Journal of rehabilitation research and development
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The construct validity and construct responsiveness of the performance scale of the Canadian Occupational Performance Measure (COPM) was measured in 87 newly admitted patients with chronic pain attending an outpatient rehabilitation clinic. At admission and after 12 wk, patients completed a COPM interview, the Pain Disability Index (PDI), and the RAND 36-Item Health Survey (RAND-36). We determined the construct validity of the COPM by correlations between the COPM performance scale (COPM-P), the PDI, and the RAND-36 at admission. ⋯ In patients with chronic pain attending our rehabilitation program, the COPM-P measures something different than the RAND-36 or PDI. Therefore, construct validity of the COPM-P was not confirmed by our data. We were not able to find support for the COPM-P to detect changes in occupational performance.
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Pain complaints are highly prevalent among military servicemembers and Veterans of the recent combat operations in Iraq and Afghanistan. The high comorbidity of pain with conditions such as posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) underscores the importance of a greater understanding of factors associated with complex polytraumatic injuries among military personnel. The present study aimed to identify correlates of current pain among 201 U. ⋯ A final model was then derived, in which older age, possible or probable mild TBI, depression symptoms, and PTSD re-experiencing symptoms emerged as significant correlates of pain. The findings further the understanding of polytrauma symptoms among military personnel by identifying specific patient characteristics and comorbidity patterns related to pain complaints. Increased awareness of demographic, psychiatric, or medical factors implicated in pain will enhance comprehensive clinical assessment and intervention efforts.
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The study objective was to examine postacute changes in bowel and bladder continence and cognition after severe traumatic brain injury (TBI) in persons with long-term functional recovery to full independence. This case series included nine patients initially admitted to inpatient rehabilitation (IR) with severe TBI who had returned to prior responsibilities and functional independence by 8 to 15 mo. Patients had initial Glasgow Coma Scale scores of 3 to 6, posttraumatic amnesia durations of 18 to 70 d, time-to-follow-commands of 16 to 56 d, initial abnormal brain computed tomography scans, and initial pupil abnormalities. ⋯ All patients had combined IR discharge sphincter FIM scores that were 12 or greater, indicating independence to modified independence with bowel and bladder function with no incontinence. Five participants (55%) were admitted to IR with sphincter FIM scores of 11 to 12, indicating recovery of continence during acute care. These findings suggest potential usefulness of IR cognitive FIM score changes and of the recovery of bowel and bladder continence for predicting favorable functional outcomes following severe TBI.
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This study examined the population-based reach of Veterans Health Administration (VHA) employment services to VHA patients with psychiatric diagnoses. Reach of services includes the percentage and characteristics of people who accessed services compared with those who did not. Using clinical administrative data, we identified patients with a psychiatric diagnosis among a random sample of all patients who received VHA services in 1 yr. ⋯ After adjusting for clinical and demographic characteristics, VHA patients with schizophrenia and bipolar disorder were more likely to receive any employment services and to receive supported employment than were patients with depression, PTSD, or other anxiety disorders. VHA patients with depression and PTSD were more likely to receive transitional work and vocational assistance than patients with schizophrenia. Future studies should examine system-level barriers to receiving employment services and identify types of employment services most appropriate for Veterans with different psychiatric diagnoses.