Posts Tagged quality of life

[Abstract] The Work Disability Functional Assessment Battery (WD-FAB) – Physical Medicine and Rehabilitation Clinics

Abstract

Accuracy in measuring function related to one’s ability to work is central to public confidence in a work disability benefits system. In the United States, national disability programs are challenged to adjudicate millions of work disability claims each year in a timely and accurate manner. The Work Disability Functional Assessment Battery (WD-FAB) was developed to provide work disability agencies and other interested parties a comprehensive and efficient approach to profiling a person’s function related to their ability to work. The WD-FAB is grounded by the International Classification of Functioning, Disability, and Health conceptual framework.

 

via The Work Disability Functional Assessment Battery (WD-FAB) – Physical Medicine and Rehabilitation Clinics

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[ARTICLE] Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles – Full Text

Objective: To evaluate the efficacy, safety and economics of levetiracetam (LEV) for epilepsy.
Materials and methods: PubMed, Scopus, the Cochrane Library, OpenGrey.eu and ClinicalTrials.gov were searched for systematic reviews (SRs), meta-analyses, randomized controlled trials (RCTs), observational studies, case reports and economic studies published from January 2007 to April 2018. We used a bubble plot to graphically display information of included studies and conducted meta-analyses to quantitatively synthesize the evidence.
Results: A total of 14,803 records were obtained. We included 30 SRs/meta-analyses, 34 RCTs, 18 observational studies, 58 case reports and 2 economic studies after the screening process. The included SRs enrolled patients with pediatric epilepsy, epilepsy in pregnancy, focal epilepsy, generalized epilepsy and refractory focal epilepsy. Meta-analysis of the included RCTs indicated that LEV was as effective as carbamazepine (CBZ; treatment for 6 months: 58.9% vs 64.8%, OR=0.76, 95% CI: 0.50–1.16; 12 months: 54.9% vs 55.5%, OR=1.24, 95% CI: 0.79–1.93), oxcarbazepine (57.7% vs 59.8%, OR=1.34, 95% CI: 0.34–5.23), phenobarbital (50.0% vs 50.9%, OR=1.20, 95% CI: 0.51–2.82) and lamotrigine (LTG; 61.5% vs 57.7%, OR=1.22, 95% CI: 0.90–1.66). SRs and observational studies indicated a low malformation rate and intrauterine death rate for pregnant women, as well as low risk of cognitive side effects. But psychiatric and behavioral side effects could not be ruled out. LEV decreased discontinuation due to adverse events compared with CBZ (OR=0.52, 95% CI: 0.41–0.65), while no difference was found when LEV was compared with placebo and LTG. Two cost-effectiveness evaluations for refractory epilepsy with decision-tree model showed US$ 76.18 per seizure-free day gained in Canada and US$ 44 per seizure-free day gained in Korea.


Conclusion: 
LEV is as effective as CBZ, oxcarbazepine, phenobarbital and LTG and has an advantage for pregnant women and in cognitive functions. Limited evidence supports its cost-effectiveness

Background

Epilepsy ranks fourth after tension-type headache, migraine and Alzheimer disease in the world’s neurological disorders burden.1 A systematic review (SR) and meta-analysis of international studies reported that the point prevalence of active epilepsy was 6.38 per 1,000 people, while the lifetime prevalence was 7.60 per 1,000 people. The annual cumulative incidence of epilepsy was 67.77 per 100,000 people, while the incidence rate was 61.44 per 100,000 person-years.2 As a fairly common clinical condition affecting all ages and requiring long-term, sometimes lifelong, treatment, epilepsy incurs high health care costs for the society.1 In 2010, the total annual cost for epilepsy was 13.8 billion and the total cost per patient was €5,221 in Europe.3 Meanwhile, in the USA, epilepsy-related costs ranged from $1,022 to $19,749 per person annually.4 What is more, drug-refractory epilepsy was a major cost driver,5 with main costs from anticonvulsants, hospitalization and early retirement.6

Currently, antiepileptic drugs (AEDs) are the main treatment method for epilepsy patients, and it was reported that approximately two-thirds of epileptic seizures were controlled by AEDs.7 Conventional AEDs such as carbamazepine (CBZ) and sodium valproate (VPA) have been proven to have good therapeutic effects and low treatment cost. However, some adverse events (AEs) related to these drugs, such as Stevens–Johnson syndrome, menstrual disorder and memory deterioration seriously affect the tolerance and compliance of patients. Compared with conventional AEDs, new AEDs have the potential to be safer, but also more expensive.8

