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Objective:To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes.Methods:MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation.Results:A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively.Conclusion:The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether the universally accepted range of normal patellar height ratios derived from radiography for the Insall-Salvati (IS) and Blackburne-Peel (BP) methods could be similarly applied to both CT and MRI.Materials and Methods: Institutional review board approval was obtained with waiver of informed consent for this HIPPA-compliant study. A total of 45 knees in 42 patients (15 men, 27 women; age range 11 to 75 years, mean age 39 ± 20 years) who underwent tri-modality (radiograph, CT, and MRI) examinations were selected. All patients had knee imaging obtained for a variety of reasons and measurements were performed by two independent readers who were blinded to each other's measurements or the respective measurements derived from each of the methods. Paired t test was used to compare the mean values among the modalities. Inter-observer and inter-method agreements were assessed using intra-class correlation coefficients.Results: Statistically significant, but small quantitative differences are noted between tri-modality patellar height ratios. For comparable results, the small addition of 0.13 and 0.10 are needed for the Insall-Salvati measurements on MRI and CT respectively, compared with radiographs. For the Blackburne-Peel ratio, an additional adjustment of 0.09 is needed between radiographs and MRI, but not between radiographs and CT. These adjustments are independent of gender. The interobserver reproducibility was excellent (ICC ≥ 0.94) for both the Insall-Salvati and Blackburne-Peel methods for all modalities.Conclusion: The results indicate that cut-off values for patella alta and baja derived from radiographs should not be directly transposed to CT and MRI; however, the adjustments are relatively minor. These measurements show excellent reproducibility for all modalities currently used for patellar height measurements. [ABSTRACT FROM AUTHOR]

Study design:Systematic review.Objectives:To identify changes in subjective quality of life (QoL) as one ages with a spinal cord injury (SCI).Setting:Vancouver, Canada.Methods:Electronic databases were searched for studies reporting on age-related QoL changes over time. Data from relevant studies were transcribed into data extraction forms and analyzed by years post injury (YPI) and chronologic age. Each study was assigned a level of evidence based on a modified Sackett scale.Results:In all, 21 studies, each with a low level of evidence, were included for review. The results indicated that regardless of chronologic age, individuals with relatively new SCI have the potential to improve their QoL. Among individuals with advanced YPI, overall QoL is consistently reported as good or excellent over time, however, with variations in different QoL domains.Conclusion:The QoL of individuals aging with a SCI has the potential to improve, and remain high and stable over time. As the identified studies provide low levels of evidence, more longitudinal research with greater methodological and measurement rigor is needed to corroborate the findings and conclusions of this review. [ABSTRACT FROM AUTHOR]

Study design:Systematic review.Objective:To systematically review evidence on aging of the body systems after spinal cord injury (SCI).Setting:Toronto, Ontario and Vancouver, British Columbia, Canada.Methods:Electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO), were searched for studies published between 1980 and 2009. The search was augmented by reviewing the reference lists of relevant papers. Non-intervention studies that were longitudinal or cross-sectional with able-bodied controls that were at minimum matched on chronological age were included for review. Levels of evidence were assigned to the study design using a modified Sackett scale.Results:Of the 74 studies selected for inclusion, 16 were longitudinal in design. The hypothesis that SCI represents a model for premature aging is supported by a large proportion of level 5 evidence for the cardiovascular and endocrine systems, level 2, 4 and 5 evidence for the musculoskeletal system, and limited level 5 evidence for the immune system. Only a few level 4 and 5 studies for the respiratory system were found. The evidence on the genitourinary system, gastrointestinal system, and for skin and subcutaneous tissues provide level 4 and 5 evidence that premature aging may not be occurring. The evidence on the nervous system does not provide evidence of premature aging as a result of SCI.Conclusions:Premature aging appears to occur in some systems after SCI. Additional longitudinal studies are required to confirm these findings.Sponsorship:Rick Hansen Institute; Ontario Neurotrauma Foundation. [ABSTRACT FROM AUTHOR]

