International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation

Published by Lippincott, Williams & Wilkins
Print ISSN: 0342-5282
A systems approach consisting of eight elements was used in the design, implementation, and evaluation of a module for physical therapy inservice training at McDonald Army Hospital, Fort Eustis, Virginia. Use of this approach was aimed at increasing the effectiveness of learning, improving participant attitudes toward inservice training, and developing a model which could be used for delivering inservice training throughout the helping professions. The design requires that the problem area be selected by staff consensus--in this case planning and administration of therapeutic exercise programs for patients with hip dysfunctions. Five sessions which centered around this patient oriented problem area were presented by the physical therapist to the three physical therapy technicians. Principles of instructional design and events of instruction were incorporated using the format of Gagne and Briggs (1979). The technicians' perception of physical therapy inservice training was rated before the implementation of the systems approach, after the second inservice session, and after the final inservice session. By the end of the five inservice sessions, all three technicians were able to accomplish the predetermined goal of planning and administering a safe therapeutic exercise program to patients with hip dysfunctions. Progress notes also indicated that patient programs were being appropriately upgraded based on the patient's condition. Technicians' ratings of inservice training also had increased after the final session. Further implementation and evaluation of this approach to training is recommended.
The aim of the study was to evaluate the outcome 6 years after completing a multiprofessional 8-week rehabilitation programme regarding the following objectives: (1) return to work, (2) level of activity and (3) pain intensity. Of 149 patients attending a rehabilitation programme, 122 were followed up after 6 years, through a structured telephone interview, and their present work situation, level of activity, sleeping habits, their estimated pain intensity and consumption of analgesics were recorded. The questions presented were the same as they had answered before entering the programme. The return-to-work rate was compared to 79 patients in a control group. At the 6-year follow-up, compared to before entering the programme, 52% had returned to work (P<0.001). In the control group the return-to-work rate was 13%. This difference was statistically significant (P<0.001). There was a statistically significant higher level of activity (P=0.037). A pain reduction was experienced by 58% of the patients (P<0.001) and 47% of the patients had decreased their consumption of analgesics (P<0.001). In conclusion, after completing the structured 8-week rehabilitation programme, the return-to-work rate was higher at a 6-year follow-up than in a control group. Furthermore, they had a higher level of activity and lower level of pain intensity than before entering the programme, indicating that the rehabilitation programme had a long-term positive effect on the return-to-work-rate, activity and pain as well as on the analgesic consumption.
The study provides estimates of reliability and minimal real difference (MRD) (i.e. the minimal change significantly different from zero, expressed in the original units) of 14 parameters obtained from six motor tasks of standing balance on the EquiTest (dynamic) and the Balance Master (static) force platforms. The different tasks and parameters allowed an assessment of balance in three domains: quiet standing, perturbed standing and multidirectional leaning. Fifteen healthy adults (eight men and seven women; age 22-42 years) were studied at baseline and retested 1 and 3 weeks later. The significance level was set at P-value less than 0.05 and adjusted for multiplicity within sets of tests reflecting the same balance domain (Bonferroni corrections). Repeated analysis of variance modelling revealed a moderate yet significant time trend across the three time points, suggesting a practice effect for the mean of one out of the 14 parameters. Changes across pairs of time points did not reach significance (Tukey's post-hoc test). Test-retest reliability across the three time points and across pairs of time points was estimated for each parameter using the intraclass correlation coefficients (ICCs) (model 3.1; range 0-1, none to perfect reliability). Across the three time points, the ICCs ranged from 0.21 to 0.85 (>0.60 in nine out of the 14 cases). The MRDs were computed from the ICCs. For all 14 parameters showing a time trend, absolute changes (root mean squares of differences) were minimal. Thus, albeit overestimated for one parameter, the MRDs provide useful thresholds for changes to be interpreted as dependent on therapeutic interventions.
Seven quadriplegic subjects participated in F. E. S. bicycle ergometry, three times per week, over an eight week period. Left thigh girth measured at 20 cm above the knee increased from 44.4 cm pre-training to 46.5 cm post-training (p less than 0.05), and right thigh girth increased from 44.3 cm to 46.2 cm (p less than 0.05). Forced vital capacity increased from 3.23 liters (pre-training) to 3.42 liters (post-training) and was significant at the p less than 0.05 level. Forced inspiratory capacity increased for 3.30 liters, pre-training, to 3.42 liters, post-training (p less than 0.05). FEV1 (liters) increased from 2.77, pre-training to 3.07 post-training (p less than 0.05). All three respiratory parameters were 55%-60% of that predicted for normals. Significant changes were also found in resting cardiovascular data. Mean resting heart rate, pre-training, was 51.4 beats per minute compared to 54.5 beats per minute, post-training, (p less than 0.05). Resting cardiac output, pre-training was 4.14 L/min. compared to 4.47 L/min., post-training (p less than 0.05). Further analysis of the cardiovascular data showed that the increased heart rate post-training was associated with a decrease in the P-R interval from 0.186 sec., pre-training to 0.170 sec., post-training (p less than 0.05). Also, the increase in cardiac output, post-training was matched by an increase in the cardiac index from 2.21 L/min./M, pre-training, to 2.36 L/min./M, post-training (p less than 0.05). A statistically significant difference in the heart rate response to the cold pressor test was demonstrated (p less than 0.05) and a similar difference in the amount of heart rate response was seen during the tilt table test (p = 0.05).
The evaluation is concerned with: easy chairs for both elderly and disabled people over 16 years of age; and the use of chairs in Health and Social Service settings and in institutions in the voluntary sector such as Cheshire Homes. The research programme will involve collecting information on chair use, an anthropometric survey of over 1,000 disabled and elderly people, and a study of individuals' preferred chair dimensions. A market survey will be undertaken to identify the types of chairs available on the market. Ergonomics and technical trials will be carried out on selected chairs. It is hoped that design specifications and information on the qualities of chairs will emerge from the project.
