Archives of Physical Medicine and Rehabilitation

Rehabilitation in the New World Order: Will Our Differences Be Our Demise

Gary R. Ulicny — 2012-02-01

Abstract: Ulicny GR. Rehabilitation in the new world order: will our differences be our demise. This ACRM Presidential Address contends that the field of rehabilitation may be ill prepared for impending health care changes. The article describes the basic tenets of the Affordable Care Act and its implications for rehabilitation. Finally, it makes suggestions and recommendations for how the field will need to change to adapt to this new world order.

Facts, Theories, Values: Shaping the Course of Neurorehabilitation. The 60th John Stanley Coulter Memorial Lecture

Keith D. Cicerone — 2012-02-01

Abstract: Cicerone KD. Facts, theories, values: shaping the course of neurorehabilitation. The 60th John Stanley Coulter memorial lecture. We have seen an increase in efforts to establish evidence-based parameters for the practice of rehabilitation. This effort has been placed in a broader context involving the role of theory in advancing rehabilitation science, particularly in relation to specifying the active ingredients and mechanisms of action of interventions. One approach to cognitive rehabilitation is through direct training of cognitive functions such as working memory, which purportedly relies on mechanisms of neuroplasticity. However, this approach is also shown to be dependent on qualities of active attention and learning, feedback, effort, and motivation. Changes in functional and structural connectivity after cognitive rehabilitation suggest that the dynamic adjustment of task-related and resting activity in areas connected to the site of injury is the most likely mechanism underlying recovery of function. Behavioral interventions that address this process have emphasized the role of metacognitive and emotional regulation, as well as an appreciation of the role of subjective experience and beliefs, as central to the rehabilitation process. Our understanding of these processes occurs in the context of scientific values that influence judgments about how much evidence is sufficient to support the evaluation and acceptance of scientific results, including judgments about the effectiveness of rehabilitation. Evidence and theory are necessary to understanding rehabilitation, but we also need to acknowledge the values that directly and indirectly guide our research and practice.

Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty

2011-12-23

Abstract: Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J, on behalf of the Multicenter Arthroplasty Aftercare Project. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Objective: To evaluate if the timing of aquatic therapy influences clinical outcomes after total knee arthroplasty (TKA) or total hip arthroplasty (THA). Design: Multicenter randomized controlled trial with 3-, 6-, 12-, and 24-month follow-up. Setting: Two university hospitals, 1 municipal hospital, and 1 rural hospital. Participants: Patients (N=465) undergoing primary THA (n=280) or TKA (n=185): 156 men, 309 women. Intervention: Patients were randomly assigned to receive aquatic therapy (pool exercises aimed at training of proprioception, coordination, and strengthening) after 6 versus 14 days after THA or TKA. Main Outcome Measures: Primary outcome was self-reported physical function as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3-, 6-, 12-, and 24-months postoperatively. Results were compared with published thresholds for minimal clinically important improvements. Secondary outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey, Lequesne-Hip/Knee-Score, WOMAC-pain and stiffness scores, and patient satisfaction. Results: Baseline characteristics of the 2 groups were similar. Analyzing the total study population did not result in statistically significant differences at all follow-ups. However, when performing subanalysis for THA and TKA, opposite effects of early aquatic therapy were seen between TKA and THA. After TKA all WOMAC subscales were superior in the early aquatic therapy group, with effect sizes of WOMAC physical function ranging from .22 to .39. After THA, however, all outcomes were superior in the late aquatic therapy group, with WOMAC effect sizes ranging from .01 to .19. However, the differences between treatment groups of these subanalyses were not statistically significant. Conclusions: Early start of aquatic therapy had contrary effects after TKA when compared with THA and it influenced clinical outcomes after TKA. Although the treatment differences did not achieve statistically significance, the effect size for early aquatic therapy after TKA had the same magnitude as the effect size of nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis of the knee. However, the results of this study do not support the use of early aquatic therapy after THA. The timing of physiotherapeutic interventions has to be clearly defined when conducting studies to evaluate the effect of physiotherapeutic interventions after TKA and THA.

Longer Versus Shorter Daily Durations of Electrical Stimulation During Task-Specific Practice in Moderately Impaired Stroke

Stephen J. Page, Linda Levin, Valerie Hermann, Kari Dunning, Peter Levine — 2012-02-01

Abstract: Page SJ, Levin L, Hermann V, Dunning K, Levine P. Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. Objective: To examine and compare efficacy of 30-, 60-, and 120-minute repetitive task-specific practice (RTP) sessions incorporating use of an electrical stimulation neuroprosthesis (ESN) on affected upper-extremity (UE) movement. Design: Prospective, single-blinded, randomized controlled trial. Setting: Outpatient rehabilitation hospital. Participants: Chronic stroke subjects (N=32) exhibiting moderate, stable affected UE motor deficits. Interventions: Subjects participated in 30-, 60-, or 120-minute therapy sessions involving RTP incorporating the ESN, occurring every weekday for 8 weeks. During sessions, they wore the ESNs to enable performance of valued activities that they had identified. A fourth group participated in a 30-minute per weekday home exercise program. Main Outcome Measures: Outcomes were evaluated using the UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Arm Motor Ability Test (AMAT), the Action Research Arm Test (ARAT), and Box and Block (B&B) 1 week before and 1 week after intervention. Results: After intervention, subjects in the 120-minute condition were the only ones to exhibit significant score increases on the FM (P=.0007), AMAT functional ability scale (P=.002), AMAT quality of movement scale (P=.0002), and ARAT (P=.02). They also exhibited the largest changes in time to perform AMAT tasks and in B&B score, but these changes were nonsignificant, (P=.15 and P=.10, respectively). Conclusions: One hundred and twenty minutes a day of RTP augmented by ESN use elicits the largest and most consistent UE motor changes in moderately impaired stroke subjects.

Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application

Sebastian H. Doeltgen, Maggie-Lee Huckabee — 2012-02-01

Abstract: Doeltgen SH, Huckabee M-L. Swallowing neurorehabilitation: from the research laboratory to routine clinical application. The recent application of neurostimulation techniques to enhance the understanding of swallowing neural plasticity has expanded the focus of rehabilitation research from manipulation of swallowing biomechanics to manipulation of underlying neural systems. Neuromodulatory strategies that promote the brain's ability to reorganize its neural connections have been shown to hold promising potential to aid the recovery of impaired swallowing function. These techniques include those applied to the brain through the intact skull, such as transcranial magnetic stimulation or transcranial direct current stimulation, or those applied to the sensorimotor system in the periphery, such as neuromuscular electrical stimulation. Recent research has demonstrated that each of these techniques, either by themselves or in combination with these and other treatments, can, under certain circumstances, modify the excitability of motor representations of muscles involved in swallowing. In some studies, experimentally induced plastic changes have been shown to have functional relevance for swallowing biomechanics. However, the transition of novel, neuromodulatory brain stimulation techniques from the research laboratory to routine clinical practice is accompanied by a number of ethical, organizational, and clinical implications that impact professions concerned with the treatment of swallowing rehabilitation. In this article, we provide a brief overview of the neuromodulatory strategies that may hold potential to aid the recovery of swallowing function, and raise a number of issues that we believe the clinical professions involved in the rehabilitation of swallowing disorders must confront as these novel brain stimulation techniques emerge into clinical practice.

Building on Transformative Learning and Response Shift Theory to Investigate Health-Related Quality of Life Changes Over Time in Individuals With Chronic Health Conditions and Disability

2012-02-01

Abstract: Barclay-Goddard R, King J, Dubouloz CJ, Schwartz CE, on behalf of the Response Shift Think Tank Working Group. Building on transformative learning and response shift theory to investigate health-related quality of life changes over time in individuals with chronic health conditions and disability. A major goal of treatment for people living with chronic illness or disability is self-management leading to optimized health-related quality of life. This change process has been described in the adult education literature as transformative learning, while in health-related quality of life research, response shift has emerged as a key concept. Response shift and transformative learning literature were reviewed, and the theoretical frameworks of the 2 concepts were compared and contrasted. Response shift is described as a change in internal standards, values, or definition of a construct (eg, health-related quality of life) over time, commonly seen in individuals with chronic illness. In the context of chronic illness, transformative learning is described as a complex process of personal change including beliefs, feelings, knowledge, and values. Transformative learning is often triggered by the diagnosis of a chronic illness. This results in a critical reflection of taken-for-granted assumptions and leads to new ways of thinking, influencing personal changes in daily living. Comparing the models of response shift and transformative learning in chronic illness, the catalyst in response shift appears comparable with the trigger in transformational learning; mechanisms to process of changing; and perceived quality of life to outcomes. Both transformative learning and response shift have much to offer health care providers in understanding the learning process for the person living with chronic illness or disability to optimize their quality of life. Suggestions for future research in response shift and transformative learning in individuals with chronic health conditions and disability are proposed.

Clinical Reality of Measuring Upper-Limb Ability in Neurologic Conditions: A Systematic Review

Louise A. Connell, Sarah F. Tyson — 2012-02-01

Abstract: Connell LA, Tyson SF. Clinical reality of measuring upper-limb ability in neurologic conditions: a systematic review. Objective: To review the psychometric properties and clinical utility of upper-limb measurement tools in people with neurologic conditions to provide recommendations for practice. Data Sources: MEDLINE, CINAHL, EMBASE, PEDro, and AMED. Study Selection: Independent reviewers searched, selected, and extracted data from articles that assessed reliability, validity, ability to detect change, and clinical utility of measures of the upper limb in adult neurologic conditions. Data Extraction: Measures with good psychometrics and 8 or higher (out of 10) clinical utility scores were recommended. Data Synthesis: The searches identified 31 measures of the upper limb. However, only 2 measures fulfilled all of the psychometric and clinical utility criteria; the Box and Block Test and the Action Research Arm Test. Conclusions: The Box and Block and the Action Research Arm Tests produce robust data and are feasible for use in clinical practice. Future development of new or existing measures should ensure the construct and content validity of the measure is clearly identified, standardized guidelines are easily available, and ensure that it is individualized and contemporary. Attention to measures of upper-limb activity for people who are unable to grip objects is also needed.

Diagnostic Accuracy of Clinical Tests for Subacromial Impingement Syndrome: A Systematic Review and Meta-Analysis

Marwan Alqunaee, Rose Galvin, Tom Fahey — 2012-02-01

Abstract: Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Objective: To examine the accuracy of clinical tests for diagnosing subacromial impingement syndrome (SIS). Data Sources: A systematic literature search was conducted in January 2011 to identify all studies that examined the diagnostic accuracy of clinical tests for SIS. The following search engines were used: Cochrane Library, EMBASE, Science Direct, and PubMed. Study Selection: Two reviewers screened all articles. We included prospective or retrospective cohort studies that examined individuals with a painful shoulder, reported any clinical test for SIS, and used arthroscopy or open surgery as the reference standard. The search strategy yielded 1338 articles of which 1307 publications were excluded based on title/abstract. Sixteen of the remaining 31 articles were included. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were followed to conduct this review. Data Extraction: The number of true positives, false positives, true negatives, and false negatives for each clinical test were extracted from relevant studies, and a 2×2 table was constructed. Studies were combined using a bivariate random-effects model. Heterogeneity was assessed using the variance of logit-transformed sensitivity and specificity. Data Synthesis: Ten studies with 1684 patients are included in the meta-analysis. The Hawkins-Kennedy test, Neer's sign, and empty can test are shown to be more useful for ruling out rather than ruling in SIS, with greater pooled sensitivity estimates (range, .69–.78) than specificity (range, .57–.62). A negative Neer's sign reduces the probability of SIS from 45% to 14%. The drop arm test and lift-off test have higher pooled specificities (range, .92–.97) than sensitivities (range, .21–.42), indicating that they are more useful for ruling in SIS if the test is positive. Conclusions: This systematic review quantifies the diagnostic accuracy of 5 clinical tests for SIS, in particular the lift-off test. Accurate diagnosis of SIS in clinical practice may serve to improve appropriate treatment and management of individuals with shoulder complaints.

