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1.
Accid Anal Prev ; 132: 105280, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31514086

RESUMO

This study aimed to develop an industry-specific tool to identify risk of poor physical and mental recovery following minor to moderate injuries sustained in a road traffic crash (RTC). Existing tools are often designed for implementation by health professionals rather than insurer case managers who may not have a background in health. This study is a secondary analysis of a longitudinal cohort study using data collected at 2-6 months and 24 months post-RTC. Participants were claimants (n = 254; Mean age = 50 years; 65% female) with mild-moderate injuries recruited through the common-law 'fault-based' compulsory third party scheme in Queensland, Australia. Sociodemographic, functional and psychological health factors were collected at baseline (2-6 months post RTC) and used as potential predictors for physical and mental health-related quality of life (Short Form 36 v2) at the 2-year follow-up. The LASSO (Least Absolute Shrinkage and Selection Operator) analysis identified six disability items (from the World Health Organization Disability Assessment Schedule 2) to predict poor physical and one item to predict poor mental health-related quality of life. Logistic regressions of these items in addition to age and gender were used to develop a screening tool. Using the tool, 90% of those at risk of poor physical and 80% of those at risk of poor mental health-related quality of life were identified correctly. To conclude, this study presents an 8-item, context-specific tool to help injury managers identify individuals at risk of poor physical and mental health recovery following mild-moderate RTC-related injuries. The tool requires validation in a new cohort and confirmation of acceptability by end-users.


Assuntos
Acidentes de Trânsito/psicologia , Avaliação da Deficiência , Qualidade de Vida , Ferimentos e Lesões , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Queensland , Medição de Risco , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/reabilitação
2.
Accid Anal Prev ; 132: 105279, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31491683

RESUMO

BACKGROUND: Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma. METHODS: A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time. RESULTS: 6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian. CONCLUSION: Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Qualidade de Vida , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/reabilitação , Adolescente , Adulto , Idoso , Ciclismo/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Estudos Longitudinais , Masculino , Motocicletas/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Pedestres/estatística & dados numéricos , Sistema de Registros , Adulto Jovem
3.
Rev. bras. cir. plást ; 34(3): 423-427, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047173

RESUMO

Introdução: Lesões que acometem as mãos com importante perda cutânea frequentemente requerem retalhos para cobertura precoce, visto que permitem melhor reabilitação. Dentre as opções, o retalho interósseo posterior reverso do antebraço é o mais utilizado para defeitos no dorso da mão e punho, com baixas taxas de complicações. Normalmente, esse retalho não é utilizado para a reconstrução de defeitos em região palmar, já que geralmente não alcança esse local. Relato de caso: Apresentamos o caso de um paciente com queimadura elétrica de terceiro grau, em palma da mão direita, cuja reconstrução foi realizada com o uso do retalho interósseo posterior reverso do antebraço, após debridamentos conservadores, no 14o dia após a queimadura. O paciente apresentou boa evolução pós-operatória, sem complicações ou sequelas funcionais a longo prazo. Conclusão: O retalho interósseo posterior reverso do antebraço permite cobertura adequada de lesões em palma da mão, preservando sua funcionalidade.


Introduction: Lesions affecting the hands with significant skin loss often require flaps for early coverage, as these permit faster healing. Among the various options, the reverse posterior interosseous flap of the forearm is most commonly used for defects involving the back of the hand and wrist due to low complication rates. Normally, this flap is not used for the reconstruction of defects in the palmar region since its distal reach is insufficient. Case report: We present the case of a male patient with third-degree electrical burns on his right palm, whose reconstruction was performed on the 14th day postinjury using the reverse posterior interosseous flap of the forearm after conservative debridement. The patient presented good postoperative evolution, without long-term complications or functional sequelae. Conclusion: The reverse posterior interosseous flap of the forearm permits adequate coverage of palm injuries, preserving its functionality.


