risk of contracting the disease or spreading it to others, the implementation of health promotion activities appropriate to this group was considered to be essential during the epidemic.

Objectives

To assess the effectiveness of delivering a telephone health education programme dealing with anxiety levels, and knowledge and practice of measures to prevent transmission of SARS among a group of older adults with low SES.

Design

Pretest/posttest design.

Settings

Subjects were recruited from registered members of a government subsidized social service center in Hong Kong and living in low-cost housing estates.

Participants

The eligibility criteria were: (1) aged 55 or above; (2) able to speak Cantonese; (3) no hearing impairment, and (4) reachable by telephone. Of the 295 eligible subjects, 122 older adults completed the whole study.

Methods

The interviewers approached all eligible subjects by telephone during the period of 15-25 May 2003. After obtaining the participants’ verbal consent, the interviewer collected baseline data by use of a questionnaire and implemented a health education programme. A follow-up telephone call was made a week later using the same questionnaire.

Results

The level of anxiety was lowered (t=3.28, p<0.001), and knowledge regarding the transmission routes of droplets (p<0.001) and urine and feaces (p<0.01) were improved after the intervention. Although statistical significant difference was found in the practice of identified preventive measures before and after intervention, influence on behavioral changes needed further exploration.

Conclusion

The telephone health education seemed to be effective in relieving anxiety and improving knowledge of the main transmission routes of SARS in this group, but not the practice of preventing SARS. Telephone contact appears to be a practical way of providing health education to vulnerable groups when face-to-face measure is not feasible and may be useful in raising health awareness during future outbreaks of emerging infections.     

Diagnostic value of ultrasonography for clinical medial epicondylitis

Park G-Y, Lee S-M, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis.

Objectives

To assess the ultrasonographic findings and to evaluate the value of ultrasonography as a diagnostic method for detecting clinical medial epicondylitis.

Design

A prospective, single-blind study.

Setting

An outpatient rehabilitation clinic in a tertiary university hospital.

Participants

Twenty-one elbows from 18 patients with clinical medial epicondylitis and 25 elbows without medial epicondylitis were evaluated.

Interventions

Not applicable.

Main Outcome Measures

The clinical diagnosis of medial epicondylitis was based on the patient’s symptoms and clinical signs in a physical examination performed by a physiatrist. An experienced radiologist made the real-time ultrasonographic diagnosis based on the detection of at least one of the following abnormal findings: a focal hypoechoic or anechoic area, tendon nonvisualization, intratendinous calcifications, and cortical irregularity.

Results

Ultrasonography revealed positive findings in 20 of 21 elbows with medial epicondylitis and was negative in 23 of 25 without medial epicondylitis. Ultrasonography showed sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for clinical medial epicondylitis of 95.2%, 92%, 93.5%, 90.9%, and 95.8%, respectively. Tendinosis was observed in 15 elbows, and a partial-thickness tear, including 1 intrasubstance tear, was detected in 5 elbows. The most common ultrasonographic abnormality was a focal echogenic abnormality (15 hypoechoic, 5 anechoic) of the tendons.

Conclusions

Our results indicate that ultrasonography is informative and accurate for the detection of clinical medial epicondylitis. Therefore, ultrasonography should be considered as an initial imaging method for evaluating medial epicondylitis.     

A Chinese version of Iowa Infant Feeding Attitude Scale: reliability and validity assessment

Background

To achieve the goal of increasing the proportion and duration of breastfeeding in Taiwan, it is essential to assess the role of attitudes in determining which method of infant feeding will be chosen. Understanding maternal attitudes toward infant feeding methods may have utility in the development and implementation of public health policy and interventions facilitating increasing breastfeeding rates. However, no validated instrument to assess breastfeeding attitudes is available in Chinese for use in Taiwan.

Objective

To translate the Iowa Infant Feeding Attitude Scale (IIFAS) into Chinese and assess its psychometric properties among Taiwanese breastfeeding women.

Design

Methodological study.

Setting

One public hospital in Taichung city, Taiwan.

Participants

A convenience sample of 140 in-hospital breastfeeding women was recruited.

