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Biomedical subjects

C D Mulrow

Publications and source records attributed to C D Mulrow.

At least 73 records · Page 4Linked to original sources
PubMed1993

Effects of physical therapy on functional status of nursing home residents.

Nursing home residents typically have decreased functional and physical status and high health care utilization and costs. This randomized trial evaluates whether physical therapy is beneficial for frail debilitated long-stay residents of nursing homes. Subjects are recruited from a cohort of academic and community nursing home residents who have resided in the nursing home for greater than 3 months and are over age 60 and dependent in at least two activities of daily living. Subjects randomized to the intervention group receive one-on-one physical therapy sessions three times weekly for 4 months, while control group subjects receive structured social visits three times weekly to control for potential Hawthorne effects. Physical therapy sessions generally last 30 minutes and consist of functional activity and general conditioning exercises; these exercises are individually tailored to the subject's level of physical and functional disability. Prime outcome variables are physical function assessed by an observer-administered, performance-based instrument and self-perceived health status assessed by the Sickness Impact Profile. Health care utilization and associated costs are calculated for the following areas: the nursing home, hospitalizations, outpatient visits and procedures, medications, and the intervention. A cost-effectiveness ratio dividing incremental health care utilization and physical therapy intervention costs by the observed improvement in physical function is calculated. It is expected that results of this study can be used to help determine whether long-stay nursing home residents should be eligible for physical therapy.

Activities of Daily Living↗
PubMed1993

Falls: an examination of three reporting methods in nursing homes.

OBJECTIVE: To examine the concordance of various fall reporting methods and to use the results to recommend a preferred method of ascertaining fall frequency for residents of nursing homes, both for research and in the collection of federally mandated nursing home data. DESIGN: A cohort study followed for 858 patient months, with a mean individual follow-up of 6.6 months. MEASUREMENTS: Falls were independently ascertained monthly by three methods: review of administrative incident reports, nursing home chart abstraction, and structured interview of subjects. Concordance of events was assessed using measures of simple agreement and Kendall's Tau-b. Simple correlation and multiple regression were used to evaluate the relation of age, sex, gender, depression, mental status, and functional status with degree of concordance between self-reported falls and chart-recorded falls. SETTING: One academic and six community nursing homes in San Antonio, Texas. PARTICIPANTS: 131 long-stay nursing home residents, greater than 60 years of age, dependent in at least two activities of daily living, and mildly cognitively impaired. RESULTS: Falls were ascertained in 74 of the 131 individuals; 53 subjects fell 124 times by incident report, 58 had 140 falls according to chart review, and 66 subjects self-reported 232 falls. Greatest agreement between reporting methods was shown for incident report and chart review, with a Kendall's Tau-b of 0.88; self-report and chart-review agreement was 0.56; and self-report and incident agreement was 0.53. Estimated total fall events were more often (P = 0.001) identified by chart review (92%) than incident report (82%). Although concordance was higher for non-fallers, no significant relationships were observed between concordance and age, sex, race, depression, mental status, and functional status. Also, there was no systematic relationship between length of follow-up and degree of concordance. CONCLUSIONS: Fall frequency varies by ascertainment method, with chart review reflecting a greater number of fall events than the traditionally counted incident reports.

Accidental Falls↗
PubMed1992

Sustained benefits of hearing aids.

This study was designed to evaluate long-term benefits of hearing aids in elderly individuals with hearing loss. A primary care cohort of 192 elderly, hearing-impaired veterans (mean age 72 +/- 6, 97% White, 94% retired) were assessed at baseline and at 4, 8, and 12 months after hearing aid fitting. Drop-out rates at 4, 8, and 12 months were 5%, 13%, and 16%, respectively. Outcome assessments included several quality-of-life scales: Hearing Handicap Inventory in the Elderly (HHIE), Quantified Denver Scale of Communication Function (QDS), Geriatric Depression Scale (GDS), and the Short Portable Mental Status Questionnaire (SPMSQ). All quality-of-life areas improved significantly from baseline to 4-month post-hearing aid fittings (p < 0.05). Social and emotional (HHIE), communication (QDS), and depression (GDS) benefits were sustained at 8 and 12 months, whereas cognitive changes (SPMSQ) reverted to baseline at 12 months. We conclude that hearing aids provide sustained benefits for at least a year in these elderly individuals with hearing impairment.

Aged↗
PubMed1992

The impact of physical therapy on nursing home patient outcomes.

