PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (217)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
more »
Document Types
1.  Does Post-Acute Care Site Matter? A longitudinal study assessing functional recovery after a stroke 
Objective
To determine the impact of post acute care site on stroke outcomes. Following a stroke, patients may receive post acute care in a number of different sites: inpatient rehabilitation (IRF), skilled nursing facility (SNF), and home health care/outpatient (HH/OP). We hypothesized that patients who received IRF would have better six-month functional outcomes than those who received care in other settings after controlling for patient characteristics.
Design
Prospective Cohort Study.
Setting
Four Northern California hospitals which are part of a single health maintenance organization.
Participants
222 patients with stroke enrolled between February 2008 and July 2010.
Intervention
Not Applicable.
Main Outcome Measure
Baseline and 6 month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC™), a test of self-reported function in three domains: Basic Mobility, Daily Activities, and Applied Cognition.
Results
Of the 222 patients analyzed, 36% went home with no treatment, 22% received HH/OP care, 30% included IRF in their care trajectory, and 13% included SNF (but not IRF) in their care trajectory. At six months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a SNF in all 3 domains and in two out of three functional domains compared to those who received HH/OP care.
Conclusions
Patients with stroke may make more functional gains if their post-acute care includes an IRF. This finding may have important implications as post-acute care delivery is reshaped through health care reform.
doi:10.1016/j.apmr.2012.09.033
PMCID: PMC3584186  PMID: 23124133
stroke outcome; stroke assessment; disability evaluation; rehabilitation
2.  Effect of durations of wheelchair tilt-in-space and recline on skin perfusion over the ischial tuberosity in people with spinal cord injury 
Objective
To compare the efficacy of various durations of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in people with spinal cord injury (SCI).
Design
Repeated measures, intervention and outcomes measure design.
Setting
University research laboratory.
Participants
Power wheelchair users with SCI (N=9).
Interventions
Three protocols of various durations (3 min, 1 min and zero) of wheelchair tilt-in-space and recline were randomly assigned to the participants. Each protocol consisted of a baseline 15 min sitting, a duration of zero to 3 min reclined and tilted, a second 15 min sitting, and a 5 min recovery. The position at the baseline and second sitting was no tilt/recline of the participant and at the reclined and tilted and recovery was at 35° tilt-in-space and 120° recline.
Main Outcome Measures
Skin perfusion response to tilt and recline was assessed by laser Doppler and was normalized to mean skin perfusion at the baseline sitting.
Results
The results showed that mean skin perfusion during recovery at the 3 min duration was significantly higher compared to the 1 min duration (P<.017), and mean skin perfusion was not significantly different between the 1 min and zero durations (N.S.). Skin perfusion during the second sitting was significantly higher at the 3 min duration compared to the 1 min and zero durations (P<.017).
Conclusions
Our findings suggest that performing the 3 min duration of wheelchair tilt-in-space and recline is more effective than the 1 min duration on enhancing skin perfusion of weight bearing soft tissues.
doi:10.1016/j.apmr.2012.11.019
PMCID: PMC3608808  PMID: 23178540
Pressure ulcer; rehabilitation; skin blood flow; spinal cord injuries; wheelchairs
3.  Walking to meet physical activity guidelines in knee osteoarthritis: Is 10,000 steps enough? 
Objective
To study if step goals (e.g. walking 10,000 steps/day) approximate meeting 2008 Physical Activity Guidelines for Americans among adults with or at high risk of knee OA.
Design
Cross-sectional observational cohort
Setting
Community
Participants
People with or at high risk of knee OA
Interventions
None
Main Outcome Measures
Objective physical activity data were collected over 7 consecutive days from people with or at high risk of knee (OA) participating in the Multicenter Osteoarthritis Study. Using activity monitor data, we determined the proportion that 1) walked ≥10,000 steps/day, 2) met the 2008 Physical Activity Guidelines, and 3) achieved both recommendations.
Results
Of 1788 subjects studied (age 67 ± 8 yrs, BMI 31 ± 6 kg/m2, 60% women), 16.7% of men and 12.6% of women walked ≥10,000 steps/day, while 6% of men and 5% of women met the 2008 Physical Activity Guidelines for Americans. Of those walking ≥10,000 steps/day, 16.7% and 26.7% of men and women also met the 2008 Physical Activity Guidelines.
Conclusions
Among this sample of older adults with or at high risk of knee OA, walking ≥10,000 steps/day did not translate into meeting public health guidelines. These findings highlight the disparity between number of steps/day believed to be needed and recommended time-intensity guidelines to achieve positive health benefits.
doi:10.1016/j.apmr.2012.11.038
PMCID: PMC3608824  PMID: 23228625
Physical Activity; knee osteoarthritis; pedometer; Public Health Guidelines; Walking
4.  The unique contribution of fatigue to disability in community dwelling adults with traumatic brain injury 
Objective
To examine the unique contribution of fatigue to self-reported disability in community dwelling adults with traumatic brain injury (TBI).
Design
A cross-sectional cohort design.
Setting
Community dwellings in the greater Pittsburgh region.
Participants
Fifty adults with a history of mild to severe TBI were assessed.
Main Outcome Measure
This study assessed the contribution of fatigue (Modified Fatigue Impact Scale) to disability (Mayo Portland Adaptability Inventory IV), controlling for executive functions (Frontal Systems Behavior Scale), depression status (major depression in partial remission/current major depression/depressive symptoms or no history of depression), and initial injury severity (uncomplicated mild, complicated mild, moderate, or severe).
