Early Predictors of Lumbar Spine Surgery After Occupational Back Injury: Results From a Prospective Study of Workers in Washington State.

Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State.

Filed under: Rehab Centers

Spine (Phila Pa 1976). 2012 Dec 12;
Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM

Study Design. Prospective population-based cohort studyObjective. To identify early predictors of lumbar spine surgery within 3 years after occupational back injurySummary of Background Data. Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury.Methods. Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers with new worker’s compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The model's area under the receiver operating characteristic curve (AUC) was used to determine the model's ability to identify correctly workers who underwent surgery.Results. In the D-RISC sample of 1,885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those under age 35, women, Hispanics, and those whose first provider was a chiropractor. 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The multivariate model's AUC was 0.93 (95% CI 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery.Conclusion. Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables. HubMed – rehab

 

Return to Play in Elite Rugby Union: Application of Global Positioning System Technology in Return to Running Programs.

Filed under: Rehab Centers

J Sport Rehabil. 2012 Dec 11;
Reid LC, Cowman JR, Green BS, Coughlan GF

Global positioning systems (GPS) are widely used in a sports setting to evaluate the physical demands on players in training and competition. The use of these systems in the design and implementation of rehabilitation and return to running program has not yet been elucidated. Objective: To demonstrate the application of GPS technology in the management of return to play in elite club Rugby Union. Design: Case Series. Setting: Professional Rugby Union club team. Participants: 8 elite Rugby Union players (Age: 27.86 ± 4.78 years, Height: 1.85 ± 0.08 m, Weight: 99.14 ± 9.96 kg). Intervention(s): Players wore a GPS device for the entire duration of a club game. Main Outcome Measure(s): Variables of locomotion speed and distance were measured. Results: Differences in physical demands between playing positions were observed for all variables. Conclusions: An understanding of the position specific physical demands measured by GPS, provides key information regarding the level and volume of loads sustained by a player in a game environment. Using this information, the sports medicine practitioner can develop rehabilitation and return to running protocols specific to that player position to optimize safe RTP.
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Effect of Eccentric Strengthening Following Anterior Cruciate Ligament Reconstruction on Quadriceps Strength.

Filed under: Rehab Centers

J Sport Rehabil. 2012 Dec 11;
Lepley LK, Palmieri-Smith R

Interventions aimed at safely overloading the quadriceps muscle after anterior cruciate ligament (ACL) reconstruction are essential to reducing quadriceps muscle weakness that often persists long after the rehabilitation period. Despite the best efforts of clinicians and researchers to improve ACL rehabilitation techniques, a universally effective intervention to restore pre-injury quadriceps strength has yet to be identified. A muscle’s force producing capacity is most optimal when an external force exceeds that of the muscle while the muscle lengthens. Hence, the potential to improve muscle strength by overloading the tissue is greater with eccentric strengthening than with concentric strengthening. Traditionally, the application of early post-operative high-intensity eccentric resistance training to the ACL reconstructed limb has been contraindicated, as there is potential for injury to the ACL graft, articular cartilage, or surrounding soft tissue structures. However, recent evidence suggests that the application of early progressive, high-force eccentric resistance exercises to the involved limb can be used to safely increase muscle volume and strength in ACL reconstructed individuals. As a result, eccentric strengthening may be another attractive alternative to traditional concentric strengthening to improve quadriceps strength post-ACL reconstruction.
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A Randomized Controlled Trial of Postthoracotomy Pulmonary Rehabilitation in Patients with Resectable Lung Cancer.

Filed under: Rehab Centers

J Thorac Oncol. 2012 Dec 12;
Stigt JA, Uil SM, van Riesen SJ, Simons FJ, Denekamp M, Shahin GM, Groen HJ

INTRODUCTION:: Little is known about the effects of rehabilitation for patients with lung cancer after thoracotomy. The primary objective of this study was to evaluate the effect of a multidisciplinary rehabilitation program on quality of life (QOL) and secondary objectives were to determine its effects on pain and exercise capacity and the feasibility of combining rehabilitation with adjuvant chemotherapy. METHODS:: Patients who had undergone a thoracotomy for lung cancer were randomized between rehabilitation and usual care. Rehabilitation consisted of twice-weekly training for 12 weeks starting 1 month after hospital discharge, scheduled visits to pain specialists, and medical social work. QOL and pain were measured with validated questionnaires at baseline and after 1, 3, 6, and 12 months. Exercise tolerance was assessed at baseline and after 3 months with a 6-minute walking distance test. RESULTS:: The study closed prematurely because of the introduction of video-assisted thoracoscopic surgery. Of 57 randomized patients, 49 patients (23 active and 26 control) were analyzed. QOL was not significantly different between groups, although, the active group reported more pain after 3 and 6 months and more limitations because of physical problems after 3 months. In the active group, 6-minute walking distance improved by 35 m from preoperative baseline, as opposed to the control group that showed a decline by 59 m (p = 0.024 for difference). Patients treated with adjuvant chemotherapy showed decreased attendance at training sessions. CONCLUSION:: Rehabilitation did not result in a better QOL. Exercise tolerance improved at the cost of more pain and more limitations because of physical problems. We suggest that rehabilitation is better postponed for 3 to 4 months after hospital discharge.
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Children with Heavy Prenatal Alcohol Exposure have Different Frequency Domain Signal Characteristics when Producing Isometric Force.

Filed under: Rehab Centers

Neurotoxicol Teratol. 2012 Dec 10;
Nguyen TT, Ashrafi A, Thomas JD, Riley EP, Simmons RW

To extend our current understanding of the teratogenic effects of prenatal alcohol exposure on the control of isometric force, the present study investigated the signal characteristics of power spectral density functions resulting from sustained control of isometric force by children with and without heavy prenatal exposure to alcohol. It was predicted that the functions associated with the force signals would be fundamentally different for the two groups. Twenty-five children aged between 7 and 17years with heavy prenatal alcohol exposure and 21 non-alcohol exposed control children attempted to duplicate a visually represented target force by pressing on a load cell. The level of target force (5 and 20% of maximum voluntary contraction) and the time interval between visual feedback (20ms, 320ms and 740ms) were manipulated. A multivariate spectral estimation method with sinusoidal windows was applied to individual isometric force-time signals. Analysis of the resulting power spectral density functions revealed that the alcohol-exposed children had a lower mean frequency, less spectral variability, greater peak power and a lower frequency at which peak power occurred. Furthermore, mean frequency and spectral variability produced by the alcohol-exposed group remained constant across target load and visual feedback interval, suggesting that these children were limited to making long-time scale corrections to the force signal. In contrast, the control group produced decreased mean frequency and spectral variability as target force and the interval between visual feedback increased, indicating that when feedback was frequently presented these children used the information to make short-time scale adjustments to the ongoing force signal. Knowledge of these differences could facilitate the design of motor rehabilitation exercises that specifically target isometric force control deficits in alcohol-exposed children.
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