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Cardiac Specialists' Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting. 心脏专家对低资源环境下心脏康复转诊和参与障碍的看法。
Q1 REHABILITATION Pub Date : 2020-08-25 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720936648
Mahdieh Ghanbari-Firoozabadi, Masoud Mirzaei, Khadijeh Nasiriani, Mozhgan Hemati, Jamal Entezari, Mohammadreza Vafaeinasab, Sherry L Grace, Hasan Jafary, Seyed Mahmood Sadrbafghi

Background: Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively.

Aim: This study investigated cardiac specialists' perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral.

Methods: In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group.

Results: Four themes emerged: "physician factors," "center factors," "patient factors," and "cultural factors." Regarding "physician factors," most participants mentioned shortage of time. Regarding "center factors," most participants mentioned poor physician-patient-center coordination. In "patient factors," the subcategories that arose were socioeconomic challenges and clinical condition of the patients. "Cultural factors" related to lack of belief in behavioral/preventive medicine.

Conclusions: Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.

背景:在确保患者获得心脏康复(CR)方面,心脏病专家可以说是最有影响力的提供者。医生转诊障碍在高收入环境之外的调查很少,而且没有定性。目的:本研究调查了心脏病专家对低资源环境下患者CR参与的障碍和促进因素的看法,重点是转诊。方法:在定性研究中,采用常规的内容分析方法进行焦点小组研究。在伊朗亚兹德工作的14名合格心脏专家中,有13名参加了一个或两个焦点小组(分别为n = 9和n = 10)。将第一次焦点小组的记录逐字抄写成word文件,所有现场笔记和抄本内容的准确性经研究小组批准,然后进行归纳分析。经过类似的过程,第二个焦点小组达到饱和。结果:出现了四个主题:“医生因素”、“中心因素”、“患者因素”和“文化因素”。关于“医生因素”,大多数参与者提到时间短缺。关于“中心因素”,大多数参与者提到了较差的医患中心协调。在“患者因素”中,出现的子类别是社会经济挑战和患者的临床状况。“文化因素”与缺乏对行为/预防医学的信念有关。结论:在高资源环境中,CR转诊和参与的障碍是多层次的。然而,在这些环境中引入CR的时间相对较短,似乎引起了极大的缺乏认识。文化信仰可能会有所不同,在这种情况下,从CR项目到转诊提供者的沟通是一个特别的挑战。
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引用次数: 4
Experience of Information Provision at the Stroke Unit From the Perspective of Relatives to Stroke Survivors. 从亲属到中风幸存者的角度看中风单位信息提供的经验。
Q1 REHABILITATION Pub Date : 2020-08-13 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720947086
Linda Kristensson, Ann Björkdahl

Introduction: Stroke not only affects the stroke survivor, it also significantly affects their families. Given the important supportive role that relatives of stroke survivor have, they should receive information that helps them plan and cope with the new situation. The objective of the study was to explore how relatives to stroke survivors perceived the information provided by the stroke unit.

Methods: This qualitative study was based on extensive semi-structured interviews with an inductive approach. A heterogeneous convenience sample of relatives to stroke survivor (n=14) was selected. Qualitative content analysis served to analyze the transcribed interview texts.

Results: The content analysis yielded four categories, each with 2-3 subcategories. The overall theme was "to be acknowledged or not": it encompassed the underlying meaning and the relationships between the categories. The four categories were as follows: shifting information needs; striving for information; lacking of continuity and structure; and taking part and being acknowledged.

Conclusions: The study highlighted that the relatives of stroke survivors have a strong need for information and showed that the relatives experienced that they did not always feel satisfactorily informed and supported by the healthcare professionals in the stroke unit. A challenge for the healthcare professionals was to be able to give the right information at the right time and in the appropriate way. The study also showed that when the relatives were acknowledged and invited to participate in the rehabilitation process, they were less anxious of the discharge.