Assuntos
Humanos , Masculino , Adulto , História do Século XXI , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Retalhos Cirúrgicos , Ferimentos e Lesões , Queimaduras , Queimaduras por Corrente Elétrica , Técnicas de Fechamento de Ferimentos , Antebraço , Traumatismos do Antebraço , Mãos , Traumatismos da Mão , Complicações Intraoperatórias , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/reabilitação , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/reabilitação , Retalhos Cirúrgicos/efeitos adversos , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/reabilitação , Queimaduras por Corrente Elétrica/cirurgia , Queimaduras por Corrente Elétrica/complicações , Técnicas e Procedimentos Diagnósticos , Técnicas de Fechamento de Ferimentos/reabilitação , Antebraço/cirurgia , Traumatismos do Antebraço/cirurgia , Traumatismos do Antebraço/complicações , Traumatismos do Antebraço/reabilitação , Mãos/cirurgia , Traumatismos da Mão/cirurgia
4.
J Athl Train ; 54(8): 858-868, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31386579

RESUMO

CONTEXT: Determining meaningful aspects of health is crucial for outcome assessment; however, limited literature exists on the aspects of health that are deemed meaningful by the athletic patient population. OBJECTIVE: To identify experiences and meaningful outcomes after lower extremity (LE) musculoskeletal injury among collegiate athletes. DESIGN: Qualitative study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A purposive sample of 20 athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and inductive data analysis were conducted. Trustworthiness of the data was established using member checks and peer debriefing. RESULTS: Four themes emerged from the data, revealing that physical changes, psychological changes, personal and lifestyle changes, and support were the most meaningful outcomes among athletes with an LE injury. The 4 themes were associated with 21 subthemes, indicating the complexity with which LE injury affects individuals. CONCLUSIONS: Our findings demonstrate the importance of caring for the whole person. Athletic trainers must broaden their focus to provide the best patient care and consider the person's activities and life demands outside of athletic participation. The themes identified in this study provide a basis for selecting appropriate health markers and outcome measures.


Assuntos
Atletas/psicologia , Extremidade Inferior/lesões , Sistema Musculoesquelético/lesões , Qualidade de Vida , Ferimentos e Lesões , Feminino , Humanos , Masculino , Assistência Centrada no Paciente/organização & administração , Pesquisa Qualitativa , Recuperação de Função Fisiológica , Apoio Social , Estudantes/psicologia , Universidades , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/reabilitação , Adulto Jovem
5.
J Athl Train ; 54(8): 869-880, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31386581

RESUMO

CONTEXT: The International Classification of Functioning, Disability and Health (ICF) provides a framework and common language for describing and understanding health that incorporates function and disability, as well as contextual factors. However, whether the meaningful patient outcomes reported by collegiate athletes who have sustained a lower extremity (LE) injury correspond to the ICF model is uncertain. OBJECTIVES: To determine if the patient outcomes reported by collegiate athletes after LE injury corresponded with the ICF classification and to identify the most relevant ICF categories and domains. DESIGN: Themes and subthemes from the qualitative analysis were linked to the ICF using established linking rules. The frequencies of the linked ICF categories were identified. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty collegiate athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and ICF linking process. RESULTS: The data from the qualitative interviews were successfully linked to 63 ICF second-level domains (eg, moving around, d455) across all 4 ICF categories: body functions (b), body structures (s), activities and participation (d), and environmental factors (e). The 63 second-level domains corresponded with 20 first-level domains (eg, mobility, d4). CONCLUSIONS: The ICF provided a common language for describing health and disability, as all outcomes reported by our collegiate athletes after LE injury were linked with the ICF classification. Athletic trainers should use the results of this study for assessing and monitoring collegiate athletes' health and function after an LE injury.