Methods

The IIFAS was translated into Chinese using forward translation, back-translation, semantic equivalence, and pilot testing. Predict validity and internal consistency was assessed. The final sample consisted of 120 women (14% attrition) that were interviewed by telephone at 6 weeks postpartum to record the breastfeeding duration and infant feeding method.

Results

One item was modified to better reflect the item content. In-hospital IIFAS scores significantly predicted breastfeeding duration as well as exclusive breastfeeding at 6 weeks postpartum. The Cronbach's alpha coefficient for internal consistency was 0.74.

Conclusions

This study provides evidence that the Chinese version of the IIFAS can be considered valid and reliable scale for assessing attitudes toward breastfeeding among breastfeeding women in Taiwan.     

Feasibility of motor capability training at home in children with acquired brain injury

Objectives

Acquired brain injury (ABI) requires an extended recovery time and residual signs may be observed years after discharge. Supervised home-based motor training may present a viable option for continuing treatment of adult patients, but little information is available on home-based treatment in children. This study assessed the feasibility of home practice in children with ABI (1 or more years post-trauma). The efficacy of the programme was also evaluated.

Design

A non-randomised, self-control study with control and intervention periods.

Setting

Home-based exercise programme.

Participants

Nineteen children (mean age 12.5 ± 3.1 years).

Interventions

A 4-week daily training programme of step-up and sit-stand-sit exercises.

Main outcome measures

Feasibility was assessed by the number of participants who completed the programme. Efficacy was evaluated at different stages using 10-metre walking and 2-minute walking tests, and the balance subitems of the Bruininks-Oseretsky Test of Motor Proficiency. An energy expenditure index was calculated for walking. Performance scores were used to assess balance.

Results

Nine participants completed the study. The mean number of training sessions was 22 ± 8 of the 30 sessions originally scheduled. Major differences were noted between the experimental stages. Walking speed, endurance and balance improved significantly during the intervention period.

Conclusions

Continuing exercising at home may be a feasible and efficient option for a considerable proportion of ABI children who are compliant with a simple but challenging exercise programme. A randomised controlled trial with a larger sample is now required.     

Employment after traumatic brain injury: differences between men and women

Corrigan JD, Lineberry LA, Komaroff E, Langlois JA, Selassie AW, Wood KD. Employment after traumatic brain injury: differences between men and women.

Objective

To determine whether there are sex differences in employment 1 year after traumatic brain injury.

Design

Prospective cohort.

Setting

Acute care hospitals in South Carolina and Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers.

Participants

Subjects in the TBIMS national dataset and the South Carolina Traumatic Brain Injury Follow-up Registry who were expected to be working before injury and followed at 1 year postinjury.

Interventions

Not applicable.

Main Outcome Measure

Change in employment from preinjury to 1 year postinjury.

Results

When other measured influences on change in hours worked were held constant, there were significant interactions for sex by age and sex by marital status. Compared with men, women were more likely to decrease hours or stop working, except in the oldest age group (55−64y) in which men were more likely to stop working. For women, there was a pattern showing better employment outcomes as age increased. Decreased employment for women was most evident for married women, who were much more likely to reduce hours or stop working. There was also a tendency for divorced women to be more likely to stop working when compared with divorced men.

Conclusions

These findings run counter to the current literature. Although definitive explanations must await future studies, causal factors arising from differential societal behavior toward women as well as discriminatory attitudes about women and employment deserve further study.     

A Method for Standardizing Procedures in Rehabilitation: Use in the Extremity Constraint Induced Therapy Evaluation Multisite Randomized Controlled Trial

Morris DM, Taub E, Macrina DM, Cook EW, Geiger BF. A method for standardizing procedures in rehabilitation: use in the Extremity Constraint Induced Therapy Evaluation multisite randomized controlled trial.

Objective

An enduring problem in the field of rehabilitation has been the lack of standardization in the protocols of treatments and tests. To develop a process evaluation method to standardize the administration of rehabilitation procedures used in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial, a randomized controlled trial of upper-extremity constraint-induced therapy implemented across 7 sites.

Design

Process evaluation.

Setting

Research laboratory.

