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1.
Brininger TL Rogers JC Holm MB Baker NA Li ZM Goitz RJ 《Archives of physical medicine and rehabilitation》2007,88(11):1429-1435
Brininger TL, Rogers JC, Holm MB, Baker NA, Li Z-M, Goitz RJ. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial.
Objective
To compare the effects of a neutral wrist and metacarpophalangeal (MCP) splint with a wrist cock-up splint, with and without exercises, for the treatment of carpal tunnel syndrome (CTS).Design
A 2×2×3 randomized factorial design with 3 main factors: splint (neutral wrist and MCP and wrist cock-up), exercise (exercises, no exercise), and time (baseline, 4wk, 8wk).Setting
Subjects were evaluated in an outpatient hand therapy clinic.Participants
Sixty-one subjects with mild to moderate CTS; 51 subjects completed the study.Interventions
There were 4 groups: the neutral wrist and MCP group and the neutral wrist and MCP-exercise group received fabricated customized splints that supported the wrist and MCP joints; the wrist cock-up group and the wrist cock-up-exercise group received wrist cock-up splints. The neutral wrist and MCP-exercise and wrist cock-up-exercise groups also received tendon and nerve gliding exercises and were instructed to perform exercises 3 times a day. All subjects were instructed to wear the assigned splint every night for 4 weeks.Main Outcome Measures
We used the CTS Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) to assess CTS symptoms and functional status.Results
Analysis of variance showed a significant main effect for splint and time on the SSS (P<.001, P=.014) and FSS (P<.001, P=.029), respectively. There were no interaction effects.Conclusions
Our results validate the use of wrist splints for the treatment of CTS, and suggest that a splint that supports the wrist and MCP joints in neutral may be more effective than a wrist cock-up splint. 相似文献2.
Kaymak B Ozçakar L Cetin A Candan Cetin M Akinci A Hasçelik Z 《Archives of physical medicine and rehabilitation》2008,89(4):743-748
Kaymak B, Özçakar L, Çetin A, Candan Çetin M, Ak?nc? A, Hasçelik Z. A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome.
Objectives
To clarify whether sonography or electrophysiologic testing is a better predictor of symptom severity and functional status in carpal tunnel syndrome (CTS) and to assess the diagnostic value of sonography in patients with idiopathic CTS.Design
Cross-sectional.Setting
University hospital physical medicine and rehabilitation clinic.Participants
Thirty-four hands with CTS and 38 normative hands were evaluated.Interventions
Not applicable.Main Outcome Measures
The Boston Carpal Tunnel Questionnaire, which comprised symptom severity and functional status scale, was applied to CTS patients. Bilateral upper-extremity nerve conduction studies of median and ulnar nerves and sonographic imaging of the median nerve were performed in all participants. Sonographic evaluation was performed by a physician blinded to the physical and electrophysiologic findings of the subjects.Results
Cross-sectional areas (CSAs) of the median nerve at the carpal tunnel entrance and proximal carpal tunnel were 12.5±2.6 and 10.6±2.6 versus 15.6±4.2 and 11.5±3.2 in CTS patients versus controls, respectively. Increased CSA of the median nerve at the carpal tunnel entrance (P<.002) and at the proximal carpal tunnel (P<.000) were detected in the hands with CTS. Flattening ratios did not differ in a statistically significant manner between the groups (P>.05). The best predictor of symptom severity was median nerve sensory distal latency and that of functional status was median nerve motor distal latency. The optimum cutoff value for median nerve CSA was 11.2mm2 at the carpal tunnel entrance and 11.9mm2 at the proximal carpal tunnel. Sensitivity, specificity, and positive and negative predictive values at the proximal carpal tunnel (88%, 66%, 71%, 80%, respectively) were higher than those at the carpal tunnel entrance (68%, 62%, 65%, 66%, respectively).Conclusions
The best predictors of symptom severity and functional status in idiopathic CTS seem to be the electrophysiologic assessments rather than sonographic measurements. On the other hand, sonography may be helpful in the diagnosis of idiopathic CTS. 相似文献3.
