Journal of Rehabilitation Research and Development最新文献

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Interdisciplinary development of an ergonomic prone mobility cart. 一种符合人体工程学的移动小车的跨学科开发。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2014.11.0279
Steven W Brose, Martin J Kilbane, Elizabeth Harpster, Steven J Mitchell, Chester Ho, Ken J Gustafson
{"title":"Interdisciplinary development of an ergonomic prone mobility cart.","authors":"Steven W Brose,&nbsp;Martin J Kilbane,&nbsp;Elizabeth Harpster,&nbsp;Steven J Mitchell,&nbsp;Chester Ho,&nbsp;Ken J Gustafson","doi":"10.1682/JRRD.2014.11.0279","DOIUrl":"https://doi.org/10.1682/JRRD.2014.11.0279","url":null,"abstract":"<p><p>Pressure ulcers remain a major source of morbidity and mortality in Veterans with neurologic impairment. Management of pressure ulcers typically involves pressure relief over skin regions containing wounds, but this can lead to loss of mobility and independence when the wounds are located in regions that receive pressure during sitting. An innovative, iterative design process was undertaken to improve prone cart design for persons with spinal cord injury and pressure ulceration. Further investigation of ways to improve prone carts is warranted to enhance the quality of life of persons with pressure ulcers.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.11.0279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34376007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effect of common wrist orthoses on the stiffness of wrist rotations. 普通腕部矫形器对腕部旋转刚度的影响。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2014.11.0274
Daniel B Seegmiller, Dennis L Eggett, Steven K Charles
{"title":"The effect of common wrist orthoses on the stiffness of wrist rotations.","authors":"Daniel B Seegmiller,&nbsp;Dennis L Eggett,&nbsp;Steven K Charles","doi":"10.1682/JRRD.2014.11.0274","DOIUrl":"https://doi.org/10.1682/JRRD.2014.11.0274","url":null,"abstract":"<p><p>Wrist orthoses (also known as splints, braces, or supports) are commonly used to support or restrict the motion of a weak or injured wrist. These orthoses generally function by stiffening the wrist joint. Therefore, choosing the proper orthosis (or improving orthoses) requires that we understand their stiffness properties. In this study, we present a method for measuring the stiffness of wrist orthoses, and we apply this method to 12 of the most common wrist orthoses. We found similarities and differences between these orthoses, indicating that different orthoses have different effects on the wrist joint and, presumably, on wrist behavior. In particular, all six orthoses with a stay on the volar side or the volar and dorsal sides added a significant amount of stiffness to the wrist joint. In contrast, only one of three orthoses with a stay on the dorsal side and none of the three orthoses without stays exhibited a significant amount of stiffness, calling into question their ability to support the wrist joint. This work lays a foundation for future studies investigating the effect of wrist orthosis stiffness on wrist behavior and how wrist orthosis stiffness can be designed to produce behavior that facilitates healing.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.11.0274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34864760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Accelerometer-based step initiation control for gait-assist neuroprostheses. 基于加速度计的步态辅助神经假体步启动控制。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2015.09.0188
Kevin M Foglyano, John R Schnellenberger, Rudi Kobetic, Lisa Lombardo, Gilles Pinault, Stephen Selkirk, Nathaniel S Makowski, Ronald J Triolo
{"title":"Accelerometer-based step initiation control for gait-assist neuroprostheses.","authors":"Kevin M Foglyano,&nbsp;John R Schnellenberger,&nbsp;Rudi Kobetic,&nbsp;Lisa Lombardo,&nbsp;Gilles Pinault,&nbsp;Stephen Selkirk,&nbsp;Nathaniel S Makowski,&nbsp;Ronald J Triolo","doi":"10.1682/JRRD.2015.09.0188","DOIUrl":"https://doi.org/10.1682/JRRD.2015.09.0188","url":null,"abstract":"<p><p>Electrical activation of paralyzed musculature can generate or augment joint movements required for walking after central nervous system trauma. Proper timing of stimulation relative to residual volitional control is critical to usefully affecting ambulation. This study evaluates three-dimensional accelerometers and customized algorithms to detect the intent to step from voluntary movements to trigger stimulation during walking in individuals with significantly different etiologies, mobility limitations, manual dexterities, and walking aids. Three individuals with poststroke hemiplegia or partial spinal cord injury exhibiting varying gait deficits were implanted with multichannel pulse generators to provide joint motions at the