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Channah Nieuwenhuijsen Mireille Donkervoort Wilbert Nieuwstraten Henk J. Stam Marij E. Roebroeck Transition Research Group South West Netherlands 《Archives of physical medicine and rehabilitation》2009,90(11):1891-1897
Nieuwenhuijsen C, Donkervoort M, Nieuwstraten W, Stam HJ, Roebroeck ME; and the Transition Research Group South West Netherlands. Experienced problems of young adults with cerebral palsy: targets for rehabilitation care.
Objective
To determine the problems experienced by young adults with cerebral palsy (CP) and the relationship between those problems and personal and CP-related characteristics.Design
Cross-sectional study.Setting
Rehabilitation centers in the southwest Netherlands.Participants
Young adults (N=87; aged 18-22y) with CP and normal intelligence (roughly corresponding to an intelligence quotient >70, excluding participants who attended schools for those with learning disabilities).Interventions
Not applicable.Main Outcome Measures
We used the Canadian Occupational Performance Measure in a semistructured interview to assess participants for experienced problems. We further categorized experienced problems according to the domains of the International Classification of Functioning, Disability and Health and assessed the relationship between those problems and personal and CP-related characteristics (eg, age, sex, level of gross motor functioning, manual ability, level of education) using appropriate correlation coefficients.Results
Approximately 70% of participants experienced problems in daily life, addressing the areas of self-care (59%), productivity (52%), and leisure activities (37%). More specifically, problems were most prevalent in recreation and leisure (30%), preparing meals (29%), housework (14%), and dressing (14%). Problems in functional mobility, paid or unpaid work, and socialization were considered as most important (represented by the highest mean importance score). Mobility problems were associated with lower levels of gross motor functioning (Spearman ρ=.39), and problems with self-care were associated with lower levels of manual ability (Spearman ρ=.40).Conclusions
Although frequently addressed during pediatric rehabilitation care, problems with mobility and self-care still prevail in young adults with CP. In addition, during the transition into adulthood, young adults with CP may experience problems regarding domestic life and work, which they consider important. 相似文献3.
Stephen E. Ryan Kent A. Campbell Patricia J. Rigby Barbara Fishbein-Germon Betty Chan 《Archives of physical medicine and rehabilitation》2009,90(1):27-33
Ryan SE, Campbell KA, Rigby PJ, Fishbein-Germon B, Hubley D, Chan B. The impact of adaptive seating devices on the lives of young children with cerebral palsy and their families.
Objective
To determine the parent-perceived effect of adaptive seating devices on the lives of young children with cerebral palsy (CP) (aged 2-7y) and their families.Design
Baseline-intervention-baseline study.Setting
Homes of participating families.Participants
Thirty parents and their children with Gross Motor Function Classification System level III or IV CP.Interventions
Two special-purpose seating devices: 1 for sitting support on the floor or on a chair and the other for postural control on a toilet.Main Outcome Measures
Family Impact of Assistive Technology Scale (FIATS) and Impact on Family Scale (IFS).Results
Thirty parents (29 mothers, 1 father) and their children with CP participated. Repeated-measures analysis of variance detected significant mean differences among the FIATS scores (F1.4,40.6=19.25, P<.001). Post hoc testing confirmed significant mean differences in overall FIATS scores between baseline and intervention and intervention and postintervention phases. The test of within-subject effects did not detect a significant change among IFS mean scores.Conclusions
The introduction of adaptive seating devices for young children who need support to sit had a meaningful, positive impact on child and family life. Removal of the study devices showed a concomitant negative impact on key aspects of child and family life. Environmental resources, such as seating and other assistive technology devices, may have an important role to play in the lives of young children with physical disabilities and their families. 相似文献4.
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Quality of Life of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up
Diana Zidarov Bonnie Swaine Christiane Gauthier-Gagnon 《Archives of physical medicine and rehabilitation》2009,90(4):634-645
Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.
Objective
To describe and compare the quality of life (QOL) of persons with lower-limb amputation (LLA) at admission (T1), discharge (T2), and 3 months after rehabilitation discharge (T3) and to explore the relationships between QOL and demographic and clinical variables including body image.Design
Longitudinal case series.Setting
Inpatient rehabilitation facility.Participants
Consecutive sample of 19 unilateral persons with LLA (14 men, mean age, 53.4±14.6y).Intervention
Interdisciplinary rehabilitation.Main Outcome Measures
Generic and specific QOL measures and perception of body image at T1, T2, and T3.Results
Subjective QOL was relatively high at T1, T2, and T3 (0.87/2, 1.1/2, and 1.0/2, respectively) except for items related to physical functioning. There was no significant change over time for all but 1 QOL satisfaction measure (ability to go outside, P=.024). Prosthesis-related QOL was high at discharge and follow-up. Body-image disturbances were absent over the study period. QOL satisfaction and prosthesis satisfaction were strongly related to lower-limb pain and psychosocial factors (eg, body image).Conclusions
QOL of persons with LLA was high and remained relatively stable during inpatient rehabilitation and 3 months after discharge. 相似文献6.
Horney C Schmader K Sanders LL Heflin M Ragsdale L McConnell E Hocker M Hastings SN 《The American journal of emergency medicine》2012,30(1):135-142
Background
Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population.Objectives
The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults.Methods
This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits.Results
Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status.Conclusion
Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. 相似文献7.
Beekhuizen KS, Field-Fote EC. Sensory stimulation augments the effects of massed practice training in persons with tetraplegia.
Objective
To compare functional changes and cortical neuroplasticity associated with hand and upper extremity use after massed (repetitive task-oriented practice) training, somatosensory stimulation, massed practice training combined with somatosensory stimulation, or no intervention, in persons with chronic incomplete tetraplegia.Design
Participants were randomly assigned to 1 of 4 groups: massed practice training combined with somatosensory peripheral nerve stimulation (MP+SS), somatosensory peripheral nerve stimulation only (SS), massed practice training only (MP), and no intervention (control).Setting
University medical school setting.Participants
Twenty-four subjects with chronic incomplete tetraplegia.Interventions
Intervention sessions were 2 hours per session, 5 days a week for 3 weeks. Massed practice training consisted of repetitive practice of functional tasks requiring skilled hand and upper-extremity use. Somatosensory stimulation consisted of median nerve stimulation with intensity set below motor threshold.Main Outcome Measures
Pre- and post-testing assessed changes in functional hand use (Jebsen-Taylor Hand Function Test), functional upper-extremity use (Wolf Motor Function Test), pinch grip strength (key pinch force), sensory function (monofilament testing), and changes in cortical excitation (motor evoked potential threshold).Results
The 3 groups showed significant improvements in hand function after training. The MP+SS and SS groups had significant improvements in upper-extremity function and pinch strength compared with the control group, but only the MP+SS group had a significant change in sensory scores compared with the control group. The MP+SS and MP groups had greater change in threshold measures of cortical excitability.Conclusions
People with chronic incomplete tetraplegia obtain functional benefits from massed practice of task-oriented skills. Somatosensory stimulation appears to be a valuable adjunct to training programs designed to improve hand and upper-extremity function in these subjects. 相似文献8.
