RESUMEN
OBJECTIVE: This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging. DESIGN: A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables. RESULTS: The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS. CONCLUSIONS: Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.
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Síndrome Pospoliomielitis/complicaciones , Síndrome Pospoliomielitis/epidemiología , Factores de Edad , Humanos , Síndrome Pospoliomielitis/diagnóstico , PrevalenciaRESUMEN
BACKGROUND: Lipid optimization comprises a therapeutic cornerstone of primary and secondary cardiovascular disease prevention. This systematic review and meta-analysis sought to clarify patterns of lipid profiles in spinal cord injury (SCI) patients compared to able-bodied individuals as well as among subgroups of SCI patients stratified by sex, activity level, race, and level of injury. METHODS: Searches were conducted in PubMed, CINAHL, PsycINFO, and EMBASE. The initial literature search broadly identified peer-reviewed studies that examined cardiovascular risk factors in SCI. A total of 50 studies were ultimately identified that focused on lipid levels in SCI. Demographic data (including subject age, duration of injury, height, weight, and body mass index [BMI]) and lipid values were extracted for able-bodied individuals and subjects with SCI. Statistical analyses included t-testing and analysis of variance (ANOVA). RESULTS: Compared with controls, individuals with SCI had significantly lower total cholesterol (TC) (183.4 mg/dL versus 194.9 mg/dL, p = 0.019) and high-density lipoprotein cholesterol (HDL-C) (41.0 mg/dL versus 49.6 mg/dL, p < 0.001) and higher TC/HDL-C ratios (4.5 versus 4.0, p = 0.002), though no significant differences were found for triglyceride (TG) and non-HDL-C values. CONCLUSIONS: SCI represents an increasingly common chronic condition, now secondarily characterized by heightened CVD risk potentially in part due to unique lipid profiles characterized primarily by low HDL-C and an increased TC/HDL-C ratio. As other at-risk patient populations have received increased acknowledgment with more stringent lipid panel screening at earlier ages and increased frequency, we would propose that the same be implemented for the SCI population until more-specific CVD risk stratification guidelines are established for this population.
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Lípidos/sangre , Traumatismos de la Médula Espinal/sangre , Médula Espinal/patología , Adolescente , Adulto , Análisis de Varianza , Índice de Masa Corporal , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , LDL-Colesterol/sangre , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Traumatismos de la Médula Espinal/patología , Adulto JovenRESUMEN
CONTEXT: There are anecdotal reports of adverse events (AEs) associated with exercise in people with spinal cord injury (SCI) and consequent concern by people with SCI and their providers about potential risks of exercise. Enumeration of specific events has never been performed and the extent of risk of exercise to people with SCI is not understood. OBJECTIVE: To systematically review published evidence to identify and enumerate reports of adverse events or AEs associated with training in persons with SCI. METHODS: Review was limited to peer-reviewed studies published in English from 1970 to 2011: (1) in adults with SCI, (2) evaluating training protocols consisting of repeated sessions over at least 4 weeks to maintain or improve cardiovascular health, (3) including volitional exercise modalities and functional electrical stimulation (FES)-enhanced exercise modalities, and (4) including a specific statement about AEs. Trained reviewers initially identified a total of 145 studies. After further screening, 38 studies were included in the review. Quality of evidence was evaluated using established procedures. RESULTS: There were no serious AEs reported. There were no common AEs reported across most types of interventions, except for musculoskeletal AEs related to FES walking. There were few AEs in volitional exercise studies. CONCLUSION: There is no evidence to suggest that cardiovascular exercise done according to guidelines and established safety precautions is harmful. To improve the strength of these conclusions, future publications should include definition of AEs, information about pre-intervention screening, and statements of the nature and extent of AEs.
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Sistema Cardiovascular/fisiopatología , Terapia por Ejercicio/métodos , Traumatismos de la Médula Espinal/terapia , Bases de Datos Factuales/estadística & datos numéricos , Terapia por Estimulación Eléctrica , Humanos , Evaluación de Resultado en la Atención de SaludRESUMEN
A systematic review (SR) is an essential component of evidence-based practice, because it synthesizes information on a particular topic that is necessary to inform health-related decision making. The purpose of this article is to document the process of producing a high-quality SR within the field of rehabilitation in contrast to other fields (eg, pharmaceutic research). We describe the notable methodologic challenges to producing high-quality SRs for rehabilitation researchers. Broadly, we outline how the quality of SRs is evaluated and suggest mechanisms for researchers to address potential pitfalls. Because meaningful SRs can and should be conducted in this field, we provide practical guidance regarding how to conduct such an SR. We outline a series of 8 important steps in the production of an SR: forming a committee, creating a development plan, conducting a literature review, selecting articles for inclusion, extracting data, preparing tables of evidence, facilitating external review and publication, and forming conclusions and recommendations. For each step of the SR process, we provide detailed description about the methodologic decisions involved and recommended strategies that researchers can implement to produce a high-quality SR. Using these preestablished steps and procedures as a guideline will not only help to increase the efficiency of the SR process, but also to improve the quality. The availability of high-quality SRs with plain language summaries promotes access to the best quality information for all involved in decision making.
