Functional Outcomes In Persons Research Articles

MYOGENIC CONTRIBUTORS TO PHYSICAL FUNCTION IN OLDER ADULTS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS

Abstract Knee osteoarthritis (OA) is a leading cause of mobility disability among middle-aged and older adults, and contributes to significant global disease burden. The impact of knee OA on physical function varies widely across individuals, and the factors contributing to this heterogeneity are poorly understood. Recent compelling research suggests that myogenic factors, including muscle quality (MQ), may underly symptoms in knee OA. While MQ is gaining attention in aging research, the role of MQ on functional outcomes in persons with knee OA remains unknown. This pilot study examined morphological and neuromuscular biomarkers of MQ among adults aged 50 years and older (N=44) who met clinical criteria for symptomatic knee OA. Physical performance was assessed using the Short Physical Performance Battery (SPPB). MQ was quantified using B-mode ultrasound (echo intensity) and isokinetic strength measures (force/body mass). Associations between MQ and physical performance were determined, with consideration for clinical pain, age, sex, and body mass index. Pearson correlation analysis indicated SPPB scores were associated with clinical pain, strength, and MQ (r values ranged -.42 – 0.60, p’s< 0.05). Multivariable backward stepwise linear regression analysis demonstrated that MQ biomarkers contributed 39% to variance for SPPB score independent of clinical pain and strength, after adjustment for age, sex, and BMI (b’s = -0.32 – 0.45; p’s < 0.05). MQ is an important consideration for physical function in older adults with chronic knee OA pain, regardless of pain severity, and represents a potentially potent treatment target for disability prevention.

The influence of personality in persons with MS

BackgroundComprehending the influence of personality traits on functional outcomes in persons with Multiple Sclerosis (pwMS) can aid in tailoring interventions and support strategies. We explored how demographic variables and personality traits predicted current vocation, information processing speed, anxiety and depression symptoms, and disability level in pwMS. MethodsWe used a retrospective chart review on pwMS treated at the London (ON) MS Clinic, that assessed demographic data and personality traits. Participants were 384 (68.8 % females, mean age of 37.8, SD = 10.4) individuals with relapsing and primary progressive MS. We performed hierarchical linear regressions to predict outcomes while considering demographic variables and personality traits. ResultsYounger age, higher education, and conscientiousness were significant predictors for better information processing speed, current vocation, depression symptoms, and disability level. Neuroticism was positively associated with anxiety and depression symptoms, while extraversion was negatively associated with depression symptoms. Women showed higher anxiety symptoms, while men showed higher depression symptoms. ConclusionPersonality traits, such as neuroticism and conscientiousness, influence psychological outcomes in pwMS. Younger age and higher education are associated with better functional outcomes. Thus, when considering personality traits, future interventions should focus on those with higher neuroticism and lower scores on both extraversion and conscientiousness. Consideration of social support, coping strategies, and disease severity in future research may further enrich our understanding of MS outcomes.

The Efficacy of the Speed of Processing Training Program in Improving Functional Outcome: From Restoration to Generalization

ObjectiveTo examine the efficacy of Speed of Processing Training (SOPT) in improving everyday functional outcomes in persons with multiple sclerosis (MS). DesignRandomized controlled trial. SettingA nonprofit rehabilitation research institution and the community. ParticipantsIn total, 60 participants with MS with impaired processing speed were randomly assigned to SOPT (n=33) or an active control group (n=27). InterventionSOPT, a restorative computerized cognitive intervention involving 10 treatment sessions consisting of visual tasks designed to improve speed and accuracy of information processing Main Outcome MeasuresOutcomes included performance on the Timed Instrumental Activities of Daily Living (TIADL) and self-report of functional behavior, quality of life, and affect. ResultsThe treatment group showed improvement in the total TIADL score and 2 subtests compared with the active control group. Participants in the treatment group who demonstrated improved cognitive performance after the intervention also showed improved performance on one TIADL subtest. Quality of life, affective symptomatology, and self-reported functional status were not changed after the intervention. ConclusionsImprovement in underlying cognitive or perceptual deficits is thought to promote recovery and everyday performance as per the restorative approach to cognitive rehabilitation. However, this study showed only selected improvements in everyday functional outcomes for persons with MS.

Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials.

BackgroundTo evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases.MethodsThe PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL).ResultsA total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months.ConclusionsPRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.

