by Shari M. Ling, M.D.
- Assistive Devices
- The Physician’s Role
- Rehabilitation Settings
- Medical Issues for the Rehabilitation Patient
- Rehabilitation Resources
- Selected References
A variety of devices are available to assist with mobility and self-care. Devices are designed to compensate for functional deficits but should be fitted for each patient’s individual needs. These devices should therefore be prescribed in consultation with an interdisciplinary team. The cost of some aids are covered by Medicare or other insurance policies but must be either ordered or prescribed by a physician. Devices prescribed for nursing home residents are provided by the nursing home. Self-care devices may be purchased upon discharge from an in-patient rehabilitation program or after returning home. Standard wheel chairs may be rented (reimbursable 80%) or purchased. Rental is preferable since repairs are covered by the rental agency. Custom-fitted wheelchairs are expensive and must be fitted to each patient’s needs. A physician’s prescription or order is required for insurance reimbursement, and should be written in such a way that therapists have some latitude to adjust a device to the patient’s needs.
|Mobility Devices||Objective||Advantages||Disadvantages||Reim- bursement|
|mobility for those who are unable to ambulate or have poor endurance||standard: easy transport; patient remains active|
power: allows quadriplegics & patients with poor lower extremity function to remain independent
|standard: energy expenditure;|
power: requires intact vision & reason; expense; high maintenance; less portable
|Medicare 80%Other Plans: vary 80-100%|
|stability and support||standard: greatest stability|
rolling: easier to lift; more normal gait pattern; better balance
hemi: larger base of support; stability for patients with 1 functional arm
platform: allows for weight bearing by humerus
|standard: difficult to maneuver; impossible on stairs; changes normal gait speed/pattern|
rolling: less stable, less control, requires an even/smooth surface
hemi: does not fit on stairs
|All walking aids covered by Medicare 80%|
|weight redistribution, compensate for visual & proprioceptive losses||varying degrees of stability and support||All walking aid covered by Medicare 80%|
|improve balance, redistribute weight||axillary: can achieve less than full weight bearing; more support than a cane|
Canadian: allows hand use & reaching
|axillary: plexus injury; less stables than a walker; requires good standing balance & upper extremity strength|
Canadian: less stable; same as axillary
|All walking aid covered by Medicare 80%|
As with mobility devices, rehabilitation team members should be used as resources to identify and specify the devices that are best suited to each patient’s needs. This list provides a small sample of devices. Self-care devices vary in cost and as a whole are not reimbursable.
Long handle sponge
Tub grab bar
|Meal Preparation||Cutting Board|
Raised toilet seat
- Physical Therapy
- Occupational Therapy
- Speech and Language Pathology
- Recreational Therapy
- Vocational Rehabilitation
- Social Worker
- Nurse & Physician’s Assistant
- Problem Specific Programs
- Goal:To maximize safe and independent mobility
- Objectives: Build strength & endurance, improve balance, & coordination, improve lower extremity joint range of motion & function, improve transfers and ambulation. Improve safety awareness. Management of orthotic/prosthetic and assistive devices. Selection of appropriate wheel chair seating.
- Modalities: Superficial heat or cold, deep heat, electrical stimulation, and massage to reduce pain and spasm and to promote stretching; hydrotherapy for wound care
- Home environment: modifications to improve safety and a barrier free accessibility
- Goal: To maximize safe and independent self-care
- Objectives: Build upper extremity strength, fine motor skills, coordination & dexterity. Improve upper extremity joint range of motion, maximize visual-perceptual & cognitive skills. Maximize home and financial management; promote safety awareness.
- Techniques: Encourage clothing & footwear modifications for ease of use. Use of appropriate assistive and adaptive equipment to compensate for self-care deficits (built-up handles, long-handled reacher, etc.). Design and management of upper extremity orthotics to stabilize and protect painful or weak joints or to facilitate holding and using utensils. Energy conservation techniques for efficient self-care and ambulation.
- Home environment: Modifications to improve self-care (ADLs, IADLs)
- Goal: Improve communication
- Objectives: Improve neurologic communication deficits; swallowing evaluation and training for dysphagia, speech training post-laryngectomy; family training
- Targeted Problems: dysphasia, dyspraxia, dysarthria, aphasia
- Devices: augmentative communication
- Goal: Develop or enhance leisure activity skills
- Objectives: Develop structured leisure time planning, fosters socialization skills
- Modalities: Group and individual activities
- Explore vocational alternatives and maximize the vocational potential for the older worker.
