Intensive exercise program after spinal cord injury (“Full-On”): study protocol for a randomized controlled trial

BACKGROUND: Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. METHODS/DESIGN: A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. DISCUSSION: The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury. TRIAL REGISTRATION: NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010)

The differential effects of co-payment and co-insurance on the use and cost of prescription drugs.

This research studies the differential effects of a fixed dollar co-payment and a fixed percentage co-insurance rate on the utilization and cost of prescription drugs. The research presents a theoretical framework and sheds light on the policy debate over whether co-payment or co-insurance is more effective in containing prescription drug use and cost. This study uses a prescription claims data file established by a national health insurance company in the US. One observation (averaged data for 1988 and 1989) per employer group, together with other related information, such as employee, employer and market characteristics, were used for analysis. The study sample includes 517 employer groups (89%) which use a 20% co-insurance, and 64 employer groups (11%) which use a $5 co-payment, for the outpatient prescriptions covered. Utilization and cost of prescriptions are modeled as a linear function of physician office visits, the form of the cost-sharing method, the effective price to the patient, and other related factors. Results show, ceteris paribus, a fixed dollar co-payment, relative to a fixed percentage co-insurance rate, is associated with: (1) a 21% lower drug utilization rate; (2) a 27% lower unit cost of prescriptions; (3) a 43% lower total drug expenditures per insured person; (4) a 59% lower employer drug cost per insured person; and (5) a 21% lower employee-shared cost per insured person.Ph.D.Health Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/104477/1/9527646.pdfDescription of 9527646.pdf : Restricted to UM users only