ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Bogner JA, Corrigan JD, Fugate L, Mysiw WJ, Clinchot D: Role of Agitation in Prediction of Outcomes After Traumatic Brain Injury.Am J Phys Med Rehabil2001;80:636–644.Objective:To determine the role of agitation in the prediction of traumatic brain injury rehabilitation outcomes.Design:A longitudinal study of 340 consecutive patients admitted to an acute traumatic brain injury rehabilitation unit was conducted. Outcomes under study included rehabilitation length of stay, discharge destination, functional independence at discharge (FIMTMinstrument), productivity at 1-yr follow-up, and life satisfaction at 1-yr follow-up (Satisfaction with Life Scale).Results:Univariate analyses suggested that the presence of agitation in rehabilitation is predictive of a longer length of stay and decreased functional independence in the cognitive realm at discharge. In addition, individuals who exhibit agitation at any time during rehabilitation are less likely to be discharged to a private residence. However, multivariate analyses indicated that cognitive functioning at admission to rehabilitation (FIM cognitive) mediates the relationship between the presence of agitation and length of rehabilitation, as well as between agitation and FIM cognitive at discharge. Similar results were found when discharge residence was the dependent variable; however, agitation also contributed some unique variance to the prediction. Lower cognitive functioning at admission to rehabilitation was associated with the occurrence of agitation during rehabilitation, longer length of stay, lower cognitive functioning at discharge, and a decreased likelihood that an individual would be discharged to a private residence.Conclusions:The results of the multivariate analyses support the contention that agitation and cognition are intimately related, with the long-term effects of the former being at least partially driven by the latter. These findings support the importance of systematically monitoring both agitation and cognition when applying interventions to reduce agitation.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Inouye M: Predicting outcomes of patients in Japan after first acute stroke using a simple model.Am J Phys Med Rehabil2001;80:645–649.Objective:Prediction of patient outcome can be useful as an aid to clinical decision making. Many studies, including my own, have constructed predictive multivariate models for outcome following stroke rehabilitation therapy, but these have often required several minutes work with a pocket calculator. The aim is to develop a simple, easy-to-use model that has strong predictive power.Methods:Four hundred sixty-four consecutive patients with first stroke who were admitted to a rehabilitation hospital during a period of 19 mo were enrolled in the study. Sex, age, the stroke type, Functional Independence Measure total score on admission (X), onset to admission interval (number of days from stroke onset to rehabilitation admission), and length of rehabilitation hospital stay (number of days from hospital admission to discharge) were the independent variables. Functional Independence Measure total score at discharge (Y) was the dependent variable.Results:Stepwise multiple regression analysis resulted in the model containing age (P< 0.0001),X(P< 0.0001), and onset to admission interval (P< 0.0001). The equation was:Y= 68.6 − 0.32 (age) + 0.80X− 0.13 (onset to admission interval), a multiple correlation coefficient (R) = 0.82, and a multiple correlation coefficient squared (R2) = 0.68. Simple regression analysis revealed the relation betweenXandY:Y= 0.85X+ 37.36, andR= 0.80,R2= 0.64. In fact, plots ofXvs.Ywere nonlinear, but seemed to be able to be linearized by some form of equation. It was found that there is a linear relation between logXandY. The equation isY= 106.88x− 95.35, wherex= logX,R= 0.84, andR2= 0.70. The correlation is improved by a regression analysis of a natural logarithmic transformation ofX(R= 0.84vs.R= 0.82).Conclusion:The results in this study confirm that the simple regression model using a logarithmic transformation ofX(R= 0.84) has predictive power over the simple regression model (R= 0.80). This model is well validated and clinically useful.