Results
Fatigue was found to contribute uniquely to the variance in self-reported disability (β=.47, P< 0.001) after controlling for injury severity, executive functions, and depression status. The overall model was significant (F4,45=17.32, P<.001) and explained 61% of the variance in self-reported disability, with fatigue alone accounting for 12% of the variance in self-reported disability (F1,45=13.97, P<.001).
Conclusions
Fatigue contributes uniquely to disability status among community-dwelling adults with chronic TBI, independently of injury severity, executive functions, and depression. Addressing fatigue through targeted interventions may help to improve self-perceived disability in this population.
doi:10.1016/j.apmr.2012.07.025
PMCID: PMC3963171  PMID: 22885286
Brain Injuries; Fatigue; Rehabilitation
5.  Improving Hand Function in Stroke Survivors: A Pilot Study of Contralaterally Controlled Functional Electrical Stimulation in Chronic Hemiplegia 
Objective
To assess the feasibility of a new stroke rehabilitation therapy for the hemiparetic hand.
Design
Case series. Pre- and post-intervention assessment with 1 and 3 month follow-ups.
Setting
Clinical research laboratory of a large public hospital.
Participants
Three subjects with chronic (> 6 mo post-CVA) upper extremity hemiplegia.
Intervention
Subjects used an electrical stimulator to cause the paretic hand extensor muscles to contract and thereby open the hand. The subjects controlled the intensity of the stimulation, and thus the degree of hand opening, by volitionally opening the unimpaired contralateral hand, which was detected by an instrumented glove. For 6 weeks the subjects used the stimulator to perform active repetitive hand opening exercises 2 hours daily at home and functional tasks 1½ hours twice a week in the laboratory.
Outcome Measures
Maximum voluntary finger extension, maximum voluntary isometric finger extension moment, finger movement control, and Box and Block score at pre- and post-treatment, and at 1 month and 3 months post-treatment.
Results
Maximum voluntary finger extension increased from baseline to end-of-treatment and from end-of-treatment to 1 month follow-up in two subjects. Maximum voluntary isometric finger extension moment, finger movement control, and Box and Block score increased from baseline to end-of-treatment and from end-of-treatment to 1 month follow-up in all 3 subjects. The improvements generally declined at 3 months.
Conclusions
The results suggest a positive effect on motor impairment, meriting further investigation of the intervention.
doi:10.1016/j.apmr.2007.01.003
PMCID: PMC3961574  PMID: 17398254
stroke; hemiplegia; rehabilitation; electrical stimulation; medical device
6.  Manual Wheelchair Skills: Objective Testing versus Subjective Questionnaire 
Objectives
To test the hypothesis that the total scores of the Wheelchair Skills Test (WST) version 4.1, an observer rated scale of wheelchair performance, and the Wheelchair Skills Test Questionnaire (WST-Q) version 4.1, a self-report of wheelchair skills, are highly correlated. We also anticipate the WST-Q will be slightly higher indicating an overestimation of capacity to perform wheelchair skills, as compared to actual capacity.
Design
A cross-sectional, within-subjects comparison design.
Participants
Convenience sample of 89 community-dwelling, experienced manual wheelchair users ranging in age from 21–94 years.
Setting
Three Canadian cities.
Intervention
Not applicable.
Main Outcome Measures
Participants completed the subjective WST-Q version 4.1, followed by the objective WST version 4.1 in one testing session.
Results
The mean ± SD total percentage scores for WST and WST-Q were 79.5% ±14.4 and 83.0% ±12.1 for capacity and 99.4% ±1.5 and 98.9% ±2.5 for safety. The correlations between the WST and WST-Q scores were ρ=0.89 (p=0.000) for capacity and ρ=0.12 (p=0.251) for safety. WST-Q total score mean differences were an average of 3.5%±6.5 higher than WST scores for capacity (p = 0.000) and 0.52%±2.8 lower for safety (p = 0.343). For the 32 individual skills, the percentage agreement between the WST and WST-Q scores ranged from 82–100% for capacity and 90–100% for safety.
Conclusion
WST and WST-Q version 4.1 capacity scores are highly correlated although the WST-Q scores are slightly higher. Decisions on which of these assessments to use can safely be based on the circumstances and objectives of the evaluation.
doi:10.1016/j.apmr.2012.06.007
PMCID: PMC3951990  PMID: 22728701 CAMSID: cams3082
Wheelchairs; Outcome assessment (health care); Rehabilitation
7.  Left-Sided Brain Injury Associated With More Hospital-Acquired Infections During Inpatient Rehabilitation 
Objective
To test the hypothesis that a left-dominant brain immune network (LD-BIN) might affect the occurrence of infection during inpatient rehabilitation of stroke and traumatic brain injury (TBI).
Design
A retrospective analysis was performed on electronic medical records between January 2009 and December 2010. All patients with left-or right-sided stroke or TBI were included into the study. The LD-BIN hypothesis was tested by comparing HAI rates depending on whether patients had left- or right-sided brain lesions.
Setting
A large inpatient rehabilitation hospital.
Participants
Among the patients (N=2236) with stroke or TBI who had either a left- or right-sided brain lesion, 163 patients were identified with HAIs.
Intervention
Not applicable.
Main Outcome Measure
Frequency of HAIs.