Assuntos
Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Extremidade Inferior/lesões , Ferimentos e Lesões , Atividades Cotidianas , Avaliação da Deficiência , Feminino , Humanos , Entrevistas como Assunto , Masculino , /normas , Recuperação de Função Fisiológica , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/reabilitação , Adulto Jovem
6.
Aust N Z J Public Health ; 43(5): 470-476, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31287940

RESUMO

OBJECTIVES: To compare the prevalence of disability between migrants and non-migrants at three and 24 months post-injury, and to identify key predictors of post-injury disability among migrants. METHODS: Disability among 2,850 injured participants, including 677 migrants to New Zealand, was measured prospectively using the World Health Organization Disability Assessment Schedule. RESULTS: Migrants experienced higher risk of disability than non-migrants at three months post-injury (aRR=1.14, 95%CI 1.03-1.26). Both groups had similar disability prevalence, but higher than pre-injury, at 24 months. For migrants, strong predictors of disability at three months post-injury were: higher injury severity, pre-injury obesity, and perceiving the injury as a threat of disability. Having multiple chronic conditions was a predictor of disability at both time points. CONCLUSIONS: Disability was persistent for migrants and non-migrants to 24 months post-injury. The disability risk at three months was higher for migrants. Certain predictors associated with disability were identified. Implications for public health: Despite having accessed healthcare services for their injury, migrants (compared with non-migrants) had higher risks of disability at least in the first three months post-injury. Interventions should be focused during this critical period on identified key predictors to promote faster recovery and reduce disability.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Hospitalização , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Ferimentos e Lesões/reabilitação , Adulto , Avaliação da Deficiência , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Prevalência , Estudos Prospectivos , Qualidade de Vida/psicologia , Fatores de Tempo , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etnologia
7.
Sensors (Basel) ; 19(15)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31357650

RESUMO

Wearable robotic braces have the potential to improve rehabilitative therapies for patients suffering from musculoskeletal (MSK) conditions. Ideally, a quantitative assessment of health would be incorporated into rehabilitative devices to monitor patient recovery. The purpose of this work is to develop a model to distinguish between the healthy and injured arms of elbow trauma patients based on electromyography (EMG) data. Surface EMG recordings were collected from the healthy and injured limbs of 30 elbow trauma patients while performing 10 upper-limb motions. Forty-two features and five feature sets were extracted from the data. Feature selection was performed to improve the class separation and to reduce the computational complexity of the feature sets. The following classifiers were tested: linear discriminant analysis (LDA), support vector machine (SVM), and random forest (RF). The classifiers were used to distinguish between two levels of health: healthy and injured (50% baseline accuracy rate). Maximum fractal length (MFL), myopulse percentage rate (MYOP), power spectrum ratio (PSR) and spike shape analysis features were identified as the best features for classifying elbow muscle health. A majority vote of the LDA classification models provided a cross-validation accuracy of 82.1%. The work described in this paper indicates that it is possible to discern between healthy and injured limbs of patients with MSK elbow injuries. Further assessment and optimization could improve the consistency and accuracy of the classification models. This work is the first of its kind to identify EMG metrics for muscle health assessment by wearable rehabilitative devices.


Assuntos
Cotovelo/diagnóstico por imagem , Eletromiografia , Músculo Esquelético/diagnóstico por imagem , Ferimentos e Lesões/diagnóstico por imagem , Adulto , Algoritmos , Análise Discriminante , Cotovelo/lesões , Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Reconhecimento Automatizado de Padrão/métodos , Processamento de Sinais Assistido por Computador , Máquina de Vetores de Suporte , Dispositivos Eletrônicos Vestíveis , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/reabilitação
8.
Health Qual Life Outcomes ; 17(1): 70, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014327

