Developing, testing, and sustaining rehabilitation interventions via participatory action research.

Few published intervention studies in the rehabilitation literature have included consumers in the research process other than as study participants. This lack of consumer involvement in intervention research may contribute to the challenges encountered developing, translating, disseminating, and sustaining evidence-based rehabilitation interventions in clinical practice. The overall objective of this article is to promote the integration of participatory action research (PAR) into rehabilitation intervention research as a mechanism for addressing these gaps. First, we outline essential components of a PAR model across 5 key phases of intervention research, specifically: agenda setting, methods, implementation, diffusion/dissemination, and sustainability. Second, we describe the use of PAR in rehabilitation intervention research within each of these phases by reviewing relevant literature and by providing an illustrative research example from a randomized controlled trial that integrated PAR throughout the research process. Finally, we conclude with a discussion of 5 specific recommendations for promoting the integration of PAR into rehabilitation intervention research.

General anxiety symptoms after acute lung injury: predictors and correlates.

OBJECTIVE: Acute lung injury (ALI) is common in the intensive care unit (ICU), typically requiring life support ventilation. Survivors often experience anxiety after hospital discharge. We evaluated general anxiety symptoms 3 months after ALI for: (1) associations with patient characteristics and ICU variables, and (2) cross-sectional associations with physical function and quality of life (QOL). METHODS: General anxiety was assessed as part of a prospective cohort study recruiting patients from 13 ICUs at four hospitals in Baltimore, MD using the Hospital Anxiety and Depression Scale--Anxiety Subscale (HAD-A), with associations evaluated using multivariable linear and logistic regression models. RESULTS: Of 152 patients, 38% had a positive screening test for general anxiety (HAD-A≥8). Pre-ICU body mass index and psychiatric comorbidity were associated with general anxiety (OR, 95% confidence interval (CI): 1.06 (1.00, 1.13) and 3.59 (1.25, 10.30), respectively). No ICU-related variables were associated with general anxiety. General anxiety was associated with the number of instrumental ADL dependencies (Spearman's rho=0.22; p=0.004) and worse overall QOL as measured by EQ-5D visual analog scale (VAS) (rho=-0.34; p<0.001) and utility score (rho=-0.30; p<0.001), and by the SF-36 mental health domain (rho=-0.70; p<0.001) and Mental Component Summary score (rho=-0.73; p<0.001). CONCLUSION: Many patients have substantial general anxiety symptoms 3 months after ALI. General anxiety was associated with patient characteristics and impaired physical function and quality of life. Early identification and treatment of general anxiety may enhance physical and emotional function in patients surviving critical illnesses.

Inpatient rehabilitation approach for a young woman with conversion hemiparesis and sensory deficits.

In the treatment of conversion disorder, the inpatient rehabilitation setting supports interdisciplinary functional goals and a structured approach consistent with encouraging psychological well-being. This case presentation illustrates 1 approach to the rehabilitation of hemiparesis secondary to conversion disorder that includes a behavioral management plan, as well as protocols for "learning to walk" and "learning to use your arm." We provide a practical starting point for advancing function in patients with conversion disorder when functional loss is present in both upper and lower extremities.

The metabolic syndrome and coronary artery disease: a structural equation modeling approach suggestive of a common underlying pathophysiology.

OBJECTIVE: The purpose of this research was to utilize a structural equation modeling (SEM) approach to simultaneously examine the relationship among the Metabolic Syndrome (MetSyn) and coronary artery calcification (CAC), a surrogate marker for sub-clinical atherosclerosis and coronary artery disease (CAD). MATERIALS/METHODS: Data were derived from the Spokane Heart Study (SHS), a prospective study designed to examine the role of traditional and non-traditional biological, psychological, and behavioral risk factors predictive of CAC. Study participants included 434 non-clinical healthy volunteers (54% female, 46% male; mean age of 56 years) who were asymptomatic for CAD at enrollment and had complete data for the primary variables of interest (MetSyn components and CAC) during the data collection period (i.e., 2002-2006). A confirmatory factor analysis (CFA) was conducted on the MetSyn factor with the following indicator variables: body mass index, fasting glucose, high-density lipoprotein cholesterol, fasting triglyceride levels, and systolic blood pressure. SEM was used to test the theoretical model that the MetSyn is associated with CAC. RESULTS: This study demonstrated that body mass index, fasting glucose, fasting triglyceride levels, HDL cholesterol, and blood pressure do cluster together under a single latent factor, and that this latent factor is associated with CAC. CONCLUSIONS: Our results highlight the possibility that there is a common pathophysiological pathway that could explain the relationship between the MetSyn and CAD. Future studies should examine these relationships in a prospective fashion for early detection and prevention of CAD and to identify ideal time points for clinical intervention.

