Therapeutic Actions Occupational Therapy

NCBI pubmed

Support service utilization and out-of-pocket payments for health services in a population-based sample of adults with neurological conditions.

Support service utilization and out-of-pocket payments for health services in a population-based sample of adults with neurological conditions. PLoS One. 2018;13(2):e0192911 Authors: Obembe AO, Goldsmith CH, Simpson LA, Sakakibara BM, Eng JJ Abstract BACKGROUND: Social support can help to deal with the consequences of neurological conditions and promote functional independence and quality of life. Our aim was to evaluate the impact of neurological conditions on the use of support and health-care services in a population-based sample of community-dwelling adults with neurological conditions. METHODS: Data were from the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents. Formal and informal support received and out-of-pocket payments were assessed by personal interviews. Logistic regression was used to explore the association between support service utilization and six common neurological conditions (Stroke, Parkinson's disease, Alzheimer's disease/dementias, traumatic brain injury, spinal cord injury and multiple sclerosis) with stroke as the reference category. RESULTS: The sample contained 2,410 respondents and equate to an estimated 459,770 when sample weights were used. A larger proportion of people within each of the neurological conditions received informal support than formal support (at least twice as much). Samples with the non-stroke conditions were more likely to receive formal assistance for personal (odds ratios 2.7 to 5.6; P < 0.05) and medical (odds ratios 2.4 to 4.4; P < 0.05) care compared to the stroke group. Also, the non-stroke conditions were more likely to receive informal assistance (odds ratios 2.7 to 17.9; P < 0.05) and less likely to make out-of-pocket payments for rehabilitation therapy (odds ratios 0.2 to 0.3; P < 0.05) than the stroke group. The Alzheimer's disease/dementia group had the highest proportion who received formal and informal support services. CONCLUSIONS: Our findings suggest that Canadians with neurological conditions receive more informal assistance than formal assistance. Furthermore, it appears that stroke survivors receive less support services, while those with Alzheimer's disease/dementia receive the most compared to other adult neurological conditions. Such data can help inform the development of support services in the community. PMID: 29474391 [PubMed - in process]

Prospective surveillance and targeted physiotherapy for arm morbidity after breast cancer surgery: a pilot randomized controlled trial.

Prospective surveillance and targeted physiotherapy for arm morbidity after breast cancer surgery: a pilot randomized controlled trial. Clin Rehabil. 2018 Feb 01;:269215518757292 Authors: Rafn BS, Hung S, Hoens AM, McNeely ML, Singh CA, Kwan W, Dingee C, McKevitt EC, Kuusk U, Pao J, Van Laeken N, Goldsmith CH, Campbell KL Abstract OBJECTIVE: To evaluate prospective surveillance and targeted physiotherapy (PSTP) compared to education (EDU) on the prevalence of arm morbidity and describe the associated program cost. DESIGN: Pilot randomized single-blinded controlled trial. SETTING: Urban with assessments and treatment delivered in hospitals. PARTICIPANTS: Women scheduled for breast cancer surgery. INTERVENTIONS: Participants were randomly assigned (1:1) to PSTP ( n = 21) or EDU ( n = 20) and assessed presurgery and 12 months postsurgery. All participants received usual care, namely, preoperative education and provision of an education booklet with postsurgical exercises. The PSTP group was monitored for arm morbidity every three months and referred for physiotherapy if arm morbidity was identified. The EDU group received three education sessions on nutrition, stress and fatigue management. MAIN OUTCOME MEASURES: Arm morbidity was based on changes in the surgical arm(s) from presurgery in four domains: (1) shoulder range of motion, (2) strength, (3) volume, and (4) upper body function. Complex arm morbidity indicated ≥2 domains impaired. Second, the cost of the PSTP program was described. RESULTS: At 12 months, 18 (49%) participants (10 PSTP and 8 EDU) had arm morbidity, with EDU participants presenting more complex arm morbidity compared to PSTP participants. PSTP participants attended 4.4 of 5 assessments with 90% retention. The PSTP program cost was $150 covered by the Health Care Provider and the Patient Out-of-Pocket Travel cost was CAN$40. CONCLUSION: Our results suggest that PSTP is feasible among women with breast cancer for early identification of arm morbidity. A larger study is needed to determine the cost and effectiveness benefits. PMID: 29473482 [PubMed - as supplied by publisher]

Predicting shoulder function after constraint-induced movement therapy: a retrospective cohort study.