The objective of this retrospective study was to assess the intensity and outcome of individual components of interdisciplinary care, including physical therapy, in a teaching nursing home. Two independent reviewers abstracted records from 90 consecutive patients admitted to the nursing home. They rated intensity and outcome of each program component using a structured, standardized data-abstraction form. Program components were physical therapy, speech therapy, psychosocial therapy, medication adjustment, and other medical and nursing care. Physical therapy and medication adjustment were the most frequently received therapies. Eighty-eight percent of the patients receiving high-intensity physical therapy and 33% of the patients receiving moderate-intensity physical therapy improved. For medication adjustment, 93% and 72% of the high- and moderate-intensity groups, respectively, improved. In univariate analyses, physical therapy intensity and age were associated with improvement. Baseline function in activities of daily living and cognitive function were not associated with physical therapy outcome. A stepwise multiple logistic regression analysis revealed that only therapy intensity was associated with improved outcome. We conclude that physical therapy was efficacious for patients receiving high-intensity treatment. Advanced age, activities-of-daily-living status, and cognitive impairment were not associated with poor physical therapy outcome.

Aged↗
PubMed1992

Physical therapy assessment and treatment protocol for nursing home residents.

This article describes a standard protocol for assessing physical function in elderly nursing home residents. Major physical dimensions that are measured with the protocol include range of motion, muscle force, muscle reflex activity, sensation, soft tissue status, balance/coordination, and posture. A practical, functionally prioritized treatment model based on the assessment is also presented. The standardized assessment and treatment plan may be useful to the physical therapist in (1) planning and prioritizing treatment, (2) identifying when goals have been met, (3) recognizing when there is a need for treatment plan modification, and (4) educating physical therapy students in applying problem-solving skills in their treatment sessions.

Activities of Daily Living↗
PubMed1992

Correlates of successful hearing aid use in older adults.

OBJECTIVE: To evaluate whether age, education, functional handicap, degree of hearing loss, amount of hearing and speech recognition gain achieved with hearing aid, locus of control, visual acuity, manual dexterity, number of comorbid diseases, and number of medications predict which elderly individuals with hearing loss are likely to benefit from hearing aids. DESIGN: A logistic regression prediction model for hearing aid benefit was developed on a training set of 89 individuals and verified in a test set of 87 individuals. Hearing aid success was assessed 4 mo after hearing aid adminstration. It was defined by assessing hearing aid satisfaction, functional handicap change post-hearing aid, and number of hours of weekly hearing aid use. SETTING: All patients were elderly male veterans from the Audie L. Murphy Memorial Veterans Hospital. There were no differences in demographic or clinical characteristics in training versus test set individuals. RESULTS: Several variables, including baseline perceived functional handicap, education, number of medications, and age correlated with individual success measures. However, no variables consistently correlated with all success measures. The accuracy of prediction rules for success utilizing the variables ranged from 75 to 88% in the training set, and 54 to 84% in the test set. CONCLUSION: Although certain baseline factors were statistically significantly related to individual measures of successful hearing aid use, no factors were good enough to consistently differentiate successful from unsuccessful hearing aid candidates.

Age Factors↗
PubMed1991

Estimating and testing an index of responsiveness and the relationship of the index to power.

Responsiveness has been proposed as a criterion, in addition to reliability and validity, to evaluate instruments that measure quality of life or functional status. The responsiveness index measures the change in a quality of life score due to a treatment relative to the variability of changes in that score within a stable control group. We derive the expected value, variance and distribution of the responsiveness index and give a large sample distribution for comparing the responsiveness of two different instruments. We also give the relationship between the responsiveness index and the power of a test of treatment effect.

Hearing Aids↗
PubMed1990

Quality-of-life changes and hearing impairment. A randomized trial.

OBJECTIVE: To assess whether hearing aids improve the quality of life of elderly persons with hearing loss. SETTING: Primary care clinics at a Bureau of Veterans Affairs hospital. PATIENTS: One hundred and ninety-four elderly veterans who were identified as being hearing impaired from a screening survey involving 771 consecutive clinic patients. Of the original 194, 188 (97%) completed the trial. INTERVENTION: Subjects were randomly assigned to either receive a hearing aid (n = 95) or join a waiting list (n = 99). MAIN ENDPOINTS: A comprehensive battery of disease-specific and generic quality-of-life measures were administered at baseline, 6 weeks, and 4 months. MEASUREMENTS AND MAIN RESULTS: Persons assigned to the two groups were similar in age, ethnicity, education, marital status, occupation, and comorbid diseases. At baseline, 82% of subjects reported adverse effects on quality of life due to hearing impairment, and 24% were depressed. At follow-up, a significant change in score improvements for social and emotional function (34.0; 95% CI, 27.3 to 40.8; P less than 0.0001), communication function (24.2; CI, 17.2 to 31.2; P less than 0.0001), cognitive function (0.28; CI, 0.08 to 0.48; P = 0.008), and depression (0.80; CI, 0.09 to 1.51; P = 0.03) was seen in subjects who received hearing aids compared with those assigned to the waiting list. Six drop-outs (three per group), no crossovers, and no significant changes in cointerventions were seen. Average, self-reported, daily aid use in the hearing aid group was 8 hours. CONCLUSION: Hearing loss is associated with important adverse effects on the quality of life of elderly persons, effects which are reversible with hearing aids.