Yuichi Yoshii Chunfeng Zhao James D. Schmelzer Phillip A. Low Kai-Nan An Peter C. Amadio 《Archives of physical medicine and rehabilitation》2009,90(2):333-339
Yoshii Y, Zhao C, Schmelzer JD, Low PA, An K-N, Amadio PC. The effects of hypertonic dextrose injection on connective tissue and nerve conduction through the rabbit carpal tunnel.
Objective
To investigate the effects of hypertonic dextrose injection on the subsynovial connective tissue (SSCT) in a rabbit model. We hypothesized that dextrose injection would induce proliferation of the SSCT, hinder median nerve conduction, and alter SSCT mechanical properties, similar to what is observed in patients with carpal tunnel syndrome (CTS).Design
Randomized, controlled prospective study.Setting
Not applicable.Participants
New Zealand white rabbits (N=28) weighing 4.0 to 4.5kg.Intervention
One forepaw was randomly injected with 0.1mL 10% dextrose solution. The contralateral paw was injected with a similar amount of 0.9% saline solution as a control. Animals were killed at 12 weeks after injection.Main Outcome Measures
Animals were evaluated by electrophysiology (EP), mechanical testing, and histology. EP was evaluated by distal motor latency and amplitude. Shear force was evaluated when the middle digit flexor digitorum superficialis tendon was pulled out from the carpal tunnel. The ultimate tensile load and the energy absorption were also measured. Tissue for histology was evaluated qualitatively.Results
EP demonstrated significant prolongation of distal motor latency. The energy absorption and stiffness were also significantly increased in the dextrose group. Histologically, the dextrose group showed thickening of the collagen bundles and vascular proliferation within the SSCT compared with the saline group.Conclusions
These results are consistent with the findings in patients with CTS and suggest that hypertonic dextrose injection has the potential to create a novel animal model in which to study the evolution of CTS. 相似文献4.
Bradley G. Impink Michael L. Boninger Heather Walker Jennifer L. Collinger Christian Niyonkuru 《Archives of physical medicine and rehabilitation》2009,90(9):1489-1494
Impink BG, Boninger ML, Walker H, Collinger JL, Niyonkuru C. Ultrasonographic median nerve changes after a wheelchair sporting event.
Objectives
To investigate the acute median nerve response to intense wheelchair propulsion by using ultrasonography and to examine the relationship between carpal tunnel syndrome (CTS) signs and symptoms and the acute median nerve response.Design
Case series.Setting
Research room at the National Veterans Wheelchair Games.Participants
Manual wheelchair users (N=28) competing in wheelchair basketball.Intervention
Ultrasound images collected before and after a wheelchair basketball game.Main Outcome Measures
Median nerve cross-sectional area, flattening ratio, and swelling ratio and changes in these after activity. Comparison of median nerve characteristics and patient characteristics between participants with and without positive physical examination findings and with and without symptoms of CTS.Results
Significant changes in median nerve ultrasound characteristics were noted after activity. The group as a whole showed a significant decrease in cross-sectional area at the radius of 4.05% (P=.023). Participants with positive physical examinations showed significantly different (P=.029) and opposite changes in swelling ratio compared with the normal group. Subjects with CTS symptoms had a significantly (P=.022) greater duration of wheelchair use (17.1y) compared with the asymptomatic participants (9y).Conclusions
Manual wheelchair propulsion induces acute changes in median nerve characteristics that can be visualized by using ultrasound. Studying the acute median nerve response may be useful for optimizing various interventions, such as wheelchair set up or propulsion training, to decrease both acute and chronic median nerve damage and the likelihood of developing CTS. 相似文献5.
