bluuebunny/crossref_metadata_2025 huggingface dataset:
Aging Increases Aortic MMP-2 Activity and Angiotensin II in Nonhuman Primates
Authors: Wang Mingyi , Takagi Gen , Asai Kuniya , Resuello Ranilo G. , Natividad Filipinas F. , Vatner Dorothy E. , Vatner Stephen F. , Lakatta Edward G.
Published: May 2003

To seek evidence that the nonhuman primate arterial wall, as it ages in the absence of atherosclerosis, exhibits alterations in pathways that are involved in the pathogenesis of experimental atherosclerosis, we assessed aortic matrix metalloproteinase-2 (MMP-2) and its regulators, ie, membrane type-1 of matrix metalloproteinase (MT1-MMP) and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2), and the expression of angiotensin II (Ang II), angiotensin-converting enzyme (ACE), and chymase in young (6.4±0.7 years) and old (20.0±1.9 years) male monkeys. With advancing age, (1) the intimal thickness increased 3-fold and contained numerous vascular smooth muscle cells and matrix, but no inflammatory cells; (2) the intimal MMP-2 antibody–staining fraction increased by 80% (
P
<0.01); (3) in situ zymography showed that MMP-2 activity, mainly confined to the intima, increased 3-fold (
P
<0.01); (4) the MT1-MMP antibody–staining fraction increased by 150% (
P
<0.001), but the TIMP-2 antibody–staining fraction did not significantly change; (5) steady levels of the mRNA-staining fraction (via in situ hybridization) for MMP-2 increased 7-fold, for MT1-MMP increased 9-fold, and for TIMP-2 increased 2-fold (all
P
<0.001); and (6) intimal Ang II and ACE immunofluorescence were increased 5-fold and 5.6-fold, respectively, and colocalized with MMP-2. Thus, age-associated arterial remodeling and the development and progression of experimental atherosclerosis in young animals share common mechanisms, ie, MMP-2 activation and increased Ang II signaling. This might explain, in part, the dramatically exaggerated prevalence and severity of vascular diseases with aging.
Fibroblast Growth Factor-18 Reduced Infarct Volumes and Behavioral Deficits After Transient Occlusion of the Middle Cerebral Artery in Rats
Authors: Ellsworth Jeff L. , Garcia Richard , Yu Jin , Kindy Mark S.
Published: May 2003

Background and Purpose—

Fibroblast growth factor 18 (FGF18) is expressed in rodent brain and is a trophic factor for neuron-derived cells in culture. The purpose of the present study was to evaluate whether FGF18 was neuroprotective in a rat model of cerebral ischemia and to compare the results with those obtained with FGF2.

Methods—

Cerebral ischemia was produced in rats by a transient 2-hour occlusion of the middle cerebral artery (MCAo) with an intraluminal filament followed by 22-hour reperfusion. Starting 15 minutes after MCAo, FGF18 or FGF2 was administered by a 3-hour intravenous infusion. Infarct volumes and behavioral deficits were measured 24 hours after MCAo.

Results—

Infusion of FGF18 produced dose-dependent reductions in infarct volumes and improvements in tests of reference and working memory, motor ability, and exploratory behavior. FGF18 was more efficacious than FGF2 on virtually all measures examined. The reductions in infarct volume and behavioral deficit were associated with FGF-mediated increases in regional cerebral blood flow.

Conclusions—

These results demonstrate that FGF18 is an effective neuroprotective agent in a rat model of transient MCAo.
Neuroprotective κ-Opioid Receptor Agonist BRL 52537 Attenuates Ischemia-Evoked Nitric Oxide Production In Vivo in Rats
Authors: Goyagi Toru , Toung Thomas J.K. , Kirsch Jeffrey R. , Traystman Richard J. , Koehler Raymond C. , Hurn Patricia D. , Bhardwaj Anish
Published: May 2003

Background and Purpose—

κ-Opioid receptors (KOR) have been implicated in neuroprotection from ischemic neuronal injury. We tested the effects of a selective and specific KOR agonist, BRL 52537 hydrochloride [(±)-1-(3,4-dichlorophenyl)acetyl-2-(1-pyrrolidinyl) methylpiperidine], on infarct volume and nitric oxide production after transient focal ischemia in the rat.

Methods—

With the use of the intraluminal filament technique, halothane-anesthetized male Wistar rats (weight, 250 to 300 g) were subjected to 2 hours of focal cerebral ischemia confirmed by Doppler flowmetry. In a blinded randomized fashion, rats were treated with intravenous saline or 1 mg/kg per hour BRL 52537 infusion, initiated 15 minutes before occlusion and maintained until 2 hours of reperfusion. In a second experiment, rats were treated during reperfusion with saline or 1 mg/kg per hour BRL 52537, initiated at onset of reperfusion and continued for 22 hours. In a final experiment, in vivo striatal nitric oxide production was estimated via microdialysis by quantification of citrulline recovery after labeled arginine infusion in striatum of intravenous BRL 52537– or saline-treated rats.

