Bio-psycho-social aspects of severe multiple trauma

Subjects with severe multiple trauma present great challenges in rehabilitation, and investigations with a holistic bio-psycho-social point of view have been scarce. In the main part of this investigation all 146 patients with severe multiple trauma (ISS 16) admitted to a regional hospital in 1990. were target. Ten years survival probability for those discharged alive from the Department of Surgery (fl: 91) was 82%. Mortality rates were significantly higher than those of the general population, particularly during the first year after discharge, during which the main cause of death was traumatic brain injury. Later, overuse of alcohol and drugs, were the main causes of death. A principal aim was to analyse the relations between impairments/ functions. disabilities/ abilities and psychological and social well-being. In a three year follow-up investigation of 69 subjects (84% of those available), 80% had one or more residual impairments: 74% had physical and 32°/g cognitive impairment. Very few subjects (n=4) were ADL-dependent. Vocational disability was present in 19% and leisure disability in 76%. Vocational disability was associated with higher age, blue collar work and cognitive impairment. Leisure disability was most prevalent in those with severe physical impairments and residual pain. Cognitive performance was significantly related both to the severity of traumatic brain injury and to degree of psychological distress. A consecutive series of subjects with severe multiple trauma without brain injury (n:26), were investigated at admission to the rehabilitation hospital, at discharge and at follow-up 1- 3.5 year following trauma. Both retrospectively and prospectively, the subjects experienced significant decreases in satisfaction with life as a whole from before to after trauma. Furthermore, compared to before trauma, significantly fewer subjects reported to be satisfied (5-6) with life as a whole, and with the domains: Sexual life. ADL, contact with friends, leisure, vocational situation and financial situation. Among the life satisfaction domains, the most important contributors for global life satisfaction after trauma. were satisfaction with leisure, family life and vocation. In multiple regression analyses, having a sufficient social network, and also a strong sense of coherence, could buffer the negative influence of disabilities on life satisfaction following trauma. Though level of sense of coherence was closely related to simultaneously measured social well-being, the SOC was not stable over time, and the hypothesis about a strong sense of coherence as protective against future distress and reduced satisfaction after stressful life events could not be confirmed, at least not the first years after multiple trauma

Mortality and one-year functional outcome in elderly and very old patients with severe traumatic brain injuries: observed and predicted

Published version. Source at http://doi.org/10.1155/2015/845491.The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models. Results. 97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI

Healthcare Professionals' Experiences with Rehabilitation Practices for Patients with Cognitive Impairment after Stroke in North Norway: A Qualitative Study

Background and Aim. Cognitive impairment is a common consequence following stroke. Previous research shows differences in rehabilitation services supporting physical, cognitive, and psychosocial needs. The aim of the current study was to explore health professionals’ experiences with service provision for patients with mild and moderate cognitive impairment after stroke in a North Norwegian context. Methods. A focus group interview with clinicians, coordinators, and leaders involved in stroke survivors’ rehabilitation trajectories was conducted. The group consisted of a strategic selection of participants with diverse professional backgrounds from specialist and primary healthcare services. The transcribed material was analyzed thematically using systematic text condensation based on an inductive, interpretive approach. Results. We found that patients with mild and moderate cognitive impairment after stroke were characterized as a neglected group in rehabilitation services and that neglect was related to both structural and professional issues. First, neglect seemed partly related to the availability of existing healthcare services, which mainly followed up on physical challenges after stroke. Second, cognitive rehabilitation seemed to be less prioritized than other health services, and the established interdisciplinary municipality teams did not seem prepared to follow-up on cognitive issues. Finally, at a professional level, the study reveals the need for building competence in cognitive rehabilitation and having services available in the long run. Conclusion. The study demonstrates the need to increase knowledge concerning cognitive rehabilitation and how rehabilitation trajectories and services should be organized to fulfil stroke survivors’ and carers’ long-term needs