Arash Babaei-Ghazani Peyman Roomizadeh Bijan Forogh Seyed-Mohammad Moeini-Taba Amin Abedini Mona Kadkhodaie Fateme Jahanjoo Bina Eftekharsadat 《Archives of physical medicine and rehabilitation》2018,99(4):766-775
Objective
To review the literature and assess the comparative effectiveness of ultrasound-guided versus landmark-guided local corticosteroid injections in patients with carpal tunnel syndrome (CTS).Data Sources
Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Embase (Ovid), and Web of Science (from inception to February 1, 2017).Study Selection
Randomized controlled trials (RCTs) comparing ultrasound-guided injection with landmark-guided injection in patients with CTS were included.Data Extraction
Two authors independently screened abstracts and full texts. The outcomes of interest were Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores of the Boston Carpal Tunnel Questionnaire and 4 electrodiagnostic parameters, including compound muscle action potential (CMAP), sensory nerve action potential (SNAP), distal motor latency (DML), and distal sensory latency (DSL).Data Synthesis
Overall, 569 abstracts were retrieved and checked for eligibility; finally, 3 RCTs were included (181 injected hands). Pooled analysis showed that ultrasound-guided injection was more effective in SSS improvement (mean difference [MD], ?.46; 95% confidence interval [CI], ?.59 to ?.32; P<.00001), whereas no significant difference was observed between the 2 methods in terms of the FSS (MD, ?.25; 95% CI, ?.56 to .05; P=.10). There were also no statistically significant differences in improvements of CMAP (MD, 1.54; 95% CI, 0.01 to 3.07; P=.05), SNAP (MD, ?0.02; 95% CI, ?6.27 to 6.23; P>.99), DML (MD, .05; 95% CI, ?.30 to .39; P=.80), or DSL (MD, .00; 95% CI, ?.65 to .65; P>.99).Conclusions
This review suggested that ultrasound-guided injection was more effective than landmark-guided injection in symptom severity improvement in patients with CTS; however, no significant differences were observed in functional status or electrodiagnostic improvements between the 2 methods. 相似文献6.
Bionka M. Huisstede Manon S. Randsdorp J. Henk Coert Suzanne Glerum Marienke van Middelkoop Bart W. Koes 《Archives of physical medicine and rehabilitation》2010,91(7):1005-1024
Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments—a systematic review.
Objective
To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS).Data Sources
The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs).Study Selection
Two reviewers independently applied the inclusion criteria to select potential studies.Data Extraction
Two reviewers independently extracted the data and assessed the methodologic quality.Data Synthesis
A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of follow-up. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting.Conclusions
Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs. 相似文献7.
Wai K. Tang Jin Y. Lu Yang K. Chen Vincent C. Mok Gabor S. Ungvari Ka S. Wong 《Archives of physical medicine and rehabilitation》2010,91(10):1511-1515
Tang WK, Lu JY, Chen YK, Mok VC, Ungvari GS, Wong KS. Is fatigue associated with short-term health-related quality of life in stroke?
Objective
To evaluate the relation between poststroke fatigue and short-term health-related quality of life (HRQOL) in Chinese patients with first or recurrent stroke.Design
Cross-sectional survey.Setting
Acute stroke unit of a general hospital.Participants
A total of 458 patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong.Interventions
Not applicable.Main Outcome Measures
HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at 3 months after the subjects' index stroke. Fatigue was evaluated by using the Fatigue Severity Scale (FSS). The correlation between the FSS and SF-36 scores was examined and adjusted for potential confounders, including age, sex, marital status, previous stroke, social support, global cognitive functions, neurologic deficits, and depressive symptoms.Results
Univariate analysis revealed that fatigue was a significant correlate of all SF-36 domain scores. The magnitude of correlation was highest for the vitality domain (r=−.605, Bonferroni corrected P<.05) and lowest for the physical functioning domain (r=−.202, Bonferroni corrected P<.05). Canonic correlation analysis indicated that FSS was strongly related to the HRQOL with a loading of −.678. Increasing fatigue was associated with a lower HRQOL. The association between FSS and HRQOL remained significant in the subsequent multivariate regression analysis, having adjusted for possible confounders.Conclusions
These findings suggest that fatigue has an impact on short-term HRQOL in Chinese stroke patients. The early identification and treatment of fatigue may improve HRQOL of stroke patients. 相似文献8.
Bionka M. Huisstede Peter Hoogvliet Manon S. Randsdorp Suzanne Glerum Marienke van Middelkoop Bart W. Koes 《Archives of physical medicine and rehabilitation》2010,91(7):981-1004
Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments-a systematic review.
