Baylor Scott and White Institute for Rehabilitation

Dubiel, R., B. Williams, E. Sullivan, L. Callender, M. Bennett and S. Driver (2019). “Prevalence of 25-Hydroxyvitamin D deficiency in the acute rehabilitation population following traumatic brain injury1.” NeuroRehabilitation Dec 18. [Epub ahead of print].

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OBJECTIVE: To determine the prevalence of vitamin D deficiency among individuals with traumatic brain injury (TBI) undergoing acute inpatient rehabilitation. SETTING: Inpatient Rehabilitation. PARTICIPANTS: Participants were admitted from November 1st, 2010 through June 30th, 2015 with diagnosis of mild-severe TBI and had serum 25 OH vitamin D levels checked upon admission. 369 out of 845 met inclusion. DESIGN: Retrospective cohort. MAIN MEASURES: 25 OH vitamin D, vitamin D treatment. RESULTS: The majority of patients were male (67%), Caucasian (89%) with private insurance (61%) and a mean age of 43.5+/-21.0 years. 25 OH vitamin D levels were categorized: deficient (<20 ng/mL), insufficient (20-29.9 ng/mL), and sufficient (>/=30 ng/mL). There were 95 (26%) patients that were deficient, 131 (36%) that were insufficient, and 143 (39%) that were sufficient. Race/ethnicity was found to be significant (p = 0.0145) with the largest percentage of Hispanics found in the insufficient and deficient categories, and the largest percentage of Blacks in the deficient category. Most patients with deficient or insufficient vitamin D levels were prescribed vitamin D replacement during their rehab stay (p < 0.0001). CONCLUSION: The majority of patients undergoing acute inpatient rehabilitation were found to have insufficient or deficient vitamin D levels, therefore it should be routinely screened and treated as indicated.

Cole, M., K. Froehlich-Grobe, S. Driver, R. Shegog and J. McLaughlin (2019). “Website Redesign of a 16-Week Exercise Intervention for People With Spinal Cord Injury by Using Participatory Action Research.” JMIR Rehabil Assist Technol 6(2): e13441.

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BACKGROUND: People with spinal cord injury (SCI) are at higher risk for numerous preventable chronic conditions. Physical activity is a protective factor that can reduce this risk, yet those with SCI encounter barriers to activity and are significantly less likely to be active. Limited evidence supports approaches to promote increased physical activity for those with SCI. OBJECTIVE: Building upon our previous theory- and evidence-based approach to increase participation in regular physical activity for those with SCI, this study aimed to use a participatory action research approach to translate a theory-based intervention to be delivered via the Web to individuals with SCI. METHODS: A total of 10 individuals with SCI were invited to participate in consumer input meetings to provide the research team with iterative feedback on an initial website designed as a platform for delivering a theory-based exercise intervention. RESULTS: A total of 7 individuals with SCI whose average age was 43.6 years (SD 13.4) and lived an average age of 12.5 years (SD 14.9) with SCI met on 2 occasions to provide their feedback of the website platform, both on the initial design and subsequently on the revamped site. Their iterative feedback resulted in redesigning the website content, format, and functionality as well as delivery of the intervention program. CONCLUSIONS: The substantially redesigned website offers an easier-to-navigate platform for people with SCI with greater functionality that delivers information using a module format with less text, short video segments, and presents more resources. Preliminary testing of the site is the next step.

Driver, S., C. Swank, K. Froehlich-Grobe, E. McShan, S. Calhoun and M. Bennett (2019). “Weight Loss After Stroke Through an Intensive Lifestyle Intervention (Group Lifestyle Balance-Cerebrovascular Accident): Protocol for a Randomized Controlled Trial.” JMIR Res Protoc 8(10): e14338. [Epub October 18]