Objectives
Most older people have suboptimal levels of habitual physical activity. This study investigated the knowledge, attitudes, intentions and barriers to participation in physical activity among older people recovering from acute illness or injury.Design
A structured face-to-face questionnaire was developed, incorporating previously validated questions for older people.Setting
Elderly care unit of an urban hospital.Participants
Of 256 consecutively admitted patients, 66 were eligible and 44 (71% female) completed the interview before discharge.Main instruments and outcome measures
Questionnaire using open and closed questions. Baseline data included Barthel Index, gait aid, length of hospital stay and grip strength (indicator of frailty).Results
Median age was 83 years (range 67 to 91), median Barthel Index was 18/20 (range 9 to 20), mean hospital stay was 13.7 days (standard deviation 9.7) and 72% (31/43) were frail. Despite hospitalisation, only 23% (10/44) reported ‘poor’ general health. Knowledge of specific health benefits of physical activity was mixed, and knowledge about hypertension and osteoporosis was poor. Most patients (23/44, 52%) wrongly believed that their habitual activity levels were adequate. Barriers to increasing activity were predominantly related to health, including ‘breathing’ and ‘leg’ problems. Intentions towards future physical activity were varied and unrelated to frailty. Needing to rest and relax was a reason given for not being more active. Few patients (5/44, 11%) recalled being advised to be physically active.Conclusions
These patients, potential benefactors from increased physical activity, had mixed knowledge and attitudes towards physical activity which was unrelated to frailty. These data provide insights relevant to the design and delivery of exercise-related health messages and interventions. 相似文献9.
Bart E. Drinkard Randall E. Keyser Scott M. Paul Ross Arena Jonathan F. Plehn Jack A. Yanovski Nicholas A. Di Prospero 《Archives of physical medicine and rehabilitation》2010,91(7):1044-1050
Drinkard BE, Keyser RE, Paul SM, Arena R, Plehn JF, Yanovski JA, Di Prospero NA. Exercise capacity and idebenone intervention in children and adolescents with Friedreich ataxia.
Objective
To determine the exercise capacity of children and adolescents with Friedreich's Ataxia (FA) and to evaluate the effects of 6 months of idebenone treatment on exercise capacity.Design
Exploratory endpoint in a randomized double-blind, placebo-controlled, phase II clinical trial designed to investigate the effects of idebenone on a biomarker of oxidative stress.Setting
Exercise physiology laboratory in a single clinical research center.Participants
Ambulatory subjects (N=48; age range, 9-17y) with genetically confirmed FA.Intervention
Idebenone administered orally 3 times a day for a total daily dose of approximately 5, 15, and 45mg/kg or matching placebo for 6 months.Main Outcome Measures
Peak oxygen consumption per unit time (peak VO2) and peak work rate (WR) were measured during incremental exercise testing at baseline and after treatment. Echocardiography and neurologic assessments were also completed before and after treatment.Results
Baseline mean peak VO2 ± SD was 746±246mL/min (16.2±5.8mL/kg/min), and WR was 40±23W for all subjects. Peak VO2 and WR were correlated with short guanine-adenine-adenine allele length and neurologic function. Relative left ventricular wall thickness was increased but left ventricular ejection fraction was normal in most subjects; there was no relationship between any exercise and echocardiographic measures. There were no significant changes in mean peak VO2 or WR after idebenone treatment at any dose level relative to placebo.Conclusions
Exercise capacity in children and adolescents with FA was significantly impaired. The basis for the impairment appears to be multifactorial and correlated to the degree of neurologic impairment. Although idebenone has previously been shown potentially to improve features of FA, idebenone treatment did not increase exercise capacity relative to placebo. 相似文献10.
Joe R. Nocera Thomas Buckley Dwight Waddell Michael S. Okun Chris J. Hass 《Archives of physical medicine and rehabilitation》2010,91(4):589-595
Nocera JR, Buckley T, Waddell D, Okun MS, Hass CJ. Knee extensor strength, dynamic stability, and functional ambulation: are they related in Parkinson's disease?
Objective
To evaluate the relationship between knee extensor strength, postural stability, functional ambulation, and disease severity in Parkinson's disease (PD).Design
A cohort study.Setting
University research laboratory.Participants
Patients (N=44) with idiopathic PD.Intervention
Not applicable.Main Outcome Measures
Participants were evaluated on their isokinetic knee extensor strength. Additionally, participants completed an assessment of their postural stability (Functional Reach Test for static stability and a dynamic postural stability assessment as measured by the center of pressure-center of mass moment arm during gait initiation). Participants also underwent an evaluation of their functional ambulation as measured by a 6-minute walk test. Lastly, participants were evaluated by a neurologist specially trained in movement disorders to assess neurologic status and disease severity using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr disability score.Results
Knee extensor strength positively correlated with dynamic postural stability and negatively correlated with disease severity. Further, dynamic postural stability was negatively correlated to disease severity and positively correlated with functional ambulation in this cohort of patients with PD (P<.05). The results also suggest that the Functional Reach Test may be a valuable assessment tool to examine postural stability in PD.Conclusions
These findings suggest a malleable relationship between knee extensor strength, dynamic stability, and disease severity in PD. Although strength is only one piece of the puzzle in the functional outcome of PD, these findings may assist clinicians in designing appropriate interventions aimed at increasing function and decreasing fall risk in PD. 相似文献11.
