摘要:

Zemper ED: Two-year prospective study of relative risk of a second cerebral concussion.Am J Phys Med Rehabil2003;82:653–659.ObjectiveTo prospectively measure the relative risk of cerebral concussion among those with a history of concussion compared with those having no previous concussions by using a population of high school and college football players.DesignA representative national sample of high school and college football players was followed for two football seasons over a 2-yr period (1997–1998) as part of a national football injury surveillance project. There were a total of 15,304 player-seasons and over 1 million athlete-exposures to the possibility of injury in practices and games; 975 of the player-seasons (6.4%) had a history of concussion in the previous 5 yr.ResultsThere were 572 concussions recorded, 161 among those with a history (16.5%) and 411 among those with no history (2.9%). Relative risk for individuals with a history of concussion is 5.8 times greater than for individuals with no history (95% confidence interval, 4.8–6.8).ConclusionThis large prospective cohort study indicates the risk of sustaining a cerebral concussion is nearly six times greater for individuals with a history of concussion than for individuals with no such history.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

LaBan MM, Kucway EJ: Aeolus myth: Chronic obstructive lung disease and nocturnal lumbosacral pain in association with lumbar spinal stenosis and pulmonary hypertension.Am J Phys Med Rehabil2003;82:660–664.ObjectiveTo describe an association between the syndromes of lumbar spinal stenosis and chronic obstructive pulmonary disease (COPD) in patients presenting with symptoms of nocturnal lumbosacral radiculopathy.DesignRetrospective review of 46 sequential inpatients referred with complaints of lumbosacral radicular pain associated with lumbar spinal stenosis. Half (23) were experiencing sleep disruptive nocturnal pain. Each had been hospitalized with a primary diagnosis of COPD. They were subsequently compared with another group of inpatients (23) who were also experiencing lumbar pain not necessarily increased at night. Each was also identified as having lumbar spinal stenosis without an antecedent history of COPD. In each case, lumbar spinal imaging studies (computed tomography or magnetic resonance imaging) were obtained. Pulmonary function tests were performed in those with COPD, and two-dimensional echocardiograms were obtained in all 46 patients.ResultsThe ratio of women to men, their ages, surgical interventions, severity of lumbar spinal stenosis, and left ventricular function as compared one group with another was not significantly different. However, pulmonary artery pressures were notably elevated (i.e., pulmonary hypertension) in those with COPD and nocturnal lumbosacral radiculopathy.ConclusionThis study suggests that in patients with COPD and lumbar spinal stenosis, pulmonary hypertension may be the dynamic link exacerbating nocturnal lumbosacral pain.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Guo Y, Young B, Palmer JL, Mun Y, Bruera E: Prognostic factors for survival in metastatic spinal cord compression: A retrospective study in a rehabilitation setting.Am J Phys Med Rehabil2003;82:665–668.ObjectiveMetastatic spinal cord compression (MSCC) occurs in 5–10% of all patients with cancer, and it is associated with short survival durations. Patients with MSCC may also have functional loss and require rehabilitation before discharge from the hospital. The purposes of this retrospective study were to identify clinical and social variables that had a significant impact on survival of patients with MSCC who underwent inpatient rehabilitation.DesignA total of 60 consecutive patients with MSCC who were admitted to the inpatient rehabilitation unit at our tertiary care cancer center between 1996 and 1998 were included. Age, discharge destination, primary tumor site, metastasis, comorbidity, hemoglobin and albumin levels, treatment rendered for MSCC, opioids used, and psychological symptoms were examined as variables, and the Kaplan-Meier survival analysis was used.ResultsOur study showed that most of the variables we examined had no significant influence on survival time (median, 4.1 mo), with the exception of gastrointestinal cancer; patients with gastrointestinal cancer had a poorer prognosis (median survival durations, 0.6 mo;P< 0.0001). We also found a 1-mo gap between the time of diagnosis and the time of transfer to the rehabilitation unit.ConclusionThis study suggests that rehabilitation programs for patients with MSCC should be of short duration and that early referral (i.e., when the patient is diagnosed of MSCC) to the rehabilitation service should be encouraged.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Nallegowda M, Singh U, Bhan S, Wadhwa S, Handa G, Dwivedi SN: Balance and gait in total hip replacement: A pilot study.Am J Phys Med Rehabil2003;82:669–677.ObjectiveEvaluation of balance, gait changes, sexual functions, and activities of daily living in patients with total hip replacement in comparison with healthy subjects.DesignA total of 30 patients were included in the study after total hip replacement. Balance was examined using dynamic posturography, and gait evaluation was done clinically. Sexual functions and activities of daily living were also assessed. A total of 30 healthy subjects of comparable age and sex served as a control group.ResultsDynamic balance and gait differed significantly in both the groups. Despite capsulectomy, no significant difference was observed on testing proprioception. In the sensory organization tests with difficult tasks, patients needed more sensory input from vision and vestibular sense, despite normal proprioceptive sense. Significant difference was observed for limits of stability, rhythmic weight shifts, and for gait variables other than walking base. Some of the patients had major difficulties with sexual functions and activities of daily living.ConclusionsCompared with the healthy age- and sex-matched controls, patients with total hip replacement did not have any proprioceptive deficit. Patients required extrasensory input, and there was a delayed motor response. Gait and dynamic balance results also indicated the motor deficit and required a compensatory strategy. Restoration of the postural control in these patients is thus essential. Necessary training is required for balance, gait, and activities of daily living, and proper sexual counseling is necessary in postoperative care.