Levetiracetam (LEV) is a novel AED that has been approved as an adjunctive therapy for adults with focal epilepsy since 1999 in the US. In 2006, it was licensed as monotherapy for adults and adolescents above 16 years of age with newly diagnosed focal-onset seizures with or without secondary generalization in Europe. Also, it has been indicated as an adjunctive therapy for partial-onset seizures in patients above 4 years of age in China since 2007. Although the precise mechanism of LEV is still unclear, current researches suggest that its pharmacological mechanism is different from those of other AEDs. It may bind to the synaptic vesicle protein 2A (SV2A), which presents on the synaptic vesicles and some neuroendocrine cells. SV2A may participate in the exocytosis of synaptic vesicles and regulate the release of neurotransmitters, especially the release of excitatory amino acids, and thus depress the epilepsy discharge.9,10 Other possible mechanisms of LEV include the following: selective inhibition of voltage-dependent N-type calcium channels in hippocampal pyramidal cells and reduction of the negative allosteric agents’ inhibition, such as zinc ions and B-carbolines, on glycine and γ-aminobutyric acid neurons, which results in indirectly increasing central nervous system inhibition.11

LEV is almost completely absorbed after oral administration and the absorption is unaffected by food. The bioavailability is nearly 100% and the steady-state concentrations are achieved in 2 days if LEV is taken twice daily. Sixty-six percent of LEV is renally excreted unchanged and its major metabolic pathway is enzymatic hydrolysis of the acetamide group, which is independent of liver CYP/CYP450; so, no clinically meaningful drug–drug interactions with other AEDs were found.12 One published SR of LEV suggested LEV has an equal efficacy compared with conventional AEDs and it is well tolerated for long-term therapy without significant effect on the immune system.13 But in recent years, apart from the most frequent AEs of LEV, such as nausea, gastrointestinal symptoms, dizziness, irritability and aggressive behavior, some rare AEs of LEV have been reported, including eosinophilic pneumonia, rhabdomyolysis, thrombocytopenia, elevated kinase and reduced sperm quality.1417

Thus, we conducted a mapping review to evaluate the efficacy, safety and economic profiles of LEV compared with all other AEDs for epilepsy, to provide evidence-based information for the rational use of LEV and research agendas.

[…]

 

Continue —>  [Full text] Levetiracetam for epilepsy: an evidence map of efficacy, safety and ec | NDT

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[Abstract] Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial

Background. Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many.

Objective. To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes.

Methods. On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases.

Results. Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log–28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences.

Conclusions. Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov. Identifier: NCT00871715).

via Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial – Rebecca Lewthwaite, Carolee J. Winstein, Christianne J. Lane, Sarah Blanton, Burl R. Wagenheim, Monica A. Nelsen, Alexander W. Dromerick, Steven L. Wolf, 2018

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[BOOK] 22 ANNUAL CONFERENCE OF THE INTERNATIONAL FUCTIONAL ELECTRICAL STIMULATION SOCIETY – Abstracts

Enhancing quality of life
through electrical stimulation technology

22. ANNUAL CONFERENCE OF THE
INTERNATIONAL FUNCTIONAL
ELECTRICAL STIMULATION SOCIETY

All of the abstracts presented are available on line at http://ifess2018.com/down/IFESS2018_program.pdf

 

 

 

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[Abstract + References] Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue

Highlights

  • Sexuality has a significant impact on interpersonal relationships and psychological well-being.
  • Up to 50% of patients with moderate to severe TBI report sexual problems.
  • Sexual disorders in TBI are closely dependent on the damaged brain area.
  • TBI patients and their caregivers should be provided with information useful to achieve a better sexual health.

Abstract

Traumatic brain injury (TBI) is any damage to the skull and/or the brain and its frameworks due to an external force. Following TBI, patients may report cognitive, physiological and psychosocial changes with a devastating impact on important aspects of the patient’s life, such as sexual functioning. Although sexual dysfunction (SD) occurs at a significantly greater frequency in individuals with TBI, it is not commonly assessed in the clinical setting and little information is available on this crucial aspect of patients’ quality of life. As the number of people with TBI is on the rise, there is a need for better management of TBI problems, including SD, by providing information to patients and their caregivers to achieve sexual health, with a consequent increase in their quality of life. Discussing and treating sexual problems in TBI patients enters the framework of a holistic approach. The purpose of this narrative review is provide clinicians with information concerning changes in sexual functioning and relationships in individuals with TBI, for a better management of patient’s functional outcomes and quality of life.

