Biomedical subjects

Diana H Rintala

Publications and source records attributed to Diana H Rintala.

13 recordsLinked to original sources

PubMed2006

Racial/ethnic differences in FIM scores and length of stay for underinsured patients undergoing stroke inpatient rehabilitation.

OBJECTIVE: To explore racial/ethnic differences in FIM data from admission to discharge in underinsured patients undergoing inpatient stroke rehabilitation. DESIGN: This is a retrospective analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database of an inpatient rehabilitation unit of a county hospital in a large urban city. Data included 171 adult patients admitted to the stroke rehabilitation unit between January 2000 and October 2003. Main outcome measures included admission and discharge total FIM score, FIM gain, FIM efficiency, and length of stay (LOS). Data were analyzed using chi analyses, t tests, univariate analysis of variance, binary logistic regression, and hierarchical multiple regression. RESULTS: Data from 68 Hispanic, 83 black, and 20 white patients were included in the study. Univariate tests revealed that race/ethnicity groups differed significantly on admission FIM score (F=5.38, P<0.005), FIM gain (F=4.35, P<0.014), and FIM efficiency (F=3.42, P<0.035). Post hoc pairwise comparisons revealed that Hispanics had lower admission FIM scores than blacks (58.9 vs. 68.9). However, Hispanics had higher FIM gain scores than blacks (26.8 vs. 21.5). Race/ethnicity was not significantly related to age, gender, side of stroke, type of stroke, time from onset of stroke to rehabilitation admission, discharge FIM score, or LOS. Multiple regression analyses revealed that after controlling for all other available factors, race/ethnicity accounted for a significant amount of additional variance in admission FIM score (5.8%) and FIM efficiency (4.6%), but not in discharge FIM score, FIM gain, or LOS. Race/ethnicity was not predictive of discharge disposition. CONCLUSIONS: Differences in functional independence at admission to poststroke rehabilitation and the average daily improvement in function are related, in part, to patients' race/ethnicity. Differences in change in functional independence from admission to discharge (FIM gain) are not related to race/ethnicity once other factors, particularly admission FIM score, are taken into account. Future studies should identify reasons why Hispanics have lower admission FIM scores because demographic and stroke-related variables were not related to ethnicity yet have outcomes similar to blacks and whites at discharge.

Activities of Daily Living↗

PubMed2006

A pilot study of healing touch and progressive relaxation for chronic neuropathic pain in persons with spinal cord injury.

This pilot study assessed the role of Healing Touch (HT), an energy-based therapy, in modulating chronic neuropathic pain and the associated psychological distress from post spinal cord injury. Twelve veterans were assigned to either HT or guided progressive relaxation for six weekly home visits. The instruments selected showed sensitivity, although there was a large variation among the groups. There was a significant difference in the composite of interference on the Brief Pain Inventory (t = -2.71, p = .035). The mean score of the fatigue subscale of the Profile of Moods decreased (ns) in the HT group and in the subscale of confusion yet remained stable in the control group. The Diener Satisfaction With Life Scale showed increased well-being in the HT group and no change in the control group. Participants reported various experiences with HT sessions indicating that it may have benefit in the complex response to chronic pain.

Adult↗

PubMed2005

Association of hemoglobin levels, acute hemoglobin decrease, age, and co-morbidities with rehabilitation outcomes after total knee replacement.

OBJECTIVE: A study was undertaken to assess the association of preoperative and postoperative hemoglobin levels with rehabilitation outcomes, age, and selected co-morbidities DESIGN: Charts of 49 patients admitted to rehabilitation after total knee arthroplasty due to degenerative joint disease were reviewed. Outcome measures included rehabilitation admission and discharge motor FIMtrade mark scores, motor FIM gain, and rehabilitation length of stay. RESULTS: Patients with higher preoperative hemoglobin levels had higher rehabilitation admission motor FIM scores (r=0.38, P<0.01) and lower motor FIM gains (r=-0.45, P<0.001). Patients who had higher hemoglobin levels at rehabilitation admission had higher admission motor FIM scores and shorter length of stay. Patients with diabetes had lower preoperative hemoglobin levels. Patients with hypertension had longer length of stay. Older patients had lower admission and discharge motor FIM scores and longer length of stay. CONCLUSIONS: Patients admitted to rehabilitation after total knee replacement have the potential to improve motor function, regardless of their preoperative and rehabilitation admission hemoglobin levels and the decrease in hemoglobin levels. However, those admitted to rehabilitation with lower hemoglobin levels, those with lower admission motor FIM scores, those who are older, and those who have hypertension may expect longer hospital stays to reach their functional goals.