Results—

In rats treated with BRL 52537 during ischemia and early reperfusion, infarct volume was significantly attenuated in cortex (16±6% versus 40±7% of ipsilateral cortex in saline group) and in caudoputamen (30±8% versus 66±6% of ipsilateral caudoputamen in saline group). Infarct volume was also reduced by treatment administered only during reperfusion in cortex (19±8% in BRL 52537 group [n=10] versus 38±6% in saline group) and in caudoputamen (35±9% versus 66±4% in saline group). BRL 52537 treatment markedly attenuated NO production in ischemic striatum compared with saline-treated controls.

Conclusions—

These data demonstrate that (1) the selective KOR agonist BRL 52537 provides significant neuroprotection from focal cerebral ischemia when given as a pretreatment or as a posttreatment and (2) attenuation of ischemia-evoked nitric oxide production in vivo may represent one mechanism of ischemic neuroprotection.
Synergistic antileukemic interactions between 17-AAG and UCN-01 involve interruption of RAF/MEK- and AKT-related pathways
Authors: Jia Wentao , Yu Chunrong , Rahmani Mohamed , Krystal Geoffrey , Sausville Edward A. , Dent Paul , Grant Steven
Published: May 2003

Interactions between the protein kinase C (PKC) and Chk1 inhibitor UCN-01 and the heat shock protein 90 (Hsp90) antagonist 17-AAG have been examined in human leukemia cells in relation to effects on signal transduction pathways and apoptosis. Simultaneous exposure (30 hours) of U937 monocytic leukemia cells to minimally toxic concentrations of 17-AAG (eg, 400 nM) and UCN-01 (eg, 75 nM) triggered a pronounced increase in mitochondrial injury (ie, loss of mitochondrial membrane potential [Δψm]; cytosolic release of cytochrome c), caspase activation, and apoptosis. Synergistic induction of apoptosis was also observed in other human leukemia cell types (eg, Jurkat, NB4). Coexposure of human leukemia cells to 17-AAG and the PKC inhibitor bisindolylmaleimide (GFX) did not result in enhanced lethality, arguing against the possibility that the PKC inhibitory actions of UCN-01 are responsible for synergistic interactions. The enhanced cytotoxicity of this combination was associated with diminished Akt activation and marked down-regulation of Raf-1, MEK1/2, and mitogen-activated protein kinase (MAPK). Coadministration of 17-AAG and UCN-01 did not modify expression of Hsp90, Hsp27, phospho-JNK, or phospho-p38 MAPK, but was associated with further p34cdc2 dephosphorylation and diminished expression of Bcl-2, Mcl-1, and XIAP. In addition, inducible expression of both a constitutively active MEK1/2 or myristolated Akt construct, which overcame inhibition of ERK and Akt activation, respectively, significantly attenuated 17-AAG/UCN-01–mediated lethality. Together, these findings indicate that the Hsp90 antagonist 17-AAG potentiates UCN-01 cytotoxicity in a variety of human leukemia cell types and suggest that interference with both the Akt and Raf-1/MEK/MAP kinase cytoprotective signaling pathways contribute to this phenomenon.
A phase 2 trial of CHOP chemotherapy followed by tositumomab/iodine I 131 tositumomab for previously untreated follicular non-Hodgkin lymphoma: Southwest Oncology Group Protocol S9911
Authors: Press Oliver W. , Unger Joseph M. , Braziel Rita M. , Maloney David G. , Miller Thomas P. , LeBlanc Michael , Gaynor Ellen R. , Rivkin Saul E. , Fisher Richard I.
Published: May 2003

Advanced follicular lymphoma is incurable with conventional chemotherapy and radiotherapy. The Southwest Oncology Group (SWOG) conducted a phase 2 trial (S9911) of a novel regimen consisting of 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy followed 4 to 8 weeks later by tositumomab/iodine I 131 tositumomab (anti-CD20 antibody) in 90 eligible patients with previously untreated, advanced stage follicular lymphoma. Treatment was well tolerated. Reversible myelosuppression was the main adverse event and was more severe during CHOP chemotherapy than following radioimmunotherapy. The overall response rate to the entire treatment regimen was 90%, including 67% complete remissions (CRs plus unconfirmed CRs [CRu's]) and 23% partial remissions (PRs). Twenty-seven (57%) of the 47 fully evaluable patients who achieved less than a CR with CHOP improved their remission status after tositumomab/iodine I 131 tositumomab. With a median follow-up of 2.3 years, the 2-year progression-free survival (PFS) was estimated to be 81%, with a 2-year overall survival of 97%. This study has established the feasibility, tolerability, and efficacy of this regimen for patients with advanced follicular lymphoma. This novel treatment appears promising compared with the SWOG's historical experience using CHOP alone and is currently being compared with CHOP plus rituximab in a randomized phase 3 trial (S0016).
The contribution of glycoprotein VI to stable platelet adhesion and thrombus formation illustrated by targeted gene deletion
Authors: Kato Kazunobu , Kanaji Taisuke , Russell Susan , Kunicki Thomas J. , Furihata Kenichi , Kanaji Sachiko , Marchese Patrizia , Reininger Armin , Ruggeri Zaverio M. , Ware Jerry
Published: May 2003