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Bayramoğlu M, Akman MN, Kılınç Ş, Çetin N, Yavuz N, Özker R: Isokinetic measurement of trunk muscle strength in women with chronic low-back pain.Am J Phys Med Rehabil2001;80:650–655.Objectives:To investigate the relationships among chronic low-back pain and obesity, total spinal range of motion, and trunk muscle strength. The short-term impact of trunk muscle strengthening exercises on this condition was also examined.Design:A controlled, prospective study of trunk muscle strengths of patients with chronic low-back pain and the short-term impact of exercise on strength. The study group consisted of 25 female patients who had been experiencing low-back pain for at least 3 mo, and the control group included 20 age-matched women without known low-back trouble. The Davenport Index was used to calculate the body mass indexes of all subjects. The Oswestry Disability Questionnaire was used to assess pain in the study group. Full flexion and extension ranges of motion were measured, then isokinetic measurements of trunk muscles were performed at 60-, 120-, and 180-degrees/sec velocities. Isometric measurements were also recorded for both flexors and extensors at a 60-degree angle.Results:Increased body mass index and decreased trunk muscle strength were found to be directly associated with chronic low-back pain (P< 0.05). After a 15-day standard trunk strengthening exercise program in the patient group, trunk muscle strength was found to be increased (P< 0.05).Conclusions:Obesity and decrease in trunk muscle strength are important factors in chronic low-back pain, and a trunk muscle strengthening program will be helpful in reducing the pain.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pantukosit S, Petchkrua W, Stiens SA: Intersection syndrome in Buriram Hospital: a 4-yr prospective study.Am J Phys Med Rehabil2001;80:656–661.Objective:To determine the prevalence, demographic characteristics, symptoms, treatment, and outcome of patients who presented to Buriram Provincial hospital and were diagnosed with intersection syndrome.Design:This was a 4-yr prospective study that included all patients with new complaints of forearm and hand pain who presented to Buriram hospital as inpatients or outpatients.Results:The prevalence of intersection syndrome was found to be 0.37% of all patients (8080) with arm or hand pain. Of the 30 patients presenting with intersection syndrome, all had forearm pain, 22 (73.3%) had swelling, and 12 (40%) had crepitus noted in the intersected region. Fourteen (46.7%) patients reported pain provoked with twisting hand motions with radial deviations, 4 (13.3%) with pulling, and 12 (40%) with combinations of multiple hand movements (threshing, planting, hammering, hand washing, spraying and cementing). The majority of the patients were male (70%) farmers (60%). Twenty-nine patients received nonoperative treatment, including modified work activities to reduce stress on the wrist, nonsteroidal anti-inflammatory, and analgesic medications. One patient received only analgesic medication. One patient additionally required a resting hand splint. Every patient was seen for follow-up within the next 7 days. By 12–18 months posttreatment, there were only 14 patients (46.6%) remaining in follow-up, none with any symptom recurrence.Conclusion:Intersection syndrome is a relatively uncommon, overused syndrome that is associated with repeated radial deviation of the wrist and responds favorably to conservative treatment.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Velozo CA, Peterson EW: Developing meaningful fear of falling measures for community dwelling elderly.Am J Phys Med Rehabil2001:80:662–673.Objective:The objective of this study is to demonstrate how a Rasch analytic approach can be used to create fear of falling measures that remain connected to the meaningful descriptions provided by the instrument items.Design:The University of Illinois at Chicago Fear of Falling Measure was developed using focus groups and consists of 19 common activities designed to represent an increasing level of concern about falling among older adults.Results:Rasch analysis of responses from 106 community dwelling elderly revealed that the two middle rating scale categories (a little worriedandmoderately worried) were not being used in the expected fashion. After modification of the rating scale, Rasch analysis showed that the three items causing the least worry (get dressed,get on/off toilet, andget in/out of bed) were statistically erratic.Conclusion:Final analysis demonstrated that the remaining 16 items represented a unidimensional construct that, in general, supported the original expected item difficulty hierarchy. Because person and item measures were calibrated on the same linear scale person measures are translatable to item descriptions. This connection provides meaning to the numeric values obtained from the instrument and provides a basis for setting clinically relevant criteria for interventions.