Variation by diagnostic and practice pattern groups in the mobility outcomes of inpatient rehabilitation programs for children and youth.
(17/411)
BACKGROUND AND PURPOSE: The purpose of this study was to describe variation in functional mobility outcomes among children and youth with different diagnoses and belonging to groups with different practice patterns from an inpatient pediatric rehabilitation hospital setting. SUBJECTS: A sample of 138 individuals between the ages of 1 and 22 years (mean=9.4, SD=5.3) was enrolled. METHODS: Physical therapists administered the "Mobility" domain of the Pediatric Evaluation of Disability Inventory at the time of admission and at the time of discharge. Mobility level (combined admission and discharge scores) and amount of change between and within 4 diagnostic groups (traumatic brain injury, non-traumatic brain injury, orthopedic, and neurological) and 5 neuromuscular and musculoskeletal practice pattern groups were calculated, and post hoc analyses were done for specific contrast comparisons. RESULTS: Mobility scores between admission and discharge for all subgroups were different. Practice pattern groups were useful for identifying variations in level of motor performance. Diagnostic groups best described differences in mobility change during inpatient rehabilitation. DISCUSSION AND CONCLUSION: The use of practice patterns as grouping categories may enhance our understanding of variation in clinical outcomes of children during inpatient rehabilitation. (+info)
Medical rehabilitation in Croatia impact of the 1991-1995 war: past problems, present state, future concerns.
(18/411)
AIM: To assess whether the 1991-1995 war has stimulated development of the medical rehabilitation system in Croatia. METHODS: Review of documents pertaining to the system, study of clinical reports describing rehabilitation activities as published in the Croatian medical literature, study of data obtained and their consideration in terms of effectiveness and quality of rehabilitation care, and comparison of data from 1991 with those from 1995. RESULTS: There has been no significant change in the number of rehabilitation facilities, beds, and rehabilitation professionals. However, elements of structure and process of rehabilitation care have improved in respect of 1) education and composition of rehabilitation professionals, 2) availability of specialized facilities for rehabilitation of patients with complex impairments (traumatic brain and spinal cord injuries), 3) interdisciplinary team approach, 4) use of functional status measurements, and 5) laying the foundations for community-based rehabilitation in the country. CONCLUSION: The 1991-1995 war has stimulated the development of medical rehabilitation system in Croatia. Other factors may have played a complementary role, too. This proves that medical rehabilitation is a field that develops in association with war. (+info)
Telehealth: reaching out to newly injured spinal cord patients.
(19/411)
OBJECTIVES: The authors present preliminary results on health-related outcomes of a randomized trial of telehealth interventions designed to reduce the incidence of secondary conditions among people with mobility impairment resulting from spinal cord injury (SCI). METHODS: Patients with spinal cord injuries were recruited during their initial stay at a rehabilitation facility in Atlanta. They received a video-based intervention for nine weeks, a telephone-based intervention for nine weeks, or standard follow-up care. Participants are followed for at least one year, to monitor days of hospitalization, depressive symptoms, and health-related quality of life. RESULTS: Health-related quality of life was measured using the Quality of Well-Being (QWB) scale. QWB scores (n = 111) did not differ significantly between the three intervention groups at the end of the intervention period. At year one post discharge, however, scores for those completing one year of enrollment (n = 47) were significantly higher for the intervention groups compared to standard care. Mean annual hospital days were 3.00 for the video group, 5.22 for the telephone group, and 7.95 for the standard care group. CONCLUSIONS: Preliminary evidence suggests that in-home telephone or video-based interventions do improve health-related outcomes for newly injured SCI patients. Telehealth interventions may be cost-saving if program costs are more than offset by a reduction in rehospitalization costs, but differential advantages of video-based interventions versus telephone alone warrant further examination. (+info)
Mobility status during inpatient rehabilitation: a comparison of patients with stroke and traumatic brain injury.
(20/411)
OBJECTIVES: To compare the mobility status (admission and discharge status, change in status) between patients with stroke and traumatic brain injury (TBI) during inpatient rehabilitation and to determine the relationship between mobility status and outcome variables including length of stay (LOS). DESIGN: Prospective study. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: A total of 210 patients with stroke (n = 136) and TBI (n = 74) consecutively admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical Outcome Variable Scale (COVS), a 13-item scale of mobility status (measured on admission and discharge from inpatient rehabilitation), and rehabilitation LOS. RESULTS: With age and time since injury controlled in the model, the TBI group showed a significantly higher mobility status on admission and discharge over the stroke group, but the change (improvement) in mobility status did not differ. The admission mobility status accounted for 61% and 60% of variability of the discharge mobility status for the stroke and TBI groups, respectively. The admission mobility status accounted for 40% and 50% of the variability in rehabilitation LOS for the stroke and TBI groups, respectively. Either the admission mobility status or the physical therapist's prediction of the discharge status could be used to determine the actual discharge mobility status, although the physical therapist's predictions were more accurate than using a statistical model. CONCLUSIONS: The TBI group showed a higher mobility status at admission and discharge from inpatient rehabilitation than the stroke group; however, the rate of improvement (improvement in mobility status per day) did not differ between groups. Admission mobility status using the COVS was an excellent predictor of discharge mobility status and rehabilitation LOS in stroke and TBI patients. (+info)
Key neurological impairments influence function-related group outcomes after stroke.