Objective
To discover the extent to which persons with Guillain-Barré syndrome receive treatment by a physiotherapist (as inpatients and outpatients), and to assess whether the amount of treatment received is related to outcome.Design
Survey method using self-administered questionnaires distributed through a national database.Participants
Members of the Guillain-Barré Syndrome Support Group (n = 1535).Main outcome measures
General patient data, general mobility, F-score, Hospital Anxiety and Depression Scale, Short Form-36 and Fatigue Severity Scale.Results
In total, 884/1535 (58%) complete responses were received. Nearly 10% of respondents had not received treatment by a physiotherapist in hospital despite their average functional level being the same as respondents who had received treatment in hospital. One-quarter of respondents said that they had not received treatment following hospital discharge despite the identification of relatively high levels of disability. Those who did not receive treatment by a physiotherapist following discharge were less severely disabled. This may indicate that physiotherapists tend to offer treatment to more severely disabled patients. The majority of patients reported disabling fatigue; whilst not statistically related to receipt of treatment by a physiotherapist, this highlights the importance of assessing fatigue in treatment plans to improve physical functioning.Conclusion
Improvements to policy and practice can be made by widening inpatient accessibility to treatment by a physiotherapist and increasing outpatient provision of treatment for patients with Guillain-Barré syndrome of all degrees of severity. 相似文献12.
Background
Managing nurse shortages is a major challenge in Trusts today given the worldwide shortage of nurses. To fill the gap created by a lack of permanent staff UK government agencies have increasingly used bank and agency staff. Managing this type of staffing effectively and efficiently, in the context of shrinking healthcare funds, is a major challenge in providing safe and quality healthcare.Objective
To analyse bank and agency nursing staffing patterns and factors that impact on these patterns.Design and setting
Case study within the largest hospital in one Welsh Integrated Healthcare Trust.Data sources
De-identified bank and agency staffing electronic and manual database records and focus group interview with bank and agency office staff.Results
A predictable bank and agency staffing pattern was found, wherein bank and agency nursing staff were used with increasing frequency towards the end of the week. Demand for bank and agency nursing staff occurred because of: hospital practices that fund a fixed staff establishment for nursing units, while patient numbers and acuity are variable; poor forward planning; sickness, and absence due to professional development or staff training.Conclusion
There is a need for managers to reconsider management and recruitment policies, particularly in relation to using bank and agency staff. The complexity of staffing challenges managers to focus on predictability of workload needs and other factors that affect staffing requirements, such as: professional development, flexible working rosters to match the need and minimize sickness and turnover of staff. 相似文献13.
Rodger A. Weddell 《Archives of physical medicine and rehabilitation》2010,91(6):897-299
Weddell RA. Relatives' criticism influences adjustment and outcome after traumatic brain injury.
