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1.
Brain Inj ; : 1-8, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38318792

RESUMO

OBJECTIVE: Investigate whether an athlete's biological sex and exposure to a dedicated athletic trainer (AT) were related to clinical milestones after a sports-related concussion (SRC). DESIGN: Retrospective chart review. METHODS: Medical charts of collegiate athletes (n = 196 [70.9% female]) diagnosed with SRC were reviewed to extract: biological sex, dedicated AT exposure for their sport (yes/no), and time (days) to reaching clinical milestones (diagnosis, symptom resolution, unrestricted return to sport [RTS]). Mann-Whitney U tests were used to determine whether time to clinical milestones differed by sex, AT exposure, or their interaction. Proportions of same-day diagnoses and times to diagnosis, symptom resolution, and unrestricted RTS were evaluated with chi-squared and spearman's rank correlations, respectively. RESULTS: There were no significant differences in times to reaching any clinical milestone by sex, AT exposure, or their interaction (ps > 0.05). Forty-three percent of participants were diagnosed on the day of their SRC. This did not differ by sex or AT exposure (ps > 0.29). Longer times to SRC diagnosis were associated with more days to symptom resolution (ρ = 0.236, p = 0.001) and unrestricted RTS (ρ = 0.223, p < 0.001). CONCLUSIONS: Athlete sex and AT exposure were not associated with times to reach any clinical milestone; however, delayed diagnosis was associated with longer times to reach clinical recovery.

2.
Am J Phys Med Rehabil ; 99(7): 571-572, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32371624

RESUMO

The global outbreak of coronavirus disease 2019 has created an unprecedented challenge to the society. Currently, the United States stands as the most affected country, and the entire healthcare system is affected, from emergency department, intensive care unit, postacute care, outpatient, to home care. Considering the debility, neurological, pulmonary, neuromuscular, and cognitive complications, rehabilitation professionals can play an important role in the recovery process for individuals with coronavirus disease 2019. Clinicians across the nation's rehabilitation system have already begun working to initiate intensive care unit-based rehabilitation care and develop programs, settings, and specialized care to meet the short- and long-term needs of these individuals. We describe the anticipated rehabilitation demands and the strategies to meet the needs of this population. The complications from coronavirus disease 2019 can be reduced by (1) delivering interdisciplinary rehabilitation that is initiated early and continued throughout the acute hospital stay, (2) providing patient/family education for self-care after discharge from inpatient rehabilitation at either acute or subacute settings, and (3) continuing rehabilitation care in the outpatient setting and at home through ongoing therapy either in-person or via telehealth.


Assuntos
Assistência ao Convalescente/organização & administração , Betacoronavirus , Infecções por Coronavirus/reabilitação , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/reabilitação , Cuidados Semi-Intensivos/organização & administração , COVID-19 , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Recuperação de Função Fisiológica , Centros de Reabilitação/organização & administração , SARS-CoV-2 , Telemedicina/organização & administração , Estados Unidos
4.
Med Care ; 50(4): 342-6, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22228249

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is the "signature injury" in the Afghanistan and Iraq wars [Operation Enduring Freedom in Afghanistan (OEF)/Operation Iraqi Freedom (OIF)]. Patients with combat-related TBI also have high rates of psychiatric disturbances and pain. OBJECTIVES: To determine the prevalence of TBI alone and TBI with other conditions and the average cost of medical care for veterans with these diagnoses. METHODS: Observational study using national inpatient, outpatient, and pharmacy data from Veterans Health Administration (VHA) datasets. Costs are estimated from utilization related to care within the VHA system. Participants were all OEF/OIF VHA users in 2009. RESULTS: Among 327,388 OEF/OIF veterans using VHA services in 2009, 6.7% were diagnosed with TBI. Among those with TBI diagnoses, 89% were diagnosed with a psychiatric diagnosis [the most frequent being posttraumatic stress disorder (PTSD) at 73%], and 70% had a diagnosis of head, back, or neck pain. The rate of comorbid PTSD and pain among those with and without TBI was 54% and 11%, respectively. The median annual cost per patient was nearly 4-times higher for TBI-diagnosed veterans as compared with those without TBI ($5831 vs. $1547). Within the TBI group, cost increased as diagnostic complexity increased, such that those with TBI, pain, and PTSD demonstrated the highest median cost per patient ($7974). CONCLUSIONS: The vast majority of VHA patients diagnosed with TBI also have a diagnosed mental disorder and more than half have both PTSD and pain. Patients with these comorbidities incur substantial medical costs and represent a target population for future research aimed at improving health care efficiency.


