Purpose:To determine the relationship between caregiver stress and compliance with home programs in caregivers of children with disabilities. Methods: Sixty-six caregivers of children with disabilities responded to a mailed survey to determine their level of compliance with a prescribed home physical therapy program and the level of caregiver stress. Compliance was defined as the degree to which caregivers followed the prescribed frequency of the home program. Results: Sixty-six percent of the caregivers reported some level of noncompliance with their home program. Linear regression analysis revealed a significant relationship between the caregivers' level of noncompliance with the home program and the level of stress that they reported. Correlation coefficients showed a significant relationship between family problems and noncompliance with home programs. As caregiver and family problems increased, noncompliance with home programs increased. Conclusions: Caregivers of children with disabilities experience stress that should be addressed by therapists to maximize compliance with home programs. (Pediatr Phys Ther 2004;16:140 -148)
The purpose of this pilot study was to assess the feasibility and efficacy of a daily standing programme in the community for subjects with multiple sclerosis (MS). A single blind randomized crossover design was used. There were two interventions; daily standing in a standing frame for 30 minutes and a daily exercise programme. Interventions were sequential and crossed after 3 weeks. The primary outcome measures were the Ashworth scale, spasm frequency scale and range of movement. Subjects consisted of six individuals with a diagnosis of secondary progressive MS. Statistically significant improvements were demonstrated in hip and ankle range of movement with standing when compared to the exercise phase for both groups. No significant differences in spasticity or spasm were found although a downward trend was seen. All subjects achieved 30 minutes of therapeutic standing. Three subjects achieved 30 minutes standing after building up tolerance over the 3-week intervention period. In conclusion therapeutic standing increased range of movement in wheelchair dependent subjects. Further examination of the immediate and long-term effects of standing on spasm and spasticity is warranted.
Background and Purpose-Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. Methods-This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. Results-Among the 67 445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility.Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]ϭ9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (ORϭ2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (ORϭ3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (ORϭ3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (ORϭ0.79; 95% CI, 0.73 to 0.85). Conclusions-These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.
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