Samuel S Wu

University of Florida, Gainesville, Florida, United States

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Publications (109)335.17 Total impact

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    ABSTRACT: Background Coronary artery disease is highly prevalent in patients with stroke, but because revascularization does not improve major clinical outcomes in patients with stable coronary artery disease relative to intensive medical therapy, routine evaluation for this disease is not warranted in stroke patients. However, it might be warranted in patients destined to undergo vigorous physical therapy. The Locomotor Experience Applied Post-Stroke study, a randomized controlled trial of 408 participants that tested the relative efficacy of two rehabilitation techniques on functional walking level, provided the opportunity to address this question.AimThe study aims to test the efficacy of screening for cardiovascular disease and an exercise tolerance test in assuring safety among patients undergoing vigorous rehabilitation for gait impairment.Methods All participants were screened for serious cardiovascular and pulmonary conditions. At six-weeks poststroke, they also completed a cardiovascular screening inventory and underwent an exercise tolerance test involving bicycle ergometry. Participants received 36, 90-min sessions of a prescribed physical therapy (three per week), initiated at either two-months or six-months poststroke.ResultsTwenty-nine participants were excluded on the basis of the cardiac screening questionnaire, and 15 failed the exercise tolerance test for cardiovascular reasons. No participant experienced a cardiac event during a treatment session. Two participants experienced myocardial infarctions, but continued in the trial. In three additional participants, myocardial infarctions caused or contributed to death.Conclusions The combination of a negative cardiac screen and the absence of exercise tolerance test failure appeared to have a high negative predictive value for cardiac events during treatment, despite the likelihood of a high prevalence of coronary artery disease in our population.
    International Journal of Stroke 09/2014; · 4.03 Impact Factor
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    ABSTRACT: Age-related impairment of neuromuscular activation has been shown to contribute to weakness in older adults. However, it is unclear to what extent impaired neuromuscular activation independently accounts for decline of mobility function. The hypothesis of this study is that capability to produce rapid neuromuscular activation during maximal effort leg muscle contractions will be shown to be an independent predictor of mobility function in older men and women after accounting for muscle size and adiposity, body composition and age. Twenty six older men and eighteen older women (aged 70-85 years) participated in this study. Mobility function was assessed by the 400-meter walk test. Neuromuscular activation of the quadriceps muscle group was assessed by surface electromyography (“rate of EMG rise”). Thigh muscle cross sectional area and adiposity was assessed by computed tomography. In males, univariate regression analysis revealed strong associations between walking speed and a number of predictors including age (p < 0.01), muscle area (p < 0.01), intermuscular adipose tissue area (p < 0.01), and rate of EMG rise (p < 0.001). Subsequent multiple regression analysis with all variables accounted for 72% of the variability in walking speed (p < .0001), with age and rate of EMG rise as the dominant variables in the model. In females, univariate analysis showed a significant association only between walking speed and subcutaneous adipose tissue area (p < 0.05). Multiple regression analysis accounted for only 44% of the variability in walking speed, and was not statistically significant (p = 0.18). The present findings indicate that the capability to rapidly activate the quadriceps muscle group is an important factor accounting for inter-individual variability of walking speed among older men, but not among older women. This research is important for informing the design of assessments and interventions that seek to detect and prevent impairments that contribute to age-related mobility disability.
