Using the electronic medical record to study the association of child and environmental characteristics on the type of physical therapy services delivered to individuals with cerebral palsy

The purpose of this study was to characterize the intervention type delivered to individuals with cerebral palsy (CP) in a pediatric outpatient medical setting and to identify factors associated with the total amount of service within each type. Four hundred and twenty-five individuals with CP (1–33 years) Gross Motor Function Classification System (GMFCS): Level I (n = 152); II (n = 63); III (n = 55); IV (n = 80); and V (n = 75). Billing code data was extracted retrospectively from 2008 medical records and categorized to reflect four types: body structures and function (BSF), activity (ACT), environment (ENV), and examination (EXAM). Age at first visit, type of insurance at first visit and GMFCS level was also collected. The majority (47%) of the PT delivered was categorized as activity based units, 25% as body structure and function, 21% as environment, and 7% as examination. Significant differences were found in: total BSF therapy units among GMFCS (p = 0.008) and insurance type (p < 0.001), ACT units among GMFCS (p < 0.001), age groups (p < 0.001), and insurance type (p = 0.008), and ENV units among GMFCS (p = 0.04). The amount of variability (R²) explained by the model for each category BSF, ACT, and ENV was 0.09 (p < 0.0001), 0.15 (p < 0.0001) and 0.02 (p = 0.04), respectively. Variations in amount of services received among types of intervention are associated with child and environmental characteristics. Low R² values indicate the need to collect information on other factors that influence service delivery. Data that are standardized and reliably collected should be validated and compared across institutions to support larger studies of service delivery patterns.     

Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study

Many patients with chronic fatigue syndrome(CFS) and/or fibromyalgia(FM) have little understanding of their condition, leading to maladaptive pain cognitions and coping strategies. These should be tackled during therapy, for instance by pain neurophysiology education (PNE). Although positive effects of PNE are well-established, it remains unclear why some patients benefit more than others. This paper aims at exploring characteristics of patients responding poor to PNE to further improve its effectiveness. Data from two RCT’s were pooled to search for baseline predictors. Subjects (n = 39) suffering from CFS/FM, as defined by the American College of Rheumatology, underwent PNE treatment. The Pain Catastrophizing Scale (PCS); Pain Coping Inventory (PCI); and Tampa Scale of Kinesiophobia (TSK) were defined as outcome measures. There was a significant negative relationship between baseline TSK and the change in both PCS total score (r = ?0.584; p < 0.001) and PCS rumination (r = ?0.346; p < 0.05). There was a significant negative relationship between the change in PCS total score and baseline PCI worrying (r = ?0.795; p < 0.001) and retreating (r = ?0.356; p < 0.05). FM/CFS patients who tend to worry allot about their pain and with high levels of kinesiophobia are likely to experience less reductions in catastrophizing following PNE. It seems that PNE alone is insufficient to reduce catastrophic thinking regarding pain, and supplementary treatment is needed.     

Relationship of depression and medications on incidence of falls among people with late effects of polio

The purpose of this study was to determine if falls in polio survivors, with or without post-polio syndrome (PPS), are related to number of medications taken, use of anti-depressant or psychoactive medications, or self-report of depression. A survey was sent to 300 members of a regional polio support group, asking them to document their fall history, medications used, and the presence of depression. Depression was measured by self-report and with the Geriatric Depression Scale, short form (GDS-15). One hundred and seventy-two usable surveys were returned with 146 of those completing the medication list. Sixty-two percent reported at least one fall in the past year. The multiple logistic regression was significant (p = 0.023), and it indicated depression to be a significant predictor (p = 0.012) of falls in polio survivors with and without PPS. The number of total medications or anti-depressant or psychoactive medications used was not related to fall incidence. Routine screening and treatment for depression may be one aspect of fall prevention which can be implemented through primary care.     

Antibodies to hepatitis C virus in autologous blood donors

Hepatitis C virus (HCV) is the major cause of posttransfusion hepatitis. Two anti-HCV enzyme immunoassay (EIA) kits and one recombinant immunoblot assay (RIBA) were used to test serum samples of 1476 donations from 692 autologous blood donors to assess the prevalence of anti-HCV and its relationship to transfusion history. Of all autologous blood donations, 23 (1.6%) reacted when tested with one EIA kit and 29 (2.0%) reacted when tested by the other EIA kit. Of the autologous donors, 12 (1.78%) reacted by the first EIA kit and 14 (2.02%) by the second. Discrepancies in the EIA results from different donations by the same donor were seen in seven donors. The RIBA was positive or indeterminate in 33 percent of the EIA-reactive donations and in 41 percent of EIA-reactive donors. All RIBA-positive and -indeterminate samples reacted with both EIA kits. There was no significant difference in the EIA-reactive rates of autologous and first-time homologous blood donors. Previously transfused autologous blood donors had a higher anti-HCV EIA-reactive rate than nontransfused autologous donors, but the difference was not significant. In regard to hepatitis C, the use of autologous blood for homologous transfusion appears to be as safe as the use of blood from first-time homologous donors. Universal testing of previously transfused patients for hepatitis C appears premature at this time. Discrepant anti-HCV EIA results from different donations from the same individual have implications regarding donor deferral.     

Modification of glutathione content in platelet concentrates by the use of acivicin

BACKGROUND: Intracellular glutathione declines progressively in platelet concentrates stored for transfusion, but little is known about the nature of this process. STUDY DESIGN AND METHODS: Acivicin, an irreversible inhibitor of gamma-glutamyl transpeptidase, was used to determine the fate of glutathione lost from platelets during storage. Glutathione, cysteinylglycine, cysteine, and their disulfides were measured by high-performance liquid chromatography. RESULTS: In control and acivicin-treated platelet concentrates, intracellular glutathione declined progressively during 7 days' storage, with half-disappearance times of 2.12 +/− 0.22 and 2.13 +/− 0.23 days, respectively. No glutathione accumulated accumulated in the medium of control concentrates. In concentrates treated with acivicin, glutathione accumulated in plasma to a level equal to 150 percent of that present in platelets and plasma on Day 1 of storage, which suggested a net synthesis of glutathione during storage. The sum of glutathione, cysteinylglycine, and cysteine in plasma was not different in control and acivicin-treated concentrates; however, plasma from control concentrates contained significantly higher amounts of cysteinylglycine and cysteine. Treatment of concentrates with acivicin had a small favorable effect on plasma lactate dehydrogenase, beta-thromboglobulin, and beta-N-acetylglucosaminidase during storage. CONCLUSION: The loss of glutathione from platelets during their storage as concentrates for transfusion is due to its egress into the suspending medium and catabolism by gamma-glutamyl transpeptidase.     

Pain Self‐Efficacy and Fear of Movement are Similarly Associated with Pain Intensity and Disability in Italian Patients with Chronic Low Back Pain

The purpose of this study was to investigate cross‐sectional associations of pain self‐efficacy and fear of movement with pain intensity and disability in Italian patients with chronic low back pain (CLBP). One hundred and three adult outpatients with nonspecific CLBP were included in the study. Socio‐demographic and clinical characteristics were assessed, together with Italian versions of self‐reported questionnaires to measure the four constructs of interest. Multiple linear regression models were built with psychosocial constructs as main determinants, and pain intensity and disability as outcomes. Potential confounding of socio‐demographic and clinical characteristics was assessed. Pain self‐efficacy and fear of movement displayed moderate correlations with pain intensity (r = ?0.41 and 0.42, respectively) and disability (?0.55 and 0.54). Association models adjusted for pain intensity showed that both pain self‐efficacy (β = ?0.35, 95% CI = ?0.5; ?0.2, R² = 41%) and fear of movement (β = 0.65, 95% CI = 0.36; 0.93, R² = 40%) are significantly and strongly associated with disability. Pain self‐efficacy was no longer significantly associated with pain intensity when disability was added as a confounder to the model, whereas fear of movement retained its significant association (β = 0.06, 95% CI = 0.00;0.11, R² = 30%). No other variables acted as confounders in these associations. Pain self‐efficacy and fear of movement are very similarly associated with main outcomes in this sample of Italian patients with CLBP. The results of this study suggest that both psychosocial constructs should be considered in clinical management. Future studies should investigate whether these findings can be replicated in other samples, in longitudinal designs and if other variables not measured in this study confound the associations.