Predicting shoulder function after constraint-induced movement therapy: a retrospective cohort study. Top Stroke Rehabil. 2018 Feb 23;:1-7 Authors: Hansen GM, Svendsen SW, Brunner I, Nielsen JF Abstract Background Several predictors have been associated with upper extremity (UE) recovery after stroke, but characteristics that predict shoulder function after constraint-induced movement therapy (CIMT) have not yet been identified. Objectives To identify predictors associated with satisfactory shoulder function in patients with reduced shoulder function at admission to CIMT. Methods One hundred and seventy five patients were treated using CIMT while in a specialized inpatient hospital. Satisfactory shoulder function was defined according to the functional ability scale of the Wolf Motor Function test. Predictors of satisfactory shoulder function after CIMT were identified using multivariable logistic regression. Results Better distal arm function and good proximal shoulder function on admission to CIMT were strong predictors of satisfactory shoulder function, while age and time of admission to CIMT since stroke were not. Seventeen percent of all CIMT-participants with reduced shoulder function pre-CIMT reached a level of satisfactory shoulder function after CIMT. Discussion A stantial part of patients with reduced shoulder function reached a level of satisfactory shoulder function after CIMT. Intensive CIMT training, comprising tasks that require both distal and proximal UE function, may increase shoulder function in patients with a potential functional reserve. PMID: 29473446 [PubMed - as supplied by publisher]

Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review.

Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review. Clin Rehabil. 2018 Feb 01;:269215518758484 Authors: Pritchard-Wiart L, Phelan SK Abstract OBJECTIVES: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature. METHODS: The scoping review process described by Arksey and O'Malley was used to guide article selection and data extraction. RESULTS: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies ( n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families ( n = 49). CONCLUSION: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes. PMID: 29473440 [PubMed - as supplied by publisher]

Making information skills meaningful: a case study from occupational therapy.

Making information skills meaningful: a case study from occupational therapy. Health Info Libr J. 2018 Mar;35(1):78-83 Authors: Spring H Abstract The effective delivery of information literacy training can be a challenging process, and health library and information professionals are constantly innovating in this area. This article presents a case study of the BHSc (Hons) Occupational therapy degree programme at York St John University to demonstrate ways in which deep integration of information skills into the curriculum can be achieved. The article advises that in the delivery of health and social care related information skills, we should look more broadly at where relevant learning can happen. In particular, contexts of the health care environment are suggested as a consideration rather than the narrow scope of the academic, classroom-based environment. Examples are provided of specific teaching and learning activities used on the programme alongside CPD activity and curriculum design. PMID: 29473330 [PubMed - in process]

A study of sensory dysregulation in children with tic disorders.

A study of sensory dysregulation in children with tic disorders. J Neural Transm (Vienna). 2018 Feb 23;: Authors: Weisman H, Parush S, Apter A, Fennig S, Benaroya-Milshtein N, Steinberg T Abstract Disrupted somatosensory processing characterized by over- or under- responsiveness to environmental stimuli plays an important, yet often overlooked, role in typical development and is aberrant in various neurodevelopmental disorders. These dysfunctional somatosensory processes have been conceptualized as an entity termed somatosensory dysregulation (SMD). Since Tourette syndrome (TS) is a prototypical example of developmental psychopathological disorder, we hypothesised that SMD would be a feature found in children suffering from the disorder. Ninety-two subjects representing consecutive admissions to a tertiary paediatric Tourette syndrome clinic were admitted to the study. Comorbid conditions included ADHD, depression, anxiety disorder, and OCD. For purposes of the study, patients completed a battery of self-, caregiver-, and clinician-rated psychological instruments measuring TS core symptoms and comorbidities and quality of life. Sensory modulation was measured by self-report and by objective measures such as stimulation with Von Frey filaments. Almost 50% of the cohort had no SMD. Of the remainder, 14 (15%) had suspected SMD and 32 (34.8%) had SMD. SMD was significantly more common and severe when there were comorbidities. The presence of SMD was associated with more severe impairments in quality of life and less participation in daily activities. The SMD, as measured by subjective measures but not by objective, is probably more associated with central processing rather than peripheral perception. PMID: 29473112 [PubMed - as supplied by publisher]

Thank you for asking: Exploring patient perceptions of barcode medication administration identification practices in inpatient mental health settings.