Participants

Convenience sample or research personnel.

Interventions

Not applicable.

Main Outcome Measures

Checklist scoring sheets were developed to rate videotapes using systematic application of prescribed steps for each of 5 procedures across 3 time periods. Time periods were immediately after training, and 1 and 2 years later. A performance score of at least 90% was required before individual research personnel were allowed to participate in the trial.

Results

Overall performance scores ranged from 85.8% to 95% of performance items correctly executed. There was a significant improvement in standard performance of procedures between the first time period (immediately after training) and each of the subsequent time periods for all but 1 procedure. The scoring of standardized performance when carried out with routine participant testing and training did not differ significantly from scoring from videotaped sessions submitted for standardization rating for 2 of the procedures, suggesting adequate validity of scoring from videotape.

Conclusions

The present method was successful in assessing protocol fidelity for the EXCITE research personnel and represents 1 means of addressing the longstanding problem in rehabilitation of the lack of standardization in administering different treatments and tests.     

ICF participation restriction is common in frail, community-dwelling older people: an observational cross-sectional study

Objectives

To determine the extent of participation restriction in a sample of frail older people, and to identify the domains of participation that are most restricted. A secondary aim was to determine which health and demographic factors were associated with participation restriction.

Design

An observational cross-sectional study.

Setting

Adults recently discharged from an aged care and rehabilitation service in Australia who were enrolled in a clinical trial.

Participants

One hundred and eighty-one community-dwelling adults aged over 70 years (mean age 84, standard deviation 5.7) who met the Cardiovascular Health Study criteria for frailty, had a Mini Mental State Examination score over 18 and a predicted life expectancy exceeding 12 months.

Main outcome measures

Participation restriction was evaluated using the Reintegration to Normal Living Index.

Results

Eighty percent of subjects reported participation restriction in at least one aspect of their life. Restricted participation was most prevalent in the areas of work in the home or community (114/181, 63%) and community mobility (92/181, 51%), and least common with regard to interpersonal relationships (9/181, 5%). Multivariate regression analysis showed that grip strength, mood, number of medical conditions and mobility were independently and significantly (P < 0.05) associated with participation restriction, and explained 29% of the variance in participation restriction. Cognition and living alone were not significantly associated with participation restriction.

Conclusions

Participation restriction was common in this sample of frail, community-dwelling older people. It was associated with factors from multiple levels of the International Classification of Functioning, Disability and Health. Further research is suggested to investigate the causes and treatment of participation restriction.     

Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?

Berlowitz DR, Hoenig H, Cowper DC, Duncan PW, Vogel WB. Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?

Objectives

To examine the impact of comorbidities in predicting stroke rehabilitation outcomes and to examine differences among 3 commonly used comorbidity measures—the Charlson Index, adjusted clinical groups (ACGs), and diagnosis cost groups (DCGs)—in how well they predict these outcomes.

Design

Inception cohort of patients followed for 6 months.

Setting

Department of Veterans Affairs (VA) hospitals.

Participants

A total of 2402 patients beginning stroke rehabilitation at a VA facility in 2001 and included in the Integrated Stroke Outcomes Database.

Interventions

Not applicable.

Main Outcome Measures

Three outcomes were evaluated: 6-month mortality, 6-month rehospitalization, and change in FIM score.

Results

During 6 months of follow-up, 27.6% of patients were rehospitalized and 8.6% died. The mean FIM score increased an average of 20 points during rehabilitation. Addition of comorbidities to the age and sex models improved their performance in predicting these outcomes based on changes in c statistics for logistic and R² values for linear regression models. While ACG and DCG models performed similarly, the best models, based on DCGs, had a c statistic of .74 for 6-month mortality and .63 for 6-month rehospitalization, and an R² of .111 for change in FIM score.

Conclusions

Comorbidities are important predictors of stroke rehabilitation outcomes. How they are classified has important implications for models that may be used in assessing quality of care.     

A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders

Vandervelde L, Dispa D, Van den Bergh PY, Thonnard J-L. A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders.

Objective

To investigate the agreement between the self-reported and examiner-reported difficulties of patients with neuromuscular disorders (NMDs) in performing daily activities at home.

