Impact of Traumatic Brain Injury on Participation in Leisure Activities

Wise EK, Mathews-Dalton C, Dikmen S, Temkin N, Machamer J, Bell K, Powell JM. Impact of traumatic brain injury on participation in leisure activities.

Objective

To determine how participation in leisure activities for people with traumatic brain injury (TBI) changes from before injury to 1 year after injury.

Design

Prospective evaluation of leisure participation at 1 year after TBI.

Setting

Level I trauma center.

Participants

Rehabilitation inpatients (mean age, 35.3 years; 77% male; 77% white) with moderate to severe TBI (N=160).

Interventions

Not applicable.

Main Outcome Measure

Functional Status Examination.

Results

At 1 year after injury, 81% had not returned to preinjury levels of leisure participation. Activities most frequently discontinued included partying, drug and alcohol use, and various sports. The activity most often reported as new after injury was watching television. Of the small fraction who returned to preinjury levels, 70% did so within 4 months of injury. Sixty percent of those who did not return to preinjury levels were moderately to severely bothered by the changes.

Conclusions

At 1 year after injury, many TBI survivors engage in a reduced number of leisure activities, which are more sedentary and less social, with a substantial fraction dissatisfied with these changes. While discontinuing some activities may be viewed as a positive change, there are few new ones to replace them.     

Effect of a home leisure education program after stroke: a randomized controlled trial

Desrosiers J, Noreau L, Rochette A, Carbonneau H, Fontaine L, Viscogliosi C, Bravo G. Effect of a home leisure education program after stroke: a randomized controlled trial.

Objective

To evaluate the effect of a leisure education program on participation in and satisfaction with leisure activities (leisure-related outcomes), and well-being, depressive symptoms, and quality of life (primary outcomes) after stroke.

Design

Randomized controlled trial.

Setting

Home and community.

Participants

Sixty-two people with stroke.

Intervention

Experimental participants (n=33) received the leisure education program at home once a week for 8 to 12 weeks. Control participants (n=29) were visited at home at a similar frequency. Participants were evaluated before and after the program by a blinded assessor.

Main Outcome Measures

Change from preintervention to postintervention in: minutes of leisure activity per day, number of leisure activities, the Leisure Satisfaction Scale, the Individualized Leisure Profile, the General Well-Being Schedule (GWBS), the Center for Epidemiological Studies Depression Scale, and the Stroke-Adapted Sickness Impact Profile (SA-SIP30).

Results

There was a statistically significant difference in change scores between the groups for satisfaction with leisure with a mean difference of 11.9 points (95% confidence interval [CI], 4.2−19.5) and participation in active leisure with a mean difference of 14.0 minutes (95% CI, 3.2−24.9). There was also a statistically significant difference between groups for improvement in depressive symptoms with a mean difference of −7.2 (95% CI, −12.5 to −1.9). Differences between groups were not statistically significant on the SA-SIP30 (0.2; 95% CI, −1.3 to 1.8) and GWBS (2.2; 95% CI, −5.6 to 10.0).

Conclusions

The results indicate the effectiveness of the leisure education program for improving participation in leisure activities, improving satisfaction with leisure and reducing depression in people with stroke.     

Hemispatial Neglect and Rehabilitation in Acute Stroke

Cumming TB, Plummer-D'Amato P, Linden T, Bernhardt J. Hemispatial neglect and rehabilitation in acute stroke.

Objectives

To compare 2 methods for determining neglect in patients within 2 days of stroke, and to investigate whether early neglect was related to rehabilitation practice, and whether this relationship was affected by an early, intensive mobilization intervention.

Design

Data were collected from patients participating in a phase II randomized controlled trial of early rehabilitation after stroke.

Setting

Acute hospital stroke unit.

Participants

Stroke patients (N=71).

Intervention

The 2 arms of the trial were very early mobilization (VEM) and standard care (SC).

Main Outcome Measures

Neglect was assessed using the Star Cancellation Test and the National Institutes of Health Stroke Scale (NIHSS) inattention item within 48 hours of stroke onset, and therapy details were recorded during the hospital stay.

Results

Assessing neglect so acutely after stroke was difficult: 29 of the 71 patients were unable to complete the Star Cancellation Test, and agreement between this test and the NIHSS measure was only .42. Presence of neglect did not preclude early mobilization. SC group patients with neglect had longer hospital stays (median, 11d) than those without neglect (median, 4d); there was no difference in length of stay between patients with and without neglect in the VEM group (median, 6d in both).

Conclusion

Early mobilization of patients with neglect was feasible and may contribute to a shorter acute hospital stay.     

Experienced Problems of Young Adults With Cerebral Palsy: Targets for Rehabilitation Care

Nieuwenhuijsen C, Donkervoort M, Nieuwstraten W, Stam HJ, Roebroeck ME; and the Transition Research Group South West Netherlands. Experienced problems of young adults with cerebral palsy: targets for rehabilitation care.

Objective

To determine the problems experienced by young adults with cerebral palsy (CP) and the relationship between those problems and personal and CP-related characteristics.

Design

Cross-sectional study.

Setting

Rehabilitation centers in the southwest Netherlands.

Participants

Young adults (N=87; aged 18-22y) with CP and normal intelligence (roughly corresponding to an intelligence quotient >70, excluding participants who attended schools for those with learning disabilities).

Interventions

Not applicable.

Main Outcome Measures

We used the Canadian Occupational Performance Measure in a semistructured interview to assess participants for experienced problems. We further categorized experienced problems according to the domains of the International Classification of Functioning, Disability and Health and assessed the relationship between those problems and personal and CP-related characteristics (eg, age, sex, level of gross motor functioning, manual ability, level of education) using appropriate correlation coefficients.

Results

Approximately 70% of participants experienced problems in daily life, addressing the areas of self-care (59%), productivity (52%), and leisure activities (37%). More specifically, problems were most prevalent in recreation and leisure (30%), preparing meals (29%), housework (14%), and dressing (14%). Problems in functional mobility, paid or unpaid work, and socialization were considered as most important (represented by the highest mean importance score). Mobility problems were associated with lower levels of gross motor functioning (Spearman ρ=.39), and problems with self-care were associated with lower levels of manual ability (Spearman ρ=.40).

Conclusions

Although frequently addressed during pediatric rehabilitation care, problems with mobility and self-care still prevail in young adults with CP. In addition, during the transition into adulthood, young adults with CP may experience problems regarding domestic life and work, which they consider important.     

Cognitive and Affective Predictors of Rehabilitation Participation After Stroke

Skidmore ER, Whyte EM, Holm MB, Becker JT, Butters MA, Dew MA, Munin MC, Lenze EJ. Cognitive and affective predictors of rehabilitation participation after stroke.

Objective

To examine associations between cognitive and affective impairments and rehabilitation participation during stroke rehabilitation.

Design

Secondary analyses of stroke patients who received acetylcholinesterase inhibitors during inpatient rehabilitation.

Setting

University-affiliated inpatient rehabilitation facilities.

Participants

Patients (N=44) admitted to inpatient stroke rehabilitation with impairment in attention, memory, or executive functions.

Interventions

Secondary analysis of patients receiving inpatient stroke rehabilitation care plus random assignment to one of two acetylcholinesterase inhibitors or no drug at rehabilitation admission.

Main Outcome Measures

Correlations between measures of cognitive (Digit Span, Hopkins Verbal Learning Test, Executive Interview) and affective impairments (Hamilton Rating Scale for Depression, Apathy Evaluation Scale) and participation (Pittsburgh Rehabilitation and Participation Scale) were examined. Significant correlates of participation were examined in a linear multiple regression model.

Results

Executive functions and depressive symptoms were significant correlates of participation. After controlling for baseline disability, executive functions predicted participation, but depressive symptoms did not (F_4,32=9.35; R²=.54, P<.001).

Conclusions

These findings are an important first step toward understanding potentially modifiable clinical factors that contribute to rehabilitation participation and overall functional status after rehabilitation. A better understanding of cognitive impairment and rehabilitation participation may be used to develop strategies for improving functional outcomes after stroke.     

