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Frank Knoefel - One of the best experts on this subject based on the ideXlab platform.
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state of the art in Geriatric Rehabilitation part ii clinical challenges
Archives of Physical Medicine and Rehabilitation, 2003Co-Authors: Jennie Wells, Paul Stolee, Jamie A Seabrook, Michael Borrie, Frank KnoefelAbstract:Abstract Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in Geriatric Rehabilitation. Part II: Clinical challenges. Arch Phys Med Rehabit 2003;84:898-903. Objectives: To examine common clinical problems in Geriatric Rehabilitation and to make recommendations for current practice based on evidence from the literature. Data Sources: A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database. Study Selection: One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to Geriatric Rehabilitation or were anecdotal or descriptive reports on a small number of patients. Data Extraction: The following areas were the major Geriatric Rehabilitation subtopics identified in the search: frailty, comprehensive Geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees. Data Synthesis: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references. Conclusions: Frail older patients with hip fracture should receive Geriatric Rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.
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state of the art in Geriatric Rehabilitation part i review of frailty and comprehensive Geriatric assessment
Archives of Physical Medicine and Rehabilitation, 2003Co-Authors: Jennie Wells, Paul Stolee, Jamie A Seabrook, Michael Borrie, Frank KnoefelAbstract:Abstract Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in Geriatric Rehabilitation. Part I: Review of frailty and comprehensive Geriatric assessment. Arch Phys Med Rehabil 2003;84:890-7. Objectives: To increase recognition of Geriatric Rehabilitation and to provide recommendations for practice and future research. Data Sources: A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database. Study Selection: One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to Geriatric Rehabilitation or were anecdotal or descriptive reports. Data Extraction: The following major Geriatric Rehabilitation subtopics were identified: frailty, comprehensive Geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in Geriatric Rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies. Data Synthesis: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references. Conclusions: Frail elderly patients should be screened for Rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to Geriatric Rehabilitation should be interdisciplinary and use a comprehensive Geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of Geriatric Rehabilitation are most effective, screening, and what outcomes are sustainable.
Paul Stolee - One of the best experts on this subject based on the ideXlab platform.
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a qualitative study of healthcare provider perspectives on measuring functional outcomes in Geriatric Rehabilitation
Clinical Rehabilitation, 2018Co-Authors: Christine Glenny, Gary Naglie, Ayse Kuspinar, Paul StoleeAbstract:Objectives:To explore, from the perspective of healthcare providers, the barriers to and facilitators of using standardized outcome measures of physical function in Geriatric Rehabilitation setting...
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state of the art in Geriatric Rehabilitation part i review of frailty and comprehensive Geriatric assessment
Archives of Physical Medicine and Rehabilitation, 2003Co-Authors: Jennie Wells, Paul Stolee, Jamie A Seabrook, Michael Borrie, Frank KnoefelAbstract:Abstract Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in Geriatric Rehabilitation. Part I: Review of frailty and comprehensive Geriatric assessment. Arch Phys Med Rehabil 2003;84:890-7. Objectives: To increase recognition of Geriatric Rehabilitation and to provide recommendations for practice and future research. Data Sources: A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database. Study Selection: One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to Geriatric Rehabilitation or were anecdotal or descriptive reports. Data Extraction: The following major Geriatric Rehabilitation subtopics were identified: frailty, comprehensive Geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in Geriatric Rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies. Data Synthesis: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references. Conclusions: Frail elderly patients should be screened for Rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to Geriatric Rehabilitation should be interdisciplinary and use a comprehensive Geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of Geriatric Rehabilitation are most effective, screening, and what outcomes are sustainable.
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state of the art in Geriatric Rehabilitation part ii clinical challenges
Archives of Physical Medicine and Rehabilitation, 2003Co-Authors: Jennie Wells, Paul Stolee, Jamie A Seabrook, Michael Borrie, Frank KnoefelAbstract:Abstract Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in Geriatric Rehabilitation. Part II: Clinical challenges. Arch Phys Med Rehabit 2003;84:898-903. Objectives: To examine common clinical problems in Geriatric Rehabilitation and to make recommendations for current practice based on evidence from the literature. Data Sources: A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database. Study Selection: One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to Geriatric Rehabilitation or were anecdotal or descriptive reports on a small number of patients. Data Extraction: The following areas were the major Geriatric Rehabilitation subtopics identified in the search: frailty, comprehensive Geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees. Data Synthesis: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references. Conclusions: Frail older patients with hip fracture should receive Geriatric Rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.