    Experimental gerontology 07/2014; · 3.34 Impact Factor
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    ABSTRACT: We previously reported a randomized, sham-controlled trial of 5 Hz dorsolateral prefrontal left- and right-side repetitive transcranial magnetic stimulation (rTMS) in 48 participants with a medically refractory major depressive disorder. Depression improved most with right-side cranial stimulation, both rTMS and sham, and to a lesser degree with left rTMS. Because depression is often associated with cognitive impairment, in this study we sought to determine whether our earlier participants had treatment-induced changes in cognition, which cognitive domains (language, executive, visuospatial, verbal episodic memory, attention) were affected, and whether treatment-induced cognitive changes were related either to improvement in depression or to other treatment variables, such as right versus left treatment and rTMS versus sham.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):77-87. · 1.09 Impact Factor
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    ABSTRACT: Phase III trials of rehabilitation of paresis after stroke have proven the effectiveness of intensive and extended task practice, but they have also shown that many patients do not qualify, because of severity of impairment, and that many of those who are treated are left with clinically significant deficits. To test the value of 2 potential adjuvants to normal learning processes engaged in constraint-induced movement therapy (CIMT): greater distribution of treatment over time and the coadministration of d-cycloserine, a competitive agonist at the glycine site of the N-methyl-D-aspartate glutamate receptor. A prospective randomized single-blind parallel-group trial of more versus less condensed therapy (2 vs 10 weeks) and d-cycloserine (50 mg) each treatment day versus placebo (in a 2 × 2 design), as potential adjuvants to 60 hours of CIMT. Twenty-four participants entered the study, and 22 completed it and were assessed at the completion of treatment and 3 months later. Neither greater distribution of treatment nor treatment with d-cycloserine significantly augmented retention of gains achieved with CIMT. Greater distribution of practice and treatment with d-cycloserine do not appear to augment retention of gains achieved with CIMT. However, concentration of CIMT over 2 weeks ("massed practice") appears to confer no advantage either.
    Neurorehabilitation and neural repair 04/2014; · 4.28 Impact Factor
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    ABSTRACT: The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking) and 0.8 m/s (community walking). Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group.
    The Journal of Rehabilitation Research and Development 04/2014; 51(1):39-50. · 1.78 Impact Factor
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    ABSTRACT: The pain experience has multiple influences but little is known about how specific biological and psychological factors interact to influence pain responses. The current study investigated the combined influences of genetic (pro-inflammatory) and psychological factors on several pre-clinical shoulder pain phenotypes. An exercise-induced shoulder injury model was used, and a priori selected genetic (IL1B, TNF/LTA region, IL6 single nucleotide polymorphisms, SNPs) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as the predictors of interest. The phenotypes were pain intensity (5-day average and peak reported on numerical rating scale), upper-extremity disability (5-day average and peak reported on the QuickDASH instrument), and duration of shoulder pain (in days). After controlling for age, sex, and race, the genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each pain phenotype. Results from the recruited cohort (n = 190) indicated strong statistical evidence for the interactions between 1) TNF/LTA SNP rs2229094 and depressive symptoms for average pain intensity and duration and 2) IL1Β two-SNP diplotype and kinesiophobia for average shoulder pain intensity. Moderate statistical evidence for prediction of additional shoulder pain phenotypes included interactions of kinesiophobia, fear of pain, or depressive symptoms with TNF/LTA rs2229094 and IL1B. These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts, to determine their involvement in the transition from acute to chronic pain conditions.
    Medicine and science in sports and exercise 03/2014; · 4.48 Impact Factor
  • Samuel S Wu, Yi-Hsuan Tu, Ying He
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    ABSTRACT: Adaptive design of clinical trials has attracted considerable interest because of its potential of reducing costs and saving time in the clinical development process. In this paper, we consider the problem of assessing the effectiveness of a test treatment over a control by a two-arm randomized clinical trial in a potentially heterogenous patient population. In particular, we study enrichment designs that use accumulating data from a clinical trial to adaptively determine patient subpopulation in which the treatment effect is eventually assessed. A hypothesis testing procedure and a lower confidence limit are presented for the treatment effect in the selected patient subgroups. The performances of the new methods are compared with existing approaches through a simulation study. Copyright © 2014 John Wiley & Sons, Ltd.
    Statistics in Medicine 02/2014; · 2.04 Impact Factor
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    ABSTRACT: Background Spinocerebellar ataxia type 10 (SCA10) is caused by an expansion of a normally polymorphic ATTCT repeat within intron 9 of the ATXN10 gene. Interrupting sequences in the expanded ATTCT repeat track are postulated to be a disease modifier, but are not fully characterized in SCA10 patients. AimAs the large size and the repetitive nature of the SCA10 expansion does not make it amenable for Sanger or next-generation sequencing, we need an alternative approach to determine whether there are interrupted repeat motifs within the SCA10 expansion. Method We developed a strategy that combines long-range PCR and shot-gun sequencing to characterize interruption sequences without full assembly of entire disease allele. We chose three SCA10-positive individuals with disparate clinical presentations and examined the resulting sequences for interrupting motifs. ResultsWith this strategy, we found both known heptanucleotide (ATTTTCT and ATATTCT) and pentanucleotide (ATCCC and ATCCT) interruption sequences in one allele. Additionally, we found novel pentanucleotide (ACTCT, ATTCA, ATTCC) and heptanucleotide (ATTCTCT) repeat interruption motifs in two additional samples. Conclusion Our results demonstrate the utility of this approach for determining the internal repeat structure of difficult to sequence repeat expansions. Furthermore, we find that the extent and type of interrupting sequences varies dramatically between these three SCA10-positive individuals.This article is protected by copyright. All rights reserved.