中风不仅影响中风幸存者,也严重影响他们的家庭。鉴于中风幸存者的亲属具有重要的支持作用,他们应该获得有助于他们计划和应对新情况的信息。该研究的目的是探讨中风幸存者的亲属如何感知中风单位提供的信息。方法:本定性研究基于广泛的半结构化访谈,采用归纳方法。选取脑卒中幸存者亲属的异质性方便样本(n=14)。定性内容分析用于分析转录的访谈文本。结果:内容分析分为四类,每类有2-3个子类。总的主题是“承认或不承认”:它包含了潜在的意义和类别之间的关系。这四个类别是:不断变化的信息需求;争取信息;不连贯的:缺乏连续性和结构的;参与并得到认可。结论:该研究强调,中风幸存者的亲属有强烈的信息需求,并表明亲属经历,他们并不总是感到满意的通知和支持的医疗保健专业人员在卒中单位。医疗保健专业人员面临的挑战是能够在正确的时间以适当的方式提供正确的信息。该研究还表明,当亲属得到承认并被邀请参与康复过程时,他们对出院的焦虑程度较低。
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引用次数: 3
Development and Construct Validity of the Work Instability Scale for People With Common Mental Disorders in a Sample of Depressed and Anxious Workers: A Rasch Analysis. 抑郁和焦虑工人样本中常见精神障碍患者工作不稳定性量表的开发和结构效度:Rasch 分析。
IF 2.3 Q1 REHABILITATION Pub Date : 2020-07-14 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720936664
Louise Danielsson, Robin Fornazar, Kristina Holmgren, Åsa Lundgren Nilsson, Gunnel Hensing

Background: Sick leave due to common mental disorders, encompassing depression and anxiety disorders, is high. Capturing early signs of reduced function could aid adjustments of work tasks and environment and, thus, endorse a pro-active approach to occupational and health care interventions to prevent long-term sick-leave spells. However, few measurements exist to identify early signs of imbalance, and none that is illness-specific. The aim of this study was to develop a work instability scale for people with common mental disorders and to test the fundamental psychometric properties of the scale.

Methods: Participants were working adults 18-65 years old with depression or anxiety. The scale development started with qualitative interviews (n = 27) which informed the drafting of a dichotomous, self-report questionnaire. Cognitive debriefing (n = 12) was used to check face validity and modify the draft. Internal construct validity of the draft was tested using Rasch analysis (n = 128). The work ability index was used as a comparator measure.

Results: The initial 63-item draft showed poor fit to Rasch model expectations. Items displaying poor fit or local response dependency were stepwise removed, resulting in a unidimensional 34-item scale fitting the model expectations, and with no differential item functioning. Person-item threshold distribution showed that the scale is better suited to measure low to moderate work instability, than to measure high instability. Correlations between the newly developed scale and the work ability index showed a significant, moderately strong correlation.

Conclusions: In the initial target sample, the 34-item scale showed acceptable fundamental properties and internal construct validity. Further validation of the scale in a larger sample, including tests for external validity, is warranted.

