Poster 29

2006 CONGRESS ANNUAL MEETING ABSTRACTS

the visual system. Key Words: Hemianopia; Perimetry; Rehabilitation; Visual fields. Poster 29 Impact of Physical and Social Environment on Quality of Life of Spinal Cord Injury Family Caregivers. T.J. Bajwa (Rehabilitation Institute of Michigan, Detroit, MI), C.D. Duggan. Disclosure: None declared. Objectives: To describe the impact of in-home physical and social environment on the quality of life (QOL) of caregivers to people with spinal cord injury (SCI). Design: Cross-sectional, mixed-method study using qualitative interviews, quantitative measures, and a focus group. Setting: SCI caregivers providing in-home care. Participants: 60 SCI family caregivers who provide care for minimum of 10 hours a week. Interventions: Not applicable. Main Outcome Measures: Self-identified stressors and unmet needs, Caregiver Burden Scale, Perceived Stress Scale, Ways of Coping Questionnaire, Self-Rated Abilities for Health Practices, Personal Resources Questionnaire, SF-12v2, and Satisfaction With Life Scale. Results: The preliminary findings from the initial data collected for this 2-year study show that there are common needs of caregivers to assist SCI consumers. Inaccessible physical environment, long hours, years of providing physically demanding care, limited information on access to available services to the SCI consumer, and limited supports, as well minimal or no monetary reimbursements to caregivers, are common concerns of all family caregivers. The majority of caregivers had low QOL scores. Conclusions: Timely and appropriate resources must be provided to SCI consumers and their families to facilitate proper and adequate in-home long-term care. Key Words: Quality of life; Rehabilitation; Spinal cord injuries. Poster 30 Management, Outcomes, and Prognostication During Coma Recovery. A. Guernon (Marianjoy Rehabilitation Hospital, Wheaton, IL), H. Roth, T. Pape, A. Hurder, S. Lundgren. Disclosure: None declared. Objective: To illustrate the predictive utility of the Disorders of Consciousness Scale (DOCS) change score and medical variables available early after injury by comparing predicted and actual outcomes. Design: Prospective observational study. Setting: Inpatient rehabilitation. Participants: 64 participants unconscious after severe brain injury. Intervention: Weekly DOCS evaluations until inpatient rehabilitation discharge. After inpatient discharge, monthly follow-up with final outcome interview 1 year after injury. Main Outcome Measures: Time to consciousness and functional outcomes 1 year after injury. Results: Evidence in the literature indicates that the first DOCS predicts the time to consciousness up to 1 year after injury with 71% certainty. Additional evidence indicates that the DOCS change score improves this prediction to 85% certainty (positive predictive value, .85; negative predictive value, .71). Predicted outcomes, according to the DOCS change scores, did not differ significantly (n⫽46; ␹21 test⫽.014, P⫽.907) from the actual outcomes. Examination of functional outcomes 1year after injury for 3 subjects revealed 75% accurate prediction based on information available during acute rehabilitation. Conclusions: Caregivers and clinicians can use prognostic information to guide resource planning and support adjustment to disability. Key Words: Coma; Rehabilitation; Outcome assessment (health care). Poster 31 A Conceptual Framework to Guide the Promotion, Support, or Improvement of Spiritually Sensitive Health Care. S. Hallenborg Ventura (Northeastern University, Boston, MA). Disclosure: None declared.

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Objective: To develop a conceptual framework to guide researchers, educators, and policy-makers interested in promoting, supporting, or improving spiritually sensitive care. Design: Grounded theory, mixed methods. Setting: Inpatient hospital. Participants: Nationwide convenience sample of physicians, nurses, and other licensed health professionals interested and trained in the spiritual aspects of care (N⫽26). Interventions: Statements describing actions to promote, support, or improve spiritually sensitive care were generated from field notes, the literature, public policies, and participant review and comment. Participants sorted statements into conceptually similar categories and rated perceived helpfulness and feasibility of actions on 5-point Likert scales. Main Outcome Measures: 9 clusters of statements emerged from the sort analysis (multidimensional scaling, cluster analysis). Average helpfulness and feasibility ratings revealed the most helpful and feasible actions within each cluster. Results: A construct to illustrate the range of concepts involved in providing spiritually sensitive care in hospitals. Overall average helpfulness ratings by cluster ranged from 4.31 (very to extremely helpful) to 3.31 (moderately to very helpful). Overall average feasibility ratings ranged from 4.01 (very feasible) to 2.63 (somewhat to moderately feasible). Conclusions: This conceptual framework will help to ensure that future work includes all relevant concepts involved. Key Words: Patient care team; Rehabilitation; Spirituality. Poster 32 Comparison of Constant Versus Variable Rate Intrathecal Baclofen Administration. L.E. Krach (Gillette Children’s Specialty Healthcare, St. Paul, MN), R.L. Kriel, A.C. Nugent. Disclosure: Supported in part by Medtronic Inc. Objective: To compare variable versus constant rate intrathecal baclofen (ITB) dosing. Design: Retrospective, nonrandomized, consecutive series. Setting: Multispecialty children’s hospital. Participants: 164 persons with ITB pumps implanted after July 1, 1999, followed for ⬎1 year. Intervention: ITB either by simple continuous (simple ITB) or complex (flex) dosing (complex ITB). Main Outcome Measures: Comparison of the 2 methods by baseline Ashworth Scale score, diagnosis, total ITB dose, and provider deciding dose method. Results: 82 persons received simple ITB and 82 complex ITB. 90% of participants in both groups had cerebral palsy, and mean baseline leg Ashworth Scale scores were similar in both groups (3.73 v. 3.71). Mean total daily dose at chart review was higher in complex ITB (429.3␮g vs 210.9␮g, P⫽.000). 3 providers made the majority of decisions to change from simple ITB to complex ITB (2 providers, 28 patients each; 1 provider 20 patients). The reasons for change included: optimization of baclofen effect, predictable tone variations during the day or night, and management of signs of ITB withdrawal or underdelivery. Overall, 53 of 82 participants remain on complex ITB. Conclusions: Complex ITB is useful for some persons. Dosing modality was not related to baseline Ashworth score. Key Words: Baclofen; Cerebral palsy; Rehabilitation. Poster 33 Measuring the Health Experiences of People With Mobility Impairments in a Massachusetts Medicaid Survey. N. Latham (Boston University, Boston, MA), P. Gallagher, V. Stringfellow. Disclosure: None declared. Objective: To develop screener and content items to assess the health care experiences of persons with mobility impairments (PWMI). Design: Items were developed by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) team and technical expert panel members, cognitively tested and evaluated in crosssectional surveys in 2004 and 2006. Setting: Community. ParticiArch Phys Med Rehabil Vol 87, October 2006