Fatigue resistance during a voluntary performance task is associated with lower levels of mobility in cerebral palsy

Moreau NG, Li L, Geaghan JP, Damiano DL. Fatigue resistance during a voluntary performance task is associated with lower levels of mobility in cerebral palsy.

Objectives

To investigate muscle fatigue of the knee flexors and extensors in people with cerebral palsy (CP) compared with those without motor disability during performance of a voluntary fatigue protocol and to investigate the relationship with functional mobility.

Design

A case-control study.

Setting

A biomechanics laboratory.

Participants

Ambulatory subjects with CP (n=18; mean age, 17.5y) in Gross Motor Function Classification System (GMFCS) levels I, II, and III and a comparison group of age-matched subjects (n=16) without motor disability (mean age, 16.6y).

Interventions

Not applicable.

Main Outcome Measures

The voluntary muscle fatigue protocol consisted of concentric knee flexion and extension at 60° a second for 35 repetitions on an isokinetic dynamometer. Peak torque for each repetition was normalized by the maximum peak torque value. Muscle fatigue was calculated as the rate of decline in normalized peak torque across all repetitions, represented by the slope of the linear regression. Self-selected and fast gait velocities were measured as well as the Pediatric Outcomes Data Collection Instrument (PODCI).

Results

Greater fatigability (slope) was observed in the comparison group for both knee flexors and extensors than in the group with CP. Within CP, lower knee extensor fatigue (slope) was associated with lower functioning GMFCS levels and lower levels of activity and participation as measured by the PODCI transfers and basic mobility.

Conclusions

Even after adjusting for maximum peak torque, the knee flexors and extensors of participants with CP were observed to be less fatigable than age-matched peers without motor disability. The lower rate of muscle fatigue was also associated with lower functional mobility in CP. These results may be related to strength or activation differences and/or muscle property alterations. Future investigations are warranted.     

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.     

Leisure Time Physical Activity in a Population-Based Sample of People With Spinal Cord Injury Part II: Activity Types, Intensities, and Durations

Martin Ginis KA, Arbour-Nicitopoulos KP, Latimer AE, Buchholz AC, Bray SR, Craven BC, Hayes KC, Hicks AL, McColl M, Potter PJ, Smith K, Wolfe DL. Leisure time physical activity in a population-based sample of people with spinal cord injury part II: activity types, intensities, and durations.

Objective

To describe the types, intensities, and average duration of leisure time physical activities (LTPAs) performed by people with chronic spinal cord injury (SCI).

Design

Cross-sectional telephone survey.

Setting

General community.

Participants

Men and women with SCI (N=347) who reported engaging in LTPA over the previous 3 days.

Interventions

Not applicable.

Main Outcome Measures

Mean minutes a day of LTPA performed at mild, moderate, and heavy intensities; proportion of respondents performing specific types of LTPA.

Results

Participants reported a mean ± SD of 55.15±59.05min/d of LTPA at a mild intensity or greater. Median LTPA was 33.33min/d. More activity was done at a moderate intensity (mean ± SD, 25.49±42.11min/d) than mild (mean ± SD, 19.14±37.77min/d) or heavy intensities (mean ± SD, 10.52±22.17min/d). Most participants reported mild (54%) or moderate intensity LTPA (68%), while a minority reported heavy intensity LTPA (43%). The 3 most frequently reported types of LTPA were resistance training (33%), aerobic exercise (25%), and wheeling (24%). Craftsmanship (mean ± SD, 83.79±96.00min/d) and sports activities (mean ± SD, 60.86±59.76 min/d) were performed for the longest durations.

Conclusions

There is considerable variability in daily LTPA among active people with SCI and variability across different types of LTPA in terms of typical durations and intensities. This information can be used to help people with chronic SCI become more active by highlighting activities that meet individual abilities, needs, and desires.     

Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial

Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial.

Objective

To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee.

Design

Randomized, single-blind, before-after trial.

Setting

Physiotherapy gymnasium and hydrotherapy pool.

Participants

Patients awaiting elective hip or knee joint replacement surgery.

Interventions

Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment.

Main Outcome Measures

Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale.

Results

Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes.

Conclusions

While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.     