Related Articles Thank you for asking: Exploring patient perceptions of barcode medication administration identification practices in inpatient mental health settings. Int J Med Inform. 2017 Sep;105:31-37 Authors: Strudwick G, Clark C, McBride B, Sakal M, Kalia K Abstract BACKGROUND: Barcode medication administration systems have been implemented in a number of healthcare settings in an effort to decrease medication errors. To use the technology, nurses are required to login to an electronic health record, scan a medication and a form of patient identification to ensure that these correspond correctly with the ordered medications prior to medication administration. In acute care settings, patient wristbands have been traditionally used as a form of identification; however, past research has suggested that this method of identification may not be preferred in inpatient mental health settings. If barcode medication administration technology is to be effectively used in this context, healthcare organizations need to understand patient preferences with regards to identification methods. PURPOSE: The purpose of this study was to elicit patient perceptions of barcode medication administration identification practices in inpatient mental health settings. Insights gathered can be used to determine patient-centered preferences of identifying patients using barcode medication administration technology. METHODS: Using a qualitative descriptive approach, fifty-two (n=52) inpatient interviews were completed by a Peer Support Worker using a semi-structured interview guide over a period of two months. Interviews were conducted in a number of inpatient mental health areas including forensic, youth, geriatric, acute, and rehabilitation services. An interprofessional team, inclusive of a Peer Support Worker, completed a thematic analysis of the interview data. RESULTS: Six themes emerged as a result of the inductive data analysis. These included: management of information, privacy and security, stigma, relationships, safety and comfort, and negative associations with the technology. Patients also indicated that they would like a choice in the type of identification method used during barcode medication administration. As well, suggestions were made for how barcode medication administration practices could be modified to become more patient-centered. CONCLUSION: The results of this study have a number of implications for healthcare organizations. As patients indicated that they would like a choice in the type of identification method used during barcode medication administration, healthcare organizations will need to determine how they can facilitate this process. Furthermore, many of the concerns that patients had with barcode medication administration technology could be addressed through patient education. PMID: 28750909 [PubMed - indexed for MEDLINE]

Reducing gait speed affects axial coordination of walking turns.

Related Articles Reducing gait speed affects axial coordination of walking turns. Gait Posture. 2017 May;54:71-75 Authors: Forsell C, Conradsson D, Paquette C, Franzén E Abstract Turning is a common feature of daily life and dynamic coordination of the axial body segments is a cornerstone for safe and efficient turning. Although slow walking speed is a common trait of old age and neurological disorders, little is known about the effect of walking speed on axial coordination during walking turns. The aim of this study was to investigate the influence of walking speed on axial coordination during walking turns in healthy elderly adults. Seventeen healthy elderly adults randomly performed 180° left and right turns while walking in their self-selected comfortable pace and in a slow pace speed. Turning velocity, spatiotemporal gait parameters (step length and step time), angular rotations and angular velocity of the head and pelvis, head-pelvis separation (i.e. the angular difference in degrees between the rotation of the head and pelvis) and head-pelvis velocity were analyzed using Wilcoxon signed-rank tests. During slow walking, turning velocity was 15% lower accompanied by shorter step length and longer step time compared to comfortable walking. Reducing walking speed also led to a decrease in the amplitude and velocity of the axial rotation of the head and pelvis as well as a reduced head-pelvis separation and angular velocity. This study demonstrates that axial coordination during turning is speed dependent as evidenced by a more 'en bloc' movement pattern (i.e. less separation between axial segments) at reduced speeds in healthy older adults. This emphasizes the need for matching speed when comparing groups with diverse walking speeds to differentiate changes due to speed from changes due to disease. PMID: 28273601 [PubMed - indexed for MEDLINE]

Strategies for Combating Opioid-Induced Constipation: Targeted Mechanisms to Maintain Pain Control Without Compromise.

Related Articles Strategies for Combating Opioid-Induced Constipation: Targeted Mechanisms to Maintain Pain Control Without Compromise. PM R. 2017 Mar;9(3):325 Authors: Brennan MJ, Stanos SP Abstract Opioid-induced constipation (OIC) is a common side effect of opioid use and can occur from the outset of opioid therapy (Online access: http://courses.elseviercme.com/aapmr2016/638e). OIC has been reported to interfere with pain management, increase health care costs, decrease work productivity and daily activities, and significantly affect patient quality of life. It can also lead to bowel obstruction. Assessing and managing OIC is important for establishing maximum function for patients. Several pharmacologic approaches, with different mechanisms of action, are available or in development. PMID: 28143720 [PubMed - indexed for MEDLINE]

Effectiveness of Aquatic Therapy vs Land-based Therapy for Balance and Pain in Women with Fibromyalgia: a study protocol for a randomised controlled trial.

Related Articles Effectiveness of Aquatic Therapy vs Land-based Therapy for Balance and Pain in Women with Fibromyalgia: a study protocol for a randomised controlled trial. BMC Musculoskelet Disord. 2017 Jan 19;18(1):22 Authors: Rivas Neira S, Pasqual Marques A, Pegito Pérez I, Fernández Cervantes R, Vivas Costa J Abstract BACKGROUND: Fibromyalgia is a disease with an increasing incidence. It impairs the quality of life of patients and decreases their functional capacity. Aquatic therapy has already been used for managing the symptoms of this syndrome. However, aquatic therapy has only recently been introduced as a treatment modality for improving proprioception in fibromyalgia. The main objective of this study is to determine the effectiveness of two physiotherapy protocols, one in and one out of water, for improving balance and decreasing pain in women with fibromyalgia. METHODS/DESIGN: The study protocol will be a single-blind randomised controlled trial. Forty women diagnosed with fibromyalgia will be randomly assigned into 2 groups: Aquatic Therapy (n = 20) or Land-based Therapy (n = 20). Both interventions include 60-min therapy sessions, structured into 4 sections: Warm-up, Proprioceptive Exercises, Stretching and Relaxation. These sessions will be carried out 3 times a week for 3 months. Primary outcomes are balance (static and dynamic) and pain (intensity and threshold). Secondary outcomes include functional balance, quality of life, quality of sleep, fatigue, self-confidence in balance and physical ability. Outcome measures will be evaluated at baseline, at the end of the 3-month intervention period, and 6-weeks post-treatment. Statistical analysis will be carried out using the SPSS 21.0 program for Windows and a significance level of p ≤ 0.05 will be used for all tests. DISCUSSION: This study protocol details two physiotherapy interventions in women with fibromyalgia to improve balance and decrease pain: aquatic therapy and land-based therapy. In current literature there is a lack of methodological rigour and a limited number of studies that describe physiotherapy protocols to manage fibromyalgia symptoms. High-quality scientific works are required to highlight physiotherapy as one of the most recommended treatment options for this syndrome. TRIAL REGISTRATION: Date of publication in ClinicalTrials.gov: 18/02/2016. ClinicalTrials.gov Identifier: NCT02695875 . PMID: 28103853 [PubMed - indexed for MEDLINE]

Impact of Secondary Prevention in an Occupational High-Risk Group.

Related Articles Impact of Secondary Prevention in an Occupational High-Risk Group. J Occup Environ Med. 2017 Jan;59(1):67-73 Authors: Welch LS, Dement J, Ringen K, Cranford K, Quinn PS Abstract BACKGROUND: A study of medical outcomes among 6857 elderly construction workers who received an initial and at least one periodic follow-up examination as a result of participating in a medical screening program was undertaken. METHODS: We compared results from the initial examination to follow-up examinations delivered at least 3 years after the initial examination for the following outcomes: body mass index (BMI); total serum cholesterol; nonhigh-density lipoprotein (non-HDL) cholesterol; hemoglobin A1c, hypertension; current cigarette smoking; and 10-year cardiovascular disease (CVD) risk scores. RESULTS: Statistically significant improvements (P < 0.05) were observed for all measures except BMI. CONCLUSIONS: Participation in a periodic medical screening program for elderly construction workers is associated with a favorable impact on common health outcomes. When presented with a program designed for them, blue-collar workers are motivated to seek improvements in their health status. PMID: 28045800 [PubMed - indexed for MEDLINE]

Quality of Care for Work-Associated Carpal Tunnel Syndrome.