A-121 Functional Outcomes in Bilingual Persons with Traumatic Brain: The Role of Mood

Abstract Introduction We examined the relationship between depression and anxiety, language, and functional outcomes in persons with traumatic brain injury (TBI). Methods The sample consisted of 48 acute TBI (ATBI: 23 Spanish-English Bilinguals; 25 English monolinguals), 30 chronic TBI (CTBI: 17 Spanish English Bilinguals; 12 English monolinguals), and 47 healthy comparison (HC: 29 Spanish-English Bilinguals; 18 English monolinguals) participants. The Hospital Anxiety and Depression Scale was used to measure depression (HADS-D) and anxiety (HADS-A). The Mayo Portland Adaptability Inventory-4 (MPAI-4) was used to measure functional outcomes (ability, adjustment, participation). Results An ANCOVA, controlling for age, revealed the ATBI group reported lower anxiety levels compared to the CTBI group, p = 0.034 np2 = 0.06. HC participants demonstrated significantly higher functional ability compared to both TBI groups, p < 0.05, np2 = 0.08–0.19. The ATBI group demonstrated worse participation scores compared to the CTBI and HC groups, p = 0.001, np2 = 0.11. Pearson correlations revealed mood was related to functional status in ATBI monolinguals (HADS-A: r = 0.29–0.64; HADS-D, r = 0.49–0.62). Monolingual participants with ATBI demonstrated correlations between depressive symptoms and functional adjustment (r = 0.57, p = 0.005) and ability (r = 0.44, p = 0.034). For monolinguals with CTBI, HADS-A correlated with functional outcomes, r = 0.60–0.66, p < 0.05. For bilinguals with CTBI, functional outcomes correlated with HADS-A, r = 0.53–0.66, p < 0.05, and HADS-D, r = 0.54–0.66, p < 0.05. For HC monolinguals, functional outcomes correlated with HADS-A, r = 0.53–0.70, p < 0.05, and HADS-D, r = 0.50–0.72, p < 0.05. Finally, for HC bilinguals, functional outcomes correlated with HADS-A, r = 0.59–0.68, p < 0.05. Conclusion Our results suggest that a relationship between anxiety and depressive symptoms is related more to functional outcomes in monolingual TBI survivors compared to bilingual TBI survivors.

Body Mass Index and Functional Outcomes in Persons with Spinal Cord Injury

To investigate the impact of body mass index (BMI) status on functional outcomes during initial hospital care among persons with spinal cord injury (SCI).

Exercise to improve functional outcomes in persons with osteoporosis: a systematic review and meta-analysis.

Four databases were searched and yielded 1587 citations. Two reviewers independently determined study eligibility, rated risk of bias, appraised methodological quality of studies, and resolved discordance by consensus. A total of 28 studies examining 2113 participants met inclusion criteria; 25 studies were suitable for meta-analyses. Four categories of exercise were identified using the ProFaNE taxonomy. After removing studies with high risk of bias and sorting them into intervention sub-types, we were able to sufficiently reduce the heterogeneity. The standardized mean difference (SMD) favored multicomponent exercise for mobility (- 0.56, 95% CI [- 0.81, - 0.32], p =0.06, I2= 51%); balance (0.50, 95% CI [0.27, 0.74], p =0.28, I2= 21%); and self-reported measures of functioning (- 0.69, 95% CI [- 1.04, - 0.34], p =0.02, I2= 61%). Trials were judged at low or unclear risk of selection bias, indicating inadequate reporting and at high risk of performance bias due to lack of participant blinding. The mean methodological quality rating of the studies was 63.5% indicating moderate quality. A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes. Due to substantial clinical heterogeneity of the target groups and specific demands of exercise modes, it is unclear which exercise program is optimal.

Constitutive activity of 5-HT2C receptors is present after incomplete spinal cord injury but is not modified after chronic SSRI or baclofen treatment.