Effects of resistance training on lower-extremity impairments in older people with hip fracture

Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M, Kiviranta I, Sipilä S. Effects of resistance training on lower-extremity impairments in older people with hip fracture.

Objective

To study the effects of resistance training on muscle strength parameters, mobility, and balance.

Design

Randomized controlled trial.

Setting

Research laboratory and senior gym.

Participants

Population-based sample of eligible 60- to 85-year-old community-dwelling men and women 0.5 to 7.0 years after hip fracture. Forty-six people had no contraindications and were willing to participate in the exercise trial.

Intervention

Twelve-week intensive progressive strength-power training (n=24), aiming to reduce asymmetric deficit in leg muscle strength and power, or no intervention (n=22).

Main Outcome Measures

Isometric knee extension torque (KET) and leg extension power (LEP) measured in the weaker and stronger leg and the asymmetric deficit ([weak/sum both legs] × 100%), 10-m walking speed, dynamic balance test, and self-reported outdoor mobility.

Results

KET increased in both legs (P<.021), LEP tended to increase in the weaker leg (P=.071), and asymmetric LEP deficit decreased (P=.010) after training compared with the control group. LEP of the stronger leg, asymmetric KET deficit, walking speed, and balance performance were not significantly affected by training. Self-reported ability to walk outdoors improved after training. The compliance to the training was over 90%, and few adverse events (n=4; mainly musculoskeletal) were likely to be caused by the training.

Conclusions

Intensive resistance training is feasible for people with a hip fracture and improved muscle strength and power. More intensive training especially for the weaker leg may be needed to obtain more marked effects on asymmetric deficit, mobility, and balance. Also, the timing and duration of training program should be considered. (ISRCTN identifier ISRCTN34271567.)     

A multiconvergent approach to the rehabilitation of patients with chronic fatigue syndrome: a comparative study

Objectives

This study investigated the efficacy of a rehabilitation technique for the treatment of chronic fatigue syndrome that was developed by a physiotherapist. Data collected retrospectively from a pilot study indicated that patients benefited from this multiconvergent approach, so further assessments were warranted.

Design

Treatment efficacy was assessed by comparing the primary and secondary outcome measures of patients attending multiconvergent therapy (MCT) with those of patients attending relaxation therapy and a group of non-intervention controls.

Setting

The active treatment took place at a clinic within the physiotherapy outpatient unit. Relaxation therapy and all assessments were conducted at the psychology unit.

Participants

Thirty-five participants, fitting the Centers for Disease Control and Prevention criteria for chronic fatigue syndrome, were recruited from two outpatient clinics and an existing patient panel.

Intervention

Patients were assigned to either MCT (n = 12) or relaxation therapy (n = 14). Nine participants who received general medical care were used as a comparison group.

Main outcome measures

The Karnofsky performance scale was used as the primary outcome measure of function. Secondary outcome measures assessing overall improvement in patient condition, fatigue and disability levels were also administered.

Results

A significant percentage of the patients attending the MCT sessions showed improvement in the primary outcome score used to measure the success of the treatment (MCT = 83%, relaxation = 21%, controls = 0; P < 0.001). A significant percentage of this group also reported improvement in their overall condition (MCT = 92%, relaxation = 64%, controls = 22%; P < 0.001), lower fatigue levels (MCT = 83%, relaxation = 57%, controls = 11%; P < 0.001) and lower levels of disability (MCT = 75%, relaxation = 43%, controls = 11%; P = 0.032) immediately post-therapy. In addition, these improvements were maintained at 6-month follow-up.

Conclusions

Outcomes from this small preliminary study were encouraging. The multiconvergent approach produced significant improvements for standardised primary and secondary outcome measures. Further research is required to examine the efficacy of this approach over time, and its effectiveness on a larger scale within the primary healthcare setting using additional therapists trained in the technique.     

Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study

Background

There is increasing emphasis on person-centred care within the literature and the health care context. It is suggested that a person-centred approach to medication activities has the potential to improve patient experiences and outcomes.

Objectives

This study set out to examine how nurses and patients interact with each other during medication activities in an acute care environment with an underlying philosophy of person-centred care.