RESUMO

BACKGROUND: Retrospective assessment of pre-injury health-related quality of life (HRQL) is frequently used to measure change from pre- to post-injury HRQL. However, retrospective measurement may be confounded by recall bias. It is assumed that presence of recall bias is influenced by several factors, such as the measurement scale or the instrument that is used, the measurement schedule, and the presence of a substantial health event during the follow up period. This study empirically tests these assumptions by comparing pre-injury EQ-5D summary scores, EQ-5D profiles and visual analogue scale (EQ-VAS) scores of trauma patients, as recorded 1 week and 12 months post-injury, respectively. METHODS: A sample of 5371 adult trauma patients who attended the Emergency Department (ED) followed by hospital admission, received postal questionnaires 1 week (T1) and 12 months (T2) post-injury. The questionnaires contained items on pre-injury health, in terms of EQ-5D3L and EQ-VAS. RESULTS: One thousand one hundred sixty-six completed data pairs with T1 and T2 pre-injury data were available. Mean pre-injury EQ-5D summary scores were 0.906 (T1) and 0.905 (T2), respectively, with moderate intertemporal agreement (intraclass correlation coefficient (ICC) T1T2 = 0.595). In absolute terms, 442 (37.9%) respondents reported a different pre-injury EQ-5D profile at T2 compared to T1. The least stable EQ-5D dimension was pain/discomfort (20.2% reported a change). Mean T2 pre-injury EQ-VAS score was significantly higher than mean T1 pre-injury EQ-VAS score (T2 84.6 versus T1 83.3). Multivariable logistic regression analysis indicated that lower educational level, comorbid disease and having PTSD symptoms were independent predictors of change of pre-injury EQ-5D profile. CONCLUSIONS: Despite one third of respondents reported a different pre-injury health level, if asked for on two interview occasions separated by 1 year, on the group level this difference was nil (EQ-5D summary score) to small (EQ-VAS). The consistent symmetrical pattern of change suggests random error to play the largest role. Intertemporal reliability was the same in EQ-5D profiles vs. EQ-VAS scores, ruling out scale effects. Particularly certain trauma subgroups showed highest distortion. While group comparisons may be trusted, in pre-post analysis and repeated measure analysis the individual injury impact and recovery pattern may be wrongly estimated.


Assuntos
Nível de Saúde , Qualidade de Vida , Ferimentos e Lesões/psicologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Ferimentos e Lesões/reabilitação
9.
PLoS One ; 14(3): e0213510, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30870451

RESUMO

OBJECTIVE: To develop and internally validate the PROgnosis of functional recovery after Trauma (PRO-Trauma) prediction model. DESIGN: A prospective single-center longitudinal cohort study. Patients were assessed at 6 weeks and 12 months post-injury. METHODS: Patients that presented at the emergency department with an acute traumatic injury, were prompted for participation. Patients that completed the assessments at 6 weeks and 12 months post injury were included. Exclusion criteria: age < 18, age > 65, pathologic fractures, injuries that resulted in severe neurologic deficits. The predicted outcome, functional recovery, was defined as a Short Musculoskeletal Function Assessment (SMFA-NL) Problems with Daily Activities (PDA) subscale ≤ 12.2 points at 12 months post-injury (Dutch population norm). Predictors were: gender, age, living with partner, number of chronic health conditions, SMFA-NL PDA score 6 weeks post-injury, ICU admission, length of stay in hospital, injury severity score, occurrence of complications and treatment type. All predictors were obtained before 6 weeks post-injury. Missing data were multiply imputed. Predictor variables were selected using backward stepwise multivariable logistic regression. Hosmer-Lemeshow tests were used to evaluate calibration. Bootstrap resampling was used to internally validate the final model. RESULTS: A total of 246 patients were included, of which 104 (44%) showed functional recovery. The predictors in the final PRO-Trauma model were: living with partner, the number of chronic health conditions, SMFA-NL PDA subscale score at 6 weeks post-injury and length of stay in hospital. The apparent R2 was 0.33 [0.33;0.34], the c-statistic was 0.79 [0.79;0.80]. Hosmer-Lemeshow test indicated good calibration (p = 0.92). Optimism-corrected R2 was 0.28 [0.27;0.29] and the optimism-corrected Area Under the Curve was 0.77 [0.77;0.77]. CONCLUSION: The PRO-Trauma prediction model can be used to obtain valid predictions of attaining functional recovery after trauma at 12 months post-injury. The PRO-Trauma prediction model showed acceptable calibration and discrimination.