Aged↗
PubMed1990

More informative abstracts revisited.

Following proposals in 1987 and 1988, several medical journals have provided more informative abstracts ("structured abstracts") for articles of clinical interest. Structured abstracts for original studies require authors to systematically disclose the objective, basic research design, clinical setting, participants, interventions (if any), main outcome measurements, results, and conclusions; and for literature reviews the objective, data sources, methods of study selection, data extraction and synthesis, and conclusions. More informative abstracts of this kind can facilitate peer review before publication, assist clinical readers to find articles that are both scientifically sound and applicable to their practices, and allow more precise computerized literature searches. We review the feasibility, acceptability, and dissemination of structured abstracts, reassess the underlying strategy, and describe modifications of the approach. This innovation can aid communication from scientists to clinicians, and other clinical journals are invited to join this effort.

Abstracting and Indexing↗
PubMed1990

A critical reevaluation of the Quantified Denver Scale of Communication Function.

The Quantified Denver Scale of Communication Function (QDS) is a 25 item questionnaire developed to measure communication difficulties in adults with hearing impairment. This study reassessed the constructs, reliability, and validity of the scale, and developed a 5 item short version. The QDS was administered to 238 elderly individuals (137 with and 101 without hearing loss). Factor analysis using this sample identified only two subscale constructs as opposed to four originally proposed constructs. The validity of the new revised two-construct model was verified by four independent investigators who labeled the two constructs as measuring self isolation and communication function. The internal reliability of the revised scale was 0.97 and of both construct subscales was 0.95. Overall test-retest reliability was 0.73. Validity examined by comparing the revised scale with another well-known handicap measure, the Hearing Handicap Inventory for the Elderly, was adequate: overall scale correlations were 0.73 and subscale correlations ranged from 0.64 to 0.72. The accuracy of the revised QDS for discriminating between individuals with and without hearing loss was 73%. Stepwise discriminant analysis generated a 5 item short version scale which contained two questions from the long communication subscale and three from the long self-isolation subscale. The accuracy of the short QDS was 74%. We conclude that the revised QDS is a reliable and valid scale that can be used to assess self isolation and communication function in elderly individuals with hearing loss, and that a new 5 item short version performs as well as the original 25 item scale.

Aged↗
PubMed1990

Discriminating and responsiveness abilities of two hearing handicap scales.

Several scales exist for screening handicap and assessing rehabilitation in elderly individuals with hearing loss. There are few comparative studies, however, to suggest which scales perform best. Using receiver-operating curves and responsiveness indices, we examined the relative discriminating ability and sensitivity to detect change of four scales: a long and short version of the Hearing Handicap Inventory in the Elderly (HHIE-L, HHIE-S), and a long and short version of the Revised Quantified Denver Scale of Communication Function (RQDS-L, RQDS-S). All scales were administered to 137 elderly veterans with hearing loss and 101 elderly veterans without hearing loss. Follow-up testing to determine relative ability to detect change was assessed in hearing impaired individuals only after they had used a hearing aid for 4 months. Discriminative accuracy for correctly identifying individuals with hearing loss were: HHIE-L 78%, HHIE-S 79%, RQDS-L 73%, and RQDS-S 74%. Overall differences between the HHIE-S and the RQDS-S were not statistically significant (p = 0.06). True positive results were greater with the HHIE-S compared to the RQDS-S (p = 0.03). Responsiveness indices were: HHIE-L 1.78, HHIE-S 1.86, RQDS-L 1.04, and RQDS-S 1.07. Differences between the HHIE-S and the RQDS-S were statistically significant (p less than 0.05). We conclude short versions of the HHIE and RQDS are as accurate and sensitive for detecting change as long versions, and the HHIE-S is a superior versatile instrument for screening and assessing rehabilitation in elderly individuals with hearing impairment.

Aged↗
PubMed1990

Association between hearing impairment and the quality of life of elderly individuals.