Age Factors↗

PubMed2005

Low ejection fraction: effect on the rehabilitation progress and outcome of stroke patients.

OBJECTIVE: To determine the effect of low ejection fraction ( 35%). DESIGN: A retrospective chart review of the 332 stroke patients admitted to the inpatient rehabilitation unit of an acute tertiary general hospital during a 36-mo period. A total of 262 (79%) of these patients (126 men and 136 women) had an ejection fraction study performed and are the subjects of this analysis. They were classified into two groups: low ejection fraction (n = 36) and high ejection fraction (n = 226). The main outcome measures included discharge total FIM score, FIM gain, FIM efficiency, length of stay, and discharge disposition. RESULTS: Patients with low ejection fraction had lower discharge FIM scores (82.9 vs. 89.1, t = 2.09, P < 0.04), lower FIM gain (15.9 vs. 19.3, t = 1.99, P < 0.05), and lower FIM efficiency (1.2 vs. 1.7, t = 232, P < 0.03), and they were less likely to return home (69% vs. 85%, chi 2= 5.25, P < 0.04) as compared with patients with high ejection fraction. Lengths of stay were not significantly different between the two groups. CONCLUSION: Compared with patients in the high ejection fraction cohort, the low ejection fraction subjects had lower discharge FIM scores, FIM gains, and FIM efficiency. However, almost 70% progressed well enough to be discharged to home. Low ejection fraction in stroke patients may well serve as an indicator of a patient population with greater medical and social needs.

Activities of Daily Living↗

PubMed2004

Telerehabilitation for veterans with a lower-limb amputation or ulcer: Technical acceptability of data.

A study was undertaken to determine the technical acceptability of information available via a customized telerehabilitation system regarding patients with lower-limb ulcers or recent lower-limb amputations receiving care at a Veterans Affairs Medical Center. Among the 54 participants, 57 wounds (39 ulcers, 19 amputation incisions) were evaluated by means of still photographs and skin temperature data sent via ordinary telephone lines. Three experienced clinicians served as raters. Intrarater agreements and McNemar chi(2) tests were assessed between decisions made after telerehabilitation sessions and decisions made by the same rater after in-person sessions. Interrater agreements and kappa coefficients were assessed between two raters for both telerehabilitation and in-person sessions. The intrarater agreement on 57 wounds for the primary rater was 93%, and the McNemar test indicated no significant difference in the ratings (p < 0.63). Interrater agreement on 18 wounds was 78% (kappa = 0.55, p < 0.02) for the telerehabilitation sessions and 89% (kappa = 0.77, p < 0.001) for the in-person sessions. Most qualitative comments by three clinicians on picture quality (54/63 = 86%) and temperature data (39/44 = 88%) were favorable (good to excellent). The information yielded from this study provides evidence that the telerehabilitation system has the potential to present sufficient information to experienced clinicians so they can make informed decisions regarding wound management. The next phase of the study will include in-home trials and improvements in the technology.

Adult↗

PubMed2003

Serum levels of vitamins A, C, and E in persons with chronic spinal cord injury living in the community.

OBJECTIVES: To determine serum levels of vitamins A, C, and E among individuals with spinal cord injury (SCI) living in the community, to compare these levels with general population norms, and to assess their association with demographic and injury-related data (age at onset, time since onset, level and completeness of injury), function, nutritional behaviors, and health status. DESIGN: Descriptive and correlational. SETTING: General community. PARTICIPANTS: A total of 110 adults (> or =18y) with traumatic SCI of at least 2 years in duration living within a 13-county area in Texas. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic information, age at onset, time since onset, American Spinal Injury Association (ASIA) total motor index score, ASIA impairment score, assay of serum vitamins, FIM trade mark instrument motor items, Health-Promoting Lifestyle Profile nutrition subscale, Medical Outcomes Study 36-Item Short-Form Health Survey general health subscale, and pressure ulcer occurrence in past 12 months. RESULTS: Many (16%-37%) of the participants had serum levels below the reference range for each vitamin. Being older at onset or less impaired was associated with higher serum vitamin A levels. Higher levels of serum vitamin A also were related to better function and health status and with not having a pressure ulcer within the past 12 months. Being older or older at onset was associated with higher serum levels of vitamin E. No relationships with vitamin C were found. CONCLUSIONS: Vitamin levels may be related to function, general health, and pressure ulcer incidence in persons with SCI. Further study is needed to determine effective interventions to improve vitamin levels and determine the effect of such improvements on overall health and rehabilitation outcomes.

