ABSTRACT
OBJECTIVES: The proposal of the present study is based on mobilizing the nervous system of the upper hemiplegic limb of stroke victims using the Upper Limb Neurodynamic Test (ULNT 1) and electromyographic analysis of the biceps brachii muscle. METHODS: A pre-experimental study was carried out with pretest and posttest repeated measurements on five stroke victims (4 men and 1 woman; mean age: 52.8 +/- 11 years), with Grade 1 and + 1 spasticity, according to the modified Ashworth scale. Electromyographic analysis of the biceps brachii muscle was performed with the elbow flexed at 90 degrees, following by complete extension. RESULTS: The neurodynamic test led to a decrease in electromyographic activity in the biceps brachii muscle (p < or = 0.05). CONCLUSION: Neural mobilization was efficient in reducing myoelectric activity in the biceps brachii muscle in patients with stroke and may used by physiotherapists as an efficient method for treating patients with this pathology.
Subject(s)
Muscle Contraction , Muscle Spasticity/physiopathology , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Physical Therapy Modalities , Stroke/physiopathology , Electromyography , Female , Humans , Male , Middle Aged , Muscle Spasticity/etiology , Muscle Spasticity/rehabilitation , Stroke/complications , Stroke Rehabilitation , Treatment OutcomeABSTRACT
The objectives of this study were to evaluate the effect of inpatient case management (CM) on a general medical service and to determine if a prediction rule, identifying patients likely to need discharge planning services, could define a subset of patients for whom CM would be most effective. We hypothesized that CM would have greatest impact on patients predicted to be at highest risk of needing discharge planning to arrange for post-discharge medical services. We carried out a prospective controlled study. Six general medicine teams from a 600-bed urban teaching hospital were randomly assigned to CM (n = 4) or standard care (SC) (n = 2). Number of patients = 302 (207 CM; 95 SC). Case managers participated in daily physician team rounds and coordinated discharge planning for CM patients; SC patients received discharge planning from staff nurses or discharge planners when requested by physicians. The outcomes measured were deviation from the hospital length of stay (LOS) expected for a patient's diagnosis, patient satisfaction and non-acute medical service utilization during the month after discharge. Overall, patients from CM and SC teams did not differ in their deviation from expected LOS, post-discharge medical service utilization and patient satisfaction. However, after stratifying patients by their predicted need for post-discharge medical services, only patients in the 'high risk' category had a significantly shorter LOS under CM (2.9 days shorter than SC patients; P = 0.02). We concluded that, in this study, the effect of case managers on a general medical service was limited to shortening LOS only among a stratum of high risk patients.
Subject(s)
Case Management , Nurse-Patient Relations , Nurses , Outcome Assessment, Health Care , Adult , Family Practice , Female , Health Services/statistics & numerical data , Humans , Length of Stay , Male , Middle Aged , Patient Discharge , Patient Satisfaction , Prospective StudiesABSTRACT
OBJECTIVE: To develop and validate a prediction rule screening instrument, easily incorporated into the routine hospital admission assessment, that could facilitate discharge planning by identifying patients at the time of admission who are most likely to need postdischarge medical services. DESIGN: Prospective cohort study with separate phases for prediction rule development and validation. SETTING: Urban teaching hospital. PATIENTS/PARTICIPANTS: General medical service patients, 381 in the derivation phase and 323 in the validation phase, who provided self-reported medical history, health status, and demographic data as a part of their admission nursing assessment, and were subsequently discharged alive. MEASUREMENTS AND MAIN RESULTS: Use of postdischarge medical services such as visiting nurse or physical therapy, medical equipment, or placement in a rehabilitation or long-term care facility was determined. A prediction rule based on a patient's age and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) physical function and social function scores stratified patients with regard to their risk of using postdischarge medical services. In the validation set, the rate of actual postdischarge medical service use was 15% (15 of 97), 36% (39 of 107), and 58% (57 of 98) among patients characterized by the prediction rule as being at "low", "intermediate," and "high" risk of using postdischarge medical services, respectively. CONCLUSIONS: This prediction rule stratified general medical patients with regard to their likelihood of needing discharge planning to arrange for postdischarge medical services. Further research is necessary to determine whether prospective identification of patients likely to need discharge planning will make the hospital discharge planning process more efficient.
