Nursing home rehabilitation after acute rehabilitation: predictors and outcomes.

OBJECTIVE: To determine the predictive factors and functional outcomes of patients who were discharged from an acute rehabilitation unit to a nursing home care unit (NHCU) at a Veterans Affairs (VA) hospital. DESIGN: Cohort descriptive study. SETTING: An academically affiliated urban VA Medical Center. PATIENTS: All patients (n = 81, median age 68 years) admitted to a VA rehabilitation unit over a 1-year period. OUTCOME MEASURES: Discharge locations, predictors for NHCU transfer, and functional status as determined by Functional Independence Measure (FIM) scores. RESULTS: Patients discharged to the NHCU (17%) were compared with those discharged to the community (80%). Multiple logistic regression analysis showed that acute rehabilitation length of stay (LOS), admission, and discharge FIM scores were the only independent variables that predicted discharge to the VA NHCU. Although overall FIM gains in both groups during acute rehabilitation were similar, the NHCU group had significantly lower admission FIM scores and lower LOS efficiency because of longer acute rehabilitation LOS. Postacute NHCU rehabilitation resulted in significant gains in FIM scores at a slower rate. Sixty-four percent of these nursing home patients eventually returned to the community. CONCLUSION: Nursing home rehabilitation can result in favorable functional and community outcomes for selected patients.

Sensory changes in adults with unilateral transtibial amputation.

The purpose of this study was to describe the sensory changes in adults with unilateral transtibial amputation (TTA), as any loss of sensation may have significant impact on the successful use of a prosthesis. Sensory modalities of light touch, deep pressure, vibration, and superficial pain (pinprick) were examined on the residual and contralateral limbs of 16 veterans with TTA. Six Subjects demonstrated normal sensation on the contralateral limb and impaired sensation of superficial pain, vibration, and/or light touch on the residual limb. Superficial pain was the most frequently impaired sensation, and vibration and superficial pain sensation appeared to be age-dependent, with increased impairment observed in the elderly. Deep pressure sensation was intact in all subjects. These preliminary data suggest that although neither the amputation nor the prosthetic rehabilitation resulted in impaired deep pressure sensation, these two factors contributed to minimal impairment of light touch and vibration, and significant impairment of the superficial pain sensation.

Serum insulin-like growth factor-I and serum testosterone status of elderly men in an inpatient rehabilitation unit.

This study was designed to estimate the prevalence of hyposomatomedinemia and hypogonadism in an inpatient rehabilitation unit. The authors studied healthy young men (HOM) ages 20-29 years (n=33); healthy old men (HOM) ages 59-98 years (n=27), and elderly men in an inpatient rehabilitation unit (ERM) ages 58-95 years (n=42). Serum concentrations of insulin-like growth factor (IGF-I), total testosterone (TT), and free testosterone (FT) were measured. A low IGF-I level (below the lower 2.5 percentile of HYM) occurred in 85% of the HOM and in 62.5% of the ERM. When a low IGF-I was defined as a value below the 2.5 percentile of the HOM, the prevalence in ERM was 6.2%. A low TT level (below the lower 2.5 percentile of the HOM) occurred in 78% of the HOM and in 90% of the ERM. Low TT, defined as a value below the lower 2.5 percentile of the HOM, occurred in 22% of the ERM. The results with FT were similar. In neither HOM nor ERM was IGF-I significantly correlated to TT and FT. A large percentage of HOM and ERM have severe hypogonadism (TT<193 ng/mL) as compared with HOM. The ERM had a higher prevalence of severe hypogonadism as compared with the HOM.

Journal clubs. Prevalence, format, and efficacy in PM&R.

Journal clubs can play an integral part in graduate medical education. They promote critical thinking, dissemination of information, and research and impact clinical practice. Little has been written, however, about how to organize a journal club or improve its efficacy. Although numerous articles discuss how journal clubs can be used to evaluate medical literature, only a few have examined what physicians are actually doing. We surveyed all accredited PM&R program chief/residents to ascertain the prevalence, format, and efficacy of PM&R residency journal clubs. All programs that responded (89%) reported having a journal club, with most stating its purpose was to disseminate information from the current literature. Review of classic articles and specialty topics (e.g., electromyography, sports medicine) was fairly uncommon. Eighty-four percent of journal clubs were department-sponsored, and most met monthly for 1 hr during the workday. Typically, four or more articles were presented under the guidance of the chief or other resident. Impacting clinical practice and teaching critical analysis were other important goals of the journal clubs, yet most (76%) lacked an organized method for critical review. This, in addition to poor faculty attendance, was a chief concern of those surveyed. Surprisingly, journal club participation was not felt to significantly alter the amount of reading residents did. Although most felt their journal clubs were successful, improving faculty participation, strengthening critical analysis skills, identifying and incorporating classic articles, improving clinical relevance, and providing a mechanism for feedback may further improve journal club efficacy and participant satisfaction.

Motorcycle helmets and spinal injuries: dispelling the myth.

STUDY OBJECTIVE: To determine the relationship between spinal injuries and helmet use in motorcycle trauma. DESIGN: Retrospective case series. SETTING: Twenty-eight hospitals in four midwestern states--Illinois, Iowa, Nebraska and Wisconsin--representing urban, suburban, and rural settings. PATIENTS AND OTHER PARTICIPANTS: Consecutive sample of motorcyclists treated at the participating centers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The major variables evaluated were helmet use, ethanol use, and significant head or spinal injuries. RESULTS: 1,153 cases were analyzed. Helmet use was not significantly associated with spinal injuries (odds ratio, 1.12; 95% confidence intervals, 0.79, 1.58) whereas head injury was markedly decreased with helmet use (odds ratio, 0.35; 95% confidence intervals, 0.23, 0.53). Ethanol use was a significant variable in both head (odds ratio, 3.89) and spinal (odds ratio, 2.41) injuries. CONCLUSION: In contrast to a significant protective relationship identified for head injuries, helmet use was not associated with an increased or decreased occurrence rate of spinal injuries in motorcycle trauma.