References

  1. Menon, D.K., Schwab, K., Wright, D.W., Maas, A.I. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil2010;91:1637–1640.
  2. Lin, C., He, H., Li, Z., Liu, Y., Chao, H., Ji, J. et al, Efficacy of progesterone for moderate to severe traumatic brain injury: a meta-analysis of randomized clinical trials. Sci Rep2015;25:13442.
  3. Adams, H., Donnelly, J., Czosnyka, M., Kolias, A.G., Helmy, A., Menon, D.K. et al, Temporal profile of intracranial pressure and cerebrovascular reactivity in severe traumatic brain injury and association with fatal outcome: an observational study. PLoS Med2017;14e1002353.
  4. Maas, A.I., Menon, D.K. Traumatic brain injury: rethinking ideas and approaches. Lancet Neurol2012;11:12–13.
  5. Giacino, J.T., Kalmar, K., Whyte, J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehab2004;85:2020–2029.
  6. Saatian, M., Ahmadpoor, J., Mohammadi, Y., Mazloumi, E. Epidemiology and pattern of traumatic brain injury in a developing country regional trauma center. Bull Emerg Trauma2018;6:45–53.
  7. Wilson, B.A. Neuropsychology rehabilitation: theory and practice. South Afr J Psych2013;43:267–277.
  8. Gordon, W.A., Zafonte, R., Cicerone, K., Cantor, J., Brown, M., Lombard, L. et al, Traumatic brain injury rehabilitation: state of the science. Am J Phys Med Rehabil2006;85:343–382.
  9. Ben-Yishai, Y. Foreward. Neuropsych Rehab2008;18:513–521.
  10. Cicerone, K.D., Mott, T., Azulay, J., Sharlow-Galella, M.A., Ellmo, W.J., Paradise, S. et al, A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Arch Phys Med Rehabil2008;89:2239–2249.
  11. Mazzucchi, A. La riabilitazione neuropsicologica. Premesse teoriche e applicazioni cliniche.ElsevierMilano (IT)2012.
  12. Ciurli, P., Formisano, R., Bivona, U., Cantagallo, A., Angelelli, P. Neuropsychiatric disorders in persons with severe traumatic brain injury: prevalence, phenomenology, and relationship with demographic, clinical, and functional features. J Head Trauma Rehabil2011;26:116–126.
  13. Ponsford, J. Sexual changes associated with traumatic brain injury. Neuropsychol Rehabil2013;13:275–289.
  14. Masel, B.E., DeWitt, D.S. Traumatic brain injury: a disease process, not an event. J Neurotr2010;27:1529–1540.
  15. Moreno, J.A., Arango Lasprilla, J.C., Gan, C., McKerral, M. Sexuality after traumatic brain injury: a critical review. Neuro Rehab2013;32:69–85.
  16. Hibbard, M.R., Gordon, W.A., Flanagan, Haddad, L., Labinsky, E. Sexual dysfunction after traumatic brain injury. Neuro Rehabil2000;15:107–120.
  17. Sandel, M.E., Williams, K.S., Dellapietra, L., Derogatis, L.R. Sexual functioning following traumatic brain injury. Brain Inj1996;10:719–728.
  18. Kreuter, M., Dahllöf, A.G., Gudjonsson, G., Sullivan, M., Siösteen, A. Sexual adjustment and its predictors after traumatic brain injury. Brain Inj1998;12:349–368.
  19. Bezeau, S.C., Bogod, N.M., Mateer, C.A. Sexually intrusive behaviour following brain injury: approaches to assessment and rehabilitation. Brain Inj2004;18:299–313.
  20. Simpson, G.K., Sabaz, M., Daher, M. Prevalence, clinical features, and correlates of inappropriate sexual behavior after traumatic brain injury: a multicenter study. J Head Trauma Rehabil2013;28:202–210.
  21. Aloni, R., Katz, S. A review of the effect of traumatic brain injury on the human sexual response.Brain Inj1999;13:269–280.
  22. Althof SE Psychological interventions for delayed ejaculation/orgasm. Int J Impot Res 2012; 24(4): 131–6..

