Objective
To identify mediating roles of mindfulness, self‐efficacy, social support, and functional independence in the relationship between pain and quality of life (QOL) in persons with spinal cord ...injury (SCI).
Methods
A cross‐sectional descriptive study was conducted using a sample of 272 persons with SCI living in the United States. The participants completed self‐report standardized questionnaires on a Qualtrics survey. A parallel mediation analysis adjusting for covariates was performed to test the hypotheses.
Results
Findings showed significant direct effects of pain on functional independence, self‐efficacy, mindfulness, and social support. Self‐efficacy, mindfulness, and social support had significant direct effects on QOL. In the mediation analysis, mindfulness, self‐efficacy, and social support significantly mediated the relationship between pain and QOL, controlling for other variables in the model.
Conclusions
This study adds to the extant literature by providing evidence that mindfulness, self‐efficacy, and social support not only directly contribute to QOL but are likely to mitigate the negative effect of pain on QOL in persons with SCI. Identifying these potential factors that can assuage the adverse effects of pain on QOL is a first step toward active intervention to facilitate the adjustment of persons with SCI.
Introduction: Coronaviruses can cause widespread systemic infections, the most common of which are respiratory complications, which are close to the symptoms of serious acute respiratory syndrome ...coronavirus (SARS-CoV). Case Description: We report a case of a 16-year-old boy who developed weakness in bilateral lower limbs, difficulty in coughing, and generalized weakness for 2 days. He was diagnosed with post-COVID Guillain-Barre syndrome (GBS). Cerebrospinal fluid (CSF) analysis manifested a CSF protein of 117 mg/dL, a white blood cell count of 6-7/mm3 , and a glucose of too low to comment. Magnetic resonance investigation of the brain revealed mucosal thickening in the bilateral maxillary, ethmoid, and left frontal sinuses. Nerve conduction studies concluded evidence of sensory-motor polyneuropathy. Physiotherapy intervention included patient education, breathing retraining, airway clearance techniques, positioning, a combination of chest proprioceptive neuromuscular facilitation (PNF) techniques, a walking program with supplemented oxygen, and psychological support. Results: Outcome measures have shown enhancement in functional independence and performance of activities of daily living. Conclusion: The evidence from this study suggests that pulmonary rehabilitation plays a pivotal role in managing a patient who is diagnosed with post-COVID GBS, which includes patient education, breathing retraining, airway clearing techniques, a combination of chest PNF techniques, positioning, a walking program with augmented oxygen, and psychological support.
•A retrospective review was conducted on patients who underwent liver transplantation.•Patients were admitted to a free-standing rehabilitation facility within 6 months.•The FIM tool was used to ...measure functional outcomes.•Patients demonstrated statistically significant improvement in functional outcomes.
To describe the outcomes (change in functional independence and discharge disposition) of patients who after liver transplantation received acute inpatient rehabilitation in a freestanding rehabilitation hospital.
A retrospective chart review was conducted of patients admitted to an acute inpatient rehabilitation hospital within 6 months of undergoing liver transplantation between January 2014 and December 2018. Change in function from rehabilitation admission to discharge was measured using FIM Change and FIM Efficiency.
A freestanding rehabilitation hospital.
107 patients who underwent acute inpatient rehabilitation at a freestanding rehabilitation hospital within 6 months after liver transplantation who met inclusion criteria (N=107). Most were men (71.96%), and the mean age of the patient population was 62.15 years.
Acute inpatient rehabilitation consisting of at least 3 hours of therapy 5 days a week split between physical therapy, occupational therapy, and speech language pathology services.
FIM Change, FIM Efficiency, Discharge Disposition.
Participants were found to have statistically significant positive FIM Change (P<.00001) and FIM Efficiency (P<.00001). The mean FIM Change and Efficiency were 35.7±11.8 and 2.4±1.0, respectively. 83.2% (n = 89) were ultimately discharged to the community.
Acute inpatient rehabilitation provides patients who have received a liver transplant with the opportunity to measurably improve their function and independence, with most patients being able to return home.
The aim of the study is to determine what improvement on the American Spinal Injury Impairment Scale correlates with functional status after a traumatic spinal cord injury.
