Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Jun 2008
The relationship between repeated epidural steroid injections and subsequent opioid use and lumbar surgery.
To evaluate whether the use of epidural steroid injections (ESIs) is associated with decreased subsequent opioid use in patients in the Department of Veteran's Affairs (VA) and to determine whether treatment with multiple injections are associated with decreased opioid use and lumbar surgery after ESIs. ⋯ Opioid use did not decrease in the 6 months after ESIs. In this population, patients who received multiple injections were more likely to start taking opioids and to undergo lumbar surgery within the 6 months after treatment with ESIs. These findings are concerning because our data suggest that ESIs are not reducing opioid use in this VA population.
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Arch Phys Med Rehabil · Jun 2008
ReviewA systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance.
To determine the reproducibility of manual palpation in identifying trigger points based on a systematic review of available literature. ⋯ The methodologic quality of the majority of studies for the purpose of establishing trigger point reproducibility is generally poor. More high-quality studies are needed to comment on this procedure. Clinicians and scientists are urged to move toward simpler, global assessments of patient status.
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Arch Phys Med Rehabil · Jun 2008
Rehabilitation setting and associated mortality and medical stability among persons with amputations.
To estimate the differences in outcomes across postacute care settings-inpatient rehabilitation, skilled nursing facility (SNF), or home-for dysvascular lower-limb amputees. ⋯ Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers.
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Arch Phys Med Rehabil · Jun 2008
Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome.
To determine the effect of associated spinal cord injury (SCI) conditions on the health status and quality of life (QOL) in people with traumatic central cord syndrome. ⋯ The associated SCI conditions bowel, bladder, and/or sexual dysfunction, neuropathic pain, decreased motor function, and spasticity negatively affect the health status of persons with traumatic central cord syndrome. Diminished motor recovery was the only associated SCI condition to impact QOL. By developing a conceptual model and adjusting for confounders, an estimate for each associated SCI condition's effect on patient outcomes was obtained. Our results indicate the importance of treating or ameliorating associated SCI conditions in order to maximize physical and mental functioning.
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Arch Phys Med Rehabil · Jun 2008
Factors affecting self-reported pain and physical function in patients with hip osteoarthritis.
To determine the factors associated with self-reported pain and physical function in patients with hip osteoarthritis (OA). ⋯ Educational level, life satisfaction, and number of comorbidities were identified as significant factors for both self-reported pain and physical functioning in hip OA. Performance measures are better predictors of physical function than pain in hip OA. Factors explaining disability and pain in hip OA are multidimensional and no single predicting factor was found to be superior to any other.