Objective
To review literature systematically concerning effectiveness of nonsurgical interventions for treating carpal tunnel syndrome (CTS).Data Sources
The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs).Study Selection
Two reviewers independently applied the inclusion criteria to select potential studies.Data Extraction
Two reviewers independently extracted the data and assessed the methodologic quality.Data Synthesis
A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 20 RCTs were included. Strong and moderate evidence was found for the effectiveness of oral steroids, steroid injections, ultrasound, electromagnetic field therapy, nocturnal splinting, and the use of ergonomic keyboards compared with a standard keyboard, and traditional cupping versus heat pads in the short term. Also, moderate evidence was found for ultrasound in the midterm. With the exception of oral and steroid injections, no long-term results were reported for any of these treatments. No evidence was found for the effectiveness of oral steroids in long term. Moreover, although higher doses of steroid injections seem to be more effective in the midterm, the benefits of steroids injections were not maintained in the long term. For all other nonsurgical interventions studied, only limited or no evidence was found.Conclusions
The reviewed evidence supports that a number of nonsurgical interventions benefit CTS in the short term, but there is sparse evidence on the midterm and long-term effectiveness of these interventions. Therefore, future studies should concentrate not only on short-term but also on midterm and long-term results. 相似文献9.
Ana Cristina R. Camargos Luci F. Teixeira-Salmela PT PhD 《Archives of physical medicine and rehabilitation》2009,90(2):314-319
Camargos AC, Rodrigues-de-Paula-Goulart F, Teixeira-Salmela LF. The effects of foot position on the performance of the sit-to-stand movement with chronic stroke subjects.
Objective
To investigate the effects of different foot positions during the sit-to-stand (STS) movements with stroke subjects.Design
Cross-sectional.Setting
Research laboratory.Participants
Twelve chronic stroke subjects (N=12).Interventions
Not applicable.Main Outcome Measures
Differential latency and electromyography (EMG) activity of the tibialis anterior, soleus, quadriceps, and hamstring muscles of the affected leg as well as the movement time, time of seat-off, weight symmetry, and rising index were obtained while the subjects performed the STS movements by using 4 different strategies: spontaneous; symmetric; asymmetric-1, with the affected foot behind; and asymmetric-2, with the unaffected foot behind.Results
Compared with the spontaneous strategy, the soleus showed the greatest differential latency in the asymmetric-2 strategy, the hamstrings had lower EMG activity in the symmetric strategy, and the movement time was greater in the asymmetric strategies.Conclusions
The asymmetric 2 strategy appeared to be the least favorable, whereas the spontaneous and the symmetric strategies appeared to be more favorable in improving the STS performance. Based on these findings, allowing the subjects to adopt the spontaneous strategy or training of the symmetric strategy could result in greater benefits for subjects with higher chronicity and higher functional levels, such as those evaluated in the present study. 相似文献10.
Murat Kara Levent Özçakar Didem Gökçay Erol Özçelik Mehmet Yörübulut Sinem Güneri Bayram Kaymak Ay?en Ak?nc? Alp Çetin 《Archives of physical medicine and rehabilitation》2010,91(8):1160-1165
Kara M, Özçakar L, Gökçay D, Özçelik E, Yörübulut M, Güneri S, Kaymak B, Ak?nc? A, Çetin A. Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging: a double-blind randomized placebo-controlled study.
Objective
To evaluate the effects of transcutaneous electric nerve stimulation (TENS) by using functional magnetic resonance imaging (fMRI) in patients with carpal tunnel syndrome (CTS).Design
Randomized controlled trial.Settings
University medical center and an outpatient imaging center.Participants
Female patients with CTS (n=20) were randomized into 2 groups receiving either TENS (n=10) or sham TENS (n=10). In both groups, an initial baseline fMRI session was performed via stimulating digits 2, 5, and 3 in turn, 1 scan run for each. TENS versus sham TENS treatment was given, and a repeat imaging was performed starting 20 minutes after the treatment as follows: second finger on the 20th minute, fifth finger on the 25th minute (ulnar nerve innervated control finger), and third finger on the 30th min.Interventions
Not applicable.Main Outcome Measure
Differences in fMRI activation between the 2 groups were evaluated.Results
Our results demonstrated that 20 to 25 minutes after TENS treatment—but not in the sham TENS group—a significant fMRI signal decrease for digit 2 (post-TENS vs baseline) was observed in the secondary somatosensory regions, ipsilateral primary motor cortex (M1), contralateral supplementary motor cortex (SMA), contralateral parahippocampal gyrus, contralateral lingual gyrus, and bilateral superior temporal gyrus. Measurements on the 25th to 30th minutes for digit 5 were similar between the groups, with presence of activities in areas other than generally activated regions because of painful stimuli. Thirty to 35 minutes after TENS treatment, a significant fMRI signal decrease for digit 3 was detected in the contralateral M1 and contralateral SMA only in the TENS group.Conclusions
Our findings showed that TENS treatment significantly decreased the pain-related cortical activations caused by stimulation of the median nerve-innervated fingers up to 35 minutes after treatment. 相似文献11.
