Intra-individual stability of rate of gross motor development in full-term infants.

The purpose of this study was to evaluate the intra-individual stability of gross motor scores obtained by normally developing full-term infants on the Alberta Infant Motor Scale (AIMS). The gross motor skills of 47 infants were assessed monthly in their homes by pairs of physical therapists. Infants were followed from two weeks of age until they achieved independent walking. A developmental pediatrician assessed each infant at 18 months of age, and classified the infant's gross motor skills as normal, suspicious or abnormal. Only the data of infants receiving a normal classification at 18 months were included in the analyses (n = 45). Individual infants' percentile ranks varied considerably from month to month, with no systematic pattern of change noted across infants. As a group, the mean percentile range over 13 assessments was 66.78 (S.D. 13.47). Fourteen infants (31.1%) received a score below the 10th percentile on at least one occasion. The results suggest that normally developing infants are not stable in the rate of emergence of gross motor skills. This instability has implications for infant screening programs, and supports the premise of serial assessments to identify accurately those infants with a motor delay.

Outcomes of enhanced physical and occupational therapy service in a nursing home setting.

OBJECTIVE: The purpose of this study was to determine if 1.0 Full-time Equivalent (FTE) physical therapy (PT) and 1.0 FTE occupational therapy (OT) per 50 beds resulted in differences in functional status for nursing home residents when compared to 1.0 FTE PT and 1.0 FTE OT per 200 beds. DESIGN: Randomized control program evaluation, cost analysis. SETTING: Nursing home in the province of Alberta, Canada. PATIENTS: 115 residents assigned to 1 PT and 1 OT per 50 beds (enhanced group) versus 1 PT and 1 OT per 200 beds (control group) using stratified random allocation by severity of condition. INTERVENTIONS: Both groups received ongoing treatment, follow-up, and restorative interventions, but enhanced group received more hours of service. OUTCOME MEASURES: Functional Independence Measure (FIM), Functional Assessment Measures (FAM), and Clinical Outcome Variables Scale (COVS) recorded at 6-month intervals over a 2-year period. RESULTS: Mean score differences favored the enhanced group for the tests over the 2 years. Significance was observed on FIM Total at 6 and 12 months, FIM Self Care at 6 months, FIM Communication at 24 months, and FIM Psychosocial at 6, 12, 18, and 24 months; FAM Total at 6, 12, 18, and 24 months, FAM Self Care at 6 months, FAM Mobility at 12 months, FAM Communication at 6 and 24 months, FAM Psychosocial at 6, 12, 18, and 24 months, and FAM Cognition at 6 and 12 months; and COVS at 6, 12, 18, and 24 months. A cost analysis demonstrated that PT/OT offered at the 1:50 ratio would result in a cost savings in terms of nursing staff dollars for 30 long-term-care beds of $16,973 over the 2 years of the study compared to the 1:200 ratio. This equates to an annual cost savings of $283 per bed. CONCLUSIONS: Increasing the amount of PT/OT can have a positive effect on the functional status and cost of care of long-term care residents.

Factors related to outcome following a work hardening program.

The purpose of this study was to determine factors related to a return to work following the completion of a work hardening program. Data from the Workers' Compensation Board of Alberta Millard Rehabilitation Centre for 1527 discharges, collected over 22 months, were examined retrospectively. Factors related to return to work were compared bivariately using logistic regression procedures. A multiple logistic regression model for return to work was also determined. The principle predictor of return to work was job-attached status to the pre-injury employer. Other factors related to return to work were education, primary diagnosis, injury to admission time, job attachment to the pre-accident employer, employer's annual payroll, and vocational direction. Due to the strength of the association between job-attached status to the pre-injury employer and a return to work, it was concluded that attempts to maintain this relationship should be a priority for rehabilitation providers and insurance carriers.

Functional activities versus work hardening in the rehabilitation of the injured worker.

A correlational study was carried out to consider whether a program based on a work-hardening paradigm would result in objective improvements in return-to-work rates relative to a functional-activities approach. Subjects, 165 nurses, were obtained from the Alberta Workers' Compensation Board Rehabilitation Centre client files. The clients were described relative to their age, accident-to-admission times, length of stay, and other relevant measures. A logistic regression was carried out to ascertain whether a work-hardening program versus a functional-activities program would be more effective in facilitating return-to-work rates. The logistic regression was carried out controlling for other relevant predictor variables. The results indicated that clients who received a work-hardening program were statistically more likely to return to work.