Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Oct 2013
Functional status impairment is associated with unplanned readmissions.
To determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care. ⋯ Functional status on admission to the CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from the CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor.
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Arch Phys Med Rehabil · Oct 2013
Clinical TrialA combined inspiratory and expiratory muscle training program improves respiratory muscle strength and fatigue in multiple sclerosis.
To determine the effects of a short-duration, combined (inspiratory and expiratory), progressive resistance respiratory muscle training (RMT) protocol on respiratory muscle strength, fatigue, health-related quality of life, and functional performance in individuals with mild-to-moderate multiple sclerosis (MS). ⋯ A short-duration, combined RMT program improved inspiratory and expiratory muscle strength and reduced fatigue in patients with mild to moderate MS.
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Arch Phys Med Rehabil · Oct 2013
Prior history of traumatic brain injury among persons in the Traumatic Brain Injury Model Systems National Database.
To determine the association between demographic, psychosocial, and injury-related characteristics and traumatic brain injury (TBI) occurring prior to a moderate or severe TBI requiring rehabilitation. ⋯ Findings suggest that earlier life TBI may have important implications for rehabilitation after subsequent TBI, especially for anticipating behavioral health issues in the chronic stage of recovery. Results provide additional evidence for the potential consequences of early life TBI, even if mild.
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Arch Phys Med Rehabil · Oct 2013
Disorders of consciousness and disordered care: families, caregivers, and narratives of necessity.
By their nature, care decisions for patients with severe disorders of consciousness must involve surrogates. Patients, so impaired, have lost their decision-making capacity and the ability to direct their own care. Surrogates-family members, friends, or other intimates-must step in and make decisions about ongoing care or its withdrawal. ⋯ Through their perspectives, the article considers challenges to ongoing care and rehabilitation that are a function of a prevailing medical infrastructure and reimbursement framework better suited to patients with acute care needs. Specific attention is paid to the ethical challenges posed by reimbursement strategies such as "medical necessity" as well as those proposed for the Affordable Care Act. The argument concludes that when it comes to care for a disorder related to consciousness, its provision is not discretionary, and its receipt is not an entitlement but a civil right.
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Arch Phys Med Rehabil · Oct 2013
Randomized Controlled Trial Multicenter StudyMedical complications during inpatient rehabilitation among patients with traumatic disorders of consciousness.
To assess the incidence of medical complications in patients with recent traumatic disorders of consciousness (DOCs). ⋯ Patients with DOCs have a high rate of medical complications early after injury. Many of these complications require brain injury expertise for optimal management. Active medical management appears to contribute to the reduction in new complications. An optimal system of care for DOC patients must provide expert medical management in the early weeks after injury.