- Evaluation of the worker’s barriers to continue the current job, skills, attitudes, functional capacities and matches this profile to job requirements, physical and other demands, etc.
- Options include returning to the previous job, transitional work, alternative jobs, retraining and retirement.
- Maximize informal and formal supports to enable independent function. A social worker can help to rally available informal supports (family members, friends, neighbors, church members), and can help to identify formal resources available in the community (home-health aides, agencies). Provides patient & family education, support and counseling.
- Goal: Maximize cognitive and affective function
- Objectives: Assesses and assists with cognitive, affective and problem solving skills
- Objectives: Reinforces functional tasks learned in therapy while monitoring for potential medical events; patient education in appropriate medication use, evaluation & management of bowel/bladder dysfunction; family training prior to or following discharge from the in-patient setting to the home. Important in all settings but can provide primary care in the home.
- Evaluates functional needs of the patient and prescribes therapy
- provides medical and rehabilitative guidance
- monitors rehabilitative progress; adjusts/adapts therapy plans
- cardiac, pulmonary, orthopedic, oncology, brain injury
- Acute Rehabilitation facilities – focus on rehabilitation goals, emphasize restoration of physical functioning with return to the previous living situation. Patients must be able to participate actively in physical, occupational, and speech/language therapy combined to total 3 hours each day per patient, five days/week. A physician directed multidisciplinary team of service providers (physical therapist, occupational therapists, speech therapists, physiatrists, rehabilitative nurses and social workers) delivers care.
- Subacute rehabilitation – Working to the same rehabilitation goals as acute facilities, subacute rehabilitation facilities provide more intensive therapy services (up to 3 hours of combined therapy each day, five days/week) than skilled nursing facilities. As with acute rehabilitation facilities, a multidisciplinary team of service providers provides care.
- Rehabilitative nursing homes – same goals as above. Medicare pays skilled nursing facilities ($2880 for 27.8 days) less than the cost of care provided in rehabilitation facilities ($9768 for 21.3 days). There are no time requirements for the amount of rehabilitative services required each day. Services may be provided independently by each rehabilitative service.
- Skilled nursing facilities – Can provide variable amounts of therapy.
- Home care – Therapy services are available to patients who are confined to the home as a result of medical reasons. A patient is considered to be homebound if that patient has an illness or injury which restricts the ability to leave the home except with the aid of a supportive device, special transportation, or the assistance of another person. Physical therapy provides restorative range of motion, therapeutic exercise, gait evaluation and training, use of therapeutic modalities. Speech and language pathology services are available through home-care and are considered skilled services. Occupational therapy available but must be delivered in conjunction with skilled nursing, physical therapy or Speech therapy.
|In-Patient||Nursing Home & Day Care Programs||Out-Patient||In-Home|
|Physician in Charge||acute hospital MD, primary physician, geriatrician, surgeon, physiatrist||primary physician, geriatrician||primary physician, geriatrician, surgeon, physiatrist||primary physician, geriatrician|
|Goals||restore prior function; safe return to community living;family training||restore prior function||restore prior function; family training||restore prior function; family training|
|Common Conditions||recovery from: orthopedic surgery, stroke; other neurologic diseases amputation; other surgery deconditioning following medical illness||deconditioning following an acute event; continuation of in-patient rehab; recovery from orthopedic surgery & stroke||musculoskeletal disorders; recovery from: orthopedic surgery, stroke/other neurologic diseases; amputation; other surgery deconditioning||deconditioning following an acute event; continuation of in-patient rehab; recovery from orthopedic surgery & stroke; home exercise instruction|
|Criteria||deficits in 2+ domains of function; have potential for recovery; medically able to participate 1-3 hrs/day x days/week||frail elderly who need rehabilitation and have recovery potential||not home-bound||home-bound|
Home safety & family training
OT with PT/SLP/skilled nursing
Home safety & family training
days 1-20 100%;
days 21-100 80%
3 days week:
Medicare part B
|5 days/week: Medicare|
days 1-20 100%;
days 21-100 80%
3 days week:
Medicare part B
|Medicare: 3 days/week for up to 3 months of therapy.|
- Thromobembolic Phenomena
- Urinary Retention or Incontinence
- Orthostatic Hypotension
- Cardiovascular Deconditioning
- Investigate the cause (new fracture? Flare of arthritis? Infection?)
