Medicine by Sfakianakis Alexandros: 09/02/16

Παρασκευή 2 Σεπτεμβρίου 2016

Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Social challenges of visible scarring after severe burn: A qualitative analysis

Burns

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Simulator-based air medical training program Christoph Life: From concept to course

Air Medical Journal

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Telehealth for paediatric burn patients in rural areas: A retrospective audit of activity and cost savings

Burns

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Intravascular imaging identifies some heart attack patients who can forego stenting

European Society of Cardiology News

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Perioperative inflammatory response in major fracture: do geriatric patients behave differently?

European Journal of Trauma and Emergency Surgery

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A rapid and effective antidote for anticoagulant bleeds

European Society of Cardiology News

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Expressions of ion co-transporter genes in salicylate-induced tinnitus and treatment effects of spirulina

Abstract

Background

Although the activity of tinnitus-related ion co-transporter are known, their mRNA expressions has seldom been reported. We aimed to investigate the mRNA expressions of tinnitus-related ion co-transporter genes, and treatment effects of Spirulina.

Methods

The mRNA expressions of K⁺–Cl⁻ co-transporter (KCC2) and Na-K-2Cl co-transporter 1 (NKCC1) genes in the cochlea and brain of mice were evaluated after tinnitus was induced by intraperitoneal injection of salicylate. The effects of spirulina water extract on these gene expressions were investigated.

Results

Compared to the control group, the tinnitus scores increased significantly, however, the salicylate-induced tinnitus could be reduced significantly by spirulina water extract. The tinnitus group had higher of borderline significance mRNA expression of KCC2 gene in the cochlear, significantly higher in the temporal lobes and in the frontal lobes. Meanwhile, compared to the tinnitus group, the spirulina group had significantly lower mRNA expression of KCC2 gene in the cochlear, temporal lobes, frontal lobes and parahippocampus/hippocampus. However, the NKCC1 mRNA expression was not significantly different between three groups in the cochlea and these brain areas.

Conclusion

Salicylate-induced tinnitus might be associated with increased mRNA expression of KCC2 gene, but not with mRNA expressions of NKCC1 gene in the cochlear and some tinnitus-related brain areas. Spirulina reduced the expression of KCC2 genes in salicylate-induced tinnitus.

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What is the role of informed decision-making?

What is the role of informed decision-making?

Expert Rev Anticancer Ther. 2016 Sep;16(9):893

Authors: Pondé N, Dal Lago L, Azim HA

PMID: 27582270 [PubMed - in process]

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The safety and efficacy of ramucirumab in combination with paclitaxel for the treatment of advanced gastric or gastro-esophageal junction adenocarcinoma.

The safety and efficacy of ramucirumab in combination with paclitaxel for the treatment of advanced gastric or gastro-esophageal junction adenocarcinoma.

Expert Rev Anticancer Ther. 2016 Aug 31;

Authors: Garrido M

Abstract
INTRODUCTION: Gastric cancer (GC) is a health problem. Platinum and fluoropyrimidine-based combinations have been established as first-line drugs used worldwide. However, there are no other options for treatment if first-line therapy fails. Therefore, second-line treatment options are needed. Targeted therapies have optimized the results of chemotherapy, specifically trastuzumab as a first-line and ramucirumab in second-line.
AREAS COVERED: Vascular endothelial growth factor (VEGF) and VEGF receptor-2 (VEGFR-2) are involved in the pathogenesis of GC. Clinical studies have evaluated VEGFR-2 blocked in second line. Two phase III trials using ramucirumab alone or associated to paclitaxel have demonstrated that second-line therapy could improve the survival of patients with GC. Expert Commentary: VEGF-2 receptor blockade is effective at treating GC. The combination of paclitaxel with ramucirumab can be used to establish an angiogenic blockade in second-line therapy. The magnitude of the treatment effect suggests that this combination should be used as the current standard.

PMID: 27582051 [PubMed - as supplied by publisher]

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Isolation And Antimicrobial Susceptibility Pattern Of Staphylococcus Aureus.

2016-09-02T04-55-34Z
Source: National Journal of Integrated Research in Medicine
Kulkarni VL*, Kulkarni DM**, Nilekar SL***, More SR****.
Introduction- Staphylococcus aureus is one of the principal human pathogens that colonizes healthy individuals as well as causes severe infections in hospitalized patients. They have differential ability to spread and cause outbreaks in hospitals. The study was done to isolate S.aureus from various clinical samples and to know their antibiogram. Methodology- The study included a total of 312 Staphylococcus aureus strains isolated from various clinical specimens. The specimens received were processed further for identification by standard microbiological procedures like direct microscopic examination, culture and various standard identification methods. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method on Mueller-Hinton agar as per CLSI guidelines. Result- A total of 312 isolates of S. aureus were obtained from various clinical samples. Male to female ratio was 1.6:1. Infection rate was more in age group 46-60 years. Staphylococcus aureus isolates were more commonly obtained from surgery department (38.78%) followed by orthopedics. All the strains were 100% sensitive to Vancomycin, Netilmicin, Linezolid and Teicoplanin. Higher resistance was noted against Penicillin(94.87%), Trimethoprim/Sulfamethoxazole(72.44%).Lower resistance was noted against Nitrofurantoin(13.33%). Conclusion- The determination of the anti-microbial susceptibility is also crucial for an optimal therapy, for epidemiological purposes and for infection control measures. [Kulkarni VL NJIRM 2016; 7(4):33-38]

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Study Of Sociodemographic and Clinical Features Of Tuberculosis Cases In Hiv Patients

2016-09-02T04-55-34Z
Source: National Journal of Integrated Research in Medicine
Siddaraya Hanjagi*, Sanganna L Lakkannavar**.
Background: Infection with HIV is the most potent risk factor for progression to active tuberculosis. Mycobacterium tuberculosis only have an approximately 10% lifetime risk of developing TB compared with 60% or more in persons infected with HIV and TB. Methodology: 100 HIV infected patients having symptoms of Tuberculosis were taken up for the study for a period of 18 months, meeting the criteria for the present study. Diagnosis of tuberculosis was based on clinical evaluation, sputum smear. Results: 100 HIV patients studied for period of 18 months . Majority of patients were in the age group of 30-41 years. 64% were males and 36% females. Labourers are commonly affected. Common presenting symptoms were fever(74%) cough (72%) and weight loss(62%). Associated clinical findings were pallor(63%), (12%) and oral thrush(14%). Pulmonary TB (69%) is the most common form. Conclusion: Majority of patients were in the age group of 30-41 years, 64% were males 36% females. Most common occupation affected was labourers. Fever (74%), cough (72%) and weight loss (62%), pallor (63%), lymphadenopathy (12%) and oral thrush (14%). Most common form of tuberculosis was pulmonary TB (69%). Among extra pulmonary tuberculosis pleural effusion (8%) was the most common presentation. [Siddaraya H NJIRM 2016; 7(4): 28-32]

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Comparative Evaluation Of C-Reactive Protein Levels And Leucocyte Counts In Patients With Sickle Cell Anemia, Chronic Generalized Periodontitis And Sickle Cell Anemia With Chronic Periodontitis: A Clinico-Biochemical Study

2016-09-02T04-55-34Z
Source: National Journal of Integrated Research in Medicine
Sachin M*, Jiji J**, Sweety S***, Abhishek S**, Poonam S***,Pooja B***.
Aim: The aim of this study is to compare the CRP levels and leucocyte counts in patients with Sickle cell anemia, Sickle cell anemia with chronic periodontitis, and chronic periodontitis. Material andMethods: A total of 90 subjects with an age range of 30-50 years having sickle cell anemia and chronic periodontitis with probing depth ≥5mm and clinical attachment level ≥ 5mm were included and three groups: Group I- Sickle cell anemia; Group II- Sickle Cell anemia with chronic periodontitis and Group III: Chronic severe periodontitis. Blood samples for CRP and leucocytes counts estimation were collected. All participants were subjected to quantitative CRP analysis. Results: Mean CRP levels and leucocyte counts were significantly greater in group II as compared to group I and group III. Conclusion: The present study indicates a positive correlation in CRP levels and leucocyte counts in patients with Sickle cell anemia, chronic periodontitis and both. [Sachin M NJIRM 2016; 7(4):22-27]