(21/411)
BACKGROUND AND PURPOSE: The function-related group (FRG) classification is based on functional assessment and has been assumed to encompass the effects of different patterns and severity of neurological impairments. This assumption may not be correct. It has been proposed as a means of comparing rehabilitation outcome across institutions. If neurological impairments significantly affect FRG outcome, then higher FRG outcome scores may reflect selection bias favoring patients with fewer neurological impairments rather than better quality of rehabilitation care. The goal of this study was to assess the influence of motor, somatosensory, and hemianopic visual impairments on FRG outcomes after stroke. METHODS: All 288 consecutive stroke patients discharged in 1999 from an acute rehabilitation hospital were assigned to 1 of 5 FRGs on the basis of their Functional Independence Measure (FIM) mobility subscore and age. Each FRG was also stratified into 1 of 4 cohorts on the basis of the presence or absence of key neurological impairments: motor impairment only (M), motor plus either somatosensory or hemianopic visual impairment (MS/MV), motor plus somatosensory plus hemianopic visual impairment (MSV), and other combinations of impairments. FIM scores were available every 10 days for all patients from admission to discharge. The effect of impairment group on outcome was assessed within each FRG category through repeated-measures analysis of variance to assess differences in serial FIM scores across the 4 impairment groups. The distribution of each of the 4 impairment groups across the 5 FRGs was assessed with chi2 analysis. RESULTS: The numbers of patients in each of the 5 FRGs from the lowest level, FRG-11, to the highest, FRG-15, were as follows: 78 (27%), 47 (16%), 75 (26%), 55 (19%), and 33 (11%). Different neurological impairments were associated with significantly different mean+/-SD discharge FIM scores as follows: for FRG-11, MSV=63+/-16, MS/MV=68+/-19, and M=81+/-13 (P=0.04); for FRG-12, MSV=47+/-14, MS/MV=61+/-12, and M=75+/-11 (P=0.01); and for FRG-13, MSV=79+/-20, MS/MV=85+/-19, and M=96+/-10 (P<0.02). For FRG-14 and FRG-15, those with M impairments had the highest and those with MSV impairments had the lowest discharge FIM scores, but the differences did not reach statistical significance. The chi2 analysis showed a highly significant difference in representation of MSV impairments across FRG-11 through FRG-15 as follows: 35 of 78 (45%), 20 of 47 (43%), 11 of 74 (15%), 4 of 55 (7%), and 2 of 33 (6%). For patients classified as having an M deficit only or other impairment, the results were as follows: 19 of 78 (24%), 15 of 47 (32%), 41 of 75 (55%), 41 of 55 (75%), and 27 of 33 (82%) (chi(2) analysis=78.7, P<0.0001). CONCLUSIONS: The presence of motor, somatosensory, and hemianopic visual impairment significantly affects FRG outcome and should be included in future outcome assessment tools. Comparisons of FIM change and efficiency scores across institutions are potentially biased by referral and selection criteria favoring equally dysfunctional but less neurologically impaired individuals. (+info)
A prolonged outbreak of Norwalk-like calicivirus (NLV) gastroenteritis in a rehabilitation centre due to environmental contamination.
(22/411)
An outbreak of Norwalk-like calicivirus (NLV) gastroenteritis occurred in a rehabilitation centre in southern Finland between December 1999 and February 2000. An epidemiological investigation was conducted to determine the source and extent of the outbreak. More than 300 guests and staff members became ill during the outbreak. No food or activity in the centre could be linked epidemiologically to illness. NLV genogroup II was detected by RT-PCR in stool samples of symptomatic guests and employees. All strains reacted similarly with the microplate hybridization probe panel and showed the same nucleotide sequence, indicating that they represented the same NLV strain. Food and water samples were negative for NLV, whereas NLV was detected in three environmental specimens. The strains from patients and environment were identical based on microplate hybridization probes, suggesting that environmental contamination may have been important for the spread of calicivirus and the protracted course of the outbreak. (+info)
Designing adverse event prevention programs using quality management methods: the case of falls in hospital.
(23/411)
OBJECTIVE: From a public health perspective, the effectiveness of any prevention program depends on integrated medical and managerial strategies. In this way, quality management methods drawn from organization and business management can help design prevention programs. The aim of this study was to analyze the potential value of these methods in the specific context of preventing falls in hospital. SETTING: Medical and Rehabilitation Care Unit of Saint-Maurice National Hospital (France). DESIGN: In phase 1, two surveys assessed the context in which falls occurred. The first survey (1995) quantified adverse events during a 1-year period (n = 564) and the second (1996-1997) documented the reasons for falls (n = 53). In phase 2, a set of recommendations to prevent falls was elaborated and implemented throughout the hospital. RESULTS: The fall frequency in this unit was 18.3% in 1995. Analysis showed organizational causes in 35 (66%) of the 53 documented falls; 24 of them were associated with individual factors. Even though the two categories of causes are interdependent, their distinction enables specific recommendations. The proposed organizational management changes recommended do not aim to achieve an illusory objective of 'zero falls', but are designed to reduce the number of avoidable falls and to limit the negative consequences of unavoidable falls. CONCLUSION: Quality improvement methods shed new light on how to prevent falls. An unexploited potential for prevention lies in organization and management of care for hospitalized patients. (+info)
Correlates of rehabilitation hospital length of stay among older African-American patients.
(24/411)
This study addresses a gap in the current literature on the correlates of rehabilitation hospital length of stay for older African Americans. Using data from 616 consecutively admitted rehabilitation patients who ranged in age from 50 to 103 years old, we tested the effect of patient's primary medical impairment; structural factors such as admit and discharge setting; level of depression (Geriatric Depression Scale); functional ability upon hospital admission (FIM score); and other control variables. Hierarchical linear regression models show that medical impairment alone was not a robust predictor of LOS. However, when controlling for structural and psychosocial factors, and medical condition, then circulation/amputation impairment was directly associated with longer LOS. Being unmarried or at risk for depression were also directly related to longer LOS. Consequently, rehabilitation administrators and hospital staff should note these findings to determine whether and how these factors affect discharge outcomes in their particular rehabilitative environments. (+info)