- Investigate contributing factors (depression, anxiety)
- provide medications with adequate timing, dose, interval
- Oral Options
- Short acting simple analgesics
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
- Short acting narcotic analgesics
- Long acting narcotic analgesics
- Gabapentin, carbamezapine
- Parenteral Options
- narcotic analgesics
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
- Transcutaneous (fentanyl)
- Pharmacologic options
- low molecular weight heparin (LMWH)
- low dose unfractionated heparin (LDUH)
- Nonpharmacologic options
- foot pumps
- intermittent pneumatic compression
- graded compression elastic stockings
|Total knee arthroplasty||Low Molecular Weight Heparin||Intermittent Pneumatic Compression with Low Molecular Weight Heparin|
|Total hip arthroplasty||Low Molecular Weight Heparin, warfarin||Add Intermittent Pneumatic Compressions|
|Hip fracture repair||Low Molecular Weight Heparin, Low Dose Unfractionated Heparin||Warfarin|
Urinary Retention or Incontinence
- identify the cause, exclude urinary tract incontinence, medication induced?, functional?, retention?
- minimize medications
- toileting schedule
- check post-void scans with intermittent catheterization for volumes > 200 cc
- exclude UTI
- Frequent event following orthopedic surgery
- fiber supplements
- review and remove meds (narcotics, anti-cholinergics)
- Frequent in patients with cardiovascular disease
- predictor of mortality
- risk for falls
- lower extremity wraps
- abdominal binder
- progressive seating schedule in a reclining wheel chair
- careful medication review
- blood pressure monitoring with therapy
- tilt table
- Appropriate medical management
- Small meals and limited activity for 30-60 minutes following meals to avoid post-prandial hypotension
- Blood pressure & oxygen monitoring with therapy
- Supplemental oxygen
- Maintain hematocrit
- Hypo- or hyperglycemia in diabetic patients:
- Regular meals
- Snacks on hand
- Frequent glycemic monitoring
- Skin Breakdown:
- Proper nutrition & hydration
- Small meals and limited activity for 30-60 minutes following meals to avoid post-prandial hypotension
- Avoidance of incontinence
- Frequent repositioning
- Proper skin care
|The Terrace Rehabilitation Unit of the Johns Hopkins Geriatric Center|
Deb Youngquist, Program Manager
|Johns Hopkins Home Care||(410) 288-8100 or 8111|
|American Physical Therapy Association||1-800-999-2782; (703) 684-2782|
|American Occupational Therapy Association||1-800-426-2547|
|National Library of Congress Referral Center||(202) 287-5670|
|National Rehabilitation Association||(703) 836-0850|
| National Rehabilitation Information Center|
8455 Colesville Road, Suite 935
Silver Spring, Maryland 20910-3319
|1-800-346-2742; (301) 588-9284|
|National Clearing House of Rehabilitation Training Materials||1-800-223-5219|
|National Institute on Disability and Rehabilitation Research|
Office of Special Education and Rehabilitative Services
US Department of Education
400 Maryland Avenue
Washington, DC 20202
|National Institute on Human Resources and Aging||1-800-647-8233|
|Rehabilitation Services Administration||1-800-346-2742; (202) 205-8926|
|US Dept of Education, Rehab Services Admin (RSA)|
|National Rehabilitation Information Center for Disability Resources & NARIC Info|
- Bell, M. J., S. C. Lineker, et al. “A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis.” J Rheumatol 25(2): 231-7, 1998.
- Bjarnason, I. “Forthcoming non-steroidal anti-inflammatory drugs: are they really devoid of side effects?” Ital J Gastroenterol Hepatol 31(Suppl 1): S27-36, 1999.
- Brewster, N. and P. Lewis “Joint replacement for arthritis.” Aust Fam Physician 27(1-2): 21-7, 1998.
- Bruera, E., M. Belzile, et al. “Randomized, double-blind, cross-over trial comparing safety and efficacy of oral controlled-release oxycodone with controlled-release morphine in patients with cancer pain [see comments].” J Clin Oncol 16(10): 3222-9, 1998.
