Disability and rehabilitation
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This study investigates coping strategies after traumatic brain injury (TBI) and their associations with health-related quality of life (HRQoL). ⋯ This study highlights the relationship of coping strategies and HRQoL after TBI. For the assessment of HRQoL a novel disease-specific instrument was applied, that provides in detail TBI-relevant aspects of well-being and HRQoL. Individuals after TBI use two main sets of coping strategies that are differentially associated with HRQoL (and clinical variables). One is adaptive and the other maladaptive for HRQoL after TBI. Maladaptive and adaptive coping strategies used by the individual should be identified and considered in rehabilitation efforts to improve HRQoL after TBI.
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To determine the reliability and validity of the Chinese version of Expanded and Revised Gross Motor Function Classification System (GMFCS-ER) for cerebral palsy (CP) and to explore if there existed differences between parents and the other raters. ⋯ The Chinese version of the GMFCS-ER is a valid measure of functional ability in school children with CP and reliable enough for use by Chinese healthcare providers and parents. Effects of environmental and personal factors should be considered when practicing GMFCS-ER assessment. Implications for Rehabilitation Cerebral palsy. Research about GMFCS-ER is needed to promote a more extensive use of GMFCS-ER in China for school children with CP. The Chinese version of the GMFCS-ER is a valid measure of functional ability in school children with CP and reliable enough for use by Chinese healthcare providers. Effects of environmental and personal factors should be considered when performing the GMFCS-ER assessment.
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This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain. ⋯ The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety. Implications for Rehabilitation The prevalence of insomnia is high in patients with complex chronic pain conditions. Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects. Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia. One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.
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Health care practice guidelines require physiotherapists to include patients in goal-setting. However, not much is known about how this process is accomplished in practice. The purpose of this study is to analyse patient-physiotherapist consultations and to identify how physiotherapists enquire about goals and how patients respond to these enquiries. ⋯ Goal-setting is not a straightforward process. Practices that entail asking patients to state their goals neither take into consideration the fact that patients may not know what an achievable goal is nor do they consider so-called social reasons for patients not to make claims to their physiotherapist about what the goals should be. Implications for Rehabilitation Patients respond to explicit goal enquiries using an open question with delayed responses indicating some communication problem. Goal-setting should not be treated as a predetermined process, but as negotiated in consultations. Goal-setting is a complex interaction in which participants manage knowledge about goals.
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Comparative Study
Physical activity and low back pain: the role of subgroups based on the avoidance-endurance model.
This study examines the relationship between low back pain, disability and fatigue and overt physical activity with respect to fear-avoidance and endurance-related subgroups. ⋯ The results indicate different pathways to chronic pain and disability with physical underuse in FAR patients and overuse/overload in endurance patients suggesting the need for individually targeted cognitive-behavioral treatments in the maladaptive groups. Implications for Rehabilitation Improving the return to a normal physical activity level is an important goal for the rehabilitation of patients after lumbar disc surgery. Different pathways to chronic pain and disability with physical underuse in fear-avoidance patients and overuse in endurance patients should be considered. Different pain-related pain response pattern, based on the avoidance-endurance model, indicate the need for individual targeting of rehabilitation programs.