  23. Katz, S., Aloni, R. Sexual dysfunction of persons after traumatic brain injury: perceptions of professionals. Int J Rehabil Res1999;22:45–53.
  24. Garden, F.H., Bontke, C.F., Hoffman, M. Sexual functioning and marital adjustment after traumatic brain injury. J Head Trauma Rehab2010;5:52–59.
  25. Sander, A.M., Maestas, K.L., Pappadis, M.R., Sherer, M., Hammond, F.M., Hanks, R. et al, Traumatic brain injury model systems module project on sexuality after TBI. Sexual functioning 1 year after traumatic brain injury: findings from a prospective traumatic brain injury model systems collaborative study. Arch Phys Med Rehabil2012;93:1331–1337.
  26. Hanks, R.A., Sander, A.M., Millis, S.R., Hammond, F.M., Maestas, K.L. Changes in sexual functioning from 6 to 12 months following traumatic brain injury: a prospective TBI model system multicenter study. J Head Trauma Rehabil2013;28:179–185.
  27. Downing, M.G., Stolwyk, R., Ponsford, J.L. Sexual changes in individuals with traumatic brain injury: a control comparison. J Head Trauma Rehabil2013;28:171–178.
  28. Mah, K., Hickling, A., Reed, N. Perceptions of mild traumatic brain injury in adults: a scoping review. Disabil Rehabil2018;40:960–973.
  29. Reddy, A., Ownsworth, T., King, J., Shields, C. A biopsychosocial investigation of changes in self-concept on the head injury semantic differential scale. Neuropsychol Rehabil2017;27:1103–1123.
  30. Iverson, G.L., Lange, R.T., Brooks, B.L., Rennison, V.L. “Good old days” bias following mild traumatic brain injury. Clin Neuropsychol2010;24:17–37.
  31. Sander, A.M., Maestas, K.L., Nick, T.G., Pappadis, M.R., Hammond, F.M., Hanks, R.A. et al, Predictors of sexual functioning and satisfaction 1 year following traumatic brain injury: a TBI model systems multicenter study. J Head Trauma Rehabil2013;28:186–194.
  32. Ponsford, J.L., Downing, M.G., Stolwyk, R. Factors associated with sexuality following traumatic brain injury. J Head Trauma Rehabil2013;28:195–201.
  33. Goldin, Y., Cantor, J.B., Tsaousides, T., Spielman, L., Gordon, W.A. Sexual functioning and the effect of fatigue in traumatic brain injury. J Head Trauma Rehabil2014;29:418–426.
  34. Cicerone, K.D., Azulay, J. Perceived self-efficacy and life satisfaction after traumatic brain injury. J Head Trauma Rehabil2007;22:257–266.
  35. Bellamkonda, E., Zollman, F. Relationship between employment status and sexual functioning after traumatic brain injury. Brain Inj2014;28:1063–1069.
  36. Miller, B.L., Cummings, J.L., McIntyre, H., Ebers, G., Grode, M. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatr1986;49:867–873.
  37. Simpson, G., Blaszczynski, A., Hodgkinson, A. Sex offending as a psychosocial sequela of traumatic brain injury. J Head Trauma Rehabil1999;14:567–580.
  38. Simpson, G., Tate, R., Ferry, K., Hodgkinson, A., Blaszczynski, A. Social, neuroradiologic, medical, and neuropsychologic correlates of sexually aberrant behavior after traumatic brain injury: a controlled study. J Head Trauma Rehabil2001;16:556–572.
  39. Mutarelli, E.G., Omuro, A.M., Adoni, T. Hypersexuality following bilateral thalamic infarction: case report. Arq Neuropsiquiatr2006;64:146–148.
  40. Bianchi-Demicheli, F., Rollini, C., Lovblad, K., Ortigue, S. Sleeping beauty paraphilia“: deviant desire in the context of bodily self-image disturbance in a patient with a fronto-parietal traumatic brain injury. Med Sci Monit2010;16:CS15-7.
  41. Graff-Radford, N.R., Damasio, H., Yamada, T., Eslinger, P.J., Damasio, A.R. Nonhaemorrhagic thalamic infarction. Clinical, neuropsychological and electrophysiological findings in four anatomical groups defined by computerized tomography. Brain1995;108:485–516.
  42. Formisano, R., Saltuari, L., Gerstenbrand, F. Presence of kluver-bucy syndrome as a positive prognostic feature for the remission of traumatic prolonged disturbances of consciousness. Acta Neurol Scand1995;91:54–57.
  43. Janszky, J., Fogarasi, A., Magalova, V., Tuxhorn, I., Ebner, A. Hyperorality in epileptic seizures: periictal incomplete Klüver-Bucy syndrome. Epilepsia2005;46:1235–1240.
  44. Wilkinson, C.W., Pagulayan, K.F., Petrie, E.C., Mayer, C.L., Colasurdo, E.A., Shofer, J.B. et al, High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury. Front Neurol2012;3:11.
  45. Schneider, H.J., Kreitschmann-Andermahr, I., Ghigo, E., Stalla, G.K., Agha, A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA2007;298:1429–1438.
  46. Lieberman, S.A., Oberoi, A.L., Gilkison, C.R., Masel, B.E., Urban, R.J. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab2001;86:2752–2756.
  47. Carroll, B.T., Goforth, H.W., Carroll, L.A. Anatomic basis of kluver-bucy syndrome. J Neuropsychiatry Clin Neurosc1999;11:116.
  48. Calabrò, R.S., Russo, M., Naro, A. Discussing sexual health after traumatic brain injury: an Unmet Need!. Innov Clin Neurosci2017;14:11–12.
  49. Rosen, R.C., Riley, A., Wagner, G., Osterloh, I.H., Kirkpatrick, J., Mishra, A. The international index of erectile function (IIEF) a multidimensional scale for assessment of erectile dysfunction. Urology2007;49:822–830.
  50. Stolwyk, R.J., Downing, M.G., Taffe, J., Kreutzer, J.S., Zasler, N.D., Ponsford, J.L. Assessment of sexuality following traumatic brain injury: validation of the brain injury questionnaire of sexuality. J Head Trauma Rehabil2013;28:164–170.
  51. Derogatis, L.R. The derogatis interview for sexual functioning (DISF/DISF-SR): an introductory report. J Sex Marital Ther1997;23:291–304.
  52. Gill, C.J., Sander, A.M., Robins, N., Mazzei, D.K., Struchen, M.A. Exploring experiences of intimacy from the viewpoint of individuals with traumatic brain injury and their partners. J Head Trauma Rehabil2011;26:56–68.
  53. Wedcliffe, T., Ross, E. The psychological effects of traumatic brain injury on the quality of life of a group of spouses/partners. S Afr J Commun Disord2001;48:77–99.
  54. Blais, M.C., Boisvert, J.M. Psychological adjustment and marital satisfaction following head injury. Which critical personal characteristics should both partners develop?. Brain Inj2007;21:357–372.
  55. Sander, A.M., Maestas, K.L., Pappadis, M.R., Hammond, F.M. Hanks multicenter study of sexual functioning in spouses/partners of persons with traumatic brain injury. RA Arch Phys Med Rehabil2016;97:753–759.
  56. Bivona, U., Antonucci, G., Contrada, M., Rizza, F., Leoni, F., Zasler, N.D. et al, biopsychosocial analysis of sexuality in adult males and their partners after severe traumatic brain injury. Brain Inj2016;30:1082–1095.
  57. Kreutzer, J.S., Zasler, N.D. Psychosexual consequences of traumatic brain injury: methodology and preliminary findings. Brain Inj1989;3:177–186.
  58. Gosling, J., Oddy, M. Rearranged marriages: marital relationships after head injury. Brain Inj1999;13:785–796.
  59. Kratz, A.L., Sander, A.M., Brickell, T.A., Lange, R.T., Carlozzi, N.E. Traumatic brain injury caregivers: a qualitative analysis of spouse and parent perspectives on quality of life. Neuropsychol Rehabil2017;27:16–37.
  60. Verschuren, J.E., Enzlin, P., Dijkstra, P.U., Geertzen, J.H., Dekker, R. Chronic disease and sexuality: a generic conceptual framework. J Sex Res2010;47:153–170.
  61. Calabrò, R.S., Polimeni, G., Bramanti, P. Current and future therapies of erectile dysfunction in neurological disorders. Recent Pat CNS Drug Discov2011;6:48–64.
  62. Calabrò, R.S., Furnari, A., Bramanti, P. Treatment and rehabilitation of sexual dysfunction in neurological diseases. in: R.S. Calabrò (Ed.) Male Sexual dysfunction in neurological disorders: From pathophysiology to rehabilitationNovaNY: Hauppauge2010.

via Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue – Journal of Clinical Neuroscience

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[Abstract] Psychometric Comparisons of the Quality of Life after Brain Injury between Individuals with Mild and Those with Moderate/Severe Traumatic Brain Injuries

This study compared psychometric properties of the Taiwanese version of the Quality of Life after Brain Injury (QOLIBRI) between patients with mild and those with moderate/severe traumatic brain injury (TBI). Of 683 participants, 548 had sustained a mild injury with Glasgow Coma Scale (GCS) scores of 13–15, and 135 had a moderate/severe injury with GCS scores of 3–12. The QOLIBRI comprises six domains: Cognition, Self, Daily Life and Autonomy, Social Relationships, Emotions, and Physical Problems. Results of the Rasch analysis showed that two items of “Problems with seeing/hearing” and “Finding one’s way about” were underfitting in the mild TBI group while the item “Problems with seeing/hearing” was underfitting and the item “TBI effects” was overfitting in the moderate/severe TBI group. The largest differential item functioning (DIF) between the mild and moderate/severe TBI groups appeared in the item “Energy,” followed by those of “Being slow/clumsy” and “Problems with seeing/hearing.” For both the mild and moderate/severe TBI groups, the two domains of Emotions and Physical Problems displayed strong ceiling effects, low person reliability and separation, and an incomplete range of the person measure covered by the item difficulty, while the remaining four domains had acceptable performances. While the psychometric performance of the QOLIBRI at the domain level was similar between the mild and moderate/severe TBI groups, certain items exhibited different functioning between the two groups. The reason why the two domains of the Emotions and Physical Problems performed poorly in the two TBI severity groups could be due to cross-cultural effects. The meanings of these DIF items, particularly for patients with a mild TBI, and factors contributing to the ceiling effect of the Emotions and Physical Problems domains in other ethnic Chinese populations need to be investigated further.