Platelet interaction with exposed adhesive ligands at sites of vascular injury is required to initiate a normal hemostatic response and may become a pathogenic factor in arterial diseases leading to thrombosis. We report a targeted disruption in a key receptor for collagen-induced platelet activation, glycoprotein (GP) VI. The breeding of mice with heterozygous GP VI alleles produced the expected frequency of wild-type, heterozygous, and homozygous genotypes, indicating that these animals had no reproductive problems and normal viability. GP VInull platelets failed to aggregate in response to type I fibrillar collagen or convulxin, a snake venom protein and known platelet agonist of GP VI. Nevertheless, tail bleeding time measurements revealed no severe bleeding tendency as a consequence of GP VI deficiency. Ex vivo platelet thrombus formation on type I collagen fibrils was abolished using blood from either GP VInull or FcR-γnull animals. Reflection interference contrast microscopy revealed that the lack of thrombus formation by GP VInull platelets could be linked to a defective platelet activation following normal initial tethering to the surface, visualized as lack of spreading and less stable adhesion. These results illustrate the role of GP VI in postadhesion events leading to the development of platelet thrombi on collagen fibrils.
An experimental controlled study on postural sway and therapeutic exercise in subjects with low back pain
Authors: Kuukkanen Tiina M , Mälkiä Esko A
Published: May 2003

Objectives: To describe postural sway and its associations to background factors, low back pain and functional capacity. To evaluate the changes in postural sway after three months of therapeutic exercise in the gym or at home.

Design: A one-year randomized experimental trial evaluated postural sway in three study groups: intensive training, home exercise and control group.

Setting: Subjects were recruited from seven local occupational health care centres in Central Finland and were examined at Central Finland Hospital by medical doctors. Measurements and therapeutic exercise programmes were carried out in the Research Laboratory of Sport and Health Sciences at Jyväskylä University.

Subjects: Initially, 49 male and 41 female subjects (aged 20–55 years) with nonspecific and subacute low back pain were examined.

Main outcome measures: Postural sway using a force platform, the Oswestry Index, as well as a measure of low back pain intensity were measured at the initial stage of the study, directly after interventions, as well as at three and nine months after the interventions.

Results: The background variables were not strongly correlated with postural sway. No changes occurred in the amplitude of sway during the study, but the sway velocity of the home exercise group increased.

Conclusions: Postural sway measurements with a force platform may be suitable for detecting impairments of balance performance among subjects with pronounced functional or activity limitations and severe low back pain problems. In order to enhance balance performance, specific and customized exercise programmes are required.
Ealuation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients
Authors: Goulding R , Bakheit A MO
Published: May 2003

Objective: Safe swallowing may be achieved in most patients with neurogenic dysphagia by manipulating the viscosity of ingested fluids. However, in clinical practice fluids are thickened using subjective judgement. This may lead to errors in the preparation of drinks to the prescribed viscosity. The aim of the present study is to examine whether the use of a viscometer improves the dietary management of dysphagic stroke patients.

Study design: A randomized controlled study design was used. The speech and language therapist determined the optimal fluid thickness for each patient. The prescribed fluid viscosity for the study group was obtained using a viscometer. Patients in the control group received fluids prepared according to current practice, i.e. the amount of thickener required to produce the prescribed viscosity was judged subjectively by the nursing staff. The two methods of fluid thickening were used for seven consecutive days. Assessment was made blind to randomization.

Main outcome measure: Pulmonary aspiration, assessed clinically and with pulse oximetry. If the patient did not drink all the fluid that was offered the residue was measured.

Results: Ten patients in the study group ( n = 23) and nine in the control group ( n = 23) aspirated. The mean viscosity of fluids offered to patients in the control group was significantly higher than that of the study patients. There was a statistically significant correlation between the viscosity and the residual volume of fluid (Pearson's test: r = 0.7, p <0.02). The findings of the study suggest that fluids prepared by subjectively assessing the amount of thickener required to produce a given consistency tend to have a higher viscosity than those prepared using the viscometer. However, the higher viscosity does not appear to protect against pulmonary aspiration and may lead to a reduced fluid intake.

Conclusion: Manipulation of fluid thickness using objective measurements with a viscometer may improve the dietary management of dysphagic stroke patients.
The efficacy of Le Bon Départ and Sensory Integration treatment for children with developmental coordination disorder: a randomized study with six single cases
Authors: Leemrijse Chantal , Meijer Onno G , Vermeer Adri , Adèr Herman J , Diemel Sandra
Published: May 2003

Objective: Evaluation of the efficacy of Le Bon Départ (LBD) treatment and Sensory Integration (SI) treatment on motor performance of children with developmental coordination disorder.

Design: A single subject design with multiple baseline and alternating treatments. Order of treatment and length of phase were randomized. Measurements were blinded.

Setting: Department of Occupational Therapy at the Academic Hospital Vrije Universiteit Amsterdam, The Netherlands.

Subjects: Five boys and one girl with developmental coordination disorder (age: 6.0–8.1 years).

Interventions: Baseline condition, Le Bon Départ treatment and Sensory Integration treatment.

Main outcome measures: The Movement ABC, Praxis Tests, a rhythm test and visual analogue scales. With the exception of the Praxis Tests, lower scores indicate better performance.

Results: During both treatments, the performance on the Movement ABC (x̄ = 7.21) and the scores on the visual analogue scales (x̄ = 46.64) were significantly better than in the baseline (Movement ABCbaseline: x̄ = 17.38; visual analogue scalesbaseline: x̄= 68.18). After treatment 2, performance on the Praxis Tests and scores on the visual analogue scales were significantly better than after treatment 1 (Praxis Tests: 113.54 versus 104.68; visual analogue scales: 34.74 versus 58.54). All six children performed better on the Movement ABC during treatment as compared to the baseline. Le Bon Départ led to significant improvement on all dependent variables, Sensory Integration on the visual analogue scales only. The improvements after Le Bon Départ were larger than the improvements after Sensory Integration treatment. On the rhythm test this difference was significant: LBD led to an improvement of 43.01 points, while the improvement after SI was 17.59 points (p < 0.05).

Conclusion: Motor performance of children with developmental coordination disorder improved significantly on all dependent variables after the combination of treatments. Le Bon Départ led to more improvement than Sensory Integration. LBD appears to be a valuable treatment method for children with developmental coordination disorder.
Relationship between timed ‘up and go’ and gait time in an elderly orthopaedic rehabilitation population
Authors: Freter Susan H , Fruchter Nadine
Published: May 2003

Objective: To analyse the relationship between the timed ‘up and go’ (TUG) and gait time in an elderly orthopaedic population, in order to determine whether additional useful information is obtained by measuring both.

Design: Observational study.

Setting: Jewish Rehabilitation Hospital, Laval, Quebec.

Subjects: Seventy-nine consecutive inpatients in the orthopaedic programme with a primary admitting diagnosis of either total hip replacement (THR), total knee replacement (TKR), or hip fracture repair.

Outcome measures: Timed ‘up and go’ and time to walk 10 metres.

Results: The admission correlation between gait time and TUG was r = 0.745. The correlation at discharge ( r = 0.816) was higher than that seen on admission. The relationship between gait time and TUG was linear both at admission and discharge. The correlation between gait time and TUG was strong for patients with TKR at admission ( r = 0.868) and discharge ( r = 0.878), and for patients with THR, both at admission ( r = 0.809) and discharge ( r = 0.879). However, the correlation on admission was weaker for patients with hip fracture ( r = 0.497). For slow walkers (people with a gait speed below 0.5 m/s) on admission, the correlation was moderate ( r = 0.649). However, for those with gait speeds faster than or equal to 0.5 m/s, the correlation was weaker ( r = 0.484). This discrepancy was no longer evident on discharge. Likewise, for patients with a fast TUG score (< 30 seconds) on admission, there was virtually no relationship between TUG and gait time ( r = 0.084), although a good correlation was present for those with ‘up and go’ times longer than 30 seconds ( r = 0.634). As with gait speed, this difference disappeared by discharge.

Conclusions: The relationship between gait time and TUG in an elderly orthopaedic rehabilitation population is good, and its strength varies by specific diagnosis, mobility, and time point in the course of therapy. The two measures are not redundant in this population.
Measuring the impact of multiple sclerosis on psychosocial functioning: the development of a new self-efficacy scale
Authors: Airlie J , Baker G A , Smith S J , Young C A
Published: May 2003

Objective: To develop a scale to measure self-efficacy in neurologically impaired patients with multiple sclerosis and to assess the scale' s psychometric properties.

Design: Cross-sectional questionnaire study in a clinical setting, the retest questionnaire returned by mail after completion at home.

Setting: Regional multiple sclerosis (MS) outpatient clinic or the Clinical Trials Unit (CTU) at a large neuroscience centre in the UK.

Subjects: One hundred persons with MS attending the Walton Centre for Neurology and Neurosurgery and Clatterbridge Hospital, Wirral, as outpatients.

Methods: Cognitively impaired patients were excluded at an initial clinic assessment. Patients were asked to provide demographic data and complete the self-efficacy scale along with the following validated scales: Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, Impact, Stigma and Mastery and Rankin Scales. The Rankin Scale and Barthel Index were also assessed by the physician.

Results: A new 11-item self-efficacy scale was constructed consisting of two domains of control and personal agency. The validity of the scale was confirmed using Cronbach' s alpha analysis of internal consistency (α = 0.81). The test–retest reliability of the scale over two weeks was acceptable with an intraclass correlation coefficient of 0.79. Construct validity was investigated using Pearson' s product moment correlation coefficient resulting in significant correlations with depression (r = –0.52) anxiety (r = –0.50) and mastery (r = 0.73). Multiple regression analysis demonstrated that these factors accounted for 70% of the variance of scores on the self-efficacy scale, with scores on mastery, anxiety and perceived disability being independently significant.

Conclusion: Assessment of the psychometric properties of this new selfefficacy scale suggest that it possesses good validity and reliability in patients with multiple sclerosis. Address for correspondence: SJ Smith, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2HL, Scotland, UK.
Patterns of hemiparesis recovery in lacunar and partial anterior circulation infarct stroke syndromes
Authors: Smith Jane , Brotheridge Sean , Young John
Published: May 2003

Objective: To investigate patterns of hemiparesis recovery in lacunar (LACI) and partial anterior circulation infarct (PACI) stroke syndromes.

Design: Prospective observational study.

Setting: District general hospital and stroke rehabilitation ward.

Subjects: Forty-seven patients (25 LACI and 22 PACI) with a first-ever stroke causing a hemiplegia. Average age 76.4 years (range 59–88).

Measures: Outcome measures assessed disability (Barthel Index), limb power (Motricity Index) and mobility (Rivermead Mobility Index) at baseline and 3, 6, 9, 12, 16 and 24 weeks post stroke onset.

Results: The time to maximum recovery, time to 50% recovery and area under the recovery curve was determined for each of the outcome measures. There were no statistical differences between these recovery parameters between the PACI and LACI stroke syndromes.

Conclusion: Classification of hemiplegic stroke into PACI or LACI syndromes does not distinguish distinctive recovery patterns.
Reliability of an interview approach to the Functional Independence Measure
Authors: Daving Yvonne , Andrén Eva , Nordholm Lena , Grimby Gunnar
Published: May 2003

Objective: To establish the reliability of an interview approach to the Functional Independence Measure (FIM).

Design: Two raters were present at the same time during the interviews in the home and did independent ratings of the 18 FIM items. The interview procedure was repeated within a week by another two raters in the clinic.

Subjects: Sixty-three stroke survivors (median age 63 years, range 18–71 years) were studied approximately two years after onset.

Raters: Three occupational therapists and one nurse.

Methods: Reliability was calculated as unweighted kappa statistics, percentage agreement (PA), and intraclass correlation coefficient (ICC).

Results: Best agreement was found in the motor items of FIM. The kappa statistics showed good to excellent inter-rater values during the same interview except for the Social interaction item. The ICCs based on sum-score for motor (0.92) and social–cognitive items (0.75) respectively, were similar to those reported in the literature. The repeated interview by different raters showed less stable agreement according to kappa values for the items dealing with transfers, locomotion and social–cognition.

Conclusions: FIM assessments showed high inter-rater agreement for the same interview setting (home as well as clinic), but the stability of the measure over time with a repeated interview by different raters was somewhat less satisfactory.
Muscle strength, pain and disability in patients with osteoarthritis
Authors: M Martijn P , Dekker Joost , van Baar Margriet E , B Rob A , J Johannes W
Published: May 2003

Objective: Reduced muscle strength is regarded as a risk factor for pain and disability in osteoarthritis (OA). Currently, various indices for muscle strength are used when assessing determinants of pain and disability. The goal of the present study was to evaluate these indices of muscle strength.

Design: Isometric muscle strength was measured for 16 muscle actions around the knees and hips in 52 patients with OA of the hip and 70 patients with OA of the knee. Various indices of muscle strength were derived from these measurements, applying five alternative approaches. These approaches ranged from a single overall index to a set of 16 separate indices. The internal consistency of these indices was determined (Cronbach's α), and it was determined to what extent they could reveal the association between reduced muscle strength on the one hand and pain and disability on the other hand.

Results: Internal consistency was satisfactory for all indices (Cronbach's α >0.74). As expected, reduced muscle strength was associated with increased disability, but no clear relationship could be established between muscle weakness and pain. The strength of these associations did not depend on the approach used to derive the indices for muscle strength.

Conclusions: The indices did not show major differences with regard to internal consistency or the extent to which the association with pain and disability could be revealed. For reasons of parsimony, approaches resulting in few indices appear to be most useful. However, muscle strength was found to be significantly reduced around affected joints, compared with muscle strength around unaffected joints. Therefore, the most suitable approach for reducing muscle strength data into indices is one that results in as few indices as possible, but with separate indices for muscle strength around affected and unaffected joints.
Research into the black box of rehabilitation: the risks of a Type III error
Authors: Wade Derick T
Published: May 2003

Type I and Type II errors in the interpretation of data from clinical trials concern statistical matters, and the probability of drawing erroneous conclusions from inadequate data. However in rehabilitation research a third possible error may arise. Successful rehabilitation depends upon the co-ordinated work of an expert multidisciplinary team, and can be considered as a network involving a whole system. Demonstrating that one part of that system looked at in isolation does not have the expected effect does not prove that the specific part is not necessary to the success of the whole system. The isolated intervention may still have an important effect when interacting with other variables or interventions. Failure to consider the interactive effects of an intervention might constitute a Type III interpretation error.
Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials
Authors: van der Lee Johanna H , Snels Ingrid AK , Beckerman Heleen , Lankhorst Gustaaf J , Wagenaar Robert C , Bouter Lex M
Published: May 2003

Objective: Assessment of the available evidence for the effectiveness of exercise therapy to improve arm function in patients who have suffered from a stroke.

Methods: A systematic search of bibliographical databases and reference checking were performed to identify publications on randomized controlled trials (RCTs) which evaluated the effect of exercise therapy on arm function in stroke patients. The methodological quality was assessed systematically by two raters, based on a standardized list of methodological criteria. Study characteristics, such as the chronicity and severity of impairment of the patient population, the amount and duration of interventions, and specific methodological criteria, were related to reported effects.

Results: Thirteen RCTs were identified, six of which reported positive results on an arm function test. In five of these six studies there was a contrast in amount or duration of exercise therapy between groups. Methodological scores ranged from 5 to 15 (maximum possible score: 19 points).

Conclusion: Insufficient evidence made it impossible to draw definitive conclusions about the effectiveness of exercise therapy on arm function in stroke patients. The difference in results between studies with and without contrast in the amount or duration of exercise therapy between groups suggests that more exercise therapy may be beneficial.
Respect for autonomy: issues in neurological rehabilitation
Authors: Sim Julius
Published: May 2003

Objective: To examine the ethical principle of respect for autonomy within the context of neurological rehabilitation.

Discussion: The nature of the principle of respect for autonomy is examined, and specific difficulties to which it may give rise in this area of practice are identified. These concern difficulties of communication with neurologically impaired patients, issues of competence related to patient decision-making, problems of consensus between patient and professional, and the role of the patient's family in the rehabilitation process.

Conclusion: A number of strategies, based on a client-centred model of practice, are suggested which may counteract these difficulties and assist in respecting the patient's autonomy to the appropriate degree, while seeking to attain high-quality clinical outcomes.
The assessment of depression in aphasic stroke patients: the development of the Stroke Aphasic Depression Questionnaire
Authors: Sutcliffe L M , Lincoln N B
Published: May 2003

Objective: The Stroke Aphasic Depression Questionnaire (SADQ) was developed to detect depressed mood in aphasic patients in the community. Design: Correlation analysis between new questionnaire and established measures.

Setting: Patients at home.

Methods: Seventy stroke patients who had been discharged from hospital were assessed on the SADQ, the Hospital Anxiety and Depression Scale and the Wakefield Depression Inventory. The SADQ was also administered to 17 aphasic patients on two occasions at a four-week interval.

Results: Results indicated that scores on the SADQ were significantly related to other measures of depression ( rs) = 0.22–0.52, p <0.05). A shortened 10-item version showed higher validity ( rs = 0.32–0.67, p <0.01). Test–retest analysis indicated the SADQ is reliable over a four-week interval ( rs = 0.72, p <0.001).

Conclusions: The SADQ may be used for assessing depressed mood in aphasic patients in the community though further validation is required.
A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study
Authors: Lord S E , Wade D T , Halligan P W
Published: May 2003

Objective: To use a pilot study to compare two physiotherapy approaches to improve walking in patients with gait disturbance due to multiple sclerosis (MS).

Design: Patients were assessed and then randomly assigned to one of two groups using a block randomization technique. They were treated by the research physiotherapist for a minimum of 15 treatments over a 5–7-week period and then reassessed by an independent therapist one week after treatment.

Setting: Both assessment and treatment were undertaken at a specialist rehabilitation centre.

Subjects: Outpatients with clinically stable MS (chronic progressive or relapsing-remitting types) who were referred for physiotherapy to improve their mobility.

Intervention: Comparison was between a facilitation (impairment-based) approach and a task-oriented (disability-focused) approach.

Outcome: Mobility was assessed using four measures: the 10-metre timed walk, the Rivermead Mobility Index, stride length and the Rivermead Visual Gait Assessment. Balance was assessed using the Berg Balance Test.

Results: Twenty-three patients were entered, and 10 in each group completed the study. The groups were similar on all measured items both before and after treatment. There was no significant difference in improvement between the two approaches. Following treatment, patients in both groups showed a significant overall improvement ( p <0.05) in both impairment and disability measures.

Conclusions: No significant differences in effectiveness between the two methods were demonstrated. Both a task-oriented approach and a facilitation approach to the treatment of MS outpatients were associated with improved mobility.
Comparison between two devices for measuring hip joint motions
Authors: Bierma-Zeinstra S MA , Bohnen A M , Ramlal R , Ridderikhoff J , Verhaar J AN , Prins A
Published: May 2003

Objective: To compare the reliability of measurements of hip motions obtained with two instruments, an electronic inclinometer and a two-arm goniometer, and to investigate whether the two instruments, and different body positions, produce the same measurement data.

Methods: Maximal active and passive hip movements were measured simultaneously with both instruments, in nine subjects during 10 consecutive measurements at short intervals.

Results: Intra-observer variability was lower with the inclinometer in measurements of passive hip rotations. The two instruments showed equal intra-observer variability for hip movements in general. The inclinometer showed lower inter-observer variability in the measurements of active internal rotation. More rotational movement was measured with the two-arm goniometer; more extension and flexion with the inclinometer. Also, more rotational movement was found in the prone position compared to sitting and supine positions.

Conclusions: The inclinometer is more reliable in measurements of hip rotation. For hip movements in general the two-arm goniometer is just as accurate when used by only one observer. The two instruments, and some positions, are not interchangeable during consecutive measurements.
The effect of a joint protection education programme for people with rheumatoid arthritis
Authors: Hammond Alison , Lincoln Nadina
Published: May 2003

Objective: To evaluate the effects of an education programme in improving adherence with joint protection by people with rheumatoid arthritis (RA).

Design: A repeated measures design. Subjects were assessed at six weeks and one week before and six and twelve weeks after education.

Setting: Rheumatology unit in a large district general hospital.

Subjects: Twenty-one people diagnosed with RA (mean age 48.95 years (SD 12.54) and disease duration of 6.43 years (SD 7.7)).

Intervention: An 8-hour arthritis education programme delivered over four sessions, including two hours of joint protection education designed to be typical of current UK practice.

Main outcome measures: The Joint Protection Behaviour Assessment (JPBA), an observational assessment of hand joint protection methods used during kitchen activities, to measure adherence with education. Other assessments included a joint protection knowledge questionnaire, hand joint counts, hand pain visual analogue scale, the Health Assessment Questionnaire (HAQ) and HAQ Pain scale to identify any short-term changes in hand pain, pain on activity and functional status. At the beginning and end of the study subjects were interviewed to obtain their self-report of joint protection behaviours and reasons for following or not following the advice given.

Results: Median JPBA scores did not improve pre- to posteducation (18.4% to 23.7%; p= 0.65) and neither did hand joint count, hand pain, HAQ and HAQ Pain scores. However, joint protection knowledge improved significantly (p = 0.01) and the majority of people believed joint protection to be a beneficial strategy. Reasons for not changing behaviour included problems recalling information; joint protection being considered inappropriate as ‘hands were not that bad yet’; lack of skill; and difficulties changing habits.

Conclusion: The joint protection education programme improved knowledge but not use of taught methods. Educational strategies being used by therapists need to be focused on enhancing adherence.
Objective and subjective assessments of temperature differences between the hands in reflex sympathetic dystrophy
Authors: Oerlemans H Margreet , Perez Roberto SGM , Oostendorp Rob AB , Goris R Jan A
Published: May 2003

Objective: A difference in temperature between the affected and normal extremity is one of the signs or symptoms of reflex sympathetic dystrophy (RSD). These temperature differences are scored anamnestically, by palpation, or by measurements. We investigated the relationship between objective and subjective differences in skin temperature between the hands.

Subjects and design: Fifty-one patients with RSD of one upper extremity participated (mean age 55 years, range 18–80). In the first 16 we investigated the reliability of the visual analogue scale (VAS) for recording perceived differences in skin temperature. In the remaining 35 patients the relationship between the VAS and objective infrared radiometry of the hands was investigated.

Setting: Outpatients clinics of two university hospitals.

Results: The VAS was found to be reliable in terms of response stability. There was no significant correlation between the objective and subjective outcomes.

Conclusions: There is lack of correspondence between objective and subjective temperature measurements, which may be due to a normal discrepancy between objective and percieved temperature, and/or to alterations in perception due to RSD.
Usability of thenar eminence orthoses: report of a comparative study
Authors: Buurke J H , Grady J H , de Vries J , Baten C TM
Published: May 2003

Objective: To determine the difference in the usability of three types of thenar eminence (TE) orthoses.

Design: Prospective comparative pre-experimental study with randomized cross-over design.

Setting: Rehabilitation centre. Subjects: Ten patients with osteoarthritis of the carpometacarpal I joint confirmed by X-ray.

Intervention: Three types of TE orthoses, made of either supple elastic material, elastic material with a semi-rigid thumb busk or a semi-rigid (polyethylene) material.

Main outcome measurements: Pain at the thenar eminence, pinch force, hand function, cosmesis, comfort and function of the TE orthosis.

Results: The supple elastic TE orthosis scores significantly better than the more rigid types on the subjects ‘comfort’, ‘function’ and the Green Test, while the semi-rigid orthosis scores best on ‘cosmesis’. The score on the subject ‘pain reduction’ shows no significant difference between the three types of TE orthoses. The scores obtained correspond with the outcome of structured interviews about the usability of the TE orthoses.

Conclusion: Eight out of 10 patients prefer the permanent use of a TE orthosis. Six patients chose the supple elastic orthosis and two chose the semi-rigid orthosis.
Psychological correlates of outcome following rehabilitation from stroke
Authors: Clark Michael S , Smith Dennis S
Published: May 2003

Objectives: To confirm, in a new sample, the value of our previously described procedure for identifying abnormal illness behaviour (AIB) in stroke rehabilitation patients, and to examine the relative effects of AIB, depression, family functioning, knowledge of stroke, and expectations of rehabilitation on long-term rehabilitation outcome.

Design: A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge.

Setting: The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia.

Subjects: Sixty twelve-month stroke survivors, residing in a family environment, who had undergone an inpatient rehabilitation programme.

Main outcome measures: AIB was assessed using the Illness Behaviour Questionnaire, depression with the Zung Self-Rating Depression Scale, family functioning with the McMaster Family Assessment Device, stroke knowledge with the Stroke Care Information Test, and expectations of rehabilitation with an open-ended question. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index.