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Effect Of Muscle Relaxation And Mental Imaginary Technics On Pain Of Patients With Second-Degree Burn

2016-09-02T04-55-34Z
Source: National Journal of Integrated Research in Medicine
Fatemeh Delfani*, Masoumeh Zakeri-Moghadam**, Zhaleh Mohammad Aliha***.
Background: Pain is main issue after burn. Medication do not relief pain in burn patients completely. Thus, use of Non-pharmacologic interventions such as Muscle relaxation andmental imagery could decrease pain. Objective:This research examined efficacy of pain management strategies, including Benson muscle relaxation and mental imagery in order to reduce pain in patients with second-degree burn. Method: This study was a clinical trial on 135 patients with burn that divided in two test groups and a control group by available method. Burn pain severity, in the first and second day, before and after dressing without any intervention in control group measured. After discharge, patients in the control group, to a group of men, relaxation techniques and another group of men, imaging techniques taught and measured pain intensity. Then pain mean all three groups compared. Results: There wasnt significant difference between mean of pain severity at first day before and after dressing with mean of pain severity before dressing at second day (P>0.05). There was significant difference between mean of pain severity before and after dressing at second day. There was no significant difference between mean of pain severity in two groups. Conclusion: Both technics resulted in decrease of pain severity in burn patients but mental imagery is more effective.[Zakeri-MoghadamMNJIRM 2016; 7(4):17-21]

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Uncommon Parameters for Hip bone sexing

2016-09-02T04-55-34Z
Source: National Journal of Integrated Research in Medicine
Dr Yuvaraj J Bhosale*, Dr Kishor D Khushale**, Dr K Shyamkishore***.
Background- It is very difficult to determine sex of skeleton when pieces of skeletal bones are exhumed Objectives- Thus our study aims at: 1. Finding accuracy of the previously set criteria for sexing of hip bone. 2. To find the validity of other criteria in sexing of hip bone by which sex of the skeleton can be determined from small portion of hip bone. Methods- 200 hip bones of known sex (100 male and 100 females) were studied from various medical colleges. Results and Interpretation- Unpaired 't' test was found to be highly significant when values of true pelvic height in males and females were compared. Similarly, 'p' value was found significant in comparing mid-pubic width in males and females. Mean of distance from ischial tuberosity to farthest rim of acetabulum in males was found to be more than that of the females. Very significant differences were observed in the mean of pubic length and acetabular diameter in females. The index mentioned by Maclaughline and Bruce in 1985 was calculated in males and females. The index showed a value of 100.226 in males and 126.944 in female. Conclusion- Apart from the previously mentioned criteria in hip bone sexing, the study helped to prove the importance of following criteria in hip bone sexing : 1.True pelvic height 2.Mid-pubic width 3.Distance from ischial tuberosity to farthest rim of acetabulum 4.Index mentioned by Maclaughline and Bruce 5.Distance from anterior superior iliac spine to pubic tubercle 6.Distance from anterior superior iliac to iliopubic eminence [Dr Yuvaraj J NJIRM 2016; 7(4):14-16]

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Uncommon Parameters for Hip bone sexing

Lipid Profile In Diabetes Mellitus

2016-09-02T04-55-34Z
Source: National Journal of Integrated Research in Medicine
Sher Sankar Roy*, Dr. Pragnesh H. Shah**.
Background: The prevalence of diabetes is rapidly rising all over the world. India is not an exception. Alteration of serum lipids & complications is significant in diabetics which lead to micro and macrovascular diseases. Aims & Objective: To know the lipid profile pattern in diabetic patients.To identify high risk group so that they can be treated early for preventing complications. Method: Total 200 OPD & indoor diabetic patients visiting at Sir Takhtsinhji General Hospital, Bhavnagar from June 2014 to May 2015 were selected using certain criteria. Results:Type I patients have onset of Diabetes at an early age with longer duration but they have normal lipid profile. Type 2 patients have onset of Diabetes at late age but they have elevated levels of Triglyceride, Cholesterol, LDL, VLDL with low HDL. Obesity is common in NIDDM.Females having higher lipid profile values than males. Uncontrolled Diabetic patients are more dyslipidemic. Interpretation & Conclusion: Type 1 diabetic patients have longer duration of disease. Type 2 diabetic patients having altered profile, having more risk for complications like atherosclerosis, Coronary Heart Disease etc. Control of Diabetes is necessary for controlling lipid profile & complications. [S S ROY NJIRM 2016; 7(4):8-13]

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Contents Vol. 16, 2016

Neurodegener Dis 2016;16:I-IV

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The effect of C1 bursting fracture on comparative anatomical relationship between the internal carotid artery and the atlas.

http:--production.springer.de-OnlineReso

The effect of C1 bursting fracture on comparative anatomical relationship between the internal carotid artery and the atlas.

Eur Spine J. 2016 Jan;25(1):103-9

Authors: Kim MS, Kim JY, Kim IS, Cho KS, Kim SD, Lee HJ, Kim JT, Hong JT

Abstract
PURPOSE: To describe the effect of the C1 bursting fracture on the location of the internal carotid artery (ICA) around the atlas.
METHODS: The authors analyzed the morphology of the atlas and the ICA in 15 patients with C1 bursting fracture and compared with control group (77 patients) without any pathology. All patients were evaluated with CT angiography for the anatomical assessment. The laterality of the ICA, the distances of the ICA from the midline, anterior tubercle, and ventral surface of the C1 lateral mass were compared between two groups. The distance between the lateral margin of the longus capitis muscle and the inner edge of the transverse foramen was also measured.
RESULTS: Medially located ICA was more common in the C1 bursting fracture group than control group (76.7 vs 42.8 %). There were no significant differences between 2 groups for the distance from the midline, anterior tubercle, and ventral surface of the C1 lateral mass, respectively. The distance of the longus capitis muscle to transverse foramen was 2.52 ± 2.09 and 4.15 ± 3.09 mm in each group, and there was statistically significant difference (p < 0.01).
CONCLUSIONS: Lateral displacement of the bony structure of C1 bursting fracture changes the relative location of the ICA medially, which increase the injury risk during the bicortical C1 screw insertion. These data suggest that CT angiography or enhanced CT scans can give critical information to choose the ideal fixation technique and the proper trajectory of the screws for C1 bursting fracture.

PMID: 25753004 [PubMed - indexed for MEDLINE]

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A Novel Model of Asymptomatic Plasmodium Parasitemia That Recapitulates Elements of the Human Immune Response to Chronic Infection.

A Novel Model of Asymptomatic Plasmodium Parasitemia That Recapitulates Elements of the Human Immune Response to Chronic Infection.

PLoS One. 2016;11(9):e0162132

Authors: Fontana MF, Baccarella A, Craft JF, Boyle MJ, McIntyre TI, Wood MD, Thorn KS, Anidi C, Bayat A, Chung MR, Hamburger R, Kim CY, Pearman E, Pham J, Tang JJ, Boon L, Kamya MR, Dorsey G, Feeney ME, Kim CC

Abstract
In humans, immunity to Plasmodium sp. generally takes the form of protection from symptomatic malaria (i.e., 'clinical immunity') rather than infection ('sterilizing immunity'). In contrast, mice infected with Plasmodium develop sterilizing immunity, hindering progress in understanding the mechanistic basis of clinical immunity. Here we present a novel model in which mice persistently infected with P. chabaudi exhibit limited clinical symptoms despite sustaining patent parasite burdens for many months. Characterization of immune responses in persistently infected mice revealed development of CD4+ T cell exhaustion, increased production of IL-10, and expansion of B cells with an atypical surface phenotype. Additionally, persistently infected mice displayed a dramatic increase in circulating nonclassical monocytes, a phenomenon that we also observed in humans with both chronic Plasmodium exposure and asymptomatic infection. Following pharmacological clearance of infection, previously persistently infected mice could not control a secondary challenge, indicating that persistent infection disrupts the sterilizing immunity that typically develops in mouse models of acute infection. This study establishes an animal model of asymptomatic, persistent Plasmodium infection that recapitulates several central aspects of the immune response in chronically exposed humans. As such, it provides a novel tool for dissection of immune responses that may prevent development of sterilizing immunity and limit pathology during infection.