Results
In the 163 patients identified with HAIs with a diagnosis of stroke or TBI, chi-square analysis revealed a significantly higher proportion of HAIs among patients with left-sided (n=98; 60.1%) relative to right-sided (n=65; 39.9%) brain injuries (χ2=6.68, P<.01). These effects could not be attributed to either clinical or demographic factors.
Conclusions
Our findings are consistent with the hypothesis that an LD-BIN may mediate vulnerability to infection during rehabilitation of patients with stroke or TBI. Further translational research investigating novel means of managing patients based on brain lesion location, and modulating the LD-BIN via behavioral and physiologic interventions, may result in neuroscience-based methods to improve infection resistance in brain-injured patients.
doi:10.1016/j.apmr.2012.10.012
PMCID: PMC3732651  PMID: 23123439
Brain; Infection; Injuries; Rehabilitation
8.  The Spinal Cord Injury- Functional Index: Item Banks to Measure Physical Functioning of Individuals with Spinal Cord Injury 
Objective
To develop a comprehensive set of patient reported items to assess multiple aspects of physical functioning relevant to the lives of people with spinal cord injury (SCI) and to evaluate the underlying structure of physical functioning.
Design
Cross-sectional
Setting
Inpatient and community
Participants
Item pools of physical functioning were developed, refined and field tested in a large sample of 855 individuals with traumatic spinal cord injury stratified by diagnosis, severity, and time since injury
Interventions
None
Main Outcome Measure
SCI-FI measurement system
Results
Confirmatory factor analysis (CFA) indicated that a 5-factor model, including basic mobility, ambulation, wheelchair mobility, self care, and fine motor, had the best model fit and was most closely aligned conceptually with feedback received from individuals with SCI and SCI clinicians. When just the items making up basic mobility were tested in CFA, the fit statistics indicate strong support for a unidimensional model. Similar results were demonstrated for each of the other four factors indicating unidimensional models.
Conclusions
Though unidimensional or 2-factor (mobility and upper extremity) models of physical functioning make up outcomes measures in the general population, the underlying structure of physical function in SCI is more complex. A 5-factor solution allows for comprehensive assessment of key domain areas of physical functioning. These results informed the structure and development of the SCI-FI measurement system of physical functioning.
doi:10.1016/j.apmr.2012.05.007
PMCID: PMC3910090  PMID: 22609299
Spinal Cord Injuries; Mobility Limitations; Outcome Assessment (Health Care); Activities of Daily Living; Psychometrics; Walking; Self Care; Quality of Life
9.  The Boston Rehabilitative Impairment Study of the Elderly: A description of methods 
Objective
To describe the methods of a longitudinal cohort study among older adults with preclinical disability. The study aims to address the lack of evidence guiding mobility rehabilitation for older adults by identifying those impairments and impairment combinations that are most responsible for mobility decline and disability progression over 2 years of follow up.
Design
Longitudinal cohort study
Setting
Metropolitan based healthcare system in the US
Participants
Community dwelling primary care patients ≥ 65 years (N=430), with self-reported modification of mobility tasks due to underlying health conditions.
Interventions: Not Applicable
Main Outcome Measures
Late Life Function and Disability Instrument (LLFDI) (primary outcome), Short Physical Performance Battery (SPPB) and 400 meter walk test (secondary outcomes)
Results
Among 7403 primary care patients identified as being potentially eligible for participation, 430 were enrolled. Participants have a mean age of 76.5 years, are 68% women and have on average 4.2 chronic conditions. Mean LLFDI scores are 55.5 for Function and 68.9 and 52.3 for the Disability Limitation and Frequency domains, respectively.
Conclusions
Completion of our study aims will inform development of primary care-based rehabilitative strategies to prevent disability. Additionally, data generated in this investigation can also serve as a vital resource for ancillary studies addressing important questions in rehabilitative science relevant to geriatric care.
doi:10.1016/j.apmr.2012.08.217
PMCID: PMC3548025  PMID: 22989700
Aged; Mobility; Disability; Primary Care
10.  Return to Primary Service Among Bone Marrow Transplant Rehabilitation Inpatients: An Index for Predicting Outcomes Authors 
Objective
To assess rehabilitation inpatient risk of return to primary service in bone marrow transplant patients.
Design
Retrospective review.
Setting
Inpatient rehabilitation unit within a tertiary referral based cancer center
Participants
All bone marrow transplant patients (131) who were admitted a total of 147 times to inpatient rehabilitation between January 1, 2002, and April 30, 2010.
Interventions
None.
Main Outcome Measures
We analyzed return to primary service and demographic information, cancer characteristics, medications, hospital admission characteristics, and laboratory values.
Results
41% (61/147) of bone marrow transplant admissions were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 38% (23/61) died after being transferred back to the primary service. Significant or near significant relationships were found for a platelet count < 43,000 per microliter (p<.01), a creatinine level > 0.9 milligrams/deciliter (p<.01), the presence of an antiviral agent (p=.0501), the presence of an antibacterial agent (p=.0519), the presence of an antifungal agent (p<.05) and leukemia, lymphoma or multiple myeloma diagnosis (p<.05). Using five of these factors the Return to Primary-Bone Marrow Transplant (RTP-BMT) index was formulated to determine the likelihood of return to the primary team.
