Injurious falls among middle aged and older adults with multiple sclerosis

Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis.

Objective

To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS).

Design

Survey.

Setting

United States.

Participants

Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey.

Interventions

Not applicable.

Main Outcome Measures

Participant's self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never).

Results

More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27−2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62).

Conclusions

Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.     

Snow shovel-related injuries and medical emergencies treated in US EDs, 1990 to 2006

Background

Injuries and medical emergencies associated with snow shovel use are common in the United States.

Methods

This is a retrospective analysis of data from the National Electronic Injury Surveillance System. This study analyzes the epidemiologic features of snow shovel-related injuries and medical emergencies treated in US emergency departments (EDs) from 1990 to 2006.

Results

An estimated 195?100 individuals (95% confidence interval, 140?400-249?800) were treated in US EDs for snow shovel-related incidents during the 17-year study period, averaging 11?500 individuals annually (SD, 5300). The average annual rate of snow shovel-related injuries and medical emergencies was 4.15 per 100?000 population. Approximately two thirds (67.5%) of these incidents occurred among males. Children younger than 18 years comprised 15.3% of the cases, whereas older adults (55 years and older) accounted for 21.8%. The most common diagnosis was soft tissue injury (54.7%). Injuries to the lower back accounted for 34.3% of the cases. The most common mechanism of injury/nature of medical emergency was acute musculoskeletal exertion (53.9%) followed by slips and falls (20.0%) and being struck by a snow shovel (15.0%). Cardiac-related ED visits accounted for 6.7% of the cases, including all of the 1647 deaths in the study. Patients required hospitalization in 5.8% of the cases. Most snow shovel-related incidents (95.6%) occurred in and around the home.

Conclusions

This is the first study to comprehensively examine snow shovel-related injuries and medical emergencies in the United States using a nationally representative sample. There are an estimated 11?500 snow shovel-related injuries and medical emergencies treated annually in US EDs.     

Microwave oven-related injuries treated in hospital EDs in the United States, 1990 to 2010

Background

The widespread availability of microwave ovens has sparked interest in injuries resulting from their use.

Methods

Using a retrospective cohort design, the objective of this study is to investigate the epidemiology of microwave oven-related injuries treated in United States emergency departments (EDs) from 1990 through 2010 by analyzing data from the National Electronic Injury Surveillance System.

Results

An estimated 155 959 (95% confidence interval [CI], 133 515-178 402) individuals with microwave oven-related injuries were treated in US hospital EDs from 1990 through 2010, which equals an average of 21 individuals per day; 60.7% were female; 63.3% were adults (≥ 18 years); 98.1% of injury events occurred at home; and 3.9% of patients were hospitalized. During the 21-year study period, the number and rate of microwave oven-related injuries increased significantly by 93.3% and 50.0%, respectively. The most common mechanism of injury was a spill (31.3%), and the most common body region injured was the hand and fingers (32.4%). Patients younger than 18 years were more likely to sustain an injury to their head and neck (relative risk: 1.65; 95% CI, 1.39-1.96) than adults.

Conclusions

To our knowledge, this is the first study to investigate microwave oven-related injuries on a national scale. Microwave ovens are an important source of injury in the home in the United States. The large increases in the number and rate of these injuries underscore the need for increased prevention efforts, especially among young children.     

Health of community-dwelling adults with mobility limitations in the United States: incidence of secondary health conditions. Part II

Rasch EK, Magder L, Hochberg MC, Magaziner J, Altman BM. Health of community-dwelling adults with mobility limitations in the United States: incidence of secondary health conditions. Part II.

Objective

To compare incident health conditions that occurred over a 2-year period in nationally representative groups of adults with mobility, nonmobility, and no limitations.

Design

Data were collected prospectively from a probability subsample of households that represent the civilian, noninstitutionalized U.S. population.

Setting

Five rounds of household interviews were conducted over 2 years.

Participants

Data were analyzed on the same respondents from the 1996−1997 Medical Expenditure Panel Survey (MEPS) and the 1995 National Health Interview Survey Disability Supplement. Respondents were categorized into 3 groups for analysis; those with mobility limitations, nonmobility limitations, and no limitations. The analytic sample included 12,302 MEPS adults (≥18y).

Interventions

Not applicable.

Main Outcome Measures

Number, types, and 2-year incidence of self-reported health conditions compared across groups.

