Perceived discrimination in healthcare settings among Latinos with limited English proficiency in South Carolina.

OBJECTIVES: Perceived discrimination in healthcare settings is reported frequently by Latino adults and is associated with reductions in healthcare utilization and having a usual source of care. Little is known about discrimination perceived by Latino adults with limited English proficiency (LEP) who also frequently experience difficulties with healthcare access and utilization. The objective of this pilot study was to examine perceived discrimination in healthcare settings among Latino adults with LEP living in South Carolina. METHODS: Sixty-two Latino adults with LEP were surveyed to examine perceived discrimination in healthcare settings using the 10-question Behavioral Risk Factor Surveillance System Reactions to Race Module. RESULTS: Seventy percent of the sample reported thinking about race/ethnicity on a daily basis. Twenty-one percent reported experiencing physical symptoms and 26% reported feeling emotionally upset in the past 30 days based on how they were treated by others because of their race. When seeking healthcare services, only 11.5% perceived discrimination in healthcare settings. CONCLUSIONS: Although a significant percentage of the sample reported thinking about race/ethnicity daily, only approximately 25% reported experiencing health symptoms based on how they were treated as a result of their race and few perceived discrimination in healthcare settings.

Use of simulated patients and reflective video analysis to assess occupational therapy students' preparedness for fieldwork.

Educators must determine whether occupational therapy students are adequately prepared for Level II fieldwork once they have successfully completed the didactic portion of their coursework. Although studies have shown that students regard the use of video cameras and simulated patient encounters as useful tools for assessing professional and clinical behaviors, little has been published in the occupational therapy literature regarding the practical application of simulated patients or reflective video analysis. We describe a model for a final Comprehensive Practical Exam that uses both simulated patients and reflective video analysis to assess student preparedness for Level II fieldwork, and we report on student perceptions of these instructional modalities. We provide recommendations for designing, implementing, and evaluating simulated patient experiences in light of existing educational theory.

Poor stroke-related risk factor control even after stroke: an opportunity for rehabilitation professionals.

The burden of chronic disease worldwide is substantial. Unfortunately, risk factor control for most chronic diseases remains poor even after diagnoses. This is a major concern because poor risk factor control often leads to secondary consequences of the disease and the development of co-existing diseases. Stroke is a chronic condition that frequently requires the services of rehabilitation professionals who can also play an important role in risk factor management to reduce recurrent stroke. Approaches to the management of stroke risk factors in stroke survivors vary greatly and consequently outcomes vary in a similar fashion. The current literature suggests that uniform offering of structured risk factor control programs over time to individuals with chronic disease can improve knowledge of stroke risk factors, knowledge of action to control risk factors and in turn facilitate self-management practices that reduce the negative consequences of chronic diseases. Rehabilitation professionals can play a vital role in the management and secondary prevention of chronic diseases during the rehabilitation process via patient education and training. Implications for Rehabilitation Evidence suggests that risk factor control remains poor in many individuals with chronic conditions such as stroke. Rehabilitation professionals can play a key role in programs designed to improve risk factor control in chronic conditions. Future risk factor control programs can be structured and implemented over time to include rehabilitation professionals.

Self-reported versus objectively assessed exercise adherence.

OBJECTIVE. We examined agreement of data between self-reported and objectively assessed exercise adherence among women with systemic lupus erythematosus. METHOD. Eleven participants completed weekly exercise logs on date and duration of exercise during a 10-wk Wii Fit™ home-based program. Afterward, exercise data from the log were compared with those recorded in the Wii console. RESULTS. Of the paired data, the mean duration of exercise recorded in the Wii was 29.5 min and that recorded in the log was 33.3 min. The composite intraclass correlation for exercise duration between exercise log and the Wii Fit was 0.4. The 95% limits of agreement indicated large between-subjects variability. CONCLUSION. Exercise logs exhibit a marginally acceptable agreement with Wii estimation of exercise duration at a group level. However, caution should be applied when using the exercise log as a measure of a person's exercise behavior because of the tendency to overreport.

Self-reported arthritis burden and management in South Carolina.

OBJECTIVE: Arthritis has garnered national attention as the leading cause of disability, yet it is important to survey the burden and management of this disabling condition at the state and local levels. This study explored the self-reported burden and management of arthritis in South Carolina using state-based data relative to other prominent chronic diseases. METHODS: Data from 9580 adults in South Carolina who participated in the 2009 Behavioral Risk Factor Surveillance System were used to quantify the self-reported burden and management of arthritis within the past year. RESULTS: Estimates indicate that 31% (3043) of adults in South Carolina were diagnosed as having arthritis in 2009. The burden of arthritis was evident with 49% (1954) of the individuals with arthritis experiencing activity limitations, 39% (1500) reported arthritis affected their employment, 92% (3705) reported living with pain, and 44% (1787) reported restricted social activities. Self-reported arthritis management included advice to lose weight (37%), encouragement to exercise (57%), and limited education on proper management (11%). The majority (75%) of individuals reported that arthritis interferes with their ability to accomplish what they want. CONCLUSIONS: Arthritis is more prevalent and burdensome for individuals in South Carolina when compared with national estimates. These findings suggest that there are potential educational opportunities to increase awareness of the disease and its burden, as well as improve education and disease management.

