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Poster 38: Reliability of a Thoracic-Lumbar Control Scale for Use in Spinal Cord Injury Research
E18
CONGRESS ANNUAL CONFERENCE ABSTRACTS
M1 activity in the affected hemisphere. Further research is required to determine the characteristics of stroke patients most likely to benefit from bilateral training. Key Words: Rehabilitation; Stroke. Poster 36 Weight-Bearing Asymmetry in Quiet Standing. Venkata Gade (Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ), Nitin Moholkar, Thomas Edwards. Disclosure: None declared. Objective: To investigate asymmetry in weight bearing during quiet stance and to compare with the asymmetry when standing on a moving platform in healthy individuals. Design: Repeated measures of subjects’ weight distribution. Setting: Balance rehabilitation research laboratory. Participants: 9 healthy subjects with no balance disorder. Interventions: Static balance assessment for quiet stance. Dual stance (feet shoulder-width apart) in quiet standing was repeated 3 times; both with eyes open and eyes closed. Main Outcome Measures: Asymmetry in weight bearing described in terms of the asymmetry index (AI) expressed as the ratio of the difference in weight bearing between the left and right side and the average weight acting on each side. Results: The mean AI score ⫾ SEM across all subjects was ⫺.085⫾.011 (P⬍.001) for quiet standing trials. 14 (33.3%) of 52 trials showed asymmetry in weight bearing for quiet standing (AI score ⬍⫺0.1), with a few trials having around 100N more weight on 1 side. The asymmetry for static dual stance was smaller as compared with the asymmetry for standing on a moving platform. Conclusions: Asymmetry in weight bearing exists in healthy subjects and should be taken into consideration when estimating joint forces, moments, and power. Key Words: Asymmetry; Balance; Rehabilitation. Poster 37 Relationship of Health Beliefs to Health Service Utilization in Minority Persons With First Episode Stroke. Angelle Sander (Baylor College of Medicine, Houston, TX), Monique Mills, Allison Clark, Margaret Struchen, Faye Tan, Diana Rintala Ana Vasquez. Disclosure: None declared. Objective: To investigate the relationship of health beliefs to health service utilization in minority stroke survivors. Design: Prospective, longitudinal prediction study. Setting: County rehabilitation hospital. Participants: 61 persons with first episode symptomatic stroke consecutively admitted to the inpatient rehabilitation unit at a county rehabilitation hospital (48% men, 59% Hispanic, 41% black). 78% of Hispanics were born outside the United States and spoke Spanish as their primary language. 85% of participants reported annual household income of less than $20,000. Primary caregivers were also recruited for each participant with stroke. Interventions: Not applicable. Main Outcome Measures: The predictor measure was the Multidimensional Health Locus of Control Scale, administered to patients and caregivers within 1 week before discharge from inpatient rehabilitation. The outcome measure was health service utilization, defined as the percentage of medical and therapy appointments attended over the first 6 months following discharge, dichotomized as high or low, using the fiftieth percentile as a cutoff, with those who attended at least 71% of appointments classified as high attendance. Results: Results of logistic regression showed that patients were more likely to fall in the high attendance group if they had higher internal locus of control, if their caregivers had lower chance locus of control, and if they were U.S. born. The interaction between being U.S. born and chance locus of control was also significant. Conclusions: In first-episode stroke patients from low income backgrounds, health beliefs are related to health service utilization after discharge from inpatient rehabilitation. Educational interventions to address locus of control may lead to Arch Phys Med Rehabil Vol 89, October 2008
improved follow through with appointments. Key Words: Health service utilization; Rehabilitation; Stroke. Poster 38 Reliability of a Thoracic-Lumbar Control Scale for Use in Spinal Cord Injury Research. Darryn Atkinson (Memorial Hermann/TIRR, Houston, TX), Kimberly Atkinson, Marcie Kern, Jennifer Hale, Michelle Feltz, Daniel E. Graves. Disclosure: None declared. Objective: To determine preliminary estimates of the structure and item analysis of the 14-item Thoracic-Lumbar Control Scale. Design: Prospective metrological investigation. Each of 6 NeuroRecovery Network centers had 2 individual raters evaluate each of the 3 volunteers on 2 separate days to provide a total of 72 evaluations. Setting: Outpatient locomotor therapy clinic. Participants: 2 of the volunteers had cervical injuries at C-07; 1 had American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade C, and the other AIS grade D. The third volunteer had a thoracic injury at T-05 AIS grade C. Interventions: Not applicable. Main Outcome Measure: ThoracicLumbar Control Scale. Results: The 14 items produced