Impact of urinary incontinence on medical rehabilitation inpatients.

Aims: To determine the prevalence of urinary incontinence (UI) and its association with rehabilitation outcomes in patients receiving inpatient medical rehabilitation in the United States.

Methods: A retrospective, cohort study of 425,547 Medicare patients discharged from inpatient rehabilitation facilities (IRFs) in 2005. We examined prevalence of UI at admission and discharge for 5 impairment groups.

Relationship of meeting physical activity guidelines with quality-adjusted life-years.

Objective: The quality-adjusted life-year (QALY) is a standard outcome measure used in cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines is associated with higher QALY estimates among adults with or at an increased risk for knee osteoarthritis.

Methods: This is a prospective study of 1794 Osteoarthritis Initiative participants.

Relationship of meeting physical activity guidelines with health-related utility.

Objective: Health-related utility measures overall health status and quality of life and is commonly incorporated into cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines translates into better health-related utility in adults with or at risk for knee osteoarthritis (OA).

Methods: Cross-sectional data from 1,908 adults with or at risk for knee OA participating in the accelerometer ancillary study of the Osteoarthritis Initiative were assessed.

Comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after hip fracture repair.

Objective: To examine differences in rehabilitation outcomes across 3 post-acute care (PAC) rehabilitation settings for patients after hip fracture repair.

Design: Prospective, observational cohort study.

Setting: Six skilled nursing facilities (SNFs), 4 inpatient rehabilitation facilities (IRFs), and 8 home health agencies (HHAs) in 10 states.

Racial and ethnic differences in physical activity guidelines attainment among people at high risk of or having knee osteoarthritis.

Objective: This cross-sectional study examined racial/ethnic differences in meeting the 2008 United States Department of Health and Human Services Physical Activity Guidelines aerobic component (≥150 moderate-to-vigorous minutes/week in bouts of ≥10 minutes) among persons with or at risk of radiographic knee osteoarthritis (RKOA).

Methods: We evaluated African American versus white differences in guideline attainment using multiple logistic regression, adjusting for sociodemographic (age, sex, site, income, and education) and health factors (comorbidity, depressive symptoms, overweight/obesity, and knee pain). Our analyses included adults ages 49-84 years who participated in accelerometer monitoring at the Osteoarthritis Initiative 48-month visit (n = 1,142 with RKOA and n = 747 at risk of RKOA).

Relationship between physical activity and health-related utility among knee osteoarthritis patients.

Objective: To estimate the relationship between physical activity and health-related utility for people with knee osteoarthritis (OA) and implications for designing cost-effective interventions.

Methods: We used generalized estimating equation regression analysis to estimate partial association of accelerometer-measured physical activity levels with health-related utility after controlling for demographics, health status, knee OA severity level, pain, and functioning.

Results: Moving from the lowest to the middle tertile of physical activity level was associated with a 0.

Public health impact of risk factors for physical inactivity in adults with rheumatoid arthritis.

Objective: To investigate the potential public health impact of modifiable risk factors related to physical inactivity in adults with rheumatoid arthritis (RA).

Methods: A cross-sectional study used baseline data from 176 adults with RA enrolled in a randomized controlled trial assessing the effectiveness of an intervention to promote physical activity. Accelerometer data were assessed for inactivity (i.

Association of functional status with changes in physical activity: insights from a behavioral intervention for participants with arthritis.

Objective: To analyze change over 6 months in accelerometer-measured physical activity for participants with arthritis in a physical activity promotion trial. We tested the hypothesis that participants with the highest baseline functional capacity, regardless of their intervention status, experienced the greatest increases in physical activity levels at 6-month follow-up.

Design: At baseline, participants were interviewed in person, completed a 5-minute timed walk, and wore a biaxial accelerometer for 1 week, with a subsequent week of accelerometer wear at 6 months.

Gender differences in cholesterol-lowering medication prescribing in peripheral artery disease.

Among 320 patients with lower extremity peripheral artery disease (PAD) and low-density lipoprotein-cholesterol (LDL-C) levels > 70 mg/dl, we determined whether male sex, higher education, and greater self-efficacy for willingness to request therapy from one's physician were associated with increases in LDL-C-lowering medication and achievement of an LDL-C level < 70 mg/dl at 1-year follow-up. Participants were enrolled in a randomized controlled clinical trial to determine whether a telephone counseling intervention can help PAD patients achieve an LDL-C level < 70 mg/dl, compared to usual care and attention control conditions, respectively. Adjusting for age, race, comorbidities, PAD severity, and other covariates, male sex (odds ratio = 3.

Relationship between accelerometer-based measures of physical activity and the Yale Physical Activity Survey in adults with arthritis.

Objective: To evaluate the correlation between the Yale Physical Activity Survey (YPAS) scores and objective accelerometer measures of time spent in light intensity physical activities, moderate to vigorous intensity physical activities, and moderate to vigorous activities in bouts lasting at least 10 minutes.