Design

A comparison between 2 methods of administering a measurement instrument.

Setting

Neuromuscular reference center in a university hospital.

Participants

Adult patients (N=57) with diagnosed NMDs living at home.

Interventions

Not applicable.

Main Outcome Measure

The ACTIVLIM questionnaire.

Results

The intraclass correlation coefficient, model 2,1 (ICC_2,1), between the measures was very good (ICC_2,1=.87), indicating a good agreement between self-perceived and observed measures.

Conclusions

The use of ACTIVLIM as a self-reporting questionnaire is a valid method for assessing activity limitations in patients with NMD.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.     

Balance self-efficacy and its relevance to physical function and perceived health status after stroke

Salbach NM, Mayo NE, Robichaud-Ekstrand S, Hanley JA, Richards CL, Wood-Dauphinee S. Balance self-efficacy and its relevance to physical function and perceived health status after stroke.

Objectives

To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status.

Design

Secondary analysis of baseline, postintervention, and 6-month follow-up data from a randomized trial.

Setting

General community.

Participants

Ninety-one subjects with a first or recurrent stroke, discharged from rehabilitation therapy with a residual walking deficit.

Interventions

Not applicable.

Main Outcome Measures

The Activities-Specific Balance Confidence (ABC) Scale, Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale, and the EQ-5D visual analog scale of perceived health status.

Results

Average balance self-efficacy was 59 out of 100 points on the ABC scale (95% confidence interval, 55-64; n=89). After adjusting for age and sex, functional walking capacity explained 32% and 0% of the respective variability in physical function and perceived health status scores obtained 6 months later. After adjustment for age, sex, and functional walking capacity, balance self-efficacy explained 3% and 19% of variation in 6-month physical function and perceived health status scores, respectively.

Conclusions

Subjects living in the community after stroke experience impaired balance self-efficacy. Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement, primarily in perceived health status, but also in physical function, than the enhancement of functional walking capacity alone.     

Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial

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.     

Reliability of the Tardieu Scale for Assessing Spasticity in Children With Cerebral Palsy

Gracies J-M, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy.

Objective

To measure the Tardieu Scale's reliability in children with cerebral palsy (CP) when used by raters with and without experience in using the scale, before and after training.

Design

Single-center, intrarater and interrater reliability study.

Setting

Institutional ambulatory care.

Participants

Referred children with CP in the pretraining phase (n=5), during training (n=3), and in the posttraining phase (n=15).

Interventions

The Tardieu Scale involves performing passive muscle stretch at 2 velocities, slow and fast. The rater derives 2 parameters; the Spasticity Angle X is the difference between the angles of arrest at slow speed and of catch-and-release or clonus at fast speed; the Spasticity Grade Y is an ordinal variable that grades the intensity (gain) of the muscle reaction to fast stretch. In phase 1, experienced raters without formalized training in the scale graded elbow, knee, and ankle plantar flexors bilaterally, without and with a goniometer. In phase 2, after training, the experienced and nonexperienced raters graded the same muscles unilaterally.

Main Outcome Measures

Intrarater and interrater reliability of the Tardieu Scale.

Results

After training, nonexperienced raters had mean ± SD intrarater and interrater agreement rates across all joints and parameters of 80%±14% and 74%±16%, respectively. For experienced raters, intrarater and interrater agreement rates before training were 77%±13% and 66%±15%, respectively, versus 90%±8% and 81%±13%, respectively, after training (P<.001 for both). Specific angle measurements at the knee were less reliable for the angles of catch measured at fast speed. Across all joints, agreement rates were similar using visual or goniometric measurements.

Conclusions

Both parameters of the Tardieu Scale have excellent intrarater and interrater reliability when assessed at the elbow and ankle joints of children with CP, with no difference noted between visual and goniometric measurements. Angle measurements were less reliable at the knee joints. Training was associated with a highly significant improvement in reliability.     

A cross-sectional survey of self-perceived health status and metabolic control values in patients with type 2 diabetes

Background

The prevalence of diabetes is increasing worldwide. Diabetes and other chronic disorders play an important role in how patients perceive their health status, this perception being an important component of general health.

