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Biomedical subjects

R W Teasell

Publications and source records attributed to R W Teasell.

At least 19 recordsLinked to original sources
PubMed1996

Functional restoration. Returning patients with chronic low back pain to work--revolution or fad?

STUDY DESIGN: A review was performed to assess the basis for functional restoration programs in returning patients with chronic low back pain to work. OBJECTIVE: To review and assess the effectiveness of functional restoration programs in the treatment of chronic low back pain. SUMMARY OF BACKGROUND DATA: Functional restoration programs generally use an aggressive program of physical exercises and psychosocial support with the focus on improving function despite the pain. METHODS: A review was conducted of significant papers presenting results of large clinical trials that used functional restoration programs. RESULTS: Several influential studies have reported statistically significant improvement in return-to-work rates of treated patients. The comparison groups consisted of treatment failures and/or patients refused entry to the programs because of insurers refusal to pay. Selection bias, incomplete follow-up, and inappropriate allocation of compared patients cast doubt on the effectiveness of these functional restoration programs. The only published prospective randomized clinical trial failed to demonstrate the efficacy of a functional restoration program. CONCLUSIONS: Further clinical trials based on sound methodology are needed.

Disability Evaluation↗
PubMed1996

The effect of litigation status on adjustment to whiplash injury.

STUDY DESIGN: This retrospective study examined the effect of civil litigation on reports of pain and disability in chronic pain patients who sustained whiplash injuries after a motor vehicle accident. OBJECTIVES: To examine the effect of litigation on adjustment to chronic pain. SUMMARY OF BACKGROUND DATA: A common methodologic weakness with many studies in this area is the composition of the nonlitigant group, which often includes individuals who have completed litigation as well as those who opted not to litigate. This introduces a confound in that litigant and nonlitigant groups differ not only with respect to litigation status but with respect to any factors that predispose one to litigate. METHODS: Questionnaire data were obtained from 41 patients (current litigants) in the process of litigation and 21 patients (postlitigants) who had completed litigation. Subjects completed self-report measures assessing demographic characteristics, psychological distress, sleep disturbance, employment status, and various pain indices. RESULTS: There were no significant group differences in demographic characteristics, employment status, or psychological distress. Litigants, however, reported more pain than did postlitigants. Group differences in pain reports remained statistically significant even after controlling for length of time since accident and initial severity of the injuries. CONCLUSIONS: That litigation status did not predict employment status suggests that secondary gain does not figure prominently in influencing the functionality of these patients. The rather robust effect of litigation status on pain reports is discussed with respect to the potential mediational role of the stress of litigation.

Adaptation, Psychological↗
PubMed1996

Pneumonia associated with aspiration following stroke.

OBJECTIVE: To determine the association between demonstrated aspiration and pneumonia in stroke patients. METHODS: Chart review of 441 consecutive stroke patients admitted to a stroke rehabilitation unit within 4 months of their stroke over an 8-year period. Videofluoroscopic modified barium swallow (VMBS) was performed on all patients suspected of aspirating. In all patients, the presence or absence of pneumonia was noted. RESULTS: Eighty-four of the 441 (19.0%) stroke patients transferred for rehabilitation demonstrated aspiration of thin liquids on VMBS. Twelve of the 441 (2.7%) developed pneumonia while in hospital, either in the acute or rehabilitation phases. The incidence of pneumonia among proven aspirators on VMBS was 10 of 84 (11.9%) patients. Two of the 357 (0.6%) patients who were presumed nonaspirators developed pneumonia. Brain stem and right hemispheric stroke patients had a higher incidence of pneumonia. CONCLUSIONS: Pneumonia is an uncommon complication of stroke. However, approximately 12% of stroke rehabilitation patients diagnosed as aspirators on VMBS developed pneumonia, a 20-fold increase over presumed nonaspirators. VMBS is a potentially valuable tool in determining those patients at risk of aspiration pneumonia.

Acute Disease↗
PubMed1996

Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients.