    Neurology and Clinical Neuroscience. 02/2014;
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    ABSTRACT: To describe changes in and predictors of comfortable gait speed (GS-C) in persons with stroke after 42 weeks (w) using a foot drop stimulator (FDS, Bioness L300™) DESIGN: Secondary analysis of prospective assessments SETTING: Multicenter clinical trial PARTICIPANTS: 99 subjects >3 months post-stroke with GS-C <0.8m/sec and drop foot with a mean age of 60.7y and time post-stroke of 4.8y. GS-C was assessed at baseline and 30w with and without FDS (therapeutic effect) and 6w, 12w, 30w, 36w and 42w with FDS (total effect.) After 8 physical therapy sessions, FDS was used for ambulation over 42w. Changes in mean GS-C over time, FDS "responder" status defined as either >0.1m/sec gain GS-C [the minimal clinically important difference (MCID)] or advancing by one Perry Ambulation Category (PAC), and adverse events (AE) RESULTS: 74 (75%) and 69 (70%) of 99 subjects completed assessments at 30w and 42w, respectively. Baseline GS-C was 0.42m/sec without and 0.49m/sec with FDS. GS-C improved to 0.54m/sec at 30w without FDS (effect size = 0.75) and .54, .55, .58, .60 and .61m/sec at 6w, 12w, 30w, 36w & 42w with FDS, respectively (effect size 0.84 at 42w.) Half achieved a maximum GS-C by 12w. About 18% were PAC and 29% MCID responders for 30w therapeutic effect and 55% were PAC and 67% MCID responders for 42w total effect. After logistic regression, younger age, faster baseline GS-C and Timed Up and Go and balance emerged as the strongest predictors of FDS responders. At 42w, 60% reported a device-related AE with 92% mild and 96% anticipated. GS-C with FDS improved progressively over 42w with >50% achieving a clinically meaningful 42w total effect and 50% achieving a maximum GS-C by 12w. Younger patients with higher mobility levels may benefit most. AE were frequent, mild and reversible.
    PM&R 01/2014; · 1.37 Impact Factor
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    ABSTRACT: Chronic pain is influenced by biological, psychological, social, and cultural factors. The current study investigated potential roles for combinations of genetic and psychological factors in the development and/or maintenance of chronic musculoskeletal pain. An exercise-induced shoulder injury model was used, and a priori selected genetic (ADRB2, COMT, OPRM1, AVPR1 A, GCH1, and KCNS1) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as predictors. Pain phenotypes were shoulder pain intensity (5-day average and peak reported on numerical rating scale), upper extremity disability (5-day average and peak reported on the QuickDASH), and shoulder pain duration (in days). After controlling for age, sex, and race, the genetic and psychological predictors were entered as main effects and interaction terms in separate regression models for the different pain phenotypes. Results from the recruited cohort (N = 190) indicated strong statistical evidence for interactions between the COMT diplotype and 1) pain catastrophizing for 5-day average upper extremity disability and 2) depressive symptoms for pain duration. There was moderate statistical evidence for interactions for other shoulder pain phenotypes between additional genes (ADRB2, AVPR1 A, and KCNS1) and depressive symptoms, pain catastrophizing, or kinesiophobia. These findings confirm the importance of the combined predictive ability of COMT with psychological distress and reveal other novel combinations of genetic and psychological factors that may merit additional investigation in other pain cohorts. Interactions between genetic and psychological factors were investigated as predictors of different exercise-induced shoulder pain phenotypes. The strongest statistical evidence was for interactions between the COMT diplotype and pain catastrophizing (for upper extremity disability) or depressive symptoms (for pain duration). Other novel genetic and psychological combinations were identified that may merit further investigation.