Robert J. Dachs Divya Kulkarni George L. Higgins III 《The American journal of emergency medicine》2011,29(9):1023-1027
Background
The Pulmonary Embolism Rule-Out Criteria (PERC) rule identifies patients who can be safely discharged from the emergency department (ED) without undergoing laboratory or radiological investigation for possible pulmonary embolism (PE). It was shown to be 99% sensitive in a large validation series. Our objective was to assess the PERC rule's performance in a representative US community hospital.Methods
A chart review of ED patients receiving computed tomographic scans (CTS) for possible PE during a 4-month study period was performed. The PERC rule was applied to this cohort, and its sensitivity and negative predictive value were determined.Results
Two hundred thirteen patients underwent chest CTS to “rule out” PE. Forty-eight patients met PERC rule criteria, and all had negative CTS. Of the remaining 165 patients, 18 patients (11%) had scans positive for PE. The overall prevalence of PE was 8.45% (95% CI, 5.22-13.24%). The PERC rule's sensitivity was 100% (95% CI, 78.12-100%), with a negative predictive value of 100% (95% CI, 90.80-100%). Application of the PERC rule at the point-of-care would have reduced CTS by 23%.Conclusions
In our community hospital, the PERC rule successfully identified ED patients who did not require CTS evaluation for PE. Had the PERC rule been applied, nearly one-quarter of all CTS performed to “rule out PE” could have been avoided. 相似文献12.
Pan SL Lien IN Yen MF Lee TK Chen TH 《Archives of physical medicine and rehabilitation》2008,89(6):1054-1060
Pan SL, Lien IN, Yen MF, Lee TK, Chen THH. Dynamic aspect of functional recovery after stroke using a multistate model.
Objective
To estimate time to functional recovery and quantify the effects of significant prognostic factors affecting the dynamic change of 3-state functional outcome after stroke.Design
Modeling of clinical predictions.Setting
Referral center.Participants
One hundred eleven patients with first-time ischemic stroke.Interventions
Not applicable.Main Outcome Measure
Serial Barthel Index scores at onset, 2 weeks, and 1, 2, 4, and 6 months poststroke. The severity of disability was classified into 3 functional states: poor functional state (PFS) for Barthel Index scores from 0 to 40, moderate functional state (MFS) for scores from 45 to 80, and good functional state (GFS) for scores greater than 80. A 3-state Markov regression model together with Bayesian acyclic graphic underpinning was used to estimate transition parameters and mean time to functional recovery between states and to predict the probability of functional recovery by using Gibbs sampling technique.Results
The mean total recovery time was 3.1 months for patients with PFS at baseline and 1.3 months for patients with MFS at baseline. The mean recovery times to different functional states were also estimated. Age predominantly affected the probabilities of MFS to GFS transitions, younger patients had faster transition rates (rate ratio, 4.51; 95% confidence interval [CI], 2.72−7.40); but age had only borderline effects on PFS to MFS transitions. In contrast, infarct size exerted substantial effects on PFS to MFS transitions: small-size infarct correlated with a higher transition rate (rate ratio, 10.17; 95% CI, 5.25−20.13), whereas only a borderline effect on MFS to GFS transitions was found. The baseline functional state significantly affected the MFS to GFS transitions.Conclusions
By using a multistate model, overall and patient-specific mean time to functional recovery to different functional states can be estimated and the effect of clinical predictors on functional transitions can be precisely quantified to predict patient-specific probability of functional recovery. 相似文献13.
