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Abstract
OBJECTIVE To examine associations between funding source, use of rehabilitation and outcomes after total joint replacement and to evaluate variations based on demographic characteristics. DESIGN Cross-sectional, questionnaire-based national survey. SUBJECTS Participants aged 45 years or older (n = 522) who received either private or public funding for their surgery, were recruited from the New Zealand Joint Registry 6 months after a total hip, total knee or unicompartmental knee replacement. RESULTS The cohort was predominantly New Zealand European (90%), aged 68 years, with more men (55%) than women (45%). Privately funded participants were younger, had higher levels of education and employment, and lower rates of comorbidities at the time of surgery. Privately funded participants also reported spending less time on the surgical waiting list, were less likely to participate in pre-surgical rehabilitation, but reported more weeks of post-surgical rehabilitation and better patient-reported outcomes in terms of pain, function and quality of life, compared with their publicly funded counterparts. CONCLUSION Factors already known to impact on joint replacement outcomes were associated with funding source in this cohort. Socio-economic differences and inequities between private and public systems exist consistent with limited available prior research. In this cross-sectional study, no clinically significant differences in outcomes between the groups were identified. Prospective research will help to clarify whether funding source directly affects joint replacement rehabilitation outcomes.
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Affiliation(s)
- Deborah L Snell
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, , 8011 Christchurch, New Zealand.
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Dunn JA, Hay-Smith EJ, Keeling S, Sinnott KA. Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years. Arch Phys Med Rehabil 2017; 97:S88-96. [PMID: 27233596 DOI: 10.1016/j.apmr.2015.09.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/18/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years. DESIGN Quantitative-qualitative mixed-methods study. SETTING Community based in New Zealand. PARTICIPANTS People (N=9) living with tetraplegia for >10 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES An audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory. RESULTS Sixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery. CONCLUSIONS Findings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time.
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Affiliation(s)
- Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Spinal Unit, Burwood Hospital, Christchurch, New Zealand.
| | - E Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Sally Keeling
- Health Care of the Elderly, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - K Anne Sinnott
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Academy of Independent Living, Burwood Hospital, Christchurch, New Zealand
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L Snell D, Hipango J, Sinnott KA, Dunn JA, Rothwell A, Hsieh CJ, DeJong G, Hooper G. Rehabilitation after total joint replacement: a scoping study. Disabil Rehabil 2017; 40:1718-1731. [PMID: 28330380 DOI: 10.1080/09638288.2017.1300947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research. MATERIALS AND METHODS We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement. We reviewed this work in the context of outcomes described from previously published research. RESULTS Thirty individual studies and seven systematic reviews were included, with most research examining the effectiveness of physiotherapy-based exercise rehabilitation after total knee replacement using randomized control trial methods. Rehabilitation after hip and knee replacement whether carried out at the clinic or monitored at home, appears beneficial but type, intensity and duration of interventions were not consistently associated with outcomes. The burden of comorbidities rather than specific rehabilitation approach may better predict rehabilitation outcome. Monitoring of recovery and therapeutic attention appear important but little is known about optimal levels and methods required to maximize outcomes. CONCLUSIONS More work exploring the role of comorbidities and key components of therapeutic attention and the therapy relationship, using a wider range of study methods may help to advance the field. Implications for Rehabilitation Physiotherapy-based exercise rehabilitation after total hip replacement and total knee replacement, whether carried out at the clinic or monitored at home, appears beneficial. Type, intensity, and duration of interventions do not appear consistently associated with outcomes. Monitoring a patient's recovery appears to be an important component. The available research provides limited guidance regarding optimal levels of monitoring needed to achieve gains following hip and knee replacement and more work is required to clarify these aspects. The burden of comorbidities appears to better predict outcomes regardless of rehabilitation approach.