Objectives

The purpose of this study is to determine self-perceived health status and metabolic control in patients with type 2 diabetes and to understand the relationship between perceived health status and metabolic control in diabetic participants.

Design

This is a cross-sectional survey.

Setting

The research population was diabetes sufferers registered with the Turkish Diabetes Society in Denizli Province, Turkey.

Participants

A convenience sample composed of 110 patients with type 2 diabetes mellitus.

Methods

The research data were collected using three tools. The first of these was a “Socio-demographic Data Form” to gather information on the diabetes patients. The second was a survey on the patients’ self-perceived health (how do rate your state of health in general) in which the patients were asked to rate their own health in one of five categories: very good, good, fair, bad and very bad. For the statistical analysis, the study group was divided into two groups: “good”, consisting of those who classified their health as either very good or good; and “poor”, those who gave other responses. The third type of data was collected by measuring metabolic control outcomes [glycosylated hemoglobin (HbA_1C), fasting blood sugar (FBS), non-fasting blood sugar, total cholesterol, high-density lipoproteins (HDL) and triglycerides] for each participant.

Results

Approximately half of the diabetic participants surveyed have poor self-perceived health. In terms of the values of HbA_1C, an important indicator of metabolic control levels, it was found that only 24.5% of the participants surveyed had good metabolic control. There was found to be a statistically significant difference between self-perceived health and levels of HbA_1C; 68% of participants who had high HbA_1C values evaluated their health as good, whereas 63.9% of those who had poor HbA_1C values evaluated their health as bad. Age, level of education, mode of treatment, adherence to treatment and level of exercise were factors that were found to have statistically significant differences from, and therefore an influence on, self-reported health.

Conclusion

When working with diabetes patients, as soon as the diagnosis has been made, it is recommended that information both on subjective perceptions of health and on perceptions of the illness (health perceptions, health beliefs related to the illness) are evaluated and objective data (metabolic control values) are gathered.     

Implanted Electrical Stimulation of the Trunk for Seated Postural Stability and Function After Cervical Spinal Cord Injury: A Single Case Study

Triolo RJ, Boggs L, Miller ME, Nemunaitis G, Nagy J, Bailey SN. Implanted electrical stimulation of the trunk for seated postural stability and function after cervical spinal cord injury: a single case study.

Objectives

To explore and quantify the physical and functional effects of stabilizing the torso with electrical stimulation of the paralyzed hip and trunk musculature after motor complete tetraplegia.

Design

Single-subject case study with repeated measures and concurrent controls.

Setting

Academic outpatient rehabilitation center.

Participants

Forty-four-year-old man with C4 American Spinal Injury Association grade A tetraplegia 20 years postspinal cord injury.

Intervention

A surgically implanted multichannel pulse generator and intramuscular stimulating electrodes to activate lumbar erector spinae, quadratus lumborum, and gluteus maximus muscles bilaterally.

Main Outcome Measures

Outcomes assessed with and without stimulation included (1) spinal alignment and pelvic orientation, (2) pulmonary function and ventilatory volumes, (3) forward bimanual reaching distance, (4) seated stability and resistance to externally applied disturbances, (5) maximal force and speed of rowing-like movements, and the ability to (6) independently return to an erect seated position from full forward or lateral flexion and (7) roll in bed without assistance.

Results

Stimulation improved spinal convexity and kyphosis by 26° and 21°, reduced posterior pelvic tilt by 11°, increased forced expiratory volume and vital capacity by 10% and 22%, and improved forward reach by more than 7cm. Average resistance to sagittal disturbances increased by more than 40% (P<.002), and mean force exerted during underhanded pulling more than doubled (P=.014) with stimulation. Restoration of upright sitting in both sagittal and coronal planes and bed turning was made possible through appropriately timed activation of the hip and trunk muscles.

Conclusions

A neuroprosthesis for controlling the paralyzed torso can positively impact spinal alignment, seated posture, pulmonary function, trunk stability, and reach. Stimulation of hip and trunk muscles can improve performance of activities of daily living as well as enable independent wheelchair and bed mobility.     