Assuntos
Modelos Biológicos , Recuperação de Função Fisiológica , Ferimentos e Lesões/reabilitação , Adolescente , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Centros de Traumatologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/fisiopatologia
11.
Rev. bras. cir. plást ; 34(1): 101-107, jan.-mar. 2019. tab
Artigo em Inglês, Português | LILACS | ID: biblio-994557

RESUMO

Introdução: Lesões decorrentes de trauma são agravos súbitos à saúde que podem levar a deficiências temporárias e interferir na qualidade de vida das vítimas. O serviço de Cirurgia Plástica Reparadora (CPR) do Hospital Metropolitano de Urgência e Emergência (HMUE) atua como a unidade de referência no tratamento de feridas dos pacientes vítimas de trauma no Estado do Pará. Métodos: Estudo observacional analítico, do tipo transversal prospectivo. A população foi composta por 78 pacientes atendidos no período de dezembro de 2015 até dezembro de 2016. Resultados: A população predominante foi de pacientes do sexo masculino, autônomos, entre 21 a 30 anos. Os acidentes automobilísticos foram os mais prevalentes. A área corporal mais afetada foi a dos membros inferiores e o tipo de cirurgia mais realizada foi enxerto. Tanto entre os pacientes submetidos à cirurgia de enxerto quanto os de retalho, predominou a viabilidade no intervalo de 90-100%. Não foi verificada associação significativa da faixa etária dos pacientes sob o grau de viabilidade. Houve relação entre o número de dias do acidente até a intervenção com o grau de viabilidade do enxerto. Conclusão: Os pacientes internados no hospital no mesmo dia do acidente têm seis vezes mais chance de apresentar viabilidade do enxerto acima de 80% e, portanto, desfecho favorável.


Introduction: Injuries due to trauma are health problems that can lead to temporary deficiencies and interfere with the quality of life of the victims. The Reconstructive Plastic Surgery (RPS) service of the Metropolitan Emergency and Emergency Hospital (HMUE) acts as the reference unit for the treatment of wounds of trauma victims in the State of Pará. Methods: An observational cross-sectional study. The population was composed of 78 patients attended in the period from December 2015 to December 2016. Results: The predominant population was male patients, between 21 and 30 years old. Automobile accidents were the most prevalent. The most affected body area was the lower limbs and the type of surgery performed was graft. Among the patients submitted to graft surgery as well as those of the graft, the viability predominated in the range of 90-100%. There was no significant association between the age of the group under the degree of viability. There was a relation between the number of days of the accident and the intervention with the degree of viability of the graft. Conclusion: Patients hospitalized on the same day of the accident are six times more likely to present graft viability than 80%.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Pacientes/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/reabilitação , Epidemiologia/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos
12.
J Surg Res ; 235: 459-469, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30691830

RESUMO

BACKGROUND: The study aim was to evaluate patient progress over time, given the limited knowledge available on gender-dependent longer-term outcomes after major trauma. MATERIALS AND METHODS: This is a prospective longitudinal survey of consecutive trauma survivors with a New Injury Severity Score ≥8, comparing working capacity and outcome scores of male versus female patients at 1- and 2-y follow-ups (trauma medical outcomes study Short Form-36, Euro Quality of Life [EuroQoL], Glasgow Outcome Scale [GOS]; mean + standard deviation; univariate analysis [Pearson's r]; P < 0.05). RESULTS: A total of 335 major trauma patients (71% male; aged 54.8 ± 18.8 y; New Injury Severity Score 18.6 ± 9.3) participated at both follow-up time points. Overall, a significant improvement in patients' working capacity was found (P < 0.001) in the second year after trauma compared with 1 y earlier. At 2 y, 24% of working patients were still suffering from a diminished capacity to work. Improvements in working capacity correlated only weakly with outcome scores; best in the GOS (r = 0.23) and the EuroQol (r = 0.22). Women, but not men, demonstrated a significant improvement in quality of life (QoL) over time: to a higher level, for example, on the GOS (P = 0.001), the EuroQoL (P = 0.018), and the physical component of the Short Form-36 (P = 0.05). CONCLUSIONS: This longitudinal longer-term follow-up found an overall improvement in capacity to work for both genders in the second year after major trauma. Surprisingly, only women demonstrated significant improvements in measures of health-related QoL and functional outcome-a finding that has to be further evaluated in greater detail in larger systematic evaluations.