After spinal cord injury (SCI), reflexes become hyperexcitable, leading to debilitating muscle spasms and compromised motor function. Previous work has described adaptations in spinal systems that might underlie this hyperexcitability, including an increase in constitutively active 5-HT2C receptors in spinal motoneurons. That work, however, examined adaptations following complete transection SCI, whereas SCI in humans is usually anatomically and functionally incomplete. We therefore evaluated whether constitutive activity of 5-HT2C receptors contributes to reflex hyperexcitability in an incomplete compression model of SCI and to spasms in vitro and in vivo. Our results confirm that 5-HT2C receptor constitutive activity contributes to reflex excitability after incomplete SCI. We also evaluated whether constitutive activity could be altered by manipulation of neural activity levels after SCI, testing the hypothesis that it reflects homeostatic processes acting to maintain spinal excitability. We decreased neural activity after SCI by administering baclofen and increased activity by administering the selective serotonin reuptake inhibitor (SSRI) fluoxetine. We found that drug administration produced minimal alterations in in vivo locomotor function or reflex excitability. Similarly, we found that neither baclofen nor fluoxetine altered the contribution of constitutively active 5-HT2C receptors to reflexes after SCI, although the contribution of 5-HT2C receptors to reflex activity was altered after SSRIs. These results confirm the importance of constitutive activity in 5-HT2C receptors to spinal hyperexcitability following SCI in the clinically relevant case of incomplete SCI but suggest that this activity is not driven by homeostatic processes that act to maintain overall levels of spinal excitability.NEW & NOTEWORTHY After spinal cord injury (SCI), most people will develop muscle spasms below their level of injury that can severely impact function. In this work, we examine the adaptations that occur within the spinal cord after SCI that contribute to these motor dysfunctions. We also evaluate one hypothesis about how these adaptations develop, which will potentially lead to intervention strategies to improve functional outcomes in persons with SCI.

Acute Effects of High-Intensity Interval Exercise on Physiological and Functional Outcomes in Multiple Sclerosis

Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system that results in physiological deconditioning and walking disability. High-intensity interval exercise (HIIE) has induced significant improvements in physiological conditioning in healthy and clinical populations. However, the effects of engaging in HIIE on cardiorespiratory functioning, gait, and walking performance in persons with MS who have mobility disability are relatively unknown. PURPOSE: To examine the effects of single sessions of recumbent stepping (HIIE) and continuous (CON) exercise on physiological and functional outcomes in persons with MS. METHODS: 5 participants with mild-to-moderate MS underwent HIIE and CON exercise bouts. The HIIE bout included 10 cycles of 1-min intervals at the wattage associated with 90% VO2peak followed by 1-min recovery intervals at 15W, totaling 20 min in length. The CON bout consisted of 20 min at the wattage associated with 50-60% VO2peak. Physiological measures were collected within session, and functional measures were collected pre-, immediately-post, and 10-minutes post-exercise. RESULTS: We observed significant differences between the CON and HIIE protocols for VO2 (t=-4.36, P=0.01), power output (t=-4.20, P=0.01), and RER (t=-7.24, P<0.01), with the HIIE condition inducing higher values than the CON condition. Heart rate approached a statistically significant difference between conditions (t=-2.61, P=0.06). There were no significant interaction effects or effects of time or condition on walking speed and gait kinematics (P>0.05). CONCLUSIONS: We determined that HIIE exercise taxes the cardiorespiratory system significantly more than CON exercise, yet without deleterious effects on walking and gait in persons with MS. This has important implications for informing an evidence-based exercise prescription in persons with MS who have walking impairments that is appropriate for improving physiological conditioning.

Impact of pre-injury family functioning and resources on self-reported post-concussive symptoms and functional outcomes in persons with mild TBI

Objective: This study investigates the contribution of pre-injury family functioning and resources on self-reported post-concussive symptoms and functional outcomes in persons with mild TBI (mTBI).Design: Participants with uncomplicated or complicated mTBIs were recruited from consecutive admissions to the emergency department of a level 1 trauma centre. Patients completed baseline assessments within 2 weeks of injury and an outcomes assessment at 3 months post-injury.Methods and procedures: One hundred and sixty-six adults with mTBI were included. Baseline measures of pre-injury history, family functioning and resources were obtained. Functional status assessments and self-reported measures of health, common TBI symptoms and psychological problems were administered at 3-months post-injury.Results: Data reduction of outcome measures using principle components analysis revealed two factors: self-reported post-concussive symptoms and current functional/participation status, explaining 60.53% of the variance. Family resources (β = –0.239, t(150) = –2.84, p = 0.005) and age (β = –0.170, t(150) = –2.19, p = 0.030), but not family functioning, were significant predictors of self-reported post-concussive symptoms at follow-up, R2 = 0.051, F(5, 150) = 4.09, p = 0.002. Neither family resources nor functioning predicted current functional/participation status.Conclusions: Fewer family resources and younger age were associated with increased self-reported post-concussive symptoms. Fewer resources may be a potential risk factor to heightened perception of post-concussive symptoms. Providing low-cost counselling or resource facilitation services may improve outcomes for those with limited resources after mTBI.