PMID: 27583554 [PubMed - as supplied by publisher]

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Tumor-initiating cell frequency is relevant for glioblastoma aggressiveness.

Tumor-initiating cell frequency is relevant for glioblastoma aggressiveness.

Oncotarget. 2016 Aug 25;

Authors: Richichi C, Osti D, Del Bene M, Fornasari L, Patanè M, Pollo B, DiMeco F, Pelicci G

Abstract
Glioblastoma (GBM) is maintained by a small subpopulation of tumor-initiating cells (TICs). The arduous assessment of TIC frequencies challenges the prognostic role of TICs in predicting the clinical outcome in GBM patients. We estimated the TIC frequency in human GBM injecting intracerebrally in mice dissociated cells without any passage in culture.All GBMs contained rare TICsand were tumorigenic in vivo but only 54% of them grew in vitro as neurospheres. We demonstrated that neurosphere formation in vitro did not foretell tumorigenic ability in vivo and frequencies calculated in vitro overestimated the TIC content.Our findings assert the pathological significance of GBM TICs. TIC number correlated positively with tumor incidence and inversely with survival of tumor-bearing mice. Stratification of GBM patients according to TIC content revealed that patients with low TIC frequency experienced a trend towards a longer progression free survival. The expression of either putative stem-cell markers or markers associated with different GBM molecular subtypes did not associate with either TIC content or neurosphere formation underlying the limitations of TIC identification based on the expression of some putative stem cell-markers.

PMID: 27582543 [PubMed - as supplied by publisher]

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Small cisterno-lumbar gradient of phosphorylated Tau protein in geriatric patients with suspected normal pressure hydrocephalus.

Small cisterno-lumbar gradient of phosphorylated Tau protein in geriatric patients with suspected normal pressure hydrocephalus.

Fluids Barriers CNS. 2016;13(1):15

Authors: Djukic M, Spreer A, Lange P, Bunkowski S, Wiltfang J, Nau R

Abstract
BACKGROUND: The composition of the cerebrospinal fluid (CSF) is not homogeneous, and concentrations of proteins from different origins diverge among ventricular, cisternal and lumbar CSF fractions. Concentrations of blood-derived proteins increase and of brain-derived proteins decrease from ventricular to lumbar fractions. We studied whether the origin of the CSF portion analysed may affect results in CSF analysis for dementia.
METHODS: In 16 geriatric patients with suspected normal pressure hydrocephalus [age 82.5 (76/87) years; median (25th/75th percentile)] a lumbar spinal tap of 40 ml was performed. The CSF was sequentially collected in 8 fractions of 5 ml with the 1st fraction corresponding to lumbar CSF, the 8th to cisterna magna-near CSF. Fractions were analysed for total protein, albumin, Tau protein (Tau), phosphorylated Tau (pTau), Amyloid beta 1-42 (Aβ1-42), Amyloid beta 1-40 (Aβ1-40), and the Aβ1-42/Aβ1-40 ratio.
RESULTS: The concentrations of total protein and albumin increased from cisternal to lumbar fractions due to diffusion-related accumulation from blood to CSF with significantly higher concentrations in fraction 1 compared to fraction 8. The concentrations of Tau showed a non-significant trend towards decreased values in lumbar samples, and pTau was slightly, but significantly decreased in the lumbar fraction 1 [26.5 (22.5/35.0) pg/ml] compared to the cistern-near fraction 8 [27.0 (24.2/36.3) pg/ml] (p = 0.02, Wilcoxon signed rank test). Aβ1-42, Aβ1-40, and the Aβ1-42/Aβ1-40 ratio remained almost constant.
CONCLUSIONS: According to the flow-related diverging dynamics of blood-derived and brain-derived proteins in CSF, the concentrations of Tau and pTau tended to be lower in lumbar compared to cisternal CSF fractions after a spinal tap of 40 ml. The differences reached statistical significance for pTau only. The small differences will not affect clinical interpretation of markers of dementia in the vast majority of cases.

PMID: 27581842 [PubMed - in process]

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Understanding Conflicting Neuropathological Findings.

http:--archneur.jamanetwork.com-images-P

Understanding Conflicting Neuropathological Findings.

JAMA Neurol. 2016 Apr;73(4):479-80

Authors: Jellinger KA

PMID: 26925877 [PubMed - indexed for MEDLINE]

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Well-differentiated and anaplastic astroblastoma in the same patient: a case report and review of the literature.

Well-differentiated and anaplastic astroblastoma in the same patient: a case report and review of the literature.

Clin Neuropathol. 2015 Nov-Dec;34(6):350-8

Authors: Samkari A, Hmoud M, Al-Mehdar A, Abdullah S

Abstract
Astroblastoma is a rare brain tumor occurring in children and adults, rarely in the elderly. It constitutes up to 3% of all brain tumors. We report a case of a 14-year-old girl who presented with recurrent seizures and minimal right hemiparesis. Magnetic resonance imaging (MRI) revealed a left fronto-parietal brain tumor. It was managed with subtotal resection in a local hospital. Subsequently, she was referred to Princess Nora Oncology Center for further characterization and management. Pathology slide revision revealed well-differentiated astroblastoma. Upon follow up, the patient had multiple recurrences of the same tumor and emergence of a new lesion at the area of Sylvian fissure. Excision of the emerging tumor revealed anaplastic astroblastoma. Astroblastoma is a glial tumor that predominantly affects females. Its clinical progression is unpredictable, with high recurrence rate. Surgical intervention is considered the mainstay of treatment, while radiotherapy and chemotherapy effectiveness is debatable. To our knowledge, this is the first reported case of well-differentiated and anaplastic astroblastoma as two separate neoplastic lesions in the same patient with its clinical, radiological, and pathological features.

PMID: 26227256 [PubMed - indexed for MEDLINE]

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Secretory meningioma with KLF4 K409Q mutation in collision with glioma.

Secretory meningioma with KLF4 K409Q mutation in collision with glioma.

Clin Neuropathol. 2015 Nov-Dec;34(6):322-9

Authors: Ruiz J, Capilla E, Díaz JF, Ruiz JA, Andrade J, Hernández T, Mollejo M, Meléndez B

Abstract
AIMS: The simultaneous occurrence of two primary intracranial tumors is a rare event, especially if unrelated to radiotherapy or genetic disorders. We present two patients, both with two primary intracranial tumors simultaneously present at adjacent sites, in order to explore a possible mechanism of synchronous tumor formation.
METHODS: We performed a molecular analysis of the K409Q mutation of the KLF4 gene, in addition to conventional immunohistochemistry.
RESULTS: Preoperative gadolinium-enhanced magnetic resonance imaging revealed a necrotic mass with an irregular ring-like enhancement adjacent to a frontal meningioma in patient 1, and an infiltrative non-enhancing glial tumor with no evidence of another tumor in patient 2. Postoperative histological examination revealed the presence of two distinct tumors in both cases: secretory meningioma and glioblastoma in patient 1 and secretory meningioma and anaplastic astrocytoma in patient 2. Secretory meningiomas both showed the KLF4 K409Q mutation, while none of the glial tumors had it.
CONCLUSIONS: To our knowledge, these are the first two cases reported of the simultaneous occurrence of secretory meningiomas with mutation of KLF4 in collision with a glioblastoma and an anaplastic astrocytoma, respectively. These collision tumors presumably have different molecular origins.

