Biomedical subjects

L Jongbloed

Publications and source records attributed to L Jongbloed.

12 recordsLinked to original sources

PubMed2006

Factors influencing discharge location following high lesion spinal cord injury rehabilitation in British Columbia, Canada.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To identify and describe factors that influence discharge location -- extended care unit (nursing home) or other (private home, group home, or acute care) -- following rehabilitation for individuals with a new high lesion spinal cord injury (SCI) (C1-C4) in British Columbia, Canada. SETTING: GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada. METHODS: Eligible clients were adults admitted to the GF Strong Rehabilitation Centre Spinal Cord Program between 1994 and 2003, with a new C1-4 lesion (traumatic or nontraumatic), and an ASIA score of A-C at time of discharge. Medical charts of 52 individuals were reviewed and data regarding individual characteristics, health-related characteristics, personal context, hospitalization factors, health resources, and other contextual factors were extracted. RESULTS: In total, 40% of clients were discharged to extended care units post rehabilitation. Seven variables were associated at a univariate level: age, employment at the time of injury, pre-existing medical conditions, social support, preinjury living situation, and insurance (worker's compensation or motor vehicle) or private funding for equipment. Four variables were associated at the multivariate level: age, preinjury living situation, and insurance or private funding for equipment. CONCLUSION: A range of individual, health-related, family and social policy variables influence discharge location following rehabilitation for high lesion SCI in British Columbia. The unique combination of variables presented by each individual should be considered by the rehabilitation team in the discharge planning process.

Adult↗

PubMed2004

Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients.

BACKGROUND AND PURPOSE: Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred. METHODS: Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control. RESULTS: We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL. CONCLUSIONS: Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.

Activities of Daily Living↗

PubMed2000

Women with multiple sclerosis and employment issues: a focus on social and institutional environments.

This paper examines employment issues for women diagnosed with multiple sclerosis (MS) and their workplace experiences, focusing analysis on the social and institutional dimensions of the environment. The analysis draws on data from a mixed method study using in-depth interviews and a survey. The findings indicate that although severity of symptoms affect employment status, non-medical factors, including modification of work conditions and understanding employers, and a supportive home environment with the possibility of delegating household tasks, can enhance women's ability to work. The specific focus in the paper on the experiences of women managing their disability in the workplace, from the qualitative phase of the study, acts as an analytic device to illustrate how context influences the way in which such factors play out. In high-lighting the issue of disclosure of diagnosis, and associated identity and income concerns for women, the paper demonstrates the importance of the social and institutional dimensions of environment in shaping occupational performance. The findings suggest that inclusion of environmental analysis in clinical practice broadens the range of intervention strategies to be considered and raises the issue of occupational therapists' role in advocacy.

Adaptation, Psychological↗

PubMed1999

Three perspectives on the rehabilitation needs of consumers.

Empowering individuals with serious mental health problems includes providing services which they themselves identify as needs. This paper reports on a study which examined needs for rehabilitation services from the perspectives of consumers with chronic mental health problems, their significant others, and case managers. In most instances far greater needs for services were expressed by consumers and significant others than by case managers, indicating that case managers pay insufficient attention to what consumers want. Professional control and power imbalance between case managers and consumers likely contribute to this situation. Study findings have been used to initiate change at the organizational level and at the level of individual professionals.

Adult↗

PubMed1991

An investigation of involvement in leisure activities after a stroke.

The purpose of this study was to determine the efficacy of occupational therapy intervention related to the leisure activities of stroke survivors. Forty discharged stroke patients were randomly assigned to an experimental group, which received occupational therapy intervention related to leisure activities, or to a control group. An independent evaluator assessed the patients' involvement in activities and satisfaction with that involvement on three separate occasions. The results showed no statistically significant differences between the experimental and control groups in activity involvement or satisfaction with that involvement. There are likely two reasons for these findings. First, the intervention was limited in scope (i.e., only five therapist visits), and second, many environmental factors strongly influence activity participation and satisfaction.

Activities of Daily Living↗

PubMed1990

Problems of methodological heterogeneity in studies predicting disability after stroke.

Comparison among studies is hindered by methodological heterogeneity. Differences among patient samples mean that predictor variables identified with one sample will not necessarily be accurate for other samples. Studies conducted across treatment centers would help ensure that the sample is representative of the population to which the predictor measure is to be applied in the future. The criterion by which functional outcome has been measured has varied. Many studies have measured function on discharge, while others have measured improvement in function. If interest lies with improvement in function, it is important to identify factors that predict which patients have greater (or less) than predicted recovery. If interest lies with the prediction of function at a particular point after the stroke, function should not be measured at discharge (since length of hospital stay varies enormously) but at a set time poststroke. Future studies should use scales whose reliability and validity is well established.

