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Biomedical subjects

Linda Resnik

Publications and source records attributed to Linda Resnik.

11 recordsLinked to original sources
PubMed2006

Promoting independence for wheelchair users: the role of home accommodations.

PURPOSE: The objective of this research is to investigate whether home accommodations influence the amount of human help provided to a nationally representative sample of adults who use wheelchairs. DESIGN AND METHODS: We analyzed data from the Adult Disability Follow-back Survey (DFS), Phase II, of the Disability Supplement to the 1994-1995 National Health Interview Surveys (NHIS-D). The analytic sample consisted of 899 adults aged 18 and older who reported using wheelchairs in the previous 2 weeks. We conducted logistic regression and ordinary least squares (OLS) regression analyses to test the influence of home accommodations on the receipt of any human help, and among respondents who received help, on the hours of help received, respectively. We analyzed paid and unpaid help separately. RESULTS: Home accommodations were related to the receipt of unpaid, but not paid, help. Relative to having no home accommodations, the presence of each additional accommodation decreased the odds of having unpaid help by 14% (OR =.86; 95% CI =.76,.97). Additionally, we observed an inverse relationship between the number of accommodations in the home and hours of unpaid help (p <.01). For wheelchair users who live alone, specific types of home accommodations were also inversely related to hours of unpaid help. IMPLICATIONS: Policies that reimburse for home accommodations may be an efficient response to the growing demand for home-care support while enabling greater autonomy and independence for people who use wheelchairs.

Activities of Daily Living↗
PubMed2006

State regulation and the delivery of physical therapy services.

OBJECTIVE: The study purpose was to examine the relationship between state regulations of physical therapists (PT) and three dependent variables: physical therapist assistant (PTA) utilization more than 50 percent of the time during the treatment episode (high PTA utilization), number of visits, and patient self-reported functional health status (FHS) at discharge. We evaluated regulations governing licensure of PTAs, PT/PTA ratio, frequency of PT re-evaluation, and PTA supervision. DATA SOURCE: The analytic sample included 63,900 patients from 38 states drawn from 395 clinics who participated in the Focus on Therapeutic Outcomes Inc. (Knoxville, TN) database in 2000 and 2001. STUDY DESIGN: Using a Bayesian modeling approach with the Markov Chain Monte Carlo estimation method, we fitted separate multilevel multivariate regression models predicting high PTA utilization, number of visits, and discharge FHS. DATA COLLECTION METHODS: Patients completed FHS surveys at intake and discharge. Clinicians recorded the number of visits and percentage of time a patient spent with each provider. PRINCIPAL FINDINGS: After controlling for patient, therapist, and clinic characteristics, the presence of state regulations regarding PTA supervision was not associated with the likelihood of high PTA utilization. High PTA utilization and regulations requiring full-time onsite supervision were associated with more visits, whereas regulation of PT/PTA ratio was associated with fewer visits. Supervisory regulations were associated with better discharge FHS. High PTA utilization and use of therapy aides were associated with more visits per episode and lower discharge FHS. CONCLUSIONS: The use of care extenders in place of PTs is likely to result in less efficient and lower quality care in outpatient rehabilitation.

Adult↗
PubMed2006

Racial and ethnic differences in use of assistive devices for mobility: effect modification by age.

PURPOSE: The authors investigated the extent to which differences in mobility device use existed by race/ethnicity and whether the effects were modified by age. METHOD: Using Phase II of the National Health Interview Survey on Disability, the authors identified 7,148 mobility-impaired adults. Logistic regression models provided estimates of race/ethnicity, adjusting for predictors of device use. RESULTS: Blacks were 1.2 times as likely as non-Hispanic Whites (95% CI: 1.0-1.4) to use devices. Hispanics were 0.78 times less likely to use devices as were non-Hispanic Whites (95% CI 0.65-0.96). Differences were attenuated by age, with a 40% increased likelihood of use attributable to being Black and aged 45 to 75, a 30% increased likelihood attributable to being Hispanic and aged 65 to 75, and a 130% increased likelihood attributable to being Hispanic and older than 75. CONCLUSION: Disentangling the observed patterns in mobility device use will provide direction for development of interventions to promote assistive device use.

Adult↗
PubMed2006

Weighing the relevant issues: obesity in nursing homes.

