Archives of physical medicine and rehabilitation
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This article compares a traditional biomedical model with an outcomes model for evaluating medical and rehabilitation care. The traditional model emphasizes diagnosis and disease-specific outcomes. In contrast, the outcomes model emphasizes life expectancy and health-related quality of life (QOL). ⋯ The outcomes model has been applied widely in rehabilitation research, but few studies estimate the benefits of treatments using QALYs. These methodologies can also serve as a basis for approaches to sharing medical decisions between patients and providers. Opportunities to apply these new methods are discussed.
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Arch Phys Med Rehabil · Dec 2002
Quality of life measurement in rehabilitation medicine: building an agenda for the future.
In November 2001, a conference convened to discuss the state of the science of measuring of quality of life (QOL) in rehabilitation medicine. The meeting brought together leading researchers in areas of behavioral health and physical medicine and rehabilitation to address the fragmentation that exists across specialty areas and disciplines. ⋯ The 5 topic areas included: (1) general versus targeted measurement, (2) QOL in policy development, (3) measuring QOL from the patient's perspective, (4) cultural aspects of QOL measurement, and (5) the future of QOL research. This introduction synthesizes the information presented at the conference and provides context to the articles contained in this 2-part supplement.
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Arch Phys Med Rehabil · Dec 2002
Clinical TrialIntrathecal baclofen therapy in children with cerebral palsy: efficacy and complications.
To describe the efficacy of intrathecal baclofen (ITB) therapy in the management of spasticity in young children with cerebral palsy (CP) and to identify risk factors for complications. ⋯ ITB therapy effectively reduced spasticity in children with CP. However, complications necessitating explantation can occur. Further research is needed to identify criteria describing the ideal pediatric candidate for ITB.
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Stroke frequently results in psychologic distress and activity limitations across multiple domains of functioning. However, most stroke outcome measurement tools and clinical trial endpoints are narrowly focused on neurologic symptom status and physical aspects of functioning, and rarely assess other important components of health. In this article, I discuss the limitations in the measurement of nonfatal stroke outcomes; propose a minimum set of fundamental assessment domains comprising a comprehensive assessment of health status in stroke survivors; and describe the conceptual development of the Burden of Stroke Scale, a comprehensive, patient-reported measure of functioning and well-being for stroke survivors.
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Arch Phys Med Rehabil · Dec 2002
Case ReportsFluoroscopically guided aspiration of a symptomatic lumbar zygapophyseal joint cyst: a case report.
Lumbar zygapophyseal joint cysts are potential pain generators in patients with axial pain and/or lower-limb radicular pain. The traditional treatment of symptomatic cysts that do not respond to conservative measures is surgical decompression. Percutaneous needle aspiration under fluoroscopic guidance is a potential minimally invasive treatment option. We present a patient with a large symptomatic L4-5 zygapophyseal joint cyst and right L5 radiculopathy who responded well to percutaneous aspiration.