hip, knee, and ankle. An accelerometer integrated into the external control unit was used to detect heel strike or walker movement, and wireless accelerometers were used to detect crutch strike. Algorithms were developed for each sensor location to detect intent to step to progress through individualized stimulation patterns. Testing these algorithms produced detection accuracies of at least 90% on both level ground and uneven terrain. All participants use their accelerometer-triggered implanted gait systems in the community; the validation/system testing was completed in the hospital. The results demonstrated that safe, reliable, and convenient accelerometer-based step initiation can be achieved regardless of specific gait deficits, manual dexterities, and walking aids.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34971398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Development of the Modified Four Square Step Test and its reliability and validity in people with stroke. 改良四方步检验在脑卒中患者中的发展及其信效度。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2014.04.0112
Margaret A Roos, Darcy S Reisman, Gregory Hicks, William Rose, Katherine S Rudolph
{"title":"Development of the Modified Four Square Step Test and its reliability and validity in people with stroke.","authors":"Margaret A Roos,&nbsp;Darcy S Reisman,&nbsp;Gregory Hicks,&nbsp;William Rose,&nbsp;Katherine S Rudolph","doi":"10.1682/JRRD.2014.04.0112","DOIUrl":"https://doi.org/10.1682/JRRD.2014.04.0112","url":null,"abstract":"<p><p>Adults with stroke have difficulty avoiding obstacles when walking, especially when a time constraint is imposed. The Four Square Step Test (FSST) evaluates dynamic balance by requiring individuals to step over canes in multiple directions while being timed, but many people with stroke are unable to complete it. The purposes of this study were to (1) modify the FSST by replacing the canes with tape so that more persons with stroke could successfully complete the test and (2) examine the reliability and validity of the modified version. Fifty-five subjects completed the Modified FSST (mFSST) by stepping over tape in all four directions while being timed. The mFSST resulted in significantly greater numbers of subjects completing the test than the FSST (39/55 [71%] and 33/55 [60%], respectively) (p < 0.04). The test-retest, intrarater, and interrater reliability of the mFSST were excellent (intraclass correlation coefficient ranges: 0.81-0.99). Construct and concurrent validity of the mFSST were also established. The minimal detectable change was 6.73 s. The mFSST, an ideal measure of dynamic balance, can identify progress in people with stroke in varied settings and can be completed by a wide range of people with stroke in approximately 5 min with the use of minimal equipment (tape, stop watch).</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.04.0112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34554384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 18
Iraq/Afghanistan-era Veterans with back pain: Characteristics and predictors of compensation and pension award. 伊拉克/阿富汗时期退伍军人背部疼痛:补偿和养老金奖励的特征和预测因素。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/jrrd.2015.08.0151
Carine J Sakr, Anne C Black, Martin D Slade, Justin Calfo, Marc I Rosen
{"title":"Iraq/Afghanistan-era Veterans with back pain: Characteristics and predictors of compensation and pension award.","authors":"Carine J Sakr,&nbsp;Anne C Black,&nbsp;Martin D Slade,&nbsp;Justin Calfo,&nbsp;Marc I Rosen","doi":"10.1682/jrrd.2015.08.0151","DOIUrl":"https://doi.org/10.1682/jrrd.2015.08.0151","url":null,"abstract":"<p><p>Approximately 440,000 U.S. Veterans receive compensation for back and/or neck conditions. Veterans Benefits Administration (VBA) criteria state that back compensation determinations are based on impaired back function and not comorbidity or lifestyle, but whether compensation is based solely on consideration of the lumbosacral region is unknown. In this study, we conducted a cross-sectional analysis of medical chart data from 178 post-9/11 Veterans applying for service connection for back pain in fiscal year 2012 at the Department of Veterans Affairs Connecticut Healthcare System. Altogether, 62% were noted to have impairment of back functioning and 74% were awarded compensation. Rates of comorbidities (obesity, depression, smoking, and illicit drug use) were high. In multivariate models predicting compensation awarded, only having an impaired back was associated with service-connected compensation. Pain was associated with extent of service connection, but this relationship was fully mediated by functional back impairment. No other measure (including work status) significantly predicted compensation. In summary, service connection was largely based on functional impairment, as called for in VBA criteria. Although pain and comorbidities undoubtedly affect day-to-day functioning, these factors were not independently related to service connection. Veterans present with many remediable conditions, and the service-connection evaluation may be an opportunity to engage them in treatment.</p>","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/jrrd.2015.08.0151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39423624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder. 慢性疼痛和物质使用障碍史退伍军人处方阿片类药物治疗的相关性