The obesity epidemic has touched all segments of society and every health care sector including the nursing home industry. Understanding the issues related to the care of obese nursing home residents is important in light of this epidemic. Such issues include the difficulties related to access to nursing homes, the structural preparedness of nursing homes to care for obese patients, and the potential for staff injuries. Policies regarding strategies to improve nursing home access for obese patients, mitigate disparities in quality of care and health outcomes owing to obesity, and better prepare for the growing obesity epidemic are needed.

Aged↗
PubMed2005

Obesity and receipt of personal care assistance for people with mobility impairments.

OBJECTIVE: The purpose of this study was to evaluate the extent to which level of obesity was associated with hours of personal care among people with mobility impairments. RESEARCH METHODS AND PROCEDURES: The analytic sample consisted of 9496 respondents to the Adult Disability Follow-Back Survey (NHIS-D Phase II) who had mobility difficulty and difficulty with at least one activity of daily living or instrumental activity of daily living. Logistic regression analyses determined the relationship between level of obesity and receipt of any paid or unpaid help, controlling for potential confounders. In addition, differences in hours of help by level of obesity were evaluated using multiple regression. RESULTS: In the crude analysis, obese respondents were significantly less likely to receive any paid help than normal weight respondents (average odds ratio 0.75) and received significantly fewer hours of both paid and unpaid help. The difference in prevalence of receipt of any unpaid and any paid help by level of obesity was explained by adjustment for age and other demographic characteristics. Adjusted hours of paid and unpaid help were equivalent for those with and without obesity. DISCUSSION: Obese people with mobility impairments received less help with personal care than those of normal weight, although these findings are explained by demographics. Nevertheless, these findings raise public health concerns given the growing obesity epidemic in the United States and lack of available resources to support younger persons with disabilities.

Adolescent↗
PubMed2005

Obesity in nursing homes: an escalating problem.

OBJECTIVES: To estimate trends in the prevalence of obesity in nursing homes, to characterize the obese nursing home population, and to evaluate the extent to which estimates of the prevalence of obesity varied by facility and geographic location. DESIGN: Cross-sectional. SETTING: One thousand six hundred twenty-five nursing homes in Kansas, Maine, Mississippi, New York, and South Dakota from 1992 to 2002; 16,110 nursing homes in the United States in 2002. PARTICIPANTS: Newly admitted residents between 1992 and 2002 (n=847,601) in selected states and 1,448,046 residents newly admitted to a U.S. nursing home in 2002 with height and weight documented on the Minimum Data Set (MDS) assessment. MEASUREMENTS: Data were from the Systematic Assessment of Geriatric Drug Use via Epidemiology database. Residents were classified as having a body mass index of less than 18.5 kg/m2, 18.5 to 24.9 kg/m2, 25.0 to 29.9 kg/m2, 30 to 34.9 kg/m2, or 35.0 kg/m2 or greater. RESULTS: Adjusting for sociodemographics, in Kansas, Maine, Mississippi, New York, and South Dakota, fewer than 15% of newly admitted residents were obese in 1992, rising to more than 25% in 2002. In U.S. nursing homes, the distribution of obese residents is not shared equally across facilities. Nearly 30% of residents with a BMI of 35 kg/m2 or greater are younger than 65, and a disproportionate percentage of obese residents are non-Hispanic black. Residents identified as obese had a higher likelihood of comorbid conditions (e.g., diabetes mellitus, arthritis, hypertension, depression, and allergies). CONCLUSION: Increasing prevalence of obesity in nursing homes and substantial variation of obesity prevalence within facilities raise concerns about nursing home preparedness and access.

Aged↗
PubMed2003

Guide to outcomes measurement for patients with low back pain syndromes.

The Guide for Physical Therapist Practice states that the physical therapist determines the expected outcomes for each intervention and engages in outcomes data collection and analysis. Outcomes tracking provides a systematic way for therapists to monitor treatment effectiveness and efficiency. A familiarity with outcome measures for the patient with low back pain is indispensable for therapists in the outpatient orthopaedic setting, where patients with lumbar pain often comprise the majority of the caseload. The therapist must be able to evaluate and choose appropriate measurement tools and understand the clinical meaning of measurements to successfully employ these instruments. The purpose of this article is to review measurement instruments for patients with low back pain and to offer practical guidelines for selection and use of outcome measures for this population. The reliability, validity, sensitivity to change, and utility of common outcome measures are discussed. An overview of generic, disease-specific, and patient-specific tools is provided with specific commentary on the use of the SF-36, SF-12, Oswestry Questionnaire, Roland-Morris Questionnaire, and patient-specific tools. Practical guidelines for utilizing outcome measures in clinical practice and the overall benefits of outcomes tracking are highlighted.