Previous studies indicate that a worldwide measurement tool may be developed based on the International Classification of Functioning Disability and Health (ICF) Core Sets for chronic conditions. The aim of the present study was to explore the possibility of constructing a cross-cultural measurement of functioning for patients with low back pain (LBP) on the basis of the Comprehensive ICF Core Set for LBP and to evaluate the properties of the ICF Core Set. The Comprehensive ICF Core Set for LBP was scored by health professionals for 972 patients with LBP from 17 countries. Qualifier levels of the categories, invariance across age, sex and countries, construct validity and the ordering of the categories in the components of body function, body structure, activities and participation were explored by Rasch analysis. The item-trait v 2 statistics showed that the 53 categories in the ICF Core Set for LBP did not fit the Rasch model (P<0.001). The main challenge was the invariance in the responses according to country. Analysis of the four countries with the largest sample sizes indicated that the data from Germany fit the Rasch model, and the data from Norway, Serbia and Kuwait in terms of the components of body functions and activities and participation also fit the model. The component of body functions and activity and participation had a negative mean location, -2.19 (SD 1.19) and -2.98 (SD 1.07), respectively. The negative location indicates that the ICF Core Set reflects patients with a lower level of function than the present patient sample. The present results indicate that it may be possible to construct a clinical measure of function on the basis of the Comprehensive ICF Core Set for LBP by calculating country-specific scores before pooling the data.
The importance of exercise for health and the long-term management of various diseases is now well documented and established. However, the challenge is the lack of patient compliance to exercises, which is true for almost all diseases, from acute back pain to chronic arthritis. One of the factors for compliance is the perception that exercises are effective in ameliorating unpleasant symptoms. Precisely, people's perception and their attitude towards exercises matter the most in determining the treatment outcome in such conditions. Unfortunately, the psychology of exercise initiation and adherence in the patient population is seriously under-researched. Recent literature has identified the need to consider various similar factors like motivation, barriers to exercise, exercise-related beliefs, attitudes, and the formulation of self-perceptions and self-identity towards exercises. However, no good instrument exists that is sensitive and standardized to evaluate people's attitude towards exercises, which is fundamental and crucial in determining the final outcome of exercise-treatable diseases. Hence we have attempted to design a questionnaire to 'evaluate the level of people's attitude towards exercises'.
In recent years discussions about the development of psychiatric care internationally and in Scandinavia have been focused on principles of opening and sectorizing, sometimes at the cost of existing differentiated and effective psychiatric in-patient care-programs. During the last 6 years a process of strengthening and opening psychiatric care was started on the Swedish island of Gotland (55 000 inhabitants), based on an existing mental hospital, utilizing the existing personnel, maintaining existing effective structures of institutional care and developing new ones in out-patient care. The intention was to combine principles of subspecialized psychiatric in-patient are treatment with ideas of sectorization, accessibility and openness. Our results seem to show that it is well possible to reach positive results, optimizing and opening up an existing institution, using a basic psychodynamic, synoptic and eclectic ideology, offering differentiated treatment programs and without the immediate use of sectorizing principles. Sectorization and accessibility without qualified treatment programs of in-patient care may not be a sufficient solution to all the problems we find in psychiatric organisations. On the other hand, our achieved positive results have probably the naturally sectorized character of the island of Gotland as a presupposition. Principles of sectorization and differentiation seem in psychiatry not to be contrary but complementary. However, it seems to be legitimate, possible and effective to start a process of psychiatric evolution transforming an existing old-fashioned mental hospital.
This feasibility study examines the coverage of employment-related issues related to people with disabilities in the Americans with Disabilities Act of 1990. The study is a first in a series of future studies focusing on disability issues in the international economic media. A survey of 39 newspaper articles published in the Wall Street Journal, a leading and most circulated business newspaper in the USA. Specifically, it comprised articles taken from three periods: 1990, the year the Americans with Disabilities Act was enacted; 2000, a decade later; and 2008, the year the amendments were revised with respect to definitions and employment. Data were analyzed by quantitative and qualitative content analysis. The results suggest a mixed representation: a decline in negative representations of disability throughout the years alongside the emergence of a legal-fiscal discourse of a disability that depicts persons with disabilities as a fiscal burden on employers. It seems that the new image of disability presents conflicting interests between the mission of the law, promoting employers' hiring of people with disabilities, and the economic realities of accommodating them at the workplace. Additional research is needed to examine whether this image is unique to the economic media or may reflect a concern in the business community.
The purpose of this study is to review the research conducted on the topic of employment status after spinal cord injury that was published between 1992 and 2005. This study follows on from an earlier review that focused on papers published between 1976 and 1991. The current study extends the earlier review by reporting an aggregate employment rate for those at least 12 months postinjury, separating rates for those living in different geographical areas (i.e. North America, Europe, Australia, and Asia), and reporting rates at various times of postinjury (rates from a minimum of 1 year postinjury, through rates at a follow-up of more than 20 years postinjury). As was found in the earlier review, a diversity of employment rates was observed; however, this diversity was reduced when studies of similar design were compared. Results indicate that although it may take some time to be realized, there is significant vocational potential amongst those with spinal cord injury. On the basis of the results of the review, it was concluded that approximately 40% of working age people greater than 12 months postinjury are employed at the time of data collection, with this rate increasing as the postinjury time increases, peaking at 10-12 years postinjury. Significant differences in employment rates depending on the geographical location of the studied population were observed. Recommendations for further research are made and implications for service provision to individuals with disabling injuries are discussed.
