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1.
Randall E. Keyser Violeta Rus Jamal A. Mikdashi Barry S. Handwerger 《Archives of physical medicine and rehabilitation》2010,91(9):1402-1409
Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus.
Objective
To determine whether oxygen consumption (V˙o2) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls.Design
Exploratory case-control study.Setting
Medical school exercise physiology laboratory.Participants
Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10).Intervention
None.Main Outcome Measures
V˙o2 on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs).Results
Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE.Conclusion
V˙o2 on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE. 相似文献2.
Henri L. Hurkmans Rita J. van den Berg-Emons PhD Henk J. Stam MD PhD 《Archives of physical medicine and rehabilitation》2010,91(10):1577-1581
Hurkmans HL, van den Berg-Emons RJ, Stam HJ. Energy expenditure in adults with cerebral palsy playing Wii Sports.
Objective
To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing.Design
Cross-sectional study.Setting
University medical center.Participants
Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers.Intervention
Participants played Wii Sports tennis and boxing, each for 15 minutes in random order.Main Outcome Measure
By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (V?o2) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as V?o2 during Wii Sports play divided by V?o2 during sitting.Results
Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing.Conclusions
Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels. 相似文献3.
Audrey L. Nelson Shirley Groer Polly Palacios Douglas Mitchell Sunil Sabharwal R. Lee Kirby Deborah Gavin-Dreschnack Gail Powell-Cope 《Archives of physical medicine and rehabilitation》2010,91(8):1166-1173
Nelson AL, Groer S, Palacios P, Mitchell D, Sabharwal S, Kirby RL, Gavin-Dreschnack D, Powell-Cope G. Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.
Objectives
(1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment.Design
This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records.Setting
Three Veterans' Administration hospitals.Participants
Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702).Interventions
Not applicable.Main Outcome Measures
Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment.Results
Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls.Conclusions
This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment. 相似文献4.
Cochrane DJ Sartor F Winwood K Stannard SR Narici MV Rittweger J 《Archives of physical medicine and rehabilitation》2008,89(5):815-821
Cochrane DJ, Sartor F, Winwood K, Stannard SR, Narici MV, Rittweger J. A comparison of the physiologic effects of acute whole-body vibration exercise in young and older people.
Objective
To examine the acute physiologic effects of acute whole-body vibration (WBV) exercise in young and older people.Design
Every participant performed 9 conditions in a static squat position, consisting of no vibration and WBV at 30Hz and 3 loads corresponding to (1) no load (0% body mass), (2) load of 20% body mass, and (3) load of 40% body mass. A Jendrassik voluntary contraction was also performed with no vibration and WBV at 30Hz with no load and 20% body mass.Setting
Laboratory facilities at a university in the United Kingdom.Participants
Healthy young people (n=12; 6 men, 6 women; mean age, 21.5y) and 12 healthy older people (6 men, 6 women; mean age, 69.2y) from the local community.Interventions
Not applicable.Main Outcome Measures
The Physical Activity Questionnaire, anthropometric measures, counter-movement jump, and isometric maximal voluntary contraction with the Jendrassik maneuver were assessed in both groups. Oxygen uptake (V?o2), blood pressure, heart rate, and rating of perceived exertion (RPE) were recorded during WBV and load conditions as the outcome of the study.Results
Both vibration and load were associated with an increase (P<.001) in V?o2 for older and young groups. WBV elicited the equivalent of a .35 metabolic equivalent (MET) increase in V?o2, with additional loads of 20% and 40% body mass increasing V?o2 by 0.8 and 1.2 METs, respectively. Additionally, there was an interaction effect of vibration and group in which the WBV-related V?o2 increase was less in the old compared with the young. Both vibration and load caused an increase in heart rate, blood pressure, and RPE (all P<.001); however, there were no significant group differences between young and older groups. The Jendrassik maneuver elicited an increase in V?o2 by 27.6% for the old and 33% for the young group (P<.001); however, there was no significant difference between groups.Conclusions
V?o2 significantly increased in both the older and young people with vibration and additional load and when the Jendrassik maneuver was superimposed with vibration and load. However, the elicited increase in V?o2 (1.2mL·kg−1·min−1) from WBV may be an insufficient stimulus to improve cardiovascular fitness. 相似文献5.
Kathleen A. Martin Ginis Amy E. Latimer Kelly P. Arbour-Nicitopoulos Andrea C. Buchholz Steven R. Bray B. Catharine Craven Keith C. Hayes Audrey L. Hicks Mary Ann McColl Patrick J. Potter Karen Smith Dalton L. Wolfe 《Archives of physical medicine and rehabilitation》2010,91(5):722-728
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. 相似文献6.
Rob J. Smeets Kees D. van Geel Jeanine A. Verbunt 《Archives of physical medicine and rehabilitation》2009,90(1):109-117
Smeets RJ, van Geel KD, Verbunt JA. Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain?
Objectives
To compare aerobic fitness of patients with chronic low back pain (CLBP) against healthy controls and to assess whether variables of the fear avoidance model are associated with loss of aerobic fitness.Design
A case-comparison study.Setting
Rehabilitation centers.Participants
Patients with CLBP (n=223), and normative data from healthy subjects (n=18,082).Interventions
Not applicable.Main Outcome Measures
Maximal oxygen uptake (V?o2max) was estimated on the basis of a modified submaximal Åstrand bicycle test performed by patients with CLBP (observed level of aerobic fitness) and compared with the normative data of healthy controls matched for age, sex, and level of sport activity (expected level of aerobic fitness). Pain (visual analog scale); disability (Roland Disability Questionnaire); pain-related fear (Tampa Scale for Kinesiophobia); depression (Beck Depression Inventory); catastrophizing (Pain Catastrophizing Scale); and the level of activity during sport, work/household, and leisure time (Baecke Physical Activity Questionnaire) were assessed. Multiple linear regression analysis was performed with the difference of the observed and expected level of aerobic fitness as dependent variable and putative influential factors including those of the fear avoidance model as independent variables.Results
V?o2max could be calculated in 175 (78%) of the patients. Both men and women with CLBP had significant lower V?o2max than expected (10.3mL/kg lean body mass (LBM)×min−1 and 6.5mL/kg LBM×min−1, respectively; P<.001). The levels of activity during leisure time and work/household were significantly associated with this reduced level of aerobic fitness. However, the variables of the fear avoidance model were not.Conclusions
Most patients with CLBP-associated disability have a lower level of aerobic fitness, but this is not associated with fear avoidance. 相似文献7.
8.
Harran Q. Al-Rahamneh James A. Faulkner Christopher Byrne Roger G. Eston 《Archives of physical medicine and rehabilitation》2010,91(2):273-277
Al-Rahamneh HQ, Faulkner JA, Byrne C, Eston RG. Relationship between perceived exertion and physiologic markers during arm exercise with able-bodied participants and participants with poliomyelitis.
Objective
To investigate the strength of the relationship between ratings of perceived exertion (RPE) and oxygen uptake (V?o2), heart rate, ventilation (V?e) and power output (PO) during an arm-crank ramped exercise test to volitional exhaustion in men and women who differed in physical status.Design
Each participant completed an arm-crank ramp exercise test to volitional exhaustion. PO was increased by 15W·min−1 and 6W·min−1 for men and women able-bodied participants, respectively; for the poliomyelitis participants, 9W·min−1 and 6W·min−1 increments were used for men and women, respectively.Setting
Laboratory facilities at a university.Participants
Able-bodied participants (n=16; 9 men, 7 women) and participants with poliomyelitis (n=15, 8 men, 7 women) volunteered for the study.Main Outcome Measures
Strength of the relationship (R2 values) between RPE and V?o2, heart rate, V?e and PO.Results
There were significantly higher values for maximum V?o2 and maximum PO for able-bodied men compared with their counterparts with poliomyelitis (P<.05). However, when the data were controlled for age, there were no significant differences in these values (P>.05). Similar results were observed for the women who were able-bodied as well as for the women who had poliomyelitis (P>.05). The relationships between heart rate and RPE and V?e and RPE for able-bodied patients and patients with poliomyelitis were similar (R2>.87). The relationship between V?o2 and RPE was stronger in the able-bodied participants compared wih the participants with poliomyelitis, regardless of sex (P<.05). However, when the data were controlled for age, there was no significant difference in the strength of this relationship between able-bodied participants and those with poliomyelitis, regardless of sex (P>.05).Conclusions
RPE is strongly related to physiologic markers of exercise intensity during arm exercise, irrespective of sex or participant's poliomyelitis status. 相似文献9.
Davies AL Hayes KC Dekaban GA 《Archives of physical medicine and rehabilitation》2007,88(11):1384-1393
Davies AL, Hayes KC, Dekaban GA. Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury.
Objective
To determine the serum cytokine profiles of patients with spinal cord injury (SCI) and varying clinical presentations relative to healthy, able-bodied, age-matched control subjects.Design
Cross-sectional study.Setting
Clinical research unit.Participants
People with SCI (N=56) and different clinical presentations, and healthy, able-bodied, age-matched control subjects (N=35).Interventions
Not applicable.Main Outcome Measures
Serum levels of the proinflammatory cytokines interleukin (IL) 1β, IL-6, tumor necrosis factor alpha (TNF-α), the anti-inflammatory cytokines IL-4 and IL-10, the regulatory cytokine IL-2, the IL-1 receptor antagonist (IL-1RA), and autoantibodies against myelin-associated glycoprotein and GM1 ganglioside (anti-GM1) immunoglobulin (IgG and IgM), as determined by enzyme-linked immunosorbent assay. The relationship between elevated serum cytokine levels and clinical variables was also studied.Results
SCI subjects exhibited serum concentrations of IL-6, TNF-α, IL-1RA, and anti-GM1 (IgG) that were greater (P<.05) than control group values. Elevated cytokine concentrations were not associated with high white blood cell counts, level of injury, or American Spinal Injury Association classification; they were evident in SCI subjects who were asymptomatic for medical complications, but were further elevated in subjects with pain, urinary tract infection (UTI), and pressure ulcers.Conclusions
Elevated levels of circulating proinflammatory cytokines and autoantibodies are present in the serum of SCI subjects without medical complications, and are further elevated in SCI subjects with neuropathic pain, UTI, or pressure ulcers, relative to healthy, able-bodied control subjects. These findings may be indicative of a protective autoimmunity, simply a consequence of occult or evident infection, or evidence of cytokine dysregulation that may contribute to an immune-mediated impairment of axonal conduction. 相似文献10.
Frances M. Weaver Stephen P. Burns Charlesnika T. Evans Lauren M. Rapacki Barry Goldstein Margaret C. Hammond 《Archives of physical medicine and rehabilitation》2009,90(3):517-521
Weaver FM, Burns SP, Evans CT, Rapacki LM, Goldstein B, Hammond MC. Provider perspectives on soldiers with new spinal cord injuries returning from Iraq and Afghanistan.
Objective
The military conflicts in Iraq and Afghanistan have resulted in many soldiers returning with serious combat injuries, including spinal cord injuries (SCIs). The purpose of this study was to query providers regarding any unique problems or needs in a cohort of these soldiers treated in Veterans Health Administration (VHA) SCI Centers.Design
Semistructured questionnaire.Setting
Seventeen VHA SCI Centers.Participants
Thirty-eight providers, including physicians, nurses, therapists, social workers, and psychologists who volunteered to return completed questionnaires.Interventions
Not applicable.Main Outcome Measures
Identification of medical and psychosocial issues, rehabilitation delays, therapy and vocational needs, social support, and discharge planning.Results
Providers identified several injuries and conditions beyond SCI that were experienced by these soldiers including fractures, pressure ulcers, traumatic brain injuries, posttraumatic stress disorder, and resistant infections. Rehabilitation was often delayed because these problems needed to be addressed first. Soldiers' family and friends provide considerable support. Vocational needs include use of technology, especially computers; education; and participation in sports. Although most return to the community after discharge, many soldiers are still active duty, and some return to military base housing.Conclusions
Combat soldiers returning with SCI often have additional medical and psychosocial problems that require appropriate and timely intervention. They have strong support from family and friends and are motivated to integrate back into the community after discharge. 相似文献11.
Kathleen A. Martin Ginis Kelly P. Arbour-Nicitopoulos Amy E. Latimer Andrea C. Buchholz Steven R. Bray B. Catharine Craven Keith C. Hayes Audrey L. Hicks Mary Ann McColl Patrick J. Potter Karen Smith Dalton L. Wolfe 《Archives of physical medicine and rehabilitation》2010,91(5):729-733
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. 相似文献12.
Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.
Objective
To compare the effect of 2 interventions on ankle mobility, ankle kinematics, and weight-bearing symmetry during functional activities in subjects with hemiparesis after a stroke.Design
Randomized trial.Setting
Academic medical center.Participants
A convenience sample of 16 subjects with hemiparesis after stroke (mean age, 55.2y; mean time since stroke, 21.4mo).Intervention
Subjects received 8 sessions over 4 weeks of either functional task practice combined with ankle joint mobilizations, or functional task practice only.Main Outcome Measures
Changes in ankle range of motion (ROM) (not blinded), ankle kinematics during sit-to-stand (STS) and gait, and lower-extremity weight-bearing symmetry during STS and static standing.Results
The combined intervention group gained 5.7°±3.1° in passive ankle ROM compared with 0.2°±2.6° in the functional practice only group (95% confidence interval [CI], 2.5-8.6; P<.01). No significant changes in ankle kinematics or weight bearing during static standing were noted in either group. The functional practice group decreased differences in weight bearing during STS by 9.5%±6.47%, whereas the combined intervention group increased this difference by 3.37%±5.29% (95% CI, 3.26-19.46; P=.01).Conclusions
The increase in ankle motion did not improve joint kinematics and may have prevented improvement in weight-bearing symmetry. 相似文献13.
van Gaal BG Schoonhoven L Mintjes JA Borm GF Koopmans RT van Achterberg T 《International journal of nursing studies》2011,48(9):1049-1057
Background
Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously.Objective
The SAFE or SORRY? programme targeted three adverse events (pressure ulcers, urinary tract infections and falls) and was successful in reducing the incidence of these events. This article explores the process of change and describes the effect on the preventive care given.Design
Separate data on preventive care were collected along the cluster randomised trial, which was conducted between September 2006 and November 2008.Settings
Ten hospital wards and ten nursing home wards.Participants
We monitored nursing care given to adult patients with an expected length of stay of at least five days.Methods
The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for pressure ulcers, urinary tract infections and falls. A multifaceted implementation strategy was used to implement this multiple guidelines programme. Data on preventive care given to patients were collected in line with these guidelines and the difference between the intervention and the usual care group at follow-up was analysed.Results
The study showed no overall difference in preventive pressure ulcer measures between the intervention and the usual care group in hospitals (estimate = 6%, CI: −7-19) and nursing homes (estimate = 4%, CI: −5-13). For urinary tract infections, even statistically significantly fewer hospital patients at risk received preventive care (estimate = 19%, CI: 17-21). For falls in hospitals and nursing homes, no more patients at risk received preventive care.Conclusion
Though the SAFE OR SORRY? programme effectively reduced the number of adverse events, an increase in preventive care given to patients at risk was not demonstrated. These results seem to emphasise the difficulties in measuring the compliance to guidelines. More research is needed to explore the possibilities for measuring the implementation of multiple guidelines using process indicators. 相似文献14.
Christine L.H. Snozek Ranjan C. Mascarenhas Dennis J. O'Kane 《Clinical biochemistry》2009,42(15):1585-1588
Objectives
The study goals were development of reference intervals and an interpretive algorithm for pancreatic cyst fluid tumor markers.Design and methods
442 pancreatic cyst fluids were tested for CEA, CA19-9, and amylase.Results
CEA > 30 ng/mL discriminates mucinous from non-mucinous cysts. After CEA analysis, amylase and CA19-9 segregate non-mucinous and mucinous subtypes, respectively.Conclusions
Pancreatic cyst fluid tumor markers supplement other diagnostic measures. This study provides estimated reference intervals and an algorithm for interpretation. 相似文献15.
Liang HW Wang YH Pan SL Wang TG Huang TS 《Archives of physical medicine and rehabilitation》2007,88(9):1193-1197
Liang H-W, Wang Y-H, Pan S-L, Wang TG, Huang T-S. Asymptomatic median mononeuropathy among men with chronic paraplegia.
Objectives
To compare electrophysiologic abnormalities of the median nerve in asymptomatic paraplegic subjects and able-bodied controls and to examine the influence of personal factors on these parameters.Design
Cross-sectional survey.Setting
University hospital.Participants
Forty-seven men with paraplegia and 36 able-bodied controls underwent nerve conduction studies on both upper limbs. All were free of hand numbness in the past month, diabetic mellitus, or neuromusculoskeletal injuries to the upper limbs.Interventions
Not applicable.Main Outcome Measure
Nerve conduction studies of the bilateral median and ulnar nerves.Results
Although the 2 groups were of comparable age and had a similar body mass index (BMI), the subjects with paraplegia had a significantly higher proportion of asymptomatic median mononeuropathy than the controls (25.5% vs 5.6%, P=.02). The spinal cord injury (SCI) group had a prolonged median distal latency and a slowed digit-wrist sensory nerve conduction velocity. Multivariate general linear model analysis showed that prolonged motor and sensory latencies of the median nerve were associated with the SCI group and with greater BMI.Conclusions
The asymptomatic subjects with paraplegia had a significantly higher frequency of median mononeuropathy than the able-bodied controls. There was also an association between BMI and distal latency of the median nerve. 相似文献16.
Macciocchi S Seel RT Thompson N Byams R Bowman B 《Archives of physical medicine and rehabilitation》2008,89(7):1350-1357
Macciocchi S, Seel RT, Thompson N, Byams R, Bowman B. Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.
Objectives
To examine prospectively the incidence and severity of co-occurring traumatic brain injury (TBI) in persons with traumatic spinal cord injury (SCI) and to describe a TBI assessment process for SCI rehabilitation professionals.Design
A prospective, cohort design to collect and analyze clinical variables relevant for diagnosing co-occurring TBI.Setting
An urban, single-center National Institute of Disability and Rehabilitation Research Model Spinal Cord Injury System in the Southeastern United States.Participants
People (N=198) who met inclusion criteria and provided consent within an 18-month recruitment window.Interventions
Not applicable.Main Outcome Measure
FIM cognitive scale.Results
Based on participants' presence and duration of posttraumatic amnesia, initial Glasgow Coma Scale total score, and presence of cerebral lesion documented by neuroimaging, 60% of our traumatic SCI sample also sustained a TBI (n=118). Most co-occurring TBIs were mild (34%). Co-occurring mild complicated (10%), moderate (6%), and severe TBI (10%) were less common but still occurred in a significant percentage (26%) of persons with traumatic SCI. Persons with traumatic SCI who were injured in motor vehicle collisions and falls were more likely to sustain a co-occurring TBI. Cervical level traumatic SCI was associated with greater rates of TBI but not more severe injuries. Tree analyses established a practical algorithm for classifying TBI severity associated with traumatic SCI. Analysis of variance established criterion validity for the algorithm's TBI severity classifications.Conclusions
Findings from our prospective study provide strong support that TBI is a common co-occurring injury with traumatic SCI. Incomplete acute care medical record documentation of TBI in the traumatic SCI population remains a considerable issue, and there is a significant need to educate emergency department and acute care personnel on the TBI clinical data needs of acute rehabilitation providers. A systematic algorithm for reviewing acute care medical records can yield valid estimates of TBI severity in the traumatic SCI population. 相似文献17.
Background
Chronic knee pain is a major cause of disability in the elderly. Management guidelines recommend exercise and self-management interventions as effective treatments. The authors previously described a rehabilitation programme integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function, but sustaining these improvements is difficult. Moreover, the programme is untried in clinical environments, where it would ultimately be delivered.Objectives
To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy.Design
Pragmatic, randomised controlled trial.Setting
Outpatient physiotherapy department and community centre.Participants
Sixty-four people with chronic knee pain.Interventions
Outpatient physiotherapy compared with ESCAPE-knee pain.Outcomes
The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences.Results
Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost £130 per person and the healthcare utilisation costs of participants over 1 year were £583. The ESCAPE-knee pain programme cost £64 per person and the healthcare utilisation costs of participants over 1 year were £320.Conclusions
ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective.Clinical Trial Registration No.: ISRCTN63848242. 相似文献18.
19.
Tyson SF, Rogerson L. Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion.
Objective
To assess the immediate effects of assistive walking devices on functional mobility, walking impairments, and patients' opinions in nonambulant patients after stroke.Design
Randomized crossover trial.Setting
Inpatient rehabilitation units of 3 United Kingdom hospitals.Participants
Twenty nonambulant patients with stroke undergoing rehabilitation to restore walking.Interventions
Five walking conditions: (1) Walking with no device (the control condition), (2) walking with a walking cane, (3) ankle foot orthosis, (4) slider shoe, and (5) a combination of all 3 devices.Main Outcome Measures
Functional mobility (functional ambulation categories), walking impairments (speed, step length of the weak leg), and patients' opinions.Results
Functional mobility improved with all assistive devices (P<.0001-.005; effect sizes 1.68-0.52; number needed to treat=2-5). Walking impairments were unchanged (P<.800-.988). Participants were generally positive about the devices. They felt their walking, confidence, and safety improved and found the appearance and comfort of the devices acceptable. They would rather walk with the devices than delay walking until a normative gait pattern was achieved without them.Conclusions
Assistive walking devices improved functional mobility in nonambulant rehabilitation patients with stroke. No changes in walking impairments were found. Participants were generally positive about using the devices. The results support the use of assistive walking devices to enable early mobilization after stroke; 2 patients would need to be treated with a cane or combined devices for 1 to improve functional mobility. 相似文献20.
Leslie R. Morse Antonio A. Lazzari Ricardo Battaglino Kelly L. Stolzmann Kirby R. Matthess David R. Gagnon Samuel A. Davis 《Archives of physical medicine and rehabilitation》2009,90(5):827-1657
Morse LR, Lazzari AA, Battaglino R, Stolzmann KL, Matthess KR, Gagnon DR, Davis SA, Garshick E. Dual energy x-ray absorptiometry of the distal femur may be more reliable than the proximal tibia in spinal cord injury.