- Chan, C. C., S. Boyce, et al. “Rofecoxib [Vioxx, MK-0966; 4-(4′-methylsulfonylphenyl)-3-phenyl-2-(5H)- furanone]: a potent and orally active cyclooxygenase-2 inhibitor. Pharmacological and biochemical profiles.” J Pharmacol Exp Ther 290(2): 551-60, 1999.
- Chan, L., T. D. Koepsell, et al. “The effect of Medicare’s payment system for rehabilitation hospitals on length of stay, charges, and total payments.” N Engl J Med 337(14): 978-85, 1997.
- Chua, D., S. B. Jaglal, et al. “An orthopedic surgeon survey on the treatment of displaced femoral neck fracture: opposing views.” Can J Surg 40(4): 271-7, 1997.
- Cornoni-Huntley J, Brock DB, Ostfeld AM, Taylor JO, Wallace RB, eds. Established populations for epidemiologic studies of the elderly: resource data book. Bethesda, MD 1986. National Institutes of Health; NIH publication 86-2443.
- Dawson D, Hendershot G, Fulton J. Aging in the eighties: Functional limitations of individuals age 65 and over. Advance data from vital and health statistics, DHHS Publications No (PHS)113, 87-1250, 1987.
- Ensrud, K. E., D. M. Black, et al. “Correlates of kyphosis in older women. The Fracture Intervention Trial Research Group.” J Am Geriatr Soc 456: 682-7, 1997.
- Ettinger, W. H., Jr. “Physical activity, arthritis, and disability in older people.” Clin Geriatr Med 14(3):633-40, 1998.
- Ettinger, W. H., Jr., R. Burns, et al. “A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST) [see comments].” JAMA 277(1): 25-31, 1997.
- Fisher, N. M., S. C. White, et al. (1997). “Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation.” Disabil Rehabil 19(2): 47-55.
- Fitzgerald, J. F., P. S. Moore, et al. “The care of elderly patients with hip fracture. Changes since implementation of the prospective payment system [see comments].” N Engl J Med 319(21): 1392-7, 1988.
- Fort, J. “Celecoxib, a COX-2–specific inhibitor: the clinical data.” Am J Orthop 28(3 Suppl): 13-8, 1999.
- Fortin, P. R., A. E. Clarke, et al. “Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery.” Arthritis Rheum 42(8): 1722-8, 1999.
- Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology and risk. JAGS 1997; 45: 92-100.
- Ganz, S. B. and L. L. Harris “General overview of rehabilitation in the rheumatoid patient.” Rheum Dis Clin North Am 24(1): 181-201, 1998.
- Geis, G. S. “Update on clinical developments with celecoxib, a new specific COX-2 inhibitor: what can we expect?” J Rheumatol 26 Suppl 56: 31-6, 1999.
- Glazier, R. H., D. M. Dalby, et al. “Management of common musculoskeletal problems: a survey of Ontario primary care physicians [see comments].” Cmaj 158(8): 1037-40, 1998.
- Gourlay, G. K. “Sustained relief of chronic pain. Pharmacokinetics of sustained release morphine.” Clin Pharmacokinet 35(3): 173-90, 1998.
- Guralnik JM, et al: Aging in the eighties: the prevalence of comorbidity and its association with disability. Advance data from Vital and Health Statistics, No 179. DHHS Publication No (PHS) 89-1250, 1989.
- Hansen, H. C. “Treatment of chronic pain with antiepileptic drugs: a new era.” South Med J 92(7): 642-9, 1999.
- Hawkey, C. J. “COX-2 inhibitors.” Lancet 353(9149): 307-14, 1999.
- Hirsh, J. “Evidence for the needs of out-of-hospital thrombosis prophylaxis: introduction.” Chest 114(2 Suppl Evidence): 113S-114S, 1998.
- Hoenig H, Nusbaum N, Brummel-Smith K. Geriatric rehabilitation: State of the art. J Am Geriatrics Society 45(11):1371-81, 1997.
- Hoenig H, Rubenstein LV, Sloane R, et al. What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med 158:513-19, 1997.