背景:常见精神障碍(包括抑郁症和焦虑症)导致的病假率很高。捕捉功能减退的早期迹象有助于调整工作任务和环境,从而支持积极主动的职业和医疗干预方法,防止长期病假的发生。然而,目前很少有测量方法可以识别失衡的早期迹象,也没有针对特定疾病的测量方法。本研究的目的是为常见精神障碍患者制定工作不稳定性量表,并测试该量表的基本心理测量特性:研究对象为 18-65 岁患有抑郁症或焦虑症的在职成年人。量表的开发始于定性访谈(n = 27),访谈结果为二分法自我报告问卷的起草提供了依据。认知汇报(n = 12)用于检查表面效度和修改草案。采用 Rasch 分析法(n = 128)检验了草案的内部结构效度。结果:最初的 63 个项目草案与 Rasch 模型的预期契合度较低。我们逐步删除了拟合度较差或存在局部反应依赖性的项目,最终得到了符合模型预期的单维 34 个项目量表,并且没有出现项目功能差异。人-项阈值分布表明,该量表更适合测量中低度工作不稳定性,而不是测量高度不稳定性。新开发的量表与工作能力指数之间存在显著的中度相关性:在最初的目标样本中,34 个项目的量表显示出了可接受的基本属性和内部构造效度。有必要在更大的样本中对该量表进行进一步验证,包括外部效度测试。
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引用次数: 0
Association Between Pediatric Inpatient Rehabilitation Services and Children's Functional Outcomes: King Fahad Medical City Experience. 儿童住院康复服务与儿童功能预后之间的关系:法赫德国王医疗城的经验。
Q1 REHABILITATION Pub Date : 2020-06-15 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720928394
Sanaa Mohammed Madi, Naif Ibrahim Alraddadi
Background: Disability may affect children’s performance of functional activities. This may translate to difficulties in returning to home and/or school. It has been documented that intensive rehabilitation programs for children with disabilities lead to an improvement in their functional abilities. Wee-FIM is a valid and reliable outcome measure that is used commonly with children undergoing rehabilitation. Objectives: To study changes in the functional status of children admitted to a specialized pediatric inpatient rehabilitation unit. Design: A retrospective cohort study. Setting: King Fahad Medical City—Rehabilitation Hospital, Riyadh, Saudi Arabia. Methods: Investigators reviewed records of children admitted to a pediatric rehabilitation unit between January 1, 2012, and December 31, 2017. The outcome measures used were rehabilitation length of stay (LOS), Wee-FIM gain, and Wee-FIM efficiency. Results: The total number of records included in this study was 361 records. Sixty percent of the children were boys. The mean age was 8.7 ± 3.8 years (range, 3-17 years). Children with cerebral palsy accounted for 45.2% of the children. The mean LOS was 43 days. Children with brain tumors had the shortest LOS compared with children with other diagnoses. Mean (SD) Wee-FIM efficiency was 0.58 (±0.6). Highest Wee-FIM efficiency was observed in children with brain tumors. Average Wee-FIM gain was 20 (±15). The highest functional gain was 27 in children with brain tumors while the lowest was 16 in children with cerebral palsy. Conclusions: Intensive inpatient rehabilitation program is associated with improvement in functional performance in children with a variety of impairments and disabilities.
背景:残疾可能影响儿童功能性活动的表现。这可能会导致返回家庭和/或学校的困难。有文献表明,对残疾儿童进行强化康复治疗可以改善他们的功能能力。Wee-FIM是一种有效和可靠的结果测量方法,通常用于接受康复治疗的儿童。目的:研究儿科康复专科住院儿童功能状态的变化。设计:回顾性队列研究。地点:沙特阿拉伯利雅得法赫德国王医疗城康复医院。方法:研究人员回顾了2012年1月1日至2017年12月31日期间入住儿科康复病房的儿童记录。使用的结果测量是康复停留时间(LOS)、Wee-FIM增益和Wee-FIM效率。结果:本研究共纳入病历361份。60%的孩子是男孩。平均年龄8.7±3.8岁(3 ~ 17岁)。脑瘫患儿占45.2%。平均生存期为43天。与其他诊断的儿童相比,脑肿瘤儿童的LOS最短。平均(SD) Wee-FIM效率为0.58(±0.6)。在儿童脑肿瘤患者中观察到最高的Wee-FIM效率。Wee-FIM平均增益为20(±15)。患有脑肿瘤的儿童的功能增益最高为27,而患有脑瘫的儿童的功能增益最低为16。结论:强化住院康复计划与各种损伤和残疾儿童功能表现的改善有关。
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引用次数: 1
A Narrative Review: The Use of the Topical NSAID Ibuprofen for the Treatment of Knee Osteoarthritis. Supporting Clinician Decision-Making in the First-Line Treatment of Osteoarthritis. 叙述性回顾:局部使用非甾体抗炎药布洛芬治疗膝骨关节炎。支持临床医生在骨关节炎一线治疗中的决策。
Q1 REHABILITATION Pub Date : 2020-06-11 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720914945
Catrin Hawthorn

A narrative review: The use of the topical nonsteroidal anti-inflammatory drugs (NSAID) ibuprofen for the treatment of knee osteoarthritis. Supporting clinician decision-making in the first-line treatment of osteoarthritis.

Objective: To open discussion at a clinical level on the guidelines for the pharmacological management of osteoarthritis of the knee, this narrative review looks into the use of topical NSAID being a clinically effective, safe, and cost-efficient treatment compared to an oral alternative.

Background: With the over prescription of NSAIDs in the age of above 65 years, there has been a call for increased restrictions of the sale of oral preparations of NSAIDs. It is our view that there is still a lack of awareness in the benefit of topical NSAIDs to the patient (no evidence of adverse reactions recorded by the Joint Formulary Committee [JFC] to date) as well as provider (topical application is cheaper as a National Health Service [NHS] prescription).