Conclusion
Bone marrow transplant patients have a high rate of transfer from the inpatient rehabilitation unit back to the primary service. The RTP-BMT score can be a useful tool to help clinicians predict the likelihood of return to the primary acute care service.
doi:10.1016/j.apmr.2012.08.219
PMCID: PMC3557705  PMID: 23022262
Bone marrow transplant; Rehabilitation; Cancer
11.  Assistive Walking Device Use and Knee Osteoarthritis: the Health, Aging, and Body Composition Study (Health ABC Study) 
Objectives
To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee.
Design
Prospective cohort study.
Setting
2,639 elderly men and women in the Health ABC (Health, Aging and Body Composition). Study followed for incident use of AWDs, including a subset of 874 with prevalent knee pain.
Participants
NA
Interventions
NA
Main Outcome Measures
Incident use of AWDs, mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores and frequency of joint space narrowing on knee radiographs over a three year time period.
Results
AWD use was initiated by 9% of the entire Health ABC cohort and 12% of the knee pain subset. Factors that predicted use in both groups were age ≥73 [entire cohort: OR 2.07 (95% CI 1.43, 3.01); knee pain subset: OR 1.87 (95% CI 1.16, 3.03)], black race [entire cohort: OR 2.95 (95% CI 2.09, 4.16); knee pain subset: OR 3.21 (95% CI 2.01, 5.11)] and lower balance ratios [entire cohort: OR 3.18 (95% CI 2.21, 4.59); knee pain subset: OR 3.77 (95% CI 2.34, 6.07)]. Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users. 20% of non-AWD users and 28% of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least one knee. 14% of non-AWD users and 12% of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least one knee.
Conclusions
Assistive walking devices are frequently used by elderly men and women. Knee pain and balance problems are significant reasons why elderly individuals initiate use of an assistive walking device. In an exploratory analysis, there was no consistent relationship between use or nonuse of an AWD and WOMAC pain scores or knee joint space narrowing progression. Further studies of the relationship of use of AWDs to changes in knee osteoarthritis are needed.
doi:10.1016/j.apmr.2012.09.021
PMCID: PMC3557749  PMID: 23041146
AWDs; Balance; Knee pain
12.  Biomechanic Evaluation of Upper-Extremity Symmetry Manual Wheelchair Propulsion Over Varied Terrain 
Objective
To evaluate upper-extremity symmetry during wheelchair propulsion across multiple terrain surfaces.
Design
Case series.
Setting
A biomechanics laboratory and the community.
Participants
Manual wheelchair users (N=12).
Interventions
Not applicable.
Main Outcome Measures
Symmetry indexes for the propulsion moment, total force, tangential force, fractional effective force, time-to-peak propulsion moment, work, length of push cycle, and power during wheelchair propulsion over outdoor and indoor community conditions, and in conditions.
Results
Upper-extremity asymmetry was present within each condition. There were no differences in the magnitude of asymmetry when comparing laboratory with indoor community conditions. Outdoor community wheelchair propulsion asymmetry was significantly greater than asymmetry measured during laboratory conditions.
Conclusions
Investigators should be aware that manual wheelchair propulsion is an asymmetrical act, which may influence interpretation when data is collected from a single limb or averaged for both limbs. The greater asymmetry identified during outdoor versus laboratory conditions the emphasizes need to evaluate wheelchair biomechanics in the user’s natural environment.
doi:10.1016/j.apmr.2008.03.020
PMCID: PMC3899826  PMID: 18929029
Biomechanics; Rehabilitation; Upper extremity; Wheelchairs
13.  Constraint-Induced Therapy Combined with Conventional Neurorehabilitation Techniques in Chronic Stroke Patients with Plegic Hands: A Case Series 
Objective
To determine in this pilot study whether the combination of CI therapy and conventional rehabilitation techniques can produce meaningful motor improvement in chronic stroke patients with initially fisted hands. In the past, limited success has been achieved using CI therapy alone for stroke patients with plegic hands.
Design
Case series
Setting
University hospital outpatient laboratory
Participants
Consecutive sample of 6 patients > 1 yr post-stroke with plegic hands
Interventions
Treatment consisted of an initial period of 3 weeks (Phase A) when adaptive equipment in the home, orthotics and splints were employed to improve ability to engage in activities of daily living. This was continued in Phase B, when CI therapy along with selected neurodevelopmental treatment techniques were added.
Main Outcome Measures
Motor Activity Log (MAL), accelerometry, Fugl-Meyer Motor Assessment (F-M)
Results
Patients exhibited a large improvement in spontaneous real-world use of the more-affected arm (mean lower-functioning MAL change = 1.3±0.4 points, P <0.001, d′ = 3.0), and a similar pattern of increase in an objective measure of real-world more-affected arm movement (mean change in ratio of more- to less-affected arm accelerometer recordings = 0.12±0.1 points, P = 0.016 d′ = 1.2). A large improvement in motor status was also recorded (mean F-M change = 5.3±3.3 points, P = 0.005, d′ = 1.6).
Conclusions
The findings of this pilot study suggest that stroke patients with plegic hands can benefit from CI therapy combined with some conventional rehabilitation techniques, even long after brain injury. More research is warranted.
doi:10.1016/j.apmr.2012.07.029
PMCID: PMC3529797  PMID: 22922823
Stroke; Rehabilitation; CI therapy; Neurodevelopmental treatment; Arm function
14.  Changes in blood flow and cellular metabolism at a myofascial trigger point with trigger point release (ischemic compression): a proof-of-principle pilot study 
Objective
To demonstrate proof-of-principle measurement for physiological change within an active myofascial trigger point (MTrP) undergoing trigger point release (ischemic compression).
