Medical ethics issues encountered in rehabilitation medicine differ from those in an acute care setting due to the complex relationships among the parties involved in rehabilitative care. The study examined the attitudes of Malaysian rehabilitation doctors toward medical ethics issues commonly encountered during patient care.
STUDY DESIGN: A cross-sectional experimental study.
OBJECTIVE: The purpose of this study is to examine the benefit of elastic abdominal binders on voluntary cough in persons with spinal cord injury.
SETTING: Spinal rehabilitation unit in a teaching hospital.
METHODS: We measured voluntary cough peak expiratory flow rate (in 21 subjects with spinal cord injury, (18 tetraplegia, 3 paraplegia) under three conditions: without abdominal binder as the baseline, with single-strap abdominal binder and triple-strap abdominal binder.
RESULTS: The results showed that the mean cough peak expiratory flow rate in all subjects without abdominal binder was 277.1 l per min. There was a significant increase in flow rate with the use of abdominal binders: 325.7 l per min with single-strap abdominal binder and 345.2 l per min with triple-strap abdominal binder (P<0.05, paired t-test). The mean cough peak expiratory flow rate in tetraplegic subjects using triple-strap abdominal binders was significantly higher compared with those using single-strap abdomina
l binders (322.1 l per min and 299.4 l per min, respectively).
CONCLUSION: Abdominal binders can be used as an effective method to improve cough ability in spinal cord injured patients, with triple-strap abdominal binder achieving greater cough peak expiratory flows.
Comment in: Frisbie JH. Question of stamina for the diaphragm. Spinal Cord. 2012 Jun;50(6):480. doi: 10.1038/sc.2011.164. Epub 2012 Jan 17. PubMed PMID: 22249332.
STUDY DESIGN: Cross-sectional survey.
OBJECTIVES: To investigate factors related to length of time between spinal cord injury (SCI) onset and start of first post-injury employment.
SETTING: Persons living with SCI in the community who are members of a disability support organization.
METHODS: Participants were randomly selected from the membership list of a non-governmental voluntary organization. They met the following four criteria: traumatic SCI, minimum of 15 years of age at the time of survey, a minimum of 2 years after SCI and had been employed for some time since SCI. The main outcome measure was time (in years) from injury onset to beginning first post-injury job.
RESULTS: Participants averaged 4.9 years (s.d. 5.1) from the time of SCI to their first post-injury job, with a range of 3 months to 20 years. Fifty percent of the participants who eventually returned to work had done so by 4 years. Return to pre-injury employer and employment were associated with early return, whereas having less years in education and being older at the time of injury were associated with longer time to return to work.
CONCLUSION: Rehabilitation team need to consider return to employment as a realistic goal even many years after SCI. Perhaps a focus on returning more people to their pre-injury employer and employment with added focus and input from rehabilitation team for those with lower education status and older age at time of injury might expedite the process of reintegration.