Internet-Supported Physical Exercise Training for Persons with Multiple Sclerosis-A Randomised, Controlled Study.

Physical exercise is effective in improving functional outcomes in persons with multiple sclerosis (pwMS). We evaluated the feasibility and effectiveness of internet-based exercise training (e-training) for pwMS on health-related quality of life (HrQoL). Secondary outcomes were muscle strength, aerobic capacity, lung function, physical activity, and fatigue. This is a randomised, controlled trial with a wait-list control group. Data were collected at baseline, after three and six months, and analysed using a hybrid linear model. One-hundred twenty-six pwMS participated in the home-based aerobic (1×/week) and strength training (2×/week) intervention that was supervised and documented via an internet-platform. The intervention group received e-training for six months, and the control group received e-training after a three months waiting period. Significant differences between the groups were only observed for muscle strength (knee flexion (effect size ES = 0.3, p = 0.003), knee extension (ES = 0.24, p = 0.015)), peak expiratory flow (ES = 0.2, p = 0.039), and sports activity (ES = 0.33, p = 0.001) after three months. E-training had no effect on HrQoL but did on muscle strength, lung function, and physical activity. It is a promising and feasible approach to facilitate large-scale, yet individual, training support.

Testing a modification of cognitive adaptation training: Streamlining the model for broader implementation

Cognitive adaptation training (CAT) is a home-based, manualized treatment that utilizes environmental supports to improve target behaviors and functional outcomes in persons with schizophrenia. Although clinical trials have shown CAT to be effective across functional, clinical, and treatment adherence domains, when the intervention is withdrawn clients experience significant declines. The aim of the current study was to test a modified version of CAT, which decreases the duration of intensive CAT intervention while utilizing ongoing case management-supported CAT to maintain the fundamental components of the treatment. Twenty-three people participated in an outcome study of the modified version of CAT, evaluating improvements after 4months of CAT specialist intervention and after an additional 5months of case manager support. Analysis revealed significant improvements in adaptive functioning, psychiatric symptomatology, and goal attainment, which were maintained throughout case management follow-up. This suggests that an intervention that has previously demonstrated good functional outcomes in randomized trials might sustain its impacts in an abbreviated format with support from existing case managers.

The Neurobiological Foundation of Neurologic Music Therapy

Neurologic music therapy (NMT) is a specific methodology of music therapy that is based on neuroscience models of music perception and production. Codified NMT techniques are developed out of basic and applied research on the unique effects of music on the brain. The distributed nature of neuronal networks for music processing in the brain, combined with the precise temporal processing ability of the auditory system, makes music a valuable tool for rehabilitation of sensorimotor, communication, and cognitive functions. A large number of clinical studies have demonstrated that music stimuli applied systematically can yield functional outcomes in persons with stroke, Parkinson disease, multiple sclerosis, and other conditions. The purpose of this article is to explain the neurobiological foundation of NMT and explore relevant research in clinical populations.

The impact of social cognition training on recovery from psychosis

Social cognition training is an emerging intervention, which aims to ameliorate impairment in social interaction and improve functional outcomes in persons with a psychosis. This article reviews the research conducted on the impact of this intervention published in English language journals over the past 2 years. Social cognition training comprises three types of programs; targeted, broad-based, and comprehensive - targeted programs being the most effective. Programs largely focus on the domains of facial affect, or emotion recognition (FAR), Theory of Mind (ToM), and attributional bias. There is some evidence that ToM is amenable to change, but not FAR and attributional bias. Interventions designed to ameliorate impairment in social functioning largely involve a skills training laboratory model underpinned by social learning theory. The evidence for the effectiveness of current social cognition training strategies to improve functional outcome for persons with psychosis in general and schizophrenia in particular remains equivocal. Clearly, further work is required beyond the laboratory training model and future research may well benefit from the inclusion of longitudinal naturalistic studies.

