RESUMEN
OBJECTIVE: Interpretation of patient scores on functional tests is enhanced by an understanding of test performance in reference groups. The purpose of this study was to expand performance values, by age and gender, on balance tests [the Multi-Directional Reach (MDRT); Berg Balance (BBS); Sharpened Romberg, eyes open (SREO), eyes closed (SREC); Activities-Specific Balance Confidence (ABC)], and a general mobility test [Physical Performance Test, (PPT-7, PPT-9)]. The study also examined relationships between test performance and subject characteristics. DESIGN AND SUBJECTS: Eighty-three community-dwelling adults over 50 participated in the study and completed the 5 functional tests during one test session. Means, standard deviations, and confidence intervals were calculated for each of the tests. Multiple linear regression analysis was used to examine relationships between test scores and age, gender, height, and weight. RESULTS: Test performance is reported by gender,within 10-year age cohorts. Regression analysis showed that age contributed significantly to prediction of performance on all of the tests and gender contributed significantly to prediction of scores on the Berg, SREO, and SREC. CONCLUSIONS: Test performance values, in a sample of community-dwelling adults, is provided by age and gender cohorts to provide additional reference data that can be used by clinicians for comparison with client data. The small sample size for subjects over 80 years limits the reference value of data for this age group. In regression analyses, age and gender help predict outcomes on the dependent variables used in the study.
Asunto(s)
Actividades Cotidianas , Evaluación de la Discapacidad , Limitación de la Movilidad , Equilibrio Postural , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Valores de Referencia , Factores SexualesRESUMEN
This study analyzed four prominent organizational factors thought to influence service quality in nursing homes. Perceptions of service quality were collected from over 400 family members who regularly visited residents in 41 nursing homes. Service quality was measured along five dimensions identified by marketing research on customers in service industries. These five dimensions were responsiveness, reliability, assurance, empathy, and tangibles. Perceptions of service quality exhibited significant associations with each of the four organizational factors: ownership, funding mix, facility size, and nurse staffing. Implications for health services administration are discussed.
Asunto(s)
Comportamiento del Consumidor/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Instituciones de Cuidados Especializados de Enfermería/normas , Financiación Personal , Encuestas de Atención de la Salud , Tamaño de las Instituciones de Salud , Humanos , Cobertura del Seguro , Medicaid , Medio Oeste de Estados Unidos , Personal de Enfermería/provisión & distribución , Propiedad , Admisión y Programación de Personal , Relaciones Profesional-Familia , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Organizational commitment on the part of nursing home employees can be a determinant of service quality. Proper design of health care jobs and clarity of roles make employees feel more dedicated to their jobs, enable them to do their jobs well, and enhance family members' evaluations of nursing home care. When management develops a dynamic, interactive, high-quality environment, nursing home employees feel encouraged to report shortcomings without fear because they are involved in the process.
Asunto(s)
Actitud del Personal de Salud , Satisfacción en el Trabajo , Satisfacción del Paciente/estadística & datos numéricos , Instituciones de Cuidados Especializados de Enfermería/normas , Anciano , Familia/psicología , Encuestas de Atención de la Salud , Administradores de Instituciones de Salud , Humanos , Funciones de Verosimilitud , Autonomía Profesional , Calidad de la Atención de Salud , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Wisconsin , Recursos HumanosRESUMEN
BACKGROUND AND PURPOSE: The purpose of this study was to do a pilot test of the effectiveness of prolonged stretch (use of splint) in reducing knee flexion contractures more than a traditional program of passive range of motion (PROM) in a group of nursing home residents. SUBJECTS: The subjects were 28 nursing home residents with 10 degrees or more of knee flexion contracture bilaterally. Eighteen subjects completed the study. METHODS: Data were collected prior to the initiation of the intervention and at monthly intervals during the 6 months of treatment. Repeated measurements were made of hip, knee, and ankle range of motion (ROM); the torque required to maintain passive impairment. knee extension; knee pain; several indicators of function; and cognitive impairment. Both legs of each subject received PROM and manual stretching twice a week; in addition, one leg was given a prolonged stretch (use of a splint) five times a week. RESULTS: There were no differences in knee ROM between the side that received prolonged stretching and the side that received only PROM and manual stretching at the beginning of the study. No differences in ROM or torque measurements existed between the side that received prolonged stretching and the side that received only PROM and manual stretching at any interval, nor in ROM or torque over time for either side. Because of the low statistical power of the study, the results should be viewed with caution. CONCLUSION AND DISCUSSION: Physical therapists need to question whether prolonged stretch for nursing home residents with knee flexion contractures greater than 10 degrees is of any greater benefit than PROM and manual stretching. Investigations of other treatment protocols and treatment doses are needed, including work in the area of prevention of knee flexion contractures. For the pilot group of nursing home residents studied, gains in knee extension did not occur with the use of prolonged stretch for 3 hours a day, 5 days per week. [Steffen TM, Mollinger LA. Low-load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents.