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BACKGROUND: Weight gain can be a consequence of stroke, or cerebrovascular accident (CVA), because of impaired mobility, behavioral and emotional disorders, and sensory losses. Weight gain increases the patient’s risk of recurrent stroke and chronic diseases, such as diabetes, metabolic syndrome, and pulmonary and heart disease. Approaches to weight loss in this population are lacking, although necessary because of the unique physiological and cognitive needs of persons after a stroke. Evidence shows that intensive behavioral therapy interventions that address both physical activity and diet offer the greatest potential for weight loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight loss program that has been used extensively with the general population; this program was modified to meet the needs of people who have had a stroke (GLB-CVA). OBJECTIVE: This randomized controlled trial (RCT) aims to examine the efficacy of the GLB-CVA on weight and secondary outcomes, compared with that of a waitlist control group. METHODS: This RCT will enroll and randomize 64 patients over an 18-month period. RESULTS: Currently, 51 people are waitlisted, with 23 out of 51 screened and 16 out of 23 eligible. CONCLUSIONS: It is anticipated that the findings from this RCT will contribute to the evidence base regarding weight loss strategies for people living with stroke. CLINICAL TRIAL: ClinicalTrials.gov NCT03873467.

Kindratt, T., L. Callender, M. Cobbaert, J. Wondrack, F. Bandiera and D. Salvo (2019). “Health information technology use and influenza vaccine uptake among US adults.” Int J Med Inform 129: 37-42.

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OBJECTIVE: This study aims to estimate the association between health information technology (HIT) use and influenza vaccine uptake among US adults. MATERIALS AND METHODS: Data analysis was conducted using 2011-2015 National Health Interview Survey (NHIS) adult data (n = 169,912). HIT use was defined as having used computers (past 12 months) to seek health information, fill prescriptions, schedule appointments, communicate with health providers via email, and/or use online health chat groups. Crude and multivariable logistic regression models were used to estimate the odds of influenza vaccine uptake among HIT users versus non-users. Interactions were tested and stratified results were reported. RESULTS: Among US adults, 39.8% received an influenza vaccine in the past 12 months, while 48.6% reported any HIT use. After adjusting for covariates, any HIT users had 1.23 times greater odds (95% CI = 1.19, 1.27) of influenza vaccine uptake relative to non-HIT users. HIT use for looking up health information on the internet (OR = 1.19, 95% CI = 1.15, 1.23), filling prescriptions (OR = 1.56; 95% CI = 1.50, 1.66), scheduling appointments (OR = 1.56; 95% CI = 1.50, 1.66), and communicating with providers via email (OR = 1.51; 95% CI = 1.44, 1.59) were significantly associated with influenza vaccine uptake. DISCUSSION: HIT use is positively associated with influenza vaccine uptake. Each category of HIT use was independently associated with influenza vaccine uptake. To our knowledge, no other studies have evaluated the relationship between HIT use and influenza vaccine uptake. Our results are exploratory and represent an association, not a causal relationship. Longitudinal, confirmatory studies are also needed to verify our cross-sectional findings.

El-Ansary, D., T. K. LaPier, J. Adams, R. Gach, S. Triano, M. A. Katijjahbe, A. Hirschhorn, S. Mungovan, A. Lotshaw and L. P. Cahalin (2019). “An Evidence-Based Perspective on Movement and Activity Following Median Sternotomy.” Phys Ther Sep 2. [Epub ahead of print].

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Cardiac surgery via median sternotomy is performed in over 1 million patients per year worldwide. Despite evidence, sternal precautions in the form of restricted arm and trunk activity are routinely prescribed to patients following surgery to prevent sternal complications. Sternal precautions may exacerbate loss of independence and prevent patients from returning home directly after hospital discharge. In addition, immobility and deconditioning associated with restricting physical activity potentially contributes to the negative sequelae of median sternotomy on patient symptoms, physical and psychosocial function, and quality of life. Interpreting the clinical impact of sternal precautions is challenging due to inconsistent definitions and applications globally. Following median sternotomy, typical guidelines involve limiting arm movement during loaded lifting, pushing, and pulling for 6 to 8 weeks. In this perspective paper, we propose that there is robust evidence to support early implementation of upper body activity and exercise in patients recovering from median sternotomy while minimizing risk of complications. We advocate a clinical paradigm shift that encourages a greater amount of controlled upper body activity, albeit modified in some situations, and less restrictive sternal precautions. Early screening for sternal complication risk factors and instability followed by individualized progressive functional activity and upper body therapeutic exercise is likely to promote optimal and timely patient recovery. Substantial research documenting current clinical practice of sternal precautions, early physical therapy, and cardiac rehabilitation provides support and the context for understanding why a less restrictive and more active plan of care is warranted and recommended for patients following a median sternotomy.