Effect of Exercise on Physical Function, Daily Living Activities, and Quality of Life in the Frail Older Adults: A Meta-Analysis

Chih-Hsuan Chou, Chueh-Lung Hwang, Ying-Tai Wu — 2012-02-01

Abstract: Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Objectives: To determine the effect of exercise on the physical function, activities of daily living (ADLs), and quality of life (QOL) of the frail older adults. Data Sources: Relevant articles published between 2001 and June 2010 were searched in PubMed, MEDLINE, EMBASE, the Chinese Electronic Periodical Service, CINAHL, and the Cochrane Library databases. Study Selection: The participants were selected based on the predetermined frailty criteria and randomly assigned to either an exercise or control group. The intervention for the exercise group was a single or comprehensive exercise training program, whereas usual care was provided to the control group. Data Extraction: The characteristics and outcome measures of the included studies were identified independently by 2 investigators. Data Synthesis: The effect sizes of physical function assessed by the timed up and go test, gait speed, the Berg Balance Scale (BBS), the ADL questionnaires, and QOL measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were calculated, using a weighted mean difference (WMD) and a 95% confidence interval (CI) to represent the results. Compared with the control group, the exercise group increased their gait speed by .07m/s (95% CI .02–.11), increased their BBS score (WMD=1.69; 95% CI .56–2.82), and improved their performance in ADLs (WMD=5.33; 95% CI 1.01-9.64). The exercise intervention had no significant effects on the Timed Up & Go test performance and the QOL between the groups. Conclusions: Exercise is beneficial to increase gait speed, improve balance, and improve performance in ADLs in the frail older adults.

Examination of Assumptions in Using Time Tradeoff and Standard Gamble Utilities in Individuals With Spinal Cord Injury

Mau-Roung Lin, Wen-Yu Yu, Shih-Chieh Wang — 2012-02-01

Abstract: Lin M-R, Yu W-Y, Wang S-C. Examination of assumptions in using time tradeoff and standard gamble utilities in individuals with spinal cord injury. Objective: To examine how the time tradeoff (TTO) and standard gamble (SG) utilities perform at different lengths of life expectancy and across patient characteristics such as risk attitudes and injury severity in individuals with traumatic spinal cord injury (SCI). Design: Survey. Setting: Structured telephone interviews of patients after discharge from 4 teaching hospitals. Participants: Subjects (N=270) who had sustained SCI were block-randomized in groups of 4 to receive 1 of 2 questionnaire versions. One version asked about the TTO and SG at 2 life expectancies of 10 and 20 years, and the other at 20 and 30 years. Interventions: Not applicable. Main Outcome Measures: The TTO and SG were used to elicit preferences for patients with an SCI. Results: Patients with SCI who were younger and had more severe neurologic lesions, had higher intense risk-taking attitudes, and experienced depression had significantly lower TTO and SG scores than their counterparts. A longer life expectancy was also significantly associated with lower TTO scores. As the life expectancy increased, patients who had sustained SCI more recently (≤1y ago) were more willing to trade off life years for full health (ie, lower TTO scores). SG scores did not significantly vary according to different life expectancies. Conclusions: Among patients with SCI, there was a nonlinear relation between the TTO and life expectancy that violated the fundamental assumption of risk neutrality toward life years. Accordingly, TTO utilities elicited for different life expectancies should not be compared in quality-of-life assessments or used in cost-utility analyses. In contrast, SG utilities remained stable at different lengths of life expectancy in SCI patients. Moreover, certain patient characteristics such as age, time lapse since the injury, neurologic severity, risk attitudes, and depressive status can account for some TTO and SG variations among patients with SCI.

No Specific Effect of Whole-Body Vibration Training in Chronic Stroke: A Double-Blind Randomized Controlled Study

Christina Brogårdh, Ulla-Britt Flansbjer, Jan Lexell — 2012-02-01

Abstract: Brogårdh C, Flansbjer UB, Lexell J. No specific effect of whole-body vibration training in chronic stroke: a double-blind randomized controlled study. Objective: To evaluate the effects of whole-body vibration (WBV) training in individuals after stroke. Design: A double-blind randomized controlled study with assessments pre- and posttraining. Setting: A university hospital rehabilitation department. Participants: Participants (N=31; mean age ± SD, 62±7y; 6–101mo poststroke) were randomized to an intervention group or a control group. Interventions: Supervised WBV training (2 sessions/wk for 6wk; 12 repetitions of 40–60s WBV per session). The intervention group trained on a vibrating platform with a conventional amplitude (3.75mm) and the control group on a “placebo” vibrating platform (0.2mm amplitude); the frequency was 25Hz on both platforms. All participants and examiners were blinded to the amplitudes of the 2 platforms. Main Outcome Measures: Primary outcome measures were isokinetic and isometric knee muscle strength (dynamometer). Secondary outcome measures were balance (Berg Balance Scale), muscle tone (Modified Ashworth Scale), gait performance (Timed Up & Go, comfortable gait speed, fast gait speed, and six-minute walk tests), and perceived participation (Stroke Impact Scale). Results: There were no significant differences between the 2 groups after the WBV training. Significant but small improvements (P<.05) in body function and gait performance were found within both groups, but the magnitude of the changes was in the range of normative variation. Conclusions: Six weeks of WBV training on a vibration platform with conventional amplitude was not more efficient than a placebo vibrating platform. Therefore, the use of WBV training in individuals with chronic stroke and mild to moderate disability is not supported.

Full Kinetic Chain Manual and Manipulative Therapy Plus Exercise Compared With Targeted Manual and Manipulative Therapy Plus Exercise for Symptomatic Osteoarthritis of the Hip: A Randomized Controlled Trial

2012-02-01

Abstract: Brantingham JW, Parkin-Smith G, Cassa TK, Globe GA, Globe D, Pollard H, deLuca K, Jensen M, Mayer S, Korporaal C. Full kinetic chain manual and manipulative therapy plus exercise compared with targeted manual and manipulative therapy plus exercise for symptomatic osteoarthritis of the hip: a randomized controlled trial. Objective: To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA). Design: Parallel-group randomized trial with 3-month follow-up. Setting: Two chiropractic outpatient teaching clinics. Participants: Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively. Interventions: Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period. Main Outcome Measures: Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes. Results: Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively). Conclusions: There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment.

Prediction of Failure to Retain Work 1 Year After Interdisciplinary Functional Restoration in Occupational Injuries

Emily Brede, Tom G. Mayer, Robert J. Gatchel — 2012-02-01

Abstract: Brede E, Mayer TG, Gatchel RJ. Prediction of failure to retain work 1 year after interdisciplinary functional restoration in occupational injuries. Objective: To identify risk factors for work retention (a patients' ability to both obtain and retain employment) at 1 year after treatment for a chronic disabling occupational musculoskeletal disorder (CDOMD). Design: Prospective cohort study. Setting: Consecutive patients undergoing interdisciplinary functional restoration treatment in a regional rehabilitation referral center. Participants: A sample of 1850 consecutive CDOMD patients, who were admitted to and completed a functional restoration program, were subsequently classified as work retention or nonwork retention at a 1-year posttreatment evaluation. Interventions: Not applicable. Main Outcome Measures: Measures, including medical evaluations, demographic and occupational data, psychosocial diagnostic evaluation, and validated measures of pain, disability, and depressive symptoms, were obtained at admission to, and discharge from, the program. Results: Using a multivariate logistic regression analysis, the following variables were found to be significant predictors of failure to retain work: older age (odds ratio [OR]=1.84; 95% confidence interval [CI], 1.33–2.54), female sex (OR=1.46; 95% CI, 1.09–1.94), nonworking status at discharge (OR=1.65; 95% CI, 1.11–2.45), extreme disability at admission (OR=1.46; 95% CI, 1.06–2.00), antisocial personality disorder (OR=2.11; 95% CI, 1.09–4.08), receipt of government disability benefits at admission (OR=2.28; 95% CI, 1.06–4.89), and dependence on opiate pain medications (OR=1.43; 95% CI, 1.02–2.00). The final model improved prediction by 75% over assigning all patients to the larger (work retention) group. Conclusions: This study identified demographic, psychosocial, and occupational factors that were predictive of failure to retain work. These risk factors may be used to individualize treatment plans for CDOMD patients in order to provide optimal functional restoration.

Concussions in Wheelchair Basketball

Karla K. Wessels, Steven P. Broglio, Jacob J. Sosnoff — 2012-02-01

Abstract: Wessels KK, Broglio SP, Sosnoff JJ. Concussions in wheelchair basketball. Objective: To estimate the incidence rate of concussions in wheelchair basketball. Design: Survey. Setting: Wheelchair basketball tournaments during the 2009 to 2010 season. Participants: Wheelchair basketball players (N=263) ranging in age from 18 to 60 years. Intervention: Not applicable. Main Outcome Measures: Participants completed a survey on their concussion history including how many concussions they have sustained, how many days they refrained from physical activity because of injury, to whom they reported their injury, and reasons for not reporting an injury if they did not. Participants also provided demographic information about their disability, age, sex, and length of wheelchair use and sports participation. Results: Within the sample of 263 wheelchair basketball players, 6.1% reported experiencing a concussion in the current season. Of those experiencing concussions during the current season, 44% did not report their concussion. Of those not reporting the incident, 67% did not because they did not want to be removed from physical activity. Analysis by sex indicated that 5.82% of the male athletes sustained a concussion during the current season, and 14.36% had sustained an injury during their athletic career. Female athletes, however, sustained concussions at a higher rate, with 6.67% having concussions during the current season and 30.6% during their athletic careers. Women were also 2.5 times more likely to sustain a concussion than men. Athletes were most likely to report their concussion to their coach (60% of concussed athletes). Conclusions: The current investigation was consistent with previous research in that women were more likely to sustain a concussion than men, and injury rates were similar to those in able-bodied basketball. Further work is needed in concussion assessment in persons with disability, as well as greater education concerning concussion in disability sports.

Effect of Duration, Participation Rate, and Supervision During Community Rehabilitation on Functional Outcomes in the First Poststroke Year in Singapore

Gerald Choon-Huat Koh, Sanjiv K. Saxena, Tze-Pin Ng, David Yong, Ngan-Phoon Fong — 2012-02-01

Abstract: Koh GCHK, Saxena SK, Ng TP, Yong D, Fong NP. Effect of duration, participation rate, and supervision during community rehabilitation on functional outcomes in the first poststroke year in Singapore. Objective: To examine the effect of duration, participation rate, and supervision during community rehabilitation on functional outcome during the first poststroke year. Design: Prospective longitudinal study with interviews at admission, discharge, 1 month, 6 months, and 1 year after discharge. Setting: Two subacute inpatient rehabilitation units and the community after discharge in Singapore. Participants: Subacute nonaphasic stroke patients (N=215). Intervention: Participation rate in supervised therapy (at an outpatient rehabilitation center) and unsupervised therapy (at home) as defined as proportion of time performing therapy as prescribed by the subacute hospital's multidisciplinary rehabilitation team at discharge. Main Outcome Measure: Performance of activities of daily living as measured by Barthel Index (BI) score at 1 year and improvement in BI scores between adjacent timepoints. Results: At 1 month after discharge, 33.3% were performing supervised therapy more than 25% of the recommended time, and 66.3% of subjects were performing unsupervised therapy more than 75% of the recommended time. On a mixed-model analysis, the independent predictors of lower BI scores were older age, hypertension, greater cognitive impairment, greater depressive symptoms, and greater neurologic impairment. Adjusting for these independent factors, performance of supervised therapy at 1 (β=8.8; 95% confidence interval [CI], 0.5–17.0; P=.039) and 6 (β=20.1; 95% CI, 11.0–29.2; P<.001) months postdischarge, but not unsupervised therapy, predicted better BI score at 1 year. Those who performed supervised therapy more than 25% of the recommended time achieved their maximal functional recovery faster than those who performed supervised therapy 25% or less of the recommended time (1mo vs 6mo). Conclusions: Supervised stroke rehabilitation in the community at 1 and 6 months was associated with better functional status at 1 year than unsupervised therapy, and a higher participation rate in supervised therapy was associated with greater and faster functional recovery.

Development of Posttraumatic Stress Disorder After Mild Traumatic Brain Injury

Jeanne M. Hoffman, Sureyya Dikmen, Nancy Temkin, Kathleen R. Bell — 2012-02-01

Abstract: Hoffman JM, Dikmen S, Temkin N, Bell KR. Development of posttraumatic stress disorder after mild traumatic brain injury. Objective: To examine the incidence of and factors associated with the development of posttraumatic stress disorder (PTSD) 6 months after civilian mild traumatic brain injury (MTBI). Design: Secondary analysis of a randomized controlled trial of telephone follow-up versus usual care to reduce MTBI symptoms and improve function. Setting: In-person and telephone interviews. Participants: Prospectively studied participants (N=239) with MTBI enrolled in the emergency department. Interventions: Not applicable. Main Outcome Measures: Secondary analysis with main outcome measure of Posttraumatic Stress Disorder Checklist–Civilian Version. Results: At 6 months after MTBI, 17% of participants met criteria for diagnosis of PTSD. Logistic regression predicting PTSD from baseline characteristics showed that participants who were Hispanic versus white, non-Hispanic and who, at the time of injury, described themselves as less happy and believed they would be more affected by their injury were significantly more likely to have PTSD. Conclusions: Rates of PTSD in civilian MTBI in this study are consistent with prior research. Results suggest that personality characteristics and attribution regarding the injury may impact the development of PTSD. Early interventions addressing risk factors may prevent or reduce the likelihood of developing PTSD.

Dual-Task Complexity Affects Gait in People With Mild Cognitive Impairment: The Interplay Between Gait Variability, Dual Tasking, and Risk of Falls

Manuel Montero-Odasso, Susan W. Muir, Mark Speechley — 2012-02-01

Abstract: Montero-Odasso M, Muir SW, Speechley M. Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Objective: To determine the effect of 2 different dual tasks on gait variability in people with mild cognitive impairment (MCI) compared with control subjects. Design: Cross-sectional study. Setting: Memory clinic at a university hospital. Participants: Older adults with MCI (n=43) and cognitively normal control subjects (n=25) from the community. Gait was assessed under single (usual walking) and dual tasking (naming animals and subtracting serial 7s), using an electronic walkway. Interventions: Not applicable. Main Outcome Measures: The dependent variable was the coefficient of variation of gait variability, a marker of gait stability and an established risk factor for falls. Two-way repeated-measures analysis of variance was used to examine main effects (group, task) and their interaction. Results: A significant difference was found within and between groups (P=.016) of increasing gait variability as dual-task complexity increased. Gait velocity decreased within groups as dual-task complexity increased. The magnitude of increased gait variability across tasks was greater for the MCI group (2.68%– 9.84%) than for the control group (1.86%–3.74%), showing a significant between-group difference (P=.041). Conclusions: Dual-task load significantly increased gait variability in the MCI group compared with the control group, an effect that was larger than the changes in gait velocity. The magnitude of this impairment on gait stability was related to the complexity of the dual task applied. Our findings help to explain the high risk of falls recently described in older adults with MCI, and may help in the identification of fall risk in cognitively impaired persons.

Multifidus Atrophy Is Localized and Bilateral in Active Persons With Chronic Unilateral Low Back Pain

George J. Beneck, Kornelia Kulig — 2012-02-01

Abstract: Beneck GJ, Kulig K. Multifidus atrophy is localized and bilateral in active persons with chronic unilateral low back pain. Objective: To compare the lumbar multifidi muscle volume devoid of fat local to the site of pain in persons with and without chronic unilateral lower lumbar pain. Design: Prospective cross-sectional design. Setting: University biokinesiology laboratory. Participants: Active individuals (n=14) with chronic unilateral lower lumbar pain (>1y) were matched for age, height, weight, and activity level with healthy individuals (n=14). Individuals with back pain had minimal disability (Oswestry Disability Index [mean ± SD], 14.9%±6.3%) at the time of testing. Interventions: Not applicable. Main Outcome Measures: Multifidus and erector spinae muscle volumes at the L5-S1 levels, multifidus muscle volumes at the L4 and S2-3 levels. Results: Average multifidus volume was diminished by 18.1% between groups (P=.026) only at the L5-S1 levels. There was no difference between painful and pain-free sides. There were no volume differences between groups above L5, below S1, or in erector spinae at the L5-S1 levels. Conclusions: The results of this study indicate that despite a low level of disability and an activity level similar to that of matched control subjects, considerable localized, bilateral multifidus atrophy is present. Such impaired size of the multifidus will likely reduce its capacity to control intersegmental motion, thus increasing the susceptibility to further injury. Unlike acute unilateral low back pain (LBP), muscle size is reduced bilaterally in persons with chronic unilateral LBP.

Predictors of Functional Outcome Change 18 Months After Anterior Ulnar Nerve Transposition

2012-02-01

Abstract: Shi Q, MacDermid J, Grewal R, King GJ, Faber K, Miller TA. Predictors of functional outcome change 18 months after anterior ulnar nerve transposition. Objective: To determine which variables derived from the electrodiagnostic examination were predictive of patient self-reported symptoms and disability at 18 months after anterior ulnar nerve transposition. Design: Retrospective cohort study. Setting: Electrodiagnostic laboratories affiliated with a tertiary care center. Participants: Patients (N=73) with cubital tunnel syndrome (CuTS). Interventions: Patients were randomly assigned to one of the anterior transpositions of the ulnar nerve (subcutaneous or submuscular). Main Outcome Measures: Outcome was a patient-rated ulnar elbow evaluation (PRUNE). Predictors were all variables derived from the electrodiagnostic examination and characteristics of participants, as well as the preoperative clinical status. A stepwise multivariable linear regression analysis was used to determine the relative importance of the selected variables on the change in PRUNE scores. Results: Above-elbow compound muscle action potentials amplitude and proportional compound muscle action potentials amplitude decreasing from above elbow to below elbow were predictors of change score of the PRUNE at 18 months after operation (R2=16%). Sex and preoperative PRUNE also showed predictive information (R2=14% and 15%, respectively). Conclusions: CuTS is predominantly a clinical diagnosis. Electrophysiologic studies are important supplemental examinations for the diagnosis of CuTS because they not only contribute to diagnosis, but are also important prognostic features. Females may have more improvement with regard to functional outcomes than males when undergoing surgical intervention.

Behavioral Factors Related to Fatigue Among Persons With Spinal Cord Injury

Lee L. Saunders, James S. Krause — 2012-02-01

Abstract: Saunders LL, Krause JS. Behavioral factors related to fatigue among persons with spinal cord injury. Objective: To examine behavioral risk factors in relation to fatigue after spinal cord injury (SCI), specifically cardiovascular-related behaviors, prescription medication use, and alcohol and cigarette use. Design: Cross-sectional. Setting: A medical university in the southeastern United States. Participants: Adults (N=2245) at least 1 year post-SCI from a large specialty hospital in the Southeast responded to a mail-in survey. Intervention: Not applicable. Main Outcomes Measure: The Modified Fatigue Impact Scale–5-item version was used to assess disabling fatigue. Results: Of participants, 8.3% had disabling fatigue, 45.3% reported fatigue rarely to never impacted their life, and 46.4% reported having some fatigue. Persons who reported having less exercise than others with a similar injury level were 2.49 times as likely to have disabling fatigue as persons who reported more exercise. Those with a fair or poor diet were also more likely to have disabling fatigue. Use of prescription medication to treat pain was associated with disabling fatigue, as was being CAGE positive. Among nonbehavioral variables, race and injury severity were significantly associated with disabling fatigue. Conclusions: We identified several behavioral predictors of disabling fatigue, including cardiovascular risk factors, prescription medication use, and alcohol use. These factors are important because they are able to be modified and could be potential factors for prevention or intervention.

Impact of Fatigue on the Health-Related Quality of Life in Persons With Spinal Cord Injury

Nirupama Wijesuriya, Yvonne Tran, James Middleton, Ashley Craig — 2012-02-01

Abstract: Wijesuriya N, Tran Y, Middleton J, Craig A. Impact of fatigue on the health-related quality of life in persons with spinal cord injury. Objective: To study the impact of fatigue on health-related quality of life (HR-QOL) associated with spinal cord injury (SCI). Design: Matched group design with several independent measures. Setting: University-based laboratory. Participants: Persons with SCI (n=41) and an average 16.5 years duration of community living with SCI and a group of able-bodied controls (n=41) with similar sex ratio, age, and level of education. Participants with SCI were enrolled through rehabilitation unit contacts and through advertising in newsletters. Interventions: Not applicable. Main Outcome Measures: The main independent measures reported in this article include the Iowa Fatigue Scale and the Medical Outcomes Study 36-Item Short-Form Health Survey. Results: As expected, persons with SCI were found to have significantly lower HR-QOL. Fatigue was found to be more prevalent in the SCI group, and was associated with lower HR-QOL in both groups. Factorial analysis of variance indicated significant interactions in which persons with SCI with low fatigue levels had similar HR-QOL to the able-bodied controls regardless of their fatigue level, while persons with SCI with elevated fatigue had significantly reduced HR-QOL. Factors such as age, education, completeness and level of lesion, and community integration were not associated with increased fatigue levels. However, a shorter time since injury was found to be significantly associated with higher levels of fatigue. Conclusions: The Iowa Fatigue Scale data suggest over 50% of the SCI group had elevated fatigue, which was associated with significantly reduced HR-QOL. Research is needed that identifies factors that raise vulnerability to fatigue, and strategies designed to address the negative impacts of fatigue need to be evaluated.

Incidence of Nontraumatic Spinal Cord Injury: A Spanish Cohort Study (1972–2008)

2012-02-01

Abstract: van den Berg MEE, Castellote JM, Mahillo-Fernandez I, Pedro-Cuesta J. Incidence of nontraumatic spinal cord injury: a Spanish cohort study (1972–2008). Objectives: To assess the incidence of nontraumatic spinal cord injury (SCI) in a determined catchment area in Spain, and to evaluate clinical presentations and trends over time. Design: Retrospective cohort study between January 1972 and December 2008. Setting: A hospital with a specialized SCI unit in a delimited health area in Spain. Participants: Hospital inpatients and outpatients with nontraumatic SCI. Interventions: Not applicable. Main Outcome Measures: Age- and sex-specific incidence rates. Results: An adjusted incidence rate of 11.4 per million population was found for this region (12.3 for males, 10.4 for females). A total of 541 cases (53% male) were reported over the 37-year study period. Incidence rates increased with age, with a peak in the 60- to 69-year age group. Tumors were the major cause of SCI. Most of the lesions were at the thoracic level, and C and D were the most frequently observed American Spinal Injury Association grades. Conclusions: Nontraumatic SCI shows a relatively even sex distribution and tends to affect older adults. Injuries are mainly attributable to age-related conditions and result mostly in incomplete lesions, which present with paraplegia. This study revealed that although incidence rates for nontraumatic SCI are similar to those previously reported for traumatic SCI in the same area and during the same period, demographic and clinical characteristics are different. These findings have important implications regarding the delivery of rehabilitation and support services to this group of patients, and suggest the need for health policies that involve improved care and prevention resources.

Role of Fear of Movement in Cancer Survivors Participating in a Rehabilitation Program: A Longitudinal Cohort Study

2012-02-01

Abstract: Velthuis MJ, Peeters PH, Gijsen BC, van den Berg JP, Koppejan-Rensenbrink RA, Vlaeyen JW, May AM. Role of fear of movement in cancer survivors participating in a rehabilitation program: a longitudinal cohort study. Objective: To study the relationship between fear of movement and perceived global health status and the role of rehabilitation with graded activity in cancer survivors. Design: Longitudinal cohort study. Setting: Rehabilitation centers. Participants: Cancer survivors (N=1236). Intervention: Twelve-week graded activity rehabilitation program. Main Outcome Measures: Fear of movement (Modified Tampa Scale for Kinesiophobia-Fatigue), fatigue (Functional Assessment of Cancer Therapy-Fatigue), and perceived global health status (European Organisation Research and Treatment of Cancer Quality of Life Questionnaire C30) were measured at baseline and after rehabilitation. We performed multiple linear regression analyses to examine the association between fear of movement and perceived global health status at baseline. Differences between baseline and postintervention scores were assessed with a paired t test and effect sizes (ESs). Hierarchical multiple regression analyses were used to investigate whether changes in fear of movement were associated with perceived global health status. Results: Fear of movement was associated with perceived global health status prior to rehabilitation (P=.001). Only participants with high scores on baseline fear of movement showed a considerable decrease in fear of movement after rehabilitation (ES=–.69; 95% confidence interval [CI], −.80 to −.57); the reduction was largest for fears because of a somatic focus (ES=–.57; 95% CI, −.68 to −.45). Changes in fear of movement because of a somatic focus were related to perceived global health status postintervention (P=.001). Conclusions: Fear of movement is associated with the perceived global health status of cancer survivors. Fear of movement decreases after rehabilitation with graded activity in high scorers on baseline fear of movement.

Prevalence of Anatomic Impediments to Interlaminar Lumbar Epidural Steroid Injection

Farah Hameed, David J. Hunter, James Rainville, Ling Li, Pradeep Suri — 2012-02-01

Abstract: Hameed F, Hunter DJ, Rainville J, Li L, Suri P. Prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection. Objective: To determine the prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection (LESI) in a community-based population. Design: Cross-sectional observational study. Setting: Community-based. Participants: Older adults (N=333) sampled irrespective of back pain status. Interventions: Not applicable. Main Outcome Measures: Computed tomography evaluation of 5 potential anatomic impediments to interlaminar LESI at the L2-S1 spinal levels, including (1) ligamentum flavum (LF) calcification, (2) interspinous ligament (ISL) calcification, (3) spinous process (SP) contact, (4) the absence of epidural fat in the posterior epidural space, and (5) the presence of fat density superficial to the LF in the midsagittal plane. Independent variables included age, sex, body mass index (BMI), and current smoking. Results: LF and ISL calcifications were prevalent in 3% to 7% and 2% to 3% of spinal levels, respectively, without significant differences by spinal level. SP contact was most common at the L4-5 level (22%). Absence of posterior epidural fat was very common at L5-S1 (65%), but infrequent at other levels. The presence of midline fat density superficial to LF was most common at L5-S1 (55%). The prevalence of LF calcification, ISL calcification, and SP contact increased with age, but the prevalence of absence of posterior epidural fat and the presence of a midline fat density superficial to LF did not. Sex and smoking status were not associated with the prevalence of anatomic impediments, but higher BMI was associated with a lower prevalence of absence of posterior epidural fat. Conclusions: Anatomic impediments to interlaminar LESI were common in this community-based population, particularly at the L5-S1 spinal level. Because of the high overall prevalence of anatomic impediments, and differences in prevalence by spinal level, knowledge of the distribution and frequency of these impediments may aid in aspects of decision-making for the interventional spine physician.

Validity of an Exercise Test Based on Habitual Gait Speed in Mobility-Limited Older Adults

2012-02-01

Abstract: Li X, Forman DE, Kiely DK, LaRose S, Hirschberg R, Frontera WR, Bean JF. 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.

Low Impact of Congenital Hand Differences on Health-Related Quality of Life

Monique S. Ardon, Wim G. Janssen, Steven E. Hovius, Henk J. Stam, Ruud W. Selles — 2012-02-01

Abstract: Ardon MS, Janssen WG, Hovius SE, Stam HJ, Selles RW. Low impact of congenital hand differences on health-related quality of life. Objective: To evaluate health-related quality of life (HRQoL) and its determinants in children with congenital hand differences (CHDs). Design: Survey. Setting: Outpatient clinic of a university hospital. Participants: Children (N=116; age range, 10–14y) with CHDs. Interventions: Not applicable. Main Outcome Measures: HRQoL evaluated by child self-reports of the Pediatric Quality of Life Inventory and compared with reference values of healthy peers. Multivariable regression analysis was performed to investigate determinants of HRQoL. Results: All children with CHDs had scores similar to those of healthy peers, except for a lower score on social functioning in children aged 13 to 14 years. Higher ease of activity performance was related to higher HRQoL scores, and presence of comorbidity was related to lower scores on all HRQoL subdomains except for school functioning. Additionally, physical health was influenced by ethnicity, bilateral involvement, and previous surgery; emotional functioning by the number of affected digits; school functioning by age; and total HRQoL by bilateral involvement. Conclusions: Children with CHDs report similar HRQoL as healthy peers. HRQoL decreased in the presence of comorbidity but increased with higher ease of activity performance. Scores on some subdomains were improved by the number of affected digits, but were reduced by age, ethnicity, bilateral involvement, and surgery. Although HRQoL is an important health outcome, it may not be sensitive to detect changes over time or changes after treatment in children with CHDs.

Preliminary Evaluation of a Commercially Available Videogame System as an Adjunct Therapeutic Intervention for Improving Balance Among Children and Adolescents With Lower Limb Amputations

2012-02-01

Abstract: Andrysek J, Klejman S, Steinnagel B, Torres-Moreno R, Zabjek KF, Salbach NM, Moody K. Preliminary evaluation of a commercially available videogame system as an adjunct therapeutic intervention for improving balance among children and adolescents with lower limb amputations. Objectives: To examine the safety, feasibility, and balance performance effects of a 4-week home-based balance therapy program using a commercially available videogame system. Design: A pilot study involving a preintervention and postintervention design was conducted with measurements taken at baseline, immediately postintervention (week 5), and at follow-up (week 13) for retention. Setting: University hospital outpatient clinic and participants' places of residence. Participants: Children and adolescents with unilateral lower limb amputation (n=6; 3 transfemoral [TF] and 3 Van Ness) and age-matched, typically developing individuals (n=10) for baseline comparison. Intervention: Two videogames involving weight shifting in standing were each played at home for 20min/d, 4d/wk for a period of 4 weeks. A physical therapist provided initial instruction and monitoring. Main Outcome Measures: Postural control characteristics using center of pressure (COP) displacements during quiet standing; functional balance using the Community Balance and Mobility Scale (CB&M); and compliance, safety, and feasibility using custom questionnaires. Results: Average playing times for the first 3 weeks ranged from 16.0 to 21.1 minutes for the 2 games. At baseline, the children and adolescents with TF amputation had substantially greater COP displacements than the Van Ness group and typically developing children and adolescents. Immediately postintervention, the COP displacements decreased in the TF amputees, resulting in values that were closer to those of the typically developing children. The average increase in CB&M score from baseline to follow-up was 6 points across participants. Conclusions: In-home, videogame-based balance training therapies can achieve excellent compliance in children and adolescents with lower limb amputation. With proper instructions and monitoring, the therapeutic intervention can be safely administered. Some improvements in postural control characteristics were seen in children and adolescents with balance deficits immediately postintervention, but long-term retention remains unclear.

Short-Term Effect of Superficial Heat Treatment on Paraspinal Muscle Activity, Stature Recovery, and Psychological Factors in Patients With Chronic Low Back Pain

Sandra E. Lewis, Paul S. Holmes, Steve R. Woby, Jackie Hindle, Neil E. Fowler — 2012-02-01

Abstract: Lewis SE, Holmes PS, Woby SR, Hindle J, Fowler NE. Short-term effect of superficial heat treatment on paraspinal muscle activity, stature recovery, and psychological factors in patients with chronic low back pain. Objective: To test the hypothesis that patients with chronic low back pain (CLBP) would have reduced paraspinal muscle activity when wearing a heat wrap and that this would be associated with increased stature recovery and short-term improvements in psychological factors. Design: A within-subject repeated-measures design. Muscle activity and stature recovery were assessed before and after a 40-minute unloading period, both without a heat wrap and after 2 hours of wear. Questionnaires were completed after both sessions. Setting: Hospital physiotherapy department. Participants: Patients with CLBP (n=24; age, 48.0±9.0y; height, 166.6±7.3cm; body mass, 80.2±12.9kg) and asymptomatic participants (n=11; age, 47.9±15.4y; height, 168.7±11.6cm; body mass, 69.3±13.1kg) took part in the investigation. Patients on the waiting list for 2 physiotherapist-led rehabilitation programs, and those who had attended the programs during the previous 2 years, were invited to participate. Intervention: Superficial heat wrap. Main Outcome Measures: Paraspinal muscle activity, stature recovery over a 40-minute unloading period, pain, disability, and psychological factors. Results: For the CLBP patients only, the heat wrap was associated with a reduction in nonnormalized muscle activity and a positive short-term effect on self-report of disability, pain-related anxiety, catastrophizing, and self-efficacy. Changes in muscle activity were correlated with changes in stature recovery, and both were also correlated to changes in psychological factors. Conclusions: Use of the heat wrap was associated with a decrease in muscle activity and a short-term improvement in certain aspects of well-being for the CLBP patients. The results confirm the link between the biomechanical and psychological outcome measures.

Prediction of Postinjury Employment and Percentage of Time Worked After Spinal Cord Injury

2012-02-01

Abstract: Krause JS, Terza JV, Erten M, Focht KL, Dismuke CE. Prediction of postinjury employment and percentage of time worked after spinal cord injury. Objective: To use a 2-part model to identify biographic, injury, educational, and vocational predictors of postinjury employment and the percentage of time employed after spinal cord injury (SCI) onset. Design: Survey. Setting: Data were collected at 3 hospitals in the Southeastern and Midwestern United States. Participants: Participants were adults with traumatic SCI of at least 1 year duration, all under 65 years at the time of SCI onset. A total of 1329 observations were used in the analysis. Interventions: Not applicable. Main Outcome Measures: Postinjury employment, defined by whether the individual had ever been employed after SCI and percentage of time employed after SCI onset. Results: Almost 52% of participants worked at some point in time postinjury. Among those who had worked postinjury, the mean portion of time spent working was 0.56. Several factors were significantly related to postinjury employment and portion of time worked postinjury. The probability of postinjury employment increased with successively less severe injury. However, only ambulatory participants were found to have a significantly greater portion of time postinjury among those who became employed. Having obtained either a 4-year or graduate degree after injury was associated with a greater likelihood of postinjury employment. Conversely, among those who worked postinjury, having obtained those degrees prior to injury was associated with a greater portion of time employed. Being white, a man, having completed a 4-year degree or a graduate degree, and having worked in the service industry prior to SCI onset were all associated with a greater portion of time working among those who had worked. Conclusions: The factors precipitating PE are not identical to those associated with a greater portion of time employed after SCI onset.

Archives Editor-in-Chief Position Announcement

2012-02-01

American Congress of Rehabilitation Medicine: Request for Proposals

2012-02-01

Masthead

2012-02-01

Editorial Board

2012-02-01

Editors' Selections From This Issue

2012-02-01

Archives of Physical Medicine and Rehabilitation

Rehabilitation in the New World Order: Will Our Differences Be Our Demise

Facts, Theories, Values: Shaping the Course of Neurorehabilitation. The 60th John Stanley Coulter Memorial Lecture

Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty

Longer Versus Shorter Daily Durations of Electrical Stimulation During Task-Specific Practice in Moderately Impaired Stroke

Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application

Building on Transformative Learning and Response Shift Theory to Investigate Health-Related Quality of Life Changes Over Time in Individuals With Chronic Health Conditions and Disability

Clinical Reality of Measuring Upper-Limb Ability in Neurologic Conditions: A Systematic Review

Diagnostic Accuracy of Clinical Tests for Subacromial Impingement Syndrome: A Systematic Review and Meta-Analysis

Effect of Exercise on Physical Function, Daily Living Activities, and Quality of Life in the Frail Older Adults: A Meta-Analysis

Examination of Assumptions in Using Time Tradeoff and Standard Gamble Utilities in Individuals With Spinal Cord Injury

No Specific Effect of Whole-Body Vibration Training in Chronic Stroke: A Double-Blind Randomized Controlled Study

Full Kinetic Chain Manual and Manipulative Therapy Plus Exercise Compared With Targeted Manual and Manipulative Therapy Plus Exercise for Symptomatic Osteoarthritis of the Hip: A Randomized Controlled Trial

Prediction of Failure to Retain Work 1 Year After Interdisciplinary Functional Restoration in Occupational Injuries

Concussions in Wheelchair Basketball

Effect of Duration, Participation Rate, and Supervision During Community Rehabilitation on Functional Outcomes in the First Poststroke Year in Singapore

Development of Posttraumatic Stress Disorder After Mild Traumatic Brain Injury

Dual-Task Complexity Affects Gait in People With Mild Cognitive Impairment: The Interplay Between Gait Variability, Dual Tasking, and Risk of Falls

Multifidus Atrophy Is Localized and Bilateral in Active Persons With Chronic Unilateral Low Back Pain

Predictors of Functional Outcome Change 18 Months After Anterior Ulnar Nerve Transposition

Behavioral Factors Related to Fatigue Among Persons With Spinal Cord Injury

Impact of Fatigue on the Health-Related Quality of Life in Persons With Spinal Cord Injury

Incidence of Nontraumatic Spinal Cord Injury: A Spanish Cohort Study (1972–2008)

Role of Fear of Movement in Cancer Survivors Participating in a Rehabilitation Program: A Longitudinal Cohort Study

Prevalence of Anatomic Impediments to Interlaminar Lumbar Epidural Steroid Injection

Validity of an Exercise Test Based on Habitual Gait Speed in Mobility-Limited Older Adults

Low Impact of Congenital Hand Differences on Health-Related Quality of Life

Preliminary Evaluation of a Commercially Available Videogame System as an Adjunct Therapeutic Intervention for Improving Balance Among Children and Adolescents With Lower Limb Amputations

Short-Term Effect of Superficial Heat Treatment on Paraspinal Muscle Activity, Stature Recovery, and Psychological Factors in Patients With Chronic Low Back Pain

Prediction of Postinjury Employment and Percentage of Time Worked After Spinal Cord Injury

Archives Editor-in-Chief Position Announcement

American Congress of Rehabilitation Medicine: Request for Proposals

Masthead

Editorial Board

Table of Contents

Editors' Selections From This Issue