Design

A qualitative approach was used comprising naturalistic observation and semi-structured interviews.

Setting

The study setting was an acute care ward with a collaboratively developed philosophy of person-centre care, in an Australian metropolitan hospital.

Participants

Eleven nurses of varying levels of experience were recruited to participate in observations and interviews. Nurses were eligible to participate if they were employed on the study ward in a role that incorporated direct patient care, including medication activities. A stratified sampling technique ensured that nurses with a range of years of clinical experience were represented. Patients who were being cared for by participating nurses during the observation period were recruited to participate unless they met the following exclusion criteria: those less than 18 years of age, non-English speaking patients, and those who were unable to give informed consent. Twenty-five patients were observed and 16 of those agreed to be interviewed.

Results

The results of the study generated insights into the nature of interactions between nurses and patients where person-centred care is the underlying philosophy of care. Three major themes emerged from the findings: provision of individualised care, patient participation and contextual barriers to providing person-centred care. While the participating nurses valued a person-centred approach and perceived that they were conducting medication activities in a person-centred way, some nurse-patient interactions during medication activities were centred on routines rather than individualised patient assessment and management. These interactions were based on nurses’ perceptions of what was important for the patient and did not provide opportunities for patient participation. Two main contextual barriers in relation to a person-centred approach to medication activities were identified as multidisciplinary communication and time constraints.

Conclusions

While some nurse-patient interactions during medication activities were consistent with the principles of person-centred care, the study results highlighted factors that influence the nature of these interactions, and identified opportunities to improve nursing practice. To ensure person-centred care is applied to medication activities, nurses should undertake ongoing assessment of patients’ needs in relation to their medications and encourage opportunities for increased patient participation.     

Leisure Time Physical Activity in a Population-Based Sample of People With Spinal Cord Injury Part I: Demographic and Injury-Related Correlates

Martin Ginis KA, Latimer AE, Arbour-Nicitopoulos KP, Buchholz AC, Bray SR, Craven BC, Hayes KC, Hicks AL, McColl M, Potter PJ, Smith K, Wolfe DL. Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates.

Objectives

To estimate the number of minutes a day of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA in a population-based sample of people with chronic SCI.

Design

Cross-sectional telephone survey.

Setting

General community.

Participants

Men and women with SCI (N=695).

Interventions

Not applicable.

Main Outcome Measures

The number of minutes/day of LTPA performed at a mild intensity or greater.

Results

Respondents reported mean minutes ± SD of 27.14±49.36 of LTPA/d; however, 50% reported no LTPA whatsoever. In a multiple regression analysis, sex, age, years postinjury, injury severity, and primary mode of mobility each emerged as a unique predictor of LTPA. Multiple correspondence analysis indicated that being a man over the age of 34 years and greater than 11 years postinjury was associated with inactivity, while being a manual wheelchair user and having motor complete paraplegia were associated with the highest level of daily LTPA.

Conclusions

Daily LTPA levels are generally low in people with SCI. Women, older adults, people with less recent injuries, people with more severe injuries, and users of power wheelchairs and gait aids are general subgroups that may require special attention and resources to overcome unique barriers to LTPA. Specific subgroups may also require targeted interventions.     

Knowledge, attitudes and intentions about participation in physical activity of older post-acute hospital inpatients

Objectives

Most older people have suboptimal levels of habitual physical activity. This study investigated the knowledge, attitudes, intentions and barriers to participation in physical activity among older people recovering from acute illness or injury.

Design

A structured face-to-face questionnaire was developed, incorporating previously validated questions for older people.

Setting

Elderly care unit of an urban hospital.

Participants

Of 256 consecutively admitted patients, 66 were eligible and 44 (71% female) completed the interview before discharge.

Main instruments and outcome measures

Questionnaire using open and closed questions. Baseline data included Barthel Index, gait aid, length of hospital stay and grip strength (indicator of frailty).