Cerebrovascular Disorders↗

PubMed1989

Stroke rehabilitation: sensorimotor integrative treatment versus functional treatment.

This study compares the effectiveness of two occupational therapy approaches to treating cerebrovascular accident patients--the functional and sensorimotor integrative approaches. Subjects were 90 patients admitted to Holy Family Hospital in Vancouver, Canada, within 12 weeks after a first stroke. Consenting subjects were randomly assigned on admission to one of two occupational therapy treatment groups. All subjects received similar medical and nursing care and physical therapy. An independent clinical evaluator assessed subjects' function in self-care and mobility, meal preparation, and sensorimotor integration at specified times after admission. Neither the evaluator nor the subjects were aware of the treatment group to which they had been assigned. Results showed no statistically significant differences between the two treatment groups on the three outcome measures. We therefore concluded that any differences between the effectiveness of the two approaches are small.

Activities of Daily Living↗

PubMed1987

Robinson Bashall Functional Assessment for arthritis patients: reliability and validity.

The Robinson Bashall Functional Assessment (RBFA) for arthritis patients has four scales: self-care, ambulation, transportation, and activity tolerance. Criticism has been directed at the Assessment because it is relatively time consuming and requires a trained professional to conduct it. Tests of reliability revealed that the internal consistency of the total Assessment was moderate, interrater reliability was high, and test-retest reliability ranged from moderate to high. Analysis of scale validity (content, clinical, concurrent, and discriminant validity) showed content validity to be low to moderate. Therapists found the scales more useful in identifying patient problems than in assessing improvement in function over time. There were low positive correlations between dressing, undressing, and ambulation scores and ROM scores on admission. Correlations between the American Rheumatism Association Functional Classification and scales of the RBFA were significant, while the Assessment as a whole and all four scales discriminated significantly between the functional abilities of patients on admission and discharge.

Activities of Daily Living↗

PubMed1984

Substitutability of work and the professionalization of occupational therapists.

This paper examines the status of occupational therapy as a profession. Achievement of status as a full-fledged profession will depend on the success with which this group convinces members of society that the work it does is non-substitutable. It is difficult for occupational therapists to prove there is no legal substitute for the services they offer. This factor will likely limit attainment of status as a full-fledged profession.

Canada↗

PubMed1980

The position of the water blow-off or safety valve in C.P.A.P.-systems.

After investigating aspects of a single nasal cannula system we conclude that the pressure read-out point should be located as close to the application point as possible; furthermore the water blow-off or safety valve should be positioned before (or at) the pressure application point.

Positive-Pressure Respiration↗

PubMedDate not supplied

Prediction of function after stroke: a critical review.

A review of 33 studies identifies the factors of prior stroke, older age, urinary and bowel incontinence, and visuo-spatial deficits as adverse prognostic indicators of function. No relationship is shown between sex, hemisphere of stroke, and functional outcome. Functional admission score is a strong predictor of discharge functional status, but its relationship with improvement in function is unclear. Findings regarding the prognostic value of severity of paralysis and onset-admission delay are ambiguous. Comparison among studies is hindered by differences in patient samples, timing of assessments, criteria by which outcome is measured and measuring instrument used. Future studies should measure function at set times post-stroke, use functional scales whose reliability and validity is well established, and be conducted in several treatment centres to ensure that the sample is representative of the population to which the predictor measure is to be applied.

Age Factors↗

PubMedDate not supplied

Adaptation to a stroke: the experience of one couple.

OBJECTIVE: Treatment of stroke, as described in the occupational therapy literature, focuses primarily on the person's physical problems, and less on the way in which the family and environment influence adaptation. This article examines family and environmental influences on adaptation to stroke. METHOD: The content of five interviews conducted over 2 years with a woman who experienced a stroke and her husband was analyzed with ethnographic research methods. RESULTS: The analysis revealed that a stroke cannot be understood as an individual phenomenon, because the life course of both this woman and her husband were profoundly affected by it. The man's roles as family member, caregiver, home maintainer, and hobbyist required change after his wife's stroke. The woman's experience of her changed body, dependence, and altered homemaking role were influenced not only by her husband's attitudes but also by societal values. CONCLUSION: The findings suggest that clinicians and researchers must pay greater attention to those living with the person who experienced a stroke and to the ways in which the person's social, cultural, and economic environments influence adaptation to disability.

Activities of Daily Living↗