Visual problems are associated with long-term fatigue after stroke

Objective: Post-stroke fatigue may be associated with functioning even in patients with mild stroke. In order to guide rehabilitation, the aim of this study was to investigate the independent contribution of 12 function-related domains to severe long-term fatigue. Design: Observational follow-up study. Subjects: A total of 144 stroke survivors (mean age 67.3, standard deviation (SD) 10.9 years) were included. Methods: Fatigue 3–4 years post-stroke was measured with the Fatigue Severity Scale (cut-off ≥5). Independent variables were the multidimensional Stroke-Specific Quality of Life scale with 12 domains, demographics, and baseline stroke characteristics. Results: Most of the participants had mild and moderate stroke. Thirty-five percent (n = 51) reported severe fatigue 3–4 years after stroke. Those living with a significant other, and working participants reported significantly less fatigue. All domains of the Stroke-specific Quality of Life scale were significantly associated with the Fatigue Severity Scale. Adjusted for age, sex, marital status, and work status, the domains “energy”, “mood”, and, unexpectedly, the domain “vision”, were all variables independently associated with severe long-term fatigue. Conclusion: Stroke survivors with prominent self-reported visual problems were more likely to experience fatigue. This finding should be verified in further studies. Visual examination and visual rehabilitation may reduce fatigue in selected stroke survivors

Factors associated with met and unmet rehabilitation needs after stroke: A multicentre cohort study in Denmark and Norway

Objectives: To examine patient-reported needs for care and rehabilitation in a cohort following different subacute pathways of rehabilitation, and to explore factors underpinning met and unmet needs. Design: Observational multicentre cohort study. Patients and methods: A total of 318 Norwegian and 155 Danish patients with first-ever stroke were included. Participants answered questions from the Norwegian Stroke Registry about perceived met, unmet or lack of need for help and training during the first 3 months post stroke. The term “training” in this context was used for all rehabilitative therapy offered by physiotherapists, occupational or speech therapists. The term “help” was used for care and support in daily activities provided by nurses or health assistants. Results: Need for training: 15% reported unmet need, 52% reported met need, and 33% reported no need. Need for help: 10% reported unmet need, 58% reported met, and 31% reported no need. Participants from both Norway and Denmark had similar patterns of unmet/met need for help or training. Unmet need for training was associated with lower functioning, (odds ratio (OR) = 0.32, p  Conclusion: Similar levels of met and unmet needs for training and help at 3 months after stroke were reported despite differences in the organization of the rehabilitation services. Functioning and psychological factors were associated with unmet rehabilitation needs

Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial

Objective To assess the efficacy of caudal epidural steroid or saline injection in chronic lumbar radiculopathy in the short (6 weeks), intermediate (12 weeks), and long term (52 weeks). Design Multicentre, blinded, randomised controlled trial. Setting Outpatient multidisciplinary back clinics of five Norwegian hospitals. Participants Between October 2005 and February 2009, 461 patients assessed for inclusion (presenting with lumbar radiculopathy >12 weeks). 328 patients excluded for cauda equina syndrome, severe paresis, severe pain, previous spinal injection or surgery, deformity, pregnancy, ongoing breast feeding, warfarin therapy, ongoing treatment with non-steroidal anti-inflammatory drugs, body mass index >30, poorly controlled psychiatric conditions with possible secondary gain, and severe comorbidity. Interventions Subcutaneous sham injections of 2 mL 0.9% saline, caudal epidural injections of 30 mL 0.9% saline, and caudal epidural injections of 40 mg triamcinolone acetonide in 29 mL 0.9% saline. Participants received two injections with a two week interval. Main outcome measures Primary: Oswestry disability index scores. Secondary: European quality of life measure, visual analogue scale scores for low back pain and for leg pain. Results Power calculations required the inclusion of 41 patients per group. We did not allocate 17 of 133 eligible patients because their symptoms improved before randomisation. All groups improved after the interventions, but we found no statistical or clinical differences between the groups over time. For the sham group (n=40), estimated change in the Oswestry disability index from the adjusted baseline value was −4.7 (95% confidence intervals −0.6 to −8.8) at 6 weeks, −11.4 (−6.3 to −14.5) at 12 weeks, and −14.3 (−10.0 to −18.7) at 52 weeks. For the epidural saline intervention group (n=39) compared with the sham group, differences in primary outcome were −0.5 (−6.3 to 5.4) at 6 weeks, 1.4 (−4.5 to 7.2) at 12 weeks, and −1.9 (−8.0 to 4.3) at 52 weeks; for the epidural steroid group (n=37), corresponding differences were −2.9 (−8.7 to 3.0), 4.0 (−1.9 to 9.9), and 1.9 (−4.2 to 8.0). Analysis adjusted for duration of leg pain, back pain, and sick leave did not change this trend. Conclusions Caudal epidural steroid or saline injections are not recommended for chronic lumbar radiculopathy