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Medicina Basada en la Evidencia , Rehabilitación/métodos , Rehabilitación/normas , Literatura de Revisión como Asunto , HumanosRESUMEN
OBJECTIVE: Headache is one of the most common physical symptoms after traumatic brain injury (TBI). The specific goals of this review include (1) determination of effective interventions for post-traumatic headache (PTHA), (2) development of treatment recommendations, (3) identification of gaps in the current medical literature regarding PTHA treatment, and (4) suggestions for future directions in research to improve outcome for persons with PTHA. DATA SOURCES: Peer-reviewed studies in PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar: (1) including adult and child samples with mild, moderate, or severe TBI, whiplash, and postconcussion syndrome; (2) with clearly described interventions; (3) with headache treatment as a primary or secondary outcome; (4) published since 1985; and (5) written in English. STUDY SELECTION: Abstracts from 812 articles from the above searches were reviewed. All research types that studied the treatment of headache after TBI were included, and 64 of the 812 articles appeared to meet the inclusion criteria. DATA EXTRACTION: The 64 articles were reviewed in full and data were extracted; 36 met all criteria for inclusion. The final 36 articles were rated according to the American Academy of Neurology criteria for classifying therapeutic studies. DATA SYNTHESIS: No class I studies and only one class II study for the management of PTHA were identified. One class I and one class II study for whiplash-associated disorder with headache as an outcome were identified. Twelve studies met criteria for class III. CONCLUSIONS: No strong evidence from clinical trials is available to direct the treatment of PTHA. Some guidelines are offered for PTHA management based on primary headache categories and treatments. It is essential that well-designed clinical studies be conducted to inform clinicians on the management and prevention of PTHA chronicity.
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Lesiones Encefálicas/complicaciones , Cefalea Postraumática/etiología , Cefalea Postraumática/rehabilitación , Humanos , Síndrome Posconmocional/complicaciones , Lesiones por Latigazo Cervical/complicacionesRESUMEN
PURPOSE: There is no consensus on the appropriate urological followup of individuals after spinal cord injury but it is well known that they are at risk for renal deterioration, bladder cancer and stones. We systematically reviewed the literature to evaluate evidence of urological screening in this population. MATERIALS AND METHODS: We reviewed 385 abstracts, of which 50 met study inclusion criteria. We rated evidence using American Academy of Neurology 2004 guidelines. RESULTS: A total of 12 articles evaluated urinary tract infection screening. Patient reported symptoms used to predict urinary tract infection yielded mixed results and urine dipstick testing had the same accuracy as microscopy. Routine urine culture was unnecessary in healthy, asymptomatic individuals with normal urinalysis. Urodynamics probably must be done periodically (6 articles) but there was no information on frequency. In 11 articles ultrasound was recommended as a useful, noninvasive and possibly cost-effective screening method. Renal scan was a good method for further testing, especially if ultrasound was positive (11 articles). Evidence was sufficient (11 articles) to recommend ultrasound of the urinary tract to detect urinary tract stones with good sensitivity but not plain x-ray of the kidneys, ureters and bladder (2 articles). There was insufficient evidence to recommend urine markers or cytology for bladder cancer screening (9 articles). CONCLUSIONS: Based on this review no definitive recommendations for screening can be made except routine renal ultrasound. Urodynamics are an important part of screening but the frequency is unclear. The optimum bladder cancer screening method has not been defined.