We carried out a prospective study to determine whether stroke patients' functional status or health-related quality of life would predict whether they lived at home 2.5 years after discharge from neurological inpatient rehabilitation. We carried out a single-center prospective cohort study. The outcome 'home care' versus 'death' or 'institutionalization' (nursing home admission) was evaluated 30 months after discharge. A total of 204 stroke survivors with remaining moderate to severe functional deficits at admission to neurological inpatient rehabilitation were included. Clinical data were obtained at admission to and/or discharge from inpatient rehabilitation. Functional status was determined using the Barthel Index; health-related quality of life was assessed using the SF-36 and EQ-5D. The outcome was assessed by telephone interview. Predictors of living at home were calculated using binary logistic regression analysis. In total, 30 months after discharge, 75% of the stroke survivors were still living at home. Multivariate analysis showed that patients continued to live at home significantly more frequently when they had fewer mortality-relevant comorbidities (P=0.001), a higher BMI (P=0.040), a higher increase in functional independence during inpatient rehabilitation (P=0.017), and above all, a better health-related quality of life, measured using the EQ-5D (P<0.001), at discharge. Stroke survivors' health-related quality of life measured with the EQ-5D and the change in functional status during multimodal neurological rehabilitation appear to be the strongest clinically relevant long-term predictors of staying at home.
We assess the knowledge available on the difficulties experienced by multiple sclerosis (MS) patients in work-related activities. A literature review was carried out using the keywords 'multiple sclerosis' and 'employment' or 'work' through PubMed and EMBASE. Papers reporting patient-derived data on difficulties at work as primary or secondary outcome measures and published in the period 2002-December 2011 were searched. A total of 26 papers were selected, for a total of 32 507 patients (mean age 46.2 years; 42.1% with relapsing-remitting MS). Most papers reported observational studies or cross-sectional surveys focused on health-related quality of life and MS costs. Symptoms more frequently addressed are fatigue, mobility and cognitive impairments. Limited research has been carried out on the working environment. We found a relatively small number of papers published in the last 10 years on the difficulties that patients with MS can experience at work, and this kind of information always appeared as a secondary outcome. In general, it is possible to affirm that MS has a strong impact on patients' employment status, as the mean unemployment rate was 59%. Research on factors promoting maintenance of remunerative employment is required.
The aim of this work was to survey the contemporary facilities for early poststroke rehabilitation in Poland. The main research questions were as follows: what is the availability of inpatient rehabilitation for poststroke patients in neurological departments and in rehabilitation departments? The growing costs of healthcare are encouraging healthcare planners to look for new organizational solutions of services that could enable rehabilitation as early as possible after disease onset. Early poststroke rehabilitation includes many elements that provide for early-onset rehabilitation and its continuation after discharge from the stroke unit. Two questionnaires evaluating neurorehabilitation of individuals who had stroke were designed and distributed: the first questionnaire was distributed to 221 neurological wards and the second questionnaire was distributed to 154 rehabilitation departments in Poland. We obtained information about delay before admission from neurological wards to rehabilitation departments, the number of sessions per day, the time duration of one session, the number of sessions per week, the average length of stay in department, the methods of outcome measurement, etc. We sent out 375 questionnaires and received 129 (35%) responses, 78 from neurological wards and 51 from rehabilitation departments. Only 25% of all patients were moved from neurological wards to the rehabilitation department after stroke (15% directly). Of those moved to rehabilitation departments, only 54% were treated early after stroke; that is, within 3 months of stroke. Considering that about half of stroke survivors will require rehabilitation (30 days after stroke onset), the current facilities of early poststroke rehabilitation in Poland cannot meet this need. We should do our best to introduce rehabilitation services such as early home-supported discharge after stroke, which is currently not available in Poland. Although we have focused on resources in Poland, we anticipate that similar patterns may be found in other countries in the region.Das Ziel dieser Arbeit war die Bereitstellung eines Überblicks über derzeitige Einrichtungen zur Frührehabilitation nach einem Schlaganfall in Polen. Die wichtigste forschungsrelevante Frage war hierbei wie folgt: Welches stationäre Rehabilitationsangebot steht Patienten nach einem Schlaganfall in neurologischen und in Reha-Abteilungen zur Verfügung? Die zunehmenden Kosten im Gesundheitswesen bestärken die Planer im Gesundheitsbereich, sich nach neuen organisatorischen Dienstleistungslösungen umzusehen, die eine Rehabilitation so früh wie möglich nach Krankheitsbeginn ermöglichen könnte. Die Frührehabilitation nach einem Schlaganfall schließt viele Elemente zur Einleitung einer baldigen Rehabilitation und zu ihrer Fortsetzung nach Entlassung aus der Stroke Unit ein. Zwei Fragebogen zur Bewertung der Neurorehabilitation von Schlaganfall-Patienten wurden ausgearbeitet und verteilt, wobei der erste Fragenbogen auf 221 neurologischen Stationen und der zweite in 154 Reha-Abteilungen in Polen verteilt wurde. Wir gewannen Informationen über den Verzug bei der