Design
Interstitial fluid was sampled continuously at a trigger point before and after intervention.
Setting
A biomedical research clinic at a university hospital.
Participants
Two subjects from a pain clinic presenting with chronic headache pain.
Interventions
A single microdialysis catheter was inserted into an active MTrP of the upper trapezius to allow for continuous sampling of interstitial fluid before and after application of trigger point therapy by a massage therapist.
Main Outcome Measures
Procedural success, pain tolerance, feasibility of intervention during sample collection, determination of physiologically relevant values for local blood flow, as well as glucose and lactate concentrations.
Results
Both patients tolerated the microdialysis probe insertion into the MTrP and treatment intervention without complication. Glucose and lactate concentrations were measured in the physiological range. Following intervention, a sustained increase in lactate was noted for both subjects.
Conclusions
Identifying physiological constituents of MTrP’s following intervention is an important step toward understanding pathophysiology and resolution of myofascial pain. The present study forwards that aim by showing proof-of-concept for collection of interstitial fluid from an MTrP before and after intervention can be accomplished using microdialysis, thus providing methodological insight toward treatment mechanism and pain resolution. Of the biomarkers measured in this study, lactate may be the most relevant for detection and treatment of abnormalities in the MTrP.
doi:10.1016/j.apmr.2012.08.216
PMCID: PMC3529849  PMID: 22975226
Massage; Headache; Myofascial pain; Complementary Medicine; Microdialysis; Lactate
15.  Recurrence of Radicular Pain or Back Pain After Nonsurgical Treatment of Symptomatic Lumbar Disk Herniation 
Archives of physical medicine and rehabilitation  2012;93(4):10.1016/j.apmr.2011.11.028.
Objectives
To determine recurrence rates of lower extremity radicular pain after nonsurgical treatment of acute symptomatic lumbar disk herniation (LDH), and identify predictors of recurrence.
Design
Prospective inception cohort.
Setting
Outpatient spine clinic.
Participants
Patients (N=79) reporting resolution of radicular pain after MRI-confirmed LDH.
Interventions
Individualized nonsurgical treatment tailored to the patient. All patients received education, but other treatments varied depending on the individual.
Measurements
Resolution of radicular pain was defined as a pain-free period of ≥1 month. Patients who reported resolution of radicular pain within 1 year after seeking care for acute LDH were asked whether pain had recurred at 1 year after seeking care, and were also reassessed 1 year after the time of resolution of radicular pain, and 2 years after seeking care. Patients reported on recurrence, and the date of recurrence if any. We evaluated the 1-year incidence of recurrence, using Kaplan-Meier survival plots. We examined predictors of recurrence using bivariate and multivariate Cox proportional hazards models. We examined the secondary outcome of back pain recurrence using identical methods.
Results
Twenty five percent (95% confidence interval [CI], 15-35%) of individuals with resolution of radicular pain for at least one month reported subsequent recurrence of pain within 1 year after resolution. The only factor independently associated with radicular pain recurrence was the number of months prior to resolution of pain (Hazard ratio per month [95% CI] 1.24 [1.13-1.37]; p <0.0001). The 1-year incidence of back pain recurrence was 43% (95% CI, 30-56%), and older age decreased the hazard of recurrence.
Conclusions
Recurrence of radicular pain is relatively common after nonsurgical treatment of LDH, and is predicted by longer time to initial resolution of pain.
doi:10.1016/j.apmr.2011.11.028
PMCID: PMC3866041  PMID: 22464091
Herniation; Intervertebral Disk Displacement; Outcome assessment (health care); Rehabilitation
16.  Association Between Chair Stand Strategy and Mobility Limitations in Older Adults with Symptomatic Knee Osteoarthritis 
Archives of physical medicine and rehabilitation  2012;94(2):10.1016/j.apmr.2012.09.026.
OBJECTIVE
To determine which lower limb strength and joint kinetic and kinematic parameters distinguish sit-to-stand (STS) performance of older adults with symptomatic knee osteoarthritis (OA) with higher and lower chair stand time.
DESIGN
Cross-sectional
SETTING
Motion analysis laboratory.
PARTICIPANTS
Age 50–79 years with radiographic knee OA and daily symptoms, stratified by chair stand times.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURE(S)
Lower limb strength and STS strategy.
RESULTS
Data were available for 49 participants (26M/23F) age 64.7±8.1 years. The respective mean±SD for chair stand times in the high, moderate and low functioning groups in men were 6.5±0.7, 8.6±0.7, and 11.5±1.3sec and in women were 7.6±1.2, 10.0±0.5, and 12.8±1.8sec. Chair stand time (p=0.0391) and all measures of lower limb strength (all p<0.0001) differed by sex. In men, no strength measure differed between groups, whereas in women hip abductor strength on the more affected side differed between groups. In men, sagittal hip ROM (p=0.0122) differed between groups and there was a trend towards a difference in sagittal knee power (p=0.0501) during STS, while, in women, only sagittal knee ROM (p=0.0392) differed between groups.
CONCLUSION(S)
Higher and lower functioning adults with symptomatic knee OA appear to use different strategies when standing from a chair. Higher functioning men flexed more at the hip and produced greater knee power than lower functioning men. Higher functioning women used less knee flexion than lower functioning women. As STS is an important mobility task, these parameters may serve as foci for rehabilitation aimed at reducing mobility limitations.
doi:10.1016/j.apmr.2012.09.026
PMCID: PMC3847816  PMID: 23063791
aging; osteoarthritis; knee; functional limitations; mobility
17.  Role of Social Support in Predicting Caregiver Burden 
Objective
To examine the unique contribution of social support to burden in caregivers of adults aging with spinal cord injuries (SCI).