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Affiliation(s)
- Deborah L Snell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.,b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Julia Hipango
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - K Anne Sinnott
- b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Jennifer A Dunn
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - Alastair Rothwell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - C Jean Hsieh
- c MedStar Health Research Institute , Washington , DC , USA.,d MedStar National Rehabilitation Hospital , Washington , DC , USA
| | - Gerben DeJong
- d MedStar National Rehabilitation Hospital , Washington , DC , USA.,e Department of Rehabilitation Medicine , Georgetown University School of Medicine , Washington , DC , USA
| | - Gary Hooper
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
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Sinnott KA, Dunn JA, Wangdell J, Johanson ME, Hall AS, Post MW. Measurement of Outcomes of Upper Limb Reconstructive Surgery for Tetraplegia. Arch Phys Med Rehabil 2016; 97:S169-81. [DOI: 10.1016/j.apmr.2015.10.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/18/2015] [Accepted: 10/20/2015] [Indexed: 10/21/2022]
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Dunn JA, Sinnott KA, Rothwell AG, Mohammed KD, Simcock JW. Tendon Transfer Surgery for People With Tetraplegia: An Overview. Arch Phys Med Rehabil 2016; 97:S75-80. [DOI: 10.1016/j.apmr.2016.01.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 10/21/2022]
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Post MW, Charlifue S, Biering-Sørensen F, Catz A, Dijkers MP, Horsewell J, Noonan VK, Noreau L, Tate DG, Sinnott KA. Development of the International Spinal Cord Injury Activities and Participation Basic Data Set. Spinal Cord 2015; 54:530-4. [PMID: 26481708 DOI: 10.1038/sc.2015.188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/23/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Consensus decision-making process. OBJECTIVES The objective of this study was to develop an International Spinal Cord Injury (SCI) Activities and Participation (A&P) Basic Data Set. SETTING International working group. METHODS A committee of experts was established to select and define A&P data elements to be included in this data set. A draft data set was developed and posted on the International Spinal Cord Society (ISCoS) and American Spinal Injury Association websites and was also disseminated among appropriate organizations for review. Suggested revisions were considered, and a final version of the A&P Data Set was completed. RESULTS Consensus was reached to define A&P and to incorporate both performance and satisfaction ratings. Items that were considered core to each A&P domain were selected from two existing questionnaires. Four items measuring activities were selected from the Spinal Cord Independence Measure III to provide basic data on task execution in activities of daily living. Eight items were selected from the Craig Handicap Assessment and Reporting Technique to provide basic data on the frequency of participation. An additional rating of satisfaction on a three-point scale for each item completes the total of 24 A&P variables. CONCLUSION Collection of the International SCI A&P Basic Data Set variables in all future research on SCI outcomes is advised to facilitate comparison of results across published studies from around the world. Additional standardised instruments to assess activities of daily living or participation can be administered, depending on the purpose of a particular study.
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Affiliation(s)
- M W Post
- Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation Centre, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - F Biering-Sørensen
- Department for Spinal Cord Injuries, Rigshospitalet and Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Catz
- Loewenstein Rehabilitation Hospital, Raanana, and Tel-Aviv University, Tel-Aviv, Israel
| | - M P Dijkers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Horsewell
- The European Spinal Cord Injury Federation, Copenhagen, Denmark
| | - V K Noonan
- The Rick Hansen Institute, Vancouver, BC, Canada
| | - L Noreau
- Université Laval and Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, QC, Canada
| | - D G Tate
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - K A Sinnott
- Burwood Academy of Independent Living, Christchurch, New Zealand
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Martin R, Levack WMM, Sinnott KA. Life goals and social identity in people with severe acquired brain injury: an interpretative phenomenological analysis. Disabil Rehabil 2014; 37:1234-41. [DOI: 10.3109/09638288.2014.961653] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Biering-Sørensen F, Bryden A, Curt A, Friden J, Harvey LA, Mulcahey MJ, Popovic MR, Prochazka A, Sinnott KA, Snoek G. International Spinal Cord Injury Upper Extremity Basic Data Set. Spinal Cord 2014; 52:652-7. [DOI: 10.1038/sc.2014.87] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/28/2014] [Accepted: 05/03/2014] [Indexed: 11/09/2022]
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Sinnott KA, Dunn JA, Rothwell AG, Hall AS, Post MWM. The development of the NZ-based international upper limb surgery registry. Spinal Cord 2014; 52:611-5. [DOI: 10.1038/sc.2014.57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/04/2014] [Accepted: 03/29/2014] [Indexed: 11/09/2022]
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Dunn JA, Rothwell AG, Mohammed KD, Sinnott KA. The effects of aging on upper limb tendon transfers in patients with tetraplegia. J Hand Surg Am 2014; 39:317-23. [PMID: 24480690 DOI: 10.1016/j.jhsa.2013.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effects of aging on hand function among patients with tetraplegia who had forearm tendon transfer surgery between 1982 and 1990. METHODS The study used a longitudinal cohort design that compared hand function outcomes in 2012 with those obtained 11 years earlier. A digital analyzer was used to measure key pinch and grip strength, and results were compared with those obtained in 2001 to determine changes in strength over time. The study also evaluated changes in participant's employment status, wheelchair use, and subjective changes in function using the Lamb and Chan questionnaire. RESULTS Participants had a mean key pinch strength force between 11.5 N (tenodeses) and 32.9 N (active transfers) and grip strength forces between 23 N (tenodeses) and 59 N (active transfers). Since 2001, people with active transfers either maintained strength or experienced decreased strength of 5% to 14%. Thumb tenodesis power decreased 40% to 51%, whereas finger tenodeses power increased 32% to 70%. Three activities in the Lamb and Chan questionnaire were identified by the majority of participants as being worse or much worse over the past 11 years. These were performing a pressure relief and propelling a manual wheelchair on level ground and up a ramp. These findings correspond with the increased number of participants who used a power wheelchair in 2012 (64%) compared with 2001 (26%). Close to half of the participants (46%) were employed compared with the 90% in 2001. CONCLUSIONS Tendon transfers continued to provide pinch and grip function for individuals with tetraplegia for many years following spinal cord injury. The decrease in strength of those with active transfers over the 11-year period was within the reported aging loss for the normal population. The small number of participants with tenodesis, however, limited our ability to draw meaningful conclusions for this group. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand.