Hope predicts positive functional role outcomes in acute rehabilitation populations.

PURPOSE/OBJECTIVE: The purpose of this study was to examine the association between facilitating psychological variables and functional rehabilitation outcomes following acute medical rehabilitation. RESEARCH METHOD/DESIGN: Using a longitudinal design and correlational and regression analyses, we studied 174 adults who were participating in inpatient rehabilitation for acute spinal cord dysfunction, stroke, amputation, or orthopedic surgery recovery. All participants completed the Hope Scale, Positive and Negative Affect Schedule, and Functional Independence Measure (FIM) during the first days of their inpatient stay, and then were contacted 3 months after discharge to complete the Craig Hospital Assessment and Reporting Technique (CHART) and FIM. RESULTS: Hope accounted for a statistically significant amount of the variance in the prediction of functional role participation at 3 months postdischarge (as measured by the CHART) above and beyond the variance accounted for by demographic and severity variables. In contrast, positive affect was not found to contribute to the prediction of functional role participation, and neither hope nor positive affect contributed to the prediction of functional skill level (FIM). CONCLUSIONS/IMPLICATIONS: The results indicate that positive psychological variables present during the rehabilitation stay, such as hopefulness, may contribute to the prediction of functional outcomes after discharge in rehabilitation populations. These findings suggest that incorporating interventions that enhance hope and build on the individual's psychological strengths may be useful to improve participation outcomes following acute medical rehabilitation.

Increase in nalidixic acid resistance among non-Typhi Salmonella enterica isolates in the United States from 1996 to 2003.

Fluoroquinolones commonly are used to treat adult Salmonella infections. Fluoroquinolone treatment has failed for persons infected with nalidixic acid-resistant Salmonella. From 1996 to 2003, state public health laboratories forwarded 12,252 non-Typhi Salmonella enterica isolates to the Centers for Disease Control and Prevention for antimicrobial susceptibility testing; 203 (1.6%) of the isolates were nalidixic acid resistant, and 14 (7%) of those were ciprofloxacin resistant. Resistance to nalidixic acid significantly increased from 0.4% in 1996 to 2.3% in 2003. All ciprofloxacin-resistant isolates had at least one point mutation in the quinolone resistance determining region (QRDR) of gyrA and did not harbor qnr or have point mutations in the QRDR of gyrB, parC, or parE. Continued surveillance of antimicrobial resistance among non-Typhi S. enterica isolates is needed to mitigate the increasing prevalence of nalidixic acid resistance.

Human Salmonella and concurrent decreased susceptibility to quinolones and extended-spectrum cephalosporins.

The National Antimicrobial Resistance Monitoring System monitors susceptibility among Enterobacteriaceae in humans in the United States. We studied isolates exhibiting decreased susceptibility to quinolones (nalidixic acid MIC >32 microg/mL or ciprofloxacin MIC > or =0.12 microg/mL) and extended-spectrum cephalosporins (ceftiofur or ceftriaxone MIC > or =2 microg/mL) during 1996-2004. Of non-Typhi Salmonella, 0.19% (27/14,043) met these criteria: 11 Senftenberg; 6 Typhimurium; 3 Newport; 2 Enteridis; and 1 each Agona, Haifa, Mbandaka, Saintpaul, and Uganda. Twenty-six isolates had gyrA mutations (11 at codon 83 only, 3 at codon 87 only, 12 at both). All Senftenberg isolates had parC mutations (S801 and T57S); 6 others had the T57S mutation. The Mbandaka isolate contained qnrB2. Eight isolates contained bla(CMY-2); 1 Senftenberg contained bla(CMY-23). One Senftenberg and 1 Typhimurium isolate contained bla(SHV-12); the Mbandaka isolate contained bla(SHV-30). Nine Senftenberg isolates contained bla(OXA-1) contained bla(OXA-9). Further studies should address patient outcomes, risk factors, and resistance dissemination prevention strategies.