Related Articles Quality of Care for Work-Associated Carpal Tunnel Syndrome. J Occup Environ Med. 2017 Jan;59(1):47-53 Authors: Nuckols T, Conlon C, Robbins M, Dworsky M, Lai J, Roth CP, Levitan B, Seabury S, Seelam R, Asch SM Abstract OBJECTIVE: To evaluate the quality of care provided to individuals with workers' compensation claims related to Carpal tunnel syndrome (CTS) and identify patient characteristics associated with receiving better care. METHODS: We recruited subjects with new claims for CTS from 30 occupational clinics affiliated with Kaiser Permanente Northern California. We applied 45 process-oriented quality measures to 477 subjects' medical records, and performed multivariate logistic regression to identify patient characteristics associated with quality. RESULTS: Overall, 81.6% of care adhered to recommended standards. Certain tasks related to assessing and managing activity were underused. Patients with classic/probable Katz diagrams, positive electrodiagnostic tests, and higher incomes received better care. However, age, sex, and race/ethnicity were not associated with quality. CONCLUSIONS: Care processes for work-associated CTS frequently adhered to quality measures. Clinical factors were more strongly associated with quality than demographic and socioeconomic ones. PMID: 28045797 [PubMed - indexed for MEDLINE]

Male-Female Differences in Work Activity Limitations: Examining the Relative Contribution of Chronic Conditions and Occupational Characteristics.

Related Articles Male-Female Differences in Work Activity Limitations: Examining the Relative Contribution of Chronic Conditions and Occupational Characteristics. J Occup Environ Med. 2017 Jan;59(1):6-11 Authors: Padkapayeva K, Chen C, Bielecky A, Ibrahim S, Mustard C, Beaton D, Smith P Abstract OBJECTIVE: The aim of this study was to examine differences in activity limitations at work among men and women, and the relative contributions that chronic conditions and occupational characteristics have on these differences. METHODS: Secondary data from the Canadian Community Health Surveys were used. Path analysis examined the role of mediating variables (chronic conditions and occupational characteristics) in male-female differences in work activity limitations. RESULTS: The prevalence of activity limitations at work was higher in women (15.0%) than in men (12.3%). Arthritis, migraines, diabetes, heart disease, and mood disorders, as well as high physical demands and prolonged standing were associated with an increased risk of work activity limitations. The increased risk of work activity limitations among women was completely explained by mediating variables. CONCLUSIONS: This study suggests that male-female differences in work activity limitations can be explained by differences in chronic conditions and occupational characteristics. PMID: 28045791 [PubMed - indexed for MEDLINE]

Illustrating and Analyzing the Processes of Interprofessional Collaboration: A Lesson Learned from Palliative Care in Deconstructing the Concept.

Related Articles Illustrating and Analyzing the Processes of Interprofessional Collaboration: A Lesson Learned from Palliative Care in Deconstructing the Concept. J Palliat Med. 2017 Mar;20(3):227-234 Authors: Witt Sherman D, Maitra K, Gordon Y, Simon S, Olenick M, Barbara S, Doherty-Restrepo J, Hough M, Randolph M, Singh A Abstract BACKGROUND: A basic tenet of palliative care is interprofessional collaboration. Palliative care educators and practitioners lead the way in responding to the Institute of Medicine's (2003) challenge to transform educational and health care systems through interprofessional collaboration. Through exemplary commitment to interprofessional collaboration, a college's academic and palliative care leader, in collaboration with Department Chairs and Directors of nursing and allied health professions, can illustrate and analyze the processes of interprofessional collaboration through the development of a simulated case study of a combat veteran with traumatic brain injury. METHODS: Methodologic components: (1) interprofessional development of a palliative care case study and (2) debriefing interviews regarding the experience of collaboration of interprofessional team members. RESULTS: The results provide the identification of steps of the interprofessional process and the shared and unique disciplinary competencies in determining a comprehensive health history, physical examination, identifying and prioritizing diagnoses, and determining collaborative discipline-specific interventions. Content analysis of debriefing team interviews provides a description of group composition, structure, process, development, and performance, as well as team member's perceptions of what fosters and challenges collaboration, benefits, and drawbacks, and what could have been done differently in developing an interprofessional initiative. DISCUSSION: Transformative change in healthcare education and clinical practice involves interprofessional collaboration of colleagues within, across, and beyond universities/colleges and healthcare systems and agencies. Advocating for teamwork has to go beyond talking about being a team player or not to having the language and behaviors we need to observe and measure. This article not only provides key processes in interprofessional collaboration but also identifies key attitudes and behaviors critical to teamwork. It provides a starting point to determine observable and measurable outcomes for interprofessional education, practice, and research. This article highlights expert behavior to move professionals from being novices in interprofessional collaboration to mastering the skills. PMID: 28001457 [PubMed - indexed for MEDLINE]