| | - Alastair G Rothwell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand
| | - Khalid D Mohammed
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand
| | - K Anne Sinnott
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago; the Burwood Spinal Unit, Canterbury District Health Board; and the Burwood Academy of Independent Living (BAIL), Burwood Hospital, Christchurch, New Zealand
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Graham F, Sinnott KA, Snell DL, Martin R, Freeman C. A more "normal" life: residents', family, staff, and managers' experience of active support at a residential facility for people with physical and intellectual impairments. J Intellect Dev Disabil 2013; 38:256-264. [PMID: 23984884 DOI: 10.3109/13668250.2013.805738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Active support (AS) has gained popularity as an approach for assisting people with intellectual disability to engage more fully in everyday activities. Although research has identified changes in the extent that residents are engaged in meaningful activities, the experience of stakeholders such as residents, staff, and family in AS is underexplored. METHOD A general inductive approach was used to analyse focus group and interview transcripts of residents (n = 4), staff (n = 13), and family (n = 2) about their experience of involvement in an AS pilot project at one residential care facility in New Zealand. RESULTS Three superordinate themes common to all stakeholders' experiences emerged: "living normal lives," "caring means doing with," and "engaging with risk." CONCLUSION Transitioning to AS had been enriching but at times challenging for all stakeholders. Valuing resident autonomy and preparedness for greater exposure to risk are significant considerations in the implementation of AS.
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Hay-Smith EJC, Dickson B, Nunnerley J, Anne Sinnott K. "The final piece of the puzzle to fit in": an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury. Disabil Rehabil 2012; 35:1436-46. [PMID: 23167432 DOI: 10.3109/09638288.2012.737079] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Little is known about employment experience after spinal cord injury (SCI) because most research to date concentrates on employment predictors. We explored the experiences of people with SCI, and vocational rehabilitation (VR) professionals working for a VR programme, in pursuing a return to employment in New Zealand (NZ) post-SCI. METHODS Twelve people with SCI (four employed, three job-seeking, five unemployed) and six VR professionals were interviewed, and the transcripts subjected to an Interpretative Phenomenological Analysis. RESULTS The core meaning of employment post-SCI was to live a normal life. Work advantages were social connectedness, a sense of self-worth, earning a living, and being occupied. Employment was the zenith of rehabilitation but not the first priority post-SCI. Employment barriers and facilitators were congruent with those found in similar studies. The role of VR was to sow the seeds of return to employment and to partner with the SCI client. CONCLUSIONS For persons employed pre-SCI, we posit that employment identity modification is part of the return to employment process, alongside a supportive social context and networks, and adapted work environments. VR professionals may facilitate return to employment through understanding and fostering the process of employment identity modification and supporting clients to find work opportunities congruent with employment identity.
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Affiliation(s)
- E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.
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Verkaaik J, Anne Sinnott K, Cassidy B, Freeman C, Kunowski T. The productive partnerships framework: harnessing health consumer knowledge and autonomy to create and predict successful rehabilitation outcomes. Disabil Rehabil 2010; 32:978-85. [PMID: 20450407 DOI: 10.3109/09638281003775386] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article examines the role of power distribution in partnerships between health consumers and professionals in determining successful desired outcomes, and the contributing role of consumer knowledge and autonomy. Recognition is given to the lack of practical tools, from both consumer and professional perspectives, to assist in the creation of productive partnerships. METHOD A conceptual analysis of the notions of consumer knowledge and autonomy in the context of outcomes, followed by the development of a prototype framework that aims to facilitate productive health partnerships. RESULTS The authors present prototype tools, which are shared between health consumer and professional, for identifying the strength of their cumulative power relative to their alignment to a common desired outcome (goal). The tools provide a choice of power contexts for the partnership to operate within, and a simple method for testing alignment to a common goal. CONCLUSION Increased health consumer knowledge and autonomy is associated with improved outcomes and these can in turn be influenced through productive health partnerships. The P2 framework is one approach to establishing robust working relationships between health professionals and consumers.
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Affiliation(s)
- Julian Verkaaik
- Burwood Academy of Independent Living, Burwood Hospital, Christchurch, New Zealand.