Assuntos
Recuperação de Função Fisiológica , Retorno ao Trabalho/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Ferimentos e Lesões/reabilitação , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Fatores Sexuais
13.
Aust J Prim Health ; 25(1): 31-36, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30642427

RESUMO

Listening to personalised music is a simple and low-cost intervention with expected therapeutic benefits, including reduced agitation, stress responses and anxiety. While there is growing evidence for the use of personalised music as a therapeutic intervention, there has been little investigation into processes and strategies that would support the implementation of playlists. The aim of this study was to identify the perceived barriers and facilitators to implementing personalised playlists on a large scale in public healthcare settings. A mixed-methods approach was used to evaluate the feasibility of the intervention in 21 different acute, sub-acute and primary healthcare settings in New South Wales (NSW), Australia, between June 2016 and June 2017. Data collection included 153 survey responses (staff n=35, patients n=49 and family members n=69), six focus groups (staff n=21) and an analysis of 37 documents. Data sources were systematically categorised using a Policy Analysis Framework. Facilitators included the use of implementation leads and volunteers, a high level of staff engagement and the integration of music selection and playlist development into routine clinical practice. Barriers included ongoing and unexpected funding, time to prepare playlists and staff turnover. The results from this study support the feasibility and acceptability of implementing playlists in different healthcare settings.


Assuntos
Demência/reabilitação , Acesso aos Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/reabilitação , Musicoterapia/métodos , Ferimentos e Lesões/reabilitação , Cuidados Críticos/métodos , Cuidados Críticos/psicologia , Demência/psicologia , Estudos de Viabilidade , Grupos Focais , Humanos , Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Música/psicologia , New South Wales , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Tratamento Domiciliar/métodos , Resultado do Tratamento , Ferimentos e Lesões/psicologia
14.
Br J Surg ; 106(1): 65-73, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30221344

RESUMO

BACKGROUND: Functional outcome measures are important as most patients survive trauma. The aim of this study was to describe the long-term impact of trauma within a healthcare region from a social perspective. METHODS: People active in work or education and admitted to hospitals in Central Norway in the interval 1 June 2007 to 31 May 2010 after sustaining trauma were included in the study. Clinical data were linked to Norwegian national registers of cause of death, sickness and disability benefits, employment and education. Primary outcome measures were receipt of medical benefits and time to return to preinjury work level. Secondary outcome measures were mortality within 30 days or during follow-up. RESULTS: Some 1191 patients were included in the study, of whom 193 (16·2 per cent) were severely injured (Injury Severity Score greater than 15). Five years after injury, the prevalence of medical benefits was 15·6 per cent among workers with minor injuries, 22·3 per cent in those with moderate injuries and 40·5 per cent among workers with severe injuries. The median time after injury until return to work was 1, 4 and 11 months for patients with minor, moderate and severe injuries respectively. Twelve patients died within 30 days and an additional 17 (1·4 per cent) during follow-up. CONCLUSION: Patients experiencing minor or major trauma received high levels of medical benefits; however, most recovered within the first year and resumed preinjury work activity. Patients with severe trauma were more likely to receive medical benefits and have a delayed return to work. Registration number: NCT02602405 (http://www.clinicaltrials.gov).


Assuntos
Ferimentos e Lesões/reabilitação , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prognóstico , Retorno ao Trabalho/economia , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Previdência Social/economia , Previdência Social/estatística & dados numéricos , Ferimentos e Lesões/economia , Ferimentos e Lesões/mortalidade , Adulto Jovem
15.
J Rehabil Med ; 51(2): 120-126, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30426136

RESUMO

OBJECTIVE: To understand clients' experiences of the recovery journey through the compensation system and to identify areas and strategies for quality improvement. METHODS: A qualitative study of 23 participants with physical or mental disabilities caused by traffic accidents, which occurred, on average, 4 years ago. Purposive sampling of long-term recovery clients who made a compensation claim after their injuries was applied until data saturation was reached. Data were collected using semi-structured interviews and analysed through conventional thematic analysis. RESULTS: This study demonstrated that recovery is a complex phenomenon that can be impacted by numerous challenges of navigating the compensation system and using its services. Clients perceived the compensation provider as limited in rules around which services they could access. A common perception amongst clients was that the compensation provider did not have the capacity and knowledge to understand health and recovery processes nor did it provide adequate guidelines or instructions that would assist clients with their recovery. Many clients dealt with numerous case managers and felt insufficiently informed on what to expect and do, which led to a lack of trust in rehabilitation management and case managers' decisions. According to clients, financial impacts were neglected and not addressed effectively. Many clients felt abandoned by the system which led to perceived feelings of desertion and negligence. CONCLUSION: Understanding modifiable barriers to recovery in compensation systems presents opportunities to amend current practices and consider a holistic, person-centred care approach. It is apparent that improved recovery management, communication and adequate provision of guidelines are needed to meet clients' needs and facilitate better outcomes. A person-centred care approach is likely to improve quality of life and help clients navigate the compensation system more effectively with assistance from health and compensation professionals, who should be actively involved in their recovery processes.