Objectives
To apply some of the methods developed to study the effects of relatives' expressed emotion (EE) on psychiatric relapse rates and to test the prediction that relatives' criticism and psychiatric distress would be associated with outcome and emotional distress after traumatic brain injury (TBI).Design
Retrospective cohort design with correlational analyses of quantitative and qualitative measures of TBI outcomes.Setting
The author interviewed participants in the hospital. The research assistant interviewed close relatives at home.Participants
Participants and relatives (N=78) were interviewed 34.3±15.2 months (mean ± SD) after a severe TBI.Interventions
None.Main Outcome Measures
Dependent variables in a series of hierarchical linear regression models were participants' scores on the Zung Depression Scale, Spielberger Trait Anxiety Inventory, State-Trait Anger Expression Inventory, an Anger Towards Relative questionnaire constructed for this study, and Extended Glasgow Outcome Scores. Participant-independent variables were social class, posttraumatic amnesia, Wechsler Memory Scale-Delayed Recall score, WAIS-R intelligence quotient, and a short version of the Smell Identification Test. Relative independent variables were the number of critical comments directed toward participants in the interview and psychiatric distress as measured by the General Health Questionnaire.Results
The contributions of variance associated with relative independent variables (predominantly criticism) were significant in stage 2 of most hierarchical regression analyses after the adjustments for variance associated with participant independent variables made in stage 1.Conclusions
Future application of EE research methods is warranted. If the present results are replicated, then evidence-based family interventions developed by EE researchers to reduce criticism might also improve TBI outcomes. 相似文献14.
Jeffrey S. Kreutzer Lisa J. Rapport Jennifer H. Marwitz Cynthia Harrison-Felix Tessa Hart Mel Glenn Flora Hammond 《Archives of physical medicine and rehabilitation》2009,90(6):939-946
Kreutzer JS, Rapport LJ, Marwitz JH, Harrison-Felix C, Hart T, Glenn M, Hammond F. Caregivers' well-being after traumatic brain injury: a multicenter prospective investigation.
Objective
To describe frequency and magnitude of caregivers' emotional distress and life satisfaction using standardized assessment procedures; compare distress levels among spouses, parents, and other caregivers; and identify risk factors.Design
Prospective collaborative cohort study.Setting
Six Traumatic Brain Injury Model System Centers providing neurotrauma care, rehabilitation, and outpatient follow-up.Participants
Caregivers (N=273) of patients who were 1, 2, or 5 years postinjury.Interventions
Acute neurotrauma care, inpatient interdisciplinary brain injury rehabilitation, and postacute services.Main Outcome Measure
Brief Symptom Inventory-18 Depression, Anxiety, and Somatic dimensions.Results
Levels of Depression, Anxiety, and Somatic symptoms were equally prevalent, with 1 in 5 caregivers scoring above the cutoff in each area. The proportion of participants with 1, 2, and 3 elevations was 17.9%, 5.5%, and 10.6%, respectively. Conversely, approximately two thirds (65.9%) had no scores exceeding cutoffs. Distress levels among spouses, parents, and other caregivers were comparable. Higher caregiver distress was associated with caring for survivors who had worse functional status, received more supervision, were less satisfied with life, and used alcohol excessively.Conclusions
Depression, Anxiety, and Somatic symptoms are common among caregivers. Findings substantiate the importance of clinical care systems addressing the needs of caregivers in the long term as well as survivors. 相似文献15.
Background
Several approaches have emerged for measuring self-reported fear of falling. A comparison of measurement scales’ psychometric properties is needed for researchers to choose the proper scale for their study.Objectives
To compare the psychometric properties of the Falling Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC) and the Geriatric Fear of Falling Measurement (GFFM).Design
Secondary analysis using baseline and 8-week data from a randomized, controlled trial on fall and fear of falling prevention.Settings
Rural area northeast of Taiwan with assessments conducted in participants’ homes.Participants
Population-based sample of 168 community-dwelling older adults aged 60 and older.Methods
During a home visit, a nurse administered the Tinetti Mobility Scale, and asked about the FES, ABC, GFFM, WHOQOL, falls, chronic illnesses and medicines taken.Results
Baseline internal consistency measured using Cronbach's alpha was 0.98 for the FES, 0.96 for the ABC and 0.88 for the GFFM. Baseline concurrent validity between the FES, ABC and GFFM measured using a correlation coefficient was 0.88 (FES vs. ABC), −0.55 (FES vs. GFFM), and −0.57 (ABC vs. GFFM), respectively, p < .001. All three instruments scores were significantly correlated at baseline with physical performance tests and WHOQOL. The GFFM demonstrated responsiveness to change at 8 weeks.Conclusions
The FES, ABC and GFFM demonstrated strong internal consistency reliability. The GFFM had stronger associations with physical and psychosocial functioning and may be more appropriate for studies focused on improving all aspects of fear of falling. Both FES and ABC instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively non-frail older community-dwelling adults. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population. 相似文献16.
