Rehabilitation medicine summit: building research capacity Executive Summary

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report (see Additional File 1)

Pompe disease diagnosis and management guideline

ACMG standards and guidelines are designed primarily as an educational resource for physicians and other health care providers to help them provide quality medical genetic services. Adherence to these standards and guidelines does not necessarily ensure a successful medical outcome. These standards and guidelines should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. in determining the propriety of any specific procedure or test, the geneticist should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. It may be prudent, however, to document in the patient's record the rationale for any significant deviation from these standards and guidelines.Duke Univ, Med Ctr, Durham, NC 27706 USAOregon Hlth Sci Univ, Portland, OR 97201 USANYU, Sch Med, New York, NY USAUniv Florida, Coll Med, Powell Gene Therapy Ctr, Gainesville, FL 32611 USAIndiana Univ, Bloomington, in 47405 USAUniv Miami, Miller Sch Med, Coral Gables, FL 33124 USAHarvard Univ, Childrens Hosp, Sch Med, Cambridge, MA 02138 USAUniversidade Federal de São Paulo, São Paulo, BrazilColumbia Univ, New York, NY 10027 USANYU, Bellevue Hosp, Sch Med, New York, NY USAColumbia Univ, Med Ctr, New York, NY 10027 USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

A meta-analysis of applied vestibular stimulation research

The results of studies examining the effectiveness of vestibular stimulation as a form of sensory stimulation were reviewed. The review employed recently developed quantitative methods that treat the literature review process as a unique type of research. Forty-one studies were located that employed some form of vestibular stimulation as the independent variable. Eighteen of these studies met criteria consistent with traditionally accepted standards of empirical inquiry in the behavioral and biomedical sciences and were included in the review. The 18 studies contained a total of 44 hypothesis tests that evaluated the efficacy of vestibular stimulation as a form of sensory enrichment designed to facilitate various developmental parameters. An analysis of the resultsof these tests, using methods of meta-analysis, revealedthat subjects receiving vestibular stimulation performedsignificantly better than members of control or comparison groups who did not receive such stimulation

The K statistic in rehabilitation research: An examination

The number and sophistication of statistical procedures reported in medical rehabilitation research is increasing. Application of the principles and methods associated with evidence-based practice has contributed to the need for rehabilitation practitioners to understand quantitative methods in published articles. Outcomes measurement and determination of reliability are areas that have experienced rapid change during the past decade. In this study, distinctions between reliability and agreement are examined. Information is presented on analytical approaches for addressing reliability and agreement with the focus on the application of the K statistic. The following assumptions are discussed: (1) K should be used with data measured on a categorical scale, (2) the patients or objects categorized should be independent, and (3) the observers or raters must make their measurement decisions and judgments independently. Several issues related to using K in measurement studies are described, including use of weighted K, methods of reporting K, the effect of bias and prevalence on K, and sample size and power requirements for K. The K statistic is useful for assessing agreement among raters, and it is being used more frequently in rehabilitation research. Correct interpretation of the K statistic depends on meeting the required assumptions and accurate reporting

Home health utilization association with discharge to community for people with dementia

Abstract Introduction The objective of this study was to identify home health utilization factors associated with successful discharge to community after home health care for patients with and without Alzheimer's disease and related dementias (ADRD). Methods This was a retrospective study of 100% national Medicare home health data files (2016 to 2017). Multilevel logistic regression was used to study the relationship of home health utilization with a modified definition of successful discharge to community (M‐SDC) after home health (no readmission or discharge within 30 days). Significant interactions were identified using backward selection. The associations between domains were examined in a model stratified by ADRD, with and without controlling for mobility, self‐care, and caregiver assistance. Results The cohort consisted of 535,691 patients, 18.0% with ADRD. The overall M‐SDC rate was 92.1%. The likelihood of M‐SDC was increased when physical therapy services were provided, episodes of care were longer than 15 days, and the total number of therapy visits was greater than 10. The likelihood of M‐SDC decreased when speech therapy, nursing, and home health aide services were provided and when patients were discharged early. When controlling for mobility, self‐care, and caregiver support, length of home health episode was the only characteristic that showed a significant interaction with ADRD. Discussion The results of this study indicate that the provision of physical therapy services and moderate lengths of care and volume of visits are associated with increased likelihood of M‐SDC. A decreased likelihood of M‐SDC when speech therapy, nursing, and home health aide services are delivered may be a proxy indicator of patient acuity and disease severity and needs to be further investigated. An important next step in understanding home health access and outcomes for people with ADRD is to examine the impact of the Patient‐Driven Groupings Model on home health utilization characteristics, especially length of episodes. Highlights Most people remain in the community after discharge from home health. Likelihood of modified successful discharge to community (M‐SDC) increased with physical therapy, longer episodes, and more than 10 visits. Likelihood of M‐SDC decreased with speech therapy, skilled nursing, home health aide visits, and early discharge. Longer home health episodes increased likelihood of M‐SDC for people with Alzheimer's disease and related dementias

Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

Abstract Objective Comorbid disorders influence the course and outcomes of rehabilitation following traumatic brain injury (TBI), yet sex- and age-related disparities in the frequency distribution of these disorders remain poorly understood. We aimed to describe comorbid disorders by the International Classification of Diseases in patients with TBI undergoing inpatient rehabilitation in Ontario, Canada over a 3-year period, by sex and age, and discuss their potential impact on rehabilitation outcomes. Results The percentage of TBI patients with one or more comorbid disorder is higher among older (≥65 years) men and women than among those who are younger or middle-aged (<65 years). Among younger and middle-aged patients, multiple injuries and trauma, mental health conditions, and nervous system disorders were the most prevalent comorbidities. In older patients, circulatory, endocrine, nutritional, metabolic, and immune disorders were the most prevalent comorbidities. Our results suggest that a multisystem view of rehabilitation of men and women with TBI across age categories is needed to reflect the complex clinical profile of TBI patients undergoing rehabilitation