OBJECTIVE: To determine associations between the nutritional status of inpatient rehabilitation (rehab) unit stroke patients and (1) length of stay (LOS) and (2) functional outcome using Modified Barthel Index (MBI). Secondary objective-to determine whether hypoalbuminemia was equally related to outcome measures. A priori hypothesis-LOS and MRI are adversely related to malnutrition. DESIGN: inception cohort study. SETTING: Tertiary care center. PATIENTS: 49 consecutive "middle-band" patients (4 declined). MAIN OUTCOME MEASURES: LOS and MRI at admission (T1), 1 month (T2), and discharge (T3). RESULTS: LOS was significantly related to overall malnutrition, T1 and T2MBI scores, T1 dysphagia, T1 enteral feeding (all p<.01), T1 malnutrition, peripheral vascular disease (negative relationship), and diabetes mellitus history (all p<.05). In analysis of covariance, adjusting for T1 MBI, overall rehab malnutrition was related to LOS (p=.011). Other covariates were not significant. T1 malnutrition was related to lower T2 MBI scores(p=.038). Lower T1 MBI scores was related to T2 malnutrition (p=.032). Diabetics (p=.005) and right hemispheric lesion patients(p=.015) had lower T1 MBI scores. Hypoalbuminemia was unrelated to LOS and MBI scores. Although malnourished and adequately nourished functionally dependent patients improved equally in MBI scores by discharge, prolonged LOS in the malnourished lowered their functional improvement rate ([T3 MBI - T1 MBI]/LOS) (p=.047). CONCLUSIONS: Malnutrition was the most potentially modifiable variable relating to LOS and functional outcome. Close attention to nutrition status may help to optimize stroke patients' rehab potential and use of health care resources.

Activities of Daily Living↗
PubMed1995

Autonomic dysreflexia in tetraplegic patients: evidence for alpha-adrenoceptor hyper-responsiveness.

A controlled study of acute pharmacological intervention was designed to determine whether decreased sympathetic nerve activity in tetraplegic patients results in increased responsiveness of alpha-adrenoceptors which might contribute to vascular hyperreactivity and the clinical scenario of autonomic dysreflexia. The study took place in a university teaching hospital and included six male tetraplegic patients and six age-matched normal male controls. All tetraplegics were 5 months or longer post-traumatic spinal cord injury and all had experienced symptoms of autonomic dysreflexia on at least one occasion. The dorsal foot vein diameter was recorded with a tonometer during local infusions of noradrenaline 0.125-256 ng/min given through a short intravenous needle. In tetraplegic patients, there was a significant shift to the left of the dose-response curve indicating increased venous responsiveness to noradrenaline. The concentration of noradrenaline required to cause a 50% reduction of the resting vein diameter was decreased in tetraplegics (1.6 ng/min, geometric mean) compared to normal controls (10.9 ng/min, p < 0.02). alpha-Adrenoceptor responsiveness in dorsal foot veins is increased in patients with tetraplegia. Hypersensitivity of vascular alpha-adrenoceptors may contribute to autonomic dysreflexia in patients with high spinal cord injury.

Adult↗
PubMed1995

Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors.

This prospective study presents the prevalence and risk factors of malnutrition in 49 consecutive stroke patients on the rehabilitation (Rehab) service and at 2- to 4-month follow-up. Malnutrition was diagnosed using biochemical and anthropometric data. Stroke patients, on admission to Rehab, have a very high prevalence of malnutrition. Malnutrition, 49% on admission, declined to 34%, 22%, and 19% at 1 month, 2 months, and follow-up, respectively. Dysphagia, 47% on admission, was associated with malnutrition (p = .032) and significantly declined over time. Using logistic regression, predictors of malnutrition on admission involved acute service tube feedings (p = .002) and histories of diabetes (p = .027) and prior stroke (p = .013). Tube feedings, associated with malnutrition on admission (p = .043), were more prevalent in brain stem lesion patients. Patients tube fed > or = 1 month during rehabilitation or at home were not malnourished. Malnutrition was associated with advanced (> 70 years) age at 1 month (p = .002) and weight loss (p = .011) and lack of community care (p = .006) at follow-up. Early and ongoing detection and treatment of malnutrition are recommended during rehabilitation of stroke patients both on the service and at follow-up.

Adult↗
PubMed1995

Work disability evaluation and the fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) is a common and costly cause of work disability. Patients with FMS, nevertheless, encounter considerable difficulties in their assessment of claims for disability payments. Factors that contribute to FMS as an important cause of disability are its high prevalence, the patients' perception of severe discomfort, and poor function. Disability evaluation in FMS is controversial for several reasons including lack of acceptance of the diagnosis, concurrent psychological abnormalities, difficulties in objectifying disability, deficiencies in instruments of evaluation, the uncertain efficacy of treatment, and physician attitudes. Third parties appear to have inappropriate expectations of the physician's role in determining disability. We suggest that the process of disability evaluation be improved by more objective assessments and by the inclusion of other health professionals in assessing disability and necessary retraining. Further research is needed to develop better instruments for measuring disability, to assess the long-term effects of various treatments, and to clarify the contributions of the work place and of compensation in causing or aggravating FMS.

Adult↗
PubMed1995

The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls.

