Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Mar 2008
Comparative StudyCognitively impaired stroke patients do benefit from admission to an acute rehabilitation unit.
To determine whether cognitively impaired stroke patients benefit (defined as having an improved level of functional independence and capable of being discharged home) from admission to an acute rehabilitation unit. ⋯ Our results suggest that despite severe neurologic impairment(s) and disability, cognitively impaired stroke patients make significant functional gains while undergoing rehabilitation and many can be discharged home. Based on these results, stroke patients with cognitive impairments benefit from rehabilitation and should be given the same access to acute rehabilitation services as stroke patients who are cognitively intact.
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Arch Phys Med Rehabil · Mar 2008
Randomized Controlled TrialA randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease.
To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity, adherence to exercise, and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program. ⋯ The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit. These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity. The intervention was acceptable to participants. Further study is needed to fashion interventions that have more persistent benefit.
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Arch Phys Med Rehabil · Mar 2008
ReviewChronic pain and opiates: balancing pain control and risks in long-term opioid treatment.
The risks and benefits of opioid analgesics for chronic pain conditions and diseases are discussed in the context of the concern about the public health problems of poorly managed pain and prescription drug abuse and addiction. New strategies for risk management in treating patients with chronic pain are described. Opioids for chronic pain may be used effectively in the context of clinical strategies for risk management and selectively tailored, biopsychosocial pain management. ⋯ To present the case for balanced use of opioid therapy in the treatment of chronic pain conditions.
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Arch Phys Med Rehabil · Mar 2008
Intravascular uptake during fluoroscopically guided cervical interlaminar steroid injection at C6-7: a case report.
We report 4 cases of intravascular venous uptake of contrast material during fluoroscopically guided cervical interlaminar epidural steroid injection at the C6-7 level. The blood vessel probably involved is the posterior internal vertebral venous plexus, which drains the interlaminar space and returns blood to the right atrium through the paired vertebral veins and right and left brachiocephalic veins. ⋯ We recommend the use of fluoroscopic guidance and the injection of contrast to identify potential placement of the injection needle within the vascular space. Potential complications of intravascular venous uptake of contrast material and steroid solution are discussed.
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Arch Phys Med Rehabil · Mar 2008
ReviewThe basis for recommending repeating epidural steroid injections for radicular low back pain: a literature review.
To determine the current evidence to support guidelines for frequency and timing of epidural steroid injections (ESIs), to help determine what sort of response should occur to repeat an injection, and to outline specific research needs in these areas. ⋯ There does not appear to be any evidence to support the current common practice of a series of injections. Recommendations for further research are made, including a possible study design.