Assuntos
Lesões Encefálicas/complicações , Transtornos Mentais/complicações , Dor/complicações , United States Department of Veterans Affairs/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Lesões Encefálicas/economia , Lesões Encefálicas/epidemiologia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Guerra do Iraque 2003-2011 , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Dor/economia , Dor/epidemiologia , Prevalência , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/economia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/economia
5.
NeuroRehabilitation ; 28(4): 309-20, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21725164

RESUMO

The ongoing wars in Iraq and Afghanistan and terrorist activity worldwide have been associated with an increased incidence of blast injuries. While blast injuries share similarities with blunt or penetrating traumatic injuries, there are unique mechanistic elements of blast injury that create increased vulnerability to damage of specific organs. This review highlights the mechanism of blast-related injury, describes the common sequelae of blast exposure that may impact rehabilitation care, and summarizes the intervention strategies for these blast-related sequelae.


Assuntos
Traumatismos por Explosões/complicações , Lesões Encefálicas/etiologia , Lesões Encefálicas/reabilitação , Avaliação de Resultados em Cuidados de Saúde , Sintomas Comportamentais/etiologia , Traumatismos por Explosões/diagnóstico , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico , Transtornos Cognitivos/etiologia , Progressão da Doença , Otopatias/etiologia , Emoções , Fadiga/etiologia , Cefaleia/etiologia , Humanos , Transtornos do Sono-Vigília/etiologia , Doenças Vestibulares/etiologia , Transtornos da Visão/etiologia
7.
J Neurotrauma ; 22(10): 1040-51, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16238482

RESUMO

Traumatic brain injury (TBI) often presents clinicians with a complex combination of clinical elements that can confound treatment and make outcome prediction challenging. Predictive models have commonly used acute physiological variables and gross clinical measures to predict mortality and basic outcome endpoints. The primary goal of this study was to consider all clinical elements available concerning a survivor of TBI admitted for inpatient rehabilitation, and identify those factors that predict disability, need for supervision, and productive activity one year after injury. The Traumatic Brain Injury Model Systems (TBIMS) database was used for decision tree analysis using recursive partitioning (n = 3463). Outcome measures included the Functional Independence Measure(), the Disability Rating Scale, the Supervision Rating Scale, and a measure of productive activity. Predictor variables included all physical examination elements, measures of injury severity (initial Glasgow Coma Scale score, duration of post-traumatic amnesia [PTA], length of coma, CT scan pathology), gender, age, and years of education. The duration of PTA, age, and most elements of the physical examination were predictive of early disability. The duration of PTA alone was selected to predict late disability and independent living. The duration of PTA, age, sitting balance, and limb strength were selected to predict productive activity at 1 year. The duration of PTA was the best predictor of outcome selected in this model for all endpoints and elements of the physical examination provided additional predictive value. Valid and reliable measures of PTA and physical impairment after TBI are important for accurate outcome prediction.


Assuntos
Lesões Encefálicas/complicações , Lesões Encefálicas/fisiopatologia , Árvores de Decisões , Atividades Cotidianas , Amnésia/etiologia , Avaliação da Deficiência , Escala de Coma de Glasgow , Humanos , Testes Neuropsicológicos , Prognóstico , Tomografia Computadorizada por Raios X
8.
Arch Phys Med Rehabil ; 85(7 Suppl 3): S3-6; quiz S27-30, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15221715

RESUMO

UNLABELLED: This self-directed learning module highlights the social and economic implications of aging. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine. This article specifically focuses on the epidemiology of aging, the economics of aging, informal and formal social support systems, ageism and societal issues, and care and treatment settings. OVERALL ARTICLE OBJECTIVE: To summarize the social and economic implications of aging in the context of physical medicine and rehabilitation.