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2014.10.0230
T. Lovejoy, S. Dobscha, D. Turk, M. Weimer, B. Morasco
{"title":"Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder.","authors":"T. Lovejoy, S. Dobscha, D. Turk, M. Weimer, B. Morasco","doi":"10.1682/JRRD.2014.10.0230","DOIUrl":"https://doi.org/10.1682/JRRD.2014.10.0230","url":null,"abstract":"Patients with a history of substance use disorder (SUD) are more likely to be prescribed opioid medications for chronic pain than patients without an SUD history; however, little is known about prescription opioid therapy in populations composed exclusively of patients with SUD. This study examined correlates of prescription opioid therapy in 214 Veterans with chronic noncancer pain and an SUD history. Participants completed psychosocial questionnaires and participated in a structured mental health diagnostic interview, and medical diagnoses and opioid pharmacy data were abstracted from their Department of Veterans Affairs electronic medical records. Participants were categorized into three groups based on opioid prescriptions in the past 90 d: no opioid therapy (n = 134), short-term (<90 d) opioid therapy (n = 31), or long-term (>/= 90 d) opioid therapy (n = 49). Relative to participants prescribed no or short-term opioid therapy, participants who were prescribed long-term opioid therapy had a greater number of pain diagnoses; reported higher levels of pain severity, interference, and catastrophizing; and endorsed lower chronic pain self-efficacy. In a multivariate model, number of pain diagnoses and pain interference were associated with a greater likelihood of being prescribed long-term opioid therapy after controlling for demographic and clinical characteristics. Findings highlight the poor pain-related functioning in patients with SUD histories who are prescribed long-term opioid therapy.","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.10.0230","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67551429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 14
Randomized controlled trial of a brief Internet-based intervention for families of Veterans with posttraumatic stress disorder. 对创伤后应激障碍退伍军人家庭进行简短网络干预的随机对照试验。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2014.10.0257
A. Interian, A. Kline, D. Perlick, L. Dixon, Ann Feder, M. Weiner, M. Goldstein, Kerry Hennessy, Lauren M St Hill, M. Losonczy
{"title":"Randomized controlled trial of a brief Internet-based intervention for families of Veterans with posttraumatic stress disorder.","authors":"A. Interian, A. Kline, D. Perlick, L. Dixon, Ann Feder, M. Weiner, M. Goldstein, Kerry Hennessy, Lauren M St Hill, M. Losonczy","doi":"10.1682/JRRD.2014.10.0257","DOIUrl":"https://doi.org/10.1682/JRRD.2014.10.0257","url":null,"abstract":"Veterans with posttraumatic stress disorder (PTSD) and their families require resources to cope with postdeployment readjustment. Responding to this need, the current study examined a brief Internet-based intervention that provided Veterans' families with psychoeducation on postdeployment readjustment. Participants were 103 dyads of Veterans with probable PTSD and a designated family member/partner. Dyads were randomized to an intervention group, in which the family member completed the intervention, or to a control group with no intervention. Each member of the dyad completed surveys at baseline and 2 mo follow-up. Family member surveys focused on perceived empowerment, efficacy to provide support, and communication (perceived criticism and reactivity to criticism). Veteran surveys assessed perceived family support and communication. Results showed that Veterans in the intervention group reported decreases in reactivity to criticism but also decreased perceived family support. No significant differences were observed in outcomes reported by family members. This preliminary study provides an early understanding of this novel outreach program, as well as the challenges inherent with a very brief intervention. Future research can build on the current study by more closely evaluating the communication changes that occur with this form of intervention and whether greater intervention intensity is needed. CLINICAL TRIAL REGISTRATION Clinical Trials Identifier: NCT01554839.","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.10.0257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67551755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