OBJECTIVE: To establish the reliability with which tenderness could be evaluated in patients with chronic myalgias, using dolorimetry and palpation. METHODS: Three blinded examiners using pressure dolorimetry and digital palpation compared 19 paired tender points and 8 paired control points in 4 matched groups of 6 patients with fibromyalgia (FM), myofascial pain, pain controls, and healthy controls. RESULTS: Good interrater and test-retest reliability were found for dolorimetry scores. There were significant differences in tenderness ratings by dolorimetry between the diagnostic groups, with the patients with FM and myofascial pain having the greatest tenderness, the normals having the least tenderness, and the pain controls having tenderness levels midway between the patients with FM or myofascial pain and the normals. In all patients, control points had higher pain thresholds than tender points. One-third of patients with localized pain complaints demonstrated a significant relationship between region of clinical pain complaint and measured tenderness thresholds by dolorimetry. In ratings of tenderness by digital palpation, there was very good intrarater reliability over 26 of 27 paired points, and good interrater reliability at 75% of the points. One-half of patients with localized pain complaints demonstrated a significant relationship between region of clinical pain complaint and number of tender points by palpation. CONCLUSION: Both dolorimetry and palpation are sufficiently reliable to discriminate control patients from patients with myofascial pain and FM, but may not discriminate patients with myofascial pain from those with FM. Neither method appears to correlate well with the location of the clinical pain complaint, regardless of diagnosis.

Adult↗
PubMed1994

Prevalence and recovery of aspiration poststroke: a retrospective analysis.

This retrospective study was undertaken to review aspiration documented by videofluoroscopic modified barium swallow (VMBS) examination in a group of patients admitted to a stroke rehabilitation unit. Forty-two of 54 patients tested demonstrated evidence of aspiration of thin liquids on VMBS performed an average of over 5 weeks following the onset of stroke. However, only patients in whom there was clinical concern of aspiration (54 of 255 stroke patients admitted to the rehab unit) were tested with VMBS evaluation. With this limitation in mind, aspiration was demonstrated in at least 9.9% of all unilateral right hemispheric patients, 12.1% of unilateral left hemispheric, 24% of bilateral hemispheric, and 39.5% of brainstem stroke patients. Of the 42 patients in whom aspiration of thin liquids was demonstrated, 31 underwent repeat VMBS studies an average of 6 weeks after the initial VMBS. 7 of these 31 (22.6%) no longer showed aspiration on VMBS. Eighteen of the 42 patients (43%) clinically stopped aspirating over this 6-week period.

Aged↗
PubMed1994

Reflex sympathetic dystrophy involving three limbs: a case study.

Reflex sympathetic dystrophy (RSD) is a symptom complex characterized by pain, hyperesthesia, and vasomotor instability. RSD has long been considered a manifestation of sympathetic nervous system dysfunction because of characteristic edema and vasomotor instability in addition to frequent alleviation of RSD symptoms by sympathetic blockade. RSD generally only affects one limb although it is recognized that the contralateral limb is also abnormal and at risk of also developing clinical RSD without the advent of a new injury. An unusual case of three-limb RSD is presented where classical RSD was first seen in the right lower extremity followed by involvement of the left upper extremity and finally the left lower extremity. Each limb went on to develop dystrophic changes. This case underscores the importance of the central nervous system in the pathophysiology of RSD and suggests this central influence is not confined to one or adjacent segments of the spinal cord.

Adult↗
PubMed1994

Rehabilitation of the elderly paraplegic.

Elderly patients with spinal cord injuries can be rehabilitated successfully. Community home can resources are crucial for managing patients at home. Regular monitoring of skin integrity and for bladder infection is important.

Age Factors↗
PubMed1994

Clinical approaches to low back pain. Part 1. Epidemiology, diagnosis, and prevention.

The epidemiology and difficulties in diagnosing low back pain are discussed. Clinical investigations should be limited to those tests that will provide useful information for effective management. Prevention is the best strategy for avoiding low back pain but is realistically hard to practise because the disorder has many environmental and intrinsic risk factors.

Acute Disease↗
PubMed1994

Strategic-behavioral intervention in the treatment of chronic nonorganic motor disorders.

Chronic nonorganic motor disorders pose particular difficulties because of a combination of diagnostic confusion and intractability to psychotherapeutic or behavioral interventions. Three cases are presented, all of whom failed a rehabilitation approach that emphasized basic behavioral principles of shaping and reinforcement. Despite this initial failure, all three patients showed dramatic and rapid improvement after implementation of an intervention combing elements of strategic and behavior therapy. The strategic element consisted of placing patients in a double bind by telling them full recovery constituted proof of an organic etiology and failure to recovery constituted conclusive evidence of a nonorganic or psychiatric etiology. These cases also illustrate the difficulty in distinguishing between conversion and factitious disorders.

Adolescent↗