Coyne I 《International journal of nursing studies》2008,45(11):1682-1689
Background
The past decade has seen a growing recognition in Ireland and internationally that children and young people have a right to participate in matters that affect their lives.Objectives
To critique the research literature on children's, parents and healthcare professionals’ experiences of children's participation in consultations and decision-making within the healthcare setting.Method
The literature was obtained from electronic databases, books, and journals focusing on work published in between 1993 and 2007.Results
Despite the importance of consulting with sick children, their views are rarely sought nor acknowledged within the healthcare setting. Children are rarely involved in decision-making process and appear to occupy a marginalized position in healthcare encounters. Healthcare professionals and parents play a significant influence on whether children's efforts to participate are facilitated and supported in the hospital setting.Conclusions
There is a need for further research to explore health professionals’ and parents’ perspectives on children's participation in consultations and decision-making, as clearly they have reservations/concerns about children's active involvement in such matters. This information could be used to develop guidelines that will assist professionals and parents in facilitating and supporting children's participation. 相似文献17.
Objective
To investigate the effect of spectators on the performance of a physiotherapy exercise.Design
Observational study.Setting
Research laboratory, Trinity College Dublin.Participants
Forty adult volunteer subjects (36 females, four males). As there were only four males, these were excluded from the analysis.Interventions
Subjects were observed and timed while performing single leg stance in two conditions 48 hours apart; once with the investigator present (investigator condition) and once with the investigator and three spectators present (spectator condition).Main outcome measure
Duration of single leg stance in seconds.Results
The mean duration of single leg stance, for females, under the investigator condition was 173 seconds [95% confidence interval (CI) 131 to 214], while that of the spectator condition was 168 seconds (95%CI 128 to 208). The mean difference between the two conditions was 5 seconds (95%CI −21 to 31). This was not statistically significant using a paired t-test (P = 0.686).Conclusions
Female performance of a straightforward exercise such as single leg stance was not affected by the presence of three spectators. 相似文献18.
Hart DL Wang YC Stratford PW Mioduski JE 《Archives of physical medicine and rehabilitation》2008,89(11):2129-2139
Hart DL, Wang Y-C, Stratford PW, Mioduski JE. A computerized adaptive test for patients with hip impairments produced valid and responsive measures of function.
Objectives
To describe the use of a computerized adaptive test (CAT) in routine clinical practice and evaluate content coverage and construct validity, sensitivity to change, and responsiveness of hip CAT functional status (FS) measures.Design
Longitudinal, prospective observational cohort study.Setting
Two hundred fifty-seven outpatient rehabilitation clinics in 31 states (United States).Participants
Two samples were examined: intake and discharge rehabilitation FS data from patients (N=8714) treated for hip impairments between January 2005 and June 2007 and data from patients (N=444) used to develop the hip CAT were examined for comparison (2002-2004).Interventions
Not applicable.Main Outcome Measures
Hip functional status and global rating of change.Results
The CAT used on average 7 items to produce precise estimates of FS that adequately covered the content range with negligible floor and slight ceiling effects. Test information functions and SEs supported FS measure precision. FS measures discriminated patients in clinically logical ways. Sixty-one percent of patients obtained discharge FS measures greater than or equal to minimal detectable change (95% confidence intervals). Change of 6 FS units (scale: 0-100) represented minimal clinically important improvement, which 64% of patients obtained.Conclusions
The hip CAT was efficient; produced valid, responsive measures of FS for patients receiving therapy for hip impairments; and functioned well in routine clinical application but would benefit from more difficult items. 相似文献19.