Study design: Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. Objective: To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. Setting: Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Methods: Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. Results:A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Conclusions: Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify the determinants of the bone strength index of the distal tibia epiphysis in chronic stroke patients. The results showed that lower cardiovascular fitness, more muscle atrophy, poorer mobility, and more severe spasticity were independently associated with lower tibial bone strength index. To identify the determinants of the bone strength index (BSI) at the distal tibia in chronic stroke patients Sixty-three chronic stroke survivors underwent scanning of the distal tibia at the 4% site on both sides using peripheral quantitative computed tomography. The primary outcomes were trabecular bone mineral density (BMD; milligram per cubic centimeter), total BMD (milligram per cubic centimeter), total bone area (square millimeter), and BSI (square gram per centimeter to the power of four). Cardiovascular fitness, leg lean mass, gait velocity, and spasticity were also measured. Scans from 45 subjects were deemed to have acceptable quality and were included for subsequent analysis. The paretic side had significantly lower trabecular BMD, total BMD, and BSI than the nonparetic side ( p < 0.05). However, the total bone area demonstrated no significant side-to-side difference ( p > 0.05). After adjusting for relevant biological factors, peak oxygen consumption, leg muscle mass, and gait velocity remained positively associated with tibial BSI on both sides ( R2 change = 6.9–14.2%), whereas spasticity of the paretic leg was negatively associated with tibial BSI on the same side ( R2 change = 4.8%). Cardiovascular function, muscle atrophy, mobility, and spasticity are independently associated with BSI of the distal tibia epiphysis among chronic stroke patients. [ABSTRACT FROM AUTHOR]

Osteoporosis beliefs were assessed in immigrant Chinese women in Chinatown, Chicago. Results from a survey utilizing the Osteoporosis Health Belief Scale showed that women expressed concern about osteoporosis but lacked both knowledge of preventive care and health motivation. The objective of this study was to assess osteoporosis beliefs in immigrant Chinese women in Chinatown, Chicago. In a community-based health fair, osteoporosis knowledge and self-efficacy among postmenopausal Chinese immigrants were assessed using the translated Osteoporosis Health Belief Scale. Bone mineral density (BMD) was assessed with calcaneal ultrasound. The study population included 94 women with mean age of 51 ± 9 years, mean length of residence in the United States of 9 ± 7 years, and 73% ( n = 76) of whom were recent immigrants. Women expressed concern about the seriousness of osteoporosis and their relative susceptibility to osteoporosis. In particular, women with a prior fracture reported higher seriousness to osteoporosis. Nonetheless, women exhibited low health motivation and low awareness of the benefits of calcium and exercise. Bone densitometry results corresponded to a T score of −1.2 ± 1.5. Multiple regression analysis revealed that a younger age and longer length of residence in the USA were associated with higher BMD. Chinese immigrant women in Chicago exhibit concern regarding osteoporosis, but are unaware of the benefits of calcium and exercise, and exhibit low health motivation. Chinese women in Chinatown lack necessary knowledge about osteoporosis to develop adequate self-efficacy. Public health initiatives should be undertaken among recent immigrant Chinese women. [ABSTRACT FROM AUTHOR]

Study design:Self-report surveyObjective:To ascertain physiatrists' opinions and current practice patterns for bone health management after spinal cord injury (SCI).Participants:Physiatrists who work in teaching rehabilitation centers in Canada.Methods:A 4-page 17-question survey (available in French and English) was sent to working physiatrists in all major Canadian SCI rehabilitation centers.Results:We had an 85% response rate (22 responses). Physiatrists reported that they should be managing bone health issues after SCI in conjunction with family physicians, and most respondents assess and treat for bone health after SCI. However, just over one-third of the physiatrists reported that the current treatment options are not effective for low bone mass; there was more support for pharmacological treatments than there was for rehabilitation modalities.Conclusion:Bone health after SCI is an important health concern that is being managed by physiatrists; however, more discussion and research is needed to ascertain the effectiveness of assessment and treatment options for low bone mass.Spinal Cord (2009) 47, 242–248; doi:10.1038/sc.2008.104; published online 19 August 2008 [ABSTRACT FROM AUTHOR]

Chronic stroke survivors with low hip bone density are particularly prone to fractures. This study shows that fear of falling is independently associated with falls in this population. Thus, fear of falling should not be overlooked in the prevention of fragility fractures in these patients. Chronic stroke survivors with low bone mineral density (BMD) are particularly prone to fragility fractures. The purpose of this study was to identify the determinants of balance, mobility and falls in this sub-group of stroke patients. Thirty-nine chronic stroke survivors with low hip BMD (T-score <−1.0) were studied. Each subject was evaluated for the following: balance, mobility, leg muscle strength, spasticity, and fall-related self-efficacy. Any falls in the past 12 months were also recorded. Multiple regression analysis was used to identify the determinants of balance and mobility performance, whereas logistic regression was used to identify the determinants of falls. Multiple regression analysis revealed that after adjusting for basic demographics, fall-related self-efficacy remained independently associated with balance/mobility performance (R2 = 0.494, P < 0.001). Logistic regression showed that fall-related self-efficacy, but not balance and mobility performance, was a significant determinant of falls (odds ratio: 0.18, P = 0.04). Fall-related self-efficacy, but not mobility and balance performance, was the most important determinant of accidental falls. This psychological factor should not be overlooked in the prevention of fragility fractures among chronic stroke survivors with low hip BMD. [ABSTRACT FROM AUTHOR]