Results

The mean number of incident conditions (95% confidence intervals [CIs]) over the 2-year period was greatest in adults with mobility limitations (mean, 4.7; 95% CI, 4.4−4.9) compared with those with nonmobility limitations (mean, 3.9; 95% CI, 3.7−4.2) or no limitations (mean, 2.6; 95% CI, 2.5−2.7). Incident conditions affected most major body systems.

Conclusions

Because secondary conditions are potentially preventable, determining factors that influence their occurrence is an important public health issue requiring specific action.     

Epidemiology of strain/sprain injuries among cheerleaders in the United States

Objective

The aim of this study is to describe the epidemiology of cheerleading-related strain/sprain injuries by type of cheerleading team and type of event.

Methods

Athlete exposure (AE) and injury data were collected from 412 United States cheerleading teams via the Cheerleading Reporting Information Online surveillance tool, and injury rates were calculated.

Results

Strains/Sprains were the most common injury (53%; 0.5 injuries per 1000 AEs) sustained by cheerleaders during our 1-year study. The lower extremities (42%), particularly the ankles (28%), were injured most often. Most injuries occurred during practice (82%); however, the rate of injury was higher during competition (0.8 injuries per 1000 AEs; 95% confidence interval [CI], 0.6-1.0) than during practice (0.6 injuries per 1000 AEs; 95% CI, 0.5-0.6) for all team types. Injuries were sustained most frequently by high school cheerleaders (51%), although college cheerleaders had the highest injury rate (1.2 injuries per 1000 AEs). Strains/Sprains occurred most frequently while attempting a stunt (34%) or while tumbling (32%). Spotting/Basing other cheerleaders (19%) was the most common mechanism of injury and was more likely to result in a lower back strain/sprain than other mechanisms of injury (odds ratio, 3.38; 95% CI, 1.41-8.09; P < .01).

Conclusions

Cheerleaders should increase their focus on conditioning and strength-building training, which may help to prevent strain/sprain injuries. Spotters and bases should additionally focus on proper lifting technique to help avoid back injury. Guidelines may need to be developed for return-to-play after cheerleading-related strain/sprain injuries.     

Forgoing Physician Visits Because of Cost: A Source of Health Disparities for Elderly People With Disabilities?

Lee JC, Heinemann AW. Forgoing physician visits because of cost: a source of health disparities for elderly people with disabilities?

Objective

To examine disparities in having a usual source of care and forgoing physician visits because of cost between elderly people (age ≥65y) with and without disabilities after consecutively controlling for predisposing, enabling, and perceived and evaluated health need factors using the Andersen behavioral model, and to identify the determinants of such disparities.

Design

Cross-sectional analysis.

Setting

Community.

Participants

Nationally representative sample of community-dwelling adults age 65 years or greater in the United States from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) (N=93,933).

Interventions

Not applicable.

Main Outcome Measures

Responses to 2 BRFSS questions: (1) whether the respondent had a health care provider, and (2) whether the respondent had forgone seeing a physician because of cost in the past 12 months.

Results

After controlling for the aforementioned factors, elderly persons with disabilities were more likely than their counterparts without disabilities to have a usual source of care (adjusted odds ratio [AOR]=1.33; 95% confidence interval [CI], 1.08-1.64), and those with disabilities were more likely to forgo physician visits because of cost (AOR=1.64; 95% CI, 1.31-2.04). The unadjusted odds of forgoing physician visits (odds ratio [OR]=2.13; 95% CI, 1.87-2.43) did not decrease after controlling for predisposing factors (AOR=2.32; 95% CI, 1.96-2.75), whereas the odds were attenuated after controlling for enabling factors (AOR=2.18; 95% CI, 1.84-2.59), perceived health need (AOR=1.70; 95% CI, 1.37-2.12), and evaluated health need (AOR=1.64; 95% CI, 1.31-2.04).

Conclusions

Although elderly people with disabilities were more likely than their counterparts without disabilities to have a usual source of care, those with disabilities were more likely to forgo physician visits because of cost. Elderly persons with greater perceived health needs were most likely to experience the disparity.     

Mortality After Discharge From Acute Care Hospitalization With Traumatic Brain Injury: A Population-Based Study

Ventura T, Harrison-Felix C, Carlson N, DiGuiseppi C, Gabella B, Brown A, DeVivo M, Whiteneck G. Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based study.

Objective

To characterize mortality after acute hospitalization with traumatic brain injury (TBI) in a socioeconomically diverse population.

Design

Population-based retrospective cohort study.