Assuntos
Acidentes de Trânsito/psicologia , Qualidade de Vida/psicologia , Ferimentos e Lesões/reabilitação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Resultado do Tratamento
16.
J Reconstr Microsurg ; 35(1): 1-7, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30085347

RESUMO

BACKGROUND: Free tissue transfer for lower extremity reconstruction is a safe and reliable option for a wide range of challenging wounds; however, no consensus exists regarding postoperative management. METHODS: A systematic review of postoperative management of lower extremity free tissue transfer was conducted using Medline, Cochrane Database, and Web of Science. Multicenter surveys, randomized controlled trials, cohort studies, and case series were reviewed. RESULTS: Fifteen articles investigating current protocols, flap physiology, and aggressive dangle protocols were reviewed. The following evidence-based conclusions were made: (1) Free tissue transfer to the lower extremity is unique due to altered hemodynamics and dependency during orthostasis. Free flap circulation is dependent on locally mediated responses and deprived of compensatory muscular and neurovascular mechanisms that prevent venous congestion in the normal extremity. (2) Compressive wrapping reduces venous congestion and edema and may induce ischemic conditioning, which can increase blood flow. (3) Dangle protocols vary widely in timing of initiation, frequency, and monitoring. Small volume studies examining aggressive mobilization protocols initiating early dependency have led to earlier ambulation and discharge, with no change in flap survival as compared with conservative protocols. (4) Weight bearing may begin after the completion of dangle protocol if no orthopedic injury is present. CONCLUSIONS: Early initiation of a dangle protocol does not appear to negatively impact flap survival based on this systematic review. Compressive wrapping may be a useful adjunct. Many surgeons agree that clinical monitoring is sufficient; there is no consensus on the utility of adjunct monitoring techniques. Weight bearing may begin after completion of dangle protocol with close flap monitoring, if not prevented by orthopedic restrictions. By providing additional outflow vasculature to reduce venous congestion, flow-through anastomoses may eliminate the need for a dangle protocol. Further research, including large randomized controlled trials is still needed to establish high-level evidence-based conclusions.


Assuntos
Sobrevivência de Enxerto/fisiologia , Extremidade Inferior/lesões , Cuidados Pós-Operatórios , Procedimentos Cirúrgicos Reconstrutivos , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Protocolos Clínicos , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Extremidade Inferior/patologia , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/reabilitação
17.
Am J Phys Med Rehabil ; 98(2): 165-168, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30124492

RESUMO

The objective of this study was to describe the incidence of complications in trauma patients that could be prevented, diagnosed, or managed by a consulting acute care physiatrist. Demographic and complication data were extracted by chart review of adult trauma patients admitted to a Canadian academic trauma center. Subjects were included if they had a diagnosis of traumatic brain injury, spinal cord injury, or multiple injuries resulting in an Injury Severity Score greater than 15. Means and standard deviations were calculated for continuous variables and frequencies for categorical data. Secondary analyses involved using Spearman's ρ and χ analysis to examine relationships between the development of complications and various patient factors. A total of 286 individuals were included. The overall incidence of a physical medicine & rehabilitation-relevant complication was 32.9%. The complications with the highest incidence were pneumonia (15.5%), delirium (14.1%), and urinary tract infection (13.4%). Secondary analyses demonstrated associations between the development of complications with older age, the presence of comorbidities, having both a traumatic brain injury and spinal cord injury, and length of stay. This study demonstrated that trauma patients may experience multiple complications that are of relevance to the consulting physiatrist.