Eamonn Delahunt Angela McGrath Naoise Doran Garrett F. Coughlan 《Archives of physical medicine and rehabilitation》2010,91(9):1383-1389
Delahunt E, McGrath A, Doran N, Coughlan GF. Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability.
Objective
To investigate whether 2 different mechanisms of ankle joint taping ([1] lateral subtalar sling or [2] fibular repositioning) can enhance actual and perceived dynamic postural stability in participants with chronic ankle instability (CAI).Design
Laboratory-based repeated-measures study.Setting
University biomechanics laboratory.Participants
Participants (n=16) with CAI.Interventions
Participants performed the Star Excursion Balance Test (SEBT) under 3 different conditions: (1) no tape, (2) lateral subtalar sling taping and (3) fibular repositioning taping.Main Outcome Measures
Reach distances in the anterior, posteromedial, and posterolateral directions on the SEBT. Participants' perceptions of stability, confidence, and reassurance when performing the SEBT under 2 different taping conditions.Results
Taping did not improve reach distance on the SEBT (P>.05). Feelings of confidence increased for 56% of participants (P=.002) under both tape conditions. Feelings of stability increased for 87.5% of participants (P<.001) using condition 2 (lateral subtalar sling taping) and 75% of participants (P=.001) using condition 3 (fibular repositioning taping). Feelings of reassurance increased for 68.75% of participants (P=.001) using condition 2 (lateral subtalar sling taping) and 50% of participants (P=.005) using condition 3 (fibular repositioning taping).Conclusions
No significant change in dynamic postural stability was observed after application of either taping mechanism; however, participants' perceptions of confidence, stability, and reassurance were significantly improved. Further research is necessary to fully elucidate the exact mechanisms by which taping may help reduce the incidence of repeated injury in subjects with CAI. 相似文献14.
Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury.
Objective
To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).Design
A 2-week methodologic study was conducted to assess the internal consistency, reliability, and construct validity of the FSS.Setting
A tertiary spinal cord rehabilitation facility.Participants
Forty-eight community-living subjects at least 1 year post-SCI with American Spinal Injury Association (ASIA) grade A or B SCI and no medical conditions causing fatigue. The sample was predominantly male (n=31 [65%]) with tetraplegia (n=26 [54%]) and ASIA grade A injuries (n=30 [63%]). The average duration since injury was 14.9 years.Interventions
Not applicable.Main Outcome Measures
The ASIA Impairment Scale, the FSS, a visual analog scale for fatigue (VAS-F), the vitality scale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale (CES-D).Results
Mean FSS score ± standard deviation at baseline was 4.4±1.4, with 54% (n=26) scoring greater than 4. The internal consistency of the FSS was excellent (Cronbach α=.89). Two-week test-retest reliability was adequate (intraclass correlation coefficient, .84; 95% confidence interval, .74-.90). The magnitude of the relationship was as hypothesized for the VAS-F (r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.Conclusions
The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI. 相似文献15.
Turner AP Kivlahan DR Kazis LE Haselkorn JK 《Archives of physical medicine and rehabilitation》2007,88(11):1394-1399
Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence, correlates, quit attempts, and unmet need for services.
Objective
To describe the prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS).Design
Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999.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, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking.Interventions
Not applicable.Main Outcome Measures
Items assessing smoking, quit attempts, and unmet need for smoking services.Results
Among all survey respondents with MS, 28.5% (95% confidence interval [CI], 26.9-30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6-62.1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1-66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity.Conclusions
Smoking among veterans with MS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation. 相似文献16.
Levent Özçakar Fatih Tok Serdar Kesikburun Deniz Palamar Gül Erden Alper Ula?l? Özlem Köro?lu Omaç Alparslan Bayram Çarl? Erhan Çapk?n Martine DeMuynck 《Archives of physical medicine and rehabilitation》2010,91(2):326-331
Özçakar L, Tok F, Kesikburun S, Palamar D, Erden G, Ula?l? A, Omaç ÖK, Çarl? AB, Çapk?n E, DeMuynck M. Musculoskeletal sonography in physical and rehabilitation medicine: results of the first worldwide survey study.