Activities of Daily Living↗

PubMed2003

Comparison of dalteparin and enoxaparin for deep venous thrombosis prophylaxis in patients with spinal cord injury.

OBJECTIVE: To determine differences between dalteparin and enoxaparin in patients with spinal cord injury. DESIGN: This prospective, randomized, open-label study was performed as a multiple hospital trial in a large urban setting. A total of 100 patients with acute (<3 mo) spinal cord injury were recruited. A total of 95 patients met all inclusion criteria. Fifty received enoxaparin, and 45 received dalteparin. Main outcome measures included deep venous thrombosis, bleeding, compliance, Short Form-12 Health Status Survey, satisfaction, and medication/labor costs. Patients were randomized to receive 30 mg of enoxaparin subcutaneously every 12 hr or 5000 IU of dalteparin subcutaneously once daily. Prophylaxis was continued for 3 mo for motor-complete and 2 mo for motor-incomplete patients. RESULTS: Six percent of the patients developed deep venous thrombosis while receiving enoxaparin and 4% while receiving dalteparin (chi2 = 0.44, df = 1, P = 0.51). Four percent developed bleeding while receiving dalteparin and 2% while receiving enoxaparin (chi2 = 0.13, df = 1, P = 0.72). No differences were noted in compliance, health status, or most of the satisfaction measures. It was, however, noted that after being discharged home, the patients receiving enoxaparin rated the shots significantly more inconvenient (two injections per day) compared with taking three pills per day, than those receiving dalteparin (one injection per day, P < 0.05). The cost of the medication was 1101 US dollars/mo for enoxaparin (two injections per day) and 750 US dollars/mo for dalteparin (one injection per day). CONCLUSION: Similar compliance, health status, deep venous thrombosis, and bleeding rates were found between dalteparin and enoxaparin.

Adolescent↗

PubMedDate not supplied

Pressure ulcers in veterans with spinal cord injury: a retrospective study.

Pressure ulcers are a major complication of spinal cord injury (SCI) and have a significant effect on general health and quality of life. The objectives of this retrospective chart review were to determine prevalence, duration, and severity of pressure ulcers in veterans with SCI and to identify predictors of (1) outcome in terms of healing without surgery, not healing, or referral for surgery; (2) number of visits veterans made to the SCI outpatient clinic or received from home care services for pressure ulcer treatment; and (3) number of hospital admissions and days hospitalized for pressure ulcer treatment. From a sampling frame of 553 veterans on the Houston Veterans Affairs Medical Center SCI roster, 215 (39%) were reported to have visited the clinic or received home care for pressure ulcers (ICD-9 code 707.0 = decubitus, any site) during the 3 years studied (1997, 1998, and 1999). From this sample, 102 veterans met the inclusion criteria for further analyses, 56% of whom had paraplegia. The duration of ulcers varied greatly from 1 week to the entire 3-year time-frame. Overall, Stage IV pressure ulcers were the most prevalent as the worst ulcer documented. Number and severity of ulcers predicted outcome and healthcare utilization. This study illustrates the magnitude of the pressure ulcer problem among veterans with SCI living in the community. Reducing the prevalence of pressure ulcers among veterans with SCI will have a significant impact on the Department of Veterans Affairs' financial and social resources. Innovative approaches are needed to reduce pressure ulcer risk in veterans with SCI.

Adult↗

PubMedDate not supplied

Informal care providers for veterans with SCI: who are they and how are they doing?

Veterans with spinal cord injury (SCI) who received care at the Houston Department of Veterans Affairs Medical Center were interviewed about their use of formal and informal assistance to meet their daily physical needs. Informal caregivers were found to play an important role in the daily care of veterans with SCI, with 37% receiving some informal, unpaid assistance-with personal care. Primary informal caregivers were mostly women, had a mean age of 53, and provided an average of almost 12 hours of care a day. Nearly one-third of participants rated their primary caregiver as being only in fair or poor health, and one-fourth thought their caregiver was unlikely to be able to provide the same level of care 5 years from now. Of particular concern, more than half reported that they did not have anyone else willing and able to provide assistance if their primary family caregiver became permanently unable to care for them.

Adult↗

PubMedDate not supplied

Predicting consistency of pain over a 10-year period in persons with spinal cord injury.

This longitudinal study was designed to test the hypothesis that persons who consistently report pain at three (women) or four (men) measurement points across 10 years (1988 to 1998) are different both physically and psychologically from those who inconsistently or never report pain. Participants were 96 persons with spinal cord injury (SCI) living in the community who participated at every measurement point. Measures included consistency of reports of pain (i.e., reported having had problems with pain in the 12 months prior to all, some, or no measurement points); demographic and injury-related data; and measures of physical and psychological health, function, and social support. Of the 96 participants, approximately half of the men and three-fourths of the women consistently reported pain at each point. Phase 1 predictors of the consistency of pain reports for men were being less impaired, being more independent, experiencing more stress, and receiving less social support. Women consistently reporting pain had more stress at Phase 1 than women inconsistently reporting pain. Persons with SCI at risk for chronic pain should be identified and referred to a multidisciplinary pain management program.

Adult↗

PubMedDate not supplied

Prevalence and characteristics of chronic pain in veterans with spinal cord injury.

To assess prevalence and characteristics of individual chronic (>6 mo) pain components in the veteran spinal cord injury (SCI) population, we conducted a telephone survey with 348 (66%) of 530 veterans with SCI who received care from one regional Department of Veterans Affairs SCI center during a 3 yr period. The short-form McGill Pain Questionnaire was used to assess qualitative properties of the pain experience. Other questions were used to assess frequency, duration, intensity, exacerbating factors, and effects on daily activities. Of the participants, 75% reported at least one chronic pain component. The majority (83%) of the chronic pain components occurred daily (mean = 27.4 d/mo) and lasted most of the day (mean = 17.4 h/d). Mean pain intensity in the week before the interview averaged 6.7 (on a 0 to 10 scale), while worst pain intensity averaged 8.6. Two-thirds (67%) of the chronic pain components interfered with daily activities. The most commonly selected pain descriptors were "aching," "sharp," "hot-burning," and "tiring-exhausting." More research is needed to identify better ways to prevent, assess, and treat chronic pain in the veteran SCI population.

Adult↗

PubMedDate not supplied

Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury.

Treatments for chronic pain in persons with spinal cord injury (SCI) have been less than effective. Cranial electrotherapy stimulation (CES), a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes, has been shown to effectively treat several neurological and psychiatric disorders. The present study examined the effects of daily 1-hour active CES or sham CES treatment (randomly assigned) for 21 days on pain intensity and interference with activities in 38 males with SCI. The active CES group (n = 18) reported significantly decreased daily pain intensity compared with the sham CES group (n = 20) (mean change: active CES = -0.73, sham CES = -0.08; p = 0.03). Additionally, the active CES group reported significantly decreased pain interference (-14.6 pre- vs postintervention, p = 0.004) in contrast to the nonsignificant decrease in the sham CES group (-4.7 pre- vs postintervention, p = 0.24). These results suggest that CES can effectively treat chronic pain in persons with SCI.

Adult↗

PubMedDate not supplied

Subjective stress in male veterans with spinal cord injury.

We undertook a telephone survey to examine perceived stress among 165 veterans with spinal cord injury (SCI) who received care from a Department of Veterans Affairs Medical Center. Measures included Perceived Stress Scale, Hassles Scale, Center for Epidemiologic Studies Depression Scale, Short-Form State-Trait Anxiety Inventory, Satisfaction with Life Scale, and Short-Form Interpersonal Support Evaluation List. The mean perceived stress score for our sample of veterans with SCI (17.3) was higher than the means for men from the general population (12.1) and nonveteran men with SCI (13.9). Physical abilities, health, and financial issues were frequently reported hassles. Stress was related positively to depressive symptomatology and anxiety and negatively to life satisfaction. The association of hassles with measures of psychological well-being was partially mediated by perceived stress. The association of perceived stress with depression and anxiety varied as a function of social support, suggesting that those with low social support are the most vulnerable to the negative impact of stress on their psychological well-being. Stress management programs designed specifically to meet the needs of veterans with SCI are needed.

Adaptation, Psychological↗