Biomedical subjects

Janet M Powell

Publications and source records attributed to Janet M Powell.

8 recordsLinked to original sources

PubMed2007

Experiences of living with non-cancer-related lymphedema: implications for clinical practice.

Lymphedema is a chronic medical condition caused by lymphatic insufficiency that can lead to extreme swelling and susceptibility to infection. Physical and psychosocial effects of the condition can have a significant impact on an individual's life and level of participation. Research about experiences of individuals living with lymphedema has focused primarily on women with breast cancer, yet individuals with non-cancer-related lymphedema are a distinct group. In this study, the authors used qualitative description to explore the experience of 7 individuals living with advanced and complicated cases of lymphedema who had been treated in an inpatient setting. Findings reveal the extensive impact lymphedema has on those who live with it. Participants spoke of difficulty finding a correct diagnosis and effective treatment, the importance of their inpatient experiences, and the challenges of daily self-management. The authors make recommendations to increase lymphedema awareness, promote inpatient treatment programs, and create effective self-management techniques.

Adult↗

PubMed2006

Clinicians' perceptions of the benefits of aquatic therapy for young children with autism: a preliminary study.

OBJECTIVE: This purpose of this study was to identify clinicians' perceptions of the benefits of aquatic therapy for young children with autism. METHODS: Eighteen aquatic occupational therapists treating young children with autism responded to a survey soliciting their opinions on changes in skill performance resulting from aquatic therapy. RESULTS: A majority of clinicians reported a substantial increase in swim skills, attention,muscle strength, balance, tolerating touch, initiating/maintaining eye contact, and water safety. CONCLUSION: The impairments, activity limitations, and participation restrictions seen in children with autism can be wide-ranging and outcomes can be difficult to operationally define and measure. In this preliminary study, clinicians identified the areas they perceived as improving as a result of aquatic therapy. This information could help narrow the field of likely outcomes as a first step toward studies of the effectiveness of aquatic therapy for children with autism.

Attitude of Health Personnel↗

PubMed2005

The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial.

OBJECTIVE: To measure the effectiveness of a scheduled telephone intervention offering counseling and education to people with traumatic brain injury (TBI) on behavioral outcomes compared with standard follow-up at 1 year postinjury. DESIGN: Two-group randomized, prospective clinical trial throughout the first year after injury. SETTING: Subjects' homes via telephone in an urban-rural catchment area from a level I trauma center. PARTICIPANTS: Subjects (N=171; age range, 18-70 y) with a primary diagnosis of TBI who were discharged from an acute rehabilitation unit. They were randomly assigned to the telephone intervention (n=85) or to standard follow-up (n=86) groups at discharge. Of these, 79 participated in the intervention and completed the outcome assessment (3 withdrew; 3 were lost to follow-up), and 78 participated in usual care and completed the outcome assessment (8 were lost to follow-up). INTERVENTIONS: Subjects were randomly assigned to receive telephone calls at 2 and 4 weeks and 2, 3, 5, 7, and 9 months after discharge. The calls consisted of brief motivational interviewing, counseling, and education, plus facilitating usual care or usual care alone through follow-up appointments and therapy prescriptions. MAIN OUTCOME MEASURES: A composite outcome was used as the primary endpoint on an intent-to-treat basis. Secondary analyses were conducted with individual measures, including the FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Neurobehavioral Functioning Inventory, Functional Status Examination, Glasgow Outcome Scale-Extended, Medical Outcomes Study 36-Item Short-Form Health Survey, Brief Symptom Inventory, EuroQol, and Modified Perceived Quality of Life scale. The primary analysis was a blocked Mann-Whitney U test. RESULTS: At 1-year follow-up, those who had received scheduled telephone intervention fared significantly better on the primary composite outcome index ( P =.002). In addition, this group fared better on specific composites such as functional status ( P =.003) and quality of well-being ( P =.006). There were no significant differences on vocational status ( P =.08) or community integration status ( P =.13). CONCLUSIONS: Scheduled telephone counseling and education resulted in improved overall outcome, particularly for functional status and quality of well-being, when compared with usual outpatient care. Telephone counseling shows promise as a low-cost, widely available rehabilitation intervention for TBI.

Adolescent↗

PubMed2003

Outcome 3 to 5 years after moderate to severe traumatic brain injury.