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Traumatismos de la Médula Espinal/complicaciones , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/etiología , Estudios de Seguimiento , Humanos , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/etiología , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/etiologíaRESUMEN
Consequences of major burn injuries often include losing the ability to engage in basic life functions such as work or employment. As this is a developing area of importance in burn care, the goal of this study was to perform a systematic review of the burn literature to ascertain a comprehensive view of the literature and identify return to work (RTW) factors where possible. A search was conducted and peer-reviewed studies that investigated predictors and barriers of returning to work of those with burn injuries, published since 1970 and written in English, were examined. From the 216 articles initially identified in the search, 26 studies were determined to meet inclusion criteria. Across studies, the mean age was 33.63 years, the mean TBSA was 18.94%, and the average length of stay was 20 days. After 3.3 years (41 months) postburn, 72.03% of previously employed participants had returned to some form of work. Important factors of RTW were identified as burn location, burn size, treatment variables, age, pain, psychosocial factors, job factors, and barriers. This systematic review suggests multiple conclusions. First, there is a significant need for attention to this area of study given that nearly 28% of all burn survivors never return to any form of employment. Second, the RTW literature is in need of coherent and consistent methodological practices, such as a sound system of measurement. Finally, this review calls for increased attention to interventions designed to assist survivors' ability to function in an employed capacity.
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Quemaduras/psicología , Quemaduras/terapia , Empleo/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Adaptación Psicológica , Adulto , Factores de Edad , Quemaduras/diagnóstico , Evaluación de la Discapacidad , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Psicología , Recuperación de la Función , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Estados Unidos , Adulto JovenRESUMEN
The purpose of this study was to perform a systematic review of the existing literature on the incidence of hypertrophic scarring and the psychosocial impact of burn scars. In a comprehensive literature review, the authors identified 48 articles published since 1965 and written in English which reported the incidence and risk factors for hypertrophic scarring or assessed outcomes related to scarring. Most studies had important methodological limitations limiting the generalizability of the findings. In particular, the absence of standardized valid measures of scarring and other outcome variables was a major barrier to drawing strong conclusions. Among studies on hypertrophic scarring, the prevalence rate varied between 32 and 72%. Identified risk factors included dark skin, female gender, young age, burn site on neck and upper limb, multiple surgical procedures, meshed skin graph, time to healing, and burn severity. With regard to psychosocial outcomes, two studies compared pediatric burn survivors with a nonburn comparison group on a body image measure; neither study found differences between groups. Across studies, burn severity and location had a modest relationship with psychosocial outcome variables. Psychosocial variables such as social comfort and perceived stigmatization were more highly associated with body image than burn characteristics. To advance our knowledge of the epidemiology of scars and the burden of scars, future studies need to implement more rigorous methodologies. In particular, standardized valid measures of scarring and other outcomes should be developed. This process could be facilitated by an international collaboration among burn centers.
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Imagen Corporal , Quemaduras/complicaciones , Cicatriz Hipertrófica/epidemiología , Cicatriz Hipertrófica/etiología , Calidad de Vida , Adaptación Psicológica , Distribución por Edad , Quemaduras/diagnóstico , Quemaduras/terapia , Cicatriz Hipertrófica/psicología , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Factores de Riesgo , Autoimagen , Índice de Severidad de la Enfermedad , Distribución por Sexo , Ajuste SocialRESUMEN
BACKGROUND: Research on screening and brief interventions (SBI) for substance misuse has demonstrated efficacy in a variety of medical settings including emergency departments and trauma centers. However, SBI has not yet been evaluated for persons who incur traumatic brain injury (TBI)-a substantial patient subpopulation for whom substance-related problems are frequent. To examine whether research on SBI efficacy and effectiveness can be generalized to persons with TBI, a systematic review of the literature was conducted to analyze how TBI populations were included in previous studies and whether there was evidence of differential outcomes. METHODS: Peer-reviewed studies that investigated SBI for misuse of alcohol or other drugs, that were implemented in emergency departments or trauma centers, and that were published in English since 1985 were examined. From 174 articles initially identified, 28 studies were determined to meet inclusion criteria. RESULTS: The review revealed that research conducted on SBI for injury populations systematically neglected patients with more severe TBI and those who presented with sufficient confusion that they could not provide informed consent. CONCLUSIONS: Future effectiveness studies should examine barriers to routine clinical use of SBI and evaluate the generalizability of expected benefits to the full spectrum of injured patients. Researchers should also develop and evaluate systematic accommodations for persons with neurobehavioral impairments who would benefit from brief interventions for substance misuse.
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Lesiones Encefálicas/complicaciones , Trastornos Relacionados con Sustancias/diagnóstico , Lesiones Encefálicas/psicología , Trastornos de la Conciencia/complicaciones , Servicio de Urgencia en Hospital , Humanos , Consentimiento Informado , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
BACKGROUND/OBJECTIVE: To determine the information needs, level of Internet access, and current and preferred formats and sources of information of adults with spinal cord injuries (SCIs). Individuals with SCIs have a high lifetime risk for medical complications and other health conditions secondary to their injury. Many secondary conditions can be prevented or mitigated through appropriate self-care and/or self-management. People with SCIs need timely, high-quality information about health and medical issues after discharge and throughout their lifetime to improve self-care and maximize quality of life. METHODS: A survey was administered as part of the third time point of a longitudinal research study on individuals with SCI. RESULTS: A total of 80.2% of the 277 respondents reported having Internet access. The most frequently selected format used currently and preferred by respondents for receiving SCI information was "Web pages/Internet". The top-ranked current and preferred source of SCI information was from a "Physician: SCI Expert/Rehabilitation Specialist". Respondents reported needing information on medical issues the most. Significantly higher percentages of individuals identified as "white" and with higher education levels had access to the Internet and ranked the selection of Web pages/Internet as their top choice. CONCLUSIONS: Results confirm that, although people with SCI prefer to receive SCI information from SCI experts, the Internet is a more accessible and more currently used source. Educational level and race predicted current and preferred use of the Internet for obtaining SCI information, suggesting that Internet distribution of SCI information will exclude subgroups.
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Servicios de Información/estadística & datos numéricos , Evaluación de Necesidades , Calidad de Vida , Traumatismos de la Médula Espinal/psicología , Adulto , Instrucción por Computador/métodos , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Participación del Paciente , Satisfacción del Paciente , Autocuidado , Traumatismos de la Médula Espinal/rehabilitaciónRESUMEN
The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published since 1980 investigating depression and depressive symptomatology in adults with TBI; 658 articles were identified. After reviewing the abstracts, 57 articles met the inclusion criteria. In addition to studies describing interventions designed to treat depression, we included intervention studies in which depressive symptoms were reported as a secondary outcome. At the end of a full review in which two independent reviewers extracted data, 26 articles met the final criteria that included reporting data on participants with TBI, and using validated depression diagnostic or severity measures pre- and post-treatment. Three external reviewers also examined the study methods and evidence tables, adding 1 article, for a total of 27 studies. Evidence was classified based on American Academy of Neurology criteria. The largest pharmacological study enrolled 54 patients, and none of the psychotherapeutic/rehabilitation interventions prospectively targeted depression. This systematic review documents that there is a paucity of randomized controlled trials for depression following TBI. Serotonergic antidepressants and cognitive behavioral interventions appear to have the best preliminary evidence for treating depression following TBI. More research is needed to provide evidence-based treatment recommendations for depression following TBI.
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Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/psicología , Trastorno Depresivo/etiología , Trastorno Depresivo/terapia , Neuropsicología/tendencias , Psiquiatría/tendencias , Antidepresivos/uso terapéutico , Lesiones Encefálicas/fisiopatología , Ensayos Clínicos como Asunto/métodos , Ensayos Clínicos como Asunto/tendencias , Terapia Cognitivo-Conductual/métodos , Terapia Cognitivo-Conductual/tendencias , Trastorno Depresivo/fisiopatología , Humanos , Neuropsicología/métodos , Psiquiatría/métodos , Psicoterapia/métodos , Psicoterapia/tendencias , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéuticoRESUMEN
BACKGROUND/OBJECTIVE: Depression has been studied extensively among people with spinal cord injury (SCI). However, basic questions persist regarding the reliability and validity of depression measurement in the context of SCI. The objective of this study was to evaluate the state of knowledge of depression measurement in persons with SCI. METHODS: English-language peer-reviewed citations from MEDLINE, CINAHL, PsycINFO, ProQuest, Google Scholar, and Web of Science from 1980 to present. Two reviewers screened 377 abstracts on SCI and depression topics to identify 144 containing classifiable psychometric data. All 144 were reviewed by 6 reviewers. Twenty-four studies reporting psychometric data on 7 depression measures in SCI samples were identified, including 7 validity studies. RESULTS: Reliability data were limited to internal consistency and were consistently good to excellent across 19 studies. Validity data were limited to concurrent validity, construct validity, and/or clinical utility in 10 studies. Measures were comparable with respect to internal consistency, factor structure, and clinical utility. Results are limited to peer-reviewed, English literature, and studies were not judged for quality. CONCLUSIONS: Greater attention should be paid to the psychometric evaluation of established measures. Although existing evidence may not justify universal screening, we recommend depression screening in clinical practice when patients may be seen by nonpsychology personnel. There is insufficient evidence to recommend one screening measure over another. Therefore, selection of measures will depend on clinician preferences. Psychometric studies are needed to show test-retest reliability, criterion validity, and sensitivity to change to improve depression recognition and treatment.