Setting

Statewide TBI surveillance program.

Participants

Colorado residents with TBI discharged alive from acute hospitalization between 1998 and 2003 (N=18,998).

Interventions

Not applicable.

Main Outcome Measures

Vital status at the end of the study period (December 31, 2005) and statewide population mortality rates were used to calculate all-cause and cause-specific standardized mortality ratios (SMRs) and life expectancy compared with population mortality rates. The influence of demographics, injury severity, and comorbid conditions on time until death was investigated using age-stratified Cox proportional hazards modeling.

Results

Patients with TBI carried about 2.5 times the risk of death compared with the general population (SMR=2.47; 95% confidence interval [CI], 2.31-2.65). Life expectancy reduction averaged 6 years. SMRs were largest for deaths caused by mental/behavioral (SMR=3.84; 95% CI, 2.67-5.51) and neurologic conditions (SMR=2.79; 95% CI, 2.07-3.77) and were smaller but significantly higher than 1.0 for an array of other causes. Injury severity and older age increased mortality among young people (age <20y). However, risk factors for mortality among adults age 20 and older involved multiple domains of demographics (eg, metropolitan residence), injury-related measures (eg, falls versus vehicular incidents), and comorbidity (eg, ≥3 comorbid health conditions versus none).

Conclusions

TBI confers an increased risk of mortality in the months and years after hospital discharge. Although life expectancy is reduced across the population, the excess in mortality lessens as time since injury increases. Specific risk factors (eg, high injury severity, poor general health) pose an especially high threat to survival and should prompt an increased vigilance of health status, especially among younger patients.     

Ethnic differences in discharge destination among older patients with traumatic brain injury

Chang P-F, Ostir GV, Kuo Y-F, Granger CV, Ottenbacher KJ. Ethnic differences in discharge destination among older patients with traumatic brain injury.

Objective

To estimate the association between ethnicity and discharge destination in older patients with traumatic brain injury (TBI).

Design

A retrospective analysis.

Setting

Nationally representative sample of older patients from the Uniform Data System for Medical Rehabilitation in 2002 and 2003.

Participants

Patients (N=9240) aged 65 years or older who received inpatient rehabilitation services for TBI.

Interventions

Not applicable.

Main Outcome Measures

Discharge destination (home, assisted living facility, institution) and ethnicity (white, black, Hispanic).

Results

Multinomial logit models showed that older Hispanics (odds ratio [OR]=2.24; 95% confidence interval [CI], 1.66-3.02) and older blacks (OR=2; 95% CI, 1.55-2.59) with TBI were significantly more likely to be discharged home than older whites with TBI, after adjusting for relevant risk factors. Older blacks were also 78% less likely (OR=.22; 95% CI, .08-.60) to be discharged to an assisted living facility than whites after adjusting for relevant risk factors.

Conclusions

Our findings indicate that older minority patients with TBI were significantly more likely to be discharged home than white patients with TBI. Studies are needed to investigate underlying factors associated with this ethnic difference.     

Wheelchair-Related Falls in Veterans With Spinal Cord Injury Residing in the Community: A Prospective Cohort Study

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.     

Potential Clinical Impact of Compounded Versus Noncompounded Intrathecal Baclofen

Moberg-Wolff E. Potential clinical impact of compounded versus noncompounded intrathecal baclofen.

Objective

To assess the differences between commercial and pharmacy-compounded preparations of baclofen for intrathecal administration.

Design

Random sample.

Setting

Pharmacies in the United States advertising compounded intrathecal baclofen preparation.

Participants

Not applicable.

Interventions

Intrathecal baclofen (ITB) samples were collected from 1 Food and Drug Administration-approved commercial source and 6 compounding pharmacies. An independent analysis of drug concentration and density was conducted. Information regarding ordering process, manufacturing, packaging, storage, and expiration was collected.

Main Outcome Measure

Comparison of concentration and density variations.

Results

Twenty-nine ITB samples in concentrations of 2000, 3000, 4000, 5000, and 6000μg/mL were analyzed. Over 40% of compounded samples were more than 5% above or below labeled concentration. Twenty-two percent of compounded samples were more than 10% above or below labeled concentration. The only samples with no concentration deviation and consistent drug density were the commercially available, noncompounded products.

Conclusions

Compounding pharmacies have variable practices in the provision of ITB. A high incidence of concentration inaccuracy existed. The use of compounded ITB may result in unintended dose alterations. Variable clinical efficacy, or life-threatening overdose or withdrawal may occur in patients who are sensitive to slight dose fluctuations. Given the variability of these compounded ITB samples, informed consent to use these products and understanding of potential side effects should be reviewed with patients.     

Discharge Destination's Effect on Bounce-Back Risk in Black, White, and Hispanic Acute Ischemic Stroke Patients

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.     

Relationship of Preinjury Caregiver and Family Functioning to Community Integration in Adults With Traumatic Brain Injury

Sady MD, Sander AM, Clark AN, Sherer M, Nakase-Richardson R, Malec JF. Relationship of preinjury caregiver and family functioning to community integration in adults with traumatic brain injury.

Objective

To investigate the relationship of preinjury caregiver and family functioning to community integration outcomes in persons with traumatic brain injury (TBI).

Design

Inception cohort.

Setting

Three TBI Model Systems inpatient rehabilitation facilities.

Participants

Persons with TBI (N=141) and their caregivers admitted to inpatient rehabilitation and followed up at 1 to 2 years after injury.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire and the Social and Occupation scales of the Craig Handicap Assessment and Reporting Technique.

Results

There were significant interactions of several preinjury caregiver and family variables with injury severity. For persons with complicated mild/moderate injury, better family functioning was associated with greater home integration, and less caregiver distress was associated with better social integration. For persons with severe injuries, greater caregiver perceived social support was associated with better outcomes in productivity and social integration.

Conclusions

Preinjury caregiver and family characteristics interact with injury severity to affect outcomes in persons with injury. Research on outcomes should include measures of caregiver and family functioning. Early interventions targeted toward decreasing caregiver distress, increasing support, and improving family functioning may have a positive impact on later outcomes.     

Posttraumatic Stress Disorder and Spinal Cord Injury

Krause JS, Saunders LL, Newman S. Posttraumatic stress disorder and spinal cord injury.

Objectives

To identify the prevalence of posttraumatic stress disorder (PTSD) after spinal cord injury (SCI) in a sample averaging over 2 decades postinjury at assessment. Related objectives are to confirm the factor structure, compare subscales with those reported in a nonclinical sample, and identify the relationship of PTSD with depression.

Design

Survey.

Setting

A medical university in the Southeastern United States.

Participants

Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States. A cohort of adults (N=927) with traumatic SCI of at least 1 year duration at enrollment in 2002 to 2003 and a minimum of 7 years at the time of assessment completed the study materials.

Interventions

Not applicable.

Main Outcomes Measures

PTSD was measured by the Purdue Posttraumatic Stress Disorder Scale-Revised, and depression was measured by the Patient Health Questionnaire 9-item.

Results

PTSD was reported by less than 10% of the participants. Item endorsement decreased as a function of years postinjury, primarily because of low rates of endorsement among those 21 or more years postinjury. Confirmatory factor analysis did not result in an acceptable fit for subscales, item sets, or factors previously reported in the literature. Participants scored higher than a nonclinical sample (reported in the literature) on the arousal and avoidance subscales but lower on the re-experiencing subscale. Item endorsements were lower for the first set of items that relate directly to the SCI itself, with the highest item endorsement for “have difficulty remembering important aspects of event.” PTSD rarely occurred in the absence of a depressive disorder.

Conclusions

PTSD does not appear to be highly prevalent in long-term SCI survivors, and endorsement of items related to re-experiencing and even recalling the injury are rare. Because SCI often is accompanied by mild traumatic brain injury, difficulty recalling the event may have an organic rather than psychologic component.     

Exercisers achieve greater acute exercise-induced mood enhancement than nonexercisers

Hoffman MD, Hoffman DR. Exercisers achieve greater acute exercise-induced mood enhancement than nonexercisers.

Objective

To determine whether a single session of exercise of appropriate intensity and duration for aerobic conditioning has a different acute effect on mood for nonexercisers than regular exercisers.

Design

Repeated-measures design.

Setting

Research laboratory.

Participants

Adult nonexercisers, moderate exercisers, and ultramarathon runners (8 men, 8 women in each group).

Interventions

Treadmill exercise at self-selected speeds to induce a rating of perceived exertion (RPE) of 13 (somewhat hard) for 20 minutes, preceded and followed by 5 minutes at an RPE of 9 (very light).

Main Outcome Measure

Profile of Mood States before and 5 minutes after exercise.