PMID: 26227255 [PubMed - indexed for MEDLINE]

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mTOR is expressed in polymyositis but not in sporadic inclusion body myositis.

mTOR is expressed in polymyositis but not in sporadic inclusion body myositis.

Clin Neuropathol. 2015 Nov-Dec;34(6):371-3

Authors: Panaite PA, Stalder AK, Ipsen S, Kuntzer T, Steck AJ

PMID: 26104108 [PubMed - indexed for MEDLINE]

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speech and language; +18 new citations

18 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

speech and language

These pubmed results were generated on 2016/09/02

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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[Not Available].

[Not Available].

HNO. 2016 Sep;64(9):622-3

Authors:

PMID: 27580994 [PubMed - in process]

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[Head and neck swelling after a visit to the dentist].

[Head and neck swelling after a visit to the dentist].

HNO. 2016 Aug 31;

Authors: Podzimek J, Jecker P

PMID: 27580885 [PubMed - as supplied by publisher]

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Influence of vegetable inclusion in rice monoculture on soil organic matter quality under sub-tropical climate

Soil organic matter (SOM) quality and iits decomposibility is influenced by cropping pattern. However, little is known on this matter, particularly so far rice monoculture or comination of vegetables with rice culture. Therefore, four pairs of fields having vegetable-rice and rice-rice cropping pattern were selected from four different locations in Bangladesh, covering floodplain and terrace soils. Soils were first physically fractionated into particulate organic matter (POM) and silt and clay sized OM. The silt and clay sized OM was further chemically fractionated by oxidation with 6% NaOCl to isolate an oxidation-resistant OM fraction, followed by extraction of mineral bound OM with 10% HF (HF-res OM). The results show that there is a small increase in POM in vegetable compared with rice soils. Among the chemical treatments, NaOCl oxidized the largest amount of OC and N from the silt and clay fractions of vegetable soils. The silt and clay N in vegetable soil was found to be more susceptible to NaOCl treatment compared with OC. Both the HF-extracted (HF-ex) and HF-res OM fractions were found to be lower in vegetable soils compared with rice soils. Results from both physical and chemical fraction of SOM suggest that SOM accumulated in vegetable-rice cropping pattern are more labile than the solely rice based cropping pattern and prone to decompose quickly in any change of land use.

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Needs and requests--patients and physicians voices about improving the management of spinal cord injury neuropathic pain.

Needs and requests--patients and physicians voices about improving the management of spinal cord injury neuropathic pain.

Disabil Rehabil. 2016;38(2):151-8

Authors: Norrbrink C, Löfgren M

Abstract
PURPOSE: The present purpose was to explore patients' and involved physicians' needs and requests for improving their management of neuropathic pain following spinal cord injury (SCI).
METHODS: Sixteen patients with SCI and neuropathic pain, and nine physicians, were interviewed in focus-groups or individual interviews. An emergent design was used and the interviews and analyses were carried out in parallel, making it possible to use and deepen new emerging knowledge. The interviews were transcribed verbatim and processed according to content analysis.
RESULTS: A final model with four themes described the results. Three themes covered the current situation: limitations in structure, lack of knowledge and competence, and frustrations. A fourth theme, needs and requests, described suggestions by patients and physicians for future improvements. Suggestions included increased participation, increased patient involvement in the pain rehabilitation process, support in the process of learning to live with pain, implementation of multi-modal pain rehabilitation, and the use of complementary treatments for neuropathic pain.
CONCLUSION: Neuropathic pain following SCI needs to be assessed and treated using a structured, inter-disciplinary, multi-modal rehabilitation approach involving patients in planning and decision-making.
IMPLICATIONS FOR REHABILITATION: For improving SCI neuropathic pain management, there is a great need for individually-tailored management, planned in a dialogue on equal terms between health care and the patient. Patients desire continuity and regularity and the possibility of receiving complementary treatments for SCI neuropathic pain. Access to structured pain rehabilitation is needed. Support and tools need to be provided in the learning-to-live with pain process.

PMID: 25918963 [PubMed - indexed for MEDLINE]

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Rehabilitation Complexity Scale: Italian translation and transcultural validation.

Rehabilitation Complexity Scale: Italian translation and transcultural validation.

Disabil Rehabil. 2016;38(1):87-96

Authors: Galletti L, Benedetti MG, Maselli S, Zanoli G, Pignotti E, Iovine R

Abstract
PURPOSE: The aim of the present study was translation, cultural adaption and validation of the extended version 12 of the Rehabilitation Complexity Scale (RCS-E) in a sample of patients with stroke and total hip replacement.
METHOD: The cross-cultural validation required RCS-E forward-backward translation, revision by an expert committee and its application in an Intensive Rehabilitation setting through a retrospective collection of data from clinical records. The evaluation of the psychometric properties was carried out by analyzing the correlations between RCS-E score and other measures (Functional Independence Measure, Braden, Morse, Cumulative Illness Rating Scale) and the assessment of reliability in terms of reproducibility (inter-observer agreement) and repeatability (intra-observer agreement).
RESULTS: The backward and forward processes of translation of the scale did not create problems of interpretation of terms. Some adaptation was required for the items nursing (N), medical care (M) and therapeutic intensity (TI) due to differences on the national health system structure. The Italian version of the scale proved to be valid, reliable with high reproducibility and repeatability.
CONCLUSIONS: The Italian version RCS-E has been successfully validated, showing good psychometric properties, which partly reproduce the results obtained for the original version. However, some assumption was made for some items thus preventing possible comparison with other countries.
IMPLICATIONS FOR REHABILITATION: Admittance at an Intensive Rehabilitation care setting in Italy requires to evaluate the complexity of rehabilitation needs. The Rehabilitation Complexity Scale (RCS-E) has proved to be reliable for assessing clinical complexity and consequently for planning rehabilitation needs. The Italian version of RCS-E has been successfully validated, showing good psychometric properties, which reproduce the results obtained for the original version. The items included in the therapy intensity subscale do not fit the Italian health system rules for intensity of rehabilitation care and needs adaptation.

PMID: 25875050 [PubMed - indexed for MEDLINE]

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Translation into Greek and initial validity and reliability testing of a modified version of the SCIM III, in both English and Greek, for self-use.

Translation into Greek and initial validity and reliability testing of a modified version of the SCIM III, in both English and Greek, for self-use.

Disabil Rehabil. 2016;38(2):180-8

Authors: Michailidou C, Marston L, De Souza LH

Abstract
PURPOSE: To translate and culturally adapt the Spinal Cord Injury Measure version III (SCIM III) into Greek (GR-SCIM III). To conduct initial testing of psychometric properties of both measures by self-report.
METHOD: Forward-backward translation was conducted to produce the GR-SCIM III. Participants completed the English or Greek versions in 2008-2009. Both versions were examined for multidimensionality, internal consistency and concurrent/criterion validity with the EQ-5D.
RESULTS: Forty-five Greek adults with spinal cord injury (SCI) (23 males), mean age 61 (SD17) years; mean time since injury 11 (SD9) years, completed the GR-SCIM III. One hundred and seventy four English-speaking adults with SCI (111 males), mean age 47 (SD12) years; mean time since injury 12 (SD11) years, completed the SCIM III. Unidimensionality was confirmed for both versions. Internal consistency was acceptable (α = 0.78 for both). Validity was strong for the "self-care" subscale (GR-SCIM III ρ = -0.78, SCIM III ρ = -0.75) and moderate for the "mobility" subscale (GR-SCIM III ρ = -0.58, SCIM III ρ = -0.45).
CONCLUSIONS: This has been the first function scale translated and validated in Greek for people with SCI. Both the GR-SCIM III and SCIM III are reliable for use by self-report. More studies are needed to further examine their psychometric properties and compare with observation or interview.
IMPLICATIONS FOR REHABILITATION: The Greek version of the Spinal Cord Independence Measure version III (SCIM) is valid and reliable for self-report. Further testing is needed to assess psychometric qualities not assessed in the present study. Researchers and therapists in Greece can use a specific measure to assess functional independence in people with Spinal Cord Injury (SCI). Consideration needs to be given to the participants' type of injury, which may affect the results of SCIM III.

PMID: 25875048 [PubMed - indexed for MEDLINE]

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Capturing complexity in work disability research: application of system dynamics modeling methodology.

Capturing complexity in work disability research: application of system dynamics modeling methodology.

Disabil Rehabil. 2016;38(2):189-94

Authors: Jetha A, Pransky G, Hettinger LJ

Abstract
BACKGROUND: Work disability (WD) is characterized by variable and occasionally undesirable outcomes. The underlying determinants of WD outcomes include patterns of dynamic relationships among health, personal, organizational and regulatory factors that have been challenging to characterize, and inadequately represented by contemporary WD models.
METHOD: System dynamics modeling (SDM) methodology applies a sociotechnical systems thinking lens to view WD systems as comprising a range of influential factors linked by feedback relationships. SDM can potentially overcome limitations in contemporary WD models by uncovering causal feedback relationships, and conceptualizing dynamic system behaviors. It employs a collaborative and stakeholder-based model building methodology to create a visual depiction of the system as a whole. SDM can also enable researchers to run dynamic simulations to provide evidence of anticipated or unanticipated outcomes that could result from policy and programmatic intervention.
DISCUSSION: SDM may advance rehabilitation research by providing greater insights into the structure and dynamics of WD systems while helping to understand inherent complexity. Challenges related to data availability, determining validity, and the extensive time and technical skill requirements for model building may limit SDM's use in the field and should be considered.
IMPLICATIONS FOR REHABILITATION: Contemporary work disability (WD) models provide limited insight into complexity associated with WD processes. System dynamics modeling (SDM) has the potential to capture complexity through a stakeholder-based approach that generates a simulation model consisting of multiple feedback loops. SDM may enable WD researchers and practitioners to understand the structure and behavior of the WD system as a whole, and inform development of improved strategies to manage straightforward and complex WD cases.

PMID: 25864874 [PubMed - indexed for MEDLINE]

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Informal caregivers' needs on discharge from the spinal cord unit: analysis of perceptions and lived experiences.

Informal caregivers' needs on discharge from the spinal cord unit: analysis of perceptions and lived experiences.

Disabil Rehabil. 2016;38(2):159-67

Authors: Conti A, Garrino L, Montanari P, Dimonte V

Abstract
PURPOSE: Spinal cord injuries (SCI) are one of the most complex and disabling diseases, implying severe consequences on aspects of life of people affected by SCI and their caregivers. The aim of our study was to explore the situation of informal caregivers of persons with SCI when discharged home from a SCI Unit, in relation to needs, emotional experiences, difficulties and subsequent reactions to discharge.
METHODS: A purposive sample of 11 caregivers were interviewed on patients' discharge home from the Spinal Injury Care Unit and at 6 months. The semi-structured interviews were analyzed using a qualitative phenomenological methodology as described by Giorgi.
RESULTS: Five main themes emerged from the caregivers' experiences including their implicit and explicit needs. Problems concerning communication with healthcare professionals and the need for an adequate multidisciplinary taking charge of caregivers in order to support their new role emerged within all the themes.
CONCLUSIONS: Results suggest that greater caregiver involvement in the rehabilitation process and their preparation for discharge are required. Communication with healthcare professionals needs to be enhanced. It would be useful to organize follow-up visits after discharge to assess intervention effectiveness.
IMPLICATIONS FOR REHABILITATION: Understanding the importance of discharge from the spinal cord unit as a meaningful step in the rehabilitation path for both patients and their informal caregivers. Orientating healthcare professionals towards a better caregiver involvement during the rehabilitation process. Promoting rehabilitation interventions addressed to the patients and their caregivers concerning supportive communication strategies as well as providing meaningful information, psychological and social support, educational intervention besides the physical aspects of care. Understanding SCI survivors caregivers' needs can assist healthcare professionals in planning and improving taking charge of this core aspect of nursing care.

PMID: 25858628 [PubMed - indexed for MEDLINE]

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Stroke survivors' and family members' perspectives of multimodal lifestyle interventions for secondary prevention of stroke and transient ischemic attack: a qualitative review and meta-aggregation.

Stroke survivors' and family members' perspectives of multimodal lifestyle interventions for secondary prevention of stroke and transient ischemic attack: a qualitative review and meta-aggregation.

Disabil Rehabil. 2016;38(1):11-21

Authors: Lawrence M, Pringle J, Kerr S, Booth J

Abstract
PURPOSE: The incidence of stroke is of global concern, and the rates of recurrence are high. Many risk factors are related to lifestyle behaviours and, as such, are amenable to change. Implementation of effective secondary prevention interventions is essential; however, little is known about influences on participation and adherence. This review and meta-aggregation aimed to improve understanding of stroke survivor and family member perspectives of secondary prevention interventions.
METHODS: We searched 11 databases, e.g. Medline and PsycINFO. We included qualitative studies that focused on adult stroke survivors and family members who had participated in a multimodal stroke secondary prevention intervention. Critical appraisal and data extraction were performed independently by two reviewers. A meta-aggregation of qualitative findings was conducted.
RESULTS: Five papers were included. One hundred and three findings were extracted and grouped into 14 categories from which three synthesised findings emerged: feeling supported, acquiring knowledge and gaining confidence.
CONCLUSIONS: The findings highlight the perceived benefits of participation in secondary prevention group interventions from the perspective of stroke survivors and family members, i.e. feeling supported, by others with shared understanding and by knowledgeable health professionals, acquiring new knowledge and gaining confidence. These findings may be used to inform development of patient-centred interventions and thereby assist in improving health outcomes.
IMPLICATIONS FOR REHABILITATION: Health professionals should consider implementing group-based secondary prevention interventions. The content of group-based secondary prevention interventions should be person-centred, i.e. meaningful and relevant to the individual. Stroke survivors and family members are more likely to comply with advice and information provided by expert and experienced health professionals.

PMID: 25858490 [PubMed - indexed for MEDLINE]

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Parenting stress in mothers with cystic fibrosis.

Parenting stress in mothers with cystic fibrosis.

Disabil Rehabil. 2016;38(2):174-9

Authors: Ullrich G, Bobis I, Bewig B

Abstract
AIM: To assess the parenting experience of mothers with cystic fibrosis (CF) and to compare with normative data.
METHODS: Cross-sectional study with a validated generic parental stress questionnaire (PSQ). This PSQ differentiates four components of parental stress: main factor "parental stress", compounding factor "role restrictions", protective factors "support from spouse", and "social support". Cut-off scores categorise results as "normal", "borderline" or "concerning".
SAMPLE: Seventy-three women were informed by their local CF centre. Of these, 36 enrolled and had a first-born child aged 1-12 years (consistent with reference values of the PSQ). Of these, 31 (86%) returned the PSQ. Mean age of mothers was 32.6 years ± 6.9 years, mean age of first-born child was 5.2 years ± 3.4 years. Most of the mothers had one biological child, five women had two children and one had three children.
RESULTS: Parental stress scores were normally distributed, the same applies for contributing factors and for the two protective factors. Favourable scores were twice as frequent as concerning scores. Mothers of younger children scored slightly better than mothers of school-aged children.
CONCLUSION: In line with the only comparable study, mothers with CF seem to be a remarkably resilient group who mostly cope well with parental stress even in the face of a progressive, chronic disease requiring time-consuming treatment.
IMPLICATIONS FOR REHABILITATION: Today, motherhood is increasingly becoming an option in fertile women with cystic fibrosis. The additional burden of parenting seems to be rewarded by fulfilling essential personal goals. CF clinics should routinely address a possible wish for a child and to discuss it, openly.

PMID: 25858309 [PubMed - indexed for MEDLINE]

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Psychometric properties of the Five-Digit Test in patients with stroke.

Psychometric properties of the Five-Digit Test in patients with stroke.

Disabil Rehabil. 2016;38(1):97-102

Authors: Lin GH, Lu Y, Wu CT, Chiu EC, Huang SL, Hsueh IP, Hsieh CL

Abstract
PURPOSE: To examine the ecological validity, predictive validity, and responsiveness of the Five Digit Test (FDT) in patients with stroke.
METHODS: We included inpatients with stroke (n = 144, 114 and 105 in the ecological validity, predictive validity, and responsiveness analysis, respectively) in the study. At admission, the FDT and Barthel Index (BI) were assessed; at discharge, the FDT, BI, Postural Assessment Scale for Stroke Patients (PASS), and Mobility Subscale of the Stroke Rehabilitation Assessment of Movement (MO-STREAM) were assessed.
RESULTS: In the ecological validity analysis, the scores of the selective and alternating attention indices of the FDT were moderately correlated with those of the BI at admission and discharge (Spearman ρ = -0.38 to -0.45). In the predictive validity analysis, the scores of the two attention indices of the FDT at admission were moderately correlated with the scores of the BI, PASS, and MO-STREAM at discharge (ρ = -0.33 to -0.45). In the responsiveness analysis, the two attention indices of the FDT between admission and discharge had large differences (success rate difference = 0.56-0.67, Wilcoxon Z = -5.90 to -6.60).
CONCLUSION: Our results indicate that the selective and alternating attention indices of the FDT have acceptable ecological validity, predictive validity, and good responsiveness in patients with stroke.
IMPLICATIONS FOR REHABILITATION: The Five Digit Test (FDT), an efficient and culture-free assessment tool, has been used to assess selective attention and alternating attention The selective index and alternating attention index of the FDT showed acceptable ecological validity, predictive validity, and good responsiveness in patients with stroke.

PMID: 25845658 [PubMed - indexed for MEDLINE]

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Associations between socio-demographic factors, encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study.

Associations between socio-demographic factors, encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study.

Disabil Rehabil. 2016;38(2):168-73

Authors: Nordgren L, Söderlund A

Abstract
PURPOSE: The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure.
METHODS: This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses.
RESULTS: For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating.
CONCLUSIONS: Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.
IMPLICATIONS FOR REHABILITATION: A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce. Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals. Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.

PMID: 25835330 [PubMed - indexed for MEDLINE]

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Psychometric properties of self-reported questionnaires for the evaluation of symptoms and functional limitations in individuals with rotator cuff disorders: a systematic review.

Psychometric properties of self-reported questionnaires for the evaluation of symptoms and functional limitations in individuals with rotator cuff disorders: a systematic review.

Disabil Rehabil. 2016;38(2):103-22

Authors: St-Pierre C, Desmeules F, Dionne CE, Frémont P, MacDermid JC, Roy JS

Abstract
PURPOSE: To conduct a systematic review of the psychometric properties (reliability, validity and responsiveness) of self-report questionnaires used to assess symptoms and functional limitations of individuals with rotator cuff (RC) disorders.
METHODS: A systematic search in three databases (Cinahl, Medline and Embase) was conducted. Data extraction and critical methodological appraisal were performed independently by three raters using structured tools, and agreement was achieved by consensus. A descriptive synthesis was performed.
RESULTS: One-hundred and twenty articles reporting on 11 questionnaires were included. All questionnaires were highly reliable and responsive to change, and showed construct validity; seven questionnaires also shown known-group validity. The minimal detectable change ranged from 6.4% to 20.8% of total score; only two questionnaires (American Shoulder and Elbow Surgeon questionnaire [ASES] and Upper Limb Functional Index [ULFI]) had a measurement error below 10% of global score. Minimal clinically important differences were established for eight questionnaires, and ranged from 8% to 20% of total score.
CONCLUSION: Overall, included questionnaires showed acceptable psychometric properties for individuals with RC disorders. The ASES and ULFI have the smallest absolute error of measurement, while the Western Ontario RC Index is one of the most responsive questionnaires for individuals suffering from RC disorders.
IMPLICATIONS FOR REHABILITATION: All included questionnaires are reliable, valid and responsive for the evaluation of individuals with RC disorders. As all included questionnaires showed good psychometric properties for the targeted population, the choice should be made according to the purpose of the evaluation and to the construct being evaluated by the questionnaire. The WORC, a RC-specific questionnaire, appeared to be more responsive. It should therefore be used to evaluate change in time. If the evaluation is time-limited, shorter questionnaires or short versions should be considered (such as Quick DASH or SST).

PMID: 25801922 [PubMed - indexed for MEDLINE]

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Promoting consistent use of the communication function classification system (CFCS).

Promoting consistent use of the communication function classification system (CFCS).

Disabil Rehabil. 2016;38(2):195-204

Authors: Cunningham BJ, Rosenbaum P, Hidecker MJ

Abstract
PURPOSE: We developed a Knowledge Translation (KT) intervention to standardize the way speech-language pathologists working in Ontario Canada's Preschool Speech and Language Program (PSLP) used the Communication Function Classification System (CFCS). This tool was being used as part of a provincial program evaluation and standardizing its use was critical for establishing reliability and validity within the provincial dataset.
METHOD: Two theoretical foundations - Diffusion of Innovations and the Communication Persuasion Matrix - were used to develop and disseminate the intervention to standardize use of the CFCS among a cohort speech-language pathologists. A descriptive pre-test/post-test study was used to evaluate the intervention. Fifty-two participants completed an electronic pre-test survey, reviewed intervention materials online, and then immediately completed an electronic post-test survey.
RESULTS: The intervention improved clinicians' understanding of how the CFCS should be used, their intentions to use the tool in the standardized way, and their abilities to make correct classifications using the tool.
CONCLUSIONS: Findings from this work will be shared with representatives of the Ontario PSLP. The intervention may be disseminated to all speech-language pathologists working in the program. This study can be used as a model for developing and disseminating KT interventions for clinicians in paediatric rehabilitation.
IMPLICATIONS FOR REHABILITATION: The Communication Function Classification System (CFCS) is a new tool that allows speech-language pathologists to classify children's skills into five meaningful levels of function. There is uncertainty and inconsistent practice in the field about the methods for using this tool. This study used combined two theoretical frameworks to develop an intervention to standardize use of the CFCS among a cohort of speech-language pathologists. The intervention effectively increased clinicians' understanding of the methods for using the CFCS, ability to make correct classifications, and intention to use the tool in the standardized way in the future.

PMID: 25801921 [PubMed - indexed for MEDLINE]

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A narrative synthesis investigating the use and value of social support to promote physical activity among individuals with schizophrenia.

A narrative synthesis investigating the use and value of social support to promote physical activity among individuals with schizophrenia.

Disabil Rehabil. 2016;38(2):123-50

Authors: Gross J, Vancampfort D, Stubbs B, Gorczynski P, Soundy A

Abstract
PURPOSE: To review and synthesise the literature detailing the use of social support to facilitate physical activity participation in individuals with schizophrenia.
METHOD: A systematic review of major electronic databases was conducted to identify literature regarding the use of social support to promote physical activity among people with schizophrenia. A narrative synthesis was undertaken in four stages, including development of a theory, developing a preliminary synthesis, exploring relationships and assessing the robustness of the synthesis.
RESULTS: From a total of 110 studies, 23 met the inclusion criteria including 883 individuals with schizophrenia. Informational support was the most documented form of social support, followed by emotional, esteem and tangible. Providers included research personnel, healthcare professionals, family members and peers. Details of the content of the different dimensions of functional support are given. Social support appears to have an important role to help individuals with schizophrenia initiate, comply and adhere with exercise interventions. Social support may have an indirect benefit on weight maintenance. However, due to the limitations of the selected literature, it was difficult ascertain what the (in)direct benefit of social support are on health outcomes.
CONCLUSIONS: Social support appears to play a pivotal role in initiating physical activity as well as ensuring compliance and adherence to physical activity. Future research is required to investigate the optimal type and mode of delivery of social support on health outcomes.
IMPLICATIONS FOR REHABILITATION: Limited evidence is available that considers the role, value and use of social support within physical activity interventions for individuals with schizophrenia. Social support appears most likely to aid an individual's initiation, adherence and compliance to physical activity interventions. There may be an indirect benefit of social support on maintaining or enhancing health outcomes.

PMID: 25786476 [PubMed - indexed for MEDLINE]

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Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland.

Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland.

Disabil Rehabil. 2016;38(1):81-6

Authors: Arnet U, Hinrichs T, Lay V, Bertschy S, Frei H, Brinkhof MW, SwiSCI study group

Abstract
PURPOSE: To examine the prevalence and determinants of handbike use in persons living with spinal cord injury in Switzerland.
METHOD: A population-based cross-sectional survey in Switzerland.
RESULTS: The crude prevalence of handbike use among the 1549 participants was 22.6%, varying between 25.3% in men and 17.7% in women. Prevalence was higher in complete than in incomplete spinal cord injury (SCI) (41.5% versus 11.9% in paraplegia, 25.6% versus 11.1% in tetraplegia). Multivariable analysis of handbike use confirmed differences with lesion characteristics and gender and showed a decline with age, lowest rates in the low-income group, variation with language, but no association with level of education or cause of spinal cord injury. In total, 45.8% of users reported to engage in handcycling at least once a week. Frequent contextual reasons for refraining from handcycling were: no interest (26%); inability due to disability (20%); unfamiliarity with the handbike (19%) and financial constraints (14%).
CONCLUSIONS: Conditional on the major determinants that include demographic factors and lesion characteristics, main barriers involve contextual factors that can principally be overcome. Our findings thus suggest scope for promoting handcycling as a means towards a healthy and more physically active lifestyle in persons living with SCI.
IMPLICATIONS FOR REHABILITATION: Handcycling is an effective means of improving health and quality of life of persons with a spinal cord injury. Persons with the following traits are most likely to use the handbike: persons younger than 62 years, with a complete paraplegia, who are German-speaking (vs. French/Italian) and having a middle or high net income. Indicated reasons for not using a handbike varied by SCI characteristics and included disinterest, inability related to the level of impairment, unfamiliarity and financial costs. Barriers that involve the above mentioned contextual factors can principally be overcome by targeted policy or information campaigns.

PMID: 25784201 [PubMed - indexed for MEDLINE]

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Well, I'm healthy, but…--lay perspectives on health among people with musculoskeletal disorders.

Well, I'm healthy, but…--lay perspectives on health among people with musculoskeletal disorders.

Disabil Rehabil. 2016;38(1):71-80

Authors: Wiitavaara B, Bengs C, Brulin C

Abstract
PURPOSE: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders.
METHOD: Semi-structured interviews were performed with 39 women and 30 men, (aged 22-63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis.
RESULTS: These people experienced health as "having resources and opportunities to lead the life one wants". Three categories, "a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life", illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on "being ill" and "being well" and what makes the difference. Five aspects influenced the dynamics of their health experiences: "body and soul, prognosis, character of symptoms, physical and social activity, and emotional state". Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want.
CONCLUSIONS: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies.
IMPLICATIONS FOR REHABILITATION: Musculoskeletal disorders (MSDs) are difficult to cure and actions to alleviate suffering are of most importance to increase wellbeing and thereby work ability. Research on lay perspectives can contribute towards a deepened understanding of the health experiences of the affected, and thereby the development of the goals and activities of rehabilitation. Our models, that present the view of health and aspects important for achieving wellness among people with MSDs, can contribute in the development of multimodal rehabilitation. The results can also be useful as a base in the evaluation of clinical practice.

PMID: 25777548 [PubMed - indexed for MEDLINE]

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Evaluation of the implementation of the protocol of an early vocational rehabilitation intervention for people with acquired brain injury.

Evaluation of the implementation of the protocol of an early vocational rehabilitation intervention for people with acquired brain injury.

Disabil Rehabil. 2016;38(1):62-70

Authors: van Velzen JM, van Bennekom CA, van Dormolen M, Sluiter JK, Frings-Dresen MH

Abstract
PURPOSE: The purpose of this study was to evaluate (1) the feasibility of an early vocational rehabilitation (EVR) protocol in the standard rehabilitation process, (2) promoting factors and barriers encountered with the EVR protocol, and (3) perceived effectiveness of the protocol in facilitating return to work (RTW) following acquired brain injury (ABI).
METHOD: A pre- and post-process evaluation was performed in a Dutch rehabilitation center. Dependent variables were feasibility (defined by the usability on process level and fulfillment of usability expectations), promoting factors and barriers, and perceived effectiveness of the protocol. Usability (defined by 13 performance and timing goals) was evaluated with existing forms and registrations. Fulfillment of usability expectations, perceived promoting factors and barriers, and perceived effectiveness were investigated with questionnaires. Data of 23 patients were available for process evaluation. Nine rehabilitation professionals, 10 patients with ABI, nine employers, and six occupational physicians completed the questionnaires.
RESULTS: Two-thirds of the performance goals and one-fourth of the timing goals were reached. All respondents cited the structured protocol as a promoting factor. Thirty-two of the thirty-four participants perceived the protocol as being suitable facilitating RTW after ABI.
CONCLUSIONS: The EVR protocol provides a structured strategy to focus on RTW during standard rehabilitation. It is now possible to implement and test the protocol in other rehabilitation settings.
IMPLICATIONS FOR REHABILITATION: The early vocational rehabilitation (EVR) facilitates an interdisciplinary and systematic focus on return to work during rehabilitation of people with acquired brain injury. The feasibility of the EVR protocol has been tested. The EVR protocol is ready for implementation and wider testing in other rehabilitation settings.

PMID: 25738905 [PubMed - indexed for MEDLINE]

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Meeting the psychological needs of community-living stroke patients and carers: a study of third sector provision.

Meeting the psychological needs of community-living stroke patients and carers: a study of third sector provision.

Disabil Rehabil. 2016;38(1):52-61

Authors: Morris R

Abstract
PURPOSE: To elucidate how community stroke staff in a major third sector organisation experienced their role and understood and responded to clients' psychological needs.
METHOD: In stage 1, three focus groups of 28 staff in total were recorded, transcribed and analysed using inductive thematic analysis. Themes were authenticated by new staff groups. In stage 2, these themes informed the construction of a questionnaire delivered through the organisation's intranet by "Survey Monkey".
RESULTS: Five themes emerged from the focus groups: background and context; perceptions of clients' psychological issues; approaches to meeting psychological needs; the experience of working with psychological needs and sources of support; aspirations for future development. Four themes were used in constructing the questionnaire. Responses from 144 staff with diverse qualifications and experience were received; over half encountered 16 (of 35) psychological issues at least once per week. Stroke survivors' needs predominated over carers' needs. Skills used to address psychological problems were identified, also training and support needs and future aspirations. Support needs included information, training and access to specialist consultants.
CONCLUSIONS: Psychological issues were central in the work of third sector community stroke staff; psychological skills were routinely used. Attention to means of supporting and developing these skills is required.
IMPLICATIONS FOR REHABILITATION: Service leaders and commissioners should be aware that third sector community stroke staff frequently deal with a diverse range of psychological issues and perceive psychological care as central. Service leaders should consider providing training in assessment and management of mood and cognition, risk assessment and management and basic counselling. Staff should be provided with access to specialist consultation and better information about psychological aspects of referrals. There is uncertainty about key methods for supporting the delivery of psychological care (supervision, mentoring and peer support) which requires consideration.

PMID: 25731861 [PubMed - indexed for MEDLINE]

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Prevention of falls for adults with intellectual disability (PROFAID): a feasibility study.

Prevention of falls for adults with intellectual disability (PROFAID): a feasibility study.

Disabil Rehabil. 2016;38(1):36-44

Authors: Hale LA, Mirfin-Veitch BF, Treharne GJ

Abstract
PURPOSE: A novel physiotherapy intervention for people with intellectual disability (ID) to improve balance was developed and evaluated in a feasibility study which quantitatively assessed potential benefits on measures of balance, gait and activity participation, and qualitatively explored its acceptability, utility and feasibility.
METHODS: Participants were 27 adults with mild to profound ID (mean age 53 years SD 10.9). We used a mixed methods approach: an uncontrolled before-after study (data analysed with the related samples sign test) and a qualitative interview evaluation (data analysed with the general inductive approach). Balance, gait and participation were assessed at baseline and 6 months after introduction of the physiotherapy intervention with four standardised measures and two questionnaires.
RESULTS: Appropriate exercises and a physical activity could be found for all participants, irrespective of the level of ID, although for many this required a high level of assistance from support staff. Only the Balance Scale for ID changed significantly by a median score of 2 (95% CI = 0.00-2.50, p = 0.04). No other outcomes changed significantly. Four themes emerged: "Understanding the intervention"; "Routine and reality"; "Remembering what I have to do" and "What happens beyond the study itself"?
CONCLUSIONS: The findings provide some evidence for the benefit, acceptability, utility and feasibility of the intervention justifying further evaluation.
IMPLICATIONS FOR REHABILITATION: Falling is a frequent and serious problem for many adults with intellectual disability. Two to three exercises targeted at increasing lower limb strength and challenging balance, performed each day as part of daily routine may help improve balance in adults with intellectual disability. The importance of exercising needs to be stressed to those who support adults with intellectual disability to encourage ongoing adherence.

PMID: 25714511 [PubMed - indexed for MEDLINE]

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Fundamental movement skills proficiency in children with developmental coordination disorder: does physical self-concept matter?

Fundamental movement skills proficiency in children with developmental coordination disorder: does physical self-concept matter?

Disabil Rehabil. 2016;38(1):45-51

Authors: Yu J, Sit CH, Capio CM, Burnett A, Ha AS, Huang WY

Abstract
PURPOSE: The purpose of this study was to (1) examine differences in fundamental movement skills (FMS) proficiency, physical self-concept, and physical activity in children with and without developmental coordination disorder (DCD), and (2) determine the association of FMS proficiency with physical self-concept while considering key confounding factors.
METHOD: Participants included 43 children with DCD and 87 age-matched typically developing (TD) children. FMS proficiency was assessed using the Test of Gross Motor Development - second edition. Physical self-concept and physical activity were assessed using self-report questionnaires. A two-way (group by gender) ANCOVA was used to determine whether between-group differences existed in FMS proficiency, physical self-concept, and physical activity after controlling for age and BMI. Partial correlations and hierarchical multiple regression models were used to examine the relationship between FMS proficiency and physical self-concept.
RESULTS: Compared with their TD peers, children with DCD displayed less proficiency in various components of FMS and viewed themselves as being less competent in physical coordination, sporting ability, and physical health. Physical coordination was a significant predictor of ability in object control skills. DCD status and gender were significant predictors of FMS proficiency.
CONCLUSIONS: Future FMS interventions should target children with DCD and girls, and should emphasize improving object control skills proficiency and physical coordination.
IMPLICATIONS FOR REHABILITATION: Children with DCD tend to have not only lower FMS proficiency than age-matched typically developing children but also lower physical self-concept. Self-perceptions of physical coordination by children with DCD are likely to be valuable contributors to development of object control skills. This may then help to develop their confidence in performing motor skills. Children with DCD need supportive programs that facilitate the development of object control skills. Efficacy of training programs may be improved if children experience a greater sense of control and success when performing object control skills.

PMID: 25698377 [PubMed - indexed for MEDLINE]

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Physiotherapy for vegetative and minimally conscious state patients: family perceptions and experiences.

Physiotherapy for vegetative and minimally conscious state patients: family perceptions and experiences.

Disabil Rehabil. 2016;38(1):22-9

Authors: Latchem J, Kitzinger J, Kitzinger C

Abstract
PURPOSE: To examine family perceptions of physiotherapy provided to relatives in vegetative or minimally conscious states.
METHOD: Secondary thematic analysis of 65 in-depth narrative interviews with family members of people in vegetative or minimally conscious states.
RESULTS: Families place great significance on physiotherapy in relation to six dimensions: "Caring for the person", "Maximising comfort", "Helping maintain health/life", "Facilitating progress", "Identifying or stimulating consciousness" and "Indicating potential for meaningful recovery". They can have high expectations of what physiotherapy may deliver but also, at times, express concerns about physiotherapy's potential to cause pain or distress, or even constitute a form of torture if they believe there is no hope for "meaningful" recovery.
CONCLUSION: Physiotherapists can make an important contribution to supporting this patient group and their families but it is vital to recognise that family understandings of physiotherapy may differ significantly from those of physiotherapists. Both the delivery and the withdrawal of physiotherapy is highly symbolic and can convey (inadvertent) messages to people about their relative's current and future state. A genuine two-way dialogue between practitioners and families about the aims of physiotherapeutic interventions, potential outcomes and patients' best interests is critical to providing a good service and establishing positive relationships and appropriate treatment.
IMPLICATIONS FOR REHABILITATION: Families of people in PVS or MCS consider physiotherapy as a vital part of good care. Clear communication is critical if therapeutic input is withdrawn or reduced. The purpose of physiotherapy interventions can be misinterpreted by family members. Physiotherapists need to clarify what physiotherapy can, and cannot, achieve. Families can find some interventions distressing to witness--explaining to families what interventions involve, what they can expect to see (and hear) may be helpful. Physiotherapists and families can attribute different meanings to physiotherapy. Physiotherapists need to identify how families view interventions and modify their explanations accordingly to enhance information sharing.

PMID: 25669235 [PubMed - indexed for MEDLINE]

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Acute phase factors associated with the course of depression during the first 18 months after first-ever stroke.

Acute phase factors associated with the course of depression during the first 18 months after first-ever stroke.

Disabil Rehabil. 2016;38(1):30-5

Authors: Eriksen S, Gay CL, Lerdal A

Abstract
PURPOSE: The aim of this study was to describe the course of post-stroke depression (PSD) during the first 18 months after first-ever stroke and to examine differences in the course of depressive symptoms in relation to patient demographic and clinical characteristics in the acute phase.
METHODS: As part of a longitudinal cohort study, data were collected from medical records and in face-to-face interviews using standardized questionnaires within 15 days after stroke and 6, 12 and 18 months later. The sample consisted of 94 patients with first-ever stroke. PSD was measured with the Beck Depression Inventory II. Repeated measures analysis of variance was used to evaluate the course of depressive symptoms over time and in relation to demographic and clinical variables.
RESULTS: Depression levels were stable during the 18 months after first-ever stroke. However, depression scores were significantly higher among patients who had lower physical functioning in the acute phase, were living alone or were not employed at the time of stroke.
CONCLUSIONS: Several demographic and acute phase factors were associated with a more severe PSD course following stroke. Psychosocial support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.
IMPLICATIONS FOR REHABILITATION: Depression levels are stable during the first 18 months after first-ever stroke. The course of post-stroke depression is related to the level of physical functioning in the acute phase, whether the stroke survivors live alone and their employment status at the time of stroke. Psychological support that begins in the acute phase and continues throughout the rehabilitation process may be helpful in improving both physical and psychological outcomes following stroke.

PMID: 25655394 [PubMed - indexed for MEDLINE]

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