Assuntos
Modalidades de Fisioterapia/efeitos adversos , Ferimentos e Lesões/reabilitação , Adulto , Fatores Etários , Idoso , Canadá , Feminino , Hospitais Urbanos , Humanos , Incidência , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/complicações , Adulto Jovem
18.
World J Emerg Surg ; 13: 57, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30524498

RESUMO

Background: There is increasing focus on long-term survival, function and quality-of-life for trauma patients. There are few studies tracking longitudinal changes in functional outcome over time. The goal of our study was to compare the Glasgow Outcome Scale-Extended (GOSE) at 6 months and 12 months in blunt trauma survivors with an Injury Severity Score (ISS) of more than 15. Methods: Using the Singapore National Trauma Registry 2011-2013, patients with 6-month GOSE and 12-month GOSE scores were analysed. Patients were grouped into three categories-those with the same score at 6 months and 12 months, an improvement in score, and a worse score at 12 months. Ordinal regression was used to identify risk factors for improved score. Patients with missing scores at either 6 months or 12 months were excluded. Results: We identified 478 patients: 174 had an improvement in score, 233 stayed the same, and 71 had worse scores at 12 months compared to 6 months. On univariate ordinal regression, the following variables were associated with same or better function at 12-months compared to 6-months: male gender, being employed pre-injury, thoracic Abbreviated Injury Scale (AIS) of 3 or more, anatomical polytrauma (AIS of 3 or more in 2 or more body regions), and road traffic injury mechanism. Older age, low fall, increasing Charlson comorbidity scores, new injury severity score, and head and neck AIS of 3 or more were associated with worse function at 12 months compared to 6 months. ISS and revised trauma score were not significant predictors on univariate or multivariable analysis.On multivariable ordinal regression, motor vehicle mechanism (OR 2.78, 1.51-5.12, p = 0.001) was associated with improved function, while male gender (OR 1.36, 95% CI 1.02-1.82, p = 0.039) predicted improved function at 12 months. Conclusions: Females experience worse functional outcomes at 12 months, potentially due to majority of female injuries being low falls in the elderly. In contrast, motor vehicle injury patients had better functional outcomes at 12 months. Additional interventional strategies for high-risk groups should be explored.


Assuntos
Técnicas de Apoio para a Decisão , Resultado do Tratamento , Ferimentos e Lesões/reabilitação , Escala Resumida de Ferimentos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Escala de Resultado de Glasgow/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/mortalidade , Análise Multivariada , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Singapura , Ferimentos e Lesões/mortalidade
20.
J Crit Care ; 48: 390-406, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30316038

RESUMO

PURPOSE: This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurological and/or traumatic injuries in the intensive care unit (ICU), identifies literature gaps and provides recommendations for future research. MATERIALS AND METHODS: We searched five databases from inception to June 2, 2018. We included published retrospective studies, case studies, observation and randomized controlled trials describing physiotherapy interventions in ICU patients with neurotrauma injuries. Two reviewers reviewed the databases and independently screened English articles for eligibility. Data extracted included purpose, study design, population (s), outcome measures, interventions and results. Thematic analysis and descriptive numerical summaries are presented by intervention type. RESULTS: 12,846 titles were screened and 72 met the inclusion criteria. Most of the studies were observational studies (44 (61.1%)) and RCTs (14 (19.4%)). Early mobilization, electrical stimulation, range of motion, and chest physiotherapy techniques were the most common interventions in the literature. Physiotherapy interventions were found to be safe with few adverse events. CONCLUSIONS: Gaps in the literature suggest that future studies require assessment of long term functional outcomes and quality of life, examination of homogenous populations and more robust methodologies including clinical trials and larger samples.


Assuntos
Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Doenças do Sistema Nervoso/reabilitação , Modalidades de Fisioterapia , Insuficiência Respiratória/reabilitação , Ferimentos e Lesões/reabilitação , Deambulação Precoce/métodos , Humanos , Qualidade de Vida , Estudos Retrospectivos
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