Care needs of persons with long-term spinal cord injury living at home in the Netherlands.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: To describe the care received, care needs and preventability of secondary conditions according to persons with long-term spinal cord injury (SCI) living at home. SETTING: The Netherlands. METHODS: A questionnaire was sent to all members of the Dutch SCI Patient Organisation. From a list of 26 SCI secondary conditions, participants chose the five conditions they perceived as most important. For each of these conditions, they described the type of care they received, their need for (extra) care and its preventability. RESULTS: Response rate was 45% (n=453) and mean time after injury was 13.3 years. In case of secondary conditions, participants were more likely to visit their general practitioner (58%) than another medical specialist (29%) or rehabilitation specialist (25%). For all most-important secondary conditions, care was received in 47% and care, or extra care, was needed in 41.3%. Treatment was the type of care most often received (29.5%) and needed (17.2%). However, for information and psychosocial care, the care needed (12.2 and 9.9%, respectively) was higher than the care received (7.6 and 5.9%, respectively). Thirty-four percent of all most-important secondary conditions were perceived as preventable, the rate increasing to 52.8% for pressure sores, of which 29.9% were considered to be preventable by the participants themselves. CONCLUSIONS: This study showed substantial unmet care needs in persons with long-term SCI living at home and underlines the further improvement of long-term care for this group. Information, psychosocial care and self-efficacy seem to be the areas to be enhanced.

Test-re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study.

PRIMARY OBJECTIVE: Assess the test-re-test reliability of walking speed, step length and step width measurement in people with traumatic brain injury (TBI). RESEARCH DESIGN: Repeated measures (two test occasions). METHODS: Thirteen people with TBI completed four comfortable and four fast-paced walking trials of the 10 m walk test and two trials of the 6-minute walk test (6MWT). Walking speed, step length and step width were measured during the 10 m walk test and walking distance and average speed were measured during the 6MWT. The tests were repeated 1-week later. MAIN RESULTS: Walking speed and distance showed excellent test-re-test reliability, with an intra-class correlation coefficient (ICC) of 0.95-0.96. Reliability was also high for step length and width measurement (ICC 0.91-0.98). CONCLUSIONS: This test-re-test reliability means that walking speed and distance and step length and width can be used by physiotherapists to monitor improvements in walking after TBI.

Inter-rater reliability and concurrent validity of walking speed measurement after traumatic brain injury.

OBJECTIVE: To assess the inter-rater reliability and concurrent validity of walking speed measurement after traumatic brain injury. DESIGN: Twelve subjects each completed five comfortably paced and five fast-paced walking trials. Walking speed was measured simultaneously by five observers using a stopwatch (clinical procedure) and by infrared timing gates (gold standard). SETTING: Brain injury rehabilitation unit. SUBJECTS: People with traumatic brain injury who could walk independently and were participating in a rehabilitation programme. MAIN OUTCOME MEASURES: Walking speed over a 10-metre distance. RESULTS: The inter-rater reliability of walking speed measured using a stopwatch was very high, with an intraclass correlation coefficient of at least 0.998 for both comfortable and fast-paced tests. Concurrent validity was excellent for comfortable and fast tests, with perfect correlations between the stopwatch and infrared timing gate measurement procedures. CONCLUSIONS: Physiotherapists can use a stopwatch as a reliable and valid measurement tool to quantify walking speed over a short distance at both comfortable and fast paces in people who have sustained traumatic brain injuries.

Inter-rater reliability and concurrent validity of step length and step width measurement after traumatic brain injury.

PURPOSE: To determine the inter-rater reliability and concurrent validity of step length and step width measurement after traumatic brain injury. METHOD: Twelve people with traumatic brain injury completed six comfortable and six fast paced walking trials over a 10 m distance. Step length and step width were measured by five observers using two procedures. First, using pens taped on the subjects' heels which marked the floor at each heel strike and a tape measure. Second, by videotaping the subjects' feet as they walked on a mat marked with 5 cm grids and using a computer program to digitize foot position and calculate step length and width. RESULTS: The inter-rater reliability of step length and width measurements was very high, with intraclass correlation coefficients between 0.94 and 1.00, for both procedures. Concurrent validity was excellent, with correlations between the procedures ranging from 0.93 to 1.00. However, attaching pens to the heels did cause a slight reduction in right step length and walking speed when walking at a fast or comfortable pace, respectively. CONCLUSIONS: Assessing step length and width using pens taped to the subjects' heels and a tape measure is a reliable and valid clinical measure after traumatic brain injury.