We performed an ...observational cohort study, analyzing prospective data from 168 patients with traumatic spinal cord injury admitted to a single level 1 trauma center. A multivariable analysis was performed to assess the relationship between functional status (from the Spinal Cord Independence Measure) at 1-year follow-up and American Spinal Injury Impairment Scale grade (baseline and 1-yr follow-up), while taking into account covariables describing the sociodemographic status, trauma severity, and level of neurological injury.
Individuals improving to at least American Spinal Injury Impairment Scale grade D had significantly higher Spinal Cord Independence Measure score compared with those not reaching American Spinal Injury Impairment Scale D (89.3 ± 15.2 vs. 52.1 ± 20.4) and were more likely to reach functional independence (68.5% vs. 3.6%), regardless of the baseline American Spinal Injury Impairment Scale grade. Higher final Spinal Cord Independence Measure was more likely with an initial American Spinal Injury Impairment Scale grade D (β = 1.504; 95% confidence interval = 0.46-2.55), and a final American Spinal Injury Impairment Scale grade D (β = 3.716; 95% CI = 2.77-4.66) or E (β = 4.422; 95% CI = 2.91-5.93).
Our results suggest that reaching American Spinal Injury Impairment Scale grade D or better 1 yr after traumatic spinal cord injury is highly predictive of significant functional recovery, more so than the actual improvement in American Spinal Injury Impairment Scale grade from the injury to the 1-yr follow-up.
Arthrogryposis (AMC) is a descriptive term to characterize a child born with multiple joint contractures. Treatment aims to improve functional independence, yet the literature objectively describing ...functional independence in this population is scarce. This study aimed to describe the functional independence of children with AMC through the lens of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) and observational activities of daily living (ADL) tasks.
Patients with AMC between the ages of 3 and 12 years participated in this prospective study. Parents completed the PEDI-CAT while a trained occupational therapist observed children as they completed a checklist of functional ADL tasks. Patients were grouped according to developmental age groups: "preschoolers" (3 to 5 y), "early school-age" (6 to 9 y), and "late school-age" (10 to 12 y). Patient's PEDI-CAT normative scores were described, comparing the study population to typically developing children, and differences in each domain were examined between developmental age groups. The observed ADL tasks completed were also described, and differences in scores were examined between developmental age groups.
Forty-four patients (mean age of 7±2.86 y) were enrolled. The distribution between age groups was nearly even. Mean daily activities T -score for patients with AMC was 25.80±11.98 and the mean mobility T -score was 17.39±9.77. Late school-age children scored significantly lower than preschool-age children in both of these domains ( P <0.01). Observed ADL tasks demonstrated a high level of required assistance for patients (range: 27.3% to 61.4%), although older school-age children did show greater independence with tested activities than preschool-age children ( P =0.05).
Children with AMC are significantly limited in functional independence, particularly regarding age-appropriate daily activities and mobility. Outcomes from this study provide a reference to help gauge the results of nonoperative and surgical treatment toward improving functional independence in this population.
Level III: prognostic study.
Abstract Introduction Spinal cord injury (SCI) radically changes a person’s life because of alterations in body dynamics, leading to disabilities and reduced functionality. Objective To analyze the ...functional independence of individuals with spinal cord injury and compare the groups. Methods Individuals with SCI were interviewed about their functional independence using the Brazilian version of the Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR) and later their respective domains and subdomains were compared between diagnostic groups, time since injury and sex. Results The sample consisted of fifty individuals aged 40.92 ± 13.93 years, predominantly men and diagnosed with paraplegia. In most brSCIM-SR domains, all respondents achieved good independence in self-care, respiration and sphincter management, and in the total brSCIM-SR, except for mobility. In paraplegia, chronic SCIs and both sexes achieved excellent independence in most subdomains and in the total. Significantly low values were found for tetraplegia and recent SCI in the self-care subdomain. In most subdomains, tetraplegia reached significantly lower values. In the subdomains of respiration and sphincter management, the participants were independent in the breathing function, but in tetraplegia, they showed significant dependence on transfer to the toilet. In terms of mobility, there was great dependence on the items going up and down stairs and transfer from the floor to the wheelchair. Conclusion The brSCIM-SR measures the degree of functionality, allowing health professionals and the patient to quantify and locate the items that indicate their deficits or gains during the rehabilitation process. Here, individuals with SCI showed good functional independence, with worse performance in the tetraplegia and recent injury groups: however, mobility showed partial dependence in the participants.