    The journal of pain: official journal of the American Pain Society 01/2014; 15(1):68-80. · 3.78 Impact Factor
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    ABSTRACT: To study mood and behavioral effects of unilateral and staged bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for Parkinson's disease (PD). There are numerous reports of mood changes following DBS, however, most have focused on bilateral simultaneous STN implants with rapid and aggressive post-operative medication reduction. A standardized evaluation was applied to a subset of patients undergoing STN and GPi DBS and who were also enrolled in the NIH COMPARE study. The Unified Parkinson Disease Rating Scale (UPDRS III), the Hamilton depression (HAM-D) and anxiety rating scales (HAM-A), the Yale-Brown obsessive-compulsive rating scale (YBOCS), the Apathy Scale (AS), and the Young mania rating scale (YMRS) were used. The scales were repeated at acute and chronic intervals. A post-operative strategy of non-aggressive medication reduction was employed. Thirty patients were randomized and underwent unilateral DBS (16 STN, 14 GPi). There were no baseline differences. The GPi group had a higher mean dopaminergic dosage at 1-year, however the between group difference in changes from baseline to 1-year was not significant. There were no differences between groups in mood and motor outcomes. When combining STN and GPi groups, the HAM-A scores worsened at 2-months, 4-months, 6-months and 1-year when compared with baseline; the HAM-D and YMRS scores worsened at 4-months, 6-months and 1-year; and the UPDRS Motor scores improved at 4-months and 1-year. Psychiatric diagnoses (DSM-IV) did not change. No between group differences were observed in the cohort of bilateral cases. There were few changes in mood and behavior with STN or GPi DBS. The approach of staging STN or GPi DBS without aggressive medication reduction could be a viable option for managing PD surgical candidates. A study of bilateral DBS and of medication reduction will be required to better understand risks and benefits of a bilateral approach.
    PLoS ONE 01/2014; 9(12):e114140. · 3.53 Impact Factor
  • Article: Response.
    Journal of Neurosurgery 10/2013; 119(4):1075. · 3.15 Impact Factor
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    ABSTRACT: Measures of central pain processing like conditioned pain modulation (CPM), and suprathreshold heat pain response (SHPR) have been described to assess different components of central pain modulatory mechanisms. Central pain processing potentially play a role in the development of postsurgical pain, however, the role of CPM and SHPR in explaining postoperative clinical pain and disability is still unclear. Seventy eight patients with clinical shoulder pain were included in this study. Patients were examined before shoulder surgery, at 3 months, and 6 months after surgery. The primary outcome measures were pain intensity and upper extremity disability. Analyses revealed that the change score (baseline - 3 months) of 5th pain rating of SHPR accounted for a significant amount of variance in 6 month postsurgical clinical pain intensity and disability after age, sex, preoperative pain intensity, and relevant psychological factors were considered. The present study suggests that baseline measures of central pain processing were not predictive of 6 month postoperative pain outcome. Instead, the 3 month change in SHPR might be a relevant factor in the transition to elevated 6-month postoperative pain and disability outcomes. In patients with shoulder pain, the 3 month change in a measure of central pain processing might be a relevant factor in the transition to elevated 6-month postoperative pain and disability scores.