Design
Secondary analyses of cross-sectional data from a large cohort of adults aging with SCI and their primary caregivers.
Setting
Multiple community locations in Pittsburgh, PA, and Miami, FL.
Participants
Caregivers of community-dwelling adults aging with SCI (n=173) were interviewed as part of a multisite randomized clinical trial. The mean age of caregivers was 53 years (SD=15) and of care-recipients 55 years (SD=13).
Interventions
Not applicable.
Main Outcome Measures
The primary outcome was caregiver burden measured with the Abridged Version of the Zarit Burden Interview. A hierarchical multiple regression analysis examined social supports (social integration, received social support, and negative social interactions) effect on burden in caregivers of adults aging while controlling for demographic characteristics and caregiving characteristics.
Results
After controlling for demographic characteristics and caregiving characteristics, social integration (β̂ =−.16, P<.05), received social support (β̂ =−.15, P<.05), and negative social interactions (β̂ =.21, P<.01) were significant independent predictors of caregiver burden.
Conclusions
Findings demonstrate that social support is an important factor associated with burden in caregivers of adults aging with SCI. Social support should be considered for assessments and interventions designed to identify and reduce caregiver burden.
doi:10.1016/j.apmr.2012.07.004
PMCID: PMC3508254  PMID: 22824248
Caregivers; Spinal Cord Injury; Aging; Social Support
18.  Physical activity patterns of patients with cardiopulmonary illnesses 
OBJECTIVES
The aims of this paper are to: 1) describe objectively-confirmed physical activity patterns across three chronic cardiopulmonary conditions, and 2) examine the relationship between selected physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance.
INTERVENTIONS
Not applicable.
DESIGN
Cross-sectional study.
SETTING
Participant’s home environment.
PARTICIPANTS
Patients with cardiopulmonary illnesses: chronic obstructive pulmonary disease (COPD, n=63), heart failure (HF, n=60), and patients with implantable cardioverter defibrillator (ICD, n=60).
MAIN OUTCOME MEASURES
Seven ambulatory physical activity dimensions (total steps, percent time active, percent time ambulating at low, medium, and high intensity, maximum cadence for 30 continuous minutes, and peak performance) were measured with an accelerometer.
RESULTS
Subjects with COPD had the lowest amount of ambulatory physical activity compared to subjects with heart failure and cardiac dysrhythmias (all seven activity dimensions, p<.05); total step counts were: 5319 vs. 7464 vs. 9570, respectively. Six minute walk distance were correlated (r=.44 to .65, p<.01) with all physical activity dimensions in the COPD sample, the strongest correlations being with total steps and peak performance. In subjects with cardiac impairment, maximal oxygen consumption had only small to moderate correlations with five of the physical activity dimensions (r=.22 to .40, p<.05). In contrast, correlations between six minute walk test distance and physical activity were higher (r=.48 to .61, p<.01) albeit in a smaller sample of only patients with heart failure. For all three samples, self-reported physical and mental health functioning, age, body mass index, airflow obstruction, and ejection fraction had either relatively small or non-significant correlations with physical activity.
CONCLUSIONS
All seven dimensions of ambulatory physical activity discriminated between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, use of one dimension such as total steps may be sufficient. Although physical activity had high correlations with performance on a six minute walk test relative to other variables, accelerometry-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary illness not already captured with existing measures.
doi:10.1016/j.apmr.2012.06.022
PMCID: PMC3508328  PMID: 22772084
ambulatory physical activity; walking; monitoring; COPD; heart failure; implantable defibrillator; exercise performance
19.  Central Hypersensitivity in Patients with Subacromial Impingement Syndrome 
Objective
To investigate the presence of primary and secondary hyperalgesia among subjects with chronic subacromial impingement syndrome (SIS) compared to pain-free controls.
Design
Cross-sectional design.
Setting
Outpatient rehabilitation clinic, urban, academic medical center.
Participants
Volunteer sample of 62 subjects (31 with SIS, 31 controls).
Interventions
Not applicable.
Main Outcome Measures
Pressure-pain thresholds (PPTs) were measured at the middle deltoid of the affected/dominant arm (primary or secondary hyperalgesia) and the middle deltoid and tibialis anterior of the unaffected/non-dominant side (secondary hyperalgesia) in SIS and healthy controls, respectively. Differences in PPTs were analyzed by Wilcoxon Rank Sum test and with linear regression analysis controlling for gender, a known confounder of PPTs.
Results
After adjusting for gender, subjects with SIS had significantly lower PPTs than controls at all locations. Controls had a 1.4 kg/cm2 (95% CI 1.2 – 1.5) higher PPT at their affected shoulder than those with SIS, a 0.7 kg/cm2 (95% CI 0.5 – 0.9) higher PPT at their non-affected shoulder, and a 1.1 kg/cm2 (95% CI 1.1 – 1.2) higher PPT at their contralateral tibialis anterior. Observers were not blinded to patient groupings but were blinded to level of applied pressure.