- Holm, M. B., J. C. Rogers, et al. “Predictors of functional disability in patients with rheumatoid arthritis.” Arthritis Care Res 11(5): 346-55, 1998.
- Hunt, D. “Low-molecular-weight heparins in clinical practice.” South Med J 91(1): 2-10, 1998.
- Hurley, M. V. “The role of muscle weakness in the pathogenesis of osteoarthritis.” Rheum Dis Clin North Am 25(2): 283-98, vi, 1999.
- Jamison, R. N., M. J. Ross, et al. “Assessment of postoperative pain management: patient satisfaction and perceived helpfulness.” Clin J Pain 13(3): 229-36, 1997.
- Kaplan, R., W. C. Parris, et al. “Comparison of controlled-release and immediate-release oxycodone tablets in patients with cancer pain.” J Clin Oncol 16(10):3230-7, 1998.
- Kaplan, R. S., M. Sinaki, et al. “Effect of back supports on back strength in patients with osteoporosis: a pilot study.” Mayo Clin Proc 71(3): 235-41, 1996.
- Klein, D. M., P. Tornetta, 3rd, et al. “Operative treatment of hip fractures in patients with renal failure.” Clin Orthop350: 174-8, 1998.
- Kramer, Andrew M., MD; Steiner, John F., MD, MPH; Schlenker, Robert E., PhD; Eilertsen, Theresa B.; Hrincevich, Carol A., MA; Tropea, Daryl A., PhD; Ahmad, Laura A., MD, FRACP, Eckhoff, Donald G., MD, MS. Outcomes and Costs After Hip Fracture and Stroke: A Comparison of Rehabilitation Settings. JAMA 277(5): 396-404, 1997.
- Janku, G. V., G. D. Paiement, et al. “Prevention of venous thromboembolism in orthopaedics in the United States.” Clin Orthop 325: 313-21, 1996.
- Lanes, S. F., L. L. Lanza, et al. “Resource utilization and cost of care for rheumatoid arthritis and osteoarthritis in a managed care setting: the importance of drug and surgery costs.” Arthritis Rheum 40(8): 1475-81, 1997.
- Lefkowith, J. B. “Cyclooxygenase-2 specificity and its clinical implications.” Am J Med 106(5B):43S-50S, 1999.
- Ling SM, Bathon JM. Osteoarthritis in older adults. J American Geriatric Society ; 46(2):216-25, 1998.
- Mahomed, N. and J. N. Katz “Revision total hip arthroplasty. Indications and outcomes.” Arthritis Rheum39(12): 1939-50, 1996.
- Mandell, B. F. “COX 2-selective NSAIDs: biology, promises, and concerns.” Cleve Clin J Med 66(5):285-92, 1999.
- Mangione, K. K., K. McCully, et al. “The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis.” J Gerontol A Biol Sci Med Sci 54(4): M184-90, 1999.
- Marshall, K. W., S. B. Trippel, et al. “The management of pain and inflammation in orthopedic medicine: question-and-answer period.” Am J Orthop 28(3 Suppl): 22-4, 1999.
- Minor, M. A. “Exercise in the treatment of osteoarthritis.” Rheum Dis Clin North Am 25(2): 397-415, viii, 1999.
- Mohammed, S.and D. W. Croom, 2nd “Gastropathy due to celecoxib, a cyclooxygenase-2 inhibitor [letter].” N Engl J Med 340(25): 2005-6, 1999.
- Morrison RS, Chassin MR, Siu AL. The medical consultant’s role in caring for patients with hip fracture. Annals of Internal Medicine 128:1010-20, 1998.
- Mulrow CD, Gerety MB, Kanten D, et al. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 271:519-524, 1994.
- Naylor, C. D. and J. I. Williams “Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority.” Qual Health Care 5(1): 20-30, 1996.
- Nightingale, S. L. “From the Food and Drug Administration.” Jama 281(9): 786, 1999.
- Novy, C. M. and M. G. Jagmin “Pain management in the elderly orthopaedic patient.” Orthop Nurs 16(1): 51-7, 1997.
- O’Reilly, S. C., K. R. Muir, et al. “Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial.” Ann Rheum Dis 58(1): 15-9, 1999.
- Parker MJ Palmer CR. Prediction of rehabilitation after hip fracture. Age and Aging 24:96-8, 1995.