“Functional Pain,” Functional Outcomes, and Quality of Life After Hyaluronic Acid Intra-articular Injection for Knee Osteoarthritis

To compare the effect of hyaluronic acid (HA) intra-articular knee injections on pain and functional outcomes in persons with knee osteoarthritis (OA) over 6 months, and to determine whether or not changes in functional pain are related to improvements in quality of life. A prospective cohort study. A research laboratory in an academic medical center. Patients with knee OA (N = 53) who were receiving medical care for OA. Intra-articular knee injections of HA (3 injections, each separated by 1 week) and a comparative noninjection group. Functional pain and outcomes assessments during chair rise, stair climbing, and a 6-minute walking test (by using 0-10 point numerical pain ratings during each test); gait parameters; Medical Outcomes Short Form-36 (SF-36) scores and subscores; the Western Ontario McMaster University Osteoarthritis Index (WOMAC). Six months after HA, the completion times for the chair rise and stair climb tasks, and the distance covered during the 6-minute walk were not different between the groups. However, functional pain ratings during stair climbing decreased in the HA-treated group (P = .05). Six-month changes in gait velocity, cadence, stride length, step length, and the percentage of the gait cycle spent in single support were all higher after HA injection at month 6 (all P < .05). Significant group-by-time interactions existed for total WOMAC scores. SF-36 Vitality subscores improved by 13%, and Role Physical scores were higher in patients treated with HA injection compared with participants in the noninjection group (P < .05). Regression analyses revealed that changes in the functional pain measures did not correspond with SF-36 scores. HA is associated with lower functional pain severity, with minimal impact on functional test scores. We interpreted this finding to represent an increase in the quality of the movement and functional activity. The change in functional pain did not correspond to changes in SF-36 quality-of-life scores.

Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India

Context:Longer duration of untreated psychosis (DUP) is known to be associated with poorer outcome of schizophrenia. DUP is also known to be longer in lower- and middle-income countries. Methodologically sound studies that have examined the association of DUP and outcome of schizophrenia in these countries are lacking.Aim:The aim was to evaluate the association between DUP and outcome of never-treated schizophrenia patients.Setting and Design:This study was conducted at the National Institute of Mental Health and Neurosciences, Bangalore, using a prospective cohort design.Materials and Methods:119 patients with schizophrenia/schizophreniform disorder diagnosed using the computerized diagnostic interview schedule for DSM-IV (CDIS-IV) were further assessed for DUP with the interview for retrospective assessment of onset of schizophrenia (IRAOS). After a mean (SD) follow-up period of 55.9 (37.2) weeks, the social and occupational functioning and psychopathology of 93 (80.2% of the surviving patients) patients were assessed using the social and occupational functioning scale (SOFS) and the positive and negative syndrome scale (PANSS), by raters blind to the DUP data. Spearman's correlation and Kendall's tau-B test were used to analyze the relationship between DUP and the outcome variables.Results:The mean DUP was 90.2 (median=30.1; SD=121.9) weeks. SOFS and PANSS scores at follow-up were statistically significantly associated with DUP, but not with other baseline variables (SOFS: rho=0.22, P=0.03; PANSS: rho=0.23, P=0.03). Among those with the shortest DUP (<16 weeks; n=33), 45.5%, 30.3%, and 24.2% had no impairment, mild-moderate impairment, and severe impairment, respectively. In contrast, 19.4%, 38.7%, and 41.9% of those with the longest DUP (>72 weeks; n=31) had no, mild-moderate, and severe impairment, respectively (Kendall's Tau-b=0.194; P=0.025).Conclusions:The delay in accessing treatment among patients with psychosis is considerable in India, a lower- to middle-income country. Longer DUP is associated with poorer psychopathological and functional outcomes in persons with schizophrenia/schizophreniform disorder.

Randomized Controlled Trial of Illness Management and Recovery in Multiple-Unit Supportive Housing

This study evaluated the effects of the illness management and recovery program on mental illness and functional outcomes of persons with serious mental illness who were receiving supportive housing services. A randomized controlled trial was conducted with 104 persons with serious mental illness who were assigned either to illness management classes for six months or to a waitlist control group, with follow-up assessments conducted six months posttreatment. Assessments included self-reports, nonblinded clinical ratings, and blinded interview ratings and included the domains of illness management, symptoms, psychosocial functioning, hospitalizations, and substance abuse and dependence. Participants assigned to the program showed significantly greater improvements than the control group in self-reported and clinician ratings of illness management, interview-based ratings of symptoms on the Brief Psychiatric Rating Scale, and interview-based ratings of psychosocial functioning on the abbreviated Quality of Life Scale. Participants in both groups improved in self-ratings of symptom distress and had low rates of hospitalization and substance abuse over the course of the study. The results suggest that the program was effective at improving illness management and functional outcomes for persons with serious mental illness who were receiving supportive housing services.