Conclusion
This study provides further evidence that SIS patients have significantly lower PPTs than controls in both local and distal areas from their affected arm consistent with primary and secondary hyperalgesia, respectively. Data suggest the presence of central sensitization among subjects with chronic SIS.
doi:10.1016/j.apmr.2012.06.026
PMCID: PMC3508388  PMID: 22789774
Hypersensitivity; Pain Thresholds; Subacromial Impingement Syndrome
20.  Association Between Participation in Life Situations of Children With Cerebral Palsy and Their Physical, Social, and Attitudinal Environment: A Cross-Sectional Multicenter European Study 
Archives of physical medicine and rehabilitation  2012;93(12):10.1016/j.apmr.2012.07.011.
Objective
To evaluate how participation of children with cerebral palsy (CP) varied with their environment.
Design
Home visits to children. Administration of Assessment of Life Habits and European Child Environment Questionnaires. Structural equation modeling of putative associations between specific domains of participation and environment, while allowing for severity of child’s impairments and pain.
Setting
European regions with population-based registries of children with CP.
Participants
Children (n=1174) aged 8 to 12 years were randomly selected from 8 population-based registries of children with CP in 6 European countries. Of these, 743 (63%) agreed to participate; 1 further region recruited 75 children from multiple sources. Thus, there were 818 children in the study.
Interventions
Not applicable.
Main Outcome Measure
Participation in life situations.
Results
For the hypothesized associations, the models confirmed that higher participation was associated with better availability of environmental items. Higher participation in daily activities—mealtimes, health hygiene, personal care, and home life—was significantly associated with a better physical environment at home (P<.01). Mobility was associated with transport and physical environment in the community. Participation in social roles (responsibilities, relationships, recreation) was associated with attitudes of classmates and social support at home. School participation was associated with attitudes of teachers and therapists. Environment explained between 14% and 52% of the variation in participation.
Conclusions
The findings confirmed the social model of disability. The physical, social, and attitudinal environment of disabled children influences their participation in everyday activities and social roles.
doi:10.1016/j.apmr.2012.07.011
PMCID: PMC3826325  PMID: 22846455
Cerebral palsy; Child; Environment; Models, statistical; Rehabilitation; Social participation
21.  Development and Validation of Participation and Positive Psychologic Function Measures for Stroke Survivors 
Archives of physical medicine and rehabilitation  2010;91(9):10.1016/j.apmr.2010.06.020.
Bode RK, Heinemann AW, Butt Z, Stallings J, Taylor C, Rowe M, Roth EJ. Development and validation of participation and positive psychologic function measures for stroke survivors.
Objective
To evaluate the reliability and validity of Neurologic Quality of Life (NeuroQOL) item banks that assess quality-of-life (QOL) domains not typically included in poststroke measures.
Design
Secondary analysis of item responses to selected NeuroQOL domains.
Setting
Community.
Participants
Community-dwelling stroke survivors (n=111) who were at least 12 months poststroke.
Interventions
Not applicable.
Main Outcome Measures
Five measures developed for 3 NeuroQoL domains: ability to participate in social activities, satisfaction with participation in social activities, and positive psychologic function.
Results
A single bank was developed for the positive psychologic function domain, but 2 banks each were developed for the ability-to-participate and satisfaction-with-participation domains. The resulting item banks showed good psychometric properties and external construct validity with correlations with the legacy instruments, ranging from .53 to .71. Using these measures, stroke survivors in this sample reported an overall high level of QOL.
Conclusions
The NeuroQoL-derived measures are promising and valid methods for assessing aspects of QOL not typically measured in this population.
doi:10.1016/j.apmr.2010.06.020
PMCID: PMC3815554  PMID: 20801251
Outcome measures; Quality of life; Rehabilitation; Stroke
22.  Wolf Motor Function Test for Characterizing Moderate to Severe Hemiparesis in Stroke Patients 
Objective
To extend the applicability of the Wolf Motor Function test (WMFT) to describe the residual functional abilities of moderate-to-severely affected stroke patients. The WMFT is a motor function test for mild to moderate upper extremity weakness in stroke patients, but it has not been routinely used for evaluation of more severe hemiparetic stroke patients due to its numerical characteristics.
Design
Data was collected as part of two double-blind sham controlled randomized interventional studies, the Transcranial Direct Current Stimulation (tDCS) in Chronic Stroke Recovery and tDCS Enhanced Stroke Recovery and Cortical Reorganization. Stroke patients were evaluated with the upper-extremity Fugl-Meyer (UFM) and the WMFT in the same setting prior to treatment.
Setting
University inpatient rehabilitation and outpatient clinic.
Participants
32 stroke patients with moderate-to-severe hemiparesis enrolled in the tDCS in Chronic Stroke Recovery and tDCS Enhanced Stroke Recovery and Cortical Reorganization studies.
Intervention
Not applicable.
Main Outcome Measures
WMFT scores were calculated using 1) median performance times, 2) new calculation using the mean rate of performance. We compared the distribution of values from the two methods and examined the WMFT-UFM correlation for the traditional and the new calculation.
Results
WMFT rate values were more evenly distributed across their range than median WMFT time scores. The association between the WMFT rate and UFM was as good as the association between the median WMFT time scores and UFM (Spearman rs 0.84 vs −0.79).
Conclusions
The new WMFT mean rate of performance is valid and a more sensitive measure in describing the functional activities of the moderate to severely affected upper extremity of stroke subjects and avoids the pitfalls of the median WMFT time calculations.
doi:10.1016/j.apmr.2012.05.002
PMCID: PMC3483403  PMID: 22579647
Hemiparesis; Rehabilitation; Assessment; Stroke
23.  Truth Be Told: Evidence of Wheelchair Users’ Accuracy in Reporting Their Height and Weight 
Objectives
To examine whether wheelchair users’ self-reports of height and weight differed significantly from direct measurements and whether weight category classifications differed substantially when based on self-reported or measured values.