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Samsa GP, Hoenig H, Branch LG: Relationship between self-reported disability and caregiver hours.Am J Phys Med Rehabil2001;80:674–684.Objective:In a large, population-based cohort of patients with spinal cord dysfunction, we assessed the relationship between self-reported physical function and hours of care received.Design:Data were obtained by a cross-sectional, self-administered survey used to help establish a national registry of veterans with spinal cord dysfunction. Participants were originally identified from Department of Veterans Affairs databases as having a high probability of spinal cord dysfunction. All 13,542 respondents reporting spinal cord dysfunction and also having complete data on physical function and caregiver hours (CGHs) were included. Physical function was measured using the Self-Reported Functional Measure, and CGHs were obtained from a self-report of hours of caregiving received during the last 2 wk.Results:The relationship between self-reported disability and CGHs was strong (Spearman correlation = −0.70). Subjects with moderate levels of disability had the most variability in CGHs. After stratifying by total Self-Reported Functional Measure score, the strongest predictors of CGHs were instrumental activities of daily living and individual Self-Reported Functional Measure items, explaining a moderate amount of variation in CGHs.Conclusion:These data support the construct validity of the Self-Reported Functional Measure and suggest that self-reported disability measures can be of use in describing the clinical epidemiology of patients with spinal cord dysfunction.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pedersen PM, J/orgensen HS, Kammersgaard LP, Nakayama H, Raaschou HO, Olsen TS: Manual and oral apraxia in acute stroke, frequency and influence on functional outcome: the Copenhagen Stroke Study.Am J Phys Med Rehabil2001;80:685–692.Objectives:To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome.Design:Seven hundred seventy six unselected, acute stroke patients who were admitted within seven days of stroke onset with unimpaired consciousness were included. If possible, the patients were assessed for manual and oral apraxia on acute admission. Neurologic stroke severity including aphasia was assessed with the Scandinavian Stroke Scale, and activities of daily living function was assessed with the Barthel Index. All patients completed their rehabilitation in the same large stroke unit.Results:Six hundred eighteen patients could cooperate with the apraxia assessments. Manual apraxia was found in 7% of subjects (10% in left and 4% in right hemispheric stroke; &khgr;2= 9.0;P= 0.003). Oral apraxia was found in 6% (9% in left and 4% in right hemispheric stroke; &khgr;2= 5.4;P= 0.02). Both manual and oral apraxia were related to increasing stroke severity, and manual, but not oral, apraxia was associated with increasing age. There was no gender difference in frequency of apraxia. Patients with either type of apraxia had temporal lobe involvement more often than patients without. When analyzed with multiple linear and logistic regression analyses, neither manual nor oral apraxia had any independent influence on functional outcome.Conclusion:Apraxia is significantly less frequent in unselected patients with acute stroke than has previously been assumed and has no independent negative influence on functional outcome.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

McKinley WO, Seel RT, Gadi RK, Tewksbury MA: Nontraumaticvs.traumatic spinal cord injury: a rehabilitation outcome comparison.Am J Phys Med Rehabil2001;80:693–699.Objective:Nontraumatic spinal cord injury (SCI) represents a significant proportion of individuals admitted for SCI rehabilitation; however, there is limited literature regarding their outcomes. As our society continues to age and nontraumatic injuries present with greater frequency, further studies in this area will become increasingly relevant. The objective of this study was to compare outcomes of patients with nontraumatic SCI with those with traumatic SCI after inpatient rehabilitation.Design:A longitudinal study with matched block design was used comparing 86 patients with nontraumatic SCI admitted to a SCI rehabilitation unit and 86 patients with traumatic SCI admitted to regional model SCI centers, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. Main outcome measures included acute and rehabilitation hospital length of stay, FIMTMscores, FIM change, FIM efficiency, rehabilitation charges, and discharge-to-home rates.Results:Results indicate that when compared with traumatic SCI, patients with nontraumatic SCI had a significantly (P< 0.01) shorter rehabilitation length of stay (22.38vs.41.35 days) and lower discharge FIM scores (57.3vs.65.6), FIM change (18.6vs.31.0), and rehabilitation charges ($25,050vs.$64,570). No statistical differences were found in acute care length of stay, admission FIM scores, FIM efficiency, and community discharge rates.Conclusions:The findings indicate that patients with nontraumatic SCI can achieve rates of functional gains and community discharge comparable with traumatic SCI. Whereas patients with traumatic SCI achieved greater overall functional improvement, patients with nontraumatic SCI had shorter rehabilitation length of stay and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with nontraumatic SCI.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID