Older adults represent the fastest-growing population of drivers with a valid driver's licence.Also common in this age group are multiple chronic medical conditions that may have an effect on physical function and driving ability. Determining the reliability of physical measures used to assess older drivers' functional ability is important to identifying those who are safe to continue driving. Most previous reliability studies of clinical physical measures of health used test-retest intervals shorter than those between patient visits with a clinician. In the present study we examined a more clinically representative interval of 1 year to determine the stability of commonly used physical measures collected during the Candrive II prospective cohort study of older drivers. Reliability statistics indicate that the sequential finger-thumb opposition, rapid pace walk and the Pelli-Robson contrast sensitivity tests have adequate stability over 1 year.Poor stability was observed for the one-legged stance and Snellen visual acuity test. Several assessments with nominal data (Marottoli method [functional neck range of motion], whispered voice test, range of motion and strength testing) lacked sufficient variability to conduct reliability analyses; however, a lack of variability between test days suggests consistency over a 1-year time frame. Our results provide evidence that specific physical measures are stable in monitoring functional ability over the course of a year.
INTRODUCTION: Deep venous thromboses in stroke patients are often asymptomatic. There is limited support that screening for asymptomatic lower extremities DVT with venous duplex ultrasound changes clinicians’ management of stroke patients. Hypothesis: We hypothesized that the detection of asymptomatic deep venous thrombosis in acute stroke patients would result in changes or intensification of anticoagulation management strategies. Methods: We performed a retrospective chart review of all strokes (ischemic and hemorrhagic), orthopedic surgery, and trauma patients admitted to our Acute Rehabilitation Unit (ARU) between January 2004 and December 2009. We selected out all stroke patients and recorded those as asymptomatic DVT if there was no documentation of signs or symptoms for DVT by the primary provider within 48 hours prior to obtaining a lower extremity venous ultrasound. A change in anticoagulation management was noted if any addition or change to the patient’s admitting anticoagulation intervention. Results: There were 909 patients admitted to our ARU. Of those patients, 78 patients were diagnosed with an asymptomatic lower extremity DVT prior to transfer to the ARU. Strokes patients accounted for 34 (43.5%) of these 78 patients. All of the stroke patients were under the care of a neurology team. A majority of the lower extremity DVT among the stroke patients were considered acute (N=30;88.2%) and 21% (N=7) had bilateral, acute DVT. Most of the stroke patients received DVT prophylaxis on admission (N=26;76.4%). After diagnosis of an acute DVT, clinicians changed their management strategies in 65% of cases, whereas in 23.5% of cases there were no changes. Among the changes in management, 50% of patients (11/22;50%) were started or had an escalation in anticoagulation treatment. Interrupted venal cava filter was placed in 5 patients and serial venous ultrasound surveillance was used for 7 patients. Conclusions: This study shows that the detection of an acute asymptomatic lower extremity DVT in stroke patients resulted in anticoagulation management strategies changes for most stroke patients. It also supports the need to perform screening venous ultrasound on all acute stroke patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.