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Chiou-Tan FY, Garza H, Chan KT, Parsons KC, Donovan WH, Robertson CS, Holmes SA, Graves DE, Rintala DH: Comparison of dalteparin and enoxaparin for deep venous thrombosis prophylaxis in patients with spinal cord injury.Am J Phys Med Rehabil2003;82:678–685.ObjectiveTo determine differences between dalteparin and enoxaparin in patients with spinal cord injury.DesignThis prospective, randomized, open-label study was performed as a multiple hospital trial in a large urban setting. A total of 100 patients with acute (<3 mo) spinal cord injury were recruited. A total of 95 patients met all inclusion criteria. Fifty received enoxaparin, and 45 received dalteparin. Main outcome measures included deep venous thrombosis, bleeding, compliance, Short Form-12 Health Status Survey, satisfaction, and medication/labor costs. Patients were randomized to receive 30 mg of enoxaparin subcutaneously every 12 hr or 5000 IU of dalteparin subcutaneously once daily. Prophylaxis was continued for 3 mo for motor-complete and 2 mo for motor-incomplete patients.ResultsSix percent of the patients developed deep venous thrombosis while receiving enoxaparin and 4% while receiving dalteparin (&khgr;2= 0.44,df= 1,P= 0.51). Four percent developed bleeding while receiving dalteparin and 2% while receiving enoxaparin (&khgr;2= 0.13,df= 1,P= 0.72). No differences were noted in compliance, health status, or most of the satisfaction measures. It was, however, noted that after being discharged home, the patients receiving enoxaparin rated the shots significantly more inconvenient (two injections per day) compared with taking three pills per day, than those receiving dalteparin (one injection per day,P< 0.05). The cost of the medication was $1101/mo for enoxaparin (two injections per day) and $750/mo for dalteparin (one injection per day).ConclusionSimilar compliance, health status, deep venous thrombosis, and bleeding rates were found between dalteparin and enoxaparin.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Fish DE, Radfar-Baublitz LS, Choi H, Felsenthal G: Correlation of standardized testing results with success on the 2001 American Board of Physical Medicine and Rehabilitation part 1 board certificate examination.Am J Phys Med Rehabil2003;82:686–691.ObjectiveTo determine if standardized testing results and other factors correlate with success on the 2001 American Board of Physical Medicine and Rehabilitation part 1 board certification examination (POE).DesignAn anonymous two-part survey was distributed to 302 senior resident physicians in the American College of Graduate Medicine Education–accredited physical medicine and rehabilitation training programs in the United States deemed eligible for the 2001 POE.ResultsA total of 94 of 302 distributed surveys (31.1%) were returned; 86 met the inclusion criteria (81 passes and five failures). A significant correlation was found between both quartile ranking on the Self Assessment Examination and United States Medical Licensing Examination (USMLE) passage on the first attempt with POE quartile rank (P< 0.01). Other factors, such as number of hours of faculty-led didactics per week, textbook use, and participation in formal board review courses did not correlate with POE quartile ranking.ConclusionResidents who were successful on previous standardized tests scored well on the POE. Quartile ranking on Self Assessment Examination and USMLE or National Board of Osteopathic Medical Examiners success was found to correlate significantly with POE quartile rank. This information may be helpful for future POE preparation and prospective candidate selection for physical medicine and rehabilitation.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Tooth LR, Ottenbacher KJ, Smith PM, Illig SB, Linn RT, Gonzales VA, Granger CV: Effect of functional gain on satisfaction with medical rehabilitation after stroke.Am J Phys Med Rehabil2003;82:692–699.ObjectiveTo examine the association between gain in motor and cognitive functional status with patient satisfaction 3–6 mo after rehabilitation discharge.DesignPatient satisfaction and changes in functional status were examined in 18,375 patients with stroke who received inpatient medical rehabilitation. Information was obtained from 144 hospitals and rehabilitation facilities contributing records to the Uniform Data System for Medical Rehabilitation and the National Follow-up Services.ResultsData analysis revealed significant (P< 0.05) differences in satisfaction responses based on whether information was collected from patient self-report or from a family member proxy, and the two subsets were analyzed separately. Logistic regression revealed the following significant predictors of satisfaction for data collected from stroke patients: cognitive and motor gain, rehospitalization, who the patient was living with at follow-up, age, and follow-up therapy. In the patient-reported data subset, compared with patients who showed improved cognitive or motor functional status, those with no change, respectively, had a 31% and 33% reduced risk of dissatisfaction. In addition, rehospitalized patients had a higher risk of dissatisfaction. For the proxy reported data subset, significant influences on satisfaction were health maintenance, rehospitalization, stroke type, ethnicity, cognitive FIM™ gain, length of stay, and follow-up therapy.ConclusionsRatings of satisfaction with rehabilitation services were affected by change in functional status and whether the information was collected from patient rating or proxy response.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Deutsch A, Fiedler RC, Iwanenko W, Granger CV, Russell CF: Uniform Data System for Medical Rehabilitation report: Patients discharged from subacute rehabilitation programs in 1999.Am J Phys Med Rehabil2003;82:703–711.This is the third annual report describing patients discharged from subacute rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation (UDSmr). The analysis included 39,562 complete records of first admission cases discharged alive from 180 facilities in 1999. Sixty-five percent of the patients were women, and most patients (91%) were white. Sixty-two percent of the patients were 75 yr of age or older. Before the impairment onset, 55% lived with at least one other person. The average total FIM™ (motor and cognitive) score change for all patients was 21.1 points, and when stratified by rehabilitation impairment group, average scores ranged from 18.3 for patients with pulmonary conditions to 25.3 for patients with a joint replacement. The percentage of patients discharged to a community-based setting ranged from 67% for patients with stroke to 94% for patients with a joint replacement. These data show that patients receiving care in subacute rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.

ISSN:0894-9115    

出版商:OVID    

年代:2003

数据来源: OVID