The process associated with motivation of a home-based Wii Fit exercise program among sedentary African American women with systemic lupus erythematosus.

OBJECTIVE: To explore the process associated with the motivation for playing Wii Fit among patients with systemic lupus erythematosus (SLE). METHODS: Individual in-depth semi-structured telephone interviews were conducted with 14 sedentary African American women with SLE to explore their experiences and reflect on their motivation for playing Wii Fit after completing a 10-week home-based Wii Fit exercise program. Interviews were audio-recorded, transcribed verbatim, and analyzed using the constant comparative method to identify categories related to participants' motivation. Three authors independently sorted, organized and coded transcript text into categories, then combined the categories into themes and subthemes. RESULTS: In addition to the two themes (Ethical principal of keeping a commitment, and Don't want to let anyone down) generic to home-based exercise trials, we identified five themes (Enjoyment, Health Benefits, Sense of Accomplishment, Convenience, and Personalized) that revealed why the participants were motivated to play the Wii Fit. Enjoyment had three subthemes: Interactive, Challenging, and Competitive with an embedded social element. However, several participants commented they were not able to do many activities, master certain games, or figure out how to play some; as a result, they were bored with the limited selection of activities that they could do. CONCLUSIONS: The motivational elements of the Wii Fit may contribute to improved exercise motivation and adherence in select sedentary African American women with SLE. Results provide a better understanding on the important elements to incorporate in the development of sustainable home-based exercise programs with interactive health video games for this population.

Arthritis knowledge: a survey of health professional students.

BACKGROUND: Recent reports indicate that disease-specific educational modules have resulted in improved knowledge among resident physicians. These findings suggest that graduate level health professional students may also benefit from similar strategies focused on arthritis, the leading cause of disability in the United States. The purpose of this pilot study was to examine arthritis knowledge among healthcare professional students whose current curriculums include didactic arthritis content. METHODS: A survey of arthritis knowledge was developed to examine general arthritis knowledge and the epidemiological impact of arthritis among healthcare professional students. The survey was administered to 164 first, second, and third year students enrolled in graduate occupational and physical therapy programs. RESULTS: The findings of the current study address risk factors recognition and arthritis knowledge. Risk factors recognition -- 94% identified age; 68% identified gender; 94% identified genetics; 90% identified joint injuries; 73% identified obesity as a risk factor; and 55% identified occupation. More than 50% of the students identified the six risk factors most likely to lead to arthritis. ARTHRITIS KNOWLEDGE: prevalence, disability impact, and cost -- 100% correctly identified arthritis symptoms; 26% of the students surveyed reported arthritis as the third leading cause of disability; 85% of the survey respondents reported that in the US women have higher rates of arthritis; and 31% knew the health care cost of arthritis in the US. CONCLUSIONS: All students recognized the symptoms of arthritis and most recognized its individual risk factors, but few exhibited knowledge of the financial and disability burden associated with arthritis. These findings suggested that despite didactic arthritis content in both the occupational and physical therapy programs arthritis risk factors recognition and arthritis knowledge were mixed. Further research examining arthritis knowledge among a broader range of health professional students may be important to determine if disease-specific educational modules are needed in all graduate health professional programs.

Racial/ethnic differences in utilization of post-stroke rehabilitation services: a systematic review.

OBJECTIVE: To examine racial/ethnic differences in utilization of stroke-related rehabilitation. METHODS: We searched Medline (from 1966-2007), CINAHL (from 1982-2007), PsycINFO (1966-2007), REHABDATA (1966-2007), the Cochrane Library, and reference lists of published articles. We identified 82 studies in our initial search, including randomized and quasirandomized controlled trials, working papers, technical reports, and conference presentations of stroke patients that reported utilization of rehabilitation services including physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), and at least two groups that differed by race/ethnicity. Because of limited information on outcomes and heterogeneity of the studies, a formal meta-analysis was not conducted. A qualitative aggregation of study findings was performed instead. RESULTS: Ten studies involving 214,229 patients met the final criteria for review. Racial/ethnic minorities were more likely to receive rehabilitation and have longer lengths of stays in studies that reported use of rehabilitation services. In contrast, when studies reported discipline-specific (PT, OT, SLP) utilization of services, the results were mixed. CONCLUSIONS: Racial/ethnic differences in the utilization of rehabilitation services primarily reflected the manner in which service utilization was reported. Future studies should be designed to ensure an accurate comparison of service utilization by race/ethnicity.