a standardized item ␣ of .919. The Beevor sign was not significantly related to the total score. The corrected item total correlation ranged from .340 to .898. The mean total score for each patient varied as expected by injury severity. Intraclass correlation coefficients (ICCs) for intrarater reliability between day 1 and day 2 was .943; interrater reliability for day 1 ICC was .962 and for day 2 ICC was .978. Conclusions: Given the complex innervations of the muscles of the thoracic and lumbar, it is difficult to estimate the extent to which the thoracic-lumbar musculature functions as a unit following SCI. The preliminary data suggest that the items that form this scale can be reliably rated on patients with SCI and that the items measure the construct of trunk control. Further investigation is necessary to determine the extent to which the validity of this scale can be established. Key Words: Rehabilitation; Spinal cord injuries. Poster 39 Work Environment and Quality of Life Outcomes: A Comparison of Informal and Formal Caregivers of Persons With a Spinal Cord Injury. Colette Duggan (Rehabilitation Institute of Michigan, Detroit, MI), Leah Maddern, Daniela Ristova-Trendov. Disclosure: None declared. Objectives: To compare and contrast the work environments of 3 spinal cord injury (SCI) caregiver groups: (1) unpaid family caregivers; (2) independent contractors hired by the SCI consumer; and (3) home care employees; and to analyze this information with specific attention to the linkages between aspects of the work environment and selected psychosocial and quality of life (QOL) outcomes. Design: Ongoing, 3-year, descriptive, cross-sectional study using a mixedmethod (qualitative, quantitative) approach to data collection and analysis. Setting: Community-based. Participants: 30 participants who have completed study requirements. Interventions: Not applicable. Main Outcome Measures: Measures of caregiver burden and job burnout, perceived stress, and self-rated QOL; patterns and themes of caregiver burden and burnout, perceived stress, and QOL embedded in the caregiver narratives. Results: Unpaid family caregivers report higher scores on caregiver burden, perceived stress, and lower scores on self-rated QOL than do independent contractors and home care employees. Content analyses of transcripts reveal major differences in the stressors identified by caregiver groups. Unpaid family caregivers mentioned sleep deprivation, the overwhelming physical and emotional demands of SCI caregiving, difficulty procuring and training reliable home care personnel, and lack of time and personal life as
CONGRESS ANNUAL CONFERENCE ABSTRACTS
M1 activity in the affected hemisphere. Further research is required to determine the characteristics of stroke patients most likely to benefit from bilateral training. Key Words: Rehabilitation; Stroke. Poster 36 Weight-Bearing Asymmetry in Quiet Standing. Venkata Gade (Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ), Nitin Moholkar, Thomas Edwards. Disclosure: None declared. Objective: To investigate asymmetry in weight bearing during quiet stance and to compare with the asymmetry when standing on a moving platform in healthy individuals. Design: Repeated measures of subjects’ weight distribution. Setting: Balance rehabilitation research laboratory. Participants: 9 healthy subjects with no balance disorder. Interventions: Static balance assessment for quiet stance. Dual stance (feet shoulder-width apart) in quiet standing was repeated 3 times; both with eyes open and eyes closed. Main Outcome Measures: Asymmetry in weight bearing described in terms of the asymmetry index (AI) expressed as the ratio of the difference in weight bearing between the left and right side and the average weight acting on each side. Results: The mean AI score ⫾ SEM across all subjects was ⫺.085⫾.011 (P⬍.001) for quiet standing trials. 14 (33.3%) of 52 trials showed asymmetry in weight bearing for quiet standing (AI score ⬍⫺0.1), with a few trials having around 100N more weight on 1 side. The asymmetry for static dual stance was smaller as compared with the asymmetry for standing on a moving platform. Conclusions: Asymmetry in weight bearing exists in healthy subjects and should be taken into consideration when estimating joint forces, moments, and power. Key Words: Asymmetry; Balance; Rehabilitation. Poster 37 Relationship of Health Beliefs to Health Service Utilization in Minority Persons With First Episode Stroke. Angelle Sander (Baylor College of Medicine, Houston, TX), Monique Mills, Allison Clark, Margaret Struchen, Faye Tan, Diana Rintala Ana Vasquez. Disclosure: None declared. Objective: To investigate the relationship of health beliefs to health service utilization in minority stroke survivors. Design: Prospective, longitudinal prediction study. Setting: County rehabilitation hospital. Participants: 61 persons with first episode symptomatic stroke consecutively admitted to the inpatient rehabilitation unit at a county rehabilitation hospital (48% men, 59% Hispanic, 41% black). 78% of Hispanics were born outside the United States and spoke Spanish as their primary language. 85% of participants reported annual household income of less than $20,000. Primary caregivers were also recruited for each participant with stroke. Interventions: Not applicable. Main Outcome Measures: The predictor measure was the Multidimensional Health Locus of Control Scale, administered to patients and caregivers within 1 week before discharge from inpatient rehabilitation. The outcome measure was health service utilization, defined as the percentage of medical and therapy appointments attended over the first 6 months following discharge, dichotomized as high or low, using the fiftieth percentile as a cutoff, with those who attended at least 71% of appointments classified as high attendance. Results: Results of logistic regression showed that patients were more likely to fall in the high attendance group if they had higher internal locus of control, if their caregivers had lower chance locus of control, and if they were U.S. born. The interaction between being U.S. born and chance locus of control was also significant. Conclusions: In first-episode stroke patients from low income backgrounds, health beliefs are related to health service utilization after discharge from inpatient rehabilitation. Educational interventions to address locus of control may lead to Arch Phys Med Rehabil Vol 89, October 2008
improved follow through with appointments. Key Words: Health service utilization; Rehabilitation; Stroke. Poster 38 Reliability of a Thoracic-Lumbar Control Scale for Use in Spinal Cord Injury Research. Darryn Atkinson (Memorial Hermann/TIRR, Houston, TX), Kimberly Atkinson, Marcie Kern, Jennifer Hale, Michelle Feltz, Daniel E. Graves. Disclosure: None declared. Objective: To determine preliminary estimates of the structure and item analysis of the 14-item Thoracic-Lumbar Control Scale. Design: Prospective metrological investigation. Each of 6 NeuroRecovery Network centers had 2 individual raters evaluate each of the 3 volunteers on 2 separate days to provide a total of 72 evaluations. Setting: Outpatient locomotor therapy clinic. Participants: 2 of the volunteers had cervical injuries at C-07; 1 had American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade C, and the other AIS grade D. The third volunteer had a thoracic injury at T-05 AIS grade C. Interventions: Not applicable. Main Outcome Measure: ThoracicLumbar Control Scale. Results: The 14 items produced a standardized item ␣ of .919. The Beevor sign was not significantly related to the total score. The corrected item total correlation ranged from .340 to .898. The mean total score for each patient varied as expected by injury severity. Intraclass correlation coefficients (ICCs) for intrarater reliability between day 1 and day 2 was .943; interrater reliability for day 1 ICC was .962 and for day 2 ICC was .978. Conclusions: Given the complex innervations of the muscles of the thoracic and lumbar, it is difficult to estimate the extent to which the thoracic-lumbar musculature functions as a unit following SCI. The preliminary data suggest that the items that form this scale can be reliably rated on patients with SCI and that the items measure the construct of trunk control. Further investigation is necessary to determine the extent to which the validity of this scale can be established. Key Words: Rehabilitation; Spinal cord injuries. Poster 39 Work Environment and Quality of Life Outcomes: A Comparison of Informal and Formal Caregivers of Persons With a Spinal Cord Injury. Colette Duggan (Rehabilitation Institute of Michigan, Detroit, MI), Leah Maddern, Daniela Ristova-Trendov. Disclosure: None declared. Objectives: To compare and contrast the work environments of 3 spinal cord injury (SCI) caregiver groups: (1) unpaid family caregivers; (2) independent contractors hired by the SCI consumer; and (3) home care employees; and to analyze this information with specific attention to the linkages between aspects of the work environment and selected psychosocial and quality of life (QOL) outcomes. Design: Ongoing, 3-year, descriptive, cross-sectional study using a mixedmethod (qualitative, quantitative) approach to data collection and analysis. Setting: Community-based. Participants: 30 participants who have completed study requirements. Interventions: Not applicable. Main Outcome Measures: Measures of caregiver burden and job burnout, perceived stress, and self-rated QOL; patterns and themes of caregiver burden and burnout, perceived stress, and QOL embedded in the caregiver narratives. Results: Unpaid family caregivers report higher scores on caregiver burden, perceived stress, and lower scores on self-rated QOL than do independent contractors and home care employees. Content analyses of transcripts reveal major differences in the stressors identified by caregiver groups. Unpaid family caregivers mentioned sleep deprivation, the overwhelming physical and emotional demands of SCI caregiving, difficulty procuring and training reliable home care personnel, and lack of time and personal life as