Rehab Centers: Relationship of Speech-Language Pathology Inpatient Rehabilitation Interventions and Patient Characteristics to Outcomes Following Spinal Cord Injury: The SCIRehab Project.

Relationship of speech-language pathology inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project.

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J Spinal Cord Med. 2012 Nov; 35(6): 565-77
Gordan W, Gerber D, David DS, Adornato V, Brougham R, Gassaway J, Kreider SE, Whiteneck G

Background/objective: Describe associations of patient characteristics and speech-language pathology (SLP) interventions provided during impatient rehabilitation for spinal cord injury (SCI) to outcomes at discharge and 1-year post-injury.Speech-language pathologists at six inpatient rehabilitation centers documented details of treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary. Cognitive, participation, and mood outcomes for a subsample of patients with traumatic brain injury (TBI) and cognitive-communication limitations (CCLs) were examined.SLP treatment factors explain a small amount of variation in cognitive Functional Independence Measure (FIM), participation, and mood. Variation explained by treatment factors for cognitive outcomes at the time of discharge increased when the patient group was more homogeneous (patients with TBI and CCLs). More time in SLP cognitive-communication interventions had a negative relationship, while longer length of stay was positive. The added explanatory power was not seen for similar outcomes at 1-year post-injury.Patients with SCI who have the greatest need for interventions to address cognitive limitations due to TBI receive the most SLP cognitive-communication treatment and show the greatest amount of improvement during rehabilitation. Their cognitive functioning remained impaired at discharge; this likely accounts for the consistent finding that more hours of SLP cognitive-communication treatment is associated with lower cognitive FIM scores at discharge. Future research on individuals with dual SCI and TBI should include more comprehensive assessment of individual differences in cognitive performance in order to better examine the complex relationships between SLP treatments and outcomes. Note: This is the fifth of nine articles in this SCIRehab series.
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Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project.

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J Spinal Cord Med. 2012 Nov; 35(6): 527-46
Ozelie R, Gassaway J, Buchman E, Thimmaiah D, Heisler L, Cantoni K, Foy T, Hsieh CH, Smout RJ, Kreider SE, Whiteneck G

Background/objective: Describe associations of occupational therapy (OT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and 1-year post-injury.Occupational therapists at six inpatient rehabilitation centers documented detailed information about treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary for a 75% subset; models were validated with the remaining 25%. Functional outcomes for injury subgroups (motor complete low tetraplegia and motor complete paraplegia) also were examined.OT treatment variables explain a small amount of variation in Functional Independence Measure (FIM) outcomes for the full sample and significantly more in two functionally homogeneous subgroups. For patients with motor complete paraplegia, more time spent in clothing management and hygiene related to toileting was a strong predictor of higher scores on the lower body items of the self-care component of the discharge motor FIM. Among patients with motor complete low tetraplegia, higher scores for the FIM lower body self-care items were associated with more time spent on lower body dressing, manual wheelchair mobility training, and bathing training. Active patient participation during OT treatment sessions also was predictive of FIM and other outcomes.OT treatments add to explained variance (in addition to patient characteristics) for multiple outcomes. The impact of OT treatment on functional outcomes is more evident when examining more homogeneous patient groupings and outcomes specific to the groupings. Note: This is the third of nine articles in the SCIRehab series.
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Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: The SCIRehab Project.

Filed under: Rehab Centers

J Spinal Cord Med. 2012 Nov; 35(6): 484-502
Whiteneck G, Gassaway J, Dijkers MP, Heinemann AW, Kreider SE

Background/objective: To examine associations of patient characteristics along with treatment quantity delivered by seven clinical disciplines during inpatient spinal cord injury (SCI) rehabilitation with outcomes at rehabilitation discharge and 1-year post-injury.Six inpatient SCI rehabilitation centers enrolled 1376 patients during the 5-year SCIRehab study. Clinicians delivering standard care documented details of treatment. Outcome data were derived from SCI Model Systems Form I and II and a project-specific interview conducted at approximately 1-year post-injury. Regression modeling was used to predict outcomes; models were cross-validated by examining relative shrinkage of the original model R(2) using 75% of the dataset to the R(2) for the same outcome using a validation subsample.Patient characteristics are strong predictors of outcome; treatment duration adds slightly more predictive power. More time in physical therapy was associated positively with motor Functional Independence Measure at discharge and the 1-year anniversary, CHART Physical Independence, Social Integration, and Mobility dimensions, and smaller likelihood of rehospitalization after discharge and reporting of pressure ulcer at the interview. More time in therapeutic recreation also had multiple similar positive associations. Time spent in other disciplines had fewer and mixed relationships. Seven models validated well, two validated moderately well, and four validated poorly.Patient characteristics explain a large proportion of variation in multiple outcomes after inpatient rehabilitation. The total amount of treatment received during rehabilitation from each of seven disciplines explains little additional variance. Reasons for this and the phenomenon that sometimes more hours of service predict poorer outcome, need additional study. Note: This is the first of nine articles in the SCIRehab series.
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Mid- to long-term follow-up of total shoulder arthroplasty using a keeled glenoid in young adults with primary glenohumeral arthritis.

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J Shoulder Elbow Surg. 2013 Jan 9;
Denard PJ, Raiss P, Sowa B, Walch G

BACKGROUND: The purpose of this study was to examine the mid- to long-term functional outcome and implant survival of total shoulder arthroplasty (TSA) in adults aged 55 years or younger with primary glenohumeral arthritis. The hypothesis was that TSA would lead to improvement in functional outcome but that implant survival would decline between 5 years and 10 years postoperatively. MATERIALS AND METHODS: Between 1992 and 2004, 52 TSAs were implanted in 8 centers for primary glenohumeral arthritis in patients aged 55 years or younger. Minimum follow-up of 5 years was available in 50 patients at a mean of 115.5 months postoperatively. Kaplan-Meier survivorship analysis was performed, and clinical outcome was assessed. RESULTS: After TSA, adjusted Constant scores improved from 37.0% to 73.4% and forward flexion improved from 97° to 128° (P < .001). The adjusted Constant score was 80.0 in patients free of revision of the glenoid compared with 43.6 in the group requiring revision of the glenoid (P < .001). Survivorship of the glenoid component with revision surgery for glenoid loosening as the endpoint was 98% (95% confidence interval, 89.4%-100%) at 5 years and 62.5% (95% confidence interval, 40.6%-81.2%) at 10 years. Factors associated with survival of the glenoid included anatomic humeral component positioning and a compaction glenoid preparation technique. CONCLUSIONS: At 5 years' follow-up, TSA leads to improvement in functional outcome and a satisfactory implant survival rate of 98% in young adults with primary glenohumeral arthritis. However, the 10-year survival rate of TSA was only 62.5% in patients aged 55 years or younger at the time of surgery. HubMed – rehab centers

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