Effect of early interdisciplinary rehabilitation for trauma patients: a systematic review

Objective To perform a systematic review to assess the current scientific evidence concerning the effect of EIR for trauma patients with or without an associated traumatic brain injury. Data Source We performed a systematic search of several electronic (Ovid MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and SveMed+) and 2 clinical trial registers (clinicaltrials.gov and International Clinical Trials Registry Platform). In addition, we handsearched reference lists from relevant studies. Data Extraction Two review authors independently identified studies that were eligible for inclusion. The primary outcome measures were functional-related outcomes and return to work. The secondary outcome measures were length of stay in hospital, number of days on respirator, complication rate, physical and mental health measures, quality of life, and socioeconomic costs. Data Synthesis Four studies with a total number of 409 subjects, all with traumatic brain–associated injuries, were included in this review. The included trials varied considerably in study design, inclusion and exclusion criteria, and had small numbers of participants. All studies were judged to have at least 1 high risk of bias. We found the quality of evidence, for both our primary and secondary outcomes, low. Conclusions No studies that matched our inclusion criteria for EIR for trauma patients without traumatic brain injuries could be found. For traumatic brain injuries, there are a limited number of studies demonstrating that EIR has a positive effect on functional outcomes and socioeconomic costs. This review highlights the need for further research in trauma care regarding early phase interdisciplinary rehabilitation.publishedVersio

Cognitive and olfactory changes in aging

Age is associated with decrease in several cognitive functions whereof some changes may indicate a beginning pathologic process resulting in a state of dementia. The papers included in the thesis addressed questions related to cognitive and olfactory changes in elderly individuals with an aim to gain knowledge on the influence of the Apolipoprotein E (ApoE) ε4 allele on cognition and to extend the understanding of the association between cognitive functioning and odor identification performance. The first paper investigated the impact of the ApoE ε4 allele on cognitive functioning in a sample of non demented elderly individuals recruited from a population with a high prevalence of this allele. Paper 2 addressed the question whether the Scandinavian Odor Identification Test (SOIT) and its cut-off scores for diagnosis (hyposmia and anosmia) is applicable and valid to be used in Norwegian samples of middle aged and older individuals. The occurrence of olfactory dysfunction was further investigated in the third paper. It was examined whether individuals who were unaware of an olfactory dysfunction performed lower on cognitive tasks compared to individuals with normal olfactory function. In paper 4, the interrelation between different odor identification tasks (familiarity, cued and free odor identification), their association with cognitive measures as well as age-related performance differences were investigated. The present thesis shows that deficits in cognitive performance, demonstrated in verbal learning and memory tasks, can be related to the ApoE ε4 allele. The papers on olfactory functioning revealed the applicability of the SOIT in the elderly segment of the Norwegian population. It was shown that olfactory dysfunction increases with age and that changes often remain unnoticed. Individuals unaware of their olfactory dysfunction performed lower on a number of cognitive measures. The ability to identify odors was associated with a varying number of cognitive measures depending on the demands of the task. In conclusion, this thesis strengthens the generality of previous findings demonstrating an association between ApoE ε4 and impaired performance on verbal learning and memory tasks. The findings indicate further that odor identification performance is associated with a number of cognitive measures, predominantly episodic memory functioning. Odor identification tasks may provide valuable information in the examination of elderly individuals at risk for pathological decline

Does it Matter How We Pose the Question “How is Your Sense of Smell?”

There is a rather large, and unfortunate, discrepancy in the outcome between self-reported and standardized assessment of olfactory function. Questions for self-evaluation are commonly used that provide no information of with what to compare (comparison target) one’s olfactory function. We therefore investigated whether responses differed between an unspecific question and two questions providing comparison targets. Ninety-six healthy community-dwelling individuals (62.5 % women) aged 49–80 years evaluated their odor identification ability, followed by standardized assessment of odor identification ability. Results revealed that response patterns varied significantly depending on comparison target. While 81 % reported normal function when no further comparison target was presented, 69 % reported normal function when referring to age-related olfactory changes in identification ability. In turn, sensitivity of the accuracy of self-reported reduced odor identification ability (with standardized assessment as reference) increased from 11 to 37 %, whereas specificity decreased from 86 to 71 % when providing a comparison target. Accuracy of self-reported olfactory function can be increased by including a comparison target. However, standardized assessment is to be preferred over self-reported assessment, irrespective of how the question is formulated

Effect of early interdisciplinary rehabilitation for trauma patients: a systematic review

Objective To perform a systematic review to assess the current scientific evidence concerning the effect of EIR for trauma patients with or without an associated traumatic brain injury. Data Source We performed a systematic search of several electronic (Ovid MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and SveMed+) and 2 clinical trial registers (clinicaltrials.gov and International Clinical Trials Registry Platform). In addition, we handsearched reference lists from relevant studies. Data Extraction Two review authors independently identified studies that were eligible for inclusion. The primary outcome measures were functional-related outcomes and return to work. The secondary outcome measures were length of stay in hospital, number of days on respirator, complication rate, physical and mental health measures, quality of life, and socioeconomic costs. Data Synthesis Four studies with a total number of 409 subjects, all with traumatic brain–associated injuries, were included in this review. The included trials varied considerably in study design, inclusion and exclusion criteria, and had small numbers of participants. All studies were judged to have at least 1 high risk of bias. We found the quality of evidence, for both our primary and secondary outcomes, low. Conclusions No studies that matched our inclusion criteria for EIR for trauma patients without traumatic brain injuries could be found. For traumatic brain injuries, there are a limited number of studies demonstrating that EIR has a positive effect on functional outcomes and socioeconomic costs. This review highlights the need for further research in trauma care regarding early phase interdisciplinary rehabilitation

Olfactory hallucinations in a population-based sample

Olfactory hallucinations referring to olfactory perceptions in the absence of chemical stimuli, occur in non-clinical and clinical populations. Few studies have investigated their prevalence in the general population and little is known about factors triggering and maintaining them such as substance use, severe life events, and mood. We analyzed self-report data from 2500 community dwelling Norwegians, aged 18-96 years, for occurrence of olfactory hallucinations and co-occurring hallucinations in other modalities (auditory, visual, tactile). Analyses included age, sex, self-reported symptoms of depression and anxiety, mental health status, and experience of severe life-events. The results show that 4.2% (95% CI 3.5-5.1%) reported having experienced olfactory hallucinations, and 56% of individuals experiencing olfactory hallucinations also reported these in combination with hallucinations in other modalities. Prevalence varied significantly in terms of age and sex, in that olfactory hallucinations were most frequently reported by young individuals and females. Self-reported symptoms of anxiety and experience of stressful life events were significantly associated with olfactory hallucinations, suggesting that experiencing olfactory hallucinations may negatively affect functioning and may increase the likelihood of developing psychopathology. Findings underline the need to continue to examine olfactory hallucinations albeit with a more comprehensive assessment in order to increase knowledge on this experience