Assuntos
Envelhecimento/psicologia , Dinâmica Populacional , Reabilitação/economia , Reabilitação/tendências , Idoso , Gastos em Saúde , Humanos , Medicare/economia , Apoio Social , Estados Unidos
9.
Arch Phys Med Rehabil ; 84(2): 192-6, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12601649

RESUMO

OBJECTIVE: To investigate the long-term follow-up costs of supported employment as well as the wage and employment characteristics for individuals with moderate to severe traumatic brain injury (TBI) who participated in supported employment services over a 14-year time period. DESIGN: Longitudinal design with prospectively collected data. SETTING: A university-based supported employment program that uses the individual placement model of supported employment. PARTICIPANTS: Fifty-nine individuals with moderate to severe TBI who were consecutively referred for supported employment services. The sample was restricted to individuals who were placed into a least 1 supported employment position during the study period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data were collected on clients placed into at least 1 competitive supported employment position from 1985 to 1999. Analyses were performed to examine the costs of supported employment, employment characteristics (eg, wages, length of employment), and benefit-cost ratios of supported employment for individuals with TBI. RESULTS: The average length of employment for the current sample was 42.58 months. Average gross earnings were US dollars 26,129.74 for individuals during their entire duration of employment. Billing charges accrued for employment services averaged US dollars 10,349.37. Individuals with TBI earned an average of US dollars 17,515 more than the costs associated with their supported employment. CONCLUSIONS: Our investigation provides additional support for the conclusion that supported employment is cost effective for individuals with disabilities, including individuals with TBI, and that the costs of supported employment decrease over time.


Assuntos
Lesões Encefálicas/reabilitação , Readaptação ao Emprego/organização & administração , Adulto , Lesões Encefálicas/economia , Análise Custo-Benefício , Custos e Análise de Custo , Eficiência Organizacional , Readaptação ao Emprego/economia , Feminino , Humanos , Renda , Masculino , Virginia
10.
Arch Phys Med Rehabil ; 84(2): 263-7, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12601659

RESUMO

OBJECTIVE: To compare demographics, injury characteristics, therapy service and intensity, and outcome in minority versus nonminority patients with traumatic brain injury (TBI). DESIGN: Retrospective analysis. SETTING: Twenty medical centers. PARTICIPANTS: Two thousand twenty patients (men, n=1,518; women, n=502; nonminority, n=1,168; minority, n=852) with TBI enrolled in the Traumatic Brain Injury Model Systems database. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Age, gender, marital status, education, employment status, injury severity (based on Glasgow Coma Scale [GCS] admission score, length of posttraumatic amnesia, duration of unconsciousness), intensity (hours) of therapy rendered, rehabilitation length of stay (LOS), rehabilitation charges, discharge disposition, postinjury employment status, FIM instrument change scores, and FIM efficiency scores. Independent sample t tests were used to analyze continuous variables; chi-square analyses were used to evaluate categorical data. DEMOGRAPHICS: overall, minorities were found to be mostly young men who were single, unemployed, and less well educated, with a longer work week if employed when injured. ETIOLOGY: motor vehicle crashes (MVCs) predominated as the cause of injury for both groups; however, minorities were more likely to sustain injury from acts of violence and auto-versus-pedestrian crashes. Minorities also had higher GCS scores on admission and shorter LOS. Rehabilitation services: significant differences were found in the types and intensity of rehabilitation services provided; these included physical therapy, occupational therapy, and speech-language pathology, but not psychology. CONCLUSION: Minority patients who sustain TBI generally tend to be young men with less social responsibility. Although MVCs predominate as the primary etiology, acts of violence and auto-versus-pedestrian incidents are more common in the minority population. Minorities tend to have higher GCS scores at admission. Also, the type and intensity of rehabilitation services provided differed significantly for the various interdisciplinary subspecialties. Rehabilitation charges, discharge disposition, and postinjury employment status were similar for the 2 groups, even though LOS is typically 3 to 4 days shorter for the minority group. A more detailed investigation is warranted to explain these findings.


Assuntos
Lesões Encefálicas/etnologia , Grupos Minoritários/estatística & dados numéricos , Acidentes de Trânsito , Adulto , Antropologia Cultural , Lesões Encefálicas/reabilitação , Feminino , Escala de Coma de Glasgow , Indicadores Básicos de Saúde , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos
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