The outcomes of a vocational rehabilitation and mentorship program in unemployed young adults with acquired brain injury

BACKGROUND: Persons with disabilities are at risk for unemployment with negative long-term consequences. OBJECTIVE: This study aimed to explore the process and outcomes of a novel vocational rehabilitation (VR) program based on the concept of mentorship. METHODS: Observational, retrospective study including unemployed young adults with acquired brain injury (ABI) taking part in a VR program including assessment, training, individual counselling and mentor support from volunteering professionals. Adherence to the program and work status were registered and at follow-up all patients were invited to complete a general questionnaire and EuroQol 5D. RESULTS: 49 patients started the program, with 41 completing the follow-up. Median age was 31 years and 19 were male. Median duration of the program was 8 months. At follow-up, 9 patients had acquired paid employment, 7 with the support of a mentor; 6 of whom were bothered by health problems at work. Nine patients left the program prematurely, with insufficient financial support for continuation being the primary reason for withdrawal (n = 6). CONCLUSIONS: A VR program including a mentor may be a promising program for patients who are unemployed at onset of ABI. Lack of financial support to complete the program and concurrent health problems were found to hamper the process and outcomes of the program, respectively.

Validity of the Michigan Hand Outcomes Questionnaire in Patients With Stroke

OBJECTIVE

To investigate the measurement properties of the Dutch version of the Michigan Hand Outcomes Questionnaire (MHQ) in patients with stroke.

DESIGN

Validation study.

SETTING

Outpatient rehabilitation clinic.

PARTICIPANTS

Consecutive patients with stroke (N=51; mean age, 60±11y; 16 women [31%]).

INTERVENTIONS

Patients were asked to complete the MHQ (57 items) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Additional assessments included the Barthel Index and performance tests for hand function (Action Research Arm Test, Nine Hole Peg Test, Frenchay Arm Test, Motricity Index).

MAIN OUTCOME MEASURES

Associations between the MHQ and other outcome measures were determined using Spearman correlation coefficients and the internal consistency of the MHQ using Cronbach α. Floor or ceiling effects were present if >15% of the patients scored minimal or maximal scores, respectively. Test-retest reliability was established by the intraclass correlation coefficient.

RESULTS

The mean MHQ total score was 70.0±22.4, with Cronbach α being .97. The MHQ total score correlated significantly with the physical component summary of the SF-36, the Barthel Index, and all hand function performance tests (P<.01). The MHQ total score showed no floor or ceiling effects. The test-retest intraclass correlation coefficient was .97.

CONCLUSIONS

This study provides preliminary evidence that the MHQ is an internally consistent, valid, and reliable hand function questionnaire in outpatients after stroke, although these results need to be further confirmed.

Cell Salvage in Hip and Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We performed a meta-analysis to assess the effectiveness of cell salvage to reduce transfusions in THA and TKA separately, and to examine whether recent trials change the conclusions from previous meta-analyses.

METHODS

We searched MEDLINE through January 2013 for randomized clinical trials evaluating the effects of cell salvage in THA and TKA. Trial results were extracted using standardized forms and pooled using a random-effects model. Methodological quality of the trials was evaluated using the Cochrane Collaboration's tool for risk-of-bias assessment.

RESULTS

Forty-three trials (5631 patients) were included. Overall, cell salvage reduced the exposure to allogeneic RBC transfusion in THA (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.51 to 0.85) and TKA (RR, 0.51; 95% CI, 0.39 to 0.68). However, trials published in 2010 to 2012, with a lower risk of bias, showed no significant effect of cell salvage in THA (RR, 0.82; 95% CI, 0.66 to 1.02) and TKA (RR, 0.91; 95% CI, 0.63 to 1.31), suggesting that the treatment policy regarding transfusion may have changed over time.

CONCLUSIONS

Looking at all trials, cell salvage still significantly reduced the RBC exposure rate and the volume of RBCs transfused in both THA and TKA. However, in trials published more recently (2010 to 2012), cell salvage reduced neither the exposure rate nor the volume of RBCs transfused in THA and TKA, most likely explained by changes in blood transfusion management.