Results

Vigor increased by a mean ± standard deviation of 8±7 points (95% confidence interval [CI], 5-12) among the ultramarathon runners and 5±4 points (95% CI, 2-9) among the moderate exercisers, with no improvement among the nonexercisers. Fatigue decreased by 5±6 points (95% CI, 2-8) for the ultramarathon runners and 4±4 points (95% CI, 1-7) for the moderate exercisers, with no improvement among the nonexercisers. Postexercise total mood disturbance decreased by a mean of 21±16 points (95% CI, 12-29) among the ultramarathon runners, 16±10 points (95% CI, 7-24) among the moderate exercisers, and 9±13 points (95% CI, 1-18) among the nonexercisers.

Conclusions

A single session of moderate aerobic exercise improves vigor and decreases fatigue among regular exercisers but causes no change in these scores for nonexercisers. Although total mood disturbance improves postexercise in exercisers and nonexercisers, regular exercisers have approximately twice the effect as nonexercisers. This limited postexercise mood improvement among nonexercisers may be an important deterrent for persistence with an exercise program.     

The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence

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.     

A Study of Bone Mineral Density in Adults With Disability

Smith ÉM, Comiskey CM, Carroll ÁM. A study of bone mineral density in adults with disability.

Objectives

To examine prevalence of low bone mineral density (BMD) among adults with disability, using World Health Organization diagnostic categories.

Design

Cross-sectional study.

Setting

National Rehabilitation Hospital, Dublin, Ireland.

Participants

Patients (N=255; 178 men, 77 women) who were disabled for at least 3 months because of acquired brain injury, spinal cord injury, other neurologic condition, or lower-limb amputation.

Interventions

None.

Main Outcome Measures

Laboratory investigations including intact parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and sex hormones; and BMD of lumbar spine and at least 1 hip, measured by dual-energy x-ray absorptiometry and expressed as T scores and z scores.

Results

Mean age ± SD of participants was 48.7±15.6 years. Vitamin D deficiency, 25-OHD level 50nmol/L or less, occurred in 154 (62.9%); insufficiency, a level between 51 and 72nmol/L, occurred in 36 (14.7%). Based on T scores, 108 participants (42.4%) had osteopenia, and 60 (23.5%) had osteoporosis. A z score of −1 or less but more than −2 occurred in 76 (29.8%); a further 52 (20.4%) had a z score of −2 or less. On multiple linear regression analysis, ambulatory status and duration of disability were independent predictors of BMD at neck of femur (β=.152, P=.007; β=−.191, P=.001, respectively) and total proximal femur (β=.170, P=.001; β=−.216, P<.001, respectively).

Conclusions

Osteopenia and osteoporosis are very common in adults with disability participating in rehabilitation, compared with the general young adult population. Duration since onset of disability and mobility status are independent predictors of BMD at the hip. Bone health monitoring should form part of the long-term follow-up in adults with newly acquired disabilities.     

Prevalence of deep tissue injuries in hospitals and nursing homes: Two cross-sectional studies

Background

Deep tissue injuries are severe damages underneath the intact skin caused by long-endured, unrelieved pressure or shear forces. Empirical evidence regarding the magnitude of this health problem is limited.

Objective

Investigation of the prevalence, characteristics of persons affected and identification of the most affected body locations.

Design

Two cross-sectional studies in 2008 and 2009.

Settings

Nursing homes and hospitals throughout Germany.

Participants

6919 (year 2008) and 8451 (year 2009) hospital patients and nursing home residents.

Methods

Trained nurses conducted full skin assessments and collected demographic data based on written data collection forms. The Braden scale was used to measure pressure ulcer risk.

Results

Pressure ulcer prevalence including grades 1-4 and deep tissue injuries ranged from 4.3% (95% CI 3.8-4.9) in nursing homes to 7.1% (95% CI 6.2-8.0) in hospitals. Point prevalence rates of deep tissue injuries were 0.4% (95% CI 0.2-0.5) in hospitals and less than 0.1% in nursing homes. In total, 30 persons were affected by 38 deep tissue injuries. The mean age was 73.4 and the mean Braden scale sum score was 12.8. The most frequently affected anatomic sites were heels (n = 24) and ischial tuberosities (n = 6).

Conclusions

Nurses must be aware that deep tissue injuries exist in clinical practice. Deep tissue injuries seem to be more common in hospitals than in nursing homes and heels are more prone to this kind of injuries than other body sites. Whenever such a lesion is suspected, optimal pressure relief is required to enable the affected tissue to heal.