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Clavet H.,University of Ottawa | Doucette S.,Ottawa Health Research Institute | Trudel G.,University of Ottawa | Trudel G.,Ottawa Hospital Rehabilitation Center
Disability and Rehabilitation

Purpose: To investigate the mortality, quality of life and functional limitations of intensive care unit (ICU) patients with and without joint contractures 3.3 years after discharge from the hospital. Methods: 155 consecutive patients admitted to a primary care referral centre ICU for 2 or more weeks with information on joint range of motion formed a retrospective cohort. The EuroQol and a Joint Contracture Questionnaire were administered to the cohort survivors. Results: Fifty patients returned the questionnaires, 57 did not return the questionnaire, and 48 were deceased. The patients who had died presented significantly more joint contractures in the ICU than the respondents and the non-respondents (p = 0.003 and p = 0.006, respectively). More respondents who reported limitations in their mobility on the EuroQol had joint contractures in ICU 13/18 (72.2%) compared to respondents who did not have contractures 7/21 (33.3%; p = 0.02). Conclusions: Joint contractures in ICU were associated with higher mortality. Patients who spent 2 weeks or more in ICU and developed joint contractures identified more difficulty with mobility 3.3 years after discharge; joint contractures may impose irreversible disability. A strategy to identify and treat joint contractures in ICU may prevent long-term functional limitations. © 2015 Informa UK Ltd. Source

Trudel G.,University of Ottawa | Laneuville O.,University of Ottawa | Coletta E.,University of Ottawa | Goudreau L.,Ottawa Hospital Rehabilitation Center | Uhthoff H.K.,University of Ottawa
Journal of Applied Physiology

Joint contractures alter the mechanical properties of articular and muscular structures. Reversibility of a contracture depends on the restoration of the elasticity of both structures. We determined the differential contribution of articular and muscular structures to knee flexion contractures during spontaneous recovery. Rats (250, divided into 24 groups) had one knee joint surgically fixed in flexion for six different durations, from 1 to 32 wk, creating joint contractures of various severities. After the fixation was removed, the animals were left to spontaneously recover for 1 to 48 wk. After the recovery periods, animals were killed and the knee extension was measured before and after division of the transarticular posterior muscles using a motorized arthrometer. No articular limitation had developed in contracture of recent onset (≤2 wk of fixation, P > 0.05); muscular limitations were responsible for the majority of the contracture (34 ± 8° and 38 ± 6°, respectively; both P ± 0.05). Recovery for 1 and 8 wk reversed the muscular limitation of contractures of recent onset (1 and 2 wk of fixation, respectively). Long-lasting contractures (≥4 wk of fixation) presented articular limitations, irreversible in all 12 durations of recovery compared with controls (all 12 P < 0.05). Knee flexion contractures of recent onset were primarily due to muscular structures, and they were reversible during spontaneous recovery. Long-lasting contractures were primarily due to articular structures and were irreversible. Comprehensive temporal and quantitative data on the differential reversibility of mechanically significant alterations in articular and muscular structures represent novel evidence on which to base clinical practice. Copyright © 2014 the American Physiological Society. Source

Murray M.A.,University of Ottawa | Stacey D.,University of Ottawa | Wilson K.G.,Ottawa Hospital Rehabilitation Center | O'Connor A.M.,University of Ottawa
Journal of Palliative Care

The effect of a program to train clinicians to support patients making decisions about place of end-of-life care was evaluated. In all, 88 oncology and/or palliative care nursing and allied health providers from three Ontario health networks were randomly assigned to an education or control condition. Quality of decision support provided to standardized patients was measured before and after training, as were participants' perceptions about the acceptability of the training program and their intentions to engage in patient decision support. Compared to controls, intervention group members improved the quality of decision support provided and were more likely to address a wider range of decision-making needs. Intervention group members scored higher on a knowledge test of decision support than controls and rated the components as acceptable. Improvements in the quality of decision support can be made by providing training and practical tools such as a patient decision aid. Source

Winck J.C.,University of Porto | LeBlanc C.,Ottawa Hospital Rehabilitation Center | Soto J.L.,Linde Group | Plano F.,Linde Group
Revista Portuguesa de Pneumologia

Insufficient cough strength has a major role in extubation and decannulation outcomes. Cough capacity can be easily evaluated by measuring flows during coughing. Values vary depending on whether cough flows are measured through the mouth or through a tracheostomy or endotracheal tube. It is important to standardize these measurements and start using them routinely in the extubation and decannulation processes. Values of cough peak flow >160 L/min measured at the mouth or a value of cough PEF >60 L/min measured at the endotracheal tube suggest successful decannulation or extubation. © 2014 Sociedade Portuguesa de Pneumologia. Source

Spring A.N.,University of Waterloo | Kofman J.,University of Waterloo | Lemaire E.D.,Ottawa Hospital Rehabilitation Center
IEEE Transactions on Neural Systems and Rehabilitation Engineering

Individuals with quadriceps muscle weakness often have difficulty generating the knee-extension moments required to complete common mobility tasks. A new device that provides knee-extension moments through a range of knee angles was designed to help individuals perform stand-to-sit and sit-to-stand tasks. The novel knee-extension assist (KEA) was designed as a modular component to be incorporated into existing knee-ankle-foot orthoses or used in a knee orthosis. During stand-to-sit, a set of springs is loaded as the knee flexes under bodyweight and the KEA thus provides a knee-extension moment that aids in achieving a smoothly controlled knee flexion. The springs can be locked in place at the end of knee flexion to prevent unwanted knee extension while the user is seated. The entire knee extension assist can be disengaged to allow free joint motion anytime the affected leg is unloaded. During sit-to-stand, the KEA assists knee extension by returning the energy stored in the springs as an extension moment. In mechanical testing of a prototype of the new KEA, a mean maximum extension moment of 42.9 $\pm$ 0.46 Nm was provided by the device during flexion and 28.4 $\pm$ 0.28 Nm during extension. A biomechanical evaluation with two able-bodied individuals demonstrated the effectiveness of the KEA in successfully assisting stand-to-sit and sit-to-stand tasks. During stand-to-sit, the KEA provided 82% and 75% of the total (muscle and KEA) knee-extension moment required by the braced leg for the task for the two subjects, respectively; and during sit-to-stand, the KEA provided 56% and 50% of the total knee-extension moment for the two subjects, respectively. This KEA performance exceeded 50% knee-extension moment assistance for a 70 kg person. © 2011 IEEE. Source

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