Results

Median age was 83 years (range 67 to 91), median Barthel Index was 18/20 (range 9 to 20), mean hospital stay was 13.7 days (standard deviation 9.7) and 72% (31/43) were frail. Despite hospitalisation, only 23% (10/44) reported ‘poor’ general health. Knowledge of specific health benefits of physical activity was mixed, and knowledge about hypertension and osteoporosis was poor. Most patients (23/44, 52%) wrongly believed that their habitual activity levels were adequate. Barriers to increasing activity were predominantly related to health, including ‘breathing’ and ‘leg’ problems. Intentions towards future physical activity were varied and unrelated to frailty. Needing to rest and relax was a reason given for not being more active. Few patients (5/44, 11%) recalled being advised to be physically active.

Conclusions

These patients, potential benefactors from increased physical activity, had mixed knowledge and attitudes towards physical activity which was unrelated to frailty. These data provide insights relevant to the design and delivery of exercise-related health messages and interventions.     

Mortality After Discharge From Acute Care Hospitalization With Traumatic Brain Injury: A Population-Based Study

Ventura T, Harrison-Felix C, Carlson N, DiGuiseppi C, Gabella B, Brown A, DeVivo M, Whiteneck G. Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study.

Objective

To characterize mortality after acute hospitalization with traumatic brain injury (TBI) in a socioeconomically diverse population.

Design

Population-based retrospective cohort study.

Setting

Statewide TBI surveillance program.

Participants

Colorado residents with TBI discharged alive from acute hospitalization between 1998 and 2003 (N=18,998).

Interventions

Not applicable.

Main Outcome Measures

Vital status at the end of the study period (December 31, 2005) and statewide population mortality rates were used to calculate all-cause and cause-specific standardized mortality ratios (SMRs) and life expectancy compared with population mortality rates. The influence of demographics, injury severity, and comorbid conditions on time until death was investigated using age-stratified Cox proportional hazards modeling.

Results

Patients with TBI carried about 2.5 times the risk of death compared with the general population (SMR=2.47; 95% confidence interval [CI], 2.31-2.65). Life expectancy reduction averaged 6 years. SMRs were largest for deaths caused by mental/behavioral (SMR=3.84; 95% CI, 2.67-5.51) and neurologic conditions (SMR=2.79; 95% CI, 2.07-3.77) and were smaller but significantly higher than 1.0 for an array of other causes. Injury severity and older age increased mortality among young people (age <20y). However, risk factors for mortality among adults age 20 and older involved multiple domains of demographics (eg, metropolitan residence), injury-related measures (eg, falls versus vehicular incidents), and comorbidity (eg, ≥3 comorbid health conditions versus none).

Conclusions

TBI confers an increased risk of mortality in the months and years after hospital discharge. Although life expectancy is reduced across the population, the excess in mortality lessens as time since injury increases. Specific risk factors (eg, high injury severity, poor general health) pose an especially high threat to survival and should prompt an increased vigilance of health status, especially among younger patients.     

Predictors of disrupted social participation in myotonic dystrophy type 1

Gagnon C, Mathieu J, Jean S, Laberge L, Perron M, Veillette S, Richer L, Noreau L. Predictors of disrupted social participation in myotonic dystrophy type 1.

Objective

To identify personal and environmental predictors of the most disrupted participation domains in people with myotonic dystrophy type 1 (DM1).

Design

Cross-sectional study.

Setting

Outpatient neuromuscular clinic.

Participants

Adults (n=200; 121 women), age 18 years or older (mean age, 47y), with a confirmed diagnosis of DM1 were selected from the registry of a neuromuscular clinic (N=416). Fifty-two participants had the mild phenotype and 148 the adult phenotype.

Interventions

Not applicable.

Main Outcome Measures

Social participation in mobility, housing, employment, and recreation was assessed with the Life Habits Measure. Disrupted participation was based on whether help was needed in performing most life habits because of incapacities or environmental barriers. Environmental factors were assessed by using the Measure of the Quality of the Environment. Personal factors were assessed with standardized instruments including the Berg Balance Scale, the Krupp Fatigue Severity Scale, and manual muscle testing.

Results

A large proportion of participants (45%-61%) reported disrupted participation in all 4 domains. Lower-extremity strength (odd ratios [OR], 15.0-5.5; P<.050) and higher fatigue (OR, 6.0-2.6; P<.05) were present in participants with disrupted participation. With regard to environmental factors, family support (OR, 3.6-2.5; P<.05) and public services (OR, 2.8-2.2; P<.05) were perceived as barriers for participants with disrupted participation in most domains.