Health-related Quality of Life 12 months after severe traumatic brain injury: A prospective nationwide cohort study

OBJECTIVE: To assess health-related quality of life in individuals with severe traumatic brain injury at 12 months post-injury, applying the Quality of Life after Brain Injury (QOLIBRI) instrument, and to study the relationship between injury-related factors, post-injury functioning and health-related quality of life. Design/subjects: The study is part of a prospective, Norwegian multicentre study of adults (≥ 16 years old) with severe traumatic brain injury, as defined by a Glasgow Coma Scale score of 3–8 during the first 24 h post-injury. A total of 126 patients were included. METHODS: Socio-demographic data and injury severity variables were collected. Functioning at 3 and 12 months was assessed with the Glasgow Outcome Scale Extended (GOSE), the Functional Independence Measure (FIM), the Rivermead Post-concussion Questionnaire (RPQ), and the Hospital Anxiety and Depression Scale (HADS). Hierarchical regression analysis was applied. RESULTS: Mean QOLIBRI score was 68.5 (standard deviation = 18.8). Predictors of the QOLIBRI in the final regression model were: employment status (p = 0.05), GOSE (p = 0.05), RPQ (p < 0.001) and HADS (p < 0.001). The adjusted R2 showed that the model explained 64.0% of the variance in the QOLIBRI score. CONCLUSION: Symptom pressure and global functioning in the sub-acute phase of traumatic brain injury and psychological distress in the post-acute phase are important for health-related quality of life at 12 months post-injury. These domains should be the focus in rehabilitation aiming to improve health-related quality of life in patients with severe traumatic brain injury

Use of health and dental care services in adults with intellectual disability in relation to age and intellectual disability levels

Background - This study investigates the use of health and dental care services in adults with intellectual disability in the last 12 months according to Norwegian recommendations and in relation to age and intellectual disability levels. Method - A cross-sectional community-based survey including 214 participants (56% men). POMONA health indicators were used for data collection. Results - Health checks and contact with general practitioners in the last year increased with age but were less frequent in those with more severe intellectual disability. Hospital admissions were age independent. Less than one-fifth of women had undergone cancer screening, with small variations according to intellectual disability severity levels. Few had an individual plan. More than one-third experienced poor dental health despite frequent controls. Conclusions - The use of health checks was lower than recommended, especially in individuals with more severe intellectual disability. Service access and individual plan use need to be enhanced, and dental care services should be improved

Barriers to physical activity participation for adults with intellectual disability: A cross-sectional study

Background - Identifying barriers that can be modified to promote physical activity is important for informing health interventions for adults with intellectual disabilities. Objectives - Exploring participation in physical activity considering age, sex, living conditions, and health conditions. Further, identifying barriers significantly associated with sedentary activity after adjustment for physical activity correlates. Methods - A cross-sectional study including physical activity and barrier questions from the POMONA-15 health indicators. Multivariate logistic regression analysis with sedentary activity level as dependent variable. Results - Among 213 participants with intellectual disabilities, 36% reported predominately sedentary activities, 53% light and 11% moderate/vigorous physical activity. Barriers related to sedentary activity after adjustment were transportation, health conditions, mobility impairment, and lack of activities at the day activity centre. Conclusions - The findings highlight the need to enhance physical activity opportunities at day activity centres, tailor programmes for wheelchair users, and improve access to physical activity facilities for adults with intellectual disabilities