Einweisung von neurologischen Stationen in Reha-Abteilungen, die Zahl der täglichen Behandlungen, die Zeitdauer einer Behandlung, die Zahl der wöchentlichen Behandlungen, die durchschnittliche Länge des Aufenthalts in der Abteilung und die Verfahren zum Messen des Outcomes usw. Wir gaben 375 Fragebogen aus und erhielten 129 (35 %) zurück, 78 von neurologischen Stationen und 51 von Reha-Abteilungen. Nur 25 % aller Patienten wurden nach einem Schlaganfall von neurologischen Stationen in eine Reha-Abteilung überwiesen (15 % direkt). Von den in Reha-Abteilungen Überwiesenen wurden nur 54 % früh, d. h. innerhalb von 3 Monaten nach Eintreten eines Schlaganfalls behandelt. Unter Berücksichtigung, dass ca. die Hälfte der Überlebenden eines Schlaganfalls eine Rehabilitation (30 Tage nach Einsetzen eines Schlaganfalls) benötigen, können die aktuellen Einrichtungen zur Frührehabilitation nach einem Schlaganfall in Polen diesen Bedarf nicht decken. Wir sollten uns nach Kräften um die Einführung von Reha-Dienstleistungen, wie z. B. die frühe Entlassung nach einem Schlaganfall mit Unterstützung nach Hause bemühen, die derzeit in Polen nicht angeboten werden. Obwohl wir uns hier auf Ressourcen in Polen konzentriert haben, gehen wir davon aus, dass sich ein ähnliches Bild auch in anderen Ländern der Region ergeben könnte.El objetivo de este estudio fue evaluar las instalaciones disponibles en Polonia para la rehabilitación temprana postictus. El tema principal de la investigación fue la disponibilidad de programas de rehabilitación interna para pacientes postictus en los departamentos neurológicos y en los departamentos de rehabilitación. Debido al aumento de los gastos de los servicios sanitarios, los encargados de la planificación sanitaria están buscando nuevas soluciones organizativas para los servicios, de modo que la rehabilitación pueda llevarse a cabo tan pronto como sea posible tras el comienzo de la enfermedad. La rehabilitación temprana postictus incluye diversos elementos que facilitan tanto la rehabilitación tras el ictus como su continuación tras el alta de la unidad de ictus. Se diseñaron y se distribuyeron dos cuestionarios que evalúan la neurorehabilitación de individuos que han sufrido un ictus: el primer cuestionario se distribuyó a 221 unidades de neurología y el segundo a 154 departamentos de rehabilitación de Polonia. Se obtuvo información sobre el tiempo que debe transcurrir antes del paso de la unidad de neurología al departamento de rehabilitación, el número de sesiones diarias, la duración de cada sesión, el número de sesiones semanales, la duración media de la estancia en el departamento, los métodos de evaluación, etc. Se enviaron 375 cuestionarios y se recibieron 129 (35%) respuestas, de las cuales 78 fueron de unidades de neurología y 51 de departamentos de rehabilitación. Solamente el 25% de los pacientes fueron trasladados de la unidad de neurología al departamento de rehabilitación tras el ictus (el 15% fueron trasladados directamente). De los pacientes trasladados al departamento de rehabilitación, tan solo el 54% recibieron un tratamiento temprano tras el ictus, es decir, dentro de los primeros 3 meses. Teniendo en cuenta que alrededor de la mitad de los supervivientes de ictus requieren rehabilitación (30 días después del ictus), las instalaciones actuales para la rehabilitación temprana postictus de Polonia no cumplen los requisitos necesarios. Deberían establecerse servicios de rehabilitación, tales como el alta temprana postictus con asistencia domiciliaria, que actualmente no está disponible en Polonia. Aunque este estudio se centra en los recursos existentes en Polonia, es posible que en otros países se observen modelos similares.Ces travaux avaient pour objet d'examiner les installations modernes pour la rééducation post-AVC précoce en Pologne. Les principales questions de l'étude étaient les suivantes : quelle est la disponibilité de la rééducation pour les patients post-AVC hospitalisés dans les services neurologiques et les services de rééducation? Le coût croissant des soins de santé encourage les planificateurs de soins de santé à chercher de nouvelles solutions d'organisation des services qui pourraient permettre une rééducation précoce dès l'apparition de la maladie. La rééducation post-AVC précoce comprend de nombreux éléments qui permettent une rééducation précoce qui se poursuit après le départ du patient de l'unité d'AVC. Deux questionnaires évaluant la neurorééducation des victimes d'AVC ont été conçus et distribués : le premier a été distribué dans 221 services de neurologie et le deuxième dans 154 services de rééducation en Pologne. Nous avons obtenu des informations sur les délais d'admission dans les services de rééducation après sortie des services neurologiques, le nombre de séances par jour, la durée d'une séance, le nombre de séances par semaine, la durée moyenne du séjour dans le service, les méthodes de mesure des résultats, etc. Nous avons envoyé 375 questionnaires et reçu 129 réponses (35 %), 78 de services de neurologie et 51 de services de rééducation. Seulement 25 % de tous les patients ont été transférés des services de neurologie vers des services de rééducation après un AVC (15 % directement). Parmi ceux qui avaient été transférés aux services de rééducation, 54 % seulement ont été traités à titre précoce après un AVC, c'est-à-dire dans les 3 mois suivant l'accident. Si l'on considère que près de la moitié des survivants d'un AVC auront besoin de rééducation (30 jours après l'accident), les installations actuelles de rééducation post-AVC précoce de Pologne ne peuvent pas satisfaire cette demande. Nous devrions faire de notre mieux pour introduire des services de rééducation, comme un soutien à domicile après sortie précoce de l'hôpital suivant un AVC, une approche qui n'est actuellement pas disponible en Pologne. Bien que nous nous soyons concentrés sur les ressources en Pologne, nous prévoyons que des tendances similaires pourront être identifiées dans d'autres pays de la région.