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an individualized approach to outcome measurement in Geriatric Rehabilitation
Journals of Gerontology Series A-biological Sciences and Medical Sciences, 1999Co-Authors: Paul Stolee, Karen Stadnyk, Anita M Myers, Kenneth RockwoodAbstract:BACKGROUND: The heterogeneity of health problems experienced by frail elderly patients makes it difficult to use a single standard measure to evaluate multiple outcomes of Geriatric Rehabilitation. Commonly, several measures are used, but an alternative is to use an individualized measure such as Goal Attainment Scaling (GAS). This study investigated the reliability, validity, and responsiveness of GAS as an outcome measure in Geriatric Rehabilitation. METHODS: We studied 173 consecutive admissions (mean age 81; 77% female; mean length of stay 33 days) to a Geriatric Rehabilitation unit. Assessment instruments were completed at admission and discharge. Individualized treatment goals were identified for each patient by using GAS; standardized measures included self-rated health, a global clinical assessment, the Barthel Index, the OARS IADL scale, the Folstein Mini-Mental State Examination (MMSE), and the Nottingham Health Profile (NHP). RESULTS: Mobility, future care arrangements, and functional impairment were the most commonly identified GAS goal areas. The interrater reliability of the GAS discharge score was 0.93. The GAS discharge score correlated strongly (r> or =0.50) with the standardized measures, except for self-rated health, the MMSE, and the NHP (r> or =0.31). GAS was more responsive to change than any of the standardized measures. The GAS score was used to derive receiver operating characteristic curves for other measures; this can provide insight into the interpretation of clinically important outcomes. CONCLUSIONS: GAS appears to be a feasible, reliable, valid, and responsive approach to outcome measurement in Geriatric Rehabilitation.
Ruth E Hubbard - One of the best experts on this subject based on the ideXlab platform.
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feasibility and validity of frailty measurement in Geriatric Rehabilitation
Australasian Journal on Ageing, 2018Co-Authors: Aparna Arjunan, Nancye M Peel, Ruth E HubbardAbstract:The measurement of frailty using a Frailty Index (FI) has been criticised as too time-consuming for use in hospital settings. We aimed to assess the feasibility and characteristics of an FI derived from routinely collected data. A total of 258 participants aged 65 and older were included in a single-centre prospective cohort study conducted in inpatient Geriatric Rehabilitation wards. The functional independence measure (FIM™), medication count and comorbidities were coded as deficits. An FI could be derived in all participants. It was normally distributed with a mean (SD) of 0.42 (0.13) and reached a submaximal limit of 0.69. Adjusting for age and sex, the odds ratio of a poor outcome (death/discharge to higher care) was 1.38 (confidence interval 1.11-1.70) per unit (0.1) increase in FI. Derivation of an FI from routinely collected data is feasible in Geriatric Rehabilitation settings and is predictive of poor outcomes.
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predictors of adverse outcomes on an acute Geriatric Rehabilitation ward
Age and Ageing, 2012Co-Authors: Inderpal Singh, John Gallacher, Karl R Davis, Antony Johansen, Eamonn Eeles, Ruth E HubbardAbstract:Background: multidisciplinary Rehabilitation is of proven benefit in the management of older inpatients. However, the identification of patients who will do well with Rehabilitation currently lacks a strong evidence base. Objectives: the aims of this study were to compare the importance of chorological age, gender, co-morbidities and frailty in the prediction of adverse outcomes for patients admitted to an acute Geriatric Rehabilitation ward. Design: prospective observational cohort study. Subjects and setting: two hundred and sixty-five patients admitted consecutively to an acute Geriatric Rehabilitation ward at a tertiary care teaching hospital. Methods: frailty status was measured by an index of accumulated deficits, giving a potential score from 0 (no deficits) to 1.0 (all 40 deficits present). Patients were stratified into three outcomes: good (discharged to original residence within 28 days), intermediate (discharged to original residence but longer hospital stay) and poor (newly institutionalised or died). Results: patients were old (82.6 ± 8.6 years) and frail (mean frailty index (FI) 0.34 ± 0.09). Frailty status correlated significantly with length of stay and was a predictor of poor functional gain. The odds ratio of intermediate and poor outcome relative to a good outcome was 4.95 (95% CI = 3.21, 7.59; P < 0.001) per unit increase in FI. Chronological age, gender and co-morbidity showed no significant association with outcomes. Conclusion: frailty is associated with adverse Rehabilitation outcomes. The FI may have clinical utility, augmenting clinical judgement in the management of older inpatients.
Gary Naglie - One of the best experts on this subject based on the ideXlab platform.
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a qualitative study of healthcare provider perspectives on measuring functional outcomes in Geriatric Rehabilitation
Clinical Rehabilitation, 2018Co-Authors: Christine Glenny, Gary Naglie, Ayse Kuspinar, Paul StoleeAbstract:Objectives:To explore, from the perspective of healthcare providers, the barriers to and facilitators of using standardized outcome measures of physical function in Geriatric Rehabilitation setting...
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validity of 3 physical performance measures in inpatient Geriatric Rehabilitation
Archives of Physical Medicine and Rehabilitation, 2006Co-Authors: Dina Brooks, Aileen M Davis, Gary NaglieAbstract:Abstract Brooks D, Davis AM, Naglie G. Validity of 3 physical performance measures in inpatient Geriatric Rehabilitation. Objective To evaluate the construct validity and the responsiveness of 3 measures of physical performance measures as outcome measures for frail older persons. Design Pre-post design with measures at admission and discharge. Setting Three inpatient Geriatric Rehabilitation programs. Participants Fifty-two subjects (35 women, 17 men; age, 80±8y). Interventions Not applicable. Main Outcome Measures Physical performance measures were Timed Up & Go (TUG) test, two-minute walk test (2MWT), and functional reach. Functional status was measured with the FIM instrument and the Modified Barthel Index. Results The TUG and 2MWT scores differed significantly in groups of patients using different ambulatory aids ( P =.006), whereas no such difference was observed for the functional reach ( P =.40). The correlations between the TUG test and FIM and between the 2MWT and FIM were –.59 and .59 ( P P ≤.04), respectively, at admission and discharge. The correlations between functional reach and the FIM were not significant ( P ≥.09). Standardized response means were 1.1 for the TUG, 0.7 for the 2MWT, and 0.5 for functional reach. Conclusions The TUG test and 2MWT are valid and responsive outcome measures in older persons participating in Geriatric Rehabilitation. Functional reach was a moderately responsive outcome measure but did not consistently reflect ambulatory or functional status.
D X Cifu - One of the best experts on this subject based on the ideXlab platform.
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Geriatric Rehabilitation. 2. Physiatric approach to the older adult.
Archives of physical medicine and rehabilitation, 2020Co-Authors: Deborah G. Stewart, Edward M. Phillips, Carol F Bodenheimer, D X CifuAbstract:This self-directed learning module highlights the physiatric approach to the older adult. It is part of the study guide on Geriatric Rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and Rehabilitation (PM and R) and Geriatric medicine. This article specifically focuses on the advantages of the physiatric approach, PM and R training in Geriatric Rehabilitation, metrics in Geriatric assessment, prevention, symptom management, medical management, falls, pain, and pharmacology. To summarize the physiatric approach to the older adult.
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Geriatric Rehabilitation. 2. Physiatric approach to the older adult.
Archives of Physical Medicine and Rehabilitation, 2004Co-Authors: Deborah G. Stewart, Edward M. Phillips, Carol F Bodenheimer, D X CifuAbstract:Abstract Stewart DG, Phillips EM, Bodenheimer CF, Cifu DX. Geriatric Rehabilitation. 2. Physiatric approach to the older adult. Arch Phys Med Rehabil 2004;85(Suppl 3):S7–11. This self-directed learning module highlights the physiatric approach to the older adult. It is part of the study guide on Geriatric Rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and Rehabilitation (PM&R) and Geriatric medicine. This article specifically focuses on the advantages of the physiatric approach, PM&R training in Geriatric Rehabilitation, metrics in Geriatric assessment, prevention, symptom management, medical management, falls, pain, and pharmacology. Overall article objective To summarize the physiatric approach to the older adult.
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Geriatric Rehabilitation. 5. The societal aspects of disability in the older adult.
Archives of Physical Medicine and Rehabilitation, 2004Co-Authors: Carol F Bodenheimer, Randolph L Roig, Gregory M. Worsowicz, D X CifuAbstract:Abstract Bodenheimer CF, Roig RL, Worsowicz GM, Cifu DX. Geriatric Rehabilitation. 5. The societal aspects of disability and the older adult. Arch Phys Med Rehabil 2004;85(Suppl 3):S23–6. This self-directed learning module highlights the societal aspects of disability and the older adult. It is part of the study guide on Geriatric Rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and Rehabilitation and Geriatric medicine. This article specifically focuses on ethical issues, including capacity, psychodynamics, sexuality, community integration, work, leisure skills, and the issue of driving a motor vehicle. Overall article objective To summarize the societal aspects of disability and the older adult.
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Geriatric Rehabilitation. 1. Social, attitudinal, and economic factors.
Archives of physical medicine and rehabilitation, 1993Co-Authors: A M Gershkoff, D X Cifu, K M MeansAbstract:This self-directed learning module highlights the social, attitudinal, and economic factors that are important in the Rehabilitation of the older adult. It is part of the chapter on Geriatric Rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and Rehabilitation. This article contains information on the epidemiology of aging and disability, Geriatric Rehabilitation treatment environments, social support systems, reimbursement issues, and ageism.
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Geriatric Rehabilitation. 3. Mid- and Late-Life Effects of Early-Life Disabilities
Archives of Physical Medicine and Rehabilitation, 1993Co-Authors: Donald M. Currie, A M Gershkoff, D X CifuAbstract:Currie DM, Gershkoff AM, Cifu DX: Geriatric Rehabilitation. 3. Mid- and late-life effects of early-life disabilities. .4rch Phys Med Rehabil 74:S-413-S-416, 1993. This self-directed learning module highlights mid- and late-life effects of early-life disabilities. It is part of the chapter on Geriatric Rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and Rehabilitation. This article contains information on how to evaluate, prevent, and manage late complica- tions seen in adults and older adults with cerebral palsy, spina bifida, spinal cord injury, multiple sclerosis, juvenile rheumatoid arthritis, and early-life amputations, including psychosocial and other quality-of-life issues. Yew advances in post-polio syndrome are also covered. ~6' 1993 /IJJ the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation