共查询到20条相似文献,搜索用时 31 毫秒
1.
Prvu Bettger JA, Stineman MG. Effectiveness of multidisciplinary rehabilitation services in postacute care: state-of-the-science. A review.
Objectives
To summarize the efficacy of postacute rehabilitation and to outline future research strategies for increasing knowledge of its effectiveness.Data Sources
English-language systematic reviews that examined multidisciplinary therapy-based rehabilitation services for adults, published in the last 25 years and available through Cochrane, Medline, or CINAHL databases. We excluded multidisciplinary biopsychosocial rehabilitation programs and mental health services.Study Selection
Using the search term rehabilitation, 167 records were identified in the Cochrane database, 1163 meta-analyses and reviews were identified in Medline, and 226 in CINAHL. The Medline and CINAHL search was further refined with 3 additional search terms: therapy, multidisciplinary, and interdisciplinary. In summary, we used 12 reviews to summarize the efficacy of multidisciplinary, therapy-based postacute rehabilitation; the 12 covered only 5 populations.Data Extraction
Two reviewers extracted information about study populations, sample sizes, study designs, the settings and timing of rehabilitation, interventions, and findings.Data Synthesis
Based on systematic reviews, the evidence for efficacy of postacute rehabilitation services across the continuum was strongest for stroke. There was also strong evidence supporting multidisciplinary inpatient rehabilitation for patients with rheumatoid arthritis, moderate to severe acquired brain injury, including traumatic etiologies, and for older adults. Heterogeneity limited our ability to conclude a benefit or a lack of a benefit for rehabilitation in other postacute settings for the other conditions in which systematic reviews had been completed. The efficacy of multidisciplinary rehabilitation services has not been systematically reviewed for many of the diagnostic conditions treated in rehabilitation. We did not complete a summary of findings from individual studies.Conclusions
Given the limitations and paucity of systematic reviews, information from carefully designed nonrandomized studies could be used to complement randomized controlled trials in the study of the effectiveness of postacute rehabilitation. Consequently, a stronger evidence base would become available with which to inform policy decisions, guide the use of services, and improve patient access and outcomes. 相似文献2.
Krahn G McCarthy M Westwood D Powers L 《Archives of physical medicine and rehabilitation》2008,89(7):1341-1349
Krahn G, McCarthy M, Westwood D, Powers L. Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers.
Objective
To evaluate the effectiveness, strengths, and limitations of an innovative research method to recruit persons with spinal cord injury (SCI).Design
A pilot study for feasibility.Setting
Community-based durable medical equipment suppliers (DMESs) in the states of Oregon, Washington, and New York.Participants
Three DMESs participated and successfully distributed surveys to 591 customers with International Classification of Disease, 9th Revision, codes reflecting SCI. Of these, 316 people completed surveys, with 270 identifying SCI among their disabling conditions.Interventions
Not applicable.Main Outcome Measures
The effort required to solicit recruitment assistance from DMESs, survey response rate, verification of SCI by self-report, and comparability of sample demographics to those of other SCI research samples from both the United States and other countries.Results
A moderate level of effort was required to solicit recruitment assistance from DMESs. The survey had a 53% response rate, and 85% of respondents verified that they had an SCI by self-report. Sample demographics were generally similar to those of comparable research samples but with more single and unemployed persons responding and with longer duration of SCI.Conclusions
This method of recruitment has the potential to address limitations of other recruitment methods but presents its own challenges with implementation. Potential sampling bias is discussed. 相似文献3.
Gagnon C Mathieu J Jean S Laberge L Perron M Veillette S Richer L Noreau L 《Archives of physical medicine and rehabilitation》2008,89(7):1246-1255
Gagnon C, Mathieu J, Jean S, Laberge L, Perron M, Veillette S, Richer L, Noreau L. Predictors of disrupted social participation in myotonic dystrophy type 1.
Objective
To identify personal and environmental predictors of the most disrupted participation domains in people with myotonic dystrophy type 1 (DM1).Design
Cross-sectional study.Setting
Outpatient neuromuscular clinic.Participants
Adults (n=200; 121 women), age 18 years or older (mean age, 47y), with a confirmed diagnosis of DM1 were selected from the registry of a neuromuscular clinic (N=416). Fifty-two participants had the mild phenotype and 148 the adult phenotype.Interventions
Not applicable.Main Outcome Measures
Social participation in mobility, housing, employment, and recreation was assessed with the Life Habits Measure. Disrupted participation was based on whether help was needed in performing most life habits because of incapacities or environmental barriers. Environmental factors were assessed by using the Measure of the Quality of the Environment. Personal factors were assessed with standardized instruments including the Berg Balance Scale, the Krupp Fatigue Severity Scale, and manual muscle testing.Results
A large proportion of participants (45%-61%) reported disrupted participation in all 4 domains. Lower-extremity strength (odd ratios [OR], 15.0-5.5; P<.050) and higher fatigue (OR, 6.0-2.6; P<.05) were present in participants with disrupted participation. With regard to environmental factors, family support (OR, 3.6-2.5; P<.05) and public services (OR, 2.8-2.2; P<.05) were perceived as barriers for participants with disrupted participation in most domains.Conclusions
This study identified personal and environmental factors that may influence the trajectory toward disrupted participation in individuals with DM1. Fatigue, strength, family support, and public services were found to be independent predictors of disrupted participation. 相似文献4.
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5.
James S. Krause Rickey Carter Yusheng Zhai Karla Reed 《Archives of physical medicine and rehabilitation》2009,90(4):628-633
Krause JS, Carter R, Zhai Y, Reed K. Psychologic factors and risk of mortality after spinal cord injury.
Objective
To identify the association of 2 distinct psychologic constructs, personality and purpose in life (PIL), with risk of early mortality among persons with spinal cord injury (SCI).Design
Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005.Setting
A large rehabilitation hospital in the southeastern United States.Participants
Adults (N=1386) with traumatic SCI, at least 1 year postinjury.Interventions
Not applicable.Main Outcome Measures
We first evaluated the significance of a single psychologic predictor (a total of 6 scales) while controlling for biographic and injury predictors using Cox proportional hazards modeling and subsequently built a comprehensive model based on an optimal group of psychologic variables.Results
There were a total of 224 (16.2%) observed deaths in the full sample. The total number of deaths was reduced to 164 in the final statistical model (of 1128 participants) because of missing data. All 6 psychologic factors were statistically significant in the model that was adjusted for biographic and injury factors, whereas only 3 psychologic factors were retained in the final comprehensive model, including 2 personality scales (Impulsive Sensation Seeking, Neuroticism-Anxiety) and the PIL scale. The final comprehensive model only modestly improved the overall prediction of survival compared with the model with only biographic and injury variables, because the pseudo-R2 increased from 0.121 to 0.129, and the concordance increased from 0.730 to 0.747.Conclusions
The results affirm the importance of psychologic factors in relation to survival after SCI. 相似文献6.
Segal NA, Hein J, Basford JR. The effects of Pilates training on flexibility and body composition: an observational study. Arch Phys Med Rehabil 2004;85:1977-81.
Objective
To assess claims regarding the effects of Pilates training on flexibility, body composition, and health status.Design
An observational prospective study.Setting
A community athletic club.Participants
A sample of 47 adults (45 women, 2 men) who presented for Pilates training.Interventions
Not applicable.Main outcome measures
Fingertip-to-floor distance, truncal lean body mass by bioelectric impedance, health status by questionnaire and visual analog scale were assessed at baseline, 2, 4, and 6 months (±1wk).Results
Thirty-two of 47 enrolled subjects met the protocol requirements of missing no more than 1 weekly 1-hour session Pilates mat class during each 2-month period. Investigators were blinded to measurements from previous time points. Median (interquartile range [IQR]) fingertip-to-floor distance improved from baseline by 3.4cm (1.3-5.7cm), 3.3cm (0.3- 7.8cm), and 4.3cm (1.5-7.6cm) at 2, 4, and 6 months, respectively (paired nonparametric analysis, all P<.01). There were no statistically significant changes in truncal lean body mass, height, weight, or other body composition parameters. Self-assessment of health also did not change in a statistically significant manner from its baseline median (IQR) value of 77mm (69-85mm).Conclusions
Pilates training may result in improved flexibility. However, its effects on body composition, health status, and posture are more limited and may be difficult to establish. Further study might involve larger sample sizes, comparison with an appropriate control group, and assessment of motor unit recruitment as well as strength of truncal stabilizers. 相似文献7.
Robert T. Gerhardt Erik Hermstad Donald M. Crawford John Rayfield James Pfaff Curtis J. Hunter 《The American journal of emergency medicine》2011,29(1):86-90
Objective
The objective of the study was to determine whether the addition of postdischarge oral secobarbital to standard emergency department (ED) migraine headache therapy improves pain relief and headache resolution compared with placebo.Setting
The setting is an urban ED with 70 000 yearly visits.Methods
This is an Institutional Review Board-approved, randomized, nonconsecutive, double-blinded, concealed, and placebo-controlled clinical trial. Patients with a clinical diagnosis of migraine underwent standard ED treatment and were discharged with 2 tablets of either secobarbital 100 mg or placebo. At home arrival, subjects recorded headache pain on a visual analog scale (VAS), took 1 tablet, and went to bed, taking the second tablet after 1 hour if not asleep. Upon awakening, subjects completed a second VAS and survey.Statistical analysis
The VAS data were analyzed using 2-tailed t test with unequal variance. Headache resolution data were analyzed using Fisher exact test.Results
Fifty subjects were enrolled. Complete data and follow-up were available for 30 subjects (60%). Fourteen subjects received placebo; 16 received secobarbital. Secobarbital subjects reported an average headache pain decrease of 25 mm (−13 to −38) compared with an average increase of 3 mm (−13 to 19) in the placebo group (P = .01). Ninety-four percent of the secobarbital group vs 50% of the placebo group had complete or partial headache resolution (P < .02). All subjects in the secobarbital group reported some relief.Conclusions
Addition of postdischarge oral secobarbital to a standard ED migraine treatment regimen decreased headache pain at 24 hours after discharge and improved the rate of headache resolution compared with placebo. 相似文献8.
Thomas M. Gill Evelyne A. Gahbauer MD MPH Peter H. Van Ness PhD MPH 《Archives of physical medicine and rehabilitation》2009,90(6):987-993
Gill TM, Gahbauer EA, Van Ness PH. Psychometric properties of a scale to assess the severity of bathing disability.
Objective
To develop and evaluate the psychometric properties of a new bathing disability scale.Design
Reliability and validity study.Setting
General community.Participants
Two subsets of community-living older persons, selected from an ongoing longitudinal study, who had some degree of bathing disability or were at increased risk for bathing disability, as determined during a comprehensive assessment at 36 (N=199) and 54 (N=213) months, respectively.Interventions
Not applicable.Main Outcome Measures
The bathing disability scale was administered at 36, 54, and 72 months, and changes in scores were assessed between 36 and 54 months and 54 and 72 months, respectively, for the 2 subsets of participants. Convergent construct validity was evaluated by comparisons with changes in activity of daily living (ADL) disability, mobility disability, and the Short Physical Performance Battery (SPPB). Discriminative construct validity was determined by comparisons according to age and physical frailty. Responsiveness was evaluated by comparisons between participants who had and had not been hospitalized and, subsequently, by plotting correlations according to the timing of these hospitalizations.Results
The test-retest reliability was high, with an intraclass correlation coefficient=0.76 (95% confidence interval=0.59−0.94). The internal consistency reliability was excellent with Cronbach α=0.91−0.97. Changes in scores on the bathing disability scale were positively correlated with changes in scores in ADL and mobility disability and inversely correlated with changes in scores on the SPPB. A greater decline in scores was observed among the oldest old and those who were physically frail, but these differences did not consistently achieve statistical significance. The scale was responsive to the occurrence and/or timing of intervening hospitalizations.Conclusions
The bathing disability scale is reliable, valid, and responsive and may be suitable for use in clinical trials to evaluate the effectiveness of interventions to enhance independent bathing. 相似文献9.
Brogårdh C, Lexell J. A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke.
Objective
To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke.Design
A 1-year follow-up after shortened CIMT (3h training/d for 2wk) where the participants had been randomized to a mitt group or a nonmitt group.Setting
A university hospital rehabilitation department.Participants
Poststroke patients (N=20, 15 men, 5 women; mean age 58.8y; on average 14.8mo poststroke) with mild to moderate impairments of hand function.Interventions
Not applicable.Main Outcome Measures
The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers.Results
One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time.Conclusions
Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed. 相似文献10.
Ogawa H Oshita H Ishimaru D Yamada K Shimizu T Koyama Y Akaike A Hori H 《Archives of physical medicine and rehabilitation》2008,89(2):329-332
Ogawa H, Oshita H, Ishimaru D, Yamada K, Shimizu T, Koyama Y, Akaike A, Hori H. Analysis of muscle atrophy after hip fracture in the elderly.
Objectives
To examine the relationship between muscle atrophy, ambulatory ability, and fracture type, and to make a specific rehabilitation regimen for each fracture type.Design
Observational study.Setting
Public hospital.Participants
Consecutive patients (N=53) with hip fracture (mean age, 83.6y) who underwent operative treatment.Interventions
Not applicable.Main Outcome Measures
The ambulatory ability score and the cross-sectional areas of lower-limb muscles as measured on computed tomography scans.Results
Muscle atrophy was not related to fracture type. Although the mean ambulatory ability score decreased significantly from 4.5±0.3 points prior to injury to 3.0±0.6 points 1 month postadmission, the degree of muscle atrophy was not associated with the decrease in ambulatory ability.Conclusions
It seems likely that other factors are more important than muscle atrophy and fracture type in determining recovery after surgical repair of a fracture and that there is no need for rehabilitation regimens based on fracture types. 相似文献11.
Magali Fourny Anne-Sophie Lucas Loïc Belle Guillaume Debaty Pierre Casez Hélène Bouvaist Patrice François Gérald Vanzetto José Labarère 《The American journal of emergency medicine》2011,29(1):37-42
Objectives
Current guidelines recommend utilization of prehospital emergency medical services (EMSs) by patients with ST-elevation myocardial infarction (STEMI). The aims of this study were to estimate the percentage of inappropriate initial dispatcher decisions and determine their impact on delays in reperfusion therapy for EMS users with STEMI.Methods
As part of a prospective regional registry of patients with STEMI, we analyzed the original data for 245 patients who called a university hospital-affiliated EMS call center in France. The primary study outcome was time to reperfusion therapy calculated from the documented date and time of the first patient call.Results
The initial EMS dispatcher's decision was appropriate (ie, dispatching a mobile intensive care unit staffed by an emergency or critical care physician) for 171 (70%) patients and inappropriate for 74 (30%) patients. Inappropriate decisions included referring the patient to a family physician (n = 59), providing medical advice (n = 9), and dispatching an ambulance (n = 6). Inappropriate initial decisions resulted in increased median time to reperfusion for 140 patients receiving fibrinolysis (95 vs 53 minutes; P < .001) and 91 patients undergoing primary percutaneous coronary intervention (170 vs 107 minutes; P < .001). In-hospital mortality was not different between the 2 study groups (6.8% vs 9.9%; P = .42).Conclusion
The initial dispatcher's decision is inappropriate for 30% of EMS users with STEMI and results in substantial delays in time to reperfusion therapy. Accuracy of telephone triage should be improved for patients who activate EMSs in response to symptoms suggestive of acute coronary syndrome. 相似文献12.
David M. Morris Edward Taub David M. Macrina Edwin W. Cook Brian F. Geiger 《Archives of physical medicine and rehabilitation》2009,90(4):663-668
Morris DM, Taub E, Macrina DM, Cook EW, Geiger BF. A method for standardizing procedures in rehabilitation: use in the Extremity Constraint Induced Therapy Evaluation multisite randomized controlled trial.
Objective
An enduring problem in the field of rehabilitation has been the lack of standardization in the protocols of treatments and tests. To develop a process evaluation method to standardize the administration of rehabilitation procedures used in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial, a randomized controlled trial of upper-extremity constraint-induced therapy implemented across 7 sites.Design
Process evaluation.Setting
Research laboratory.Participants
Convenience sample or research personnel.Interventions
Not applicable.Main Outcome Measures
Checklist scoring sheets were developed to rate videotapes using systematic application of prescribed steps for each of 5 procedures across 3 time periods. Time periods were immediately after training, and 1 and 2 years later. A performance score of at least 90% was required before individual research personnel were allowed to participate in the trial.Results
Overall performance scores ranged from 85.8% to 95% of performance items correctly executed. There was a significant improvement in standard performance of procedures between the first time period (immediately after training) and each of the subsequent time periods for all but 1 procedure. The scoring of standardized performance when carried out with routine participant testing and training did not differ significantly from scoring from videotaped sessions submitted for standardization rating for 2 of the procedures, suggesting adequate validity of scoring from videotape.Conclusions
The present method was successful in assessing protocol fidelity for the EXCITE research personnel and represents 1 means of addressing the longstanding problem in rehabilitation of the lack of standardization in administering different treatments and tests. 相似文献13.
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14.
Resnik L, Plow M. Measuring participation as defined by the International Classification of Functioning, Disability and Health: an evaluation of existing measures.
Objectives
The content and theoretic underpinning of measures designed to assess participation, disability, and handicap vary widely, and few authors have attempted to compare the content of existing measures. The objectives of this study were to use the International Classification of Functioning, Disability and Health (ICF) taxonomy to (1) evaluate the participation content of measures and (2) identify the most comprehensive measures.Design
We searched PubMed, Cumulated Index of Nursing and Allied Health Literature, and Health and Psychosocial Instruments databases to identify appropriate measures. Content analysis was conducted by classifying participation-related items of each measure into 1 or more of the 9 activities and participation chapters of the ICF taxonomy.Setting
Not applicable.Participants
We evaluated 40 generic and condition-specific self-report measures that met study inclusion criteria.Interventions
Not applicable.Main Outcome Measures
The most comprehensive measures were identified and coded by using second- and third-level ICF codes.Results
Five measures containing participation items linked to all 9 chapters were the Community Living Skills Scale, the Assessment of Life Habits, Mayo-Portland Adaptability Inventory, the participation measure for postacute care, and the Psychosocial Adjustment to Illness Scale. The breadth and coverage of these 5 measures were compared.Conclusions
We identified 5 measures that had items that were linkable to all 9 chapters of activities and participation; however, these measures differed in specifics of coverage and the approach to assessing participation. These findings can be used by clinicians and researchers to select the most comprehensive participation outcome measure for their populations. 相似文献15.
16.
Amy J.H. Kind Maureen A. Smith Jinn-Ing Liou Nancy Pandhi Jennifer R. Frytak Michael D. Finch 《Archives of physical medicine and rehabilitation》2010,91(2):189-727
Kind AJH, Smith MA, Liou J-I, Pandhi N, Frytak JR, Finch MD. Discharge destination's effect on bounce-back risk in black, white, and Hispanic acute ischemic stroke patients.
Objective
To determine whether racial and ethnic effects on bounce-back risk (ie, movement to settings of higher care intensity within 30d of hospital discharge) in acute stroke patients vary depending on initial posthospital discharge destination.Design
Retrospective analysis of administrative data.Setting
Four hundred twenty-two hospitals, southern/eastern United States.Participants
All Medicare beneficiaries 65 years or more with hospitalization for acute ischemic stroke within one of the 422 target hospitals during the years 1999 or 2000 (N=63,679).Interventions
Not applicable.Main Outcome Measures
Adjusted predicted probabilities for discharge to and for bouncing back from each initial discharge site (ie, home, home with home health care, skilled nursing facility [SNF], or rehabilitation center) by race (ie, black, white, and Hispanic). Models included sociodemographics, comorbidities, stroke severity, and length of stay.Results
Blacks and Hispanics were significantly more likely to be discharged to home health care (blacks=21% [95% confidence interval (CI), 19.9-22.8], Hispanic=19% [17.1-21.7] vs whites=16% [15.5-16.8]) and less likely to be discharged to SNFs (blacks=26% [95% CI, 23.6-29.3], Hispanics=28% [25.4-31.6] vs whites=33% [31.8-35.1]) than whites. However, blacks and Hispanics were significantly more likely to bounce back when discharged to SNFs than whites (blacks=26% [95% CI, 24.2-28.6], Hispanics=28% [24-32.6] vs whites=21% [20.3-21.9]). Hispanics had a lower risk of bouncing back when discharged home than either blacks or whites (Hispanics=14% [95% CI, 11.3-17] vs blacks=20% [18.4-22.2], whites=18% [16.8-18.3]). Patients discharged to home health care or rehabilitation centers demonstrated no significant differences in bounce-back risk.Conclusions
Racial/ethnic bounce-back risk differs depending on initial discharge destination. Additional research is needed to fully understand this variation in effect. 相似文献17.
Jun Hirose Junji Ide Toshitake Yakushiji Yasuyuki Abe Kimiaki Nishida Satoshi Maeda Yoshihisa Anraku Koichiro Usuku Hiroshi Mizuta 《Archives of physical medicine and rehabilitation》2010,91(1):67-72
Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery.
Objectives
To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status.Design
Cohort study.Setting
Twelve hospitals belonging to the regional network for hip fracture in Japan.Participants
The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers.Interventions
Not applicable.Main Outcome Measures
We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status.Results
In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (ρ=0.6, P<.001).Conclusions
In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery. 相似文献18.
DeMatteo CA Cousins MA Lin CY Law MC Colantonio A Macarthur C 《Archives of physical medicine and rehabilitation》2008,89(9):1803-1810
DeMatteo CA, Cousins MA, Lin C-YA, Law MC, Colantonio A, Macarthur C. Exploring postinjury living environments for children and youth with acquired brain injury.
Objectives
To explore and describe the extent to which children and youth (10−18y) with acquired brain injury in Ontario are living in environments considered inappropriate, to describe the nature of services and supports in those environments, and to determine appropriate living environments for children and youth with acquired brain injury.Design
A mixed-methods approach with a case-study design was used in which the living environment represented the case. This article reports on the qualitative component.Setting
Community agencies and service providers.Participants
Forty-four service providers across a wide range of profit and nonprofit services for children and youth with acquired brain injury throughout the province of Ontario.Interventions
Not applicable.Main Outcome Measure
Semistructured in-depth interviews with participants.Results
Seven major themes emerged from the data: kids go home, a continuum of appropriateness, show me the way home, same chapter different story, cracking the acquired brain injury code, who said care was fair, and coping, and managing and advocating: new dimensions for families. Important service recommendations were also reported.Conclusions
Most children and youth with acquired brain injury are living at home. The level of appropriateness of the environment for children and youth after acquired brain injury can depend on multiple interrelated factors including type and severity of acquired brain injury, existing services and service delivery, acquired brain injury knowledge, and family's ability to cope and manage. 相似文献19.
Anna M. Chudyk Jeffrey W. Jutai Robert J. Petrella Mark Speechley 《Archives of physical medicine and rehabilitation》2009,90(2):246-262
Chudyk AM, Jutai JW, Petrella RJ, Speechley M. Systematic review of hip fracture rehabilitation practices in the elderly.
Objective
To address the need for a research synthesis on the effectiveness of the full range of hip fracture rehabilitation interventions for older adults and make evidence based conclusions.Data Sources
Medline, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched from 1980 to 2007 for studies published in English. The terms rehabilitation and hip fracture were exploded in order to obtain related search terms and categories.Study Selection
In the initial search of the databases, a combined total of 1031 articles was identified. Studies that did not focus on hip fracture rehabilitation, did not include persons over the age of 50 years, and/or did not include measures of physical outcome were excluded.Data Extraction
Only studies with an Oxford Center for Evidence-Based Medicine Levels of Evidence level of I (randomized controlled trial, RCT) or II (cohort) were reviewed. The methodologic quality of both types of studies was assessed using a modified version of the Downs and Black checklist.Data Synthesis
There were 55 studies that met our selection criteria: 30 RCTs and 25 nonrandomized trials. They were distributed across 6 categories for rehabilitation intervention (care pathways, early rehabilitation, interdisciplinary care, occupational and physical therapy, exercise, intervention not specified) and 3 settings (acute care hospital, postacute care/rehabilitation, postrehabilitation).Conclusions
When looking across all of the intervention types, the most frequently reported positive outcomes were associated with measures of ambulatory ability. Eleven intervention categories across 3 settings were associated with improved ambulatory outcomes. Seven intervention approaches were related to improved functional recovery, while 6 intervention approaches were related to improved strength and balance recovery. Decreased length of stay and increased falls self-efficacy were associated with 2 interventions, while 1 intervention had a positive effect on lower-extremity power generation. 相似文献20.
Burger H, Marin?ek ?, Jaeger RJ. Prosthetic device provision to landmine survivors in Bosnia and Herzegovina: outcomes in 3 ethnic groups. Arch Phys Med Rehabil 2004;85:19-28.