The aim of this study was to reach consensus about the prognostic factors when deciding the discharge destination from a hospital stroke unit, and to construct a prognostic conceptual framework. To realise an optimal integration of knowledge from research findings and from clinical experience by expert opinions we used a 'modified Delphi Technique', which is the most commonly used method for the production of clinical guidelines. The process yielded 26 prognostic factors, which were arranged in clinical and social sub-domains. The sub-domains and the factors within each sub-domain were prioritised according to their assumed predictive value for the decision process. The order of importance of the prognostic factors in the clinical domain was: (1) disabilities, (2) pre-morbid disabilities, (3) impairments and (4) disease/biology; and the order of importance of the factors in the social domain was: (1) home front, (2) social situation and (3) residence. The Delphi procedure is an excellent instrument to determine and prioritise prognostic factors. With this procedure research-based and consensus-based knowledge can be combined. For a valid procedure it is mandatory to state explicitly in advance how the scores will be judged, and to explain the scientific level of the evidence during the whole procedure.
Health-related quality of life (HRQOL) is increasingly being considered in the management of patients with various conditions. HRQOL instruments can be broadly classified as generic or disease-specific measures. Several generic HRQOL instruments in different languages have been developed for paediatric populations including the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) Generic Core Scale. This tool and a condition-specific tool, PedsQL 3.0 Cerebral Palsy (CP) Module, are widely used in children with CP. No psychometric properties have been reported for Thai PedsQL 4.0. Therefore, this study aimed to explore the psychometric properties of the Thai version of the PedsQL 4.0 Generic Core Scales and compare these with the values for the Thai PedsQL 3.0 CP Module reported previously. Thai PedsQL 4.0 Generic Core Scales and the PedsQL 3.0 CP Module were completed, respectively, by children with CP and their parents or caregivers twice within 2-4 weeks. Respondents were 97 parents or caregivers and 54 children. Minimal missing data were found in most scales. Acceptable internal consistency was supported, except for Emotional, Social, and School Functioning. Intraclass correlation coefficients for parent-proxy report and self-report were good to excellent (0.625-0.849). The feasibility and reliability of the Thai PedsQL 4.0 Generic Core Scales were supported. The Thai PedsQL 3.0 CP Module showed higher values for the psychometric properties. Low-to-good correlations were found among the scales between the PedsQL 4.0 Generic Core Scales and the 3.0 CP Module. Both instruments could be used to measure HRQOL for children with CP, and may provide different information.
Results of independent t-tests for different groups in relation to PCS and MCS
Self-reported disability related to neck pain can be measured using general health questionnaires. The validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in patients with nonspecific chronic neck pain (CNP) in a tertiary outpatient rehabilitation setting is unknown. This study investigates construct validity of the SF-36 in these patients using 16 a-priori formulated hypotheses. Ninety-one patients admitted for rehabilitation completed the SF-36 before the rehabilitation program. SF-36 domain scores of patients with CNP were compared with general population reference values and standardized differences were calculated. For both the SF-36 physical and the mental component summary (PCS and MCS), differences between primary and tertiary care setting, men and women, age groups, litigants and nonlitigants, patients with and without compensation, and with ≥3 versus≤2 concomitant complaints were analyzed using independent t-tests. Differences between PCS and MCS scores were analyzed using a paired t-test. Twelve hypotheses were not rejected and four were rejected. All SF-36 domain scores were significantly lower than the general population references values. The domain scores 'role physical', 'bodily pain', 'vitality', 'social functioning,' and 'role emotional' were relevantly (≥1 SD) lower. SF-36-PCS and SF-36-MCS scores were significantly lower in tertiary care. The SF-36-PCS score was significantly lower for patients with workers compensation and patients with at least three concomitant complaints. The SF-36-MCS score was significantly lower for the age group of at least 39 years. The SF-36 has good construct validity and can be used to measure self-reported general health in patients with nonspecific CNP in outpatient tertiary rehabilitation.
We studied 56 boarding institutions caring for 834 children and adolescents with different kinds of difficulties or handicaps in the Swiss Canton of Vaud. In order to weigh the purely qualitative approach we performed two different statistical analyses: 1) a correlation matrix between all qualitative and quantitative variables with the daily individual cost of the institutional care. This cost has been calculated in a standard manner and independently of each institution's accounts. 2) a factor analysis of the collected data led us to the identification of different patterns of institutional functioning. This study stresses the importance of the staff/pupil coefficient, i.e. the richness of the pedago-therapeutic framing--the intervention of specialists such as special teachers, psychologists, and speech and/or motor therapists-, and more particularly the higher ratio of specialist help compared to pure educative staff. The severity of the cases, evaluated by independent specialist observers, was in direct relation to this factor independently of the kind of difficulty or handicap.
The purpose of this study was to determine the factors explaining changes in the generic quality of life among patients with Menière's disorder (MD) and to evaluate the EuroQol 5D (EQ-5D) quality-of-life measures. A questionnaire focusing on symptoms and disabilities caused by MD was collected from 726 individuals. General health-related quality of life (EQ-5D) was evaluated using the time trade-off (TTO) and visual-analogue scale (VAS). Personal traits were measured with the sense of coherence. The TTO-VAS score difference was modeled with activity limitations, participation restrictions, attitudes, and symptoms. For TTO as the outcome measure, one symptom-based, three attitude-based, one activity limitation, and one participation restriction item explained 43% of the variability. For VAS, six attitude-based, one symptom-based, three activity limitations, and one participation restriction item explained 43% of the variability of the data. The correlation between TTO and VAS (r=0.515, P<0.001) explained only 27% of the variance. The difference between TTO and VAS was reflected in attitudes towards the illness. The model explained 10% of the variability in the VAS and TTO difference. There was a disease duration effect in the TTO-VAS difference. In conclusion, a symptom-based model combined with disabilities provided a good description of general quality of life in MD. The TTO-based and VAS-based evaluation explained somewhat different aspects of MD. The difference between TTO and VAS could be described as an attitude toward the ailment. Evaluation of disabilities and the difference in TTO and VAS can be used to guide the rehabilitation to promote attitude change.
