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1.
Giuseppe Bellelli Giovanni Buccino Bruno Bernardini Alessandro Padovani Marco Trabucchi 《Archives of physical medicine and rehabilitation》2010,91(10):1489-1964
Bellelli G, Buccino G, Bernardini B, Padovani A, Trabucchi M. Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect?
Objective
To assess whether action observation treatment (AOT) may also improve motor recovery in postsurgical orthopedic patients, in addition to conventional physiotherapy.Design
Randomized controlled trial.Setting
Department of rehabilitation.Participants
Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure.Interventions
All participants underwent conventional physiotherapy. In addition, patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward. Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment.Main Outcomes Measures
Changes in FIM and Tinetti scale scores, and dependence on walking aids.Results
At baseline, groups did not differ in clinical and functional scale scores. After treatment, patients in the case group scored better than patients in the control group (FIM total score, P=.02; FIM motor subscore, P=.001; Tinetti scale score, P=.04); patients in the case group were assigned more frequently to 1 crutch (P=.01).Conclusions
In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients. 相似文献2.
Timothy A. Reistetter James E. Graham Anne Deutsch Carl V. Granger Samuel Markello Kenneth J. Ottenbacher 《Archives of physical medicine and rehabilitation》2010,91(3):345-350
Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke.
Objective
To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke.Design
Retrospective cross-sectional design.Setting
Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation.Participants
Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007.Interventions
Not applicable.Main Outcome Measure
Discharge FIM rating and discharge setting (community vs institutional).Results
Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77).Conclusions
Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings. 相似文献3.
Anita D. Mountain R. Lee Kirby Donald A. MacLeod Kara Thompson 《Archives of physical medicine and rehabilitation》2010,91(4):639-643
Mountain AD, Kirby RL, MacLeod DA, Thompson K. Rates and predictors of manual and powered wheelchair use for persons with stroke: a retrospective study in a Canadian rehabilitation center.
Objectives
To determine the rates of manual and powered wheelchair use at discharge for people with stroke admitted to a rehabilitation center and to determine whether any predictors of wheelchair use at discharge could be identified.Design
Retrospective cohort study.Setting
Rehabilitation center.Participants
Consecutive former inpatients (N=100) with a primary diagnosis of stroke, a sample of convenience.Interventions
None.Main Outcome Measures
We reviewed the inpatient health records to determine the rates of wheelchair use at discharge and to record some readily available demographic and clinical data that might serve as predictors of wheelchair use.Results
At discharge, 40 people (40%) were using manual wheelchairs, 1 person (1%) was using a powered wheelchair, and 59 (59%) were not using a wheelchair. Of the patients who were walkers on admission (ie, walking FIM scores of 6 or 7), none (0%) used wheelchairs at discharge. Of those with nonwalking FIM scores (1-5) on admission, 56% were using wheelchairs at discharge. Multivariate analyses revealed that the adjusted odds ratios of using a wheelchair (manual or powered) were 3.33 (95% confidence interval [CI], 1.33-8.33) for those with left-hemisphere versus right-hemisphere strokes (P=.010), .94 (CI, .91-.96) for each point rise in the total raw FIM score on admission (P<.0001), and 19.46 (CI, 6.33-59.81) if the total admission FIM score was less than 80 versus greater than or equal to 80 (P<.0001).Conclusions
On discharge from our rehabilitation center, 40% of people with stroke were using manual wheelchairs and 1% powered wheelchairs. People who were not walking on admission, those with left-hemisphere strokes, and those with lower total admission FIM scores were more likely to use a wheelchair. These findings may permit clinicians to predict wheelchair use better early in the rehabilitation process, when it can affect rehabilitation planning. 相似文献4.
Strasser DC Falconer JA Stevens AB Uomoto JM Herrin J Bowen SE Burridge AB 《Archives of physical medicine and rehabilitation》2008,89(1):10-15
Strasser DC, Falconer JA, Stevens AB, Uomoto JM, Herrin J, Bowen SE, Burridge AB. Team training and stroke rehabilitation outcomes: a cluster randomized trial.
Objective
To test whether a team training intervention in stroke rehabilitation is associated with improved patient outcomes.Design
A cluster randomized trial of 31 rehabilitation units comparing stroke outcomes between intervention and control groups.Setting
Thirty-one Veterans Affairs medical centers.Participants
A total of 237 clinical staff on 16 control teams and 227 staff on 15 intervention teams. Stroke patients (N=487) treated by these teams before and after the intervention.Intervention
The intervention consisted of a multiphase, staff training program delivered over 6 months, including: an off-site workshop emphasizing team dynamics, problem solving, and the use of performance feedback data; and action plans for process improvement; and telephone and videoconference consultations. Control and intervention teams received site-specific team performance profiles with recommendations to use this information to modify team process.Main Outcome Measures
Three patient outcomes: functional improvement as measured by the change in motor items of the FIM instrument, community discharge, and length of stay (LOS).Results
For both the primary (stroke only) and secondary analyses (all patients), there was a significant difference in improvement of functional outcome between the 2 groups, with the percentage of stroke patients gaining more than a median FIM gain of 23 points increasing significantly more in the intervention group (difference in increase, 13.6%; P=.032). There was no significant difference in LOS or rates of community discharge.Conclusions
Stroke patients treated by staff who participated in a team training program were more likely to make functional gains than those treated by staff receiving information only. Team based clinicians are encouraged to examine their own team. (ClinicalTrials.gov identifier NCT00237757). 相似文献5.
Yokoyama O Sakuma F Itoh R Sashika H 《Archives of physical medicine and rehabilitation》2006,87(9):1189-1194
Yokoyama O, Sakuma F, Itoh R, Sashika H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation.
Objective
To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI).Design
Case-controlled study.Setting
SCI unit in a rehabilitation center.Participants
Seventeen patients with SCI-AA and 17 patients with traumatic SCI.Intervention
Standard rehabilitation therapy for SCI.Main Outcome Measures
Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge.Results
No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community.Conclusions
SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community. 相似文献6.
James E. Graham Cynthia M. Ripsin Anne Deutsch Yong-Fang Kuo Sam Markello Carl V. Granger Kenneth J. Ottenbacher 《Archives of physical medicine and rehabilitation》2009,90(7):1110-1116
Graham JE, Ripsin CM, Deutsch A, Kuo Y-F, Markello S, Granger CV, Ottenbacher KJ. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation.
Objectives
To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.Design
Secondary data analysis.Setting
Inpatient rehabilitation facilities (N=864) across the United States.Participants
Patients (N=135,097) who received medical rehabilitation for stroke in 2002-2003.Intervention
None.Main Outcome Measures
Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.Results
Mean ± standard deviation age of the sample was 70.4±13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.Conclusions
The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age. 相似文献7.
Treger I Ring H Schwartz R Tsabari R Bornstein NM Tanne D;National Acute Stroke Israeli Survey Group 《Archives of physical medicine and rehabilitation》2008,89(3):435-440
Treger I, Ring H, Schwartz R, Tsabari R, Bornstein NM, Tanne D; for the National Acute Stroke Israeli Survey Group. Hospital disposition after stroke in a national survey of acute cerebrovascular diseases in Israel.
Objective
To investigate predictive factors for disposition after acute stroke.Design
A nationwide survey (2004 National Acute Stroke Israeli Survey).Setting
All 28 primary general medical centers operating in Israel.Participants
Acute stroke patients (n=1583) admitted during February and March 2004 and discharged from the primary hospital.Interventions
Data collected on baseline characteristics, stroke presentation, type and severity, in-hospital investigation and complications, discharge disability, acute hospital disposition, and mortality follow-up.Main Outcome Measure
Hospital disposition to home, acute rehabilitation, or nursing facility.Results
Among patients, 58.9% (n=932) were discharged home, 33.7% (n=534) to rehabilitation departments, and only 7.4% (n=117) to nursing facilities. Admission neurologic status was a good predictor of hospital disposition. Patients with severe strokes were mostly discharged to rehabilitation facilities. Patients with significant functional decline before the index stroke, resulting from a previous stroke or another cause, were sent to inpatient rehabilitation less frequently. Disability level at discharge from acute hospitalization had high predictive value in hospital disposition after stroke. In the northern region of Israel, a higher proportion of patients were sent home and a lower proportion to rehabilitation and nursing facilities, probably because of lower availability of rehabilitation care in this region of Israel.Conclusions
This nationwide survey shows that most stroke survivors in Israel are discharged home from the acute primary hospital. Good functional status before the index stroke is an important predictor for being sent to acute inpatient rehabilitation. Severity of neurologic impairment and level of disability after the stroke at discharge from the primary hospital are strong predictors for disposition after stroke in Israel. Our data may be useful in discharge planning for stroke patients by policy-makers and health care providers in Israel. 相似文献8.
Berlowitz DR Hoenig H Cowper DC Duncan PW Vogel WB 《Archives of physical medicine and rehabilitation》2008,89(10):1903-1906
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. 相似文献9.
Woan Shin Tan Bee Hoon Heng Karen Sui-Geok Chua Kay Fei Chan 《Archives of physical medicine and rehabilitation》2009,90(7):1202-1066
Tan WS, Heng BH, Chua KS, Chan KF. Factors predicting inpatient rehabilitation length of stay of acute stroke patients in Singapore.
Objective
To determine the predictors of hospital length of stay (LOS) of stroke patients at the point of admission.Design
A retrospective cohort study.Setting
An acute hospital rehabilitation center in Singapore.Participants
Stroke patients (N=491) admitted between March 2005 and December 2006.Interventions
None.Main Outcome Measures
Rehabilitation LOS was calculated as the total number of rehabilitation days before discharge. We measured the functional status of patients by using the Functional Independence Measure (FIM).Results
The median LOS was 29 days (mean = 30.8d). Independent clinical and sociodemographic characteristics found to significantly predict rehabilitation LOS were FIM motor score at admission, the presence of more than 3 comorbid conditions at admission, living with nonimmediate relatives before admission, and the hospital subsidy status of the patient. In particular, the admission FIM motor score explained 43% of the variation in LOS and decreased the LOS by approximately 1.1 days for each 1-point increase in score.Conclusion
Patients' socioeconomic status and family structure was found to influence LOS and should be considered in allocating resources and determining treatment need. The extent of motor function of patients at admission is an important factor influencing rehabilitation LOS and is a useful tool for facilitating rehabilitation resource planning for stroke patients. 相似文献10.
Horn SD Deutscher D Smout RJ DeJong G Putman K 《Archives of physical medicine and rehabilitation》2010,91(11):1712-1721
Horn SD, Deutscher D, Smout RJ, DeJong G, Putman K. Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation.
Objective
To describe racial differences in patient characteristics, nontherapy ancillaries, physical therapy (PT), occupational therapy (OT), and functional outcomes at discharge in stroke rehabilitation.Design
Multicenter prospective observational cohort study of poststroke rehabilitation.Setting
Six U.S. inpatient rehabilitation facilities.Participants
Black and white patients (n=732), subdivided in case-mix subgroups (CMGs): CMGs 104 to 107 for moderate strokes (n=397), and CMGs 108 to 114 for severe strokes (n= 335).Interventions
Not applicable.Main Outcome Measure
FIM.Results
Significant black-white differences in multiple patient characteristics and intensity of rehabilitation care were identified. White subjects took longer from stroke onset to rehabilitation admission and were more ambulatory prior to stroke. Black subjects had more diabetes. For patients with moderate stroke, black subjects were younger, were more likely to be women, and had more hypertension and obesity with body mass index greater than or equal to 30. For patients with severe stroke, black subjects were less sick and had higher admission FIM scores. White subjects received more minutes a day of OT, although black subjects had significantly longer median PT and OT session duration. No black-white differences in unadjusted stroke rehabilitation outcomes were found.Conclusions
Reasons for differences in rehabilitation care between black and white subjects should be investigated to understand clinicians' choice of treatments by race. However, we did not find black-white differences in unadjusted stroke rehabilitation outcomes. 相似文献11.
Elizabeth R. Skidmore Ellen M. Whyte Margo B. Holm James T. Becker Meryl A. Butters Mary Amanda Dew Michael C. Munin Eric J. Lenze 《Archives of physical medicine and rehabilitation》2010,91(2):203-207
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 (F4,32=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. 相似文献12.
Bürge E Kupper D Finckh A Ryerson S Schnider A Leemann B 《Archives of physical medicine and rehabilitation》2008,89(10):1857-1862
Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.
Objective
To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.Design
Randomized trial.Setting
Rehabilitation center.Participants
Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.Intervention
The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.Main Outcome Measures
Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.Results
At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.Conclusions
Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery. 相似文献13.
Luk JK, Chiu PK, Chu LW. Rehabilitation of older Chinese patients with different cognitive functions: how do they differ in outcome?
Objective
To examine the effect of cognition on functional and motor gain in older Chinese patients undergoing geriatric inpatient rehabilitation.Design
A retrospective cohort study.Setting
Geriatric rehabilitation units of 2 convalescence hospitals in Hong Kong.Participants
Older Chinese patients (N=778).Interventions
Comprehensive geriatric assessment and inpatient rehabilitation by a multidisciplinary team.Main Outcome Measures
Cognitive status was assessed with the Cantonese version of the Mini-Mental State Examination (C-MMSE). We measured the absolute functional gain and motor gain by using the Barthel Index and Elderly Mobility Scale (EMS) and expressed it as Barthel Index efficacy and EMS efficacy. Relative efficacy was assessed by the Montebello Rehabilitation Factor Score (MRFS). Relative efficiency was deduced by relative efficacy divided by the hospital length of stay (LOS).Results
There were significant differences in the total Barthel Index and EMS on admission and at discharge, with lower discharge scores in low C-MMSE groups. The change of Barthel Index (Barthel Index efficacy) and EMS (EMS efficacy) during rehabilitation did not differ among different C-MMSE groups. Significant differences were observed in Barthel Index MRFS efficacy and efficiency as well as EMS MRFS efficacy and efficiency in different cognitive groups; those with better cognitive function had better results. Multivariate analysis showed that LOS (odds ratio [OR]=1.02, P=.002) and diagnosis of musculoskeletal problems (OR=2.24, P=.007) were positive predictors for a Barthel Index MRFS efficacy of .25 or higher. C-MMSE was not an independent predictor for a Barthel Index MRFS efficacy of .25 or higher. LOS (OR=1.02, P=.003), admission C-MMSE (OR=1.04, P=.001), body mass index (OR=1.05, P=.006), and diagnosis of musculoskeletal disorders (OR=1.75, P=.04) were significant positive predictors for an EMS MRFS efficacy of .25 or higher, whereas urinary incontinence was a negative predictor for EMS MRFS efficacy (OR=0.69, P=.04).Conclusions
There was a strong association between admission cognition and relative change in functional and motor efficacy and efficiency. Cognitive function was not associated with absolute functional and motor gain. Cognitive function was an independent predictor for satisfactory mobility outcome but not for functional outcome. Older patients with impaired cognitive function could still benefit from rehabilitation. 相似文献14.
Douglas Conner Carol Barnes Cynthia Harrison-Felix Nora Reznickova 《Archives of physical medicine and rehabilitation》2010,91(10):1505-1510
Conner D, Barnes C, Harrison-Felix C, Reznickova N. Rehabilitation outcomes in a population of nonagenarians and younger seniors with hip fracture, heart failure, or cerebral vascular accident.
Objectives
To compare rehabilitation characteristics and patient outcomes between nonagenarians and younger seniors with hip fracture (HFx), heart failure (HF), or cerebral vascular accident (CVA).Design
Data only, retrospective cohort.Setting
Seven skilled nursing facilities providing rehabilitation services to a managed care organization.Participants
Subjects (N=2563; age, ≥65y) with HFx, HF, or CVA receiving rehabilitation services.Interventions
Not applicable.Main Outcome Measures
Patient and rehabilitation characteristics influencing FIM score at discharge and the proportion of patients discharged to the community were compared between nonagenarians and younger seniors with HFx, HF, or CVA.Results
Patients with higher admission FIM scores were discharged with better function. Different patient characteristics were important for successful rehabilitation for different conditions and outcomes. Except for HFx, nonagenarians had admission and discharge characteristics similar to those of younger seniors, although fewer were discharged to the community. Nonagenarians and younger seniors with CVA were most similar for all measures.Conclusions
Fewer nonagenarians were admitted from the community and fewer were discharged to the community, even if admitted from the community. Nonagenarians with HFx differed most strikingly from their younger counterparts in admission and discharge measures, as well as total discharge FIM score and discharge to the community. Nonagenarians and younger seniors with CVA were most similar for all measures. Our results suggest that a large proportion of the nonagenarian population can benefit from rehabilitation efforts for these 3 conditions; however, more rehabilitation resources may be required for some conditions to achieve similar outcomes. 相似文献15.
Jaros?aw Marusiak Artur Jaskólski PhD 《Archives of physical medicine and rehabilitation》2010,91(5):800-802
Marusiak J, Kisiel-Sajewicz K, Jaskólska A, Jaskólski A. Higher muscle passive stiffness in Parkinson's disease patients than in controls measured by myotonometry.
Objective
To assess muscle passive stiffness in medicated Parkinson's disease patients using myotonometry.Design
Case-control study.Setting
Kinesiology laboratory.Participants
Women with Parkinson's disease (PD) (n=8) and healthy matched elderly women (controls) (n=10) (mean age: PD, 77±3y; controls, 77±4y).Interventions
Not applicable.Main Outcome Measures
Passive stiffness of relaxed biceps brachii (BB) muscle was measured using myotonometry. Additionally, surface electromyographic and mechanomyographic signals were recorded from the muscle at rest, and amplitude of those signals was analyzed offline.Results
The values of BB muscle passive stiffness were significantly (P=.004) higher in PD than in the controls, with a statistically significant influence of parkinsonian rigidity score (Unified Parkinson's Disease Rating Scale) on intergroup differences (P<.001). The Spearman correlation coefficient ρ value showed a significant (P=.005) positive relationship (ρ=.866) between the parkinsonian rigidity score and passive stiffness values of BB in PD. The groups did not differ significantly in the electromyogram amplitude (P=.631) and mechanomyogram amplitude (P=.593) of the BB muscle, and values of these parameters did not correlate significantly with rigidity score (P=.555, P=.745, respectively) in the patients.Conclusions
Myotonometer is a sensitive enough tool to show that PD patients have higher muscle passive stiffness than healthy controls. 相似文献16.
Friedbert Kohler Helen Redmond Hugh Dickson Carol Connolly John Estell 《Archives of physical medicine and rehabilitation》2010,91(7):1031-1037
Kohler F, Redmond H, Dickson H, Connolly C, Estell J. Interrater reliability of functional status scores for patients transferred from one rehabilitation setting to another.
Objective
To report the interrater reliability of FIM total score, FIM motor subscore, and FIM cognitive subscore from scoring that occurred in routine clinical practice in 2 closely linked inpatient rehabilitation services in Sydney, Australia.Design
A natural-experiment blind clinical interrater reliability cohort study of the FIM across 2 rehabilitation units.Setting
This study is set in 2 inpatient rehabilitation units immediately adjacent to each other in southwestern Sydney, New South Wales, Australia.Participants
All patients (N=143) who were transferred between the 2 rehabilitation units between August 2006 and October 2007 were included in the study.Intervention
Discharge FIMs were scored by the first unit and an admission FIM was scored independently by the second unit within a few days. The FIM scores were analyzed for agreement and systematic bias.Main Outcome Measure
Intraclass correlation coefficients, kappa statistic, weighted kappa statistic, and Bland-Altman plots were used.Results
There were 143 sets of scores identified. The range of differences between the 2 FIM totals was −32 to 50, between the FIM motor subscores was −22 to 43, and between the FIM cognitive subscores was −14 to 21. Bland-Altman plots demonstrated poor agreement. Few FIM totals were perfectly matched. The intraclass correlation coefficients ranged from .872 for the FIM total to .830 for the cognitive subscales. Values for kappa ranged from −.007 (FIM motor subscore) to .123 (FIM cognitive subscore). Values for weighted kappa ranged from .465 (FIM cognitive subscore) to .521 (FIM total).Conclusions
There was no systematic scoring bias evident. Intraclass correlation coefficients were high, but tests of agreement demonstrated poor agreement. These findings have implications for the use of the FIM and any patient classification or funding system based on the FIM, especially if poor levels of agreement were found in the presence of all staff being FIM credentialed and standardization of methods of assessment. This study indicates that further investigation of agreement of both FIM totals and FIM item scores in the clinical setting is warranted. 相似文献17.
James S. Krause Karla S. Reed John J. McArdle 《Archives of physical medicine and rehabilitation》2010,91(8):1218-1224
Krause JS, Reed KS, McArdle JJ. Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: a longitudinal study after spinal cord injury.
Objective
To investigate the factor structure and predictive validity of somatic and nonsomatic depressive symptoms over the first 2.5 years after spinal cord injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9).Design
Somatic and nonsomatic symptoms were assessed at baseline during inpatient hospitalization (average of 50 days after onset) and during 2 follow-ups (average of 498 and 874 days after onset).Setting
Data were collected at a specialty hospital in the Southeastern United States and analyzed at a medical university. We performed time-lag regression between inpatient baseline and follow-up somatic and nonsomatic latent factors of the PHQ-9.Participants
Adults with traumatic SCI (N=584) entered the study during inpatient rehabilitation.Interventions
Not applicable.Main Outcome Measure
PHQ-9, a 9-item measure of depressive symptoms.Results
The inpatient baseline nonsomatic latent factor was significantly predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient baseline did not significantly predict either factor. In contrast, when regressing latent factors between the 2 follow-ups, the nonsomatic factor predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor structure was not stable over time. Item analysis verified the instability of somatic items between inpatient baseline and follow-up and also indicated that self-harm at inpatient baseline was highly predictive of future self-harm.Conclusions
Nonsomatic symptoms are better predictors of future depressive symptoms when first assessed during inpatient rehabilitation, whereas somatic symptoms become stable predictors only after inpatient rehabilitation. Self-harm (suicidal ideation) is the most stable symptom over time. Clinicians should routinely assess for suicidal ideation and use nonsomatic symptoms when performing assessments during inpatient rehabilitation. 相似文献18.
Christine Glenny Paul Stolee Janice Husted Mary Thompson Katherine Berg 《Archives of physical medicine and rehabilitation》2010,91(7):1038-1043
Glenny C, Stolee P, Husted J, Thompson M, Berg K. Comparison of the responsiveness of the FIM and the interRAI Post Acute Care Assessment Instrument in rehabilitation of older adults.
Objective
To compare the responsiveness of 2 major systems developed for rehabilitation settings—the FIM and the interRAI Post Acute Care (PAC) assessment—in older patients.Design
Trained raters assessed patients with both tools at admission and discharge.Setting
Musculoskeletal (MSK) and geriatric rehabilitation units (GRUs) in 2 rehabilitation hospitals.Participants
Older adults receiving rehabilitation (N=208; mean age ± SD, 78.5±9.3; 67% women).Interventions
Not applicable.Main Outcome Measures
Responsiveness was evaluated using effect size (ES) and standardized response mean (SRM).Results
ES and SRM were somewhat higher for the FIM motor (GRU ES=1.68, SRM=1.31; MSK ES=2.12, SRM=2.25) than the PAC (GRU ES=1.64, SRM=1.29; MSK ES=1.57, SRM=1.89) in both patient groups. Both tools were more responsive in MSKs than GRUs. This may reflect the greater frailty and clinical complexity of GRU patients.Conclusions
Both the FIM motor and the PAC were able to detect clinically relevant improvement in functional ability in older rehabilitation inpatients. 相似文献19.
David T. Burke MD MA Samir Al-Adawi Regina B. Bell Kirk Easley Shou Chen Daniel P. Burke 《Archives of physical medicine and rehabilitation》2014
Objective
To investigate the association between body mass index (BMI) and the functional progress of patients with stroke, admitted to a rehabilitation hospital.Design
A retrospective cohort study.Setting
A freestanding university rehabilitation hospital stroke unit.Participants
All patients (N=819) admitted to the stroke unit of a rehabilitation hospital during the study.Interventions
Not applicable.Main Outcome Measures
The primary study outcome measure was the FIM efficiency of patients by BMI category.Results
For the 819 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency differed by BMI. The underweight group had the lowest FIM efficiency, followed by the obese and normal-weight subgroups. The overweight group had the highest FIM efficiency (P=.05) when compared with the obese subgroup.Conclusions
Among patients admitted to an acute rehabilitation hospital for stroke rehabilitation, overweight patients had better functional progress than did patients in the other weight categories. 相似文献20.
Fan Gao Thomas H. Grant Elliot J. Roth Li-Qun Zhang 《Archives of physical medicine and rehabilitation》2009,90(5):819-2500
Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.