Design
Single group, cross-sectional analysis. Analyses included paired t tests, chi-square test, analysis of variance, and Bland-Altman agreement analyses.
Setting
A university-based exercise lab.
Participants
Community-dwelling wheelchair users (N=125).
Interventions
Not applicable.
Main Outcome Measure
Participants’ self-reported and measured height, weight, and body mass index.
Results
Paired t tests revealed that there were significant differences between wheelchair users’ self-reported and measured values for height (difference of 3.1±7.6cm [1.2±3.0in]), weight (−1.7±6.5kg [−3.6±14.2lb]), and BMI (−1.6±3.3). These discrepancies also led to substantial misclassification into weight categories, with reliance on self-reported BMI underestimating the weight status of 20% of the sample.
Conclusions
Our findings suggest that similar to the general population, wheelchair users are prone to errors when reporting their height and weight and that these errors may exceed those noted in the general population.
doi:10.1016/j.apmr.2012.05.005
PMCID: PMC3562126  PMID: 22609118
Obesity; Overweight; Public health; Rehabilitation
24.  Validity of an Exercise Test Based on Habitual Gait Speed in Mobility-Limited Older Adults 
Objective
To evaluate whether a customized exercise tolerance testing (ETT) protocol based on an individual’s habitual gait speed (HGS) on level ground would be a valid mode of exercise testing older adults. Although ETT provides a useful means to risk-stratify adults, age-related declines in gait speed paradoxically limit the utility of standard ETT protocols for evaluating older adults. A customized ETT protocol may be a useful alternative to these standard methods, and this study hypothesized that this alternative approach would be valid.
Design
We performed a cross-sectional analysis of baseline data from a randomized controlled trial of older adults with observed mobility problems. Screening was performed using a treadmill-based ETT protocol customized for each individual’s HGS. We determined the content validity by assessing the results of the ETTs, and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly (PASE) and the Late Life Function and Disability Instrument (LLFDI).
Setting
Outpatient rehabilitation center.
Participants
Community-dwelling, mobility-limited older adults (N = 141).
Interventions
Not applicable.
Main Outcome Measures
Cardiac instability, ETT duration, peak heart rate, peak systolic blood pressure, PASE, and LLFDI.
Results
Acute cardiac instability was identified in 4 of the participants who underwent ETT. The remaining participants (n = 137, 68% female; mean age, 75.3y) were included in the subsequent analyses. Mean exercise duration was 9.39 minutes, with no significant differences in durations being observed after evaluating among tertiles by HGS status. Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/ min and 175.0mmHg, respectively. Within separate multivariate models, ETT duration in each of the 3 gait speed groups was significantly associated (P<.05) with PASE and LLFDI.
Conclusions
Mobility-limited older adults can complete this customized ETT protocol, allowing for the identification of acute cardiac instability and the achievement of optimal exercise parameters.
doi:10.1016/j.apmr.2011.08.032
PMCID: PMC3797445  PMID: 22289248
Aged; Exercise Test; Mobility limitation; Rehabilitation
25.  Amputee Locomotion: Determining the Inertial Properties of Running-Specific Prostheses 
Objectives
To (1) test the validity of a trifilar pendulum in estimating moments of inertia (MOI) for running-specific prostheses (RSPs), (2) provide RSP inertial property values for the scientific community, and (3) develop a predictive equation to estimate RSP center of mass (CM) positions.
Design
An aluminum block with known MOI was used for verifying the accuracy of the trifilar pendulum MOI measurements. MOI errors were investigated by systematically misaligning the block and pendulum principal axes across a range of 1–10 cm. Mass, CM position, and MOI were tested across four RSP designs having three stiffness categories each.
Setting
University biomechanics laboratory.
Specimens
Freedom Innovations Nitro, Ossur Cheetah, Ossur Flex-Run, Otto Bock 1E90. Three stiffness categories per RSP were examined.
Interventions
Not applicable.
Main Outcome Measures
MOI errors from known values and principal axis misalignments between RSPs and pendulum; mass, CM positions, RSP principal axis MOIs; predictive equation CM position errors.
Results
The trifilar pendulum estimated MOI within −6.21 × 10−5 kg·m2 (≤ 1% error) for a block with known MOI. Misalignments of 1cm - 5cm between the RSPs’ and pendulum’s CM yielded errors from 0.00002 to 0.00113 kg·m2 (0.3 – 59.2%). Each RSP’s inertial properties are presented. MOI about any axis varied ≤ 0.0038 kg·m2 across stiffness categories; MOI differed up to 0.0132 kg·m2 between different designs. The predictive CM equation erred between 0.010–0.028 m when using average input values across an RSP design.
Conclusions
Trifilar pendulums can accurately measure RSP MOI. RSP inertial properties differed slightly across stiffness categories within each design, but differed more substantially across different RSP designs. Using a predictive equation to estimate RSP CM positions can provide adequate data, but directly measuring CM positions is preferable.
doi:10.1016/j.apmr.2013.03.010
PMCID: PMC3793256  PMID: 23542403
mass; center of mass; moment of inertia; prosthesis; amputation

Results 1-25 (217)