Methods: Key online resources included PubMed, Athens, Cochrane Library, Google Scholar, MEDLINE, and relevant clinical and commissioning guidelines with the final date of data collection in March 2017. We also contacted the manufacturer and license holder directly for further clarification. Randomized, double-blind control studies, commissioned reports, International Guidelines, MEHA Guidelines, and license holder data were included. Where possible studies included had to have fair randomization and adhere to key treatment pathways as highlighted by National Institute for Health and Clinical Excellence (NICE) and other guidelines.

Discussion: Current guidelines advise that patients who seek initial treatment of osteoarthritis of the knee should consider a combination of treatment modalities, including pharmacological therapies, particularly the use of NSAIDs. At a clinical level, a reoccurring issue identified with this advice is the inappropriate use of oral NSAIDs, and the concern that the risks associated with ease of access ("over the counter"), and overuse, may result in systemic adverse events in this cohort of patients. Multiple studies have examined the negative effect of oral NSAIDs and the associated risks of use. We were unable to source studies that showed any adverse systemic events from the use of topical NSAIDs; however, there are good quality trials comparing oral to topical NSAIDs, showing similar levels of efficacy at 6 and 12 weeks.

Conclusion: Topical NSAIDs provide good levels of pain relief in subjects with mild to moderate knee osteoarthritis. There is also evidence for the use of the topical application being a clinically effective, safe, and cost-efficient treatment.

一个叙述性的回顾:使用外用非甾体抗炎药(NSAID)布洛芬治疗膝骨关节炎。支持临床医生在骨关节炎一线治疗中的决策。目的:为了在临床层面上对膝关节骨关节炎的药理学治疗指南进行讨论,这篇叙述性综述着眼于与口服替代药物相比,局部使用非甾体抗炎药是一种临床有效、安全且具有成本效益的治疗方法。背景:随着65岁以上人群非甾体抗炎药处方的过度使用,越来越多的人呼吁加大非甾体抗炎药口服制剂的销售限制。我们认为,对于局部使用非甾体抗炎药对患者的益处(迄今为止联合处方委员会[JFC]没有记录不良反应的证据)和提供者(局部使用比国民健康服务[NHS]处方更便宜)仍然缺乏认识。方法:主要在线资源包括PubMed、Athens、Cochrane Library、Google Scholar、MEDLINE以及相关临床和试验指南,数据最终收集日期为2017年3月。我们也直接联系了制造商和许可证持有人进一步澄清。纳入随机、双盲对照研究、委托报告、国际指南、MEHA指南和许可证持有人数据。在可能的情况下,纳入的研究必须公平随机化,并坚持国家健康与临床卓越研究所(NICE)和其他指南所强调的关键治疗途径。讨论:目前的指南建议,寻求膝关节骨关节炎初始治疗的患者应考虑综合治疗方式,包括药物治疗,特别是使用非甾体抗炎药。在临床层面,这一建议所确定的一个反复出现的问题是口服非甾体抗炎药的不当使用,以及对易于获得(“非处方”)和过度使用相关风险的担忧,可能导致该队列患者的全身不良事件。多项研究调查了口服非甾体抗炎药的负面影响和使用的相关风险。我们无法找到表明局部使用非甾体抗炎药有任何不良系统事件的研究来源;然而,有比较口服非甾体抗炎药和外用非甾体抗炎药的高质量试验,在6周和12周时显示出相似的疗效水平。结论:局部使用非甾体抗炎药可以很好地缓解轻度至中度膝骨关节炎患者的疼痛。也有证据表明,局部应用是一种临床有效、安全、经济的治疗方法。
{"title":"A Narrative Review: The Use of the Topical NSAID Ibuprofen for the Treatment of Knee Osteoarthritis. Supporting Clinician Decision-Making in the First-Line Treatment of Osteoarthritis.","authors":"Catrin Hawthorn","doi":"10.1177/1179572720914945","DOIUrl":"https://doi.org/10.1177/1179572720914945","url":null,"abstract":"<p><strong>A narrative review: </strong>The use of the topical nonsteroidal anti-inflammatory drugs (NSAID) ibuprofen for the treatment of knee osteoarthritis. Supporting clinician decision-making in the first-line treatment of osteoarthritis.</p><p><strong>Objective: </strong>To open discussion at a clinical level on the guidelines for the pharmacological management of osteoarthritis of the knee, this narrative review looks into the use of topical NSAID being a clinically effective, safe, and cost-efficient treatment compared to an oral alternative.</p><p><strong>Background: </strong>With the over prescription of NSAIDs in the age of above 65 years, there has been a call for increased restrictions of the sale of oral preparations of NSAIDs. It is our view that there is still a lack of awareness in the benefit of topical NSAIDs to the patient (no evidence of adverse reactions recorded by the Joint Formulary Committee [JFC] to date) as well as provider (topical application is cheaper as a National Health Service [NHS] prescription).</p><p><strong>Methods: </strong>Key online resources included PubMed, Athens, Cochrane Library, Google Scholar, MEDLINE, and relevant clinical and commissioning guidelines with the final date of data collection in March 2017. We also contacted the manufacturer and license holder directly for further clarification. Randomized, double-blind control studies, commissioned reports, International Guidelines, MEHA Guidelines, and license holder data were included. Where possible studies included had to have fair randomization and adhere to key treatment pathways as highlighted by National Institute for Health and Clinical Excellence (NICE) and other guidelines.</p><p><strong>Discussion: </strong>Current guidelines advise that patients who seek initial treatment of osteoarthritis of the knee should consider a combination of treatment modalities, including pharmacological therapies, particularly the use of NSAIDs. At a clinical level, a reoccurring issue identified with this advice is the inappropriate use of oral NSAIDs, and the concern that the risks associated with ease of access (\"over the counter\"), and overuse, may result in systemic adverse events in this cohort of patients. Multiple studies have examined the negative effect of oral NSAIDs and the associated risks of use. We were unable to source studies that showed any adverse systemic events from the use of topical NSAIDs; however, there are good quality trials comparing oral to topical NSAIDs, showing similar levels of efficacy at 6 and 12 weeks.</p><p><strong>Conclusion: </strong>Topical NSAIDs provide good levels of pain relief in subjects with mild to moderate knee osteoarthritis. There is also evidence for the use of the topical application being a clinically effective, safe, and cost-efficient treatment.</p>","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":"9 ","pages":"1179572720914945"},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572720914945","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39414720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Identifying the Most Common CrossFit Injuries in a Variety of Athletes. 确定各种运动员中最常见的混合训练损伤。
Q1 REHABILITATION Pub Date : 2020-01-22 eCollection Date: 2020-01-01 DOI: 10.1177/1179572719897069
Kirill Alekseyev, Alex John, Andrew Malek, Malcolm Lakdawala, Nikhil Verma, Colton Southall, Argyrios Nikolaidis, Sudheer Akella, Samantha Erosa, Rayeed Islam, Efrain Perez-Bravo, Marc Ross

