Health of Community-Dwelling Adults With Mobility Limitations in the United States: Prevalent Health Conditions
Although as many as 1 in 5 adults in the United States report 1 or more sensory, cognitive, communication, or functional limitations, the magnitude of their impact on people with disabilities is poorly understood. This month’s Archives includes 2 articles by Rasch and colleagues that analyze the self-report health conditions of over 12,000 people from the Medical Expenditure Panel and National Health Interview surveys of the late 1990s. Respondents were divided into 3 groups: those with mobility limitations, those with nonmobility limitations, and those without limitations. The findings indicate that while the nature of medical conditions (eg, musculoskeletal) was similar between groups, their presence in people with mobility limitations (n=3.6) was significantly greater than in those with nonmobility (2.4) or no limitations (1.3). The onset of new conditions over the 2-year period of study followed a similar pattern with people with mobility limitations, gaining an average of 4.7 new conditions while those in the nonmobility or no limitations groups gained 3.9 and 2.6 conditions, respectively. Respondents with mobility limitations were the most likely to be older, female, unmarried, obese, and living alone. While the tenor of the findings may not be surprising, their quantitation and the observation that comorbid conditions may increase more rapidly in those with disabilities may permit an improved rationalization of medical and rehabilitation efforts. • SEE PAGES 210, 219
Pei-Fen J. Chang, PhD, OTR
Glenn V. Ostir, PhD
Yong-Fang Kuo, PhD
Carl V. Granger, MD
Kenneth J. Ottenbacher, PhD, OTR
Ethnic Differences in Discharge Destination Among Older Patients With Traumatic Brain Injury
Traumatic brain injury (TBI), while most frequent and most studied in younger patients, is also relatively common in older adults. As with younger patients, its consequences can preclude an easy return to independent living. Discharge planning is, therefore, important, because a poor plan may result in unnecessary social isolation or an unsustainable burden on caregivers. Chang and colleagues retrospectively analyzed the Uniform Data System database to examine the influence of ethnic and socioeconomic factors on the disposition of older patients with TBI. The sample, which the investigators believe is nationally representative, was used to track the discharge destination and ethnicity of 9000 patients of age 65 or greater. The investigators found that about 70% of the patients returned home while the remainder was transferred to subacute, skilled, intermediate, and acute care facilities. Ethnicity was significantly associated with discharge destination; Hispanics (OR=2.24) and blacks (OR=2.00) were significantly more likely to be discharged home than their white counterparts, despite the fact that whites tended to have a somewhat higher level of function. The reasons for this disparity require further exploration. • SEE PAGE 231
William C. Logan Jr, MD
Richard Sloane, MS
Kenneth W. Lyles, MD
Barry Goldstein, MD, PhD
Helen M. Hoenig, MD, MPH
Incidence of Fractures in a Cohort of Veterans With Chronic Multiple Sclerosis or Traumatic Spinal Cord Injury
Spinal cord injury (SCI) is associated with increased rates of osteoporosis and pathologic fractures that correlate with a patient’s injury and activity levels. Logan and colleagues used the Veterans Health Administration’s National Spinal Cord Disease Registry to further explore the association of neurologic injury on bone health by assessing fracture occurrence, location, and level of motor function in 1789 patients with multiple sclerosis (MS) and 6361 with traumatic SCI over an almost 9-year period. The investigators found that subjects were predominately male, in their fifties, and had had their condition for more than 20 years. Slightly more than 1700 fractures were found in the period, with an overall relative risk of a fracture 3.1 per 100 patient-years. Patients with SCI were twice as likely as those with MS to experience a fracture and those with moderate motor impairments had a significantly higher rate of fracture than those with milder or more severe limitations. • SEE PAGE 237
Rachel E. Cowan, MS
Michael L. Boninger, MD
Bonita J. Sawatzky, PhD
Brian D. Mazoyer, PTA
Rory A. Cooper, PhD
Preliminary Outcomes of the SmartWheel Users’ Group Database: A Proposed Framework for Clinicians to Objectively Evaluate Manual Wheelchair Propulsion
There is a dichotomy between the assessment of wheelchair propulsion that can occur in a laboratory and what is possible in the clinic. In a laboratory, specifications can be carefully assessed; in a clinic, the clinician has at best has a limited amount of time and equipment at his/her disposal. Cowan and colleagues propose a more formulized and objective approach for assessment in the clinic and assess its utility in a database of 128 manual wheelchair users who had been asked to propel themselves at a self-selected speed across a hard level surface, a level pile carpet, and a ramp. Differences in self-selected velocity, peak resultant force, and push frequency were used to develop proposed standards and provide reference values The authors conclude that their method may be an effective clinical tool capable of both assessing the effects of an invention on a patient’s propulsion as well as comparing their performance to a normative population. • SEE PAGE 260
FULL TEXT