Biomedical subjects

A M Jette

Publications and source records attributed to A M Jette.

At least 19 recordsLinked to original sources

PubMed1996

Disentangling the disablement process.

A model was proposed to assess the premise that functional limitations are an intermediary stage between risk factors (e.g., sex and frequency of walking a mile), pathology/impairments (e.g., musculoskeletal problems), and the onset and course of Instrumental Activities of Daily Living (IADL) disability. Analyses were based on two random subsamples (each with n = 524) of Longitudinal Study of Aging respondents who were nondisabled at baseline (1984) and reinterviewed in 1988 and 1990. The model's central premise was supported in two ways. The main influence of age, frequency of walking, and musculoskeletal problems was on the onset of functional limitations, rather than the onset of IADL disability. And, onset of lower body functional limitations influenced future disability (1990) through its relationship with disability in 1988 and functional limitations in 1990. The results underscore the value of clinical trials which focus on minimizing functional limitations as a strategy for preventing disability.

Activities of Daily Living↗

PubMed1996

Quality of Medicare-reimbursed home health care.

We investigated the prevalence of quality of care deficiencies in 4,324 Medicare-reimbursed episodes of care provided by 47 home health agencies. The quality of care protocol consisted of a process-oriented, systematic record review by a trained nurse reviewer. Results suggest that an estimated 14.4% of home health care episodes had quality deficiencies with the potential for or actual adverse effects on the patient. Multivariate analyses revealed that the complexity of patients' needs increased the likelihood and severity of the quality problems. Agency ownership was not related to risk of a quality problem, but regional variation in agency effects was observed. Specific problem areas were identified that suggested several ways that home health care could be improved.

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PubMed1996

Physical therapy and health outcomes in patients with spinal impairments.

BACKGROUND AND PURPOSE: Little is known concerning the effects of physical therapy on health outcomes in patients with spinal impairments. This research examined the pattern of health outcomes in patients with spinal impairments and the relationship of outcomes to the physical therapy provided. SUBJECTS: Data were obtained from 1,097 patients with spinal impairments who completed an episode of care in any of 68 physical therapy practices across the United States. METHODS: Data were derived from the Focus on Therapeutic Outcomes database during 1993 and 1994. Multivariate analyses were used to determine which of the treatment variables, controlled for baseline health status and relevant patient characteristics, were related to outcomes. RESULTS: Improvement occurred in nearly all health scales. Inclusion of endurance exercise was most consistently associated with better outcomes. Inclusion of heat or cold modalities was associated with poorer outcomes. CONCLUSION AND DISCUSSION: This study suggests that physical therapists take a broader view of patient-related goals and documentation of outcomes. It also provides evidence that the type of intervention is related to outcomes.

Activities of Daily Living↗

PubMed1996

A home-based exercise program for nondisabled older adults.

OBJECTIVES: This paper describes a videotaped, home-based, strength training program, titled Strong-for-Life and reports on its effectiveness in improving muscle strength, psychological well-being, and health status in a sample of older persons. DESIGN AND SETTING: We enrolled 102 nondisabled, community-dwelling older people aged 66 to 87, identified from the Medicare beneficiary list, into a randomized, controlled trial. MEASUREMENTS: Effectiveness was based on change in isokinetic upper and lower extremity muscle strength, psychologic well-being, and health status. RESULTS: Results revealed several statistically significant short-term benefits after 12 to 15 weeks of exercise, especially for men. Younger older adults demonstrated a 10% improvement in knee extensor strength relative to control subjects. Older male exercisers achieved significant differences relative to controls in perceived anger, tension, and overall social functioning. Male exercisers, in general, achieved significant improvement in perceived vigor. Women did not report psychological benefits following participation in the program. CONCLUSION: Study results reveal that the Strong for Life program, designed to be widely disseminated to the nondisabled older population, has many short-term positive benefits.

Affect↗

PubMed1996

Health status assessment in the occupational health setting.

This article discusses the conceptual roots of measuring health- related outcomes based on a biopsychosocial model of health. The selection and applicability of instruments for measurement of health status are discussed and suggestions are made concerning how health-status instruments may be used in the occupational- health setting. The potential value of measuring health status in the occupation-health setting is explored with a brief review of current literature and an example from one investigation in which measurements of health status were used to examine outcomes of common musculoskeletal impairments.

Health Status Indicators↗

PubMed1995

How does formal and informal community care affect nursing home use?

We examined the effects of informal and formal community care on the 6-year risk of nursing home use in a representative sample of disabled elders. Increased risk was associated with receiving formal community services and with caregiver burnout. There was a modest reduction in risk of using a nursing home among those receiving greater amounts of informal care. Elders with male caregivers were at over twice the risk of using a nursing home than those with female caregivers, while those who lived with their primary caregiver were at reduced risk. Increasing amount of formal services was associated with reduced risk of nursing home use for cognitively impaired older persons. Formal community services did not buffer the effects of severity of disability on nursing home use. Supplementing informal services with formal care was associated with greater risk of using a nursing home. Future research should move beyond testing global hypotheses regarding the protective effects of informal and formal community care and examine the impact of specific types of community care for specific subgroups of older persons on subsequent nursing home use.

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PubMed1995

Outcomes research: shifting the dominant research paradigm in physical therapy.

This article discusses outcomes research in physical therapy and places its conceptual roots within the work on quality-of-care assessment. An argument is advanced that the outcomes research movement in medicine has stimulated clinical researchers in physical therapy to address disability outcomes in addition to traditional impairment outcomes. If physical therapy clinical research moves beyond this broadening of clinical outcomes to investigate explicitly the hypothesized relationship between impairment and disability, outcomes research will have stimulated a shift in the dominant research paradigm in the profession. The development and testing of theory regarding the pathogenesis of disability will be needed to guide the direction of this type of physical therapy research. Such a shift in the dominant research paradigm in physical therapy could produce dramatic findings that have a direct impact on clinical practice.

Health Services Research↗

PubMed1994

Functional disability screening of ambulatory patients: a randomized controlled trial in a hospital-based group practice.

The authors conducted a randomized controlled trial of functional disability screening in a hospital-based internal medicine group practice. They assigned 60 physicians and 497 of their patients to either an experimental or a control group. Every four months the patients in both groups completed a self-administered questionnaire measuring physical, psychological, and social function. The experimental group physicians received reports summarizing their patients' responses; the control group physicians received no report. At the end of one year the authors found no significant difference between the patients of the experimental and control group physicians on any measure of functional status. Functional disability screening alone does not improve patient function.

Activities of Daily Living↗

PubMed1994

The disablement process.

Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicians tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.

Activities of Daily Living↗

PubMed1994

How measurement techniques influence estimates of disability in older populations.

Measures of disability in activities of daily living (ADL) have become important indicators of the health of older persons. One fundamental decision in disability research is constructing or choosing a rating scale to measure ADL disability. Although there is growing consensus in the field on what ADLs to measure, there is little agreement on how to measure ADL disability. This study compares the effect of scales that rate the presence of difficulty, use or human assistance and use of any type of assistance to perform seven different ADLs on prevalence estimates of disability in a probability sample of 1818 adults 70 years of age and older living in the six New England states. Results reveal that different disability rating scales can have a dramatic impact on prevalence estimates of disability in older populations. Measures that used the 'difficulty' scale produced disability estimates from 1.2 to 5 times greater than estimates from the 'human assistance' scale. The effect of rating scales was associated with respondents' age, social factors, and health status. Effects also varied substantially across different ADLs. Researchers need to make careful choices of the disability ratings scales and use caution in drawing inter-study comparisons where different scaling methods were employed.

Activities of Daily Living↗

PubMed1994

Performance-based driving evaluation of the elderly driver: safety, reliability, and validity.

BACKGROUND: Our driving population is aging and faces increased risk for injury and death from motor vehicle crashes. Clinicians are often asked to judge the driving safety of their patients without adequate guidelines. This article describes the development of a systematic performance-based road test for measuring driving skills of elderly drivers and its correlation with cognitive measures. METHODS: This was a prospective, masked, observational study in which a driving instructor's global scores ("criterion standard") and cognitive test scores were correlated with research driving scores created by two independent research raters sitting in the back seat of the care during each driving test. A convenience sample of 30 licensed drivers with a broad range of cognitive skills, over age 60, were studied on a closed course and in traffic. RESULTS: Statistically significant correlations were observed between the "criterion standard" and closed course scores (r = .35, p < .05) and between the "criterion standard" and in-traffic scores (r = .64, p < .01). Significant correlations were obtained between in-traffic and cognitive test scores, e.g., Mini-Mental State Exam (r = .72, p < .01). Inter-rater reliability on the closed course was .84 and on the in-traffic component was .74. Internal consistency for the closed course was .78 and for in-traffic was .89. CONCLUSION: This study documented the safety, reliability, and validity of a systematic road test for elderly drivers with a range of cognitive skills. Larger studies are needed to determine the cognitive factors that independently predict driving performance.

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PubMed1994

Physical therapy episodes of care for patients with low back pain.

BACKGROUND AND PURPOSE: Although individuals with low back pain frequently receive treatment from a physical therapist, few published studies exist that describe who sees a physical therapist for their low back pain nor is much known about physical therapy episodes of care for this condition. Secondary analysis of data from the American Physical Therapy Association's Survey of Physical Therapy Outpatient Practice provides new descriptive data on services provided to a national, representative sample of patients discharged from hospital-based and private outpatient practices. In addition, specific hypotheses were tested on clinical and background factors believed to influence low back pain episodes of care. SUBJECTS: Patients with low back pain represented over 25% of all outpatient discharges from physical therapy practices. METHODS: A mail survey was conducted with representatives of a national probability sample of facilities that provided outpatient physical therapy services. Data were provided on each facility and on a discharge sample of patients treated at each facility. RESULTS: On average, episodes of care extended over 5 weeks and consisted of 11 therapy visits, for an average charge of $766.70. Duration and charge for low back episodes of care did not differ, on average, in private versus hospital-based practices. Certain aspects of care, however, did vary across regions of the country. Episodes of care charged to workers' compensation were costlier than those charged to other insurance carriers, and whites were charged less, on average, than nonwhites. Duration of back symptoms was related to intensity, duration, and charges incurred for the episode of care. CONCLUSION AND DISCUSSION: Further research is needed to understand the reasons for the relationships observed in this study, as well as studies that relate care provided by physical therapists to specific patient outcomes. Further research is also needed to compare outcomes achieved across different health professions.

Adult↗

PubMed1994

Physical disablement concepts for physical therapy research and practice.

Disability, one of modern society's greatest public health problems, affects individuals, families, and society. Understanding the complex process of disablement, therefore, is critical given the current and projected increases in disability. Terminology in the field of disablement continues to breed confusion and controversy across and within disciplines. This article discusses some of the major models that have been developed to guide physical therapy researchers and clinicians in their thinking about disablement. Emphasis is on physical disablement because of its central role in physical therapy research and practice. Detailed descriptions are provided for two disablement formulations. One was developed in the 1960s by sociologist Saad Nagi. The other is the International Classification of Impairments, Disabilities, and Handicaps, developed for the World Health Organization. Both can serve as the basic conceptual architecture for disablement research in physical therapy. Researchers and clinicians need a common vocabulary and language for thinking and speaking about the process of disablement, although it appears premature to reach consensus on any one conceptual approach. Physical therapists should play an active role in guiding future research and scholarship on physical disablement.

Activities of Daily Living↗

PubMed1994

Understanding dental service use by older adults: sociobehavioral factors vs need.

OBJECTIVES: This study investigated correlates of dental care use in a representative sample of adults aged 70 and older throughout New England. METHODS: Data were collected in in-home interviews and dental examinations. Following Andersen's behavioral model of health services utilization, varied measures of sociodemographic characteristics, dental health attitudes and practices, perceived need for care, and need objectively determined by clinical examination were included as potential correlates. RESULTS: Recency of last visit was associated with positive attitudes toward dental care, regular dental hygiene, and having a usual source of care. Among dentulous subjects, recency of last visit also was related to sex and living arrangements. Frequency of visits for dentulous subjects was associated with the same variables, as well as with age and social class or education, in addition to need for care. For edentulous subjects, only a usual source of care and higher social class were associated with more frequent visits. CONCLUSIONS: Perceived need and attitudes toward dental care are important influences on use of care. Older persons must be convinced of the importance of regular dental care.

Activities of Daily Living↗

PubMed1994

Periodontal disease among New England elders.

Much of the existing oral epidemiologic literature is limited by having inadequate numbers of the oldest-old in their sample, having used rudimentary periodontal measures, or not having examined probability samples of community-dwelling elders. The New England Elders Dental Study (NEEDS) is the first study that documents the periodontal disease status of a probability sample of 554 adults aged 70 to 96 living within an entire U.S. Public Health Service region. The NEEDS study revealed substantially higher estimates of periodontal destruction among older adults than previous national studies would suggest. These results are consistent with several papers in the literature that suggest that periodontal disease rates are on the increase in older adults. In the coming decades dentistry should be prepared to meet the increasing need and demand for periodontal services in the growing older population.

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PubMed1994

A strength training program for postmenopausal women: a pilot study.

This pilot study examined a specific exercise program designed for skeletal muscle strengthening in postmenopausal women. The program consisted of patterns of movement using diagonal and spiral patterns, superimposed on a progressive weight-bearing sequence from prone lying to standing. Progressive resistance was provided with the use of progressively thicker elastic straps. Eighteen of an initial 22 healthy volunteer women aged 50 to 64 years completed 8 weekly hour-long group exercise sessions supplemented with twice weekly sessions at home to pilot test the program's safety, acceptability, and effectiveness in changing muscle strength. A physical therapist conducted baseline and final quadriceps, hamstrings, and grip strength assessments using a portable isokinetic dynamometer. Participants achieved a 21% increase in quadriceps (p < or = .001), 9% increase in hamstrings (p < or = .07), and a 14% increase in grip strength (p < or = .002). A positive dose-response relationship was observed between strength gains and compliance with the program. This approach to strength training in postmenopausal women is feasible and effective in increasing muscle strength. It has considerable promise and deserves further testing and evaluation.

Biomechanical Phenomena↗

PubMed1993

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

A Physical Activity Scale for the Elderly (PASE) was evaluated in a sample of community-dwelling, older adults. Respondents were randomly assigned to complete the PASE by mail or telephone before or after a home visit assessment. Item weights for the PASE were derived by regressing a physical activity principal component score on responses to the PASE. The component score was based on 3-day motion sensor counts, a 3-day physical activity dairy and a global activity self-assessment. Test-retest reliability, assessed over a 3-7 week interval, was 0.75 (95% CI = 0.69-0.80). Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68). Construct validity was established by correlating PASE scores with health status and physiologic measures. As hypothesized, PASE scores were positively associated with grip strength (r = 0.37), static balance (r = +0.33), leg strength (r = 0.25) and negatively correlated with resting heart rate (r = -0.13), age (r = -0.34) and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42). The PASE is a brief, easily scored, reliable and valid instrument for the assessment of physical activity in epidemiologic studies of older people.

Activities of Daily Living↗

PubMed1993

Oral health status of the elderly in New England.

The New England Elders Dental Study (NEEDS) reports the prevalence, extent and severity of oral diseases and conditions among a representative sample of community-dwelling elders age 70 and older residing throughout the six New England states. In-home, full-mouth examinations were conducted by four calibrated dentists who used National Institute of Dental Research (NIDR) standardized disease measures plus additional diagnostic codes on all tooth surfaces. Only 37.6% of elders age 70 and older were edentulous, while dentate elders had a mean number of teeth per person ranging from 21.5 to 17.9 across age and gender cohorts. The prevalence of untreated coronal decay in elders with teeth was 28% in female elders and 34% in male elders. More than 90% of all elders with teeth had coronal fillings and 22% exhibited untreated root caries. Periodontal destruction was substantial, with 66% of dentate elders exhibiting moderate periodontal pockets (4-6 mm) while 21% exhibited severe periodontal pocketing (> 6 mm). Comparisons with national surveys suggest that periodontal disease prevalence and severity appear to have been underestimated in previous national studies of the elderly. Because of aging and tooth retention trends, the periodontal disease problem of the elderly may be increasing in the face of dentists' tendency to underdiagnose the periodontal diseases, legal constraints on dental hygienists to independently treat them, and inadequate funding for conservative nonsurgical therapies.

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