Disability Evaluation↗
PubMed2003

Using clinical outcomes to identify expert physical therapists.

BACKGROUND AND PURPOSE: Previous studies of expert physical therapists have sampled therapists based on years of clinical experience or reputation, not on their patients' clinical outcomes. The purposes of this study were to identify expert physical therapists by using patient self-reported outcomes and to describe the characteristics of clinicians whose patients with lumbar spine syndromes reported higher health-related quality of life (HRQL) following rehabilitation. METHODS: Retrospective data were analyzed on 24276 patients (mean age=47.8 years, SD=16, range=14-97) with lumbar spine syndromes treated by 930 physical therapists participating in the Focus On Therapeutic Outcomes database in 1999-2000. Physical therapists and staff answered questions concerning years of experience and practice setting when starting their participation in the outcomes system. Patient self-report HRQL data were collected at intake and discharge from outpatient rehabilitation. Discharge HRQL data were risk adjusted using patient characteristics. Data were aggregated by physical therapist. Risk-adjusted discharge HRQL scores were used to classify physical therapists whose patients reported mean HRQL improvement above the 90th percentile as experts and physical therapists whose patients reported mean HRQL improvement between the 45th and 55th percentiles as average. RESULTS: Therapists classified as expert had fewer patients in the database than did therapists classified as average (mean SD) (19 +/-17 versus 29 +/-22). Mean treatment duration was different between groups (32 +/- 11 days for the expert group versus 31+/-8 days for the average group). DISCUSSION AND CONCLUSION: The results challenge assumptions that extensive clinical experience is necessary to achieve superior patient outcomes, and they provide information about the relationship between therapist characteristics and patient outcomes.

Adolescent↗
PubMed2003

Using clinical outcomes to explore the theory of expert practice in physical therapy.

BACKGROUND AND PURPOSE: Theoretical models of physical therapist expertise have been developed through research on physical therapists sampled solely on the basis of years of experience or reputation. Expert clinicians, selected on the basis of their patients' outcomes, have not been previously studied, nor have the patient outcomes of peer-nominated experts been analyzed. The purpose of our study was to describe characteristics of therapists who were classified as expert or average therapists based on the outcomes of their patients. SUBJECTS: Subjects were 6 therapists classified as expert and 6 therapists classified as average through retrospective analysis of an outcomes database. METHODS: The study was guided by grounded theory method, using a multiple case study design. Analysis integrated data from quantitative and qualitative sources and developed a grounded theory. RESULTS: All therapists expressed a commitment to professional growth and an ethic of caring. Therapists classified as expert were not distinguished by years of experience, but they differed in academic and work experience, utilization of colleagues, use of reflection, view of primary role, and pattern of delegation of care to support staff. Therapists classified as expert had a patient-centered approach to care, characterized by collaborative clinical reasoning and promotion of patient empowerment. DISCUSSION AND CONCLUSION: These findings add to the understanding of factors related to patient outcomes and build upon grounded theory for elucidating expert practice in physical therapy.

Adult↗
PubMedDate not supplied

Outcomes measurement for patients with low back pain.

Outcomes tracking provides a systematic method of monitoring treatment effectiveness and efficiency. A familiarity with outcome measures for the patient with low back pain is very important for clinicians working in orthopaedic settings, where patients with lumbar pain are prevalent. The clinician must be able to evaluate and choose appropriate measurement tools, and understand the clinical meaning of measurements to successfully employ these instruments. The purposes of this article are to review measurement instruments and to offer practical guidelines for selection and use of outcome measures for this population. The reliability, validity, sensitivity to change, and utility of common outcome measures are discussed. An overview of generic, disease-specific, and patient-specific tools is provided, with specific commentary on the use of the SF-36, SF-12, Oswestry, Roland Morris, and patient-specific tools. Practical guidelines for utilizing outcome measures in clinical practice and the overall benefits of outcomes tracking are highlighted.

Activities of Daily Living↗