Conclusions

This study identified personal and environmental factors that may influence the trajectory toward disrupted participation in individuals with DM1. Fatigue, strength, family support, and public services were found to be independent predictors of disrupted participation.     

Exercise and Quality of Life Among People With Multiple Sclerosis: Looking Beyond Physical Functioning to Mental Health and Participation in Life

Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life.

Objective

To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction.

Design

Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999.

Setting

Veterans Health Administration.

Participants

Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency.

Results

Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties).

Conclusions

Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.     

Subacromial Corticosteroid Injection for Poststroke Shoulder Pain: An Exploratory Prospective Case Series

Chae J, Jedlicka L. Subacromial corticosteroid injection for poststroke shoulder pain: an exploratory prospective case series.

Objective

To assess the effectiveness of subacromial corticosteroid injections for poststroke shoulder pain.

Design

Exploratory, prospective case series.

Setting

Ambulatory setting, university-affiliated hospital.

Participants

Stroke survivors (N=10) with pain in the hemiparetic shoulder.

Intervention

Consecutive stroke survivors with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis received subacromial corticosteroid injections.

Main Outcome Measures

The primary outcome measure was the Brief Pain Inventory (BPI) question 12 (BPI 12), which assesses “worst pain” in the previous 7 days. Secondary measures included BPI question 15, which assesses present pain and BPI question 23 (BPI 23), which assesses pain interference with 7 daily activities. Outcomes were assessed at baseline, weekly for the first 4 weeks and then at 8 and 12 weeks postinjection.

Results

Repeated measure analysis of variance revealed significant within group time effect for BPI 12 (F=7.7, P<.001). Based on absolute means, the largest therapeutic benefit was seen by the second week postinjection with partial loss of effect thereafter. There were significant within group time effects for the general activity (F=3.2, P=.009), sleep (F=3.9, P=.003), and enjoyment of life (F=2.3, P=.044) domains of BPI 23.

Conclusions

Subacromial corticosteroid injection is associated with significant reduction in poststroke shoulder pain in patients with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis. However, there is a gradual loss of effect with time. Controlled trials are needed to show a cause and effect relationship.     

Development and Validation of Participation and Positive Psychologic Function Measures for Stroke Survivors

Bode RK, Heinemann AW, Butt Z, Stallings J, Taylor C, Rowe M, Roth EJ. Development and validation of participation and positive psychologic function measures for stroke survivors.

Objective

To evaluate the reliability and validity of Neurologic Quality of Life (NeuroQOL) item banks that assess quality-of-life (QOL) domains not typically included in poststroke measures.

Design

Secondary analysis of item responses to selected NeuroQOL domains.

Setting

Community.

Participants

Community-dwelling stroke survivors (n=111) who were at least 12 months poststroke.

Interventions

Not applicable.

Main Outcome Measures

Five measures developed for 3 NeuroQoL domains: ability to participate in social activities, satisfaction with participation in social activities, and positive psychologic function.

Results

A single bank was developed for the positive psychologic function domain, but 2 banks each were developed for the ability-to-participate and satisfaction-with-participation domains. The resulting item banks showed good psychometric properties and external construct validity with correlations with the legacy instruments, ranging from .53 to .71. Using these measures, stroke survivors in this sample reported an overall high level of QOL.

Conclusions

The NeuroQoL-derived measures are promising and valid methods for assessing aspects of QOL not typically measured in this population.     

Bandura's exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting

Background

Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise.

Objectives

To assess the psychometric properties of Bandura's exercise self-efficacy (ESE) scale in an Australian CR setting.

Design

Validation study.

Setting

Cardiac rehabilitation.

Participants

One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years).

Methods

Participants completed a six-minute walk test (6MWT) and Bandura's exercise self-efficacy scale at enrolment and on completion of a 6-week CR program.

Results

Bandura's ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p = 0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r = 0.28, p = 0.035) was seen.

Conclusions

The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patient's efficacy for regular physical activity.