Background: CrossFit is an increasingly popular, rapidly growing exercise regimen. Few studies have evaluated CrossFit-associated musculoskeletal injuries on a large scale. This study explores such injuries and associated risk factors in detail.

Objective: To identify the most common musculoskeletal injuries endured during CrossFit training among athletes at different levels of expertise.

Design: Survey-based retrospective cross-sectional study.

Setting: Distribution at CrossFit gyms in the United States and internationally. Also published on active online forums.

Participants: A total of 885 former and current CrossFit athletes.

Methods: Institutional review board-approved 33-question Web-based survey focused on CrossFit injuries and associated risk factors. Survey submissions were accepted for a period of 6 months.

Main outcome measurements: Specific injuries with associated workouts, risk factors that affected injury including (1) basic demographics, (2) regional differences in reported injuries, (3) training intensity, and (4) expertise level at time of injury.

Results: Of the 885 respondents, 295 (33.3%) were injured. The most common injuries involved the back (95/295, 32.2%) and shoulder (61/295, 20.7%). The most common exercises that caused injury were squats (65/295, 22.0%) and deadlifts (53/295, 18.0%). Advanced-level (64/295, 21.7%) athletes were more significantly injured than beginner-level (40/295, 13.6%) athletes. International participants were 2.2 times more likely than domestic US participants to suffer injury. Individuals with 3+ years of CrossFit experience were 3.3 times more likely to be injured than those with 2 or less years of experience. Participants who trained for 11+ h/week were significantly more likely to be injured than those who trained less than or equal to 10 h/week.