VHA Pain Research Working Group and VHA Pain Care. VHA疼痛研究工作组和VHA疼痛护理。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2015.10.0195
R. Gallagher
{"title":"VHA Pain Research Working Group and VHA Pain Care.","authors":"R. Gallagher","doi":"10.1682/JRRD.2015.10.0195","DOIUrl":"https://doi.org/10.1682/JRRD.2015.10.0195","url":null,"abstract":"This important special issue of the Journal of Rehabilitation Research & Development (JRRD) documents the steady progress of the Veterans Health Administration (VHA) in promoting and supporting pain research. As described by Drs. Kerns and Heapy in their Editorial [1], the development of the VHA's pain research enterprise has evolved over many years, with a particular focus on understanding the factors, including combined treatments, that affect the course and outcome of pain care for Veterans and inform clinical policy. The articles herein provide a sample of the breadth and sophistication of the VHA pain research enterprise in several domains: observational studies that help us understand the biopsychosocial factors influencing the development and perpetuation of chronic pain and pain treatment outcomes in Veterans with chronic pain and its comorbidities, such as posttraumatic stress disorder; investigations of the effects of exercise on pain sensitivity; and studies of the efficacy of multimodal treatments, e.g., combining exercise with medications to improve physical capacity. An important nidus of the VHA's effort lies in the Pain Research Working Group (PRWG), led by Dr. Kerns, which has met by telephone monthly for many years and in face-to-face meetings in several venues. These meetings have served to enable dialog between officials from the VHA's Office of Research Development (ORD) with pain investigators, to introduce new investigators to the VHA pain research enterprise, and to foster collaborations among VHA investigators and research centers. Meetings of the PRWG in several retreats and, in recent years, at the yearly Health Services Research & Development (HSR&D) meetings have enabled the interpersonal connectivity so critical to social networking in the development of a multicenter research enterprise. As an example, the VHA Center for Healthcare Equity Research and Promotion based at my VHA institution, the Philadelphia Department of Veterans Affairs (VA) Medical Center, supported a PRWG retreat chaired by Dr. Kerns in 2005, when I was new to the VHA, that led to my connection to VHA's Rehabilitation Research & Development Service (RR&D) and my subsequent research, education, and policy work with the Department of Defense and with several VHA investigators. The RR&D-sponsored pain state-of-the-art research conference in September 2007, focusing on Veterans of the wars in Iraq and Afghanistan and chaired by Dr. Kerns, led to a special issue on VHA pain research in Pain Medicine in 2009, co-edited by Dr. Kerns and pain research leader Dr. Steve Dobscha from Oregon [2]. Dr. Kerns' extraordinary leadership in encouraging, sustaining, and expanding VHA pain research over these many years, which has been strongly supported by Dr. Kusiak and VHA ORD as well as VHA Central Office leadership, has been accompanied by a steady growth in the pain research enterprise throughout VHA. A recent highlight is the HSR&D-funded Center of Innovation ","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67552065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advances in pain management for Veterans: Current status of research and future directions. 退伍军人疼痛管理的进展:研究现状和未来方向。
Journal of Rehabilitation Research and Development Pub Date : 2016-01-01 DOI: 10.1682/JRRD.2015.10.0196
R. Kerns, A. Heapy, A. Heapy
{"title":"Advances in pain management for Veterans: Current status of research and future directions.","authors":"R. Kerns, A. Heapy, A. Heapy","doi":"10.1682/JRRD.2015.10.0196","DOIUrl":"https://doi.org/10.1682/JRRD.2015.10.0196","url":null,"abstract":"Military Veterans have been identified as being particularly vulnerable to the development and perpetuation of pain [1]. Among the 23 million U.S. military Veterans, it has been estimated that as many as 50 percent of male Veterans and as many as 75 percent of female Veterans experience chronic pain [2]. Painful musculoskeletal conditions are the most common disorders among Veterans returning from the recent conflicts in Iraq and Afghanistan, surpassing the rates of all mental health conditions combined [3]. Pain among these Veterans is highly comorbid with the \"signature injuries\" of these conflicts, namely posttraumatic stress disorder (PTSD) and traumatic brain injury [4]. Although not unique to Veterans, compounding the challenges associated with successful management of chronic pain is continued evidence of a provider workforce that is ill-prepared to assess and manage common pain conditions [5], limited effectiveness of analgesic medications and other nonpharmacological approaches [6], and growing concerns about harms associated with long-term opioid therapy [7]. In 2011, the Institute of Medicine (IOM) published its seminal report, \"Relieving pain in America: A blueprint for transforming prevention, care, education, and research,\" and called on the Department of Veterans Affairs (VA) and other Government and stakeholder groups to renew their commitment to this national transformational effort [1]. Research on pain among Veterans is not new. In fact, some of the early pioneering work to advance the multidimensional assessment of chronic pain and establish the efficacy of psychological approaches for pain management was conducted in the VA [8-9]. By 1998, former VA Undersecretary for Health Kenneth Kizer, MD, identified the need for more pain research as one of the objectives of a VA Pain Management Strategy [10]. A special topic issue of the Journal of Rehabilitation Research and Development (JRRD) in 2007 highlighted sustained growth in the VA pain research portfolio [11], and annual reports since that time provide evidence of yearly growth in terms of the number, scope, and financial expenditures in support of the VA's pain research portfolio. This special topic issue of JRRD presents results from pain research projects taking place in the VA healthcare system, with a focus on innovative research and its practice and policy implications. The specific objectives of the issue are to educate readers about (1) special issues faced by Veterans with pain, especially Veterans of the recent wars in Iraq and Afghanistan; (2) potential sources of inequities in pain care that may have special relevance for Veterans; and (3) novel approaches to the assessment and treatment of pain and comorbid conditions for Veterans with pain. As such, contributions to this special issue come from the VA clinical, rehabilitation, and health services research communities as opposed to investigators conducting basic laboratory science and preclinical research. Ultimat","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67552115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends. 下肢截肢及创伤后应激障碍对退伍军人事务部门诊费用趋势的影响。
Journal of Rehabilitation Research and Development Pub Date : 2015-07-01 DOI: 10.1682/JRRD.2014.11.0288
V. Bhatnagar, E. Richard, T. Melcer, Jay Walker, M. Galarneau
{"title":"Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends.","authors":"V. Bhatnagar, E. Richard, T. Melcer, Jay Walker, M. Galarneau","doi":"10.1682/JRRD.2014.11.0288","DOIUrl":"https://doi.org/10.1682/JRRD.2014.11.0288","url":null,"abstract":"Department of Veterans Affairs (VA) outpatient costs were analyzed for combat Veterans injured in Iraq and Afghanistan from 2001 to 2008. Patients had serious lower-limb injuries (n = 170) or unilateral (n = 460) or bilateral (n = 153) lower-limb amputation(s). Total costs over the follow-up period (2003 to 2012) and annual costs were analyzed. Unadjusted mean costs per year in 2012 U.S. dollars were $7,200, $14,700 and $18,700 for limb injuries and unilateral and bilateral lower-limb amputation(s), respectively (p < 0.001). Multivariate modeling indicated that annual cost declined after the first year in the VA for Veterans with limb injuries (p < 0.001, repeated measures). In contrast, annual costs doubled after 3-5 years with unilateral (p < 0.001) and bilateral amputation(s) (p < 0.001). Among amputees, prosthetics comprised more than 50% of outpatient cost; unadjusted mean cost per year for prosthetics was 7-9 times higher in comparison with Veterans with limb injuries. Amputation status was associated with an adjusted 3.12-fold increase in mean prosthetic cost per year (p < 0.001, generalized linear model). In addition, posttraumatic stress disorder (PTSD) was associated with increased prosthetic cost by amputation status (p < 0.001) and increased psychiatric and pharmacy costs (both p < 0.001). Results indicate relatively high and sustained outpatient costs driven by prosthetics following amputation. Finally, PTSD affected cost for multiple domains of health, highlighting the importance of accurate diagnosis, treatment, and support for PTSD.","PeriodicalId":50065,"journal":{"name":"Journal of Rehabilitation Research and Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1682/JRRD.2014.11.0288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67551438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 20
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