Neurocognitive and functional outcomes in persons recovering from West Nile virus illness

Long-term neurocognitive and functional impairments following West Nile virus (WNV) disease are poorly understood. We assessed quality-of-life indices and neurocognitive performance in a cohort of 54 persons recovering from one of three WNV disease syndromes (fever [WNF], meningitis [WNM], or encephalitis [WNE]) approximately 1.5 years following acute illness. We compared findings between the three syndromic groups; the study cohort and a demographically similar group of 55 controls from a study of chronic fatigue syndrome (CFS); and the study cohort and a 'normative' control population based on cognitive test data. Persistent symptoms, diminished quality of life, and functional impairment were reported by 50% of WNF patients, and 75% each of WNM and WNE patients. Overall, objective neurocognitive performance did not differ significantly between the three syndromic groups, or between the study cohort and the CFS controls or the normative controls. In some neurocognitive subtests, the study cohort scored below the 15th percentile when compared with normative control data. Most persons who returned to independent living following hospitalization for WNV illness had persistent subjective complaints, but had normal cognitive function. However, a minority displayed subtle neurocognitive deficits more than 18 months following acute disease.

Duloxetine for the Management of Diabetic Peripheral Neuropathic Pain: Evaluation of Functional Outcomes

To assess the effectiveness of duloxetine, compared with placebo, on patient-reported health outcomes over a 12-week period, in the management of diabetic peripheral neuropathic pain (DPNP). The results were pooled from three 12-week multicenter, double-blind studies. In study 1 (N = 457), patients with DPNP were randomly assigned to treatment with duloxetine 20 mg once daily (QD), 60 mg QD, 60 mg twice daily (BID), or placebo. In studies 2 (N = 334) and 3 (N = 348), patients with DPNP were randomly assigned to treatment with duloxetine 60 mg QD, 60 mg BID, or placebo. Patient-reported functional outcomes were measured by the Short Form 36 (SF-36), the interference portion of the Brief Pain Inventory (BPI), and EuroQol 5D Health Questionnaire (EQ-5D). Results for all functional outcomes from the intent-to-treat and completer populations are discussed. In the SF-36 health survey and the BPI interference, duloxetine 60 mg QD and 60 mg BID were significantly superior to placebo in all the domains (P <or= 0.03). In the analysis of the EQ-5D, duloxetine 60 mg QD (P = 0.004) and 60 mg BID (P < 0.001) were significantly better than placebo on all items. Acute treatment with duloxetine was associated with significant improvement in functional outcomes in persons with DPNP.

Article 14: Effect of a wheelchair-mounted robotic arm on functional outcomes in persons with spinal cord injury

Objective: To determine the effect of a wheelchair-mounted robotic arm (WMRA) on function in persons with spinal cord injury (SCI). Design: Participants enrolled in the 2-week protocol. Setting: Veterans Affairs medical centers in Houston and Pittsburgh. Participants: 11 men (mean age, 42±12y) with cervical SCI (C3–4 to C6–7). All used power wheelchairs with joystick controls. Intervention: Training took place for 6 hours over 3 days. Subjects practiced activities of daily (ADL) tasks for 14 hours over 7 days. Tasks were timed and subjects were classified functionally as dependent (0), needs assistance (1), or independent (2). After 2 weeks, they were reevaluated for functional improvement with the WMRA. Main Outcome Measures: Number and time to complete tasks were calculated. Results: Mean ADL scores (independence) at reevaluation were significantly higher ( P<.02) than at baseline. Average ADL performance times decreased from 226 to 171 seconds, a statistically significant reduction in time ( P<.0001). Data revealed significant differences in subjects’ functional independence and time to complete tasks with the WMRA in 7 activities ( P<.05). Conclusions: The WMRA has the potential to enable persons with SCI to perform functional tasks that would otherwise be impossible for them. However, design problems (ie, added wheelchair width when WMRA is installed) interfered with maximum utilization and satisfaction.