Objective-To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation.Methods-A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score <4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI.Results-No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 ± 0.6 m/s, n = 30) and CONT (1.1 ± 0.7, n = 25) groups.Conclusions-The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies.Annually, approximately 10,000 Americans have a traumatic spinal cord injury (SCI). For many patients, the most visible lingering disability is the inability to walk or a slow spastic- NIH Public Access Author ManuscriptNeurology. Author manuscript; available in PMC 2014 July 17. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript paretic gait with high energy cost. 1 A gait training strategy, using body weight support on a treadmill (BWSTT), 2,3 has evolved from physiologic studies of the effects of the level and timing of limb loading during stepping and of stance and swing phase kinematics in spinal transected quadrupeds [4][5][6][7] and in patients with complete SCI. [8][9][10] The experimental intervention received clinical support from nonrandomized studies of patients with incomplete SCI early and late after injury. 2,3,[11][12][13] No randomized trials with blinded outcomes, however, had compared different physical therapy strategies aimed at the recovery of walking during initial inpatient and outpatient rehabilitation. Further, no prospective trials in SCI had collected measures related to functional walking, such as walking speed, distance, and the need for assistive devices. 14,15The Spinal Cord Injury Locomotor Trial (SCILT) was a single-bli...

Background. The Spinal Cord Injury Locomotor Trial (SCILT) compared 12 weeks of step training with body weight support on a treadmill (BWSTT) that included overground practice to a defined but more conventional overground mobility intervention (CONT) in patients with incomplete traumatic SCI within 8 weeks of onset. No previous studies have reported walking-related outcomes during rehabilitation. Methods. This single-blinded, randomized trial entered 107 American Spinal Injury Association (ASIA) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation. The Functional Independence Measure (FIM-L) for walking, 15-m walking speed, and lower extremity motor score (LEMS) were collected every 2 weeks. Results. No significant differences were found at entry and during the treatment phase (12-week mean FIM-L = 5, velocity = 0.8 m/s, LEMS = 35, distance walked in 6 min = 250 m). Combining the 2 arms, a FIM-L ≥ 4 was achieved in < 10% of ASIA B patients, 92% of ASIA C patients, and all of ASIA D patients. Walking speed of ≥ 0.6 m/s correlated with a LEMS near 40 or higher. Conclusions. Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT, consistent with the primary outcome data at 6 months. Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes. By about 6 weeks after entry, most patients who will recover have improved their FIM-L to >3 and are improving in walking speed. Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still graded ASIA B and at > 12 weeks if still ASIA C.

This article describes the development of a 38-item self-report Adherence Determinants Questionnaire (ADQ) to assess 7 elements of patients' adherence to medical treatment and prevention: (a) perceptions of interpersonal care, (b) beliefs about susceptibility to disease, (c) beliefs about severity of disease, (d) assessments of perceived utility of adhering (efficacy and benefits vs. costs of adhering), (e) perceptions of subjective social norms for adhering, (f) intentions to adhere, and (g) perceptions of supports available for and absence of barriers to adherence. Past adherence and health value were also assessed. In 4 diverse field settings, intentions to adhere were most highly correlated with the perceived utility of adhering. Adherence (self-reported and objectively measured) was related most strongly to the presence of supports for and the absence of barriers to adherence.Patient nonadherence to medical treatment is a ubiquitous phenomenon, occurring in many settings; prevalence rates range from 15% to 93% of patients, depending on the regimen prescribed (Kaplan & Simon, 1990). Between 30% and 60% of patients given prescriptions for medication are nonadherent (Kruse & Weber, 1990;Luscher & Vetter, 1990). Those told to engage in health-protective behaviors, such as smoking cessation, increased exercise, and dietary modification, tend to have lower initial adherence rates and higher relapse rates than those who have been prescribed medication (Brownell, Marlatt, Lichtenstein, & Wilson, 1986).Despite its prevalence, nonadherence is often undetected by health professionals, even those with considerable clinical experience (Steele, Jackson, & Gutmann, 1990). The substantial variation in estimates of nonadherence and the failure to recognize nonadherence when it occurs are likely the result of two serious shortcomings in our current efforts to understand the adherence phenomenon: imprecise measurement of adherence

The cigarette-smoking behavior of 840 patients with resected Stage I non-small cell lung cancer was analyzed prospectively for up to four years following diagnosis. Lung cancer patients were heavier smokers at diagnosis than other cancer patients and the general population. At one year, only 16.8 percent of the 317 current smokers at baseline, who were followed for two years or longer, continued to smoke, while 83.2 percent of patients either quit permanently (53.0 percent) or for some time period (30.2 percent). By two years, permanent cessation stabilized at over 40 percent; however, the prevalence of continuing smoking decreased through all periods of follow-up. Subjects who tried to quit or did quit permanently were more likely to be female and healthier than continuous smokers.

Concurrent validity of the WISCI scale was supported by significant correlations with all measures at 3, 6, and 12 months. Correlation of change scores supports predictive validity. The LEMS at baseline was the best predictor of the WISCI score at 12 months and explained most of the variance, which supported both predictive and construct validity. The combination of the LEMS, BBS, WISCI, 50FW-S, and LFIM appears to encompass adequate descriptors for outcomes of walking trials for incomplete SCI.