American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Jun 2012
Review Comparative StudyAttitudes of healthcare students and professionals toward patients with physical disability: a systematic review.
Negative healthcare provider attitudes toward patients with physical disabilities may challenge the delivery of quality care to patients. The objective of this study was to systematically review published studies examining the attitudes of healthcare students and professionals toward patients with physical disabilities. ⋯ Overall, healthcare students' and professionals' attitudes toward persons with physical disabilities were favorable. However, some studies revealed the possibility that some healthcare providers demonstrate fear and anxiety with the challenge of caring for a patient with physical disabilities. Some of the factors associated with providers' attitudes toward patients with physical disabilities are potentially modifiable (e.g., experience) and could be the target of educational interventions to ameliorate this fear and facilitate higher quality care.
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Am J Phys Med Rehabil · Jun 2012
Comparative StudyDesigning the objective structured clinical examination to cover all major areas of physical medicine and rehabilitation over 3 yrs.
The Accreditation Council for Graduate Medical Education requires that training programs comprehensively evaluate residents in the six core Accreditation Council for Graduate Medical Education competencies. One of the ways we do this in our residency is by administering a nine-station Objective Structured Clinical Examination (OSCE) at the end of each year, which evaluates tasks such as history taking, focused physical examination, communication, professionalism, procedural skills, management, prescription writing, and understanding systems-based practice. We have classified our OSCE stations into what we consider key areas in our field and assessed these on a rotating basis over 3 yrs. ⋯ Structuring the OSCE as a series of stations over 3 yrs is an efficient method to evaluate residents' competencies that are required by the Accreditation Council for Graduate Medical Education and certifying boards. An analysis of OSCE scores when compared with American Board of Physical Medicine & Rehabilitation parts 1 and 2 scores and final summative resident evaluation scores reveals that OSCE results correlate with part 1 scores and final evaluation scores but do not show the same strong correlations with part 2 scores. We discuss the way the OSCE can complete other assessment techniques and ways to improve cases in the future.
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Am J Phys Med Rehabil · May 2012
Predictors of discharge to acute care after inpatient rehabilitation in severely affected stroke patients.
This study aimed to determine the predictors of discharge to acute care after inpatient rehabilitation in severely affected stroke patients. ⋯ In the current study, controlling for impairment (stroke), severity of condition, demographic variables, inpatient rehabilitation admission day of the week and discharge day of the week, prehospitalization living setting, prehospitalization living with (alone, family, other), payer (secondary insurance coverage), onset days, co-morbid medical conditions, and classification of stroke-related neurologic deficits, the only variable predictive of discharge to the acute care hospital from an inpatient rehabilitation facility is function at admission, mainly the admission motor Functional Independence Measure rating. If clinicians routinely assess the functional status of patients during the preadmission screening process, it may aid in identifying whether the patient is at an increased risk of being readmitted to the acute care hospital.
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Am J Phys Med Rehabil · May 2012
Agreement and reliability of functional performance and muscle power in patients with advanced osteoarthritis of the hip or knee.
The purpose of this study was to test the reproducibility and clinical feasibility of three functional performance measures and five single-joint or multijoint muscle power measures. ⋯ Isolated muscle power over the hip and knee can safely be evaluated with poor to good agreement and good to excellent reliability in patients with advanced hip or knee osteoarthritis. Functional performance and muscle power may be assessed concurrently.
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Am J Phys Med Rehabil · May 2012
The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait.
Wearing high-heeled shoes may produce deleterious effects on the musculoskeletal system. The purpose of this study was to evaluate the changes in electromyographic (EMG) activity of the erector spinae muscles and pelvis kinematics during gait while wearing low- and high-heeled shoes in both young and middle-aged adult women. ⋯ From a clinical perspective, increased lumbar erector spinae muscle activity associated with wearing high-heeled shoes could exacerbate muscle overuse and lead to low back problems. The lower pelvic range of motion associated with wearing high heels in middle-aged women may indicate that tissues in the lumbopelvic region become more rigid with age and that the harmful effect of high-heeled shoes on posture and spinal tissues may be more pronounced with advancing age.