Conclusions: As CrossFit becomes more popular, it is important to monitor the safety of its practitioners. Further studies are needed to explore how to lower this injury prevalence of 33.3%. Areas to focus on include factors that have caused the regional (international vs US states) differences, level of expertise/experience differences (advanced level vs intermediate and beginner levels), and stretching routine modifications.

背景:混合健身是一种日益流行、发展迅速的锻炼方式。很少有研究大规模评估混合健身相关的肌肉骨骼损伤。本研究详细探讨了此类损伤及其相关危险因素。目的:确定不同专业水平的运动员在混合健身训练中最常见的肌肉骨骼损伤。设计:基于调查的回顾性横断面研究。环境:分布在美国和世界各地的综合健身馆。也发表在活跃的网上论坛。参与者:共有885名前和现任混合健身运动员。方法:由机构审查委员会批准的基于网络的33个问题调查,重点关注CrossFit损伤及其相关危险因素。接受调查意见书为期6个月。主要结果测量:与训练相关的特定损伤,影响损伤的危险因素包括(1)基本人口统计学,(2)报告损伤的地区差异,(3)训练强度,(4)受伤时的专业水平。结果:885名被调查者中,295人受伤,占33.3%。最常见的损伤包括背部(95/295,32.2%)和肩部(61/295,20.7%)。引起损伤最常见的运动是深蹲(65/295,22.0%)和硬举(53/295,18.0%)。高水平运动员(64/295,21.7%)损伤明显高于初级水平运动员(40/295,13.6%)。国际参与者受伤的可能性是美国国内参与者的2.2倍。有3年以上混合健身经验的人受伤的可能性是有2年或更少经验的人的3.3倍。与每周训练少于或等于10小时的参与者相比,每周训练11小时以上的参与者明显更容易受伤。结论:随着混合健身运动越来越流行,对其使用者的安全进行监测是非常重要的。如何降低33.3%的损伤发生率需要进一步的研究。需要关注的领域包括导致地区(国际vs美国各州)差异的因素,专业知识/经验水平差异(高级水平vs中级和初级水平),以及拉伸常规修改。
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引用次数: 17
Accepting the Challenge-Moderate-Intensity Exercise with Individuals with Dementia: A Case Series. 接受挑战-中等强度运动对痴呆症患者的影响:一个病例系列。
Q1 REHABILITATION Pub Date : 2019-07-09 eCollection Date: 2019-01-01 DOI: 10.1177/1179572719853592
Nicole Dawson, Katherine Judge

Background and purpose: The global impact of dementia demands a response from researchers and clinicians to not only assist with prevention and a cure, but also to assist in the management of symptoms related to this progressive disease. The purpose of this case series is to highlight the participation of 3 individuals with varying levels of dementia in a moderate-intensity functional exercise program.

Intervention: The intervention, developed using principles from exercise science and a Strength-Based Approach, consisted of 24 sessions of moderate-intensity exercises delivered in participant's home.

Outcomes: Each participant completed a pre- and post-assessment including gait speed, strength, balance, depressive symptoms, cognition, and perceived difficulty with activities of daily living. Despite various clinical presentations, each participant successfully completed all 24 sessions with noted improvements in at least two measures.

Discussion: These findings highlight the flexibility of using the Strength-Based Approach to enhance participation in a standardized exercise program.

背景和目的:痴呆症的全球影响要求研究人员和临床医生做出反应,不仅要协助预防和治疗,还要协助管理与这种进行性疾病相关的症状。本病例系列的目的是强调3名不同程度的痴呆症患者参与中等强度的功能锻炼计划。干预:采用运动科学和力量为基础的方法开发的干预,包括24次中等强度的锻炼,在参与者家中进行。结果:每位参与者完成了包括步态速度、力量、平衡、抑郁症状、认知和日常生活活动感知困难的前后评估。尽管有不同的临床表现,每个参与者都成功地完成了所有24个疗程,并在至少两项措施上有了明显的改善。讨论:这些发现强调了使用基于力量的方法来提高参与标准化锻炼计划的灵活性。
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引用次数: 1
Minor Head Injury Symptoms and Recovery From Whiplash Injury: A 1-Year Prospective Study. 颈部轻伤的症状和恢复:一项为期1年的前瞻性研究。
Q1 REHABILITATION Pub Date : 2019-04-26 eCollection Date: 2019-01-01 DOI: 10.1177/1179572719845634
Helge Kasch, Luana Leonora Jensen

Aim: To examine concussion-related disability in neck injuries, the Rivermead Head Injury Follow-Up Questionnaire (RHFUQ) was applied. Furthermore, we wanted to investigate symptoms found in post-concussion syndrome (PCS) and global pain, neck pain intensities obtained from acute whiplash patients within 1 week and at 6 months after injury in a prospective study on 1-year work disability.