 

via Psychometric Comparisons of the Quality of Life after Brain Injury between Individuals with Mild and Those with Moderate/Severe Traumatic Brain Injuries | Journal of Neurotrauma

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[Abstract] Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis

Abstract

Objective

To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, are safe and cost effective for patients with acute or sub-acute conditions.

Data sources

Electronic database (AMED, CINAHL, EMBASE, MEDLINE, PEDro, PubMed) searches were updated from 2010 through June 2017.

Study selection

Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay or cost effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review.

Data extraction

Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale and The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis.

Data synthesis

Post intervention data were pooled with an inverse variance, random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate quality evidence that additional physical therapy services reduced length of stay by 3 days in sub-acute settings (MD-2.8, 95%CI -4.6 to -0.9, I20%) and low quality evidence that it reduced length of stay by 0.6 days in acute settings (MD -0.6, 95%CI -1.1 to 0.0, I2 65%). Additional physical therapy led to small improvements in self-care (SMD 0.11, 95%CI 0.03 to 0.19, I2 0%), activities of daily living (SMD 0.13, 95%CI 0.02 to 0.25, I2 15%) and health-related quality of life (SMD 0.12, 95%CI 0.03 to 0.21, I2 0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in sub-acute rehabilitation.

Conclusions

Additional physical therapy services improve patient activity and participation outcomes, while reducing hospital length of stay for adults. These benefits are likely safe and there is preliminary evidence to suggest they may be cost effective.

via Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study

The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18–67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.

 

via Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study | Journal of Neurotrauma

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[ARTICLE] Test-retest reliability, internal consistency and concurrent validity of Fatigue Severity Scale in measuring post-stroke fatigue – Full Text PDF

BACKGROUND: Post-stroke fatigue (PSF) is a common complaint among stroke survivors and has significant impacts on recovery and quality of life. Limited tools that measure fatigue have been validated in stroke.
AIM: The purpose of this study was to determine the psychometric properties of Fatigue Severity Scale (FSS) in patients with stroke.
DESIGN: Cross-sectional study.
SETTING: Teaching hospital outpatient setting.
POPULATION: Fifty healthy controls (mean age 61.1±7.4 years; 22 males) and 50 patients with stroke (mean age 63.6±10.3 years; 34 males).
METHODS: FSS was administered twice approximately a week apart through face-to-face interview. In addition, we measured fatigue with Visual Analogue Scale – Fatigue (VAS-F) and Short-Form Health Survey 36 version 2 vitality scale. We used Cronbach alpha to determine internal consistency of FSS. Reliability and validity of FSS were determined by intraclass correlation coefficient (ICC) and Spearman correlation coefficient (r).
RESULTS: FSS showed excellent internal consistency for both stroke and healthy groups (Cronbach’s alpha >0.90). FSS had excellent test-retest reliability for stroke patients and healthy controls (ICC=0.93 and ICC=0.90, respectively). The scale demonstrated good concurrent validity with VAS-Fatigue (all r>.60) and a moderate validity with the SF36-vitality scale. Furthermore, FSS was sensitive to distinguish fatigue in stroke from the healthy controls (P<0.01).
CONCLUSIONS: FSS has excellent internal consistency, test-retest reliability and good concurrent validity with VAS-F for both groups.
CLINICAL REHABILITATION IMPACT: This study provides evidence that FSS is a reliable and valid tool to measure post-stroke fatigue and is readily to be used in clinical settings.

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via Test-retest reliability, internal consistency and concurrent validity of Fatigue Severity Scale in measuring post-stroke fatigue – European Journal of Physical and Rehabilitation Medicine 2017 October;53(5):703-9 – Minerva Medica – Journals

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[WEB SITE] ROBOTS FOR REHAB

via Restoring collagen in menopausal women – HEALTH & SCIENCE – Jerusalem Post

BY JUDY SIEGEL-ITZKOVICH

 

 NOVEMBER 25, 2017 23:29

Jerusalem’s Alyn Hospital recently discussed at its annual conference a variety of modern ways to improve the quality of life of disabled young people.

wheelchairs

THE MOST modern wheelchairs are available for children who can even maneuver them with eye movements or joysticks, but robots and virtual reality have joined them.. (photo credit:JUDY SIEGEL-ITZKOVICH)

Rehabilitation of disabled children and teens no longer involves just training in the use of wheelchairs and providing prostheses to replace missing limbs. Ever-advancing technology has added robots, virtual reality, video screens and other assisting devices and ways to improve the youngsters’ quality of life and family cohesion. There are even (highly expensive) drugs that significantly ameliorate diseases that used to be considered hopeless. One powerhouse behind this revolution is Jerusalem’s ALYN Hospital, a national and comprehensive rehabilitation center for physically challenged and disabled children, adolescents and young adults.