Objectives
To explore the current status of musculoskeletal ultrasound (MSUS) in the realm of physical medicine and rehabilitation (PMR), and to determine the effects of a 1-day MSUS course on the awareness of physiatrists.Design
Survey.Setting
International Society of Physical and Rehabilitation Medicine Congress, 2009, ?stanbul.Participants
Physiatrists attending the congress (n=276) and the MSUS course (n=30).Intervention
Not applicable.Main Outcome Measures
The survey contained 17 multiple-choice and open-ended questions concerning personal background, perceptions regarding MSUS, and current use of MSUS. Additionally, a group of physicians who attended the 1-day MSUS course before the congress were evaluated twice (before and after the course) to assess the change in their awareness.Results
Data from 306 physiatrists (with a mean experience of 10.5±8.1y in the field of PMR) were evaluated. Among the participants, 57.8% were using MSUS in their diagnostic algorithms, 90.4% were thinking that physiatrists should perform sonography themselves, and 75.1% declared that they would perform sonography if they had a device. The ratio of subjects who rated MSUS to be essential for their clinical practice increased from 35.7% to 58.6% after the MSUS course (P>.05).Conclusions
Physiatrists strongly believe that they should perform MSUS themselves, lack of education and lack of device seem to be important issues to be addressed, and even a 1-day course significantly changes awareness of MSUS. 相似文献17.
Marije S. Koelewijn-van Loon Jeroen W.G. Eurlings Glyn Elwyn Richard Grol Trudy van der Weijden 《International journal of nursing studies》2011,48(3):285-291
Background
Practice nurses play an increasingly important role in the prevention of cardiovascular diseases but we do not have evidence about the accuracy of their cardiovascular risk assessments during real practice consultations.Objectives
To examine how nurses perform with regard to absolute 10-year cardiovascular risk assessment in actual practice.Design
Cross-sectional study.Setting
This study was nested in the IMPALA study, a clustered randomised controlled trial involving 24 general practices in The Netherlands.Participants
24 practice nurses, trained in 10-year cardiovascular risk assessment, calculated the risk of a total of 421 patients without established cardiovascular diseases but eligible for cardiovascular risk assessment.Methods
The main outcome measure was the accuracy of risk assessments, defined as (1) the difference between the 10-year cardiovascular risk percentage calculated by nurses and an independent assessor, and (2) the agreement between the treatment categories assigned by the nurses (low, moderate or high risk) and those assigned by the independent assessor.Results
Thirty-one (7.4%) of the calculated risk percentages differed by more than our preset limits, 25 (81%) being underestimations. Elderly patients (OR 1.1, 95% CI 1.0-1.1), male patients (vs. female OR 3.1, 95% CI 1.2-7.3), and smoking patients (vs. non-smoking OR 3.8, 95% CI 1.7-8.9) were more likely to have their cardiovascular risk miscalculated. Ten (28%) of the 36 patients who should be assigned to the high-risk treatment category according to the independent calculation, were missed as high-risk patients by the practice nurses.Conclusions
The overall standard of accuracy of cardiovascular risk assessment by trained practice nurses in actual practice is high. However, a significant number of high-risk patients were misclassified, with the probability that it led to missed opportunities for risk-reducing interventions. As cardiovascular risk assessments are frequently done by nurses in general practice, further specific training should be considered to prevent undertreatment. 相似文献18.
Stineman MG Kwong PL Kurichi JE Prvu-Bettger JA Vogel WB Maislin G Bates BE Reker DM 《Archives of physical medicine and rehabilitation》2008,89(10):1863-1872
Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system.
Objective
To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.Design
An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.Setting
Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.Participants
A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004.Interventions
Not applicable.Main Outcome Measures
One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year.Results
After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26-1.80) and home discharge (OR=2.58; 95% CI, 2.17-3.06). Prosthetic limb procurement did not differ significantly between groups.Conclusions
The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation. 相似文献19.
20.
Metabolic and Mechanical Energy Costs of Reducing Vertical Center of Mass Movement During Gait 总被引:1,自引:0,他引:1
Keith E. Gordon Daniel P. Ferris Arthur D. Kuo 《Archives of physical medicine and rehabilitation》2009,90(1):136-98
Gordon KE, Ferris DP, Kuo AD. Metabolic and mechanical energy costs of reducing vertical center of mass movement during gait.