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Sinnott KA, Dunn JA, Rothwell AG. Use of the ICF conceptual framework to interpret hand function outcomes following tendon transfer surgery for tetraplegia. Spinal Cord 2004; 42:396-400. [PMID: 15111992 DOI: 10.1038/sj.sc.3101610] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Clinical commentary OBJECTIVE AND SETTING This paper is a clinical commentary based on the Round Table discussion on Assessment and Outcomes at the 7th International Conference on Tetraplegia: Surgery and Rehabilitation, Bologna, Italy 6-8 June, 2001. It refers specifically to the 10-year re-review undertaken in 2001 at the Spinal Unit, Burwood Hospital, Christchurch, New Zealand. SUBJECTS In all, 24 tetraplegic persons at a minimum of 12 years and up to 18 years following bilateral forearm tendon transfer surgery. METHOD The data were interpreted using the International Classification of Functioning, Disability, and Health (ICF) conceptual framework as the basis of interdisciplinary understanding of the participation dimension. RESULTS The results of the study outlined confirm that outcome measurement at more than one level of functioning is desirable to determine the functional effects beyond grip strength levels and activities of daily living, to consider the dimension of participation. CONCLUSIONS Use of the ICF as a theoretical framework for interpretation of the results enhanced the clinical applicability of the outcome measures used in the 10-year re-review undertaken in New Zealand in 2001.
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Affiliation(s)
- K A Sinnott
- Rehabilitation Teaching and Research Unit, Wellington School of Medicine & Health Sciences, University of Otago, New Zealand
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Abstract
PURPOSE To perform a 10-year re-review of hand function outcome for 24 tetraplegic persons who had received bilateral tendon transfers and tenodeses. METHODS The Lamb and Chan questionnaire with additional questions, the Quadriplegic Index of Function (QIF), the Swanson sphygmomanometer technique for hook grip, the Preston Pinch Meter (PP) for key pinch, and a digital analyzer (DA) for both hook and key pinch were the test instruments used. The QIF and DA had not been used previously. RESULTS Levels of functional independence and expectations were maintained. Mean hook grip values were maintained for the right hand but increased significantly for the left to reach right hand values. Mean pinch grip values decreased significantly. DA measurements confirmed similar hook grip values for both hands but key pinch values were significantly higher than the PP values. Active transfers averaged approximately twice the strength of tenodeses. CONCLUSIONS Hand function improvements gained from tendon transfers and tenodeses are maintained over time.
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Abstract
BACKGROUND The study was concerned with the secondary functional compromise persons with long-term paraplegia contend with, that has been shown to be associated with wheelchair use. Of particular interest was the relationship between the level of thoracic spinal cord injury (SCI) and factors predisposing to rotator cuff disorders (RCD), one of the most common upper extremity musculoskeletal complications linked with long-term SCI. Disorders of these peri-articular structures have previously been associated with impaired trunk postural control and abnormal muscle strength ratios in both able-bodied groups and in paraplegic athletes. Despite their neurologically intact shoulder joint musculature, high-level and low-level paraplegics have different degrees of trunk and pelvic stability available to them during activities of daily living (ADL). This fundamental functional anatomical difference between high-level and low-level paraplegics had not previously been related to the diagnosis of RCD in a non-athletic long-term paraplegic population. METHODS A descriptive cross sectional study was undertaken to demonstrate the differences in the prevalence of clinically diagnosed RCD in a high-level (n=22) and a low-level (n=20) group of persons with long-term paraplegia. Any perceived differences were then related to the functional anatomical variations between the two groups. Inferences were made based on factors predisposing to RCD known to exist among both able-bodied and paraplegic athletes. The 42 subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) to establish the presence or absence of shoulder pain and the Musculoskeletal Function Assessment (MFA) instrument to determine differences in functional ability and perceived degree of difficulty within five categories of ADL. Each participant underwent a clinical examination using validated provocative clinical tests and isometric muscle strength ratio testing. RESULTS There was a higher prevalence of RCD in the high-level group (P=0.009) which correlated with decreased trunk control (P=0.009). Differences in ability to perform functional tasks were not shown to be greater in the high-level group, although there was a higher degree of perceived difficulty in ADL. Muscle strength imbalances between the shoulder adductors and abductors were shown to be greater in the high-level group. CONCLUSIONS The results of this study suggest that the functional anatomical differences that exist within paraplegia contribute to the propensity of high-level paraplegic persons to suffer from RCD. These findings send a clear message to service-providers that greater acknowledgement of the differences in trunk postural control specific to the level of thoracic SCI is required. This may have implications for the prescription of wheelchairs, assistive devices and instruction for alternative ADL techniques to this specific population.
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Affiliation(s)
- K A Sinnott
- Rehabilitation Teaching and Research Unit, Wellington School of Medicine, University of Otago, Dunedin, New Zealand
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