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.     

Characteristics of a Mild Head Injury Subgroup With Extreme, Persisting Distress on the Rivermead Postconcussion Symptoms Questionnaire

Kirsch NL, de Leon MB, Maio RF, Millis SR, Tan-Schriner CU, Frederiksen S. Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms Questionnaire.

Objective

To examine baseline variables and identify characteristics of participants with extremely high reports of symptoms (ie, outliers) 12 months after mild head injury (MHI).

Design

A prospective cohort study of MHI with and without loss of consciousness (LOC) and/or posttraumatic amnesia (PTA) 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 LOC less than or equal to 30 minutes and/or PTA less than 24 hours and participants (n=173) with MHI but no PTA/LOC. Inclusion criteria: age greater than or equal to 18 years, less than or equal to 24 hours after injury, Glasgow Coma Scale score greater than or equal to 13, and discharge from the ED. Fourteen (6%) participants had extremely high scores on the Rivermead Postconcussion Symptoms Questionnaire (RPQ).

Main Outcome Measures

RPQ and questions on health services use and litigation.

Results

Characterizing the outlier cases are prior head injury, preinjury disability, history of substance use, unemployment, and elevated somatic symptoms at the ED. At 12 months, outliers had higher use of health services and litigation.

Conclusions

The existence of a subgroup with a distinctive pattern of baseline characteristics in combination with elevated somatic symptoms at the time of presentation to the ED suggests that further taxonomic distinctions may be warranted for the MHI population, each requiring appropriately targeted interventions for addressing symptomatic complaints.     

Characterizing wandering behaviors in persons with traumatic brain injury residing in veterans health administration nursing homes

Belanger HG, King-Kallimanis B, Nelson AL, Schonfeld L, Scott SG, Vanderploeg RD. Characterizing wandering behaviors in persons with traumatic brain injury residing in Veterans Health Administration nursing homes.

Objective

To examine the prevalence and correlates of wandering in persons with traumatic brain injury (TBI) in nursing homes (NHs).

Design

Using a cross-sectional design, logistic regression modeling was used to analyze a national database.

Setting

One hundred thirty-four NH facilities operated by the Veterans Health Administration.

Participants

NH residents (N=625) with TBI as well as a sample (n=164) drawn from a larger dataset of NH residents without TBI using 1:K matching on age.

Interventions

Not applicable.

Main Outcome Measure

Wandering.

Results

Wanderers with and without TBI did not differ significantly overall. The prevalence of wandering among patients with TBI was 14%, compared with 6.5% of the general nursing home population. The results of the multivariate logistic regression suggested that wandering was associated with poor memory, poor decision making, behavior problems, independence in locomotion and ambulation, and dependence in activities of daily living related to basic hygiene.

Conclusions

Wandering is relatively common in NH residents with TBI. As expected, it is associated with cognitive, social, and physical impairments. Further research with a larger sample should examine those with comorbid dementia and/or psychiatric diagnoses.     

Prevalence of automated external defibrillators at cardiac arrest high-risk sites

Objective

Automated external defibrillators (AEDs) distributed throughout communities may improve survival from cardiac arrest. The purpose of this study was to determine if AEDs were present at high-risk locations for cardiac arrest in King County, Washington.

Methods

The authors compiled a list of sites based on a five-year study that identified public sites with the highest incidence of cardiac arrests in King County. They conducted a structured telephone survey with the manager, director, or owner of those high-risk sites.

Results

Of the 263 identified high-risk cardiac arrest sites, we obtained information for 228 (87%) sites. Overall, 87 of 228 (38%) high-risk sites had one or more AEDs. The AED dissemination varied greatly by type of site. The airport, the two county jails, the five public sports venues, and the nine ferries/train terminals each reported at least one AED on site. In contrast, none of the 13 shelters and 19% of health clubs/gyms reported an AED on site. Nearly half (44%) of sites without AEDs cited cost as a factor preventing them from purchasing AEDs in the future.

Conclusion

Although AEDs have diffused into high-risk sites in this community, the diffusion appears to vary by the type of site.