Methods: This study analyzed baseline data from 171 persons with rheumatoid arthritis (RA) and 139 persons with osteoarthritis (OA) in a randomized clinical trial (Increasing Motivation for Physical Activity in Arthritis Clinical Trial). Persons fulfilling the 1987 American College of Rheumatology criteria for RA and persons with symptomatic radiologic knee OA (Kellgren/Lawrence class ≥2) wore an accelerometer for 7 days, then responded to the YPAS questionnaire and questions regarding demographics (age, sex, and race) and health factors (body mass index, disease status [Health Assessment Questionnaire/Western Ontario and McMaster Universities Osteoarthritis Index], comorbidities, pain, and function).

Activating peripheral arterial disease patients to reduce cholesterol: a randomized trial.

Background: Peripheral arterial disease patients are less likely than other high-risk patients to achieve ideal low-density lipoprotein (LDL) cholesterol levels. This randomized controlled trial assessed whether a telephone counseling intervention, designed to help peripheral arterial disease patients request more intensive cholesterol-lowering therapy from their physician, achieved lower LDL cholesterol levels than 2 control conditions.

Methods: There were 355 peripheral arterial disease participants with baseline LDL cholesterol ≥70 mg/dL enrolled.

A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.

Objective: To examine differences in outcomes of patients after lower-extremity joint replacement across 3 post-acute care (PAC) rehabilitation settings.

Design: Prospective observational cohort study.

Setting: Skilled nursing facilities (SNFs; n=5), inpatient rehabilitation facilities (IRFs; n=4), and home health agencies (HHAs; n=6) from 11 states.

Gender disparities in health and healthcare use among older adults.

Background: Gender differences in health and the use of health services are a long-standing concern for the U.S. medical system.

Effects of etiology on inpatient rehabilitation outcomes in 65- to 74-year-old patients with incomplete paraplegia from a nontraumatic spinal cord injury.

Objective: To examine differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT-SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess.

Design: Retrospective cohort study that used Medicare claims and assessment data.

Setting: A total of 479 inpatient rehabilitation hospitals and units.

Assessing physical activity in persons with rheumatoid arthritis using accelerometry.

Purpose: To investigate empirically if the nonwear threshold and the "valid day" definition for accelerometer data from the general adult US population are appropriate for accelerometer data from persons with rheumatoid arthritis (RA).

Methods: This study analyzed data from 107 persons with RA participating in the baseline (2006-2008) accelerometer assessment from two studies with common inclusion/exclusion criteria. We examined candidate nonwear thresholds ranging from 20 to 300 min of zero activity count.

Impact of Medicare's prospective payment system for inpatient rehabilitation facilities on stroke patient outcomes.

Objective: To estimate the effect of Medicare's prospective payment system for inpatient rehabilitation facilities on discharge functional status, community discharge, and length of stay.

Design: Secondary analysis using data drawn from the American Medical Rehabilitation Providers Association subscription database. Eligible patients were Medicare and non-Medicare stroke patients discharged from inpatient rehabilitation facilities from 1998 through the first two quarters of 2006.

Differences in medical care expenditures for adults with depression compared to adults with major chronic conditions.

Background: Approximately 17.1 million adults report having a major depressive episode in 2004 which represents 8% of the adult population in the U.S.

Patient-reported changes in communication after computer-based script training for aphasia.

Objective: To evaluate changes in patient-reported communication difficulty after a home-based, computer-delivered intervention designed to improve conversational skills in adults with aphasia.

Design: Delayed treatment design with baseline, preintervention, postintervention, and follow-up observations.

Setting: Outpatient rehabilitation.

Assisted living pilot program: utilization and cost findings.

Objective. The Department of Veterans Affairs funded assisted living, adult family home, and adult residential care for the first time in the Assisted Living Pilot Program (ALPP). This article compares the use and cost for individuals that entered ALPP and a comparison group.

Correlates of improvement in walking ability in older persons in the United States.

Objectives: We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study.

Methods: We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors.

Assisted living pilot program: health outcomes.

Objectives. Assisted living programs demonstrate variation in structure and services. The Department of Veterans Affairs funded this care for the first time in the Assisted Living Pilot Program (ALPP).

Trends in the supply of inpatient rehabilitation facilities services: 1996 to 2004.

Objectives: Describe the supply of inpatient rehabilitation facilities (IRFs) services in 1996 and examine changes between 1996 and 2004, including the impact of the IRF prospective payment system (PPS) in 2002 on organizational trends.

Design: Retrospective pre-post design.

Setting: Freestanding and subprovider (distinct-part units) IRFs.

Trends in out-of-pocket medical care expenditures for Medicare-age adults with arthritis between 1998 and 2004.

Objective: To provide estimates of the growth in out-of-pocket (OOP) medical expenditures for persons with arthritis.

Methods: OOP medical expenditures were estimated for 1998-2004 based on 7 panels of the Medical Expenditures Panel Survey, which provide nationally representative data. A simple simulation then extrapolated the data through 2006, for which the potential effects of Medicare Part D drug coverage were computed.

Age and racial/ethnic disparities in arthritis-related hip and knee surgeries.

Background: Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed.

Racial/ethnic differences in the development of disability among older adults.

Objectives: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.

Methods: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.