Resumo Introdução A lesão da medula espinal (LME) muda radicalmente a vida da pessoa devido às alterações na dinâmica corporal, levando à incapacidades e redução da funcionalidade. Objetivo Analisar a independência funcional de indivíduos com LME e comparar os grupos. Métodos Indivíduos com LME foram entrevistados sobre sua independência funcional por meio da versão brasileira do Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR) e posteriormente seus respectivos domínios e subdomínios foram comparados entre os grupos diagnósticos, tempo de lesão e gênero. Resultados A amostra foi composta por 50 indivíduos com idade de 40,92 ± 13,93 anos, prevalecendo homens e diagnóstico de paraplegia. Na maioria dos domínios do brSCIM-SR todos os entrevistados atingiram boa independência no autocuidado, na respiração e controle esfincteriano e no total do brSCIM-SR, exceto na mobilidade. Na paraplegia, as LMEs crônicas e ambos os sexos alcançaram excelente independência na maioria dos subdomínios e no total do instrumento. Valores significantemente baixos foram encontrados na tetraplegia e nas LMEs recentes no subdomínio autocuidado. Na maioria dos subdomínios, a tetraplegia atingiu valores significativamente inferiores. Nos subdomínios da respiração e controle esfincteriano, os participantes eram independentes na função respiração, mas nas tetraplegias apresentaram significativa depen-dência nas transferências para o vaso sanitário. Na mobilidade houve grande dependência nos itens subir e descer escadas e transferir-se do chão para a cadeira de rodas. Conclusão Os indivíduos com LME demonstra-ram boa independência funcional, com pior desempenho na tetraplegia e lesões recentes, mas a mobilidade apresentou parcial dependência nos participantes.
Background and purpose
Whether pre-intravenous thrombolysis (IVT) provides any extra benefits to mechanical thrombectomy (MT) remains controversial. We conducted a systematic review and meta-analysis ...to compare MT with pre-IVT (IVT + MT) and MT without pre-IVT (MT) for acute ischemic stroke of large vessel occlusion.
Methods
We systematically searched PubMed, EMBASE and Cochrane Library to identify studies comparing outcomes between IVT + MT and MT from inception to Jan 24, 2019. Random effects mode was used to pool relative risk (RR) with confidence intervals (CI) to compare functional independence in terms of modified Rankin Scale (mRS) 0–2, favorable outcome (mRS 0–1) and mortality at three-months, symptomatic intracerebral hemorrhage, successful reperfusion, and complete reperfusion between the two treatments groups.
Results
We included 30 studies enrolling 8970 patients with acute ischemic stroke of large vessel occlusion. Compared with MT, IVT + MT significantly increased the rate of 3-month functional independence (RR 1.20, 95% CI 1.12–1.30;
P
< 0.0001) and favorable outcome (RR 1.28; 95% CI 1.16–1.40;
P
< 0.0001), increased the rate of successful reperfusion (RR 1.04,95% CI 1.01–1.08;
P
= 0.013) and complete reperfusion (RR 1.10; 95% CI 1.01–1.19;
P
= 0.024), reduced the rate of mortality (RR 0.74, 95% CI 0.67–0.82;
P
< 0.0001), without significantly increasing the rate of symptomatic intracerebral hemorrhage (RR 0.98,95% CI 0.82–1.17;
P
= 0.833). The results remained stable in sensitivity analyses and adjusting for publication bias.
Conclusions
Pre-IVT provides extra benefits to MT on clinical and imaging outcomes without increasing symptomatic intracerebral hemorrhage in acute ischemic stroke of large vessel occlusion.
Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective ...clinical supervision of allied health professionals improves patients' outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence.
Methods: A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure.
Results: Physiotherapists (n = 27) and occupational therapists (n = 26) in inpatient rehabilitation were recruited and the medical records of their patients (n = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence.
Conclusions: Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients' mobility or personal care, respectively.
Implications for rehabilitation
Effective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients.
Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision.
Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice.
Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.
Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at ...rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury.
(1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors.
This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R
2
, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation.
The top three predictors, each from a different FIM domain, were Toilet (adjusted R
2
= 0.53, Transfers domain), Toileting (adjusted R
2
= 0.46, Self-care domain), and Bowel (adjusted R
2
= 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay.
Discharge FIM items accurately predict long-term functional independence.