The Effect of Propulsion Style on Wrist Movement Variability During the Push Phase After a Bout of Fatiguing Propulsion.

Related Articles The Effect of Propulsion Style on Wrist Movement Variability During the Push Phase After a Bout of Fatiguing Propulsion. PM R. 2017 Mar;9(3):265-274 Authors: Zukowski LA, Christou EA, Shechtman O, Hass CJ, Tillman MD Abstract BACKGROUND: Wheelchair propulsion has been linked to overuse injuries regardless of propulsion style. Many aspects of the arcing (ARC) and semicircular (SEMI) propulsion styles have been compared, but differences in intracycle movement variability, which have been linked to overuse injuries, have not been examined. OBJECTIVE: To explore how ARC and SEMI affect changes in intracycle wrist movement variability after a fatiguing bout of propulsion. DESIGN: Repeated measures crossover design. SETTING: Wheelchair rollers and wheelchair fatigue course in a research laboratory. PARTICIPANTS: Twenty healthy, nondisabled adult men without previous wheelchair experience. INTERVENTIONS: Participants learned ARC and SEMI and used each to perform a wheelchair fatigue protocol. MAIN OUTCOME MEASUREMENTS: Thirty seconds of propulsion on rollers were recorded by motion-capture cameras before and after a fatigue protocol for each propulsion style on 2 testing days. Angular wrist orientations (flexion/extension and radial/ulnar deviation) and linear wrist trajectories (mediolateral direction) were computed, and intracycle movement variability was calculated as standard deviations of the detrended and filtered values during the push phase beginning and end. Paired samples t tests were used to compare ARC and SEMI based on the percent changes from pre- to postfatigue protocol. RESULTS: Both propulsion styles resulted in increased intracycle wrist movement variability postfatigue, but observed increases did not significantly differ between ARC and SEMI. CONCLUSIONS: This study evinces that intersubject variability exceeded average changes in intracycle wrist movement variability for both propulsion styles. Neither propulsion style resulting in a greater change in intracycle movement variability may suggest that no single propulsion style is ideal for everyone. The large intersubject variability may indicate that the propulsion style resulting in the smallest increase in intracycle movement variability after a fatiguing bout of propulsion may differ for each person and may help explain why wheelchair users self-select to use different propulsion styles. PMID: 27390056 [PubMed - indexed for MEDLINE]

Characteristics and Concerns of Caregivers of Adults With Traumatic Brain Injury.

Related Articles Characteristics and Concerns of Caregivers of Adults With Traumatic Brain Injury. J Head Trauma Rehabil. 2017 Jan/Feb;32(1):E33-E41 Authors: Powell JM, Wise EK, Brockway JA, Fraser R, Temkin N, Bell KR Abstract OBJECTIVE: To describe the characteristics of caregivers of adults with traumatic brain injury (TBI) and their concerns in the first months after community discharge of the TBI survivor. DESIGN: Secondary analysis of data collected during a parallel-group randomized controlled trial. SETTING: Community. PARTICIPANTS: A total of 153 consecutively enrolled caregivers of adults with moderate to severe TBI discharged to the community following acute and/or rehabilitation care at a Level I trauma center with 71 caregivers in the treatment group identifying concerns as part of the intervention procedures. MAIN MEASURES: Caregiver demographics, caregiver-survivor relationship characteristics, caregiver activity changes, and concerns targeted by caregivers for education and problem-solving via biweekly phone calls. RESULTS: Thirty-nine percent of caregivers were spouses and 35% parents. Sixty-five percent lived in the same house as the survivor preinjury with 86% in touch daily to several times per week. Concerns targeted by more than one-third of caregivers related to managing their emotional adjustment, strategies for getting things done, managing survivor emotions and behaviors, and engaging in healthful habits. CONCLUSIONS: Caregivers of TBI survivors targeted personal concerns relating to their own emotional adjustment and participation as well as concerns relating to symptoms and recovery of the TBI survivor to address through education and problem-solving. PMID: 27022956 [PubMed - indexed for MEDLINE]

How kinematic disturbance in the deformed rheumatoid thumb impacts on hand function: a biomechanical and functional perspective.

Related Articles How kinematic disturbance in the deformed rheumatoid thumb impacts on hand function: a biomechanical and functional perspective. Disabil Rehabil. 2017 Feb;39(4):338-345 Authors: Tsai CL, Lin CF, Lin HT, Liu MF, Chiu HY, Hsu HY, Kuo LC Abstract Purpose This study investigates the effects of kinematic disturbances in rheumatoid thumb on patient's hand functions via objective and patient-perceived measurements. Method Twenty-one patients with rheumatoid arthritis (RA) and 21 healthy age- and gender-matched individuals were recruited to receive the objective evaluations, including the Purdue Pegboard Test, Jamar dynamometer, pinch-meter, Permanent Impairment Scale and self-administrated measurements, including the Health Assessment Questionnaire (HAQ) and Manual Ability Measure-36 (MAM-36). An electromagnetic tracking system was used to measure thumb kinematics. The differences in the measures between the RA and control groups and the dominant and non-dominant hands of the RA group were examined. The relationships between the thumb kinematics and hand functional capabilities, as well as impairment levels, were also explored. Results The RA group showed significantly smaller thumb movement capabilities and hand strength, as well as worse scores in hand dexterity, MAM-36 and HAQ than healthy controls. The movement workspace of the RA thumb showed moderate correlations with the factors of hand strength, dexterity, impairment scale, MAM-36 and HAQ scores. Conclusions The findings indicate deficits related to the movement capability of the RA thumb may negatively influence hand dexterity and functional hand performance, as well as life quality, for the patients with RA. Implications for Rehabilitation A deformed rheumatoid thumb might limit the movement workspace of the thumb and consequently impair the hand performance as well as the life quality. The dominant thumb of the RA patients might have greater structural and functional deterioration than the non-dominant side. Suitable joint protection strategies, exercises and orthotics should be early applied to the RA patients for preserving hand functions. PMID: 26883482 [PubMed - indexed for MEDLINE]

Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden.

Related Articles Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden. J Head Trauma Rehabil. 2017 Jan/Feb;32(1):1-15 Authors: Janak JC, Cooper DB, Bowles AO, Alamgir AH, Cooper SP, Gabriel KP, Pérez A, Orman JA Abstract OBJECTIVE: To investigate the pre- to posttreatment changes in both posttraumatic stress disorder (PTSD) and persistent postconcussive symptoms (PPCSs). SETTING AND PARTICIPANTS: We studied 257 active-duty patients with a history of mild traumatic brain injury (mTBI) who completed multidisciplinary outpatient treatment at Brooke Army Medical Center TBI Clinic from 2008 to 2013. This treatment program included cognitive rehabilitation; vestibular interventions; headache management; and integrated behavioral healthcare to address co-occurring psychiatric conditions such as PTSD, depression, and sleep disturbance. DESIGN: A 1-group; preexperimental, pre- to posttreatment study. MAIN MEASURES: The Neurobehavioral Symptom Inventory (NSI) was used to assess PPCSs, and the PTSD Checklist-Military Version (PCL-M) was used to asses PTSD symptoms. RESULTS: Global PPCS resolution (mean NSI: 35.0 pre vs 23.8 post; P < .0001; d = 0.72) and PTSD symptom resolution (mean PCL-M: 43.2 pre vs 37.7 post; P < .0001; d = 0.34) were statistically significant. Compared with those with only mTBI, patients with mTBI and PTSD reported greater global PPCS impairment both pretreatment (mean NSI: 48.7 vs 27.9; P < .0001) and posttreatment (mean NSI: 36.2 vs 17.4; P < .0001). After adjusting for pretreatment NSI scores, patients with comorbid PTSD reported poorer PPCS resolution than those with mTBI alone (mean NSI: 27.9 pre vs 21.7 post; P = .0009). CONCLUSION: We found a reduction in both self-reported PPCSs and PTSD symptoms; however, future studies are needed to identify specific components of care associated with symptom reduction. PMID: 26709579 [PubMed - indexed for MEDLINE]

Correspondence in Stakeholder Assessment of Health, Work Capacity and Sick Leave in Workers with Comorbid Subjective Health Complaints? A Video Vignette Study.

Related Articles Correspondence in Stakeholder Assessment of Health, Work Capacity and Sick Leave in Workers with Comorbid Subjective Health Complaints? A Video Vignette Study. J Occup Rehabil. 2016 Sep;26(3):340-9 Authors: Maeland S, Magnussen LH, Eriksen HR, Werner EL, Helle-Valle A, Hensing G Abstract Purpose The purpose of this study is to test if there is correspondence in stakeholders' assessments of health, work capacity and sickness certification in four workers with comorbid subjective health complaints based on video vignettes. Methods A cross sectional survey among stakeholders (N = 514) in Norway in 2009/2010. Logistic regression and multinomial logistic regression was used to obtain the estimated probability of stakeholders choosing 100 % sick leave, partial sick leave or work and the estimation of odds ratio of stakeholder assessment compared to the other stakeholders for the individual worker. Results The supervisors were less likely to assess poor health and reduced work capacity, and more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. The public was less likely to assess comorbidity and reduced work capacity, and 6 and 12 times more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. Stakeholders generally agreed in their assessments of workers 2 and 3. The public was more likely to assess poor health, comorbidity and reduced work capacity, and the supervisors more likely to assess comorbidity and reduced work capacity, compared to the GPs for worker 4. Compared to the GPs, all other stakeholders were less likely to suggest full time work for this worker. Conclusions Our results seem to suggest that stakeholders have divergent assessments of complaints, health, work capacity, and sickness certification in workers with comorbid subjective health complaints. PMID: 26615412 [PubMed - indexed for MEDLINE]

Rasch Analysis of the General Self-Efficacy Scale in Workers with Traumatic Limb Injuries.

Related Articles Rasch Analysis of the General Self-Efficacy Scale in Workers with Traumatic Limb Injuries. J Occup Rehabil. 2016 Sep;26(3):332-9 Authors: Wu TY, Yu WH, Huang CY, Hou WH, Hsieh CL Abstract Purpose The purpose of this study was to apply Rasch analysis to examine the unidimensionality and reliability of the General Self-Efficacy Scale (GSE) in workers with traumatic limb injuries. Furthermore, if the items of the GSE fitted the Rasch model's assumptions, we transformed the raw sum ordinal scores of the GSE into Rasch interval scores. Methods A total of 1076 participants completed the GSE at 1 month post injury. Rasch analysis was used to examine the unidimensionality and person reliability of the GSE. The unidimensionality of the GSE was verified by determining whether the items fit the Rasch model's assumptions: (1) item fit indices: infit and outfit mean square (MNSQ) ranged from 0.6 to 1.4; and (2) the eigenvalue of the first factor extracted from principal component analysis (PCA) for residuals was <2. Person reliability was calculated. Results The unidimensionality of the 10-item GSE was supported in terms of good item fit statistics (infit and outfit MNSQ ranging from 0.92 to 1.32) and acceptable eigenvalues (1.6) of the first factor of the PCA, with person reliability = 0.89. Consequently, the raw sum scores of the GSE were transformed into Rasch scores. Conclusions The results indicated that the items of GSE are unidimensional and have acceptable person reliability in workers with traumatic limb injuries. Additionally, the raw sum scores of the GSE can be transformed into Rasch interval scores for prospective users to quantify workers' levels of self-efficacy and to conduct further statistical analyses. PMID: 26614307 [PubMed - indexed for MEDLINE]