Study design:Systematic review.Objectives:To systematically review the psychometric properties of outcome measures used to assess ambulation in people with spinal cord injury (SCI).Setting:Vancouver, BC, Canada.Methods:A keyword literature search of original articles that evaluated the psychometric properties of ambulation outcome measures in the SCI population was conducted using multiple databases. Multidimensional scales of function were included if specific data were available on ambulation-related subscales. Reliability, validity and responsiveness values were extracted and conclusions drawn about the psychometric quality of each measure.Results:Seven outcome measures were identified and were broadly categorized into timed and categorical measures of ambulation. Timed measures included timed walking tests that showed excellent reliability, construct validity and responsiveness to change. The psychometric properties of the categorical scales were more variable, but those that were developed specifically for the SCI population had excellent reliability and validity. Categorical scales also exhibited some floor or ceiling effects.Conclusion:Excellent tools are available for measuring functional ambulation capacity. Further work is required to develop and evaluate outcome measures to include environmental factors that contribute to the ability to achieve safe, functional ambulation in everyday settings.Sponsorship:Rick Hansen Man-in-Motion Foundation and Ontario Neurotrauma Fund.Spinal Cord (2008) 46, 246–254; doi:10.1038/sj.sc.3102134; published online 9 October 2007 [ABSTRACT FROM AUTHOR]

Bone health status of the radius in individuals with chronic stroke was evaluated using peripheral quantitative computed tomography. Bone mineral density and cortical thickness on the affected side were compromised when compared with the unaffected side. Muscle weakness, spasticity, and disuse were identified as contributing factors to such changes. Following a stroke, demineralization and geometric changes occur in bone as a result of disuse and residual impairments, and these can contribute to an increased risk of fragility fractures. This study used peripheral quantitative computed tomography (pQCT) to evaluate volumetric bone mineral density and geometry at the midshaft radius in people living with chronic stroke. Older individuals with chronic stroke were recruited. Each subject underwent a pQCT scan of the midshaft radius at the 30% site on both upper limbs. Muscle strength, motor function, spasticity, and chronic disuse were also evaluated. Data from 47 subjects (19 women) were assessed. A significant difference was found between the two limbs for cortical bone mineral content, cortical bone mineral density, cortical thickness, and polar stress-strain index. There was no significant side-to-side difference in total bone area. Percent side-to-side difference in muscle strength, spasticity, and chronic disuse were significant determinants of percent side-to-side difference in cortical bone mineral content and cortical thickness. The findings suggest that following chronic stroke, endosteal resorption of the midshaft radius occurred with a preservation of total bone area. Muscle weakness, spasticity, chronic disuse significantly contributed to demineralization and geometric changes in the radius following chronic stroke. [ABSTRACT FROM AUTHOR]

BACKGROUND: Because serum creatinine is an insensitive measure of kidney dysfunction, guidelines have advocated routine use of estimated glomerular filtration rate (eGFR) to identify patients with chronic kidney disease (CKD). Patients with early (stage 3) CKD remain undiagnosed in primary care clinics; therefore, we hypothesized that routine reporting of eGFR in outpatient clinics would improve the recognition and treatment of CKD. METHODS: A retrospective review of primary care patients was undertaken at the Bronx Veterans Affairs Medical Center, Bronx, New York, before and after the institution of routine eGFR reporting. We evaluated the achievement of diagnostic and therapeutic treatment goals based on the Kidney Disease Outcomes Quality Initiative guidelines (documentation of CKD, urinalysis assessment, blood pressure < 130/80 mm Hg, and renin-angiotensin system blockade) for patients with stage 3 CKD during each period. RESULTS: Overall, patients with diabetes with early-stage CKD achieved superior treatment rates than similar patients without diabetes. Routine reporting of eGFR improved the documentation and identification of CKD by almost 50%, although absolute improvement was modest. Use of renin-angiotensin system blockers improved minimally, as did blood pressure control. Patients with documented CKD achieved treatment goals more frequently than patients without documented CKD. CONCLUSION: Routine reporting of eGFR alone modestly improved the identification of patients with CKD without a clinically significant effect on care. For Modification of Diet in Renal Disease Study calculation of eGFR reporting to effect improvements in CKD care, it will be necessary to pair eGFR reporting with provider education to identify these patients and treat them effectively.Copyright © 2007 by National Kidney Foundation, Inc. [ABSTRACT FROM AUTHOR]