    The Clinical journal of pain 09/2013; · 3.01 Impact Factor
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    ABSTRACT: The step activity monitor (SAM) quantifies steps taken in the home and community by patient populations. While the SAM has been used to study individuals post-stroke, compliance with SAM has not been addressed. Participants' compliance in wearing the monitor is critical for obtaining accurate assessments. The purpose of this study was to determine the rate of and predictors for inferred compliance with the SAM post-stroke. Cross-sectional. 408 community-dwelling individuals two-months post-stroke with moderate-to-severe gait impairment (gait speed of ≤ 0.8 m/s). Step activity was assessed for two days with the SAM. Inferred compliance was established in three periods: 6:00AM-12:00PM, 12:01PM-6:00PM, and 6:01PM-12:00AM. Compliance was defined as activity recorded in all three periods. The percentage of participant compliance for the first day, second day, both days, and either day was calculated. Demographic and clinical characteristics of compliers and non-compliers were compared. Independent compliance predictors were identified using stepwise logistic regression. Inferred compliance rate in the first day, second day, both days, and either day was 68, 61, 53, and 76%, respectively. Upper and lower extremity impairment, balance control and endurance were significantly different between compliers and non-compliers. On the other hand, older age, greater balance self-efficacy, and better walking endurance were found to be significant predictors of compliance. Participants consisted of individuals with sub-acute stroke. Therefore, our findings may not be generalized to individuals during the acute and chronic phases of stroke recovery. Strategies to improve compliance are needed, when collecting data for more than one day, and in samples with younger individuals, and persons with low levels of balance self-efficacy and walking endurance.
    Physical Therapy 09/2013; · 2.78 Impact Factor
  • David H. Annis, Samuel S. Wu
    CHANCE 08/2013; 20(1):6-10.
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    ABSTRACT: Parkinson's disease (PD) patients are hospitalized more frequently than their peers as a result of falls, psychosis, infections and other medical complications. However, patient-specific risk factors for hospitalization are unclear. To identify rates and risk factors for hospital encounters (Emergency Room [ER] visits or hospitalization) among people with PD. 3415 PD participants (mean age 67 ± 10 years, disease duration 9 ± 6 years, H&Y 2 47%, H&Y 3 26%) enrolled in the prospective international multicenter NPF-QII Study. One-year follow-up data was available for 1030 patients. Rates and risk factors for hospital encounters were determined at baseline and after one year follow-up. Of 3415 PD participants at study entry, 1120 (33%) reported at least one hospital encounter. Associations were: longer timed up-and-go test (OR: 1.33), increased comorbidities (OR: 1.25), motor fluctuations (OR: 1.32), and deep brain stimulation (DBS) (OR: 2.49). Of these 1120 persons, 311 had follow-up data and 158 (51%) had a repeat encounter one year later, associated with higher H&Y stage, fluctuations, and lower health-related quality-of-life. Of 2295 participants without a hospital encounter at baseline, 719 had follow-up data and 178 (25%) had a first hospital encounter one year later. Risk factors were female gender, comorbidities, lower cognition, fluctuations, and DBS. One-third of people with PD had a hospital encounter each year, and one-half of those had a repeat encounter. These high rates correlated with disease severity, comorbidities and DBS. There is an urgent need to develop programs to reduce PD hospital encounters.
    Parkinsonism & Related Disorders 07/2013; · 3.27 Impact Factor
  • Xiaomin Lu, Anqi Sun, Samuel S. Wu
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    ABSTRACT: Adaptive design is widely used in clinical trials. In this paper, we consider the problem of estimating the mean of the selected normal population in two-stage adaptive designs. Under the LINEX and L2 loss functions, admissibility and minimax results are derived for some location invariant estimators of the selected normal mean. The naive sample mean estimator is shown to be inadmissible under the LINEX loss function and to be not minimax under both loss functions.
    Journal of Statistical Planning and Inference 07/2013; 143(7):1215–1220. · 0.71 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: Drop foot after stroke may be addressed using an ankle foot orthosis (AFO) or a foot drop stimulator (FDS). The Functional Ambulation: Standard Treatment versus Electric Stimulation Therapy (FASTEST) trial was a multicenter, randomized, single-blinded trial comparing FDS and AFO for drop foot among people ≥3 months after stroke with gait speed ≤0.8 m/s. METHODS: Participants (n=197; 79 females and 118 males; 61.14±11.61 years of age; time after stroke 4.55±4.72 years) were randomized to 30 weeks of either FDS or a standard AFO. Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial. RESULTS: There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed (95% confidence interval for mean change, 0.11-0.17 m/s for FDS and 0.12-0.18 m/s for AFO) and fast gait speed. However, no significant differences in gait speed were found in the between-group comparisons. Secondary outcomes (standard measures of body structure and function, activity, and participation) improved significantly in both groups, whereas user satisfaction was significantly higher in the FDS group than in the control group. CONCLUSIONS: Using either an FDS or an AFO for 30 weeks yielded clinically and statistically significant improvements in gait speed and other functional outcomes. User satisfaction was higher in the FDS group. Although both groups did receive intervention, this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke.Clinical Trial Registration Information-URL: Unique Identifier: NCT01138995.
    Stroke 05/2013; · 6.16 Impact Factor
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    ABSTRACT: BACKGROUND CONTEXT: Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP. PURPOSE: The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. STUDY DESIGN/SETTING: The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. METHODS: In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. RESULTS: After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing total health care costs. Had the 1,995 soldiers in the PSEP group not received PSEP, we would estimate that 16.7% of them would incur an adjusted median LBP-related health care cost of $517 compared with the current 15.0% soldiers incurring an adjusted median cost of $399, which translates into an actual LBP-related health care cost savings of $52,846 during the POLM trial. However, it is likely that the unaccounted for direct and indirect costs might erase even these small cost savings. CONCLUSION: The results of this study will help to inform policy- and decision-making regarding the feasibility of implementing psychosocial education in military training environments across the services. It would be interesting to explore in future research whether cost savings from psychosocial education could be enhanced given a more individualized delivery method tailored to an individual's specific psychosocial risk factors.
    The spine journal: official journal of the North American Spine Society 04/2013; · 2.90 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess the relationship between Exercise Tolerance Test (ETT) performance at 6-weeks post-stroke and subsequent performance in a treadmill and overground Locomotor Training Program (LTP). DESIGN: Prospective, cohort study. SETTING: Exercise testing laboratory in either a primary care hospital or outpatient clinic. PARTICIPANTS: Community-dwelling individuals (n= 469), 54.9±19.0 days post-stroke, enrolled in the Locomotor Experience Applied Post Stroke (LEAPS) randomized controlled trial. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: For participants randomized to LTP, the number of sessions needed to attain the training goal of 20 minutes of treadmill stepping was determined. Regression analyses determined the contribution of ETT performance (cycling duration), age, and Six-Minute Walk Test (6MWT) distance to attainment of the stepping duration goal. RESULTS: Age, 6MWT and ETT performance individually accounted for 10.74%, 10.82% and 10.76%, respectively, of the variance in number of sessions needed to attain 20 minutes of stepping. When age and 6MWT were included in the model, the additional contribution of ETT performance was rendered non-significant (p=0.150). CONCLUSION: To the extent that ETT performance can be viewed as a measure of cardiovascular fitness rather than neurological impairment, cardiovascular fitness at the time of the ETT did not make a significant unique contribution to number of sessions needed to achieve 20 minutes stepping duration . The 6MWT, which involves less intensive exercise than the ETT and therefore likely to be predominantly affected by neurological impairment and muscular condition, appeared to account for as much variance as the ETT.
    Archives of physical medicine and rehabilitation 03/2013; · 2.18 Impact Factor

Publication Stats

1k Citations
335.17 Total Impact Points


  • 2001–2014
    • University of Florida
      • • Department of Biostatistics
      • • Department of Physical Therapy
      • • College of Medicine
      • • Department of Occupational Therapy
      • • Department of Statistics
      • • Department of Neurosurgery
      Gainesville, Florida, United States
  • 2013
    • Kaye Academic College of Education
      Be'er Sheva`, Southern District, Israel
  • 2012
    • Cardinal Hill Rehabilitation Hospital
      Lexington, Kentucky, United States
  • 2011–2012
    • University of Southern California
      • Division of Biokinesiology and Physical Therapy
      Los Angeles, CA, United States
    • Duke University
      Durham, North Carolina, United States
    • University of South Florida
      • College of Pharmacy
      Tampa, FL, United States
  • 2010
    • Wake Forest School of Medicine
      • Department of Neurology
      Winston-Salem, NC, United States
  • 2007–2008
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
    • Richard L. Roudebush VA Medical Center
      Indianapolis, Indiana, United States
  • 2004
    • University of North Texas HSC at Fort Worth
      • Department of Pharmacology and Neuroscience
      Fort Worth, TX, United States
  • 2002
    • University of North Texas
      • Department of Pharmacology & Neuroscience
      Denton, TX, United States