The nonprofit facility, which treats all young patients, regardless of religious belief, nationality or ethnic background, was founded in 1932 by American orthopedist Dr. Henry Keller, who dedicated his life to such children. Working out of an old re-purposed monastery in the capital’s Katamon neighborhood, the medical staff cared for children disabled in the polio epidemic that spread through Israel and the rest of the world in the 1940s and 1950s. ALYN served as a treatment center, residence and school for 200 young patients.

In 1971, the voluntary organization was able to build the impressive Woldenberg Family Hospital complex in Jerusalem’s Kiryat Hayovel neighborhood to serve inpatients and outpatients.

Today, it is one of the world’s leading hospitals specializing in the active and intensive rehabilitation of children who have a broad range of physical disabilities caused not only by various congenital and progressive muscle, nerve and bone diseases, but also feeding disorders, severe respiratory problems, road and home accidents, terrorist attacks and severe burns. Patients who underwent orthopedic operations and neurosurgery also recover and are rehabilitated at ALYN.

The center includes a pre-school daycare center for children aged six months to three years, kindergartens, an after-school integration program and school classes. It provides services including occupational therapy, physiotherapy, hydrotherapy, speech therapy and psychological counseling in addition to support by medical specialists and social workers.

Its director-general since 2011, Dr. Maurit Beeri recently opened ALYN’s Third Annual Conference on Rehabilitation at the capital’s Crowne Plaza Hotel. An accompanying exhibition displayed a large variety of equipment available for disabled youngsters from wheelchairs to electronic devices.

Beeri, who graduated from the Hebrew University Medical Faculty and trained as a pediatrician at the Hadassah University Medical Center in Jerusalem, had never heard about ALYN until, as a medical resident, she was sent to work there for a few months. She saw there that children in wheelchairs could be taught to walk.

“I went and felt in love with it. It was a big discovery for me. If you want to create a real change in the life of a child, this is the place you should be.”

Health, she said at the conference attended by some 200 doctors, nurses, physiotherapists, occupational therapists and other, “is not just the absence of disease. It is to grow and develop, to enjoy well-being. Over a billion people in the world – one in seven – suffer from some type of disability. They have three times the risk of the non-disabled to be hurt in the health system, and half lack accessibility to a decent health system.”

While 250 million people around the globe need eyeglasses and don’t have them and many disabled people lack wheelchairs and other basic equipment, humanity is still much better off today than 200 years ago, said Beeri. Medical technology is developing at a rapid pace – faster than the health system does, so not all get the rehabilitation they need.

Over 17% of Israelis have some kind of physical disability, but today’s Israeli medical students “don’t hear the word ‘rehabilitation.’ They aren’t exposed to it in their studies.

They are not told what physiotherapists, occupational therapists, speech pathologists and audiologists do.” Child rehabilitation here is nevertheless more advanced than in many countries, she added, but even so, many significant things are lacking.”

Only recently did the Health Ministry open a rehabilitation division (headed by Dr. Tsaki Ziv-Ner) to coordinate such functions. “The future is very promising. There is more awareness of the rights of disabled; the problem is in the details. Everyone has the right to live with honor and as much independence as they can.”

DR. KEREN Politi, a pediatric neurologist at ALYN, told the participants that only a few decades ago, there was little to do to help children. “But thanks to genetics, we can give treatments, prevent problems and improve their quality of life – even with spinal muscular atrophy (SMA, which affects about 80 Israeli children) and Duchenne muscular dystrophy.

“We can influence gene regulation. We can give treatment with medical cannabis or with blood from the umbilical cord,” she said. “We can insert healthy genes into sick cells using exon skipping [a form of RNA splicing used to cause cells to “skip” over faulty or misaligned sections of genetic code, creating a shorter but still functional protein].”

A new drug approved by the US Food and Drug Administration named Spinraza that costs NIS 2 million a year per patient can help SMA kids hold up their head better, roll over, crawl and even stand. If the child is treated within 13 weeks of diagnosis, said Politi, they do much better. But covering the bill for all SMA children would gobble up a third of the annual increase to the basket of health services. “There are a lot of things we don’t know, such as how early to start. Maybe it could be given to the fetus, but there is a risk that this might cause leukemia.

Another drug, in an earlier stage of development, would be in pill form and threaten the sales of Spinraza if it proves just as effective, but there is as yet no evidence of longterm benefits.”

Medical cannabis for children is controversial.

“There are three types, and they have 60 different chemicals. Cannabis was used even in the 1850s for headaches and seizures, but its medical use declined as drug companies [falsely] claimed it was addictive and caused violence and psychosis. In the last 20 years, however, it has been brought back and used for numerous medical purposes in all ages.”

Every large Israeli pediatrics department tries cannabis oil on some children. “At ALYN,” said Politi, many parents want it for painful spasms and other things, but I dispense it carefully, not for children with normal cognition.”

Umbilical cord blood is being used experimentally to turn regular cells from the bone marrow into stem cells that can produce growth factors and have an anti-inflammatory effect. There is a group at Duke University in North Carolina that is looking at use of umbilical cord blood on cerebral palsy, but it has not brought about a big change.”

One of her young patients who suffered damage due to separation of her mother’s placenta got umbilical cord blood, but it didn’t help with the seizures. But medical cannabis was tried and he was able to sleep at night for the first time without crying.

PROF. TAMAR Weiss, a University of Haifa expert in the use of technology for rehabilitation, noted that there “is huge and accelerating growth in use of technologies. Almost every day there is something new. It took 50 years for half of public to get a telephone, and much less for smartphone. In rehabilitation, we have not yet reached this speed. We have to use ‘disruptive technologies’ – innovation that creates a new market and eventually disrupts an existing market, displacing established firms and products. But not all paradigm shifts mean an improvement in treatment,” she said. More than half of all rehabilitation technologies that came to the market in the last decade are not used today or they are underused because people didn’t know how to use it. Children from Gaza, for example, were given many devices for their disability but when they went home, they were just put in the closet.

A successful item for rehabilitation is video on a screen so disabled children can move. There are relatively cheap virtual reality devices that can benefit them and are easy to use. A company named SenSerum offers a virtual playground that children with autism can use to jump as if they were on a real trampoline.

“There is a need to find a way for robots to copy human movements, and the technology should be inexpensive, small in size and light in weight. They should be adaptable to the intelligence and abilities of each child and be able to document changes and improvements.”

Robots are very good for disabled kids because “they repeat and are consistent. They can provide exact, continuous quantitative feedback through sensors,” Weiss said. Obviously, robots alone are not enough. They must be complemented by human therapists.

ALYN PHYSIOTHERAPIST Orit Bartov presented the benefits of “intelligent wheelchairs” with built-in sensors to prevent collisions and “eye-drivers” that enable steering with one’s eyes. Children can visit the zoo along with the family using a respirator that’s the size of a laptop. There are cheap children’s plastic and metal wheelchairs for the developing countries.”

While physiotherapy in the 1990s was aimed at strengthening one joint at a time, said Bartov, today it involves rehabilitating the whole body, creating balance, control of movement and coordination.

“Muscle tone is not an aim but a means. There is cognitive rehabilitation, not just medical but also biological, psychological and social. We have to learn about the longterm effects of operations on muscle and use new knowledge in engineering, neuroscience and rehabilitation to create new interventions.”

It takes about a decade for knowledge to be translated from development of technology into a product used in the field.

“We used to try to change the patient, but it’s more important to change the patient’s environment to suit him,” she explained.

The physiotherapist’s take-home message is that the disabled patient should always be the focus; we are not technicians but evidence-based clinicians; there is no alternative to using your hands; and don’t be afraid to try something new.”

ALYN RECENTLY set up a program called PELE (Child Solutions) to create individualized products for helping children with special needs identified by therapists or family members. Professionals and volunteers in engineering and other fields donate their time to design what they need, said Dana Hochstein Mann, the director of ALYNnovation to match the innovative products with manufacturers around the world who want, through cooperation, to bring it to the world market.

Mann noted that zippers developed by Under Armor for the disabled to close with one hand have expanded their use to the wider public. “A child asked Nike to make a shoe with a zipper in the back to make it easy to put on. Now they are being made as a fashionable item for the general public. Companies such as ReWalk and OrCam, are talking about accessibility for the disabled all the time.”

Israel became the “Startup Nation,” said Mann, for good reasons.

“We are not satisfied with situations that need improvement. We don’t like failure, but it is acceptable, as it’s better for an entrepreneur to try something than having never tried; one learns from failure. Due to the lack of funds in Israel, creative solutions result.

It’s a minuscule market without neighboring countries where we can sell products, so one can start small and then grow and think global.” In the rehabilitation field, all these conditions are beneficial, she concluded.

PERHAPS THE most inspiring speaker was a young man who reached the stage on his wheelchair via a ramp. Shahar Botzer, who was born with paralyzed legs but whose arms are functional, heads 2B Community, a venture capital group that invests in young, small-to-medium businesses with potential for significant growth and a turnover of over NIS 1 million a year.

It aims not only at making money but also has a social goal and strict standards that examine the business’s ethical conduct in a wide variety of parameters, including fair employment, environmental protection and contribution to the community.

Married and with a family, Botzer clearly exemplifies what ALYN would want all its “graduates” to strive for.

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