Hearing impairment is one of the most common chronic health problems of elderly Americans. Although adverse effects on quality of life are thought to be considerable, they have not been rigorously evaluated. This study was designed to identify the types and extent of dysfunction experienced by elderly individuals with hearing loss, and to define the most appropriate measures for assessing this dysfunction. Elderly male veterans attending a primary care clinic were screened for hearing loss and had their quality of life assessed with a comprehensive battery of disease-specific and generic measures. Of 472 people who had their hearing tested, 106 had hearing loss. Hearing loss was associated with significant emotional (P = .0001), social (P = .0001), and communication (P = .02) dysfunction. Most individuals (66%) perceived these dysfunctions as severe handicaps even though audiologic loss revealed only mild to moderate impairment (pure tone average loss, 27-55 dB). Adverse effects were best detected with disease-specific rather than generic functional status measures. We conclude that hearing impairment is associated with important adverse effects on the quality of life of elderly individuals, and that these effects are perceived as severe handicaps even by individuals with only mild to moderate degrees of hearing loss.

Activities of Daily Living↗
PubMed1989

Captopril-stimulated renin secretion in the diagnosis of renovascular hypertension.

Evidence concerning the clinical utility of single dose captopril in the diagnosis of renovascular hypertension was evaluated. Of 173 identified papers, 16 were specifically selected because they used single dose oral captopril and obtained pre-dose and post-dose peripheral renin levels in at least one patient with renovascular hypertension. These 16 studies were appraised independently by three reviewers using standardized forms for evaluation of diagnostic tests. The 16 studies included 805 patients. All studies involved referred hypertensive populations; detailed demographics and clinical characteristics were not provided. Captopril test procedures varied in all studies. Thirteen of 16 studies used arteriography as a gold standard for the diagnosis of renovascular hypertension, and three of 16 used surgical outcome data. In ten studies, patients with renovascular hypertension clearly had a significantly greater increase in plasma renin activity than patients with essential hypertension. In the remaining six, plasma renin activity was increased in patients with renovascular hypertension but control comparisons were not made adequately. Existing data suggest that the captopril test may be useful in identifying patients with renovascular hypertension. However, specific clinical recommendations regarding its use cannot be made until future research better defines test cutoff points and identifies which patients are most likely to benefit from the test.

Captopril↗
PubMed1988

Relative efficacy of vasodilator therapy in chronic congestive heart failure. Implications of randomized trials.

We examined existing evidence concerning the relative efficacy of various vasodilator agents in chronic congestive heart failure. Only randomized placebo-controlled trials with clinical end points and treatment durations of four weeks or more were selected from an exhaustive search of the English-language medical literature. Twenty-eight trials involving 1976 patients were found. Treatment durations of the trials varied from one month to two years. Patients with symptomatic heart failure despite digitalis and diuretic therapy were studied; most were middle-aged men and approximately half had coronary artery disease. Results of the trials were appraised by three independent observers, and mortality and functional status outcomes were pooled in a meta-analysis. All vasodilator agents except hydralazine hydrochloride were associated with improvements in functional status. Angiotensin converting-enzyme inhibitors were the only agents associated with both decreased mortality (odds ratio, 0.51; 95% confidence interval, 0.34 to 0.75) and improved functional status (odds ratio, 4.53; 95% confidence interval, 3.46 to 5.92). The optimal timing for initiation of these agents was not established.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1988

A proposal for more informative abstracts of review articles.

This proposal presents guidelines for preparing informative abstracts of review articles. Six guidelines are proposed: 1. The abstract should begin with a precise statement of the primary objective of the review. 2. The data sources for the review should be succinctly summarized. 3. The criteria used to select studies from the data sources and the method by which these criteria were applied should be specified. 4. The guidelines used for abstracting data and assessing data quality should be described. 5. The main results of the review and the methods used to obtain these results should be stated. 6. Conclusions and potential applications of the review's results should be clearly and succinctly stated. Application of these guidelines can lead to efficient identification of relevant, scientifically sound review articles, a greater awareness of the vital elements of a good review article, more precise computerized literature searches, and improved peer-review processes.

Abstracting and Indexing↗
PubMed1987

Guidelines for reading case-control studies.

To develop guidelines for evaluation of case-control reports a survey of 37 experts in the performance and evaluation of case-control studies was conducted. A majority of the respondents listed 20 items as essential; 80-90% considered identification of case and control sources, exclusion criteria, and response rate as essential; 75-80% considered information on methods of data collection, "blinding" of interviewers, investigation of bias, and methods of dealing with confounding variables essential; 70% considered a description of the analytic methods and 57% the presentation of confidence limits essential. Twenty items judged essential by more than half the survey participants were used as guidelines to appraise 48 case-control studies published in 1984. In 88% of these studies information was lacking on at least one of the items. The proposed guidelines serve as a framework for readers to effectively assess the validity of a case-control report.

Epidemiologic Methods↗