The aim of this study was to investigate the performance of the recent EQ-5D-Y instrument compared with the standard EQ-5D in assessing the health-related quality of life of high school children in Cape Town. Either the EQ-5D or the EQ-5D-Y was given to high school children. The sample consisted of 521 respondents. The EQ-5D-Y was found to be superior in that there were statistically significant fewer missed item responses, both in the domains and the health status Visual Analogue Scale (VAS). A grade differential was noted with more missing responses in the lower grades, particularly with the EQ-5D. More children reported problems with the mobility, self-care and anxiety and depression domains when responding to the EQ-5D-Y. In addition, the mean VAS score was marginally greater using the EQ-5D-Y. The EQ-5D-Y performed better than the EQ-5D, particularly in the younger children, and should be used in early secondary school. The EQ-5D-Y generated a wider range of responses in both the domains and the VAS, and may be more responsive than the Adult version. The two seem to give different results and consequently should be considered two related but separate instruments.
Distribution of risk factors
Distribution of types of cerebral palsy cases
Risk factors in relation to types of CP
The aim of the study was to investigate risk factors, clinical profiles and gross motor function levels of Turkish children with cerebral palsy (CP). A total of 625 consecutive children with CP, who were rehabilitated in the pediatrics rehabilitation clinic between 2000 and 2004 years, were included. Factors causing CP were investigated by interviewing the families and by scanning medical files. Risk factors were recorded as consanguineous marriage, maternal disorder, preterm birth, birth asphyxia, low birth weight, multiple pregnancy, neonatal convulsion, kernicterus, postnatal central nervous system infection and brain injury. Swedish classification was followed in CP typing. Of 625 children with CP, 370 (59.2%) were males and 255 (40.8%) were females, with ages ranging between 2 and 13 years (the mean age was 5.11+/-2.19 years). It was determined that 47.8% of the cases were spastic diplegic CP, 27.7% were spastic tetraplegic CP, 12.8% spastic hemiplegic CP and 11.7% were other types (ataxic, dyskinetic and mixed CP types). The most frequently encountered risk factors were low birth weight (45.1%), preterm birth (40.5%), birth asphyxia (34.6%) and consanguineous marriage (23.8%). Low birth weight, preterm birth, birth asphyxia and consanguineous marriage were top-ranked risk factors that were determined in Turkish children with CP. Compared with other countries, consanguineous marriage is still an important problem in Turkey.
We evaluated the differences in gait and functional performance between two groups of elderly people, one consisting of people between 65 and 79 years of age and the other consisting of people over 80 years of age. We analysed whether knee pain affected gait and looked at the functional performance of the timed 'up and go' (TUG) and functional reach (FR) tests. In 247 community-dwelling people aged 65 years and older, consisting of 90 men and 157 women with a mean age of 80 years (range 65-94 years), 47% had knee pain. Shorter stride, shorter step, slower speed, longer TUG and shorter FR were seen in the group aged 80 years and over compared with the group aged 65-79 years. Knee pain was associated with TUG, especially in the group aged 65-79 years. In the group aged 65-79 years with knee pain, a shorter stride and step length, a longer time required to hold a double stance, a slower walking speed and a longer TUG were shown. However, in the group aged 80 years and over, there was no significant difference between participants with and without knee pain for these parameters.
The aim of the study was to test the U.S.A. Validated 'Attitude Towards Disabled Persons' Inventory (A.T.D.P. Form O) on a British student population to establish norms. The objectives were to test specific hypotheses related to the sex of the respondent, contact with physically disabled people and whether social work students had different attitude scores than non social work students. In addition, a comparison was made between the British and U.S.A. 'norms'. The student population of four specific British Universities comprised the sampling frame. The sample was a non probability accidental sample of social work and non social work students. Standardised A.T.D.P. Form Os were administered in group situations. Each form was accompanied by a letter explaining the study, together with a short questionnaire eliciting the sex of respondent and type and extent of any contact with disabled people. The findings demonstrated that there are probably differences between U.S.A. and British norms but that there are general similarities between the two countries. In both countries females, scored higher than males, which by interpretation indicates possibly a more favourable attitude. Contact with the disabled is also a contributing factor in higher scores. Social work students also tended to score more highly than non social work students. The implications of these findings are discussed with regard to the possible development of professional attitudes for those who work with the disabled. It is postulated that 'idealisation' may be reflected in attitudes of students who intend to work with the disabled which, after general and professional life experience gives way to less favourable attitudes. Closeness of contact of respondents to disabled people is a factor which needs further exploration in connection with changing attitude scores.
Return to work represents a significant marker of functional outcome for persons who have suffered a brain injury. Neuropsychological assessment forms an integral part of treatment planning following brain injury and aims to document cognitive strengths and weaknesses, including general intellectual abilities. Neuropsychological testing has been criticised for having limited ability to predict functional outcomes such as return to work. The present study sought to examine the association between return to work following ABI and the Wechsler Abbreviated Scale of Intelligence (WASI). Patient files in a community neurorehabilatation service were reviewed retrospectively and 52 individuals were identified who had been employed at the time of their injury and for whom a WASI was completed. The study found full-scale IQ, verbal IQ, the similarities sub-test, and severity of injury to be associated with return to work.