- Pellino, T. A. and S. E. Ward “Perceived control mediates the relationship between pain severity and patient satisfaction.” J Pain Symptom Manage 15(2): 110-6, 1998.
- Philbin, E. F., G. D. Groff, et al. “Cardiovascular fitness and health in patients with end-stage osteoarthritis.” Arthritis Rheum 38(6): 799-805, 1995.
- Rejeski, W. J., L. R. Brawley, et al. “Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability.” Med Sci Sports Exerc 29(8): 977-85, 1997.
- Rejeski, W. J., W. H. Ettinger, Jr., et al. “Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain [In Process Citation].” Arthritis Care Res 11(2): 94-101, 1998.
- Richeimer, S. H., Z. H. Bajwa, et al. “Utilization patterns of tricyclic antidepressants in a multidisciplinary pain clinic: a survey.” Clin J Pain 13(4): 324-9, 1997.
- Rosenberg, A. D. “Ensuring early discharge following major surgery: orthopedic surgery.” J Cardiothorac Vasc Anesth 12(6 Suppl 2): 7-10; discussion 41-4, 1998.
- Rosner, H., L. Rubin, et al. “Gabapentin adjunctive therapy in neuropathic pain states.” Clin J Pain 12(1): 56-8, 1996.
- Ryan, S. D. and L. P. Fried “The impact of kyphosis on daily functioning.” J Am Geriatr Soc 45(12): 1479-86, 1997.
- Sandrick, K. “The evolution of orthopedic outcomes measurement.” Med Manag Netw 7(4): 7-9, 16, 1999.
- Shorvon, S. and H. Stefan “Overview of the safety of newer antiepileptic drugs.” Epilepsia 38(Suppl 1): S45-51, 1997.
- Sist, T. C., V. A. Filadora, 2nd, et al. “Experience with gabapentin for neuropathic pain in the head and neck: report of ten cases [see comments].” Reg Anesth 22(5): 473-8, 1997.
- Slemenda, C., K. D. Brandt, et al. “Quadriceps weakness and osteoarthritis of the knee.” Ann Intern Med 127(2): 97-104, 1997.
- Slemenda, C., D. K. Heilman, et al. “Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women?” Arthritis Rheum 41(11): 1951-9, 1998.
- Smith, A. J. “The analgesic effects of selective serotonin reuptake inhibitors.” J Psychopharmacol 12(4): 407-13, 1998.
- Steinberg FU. Medical evaluation, assessment of function and potential, and rehabilitation plan.
- Striebel, H. W., T. Olmann, et al. “Patient-controlled intranasal analgesia (PCINA) for the management of postoperative pain: a pilot study.” J Clin Anesth 8(1): 4-8, 1996.
- Sullivan, D. J. “Knee-replacement surgery in the United States and Ontario [letter; comment].” N Engl J Med 332(12): 822; discussion 822-3, 1995.
- Tamayo-Orozco, J., P. Arzac-Palumbo, et al. “Vertebral fractures associated with osteoporosis: patient management.” Am J Med 103(2A): 44S-48S; discussion 48S-50S, 1997.
- Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. NEJM 331: 821-7, 1994.
- Van den Ende, C. H., T. P. Vliet Vlieland, et al. “Dynamic exercise therapy in rheumatoid arthritis: a systematic review.” Br J Rheumatol 37(6): 677-87, 1998.
- Vanek, V. W. “Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh-high to knee-high sleeves.” Am Surg 64(11): 1050-8, 1998.
- Walker, S. “Orthopaedic patients’ reporting of pain management.” Nurs Stand 12(46): 43-7, 1998.
- Warwick, D. “Thromboembolic prophylaxis in orthopaedic trauma patients: a comparison between fixed dose and an individually adjusted dose of a low molecular weight heparin [letter; comment].” Injury 28(3): 233-4, 1997.
- Weber DC, Fleming KC, Evans JM. Rehabilitation of Geriatric Patients. Mayo Clin Proc 70:1198-1204, 1995.
- Wolfe, F. and S. H. Zwillich “The long-term outcomes of rheumatoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis.” Arthritis Rheum 41(6): 1072-82, 1998.
- Zuckerman JD. Hip Fracture. New England Journal of Medicine 334(23):1519-25, 1996.