OBJECTIVE: To investigate neuropsychologic, emotional, and functional status and quality of life (QOL) 3 to 5 years after moderate to severe traumatic brain injury (TBI). DESIGN: Observational cohort. SETTING: Level I trauma center. PARTICIPANTS: Consecutive adult admissions with TBI involving intracranial abnormalities, prospectively followed up for 3 to 5 years, with 80% follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Neuropsychologic functioning (Paced Auditory Serial Addition Test, California Verbal Learning Test), emotional status (Center for Epidemiologic Studies Depression Scale, Brief Symptom Inventory), functional status (Functional Status Examination, Glasgow Outcome Scale, Medical Outcomes Study 36-Item Short-Form Health Survey, employment), and perceived QOL. RESULTS: Significant functional limitations were observed in all areas. Recovery to preinjury levels ranged from 65% of cases in personal care to approximately 40% in cognitive competency, major activity, and leisure and recreation. Brain injury severity, measured by the modified Abbreviated Injury Scale, related to functional status and neuropsychologic functioning, but not to emotional or QOL measures. Length of impaired consciousness appeared to contribute to outcome more than did anatomic lesions. CONCLUSIONS: The results provide representative estimates of long-term morbidity in patients with TBI involving intracranial lesions. The magnitude of morbidity was high. Although direct costs of TBI have received the most attention, the long-term consequences and their cost implications are much larger, unfold over time, and are borne by the survivors, their families, and the public subsidy system.

Activities of Daily Living↗

PubMed2002

Nonrandomized studies of rehabilitation for traumatic brain injury: can they determine effectiveness?

OBJECTIVE: To examine the feasibility of investigating rehabilitation effectiveness for traumatic brain injury (TBI) with a nonrandomized design. DESIGN: Observational cohort with confounder control by regression methodology. SETTING: Level I trauma center. PARTICIPANTS: Consecutive series of 365 individuals with TBI discharged to inpatient rehabilitation or home (78% follow-up). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Glasgow Outcome Scale (GOS), Sickness Impact Profile (SIP), Burden Inventory, and Perceived Quality of Life (PQOL). The predictors of interest: discharge to comprehensive inpatient rehabilitation or home and inpatient rehabilitation length of stay (LOS). RESULTS: Discharge to rehabilitation was associated with poorer functioning on the GOS (P=.03) and SIP (P=.57), an increase on the Burden Inventory (P=.14), and improved PQOL (P=.20). Similar results were found for longer lengths of inpatient rehabilitation. CONCLUSIONS: The results appear to be because of a confounding effect rather than rehabilitation. The study design could not control for confounding that resulted from unmeasured or difficult to measure aspects of the clinical decisions for discharge placement and rehabilitation LOS. Furthermore, typical severity indices were inadequate to control for injury severity and recovery. Matching designs that investigate TBI rehabilitation are also at risk for inadequate confounder control.

Adolescent↗

PubMedDate not supplied

Collaboration between cognitive science and cognitive rehabilitation: a call for action.

The fields of cognitive science and cognitive rehabilitation share a fundamental interest in the nature of cognition. Both groups address questions that are critical to our understanding of human thought. Researchers in basic cognitive science address these questions from a theoretical perspective. Clinicians in cognitive rehabilitation address them from an applied perspective for individuals with brain injuries. Collaborative efforts and cross-fertilization of theory and practice have been less than what might be expected given the underlying commonality of the two fields. Here, we explore the complex nature of the relationship between cognitive rehabilitation and cognitive science, discuss barriers to collaboration, and suggest ways of overcoming those barriers.

Brain Injuries↗

PubMedDate not supplied

Development of a telephone follow-up program for individuals following traumatic brain injury.

OBJECTIVE: To describe the development of a telephone follow-up program that addresses the needs of survivors of traumatic brain injury (TBI) and their families in the year following injury. The process of developing the program is reviewed from the initial steps of identifying needs through final implementation of the program. PARTICIPANTS: Eighty-four TBI survivors with moderate to severe injuries and their families. RESULTS: Descriptive statistics are presented including number of contacts, areas of concern for participants, and the types of interventions conducted. Case examples are provided to illustrate the impact of the telephone follow-up program. CONCLUSION: This project demonstrated the feasibility of using the telephone as a means of providing information and support during the first year after moderate to severe traumatic brain injury. Telephone follow-up may enhance service provision for persons with TBI, especially those with a lack of transportation or geographic isolation.

Adult↗

PubMedDate not supplied

Occupational therapy workforce needs: a model for demand-based studies.

PURPOSE: To provide a model for assessing occupational therapy workforce needs by using a demand-based approach to determine current workforce status in the Northwest region. Regional information may have implications for addressing national occupational therapy service needs. METHOD: A questionnaire was sent to a proportional random sample of 234 facilities that hire occupational therapy practitioners. Data were collected in July-August 2003 using structured mailing and follow-up procedures. RESULTS: Response rate was 79%. Twenty-four percent reported occupational therapy vacancies and 11% occupational therapy assistant vacancies; 48% predicted an increase in occupational therapy positions in the next 2 years and 41% an increase in occupational therapy assistant positions. Sixty-three percent of respondents reported difficulty in hiring. DISCUSSION: This study identifies an occupational therapy workforce shortage in the Northwest. Management of a shortage is critical, for even short-term adjustments could lead to permanent changes in service provision. This study demonstrates the importance of current information on the status of the national workforce and serves as a model for future studies.

Employment↗