To evaluate the adequacy of abbreviated versions of International Classification of Functioning, Disability and Health (ICF) (the WHO ICF Checklist and the ICF Comprehensive Core Set for Stroke) with respect to the specific clinical needs of a stroke rehabilitation unit before their implementation at a practical level. Common descriptions of functional limitations were identified from patient records of 10 subsequent subacute stroke patients referred to an inpatient multiprofessional rehabilitation unit of a university hospital. These descriptions were then converted into ICF categories, and the list was compared with the ICF Checklist of the WHO and the ICF Comprehensive and Brief Core Sets for Stroke developed by the ICF Research Branch. From the study population (50% women), 71 different, second-level ICF categories were identified, averaging 36.4 categories/patient (SD 5.8, range 28-46). Except for one category, all of the categories identified were also found in the ICF Comprehensive Core Set for Stroke. Of the categories identified, 49 (69%) were found in the WHO ICF Checklist. All except one category included in the ICF Brief Core Set for Stroke were also in our list. The Comprehensive Core Set for Stroke was found to be a good potential starting point for the practical implementation of the ICF in a stroke rehabilitation unit.
ABILHAND is, in its original version, a 46-item, 4-level questionnaire. It measures the difficulty perceived by patients with rheumatoid arthritis as they do various daily manual tasks. ABILHAND was originally built through Rasch analysis. In a later study, it was simplified to a generic 23-item, three-level questionnaire, showing both cross-cultural (Belgium vs. Italy) and cross-impairment (rheumatoid arthritis vs. stroke) validity. Later research returned to the development of impairment-specific versions, with modified item sets and levels. Each version has its own Rasch-derived item difficulty calibrations, which are required to extract the patient's measure from the individual string of responses, through computerized algorithms. All of these hamper the practical application of the scale in rehabilitation units, where patients with diverse conditions may share similar impairments and treatment approaches. In this study through Rasch analysis the 'generic' scale was applied to 126 chronic patients with different upper limb impairments, and to 24 healthy controls. It was supported that the generic questionnaire remains valid across a variety of motor impairments. To further facilitate clinical application, a normative cut-off (>79 of 100) is suggested. Rasch-based item calibrations are provided together with a software routine designed to calculate, on individual patients, linear 0-100 measures and error estimates from the raw scores.
An understanding of the ability of persons with hearing impairments to interact socially needs to consider the impact of their disabilities on communication with non-disabled persons. This study examined the responses of 197 hard of hearing and deaf adolescents and a control group of 53 non-disabled young people between 14 and 18 years of age to statements in a questionnaire designed to elecit how they might behave in different contexts, with additional, independent assessment of the subjects by teachers and other educational staff. Results suggest that biological differences alone do not account for differences in self-conception found between those with hearing disabilities and those without, nor between different subgroups of those with hearing disabilities. Other cognitive, emotional, motivational and social factors also play a part. This opens up the possibility of developing new rehabilitation and training programmes to help young people with hearing disabilities acquire more positive self-assessments.
The vocational development of 547 disabled students in the United States and the Federal Republic of Germany was compared with a group of able bodied students in the U.S. on the Goldberg Scale of Vocational Development (GSVD), measuring plans, realism, initiative, work values, commitment, and occupational awareness. The students were classified into 8 groups, and covaried by age. The average scores from high to low on vocational development were: able bodied, cystic fibrosis, congenital heart, orthopedic, facial burns, delinquent, developmental disability, learning or mental retardation. The German students made plans specifically tailored to training courses whereas the American students made more varied and open ended plans with higher aspirations for the future. All 7 disabled groups scored lower than the able bodied group, with only the cystic fibrosis group approaching normality.
The ability to quantitatively document the characteristic gait patterns of disabled persons can contribute to the understanding of the mechanisms involved in the abnormal movement inherent in certain disease processes and also provide guidelines for evaluation of the efficacy of various treatment procedures.
For the rehabilitation process, the treatment of patients surviving brain injury in a vegetative state is still a serious challenge. The aim of this study was to investigate patients exhibiting severely disturbed consciousness using functional magnetic resonance imaging. Five cases of posttraumatic vegetative state and one with minimal consciousness close to the vegetative state were studied clinically, electrophysiologically, and by means of functional magnetic resonance imaging. Visual, sensory, and acoustic paradigms were used for stimulation. In three patients examined less than 2 months after trauma, a consistent decrease in blood oxygen level dependent (BOLD) signal ('negative activation') was observed for visual stimulation; one case even showed a decrease in BOLD activation for all three activation paradigms. In the remaining three cases examined more than 6 months after trauma, visual stimulation yielded positive BOLD contrast or no activation. In all cases, sensory stimulation was followed by a decrease in BOLD signal or no activation, whereas auditory stimulation failed to elicit any activation with the exception of one case. Functional magnetic resonance imaging in the vegetative state indicates retained yet abnormal brain function; this abnormality can be attributed to the impairment of cerebral vascular autoregulation or an increase in the energy consumption of activated neocortex in severe traumatic brain injury.
Early ambulation after lower extremity amputation has profound benefits on the functional, psychological outcomes and enhanced prosthetic compliance among this clientele. The various potential risks of immobility--pain, oedema, muscle atrophy, phantom sensations, contractures, aerobic de-conditioning, and the like, are reduced due to early ambulation. Moreover, it assists in accelerated wound healing, preservation of postural reflexes and, above all, achievement of better psychological well-being. Though such benefits have been observed in the history of prosthetic rehabilitation, a cost-effective prosthesis for such an early management among Third World nations is still unavailable. Therefore, this article is an attempt to present an indigenously developed temporary prosthesis designed to make the above benefits possible at a lower cost. This prosthesis helps in myriad ways--immediate prosthetic fitting, early weight bearing, early ambulation--and also has the added advantage of being adjustable to anthropological variations. The ischial weight bearing, lateral opening socket reduces the pressure and shear over the stump, thus avoiding stump complications. This increases the prosthetic acceptance by the client due to early involvement in the rehabilitation. Above all, it is cost effective and comfortable, thus enhancing compliance and superior outcome in prosthetic rehabilitation, especially among the clients in Third World nations.