Methods: A total of 143 consecutive acute whiplash-injured patients were admitted to the study from the Emergency Unit (Aarhus University Hospital). Patients with direct head trauma or reported retro- or anterograde amnesia were excluded from the study. Average neck pain and global pain intensity were measured on a Visual Analogue Scale (VAS 0-10). The RHFUQ (10 items, score from 0 to 4, total score from 0 to 40) was fulfilled after 1 week and 6 months. Patients underwent neurological examination within 1 week after injury. Recovery (return to work) was assessed 1 year post-injury.

Results: In total, 97% completed the study, and 9% (12/138) did not recover. Non-recovered patients reported more neck pain and global pain after 1 week (P < .003) and 6 months (P < .008) and higher PCS symptom score after 1 week (P < .001) and 6 months (P < .002). Using the RHFUQ total score as a predictive test, a receiver-operating characteristic curve (ROC) area of 0.77 (0.61-0.92) and a cut-off at 10 points revealed a sensitivity of 75% and a specificity of 67.2%. At 1 week, 8 of 10 items reached higher scores among non-recovered and 10 of 10 items after 6 months post-injury.

Conclusions: RHFUQ is useful in acute whiplash patients for predicting 1-year work disability. PCS-related symptoms along with neck pain and global pain are more burdensome in the non-recovered group. This emphasizes that post-concussion symptoms are not a sign of brain injury alone, but are found in other types of mishaps like whiplash injuries.

目的:应用Rivermead头部损伤随访问卷(RHFUQ)研究颈部损伤的脑震荡相关残疾。此外,我们希望在一项为期1年的工作残疾的前瞻性研究中,调查脑震荡后综合征(PCS)的症状和全身疼痛,急性颈椎扭伤患者在受伤后1周和6个月内获得的颈部疼痛强度。方法:从急诊科(奥尔胡斯大学医院)连续收治143例急性鞭伤患者。有直接头部创伤或报告的逆行性或顺行性遗忘的患者被排除在研究之外。用视觉模拟量表(VAS 0-10)测量平均颈部疼痛和整体疼痛强度。RHFUQ(10项,评分0 ~ 4分,总分0 ~ 40分)分别于1周和6个月后完成。患者伤后1周内行神经学检查。伤后1年评估恢复(重返工作)情况。结果:97%的患者完成了研究,9%(12/138)患者没有康复。未康复患者在1周(P < 0.003)和6个月(P < 0.008)后颈部疼痛和全身疼痛加重,1周(P < 0.001)和6个月(P < 0.002)后PCS症状评分升高。使用RHFUQ总分作为预测检验,受试者-工作特征曲线(ROC)面积为0.77(0.61-0.92),截止点为10点,灵敏度为75%,特异性为67.2%。伤后1周未恢复者10项中有8项得分较高,伤后6个月后10项中有10项得分较高。结论:RHFUQ可用于预测急性颈部扭伤患者1年的工作能力丧失。在未康复组中,与pcs相关的症状以及颈部疼痛和全身疼痛更为严重。这强调了脑震荡后的症状不仅仅是脑损伤的征兆,也存在于其他类型的事故中,比如鞭伤。
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引用次数: 5
Our Peers-Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries With Physical Disabilities. 我们的同伴授权和导航支持(OP-ENS):同伴健康导航干预的发展,以支持身体残疾的医疗补助受益人。
Q1 REHABILITATION Pub Date : 2019-04-26 eCollection Date: 2019-01-01 DOI: 10.1177/1179572719844759
Susan Magasi, Christina Papadimitriou, Judy Panko Reis, Kimberly The, Jennifer Thomas, Laura VanPuymbrouck, Tom Wilson

People with disabilities (PWD) are a health disparities population who experience well-documented physical, structural, attitudinal, and financial barriers to health care. The disability rights community is deeply engaged in advocacy to promote health care justice for all PWD. As the community continues to work toward systems change, there is a critical need for community-directed interventions that ensure individuals with disabilities are able to access the health care services they need and are entitled to. Peer health navigator (PHN) programs have been shown to help people from diverse underserved communities break down barriers to health care. The PHN model has not been systematically adapted to meet the needs of PWD. In this article, we describe the collaborative process of developing Our Peers-Empowerment and Navigational Supports (OP-ENS), an evidence-informed PHN intervention for Medicaid beneficiaries with physical disabilities in Chicago, IL, USA. Our Peers-Empowerment and Navigational Supports is a 12-month community-based PHN intervention that pairs Medicaid beneficiaries with physical disabilities (peers) with disability PHNs who use a structured recursive process of barrier identification and asset mapping, goal setting, and action planning to help peers meet their health care needs. Our Peers-Empowerment and Navigational Supports was developed by a collaborative team that included disability rights leaders, representatives from a Medicaid managed care organization, and academic disability health care justice researchers. We highlight both the conceptual and empirical evidence that informed OP-ENS as well as the lessons learned that can assist future developers.

残疾人(PWD)是一个存在健康差异的人群,他们在获得卫生保健方面经历了充分记录的身体、结构、态度和经济障碍。残疾权利团体深入参与宣传活动,以促进所有残疾人士的保健正义。随着社区继续致力于系统变革,迫切需要以社区为导向的干预措施,以确保残疾人能够获得他们需要和有权获得的卫生保健服务。同伴健康导航员(PHN)项目已经被证明可以帮助来自不同服务不足社区的人们打破卫生保健的障碍。PHN模型还没有系统地适应残疾人士的需要。在本文中,我们描述了开发我们的同伴赋权和导航支持(OP-ENS)的合作过程,这是美国伊利诺伊州芝加哥市针对身体残疾的医疗补助受益人的循证PHN干预。我们的同伴赋权和导航支持是一项为期12个月的基于社区的PHN干预,将医疗补助受益人与身体残疾(同伴)配对,残疾PHN使用结构化递归过程识别障碍和资产映射,目标设定和行动计划,以帮助同伴满足他们的医疗保健需求。我们的同伴赋权和导航支持是由一个协作团队开发的,该团队包括残疾人权利领导人、医疗补助管理医疗组织的代表和学术残疾医疗保健司法研究人员。我们强调了OP-ENS的概念和经验证据,以及可以帮助未来开发人员的经验教训。
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引用次数: 9
Adherence and Continued Participation in a Wellness Class for Individuals with Disabilities. 坚持和继续参与残疾人健康班。
Q1 REHABILITATION Pub Date : 2019-04-17 eCollection Date: 2019-01-01 DOI: 10.1177/1179572719843257
Megan Elizabeth Ware, Kathleen B deMarrais, Kevin K McCully

Background: For individuals with disabilities, adherence and participation in wellness programs is a challenge. Adherence and participation were explored in a wellness class for people with disabilities.

Objective: Understand what factors impact participant adherence and participation in the wellness class.

Methods: Eight wellness class participants, who have been in the class for 6 to 36 months, were chosen for qualitative interviews. Interview responses were coded and analyzed for overarching themes.

Results: A total of 77 codes were obtained from interview data. The primary theme identified from the codes was related to social interaction with the student-trainers, divided into subthemes of social accountability, motivation, supporting classroom environment, and participant-student interaction.

Conclusion: The primary factor influencing adherence and participation was related to social interaction with student-trainers. These results suggest that social interaction can play a major role in continued participation in exercise as well as exercise adherence.

背景:对于残疾人来说,坚持和参与健康计划是一个挑战。在一个为残疾人开设的健康课程中,我们探讨了坚持和参与的问题。目的:了解影响参与者坚持和参与健康课程的因素。方法:选取8名入班6 ~ 36个月的健康班学员进行定性访谈。对采访的回答进行编码和分析,以确定总体主题。结果:从访谈资料中共获得77个编码。从准则中确定的主要主题与与学生-培训师的社会互动有关,分为社会责任、动机、支持性课堂环境和参与者-学生互动等子主题。结论:影响依从性和参与性的主要因素与辅导员的社会互动有关。这些结果表明,社会互动可以在持续参与运动和坚持运动方面发挥重要作用。
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引用次数: 1
期刊
Rehabilitation Process and Outcome
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