Asunto(s)
Contractura/rehabilitación , Articulación de la Rodilla , Modalidades de Fisioterapia/métodos , Férulas (Fijadores) , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Contractura/fisiopatología , Femenino , Evaluación Geriátrica , Hogares para Ancianos , Humanos , Estudios Longitudinales , Masculino , Casas de Salud , Proyectos Piloto , Rango del Movimiento Articular , Soporte de PesoRESUMEN
BACKGROUND AND PURPOSE: The purpose of this study was to document the prevalence, severity, and progression of knee flexion contractures (KFCs) in a population of institutionalized elderly and to identify relationships between knee extension and other variables. SUBJECTS: The subjects were 112 nursing home residents who exhibited a broad range of ambulation and cognitive function abilities. METHODS: Data were collected initially (T1) and after a 10-month period (T2). RESULTS: Only 25% of the population had extension in the 0- to 5-degree (lacking full extension) range bilaterally at T1 and T2, leaving the majority of subjects with some degree of unilateral KFC. Most of the subjects with a KFC greater than 20 degrees were nonambulatory and had a significantly higher occurrence of resistance to motion than did nonambulators with a KFC of less than 20 degrees. Knee extension measurements did not change in most subjects between T1 and T2. The knees that did show a change in KFC (either an increase or a decrease) had a significantly higher occurrence of resistance to passive motion than did other knees. Compared with the subjects who gained extension, the subjects who lost extension over the study period more frequently had minimal KFC at T1, were ambulatory at T1, showed a regression in ambulation at T2, and developed resistance to motion at T2. CONCLUSION AND DISCUSSION: The data confirmed significant positive correlations between degree of KFC and presence of resistance to passive knee motion, cognitive impairment, impaired ambulation, and presence of knee pain. Physical therapy assessment and intervention may be appropriate in nonambulatory nursing home residents with resistance to passive motion, residents with KFC approaching 20 degrees, and ambulatory residents with minimal KFC who develop resistance and begin to regress in ambulation. Several areas for future study are suggested.
Asunto(s)
Contractura/epidemiología , Contractura/fisiopatología , Institucionalización , Articulación de la Rodilla/fisiopatología , Casas de Salud , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Escala del Estado Mental , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Factores de Tiempo , Caminata , WisconsinRESUMEN
When managers confront complex problems, their attitudes toward problem solving affect their behavior. The problem-solving attitudes of over 100 women and men who manage six hospitals are analyzed.
Asunto(s)
Actitud del Personal de Salud , Administradores de Instituciones de Salud/psicología , Administradores de Hospital/psicología , Solución de Problemas , Análisis de Varianza , Factores Sexuales , Encuestas y CuestionariosRESUMEN
This article addresses the problem of documenting the outcomes of physical therapy. This is a timely issue because new approaches to reimbursing health-care costs will favor those providers and professions able to demonstrate sufficient benefits to patients to justify prospective cost reimbursement. To assess the adequacy of existing outcome data, we conducted detailed longitudinal audits of 63 geriatric patients' medical records. For nearly half of these patients, the records contained insufficient data to document any improvement in physical functioning. The number of treatments administered correlated with functional improvements documented, but diagnostic related group classifications and patient demographics did not. We found practicing physical therapists overestimated the amount of outcome data recorded and documented some areas of physical functioning more frequently than others. A wider scope for functional assessment and greater standardization in record keeping are advocated. We discuss implications for clinical practice and research and offer a new instrument for quantifying outcomes.