A postal questionnaire was sent to 1500 randomly selected men and women aged 20-64 years living in three sparsely populated municipalities in northern Sweden with high rates of sickness absence, and to 1000 corresponding inhabitants in the Swedish capital Stockholm with a low rate of sickness absence. The proportion of participants aged >or=45 years was higher and incomes were lower in municipalities with high rates of sickness absence. In multiple logistic regression analyses with age, education, income, somatic health, mental health, pain and place of residence as independent variables, significant correlates of sick listing in men were: age >or=45 years (odds ratio 5.0; 95% confidence interval 2.4-10.3), poor somatic health (5.4; 2.6-11.0) and severe musculoskeletal pain (4.7; 2.4-9.1); and in women: age >or=45 years (2.6; 1.5-4.8), poor somatic health (12.2; 6.1-24.4), poor mental health (4.5; 2.0-10.1) and severe musculoskeletal pain (5.4; 2.7-10.5). Mental health was deleted by the logistic model for men, and income, education and place of residence for both sexes. We conclude that no support was found for the assumption that factors attributable to place of residence could explain the regional differences in sickness absence.
This study investigates whether psychosocial work characteristics and work-related psychological states predict return to work (RTW) after long-term sickness absence among eldercare staff. We followed 9947 employees in a national register on payment of sickness-absence compensation for 1 year and found that 598 employees had absence periods of 8 or more consecutive weeks. Using Cox regression analysis, these 598 employees were followed for a year after onset of sickness absence to investigate associations between baseline questionnaire data on psychosocial work characteristics and work-related psychological states on the one side and 'risk' of RTW on the other. The results showed that none of the psychosocial work characteristics, emotional demands, role conflicts, quality of leadership and influence, were significantly associated with RTW. Of the two work-related psychological states, affective organizational commitment and experience of meaning at work, the results showed that sickness-absent employees who experienced low meaning at work at baseline had a significantly reduced 'risk' of RTW when compared with employees who experienced high meaning at work. No significant associations were found for affective organizational commitment. The results imply that experience of meaning at work must be considered an important work-life resource, as it enhances the capacity of sickness-absent employees to RTW after extended sickness-absence periods.
Rehabilitation professionals sometimes believe that sickness absence from work is unduly prolonged. This paper examines the implications of factors that influence the timing of return to work, among patients with minor fractures, for the appropriateness of the time at which they should return to work. Data about a consecutive series of 85 employed hospital outpatients with fractures of the wrist, hand or foot bones were collected by means of interviews with the patients and from the orthopaedic case notes. The mean length of sickness absence from work was 3 weeks. Variations were related to the site and severity of the injury. Patients with physically heavy jobs, and patients with a husband or wife at home while they were off work, were off work for longer than average (6 and 5 weeks respectively). 76 per cent of the patients said they returned to work at the right time, and 23 per cent too early. Comparable findings relating to fracture patients, appear not to have been reported in the research literature previously. The patients in the series were away from work longer than advocates of aggressive rehabilitation might consider necessary, although the patients themselves felt they had returned to work at the right time or too early. The development of explicit criteria, based on the nature of the patient's injuries, recovery and job, might enable doctors to give patients more helpful advice about the time at which they should appropriately return to work.
The aim of this study is to investigate excitability changes in the human motor cortex induced by variable therapeutic electrical stimulations (TESs) with or without voluntary drive. We recorded motor-evoked potentials (MEPs) from extensor and flexor carpi radialis (FCR) muscles at rest and during FCR muscle contraction after the application of TES on FCR. TES application conditions were changed intensities, frequencies, and trains. In addition, to evaluate the contribution of M1 inhibitory circuits to the effects of TES application, we also recorded MEPs using paired-pulse transcranial magnetic stimulation. In resting muscle states, an increase in TES intensity resulted in an increase in MEP ratio in both the muscles. In contrast, when TES was applied to FCR during contraction, MEP ratios of both the muscles decreased with increased number of pulse trains. However, under both the states, MEP ratios decreased induced by paired-pulse transcranial magnetic stimulation in extensor carpi radialis to which TES was not applied. Excitability changes in M1 induced by TES application were reversibly modulated depending on the presence or absence of voluntary drive. This study showed that the therapy and the voluntary drive of the target muscles act together, and complement the effects of each other, which may be beneficial for optimizing the rehabilitation if the therapy accompanies voluntary drive.
Socio-demographic determinants of return to work: hazard ratios express 'hazard' of returning (n = 930)
This study investigates the determinants within socio-demography, health behaviour, employer characteristics, and psychosocial and physical work environment for return to work. In 2000, a total of 5357 employees were interviewed regarding age, gender, family status, education, health behaviour, employer characteristics and work environment. They were followed in a national register for 18 months in order to identify subjects with 2 weeks or more of sickness absence. They were followed for an additional 12 months in order to establish associations between baseline measurements and time to first return to work. A total of 930 (17.4%) employees experienced sickness absence in the 18 months after baseline. During the 12-month follow-up, 856 (92.0%) returned to work, the mean absence period being 6.6 weeks. Prolonged time to first return to work was associated with female gender, increased age, no post-school education, being employed by a public employer, working at a workplace with 20 or more employees, high emotional demands in work, high job insecurity and sedentary work. There were no associations between health behaviour variables and return to work. The study indicates a potential for promoting return to work through interventions targeting emotional job demands, job insecurity and decreasing the risks associated with sedentary work.
Top-cited authors
Richard W Bohannon
  • Physical Therapy Consultants
Peter J Huxley
  • Bangor University
Geoffrey Norman
  • McMaster University
David Goldberg
  • King's College London
Michiel F Reneman
  • University of Groningen