Results: Using our previously derived AIB classification rule, AIB cases scored poorly on functional, social and psychological indicators. Further, cluster analysis of discharge data replicated the rule for identifying patients with AIB. AIB was a strong predictor of functional competence and performance at rehabilitation discharge and both six and twelve months later, while depression was associated with an inactive lifestyle at both six and twelve months. Greater stroke knowledge and clearer expectations of rehabilitation were associated with better functional outcome at discharge. Family functioning was strongly associated with lifestyle activities and ADL performance at both six and twelve months.

Conclusions: The procedure for identifying AIB in this rehabilitation environment appears to be robust. AIB was a key determinant of long-term functional disability, while depression was associated with poorer social functioning. Family functioning was an important determinant of social activities, and of the activities the patient actually does, rather than those the patient is capable of carrying out. Good stroke knowledge and clear expectations of rehabilitation were important determinants of rehabilitation success, and should be fostered to ensure a good rehabilitation outcome. Psychological factors are crucial in determining long-term outcome after rehabilitation from stroke.
The Short Orientation–Memory–Concentration Test: a study of its reliability and validity
Authors: Wade D T , Vergis E
Published: May 2003

Objective: To establish the limits of intra-observer test–retest reliability of the Short Orientation–Memory–Concentration Test (SOMC), and to investigate the relationship of performance on the SOMC with a test of verbal memory.

Design: Each patient was assessed twice by the same assessor over an interval of 3–7 days.

Setting: Two specialist rehabilitation units concerned with patients with severe and/or complex disability arising from neurological disease.

Subjects: Thirty-eight patients aged 17–63 years, 25 being men, with a variety of neurological diseases. The Barthel Activities of Daily Living Index score ranged from 0 to 20, median 10.5.

Measures: The Short Orientation–Memory–Concentration Test, the Barthel Activities of Daily Living Index and the paragraph recall subtest of the Rivermead Behavioural Memory Test (RBMT).

Results: There was a slight but statistically significant (p<0.01) improvement in the score of 2 points (out of 28) between the two test occasions, but this was not related to the interval between testing or to the mean score of the two tests. The scores differed by as much as +10 to –8, but most patients (n= 35; 92%) showed a difference between –2 and +6 points. The SOMC scores were correlated with the RBMT paragraph recall immediate and delayed scores (r= 0.74) but the scatterplot showed considerable variation.

Conclusion: If used by the same observer, changes in the SOMC score are likely to reflect a real difference if it increases by more than 6 points or decreases by more than 2 points. The SOMC does seem to reflect verbal memory.
Joint reposition sense in subjects with unilateral osteoarthritis of the knee
Authors: Garsden L R , Bullock-Saxton J E
Published: May 2003

Objective: To identify the sensory deficit of partial weight-bearing joint repositioning sense in subjects with unilateral osteoarthritis (OA) of the knee. The methodology was developed to incorporate measures made easily in a clinical setting. In OA, local degenerative changes can affect the function of sensory receptors and mechanoreceptors. As a result, appreciation of limb position as well as function may be compromised. Because proprioceptive sense plays an important role in reflex muscle contraction and stabilization of the joint, functional stability and joint integrity may be at risk if proprioception is impaired.

Design: Twenty subjects with unilateral OA of the knee were age-matched with 20 controls for the purpose of this study. The difference in degrees between a target angle of knee flexion and a reposition angle was measured during a partial weight-bearing test. A Dualer™ (electronic dual inclinometer) was used to measure the joint reposition sense (JRS) of the knee. Both sides were tested with six repetitions on each side. A mixed-model ANOVA was applied to the data for analysis.

Results: Comparison of the JRS between groups revealed a significant difference, with OA subjects having higher JRS error (JRSE) (p<0.001) than controls. There was no significant difference in JRSE for either side, regardless of group.

Conclusions: Subjects with unilateral OA of the knee demonstrated poorer performance on both legs in a partial weight-bearing reposition test than did control subjects.
Detecting individual change in children with mild to moderate motor impairment: the standard error of measurement of the Movement ABC
Authors: Leemrijse Chantal , Meijer Onno G , Vermeer Adri , Lambregts Brigitte , Adèr Herman J
Published: May 2003

Objective: To assess whether the Movement ABC can be used to monitor individual change in motor performance.

Design: Motor-impaired children were tested three times in succession with the Movement ABC without any intervention.

Setting: Two schools for special education and one school for children who are chronically ill.

Subjects: Three girls and 20 boys aged 6–8 years. Main outcome measures : Scores were measured per item (0→ 5), added to cluster scores (0→ 10 or 15), added to form the total scores (0→ 40). Mean scores, standard errors of measurement (SEMs) and least detectable differences (LDDs) were calculated per item, per cluster and for the total scores. A repeated measures analysis of variance was performed to test for the effects of time.

Results: The total scores improved significantly from the first session (mean: 15.4 points) to the second (mean: 13.3), but not from the second to the third (mean: 13.2). Average item scores ranged from 0.6 to 2.7 points with SEMs of 0.79→1.54 and LDDs of 2.20→ 4.27. Average cluster scores ranged from 3.4 to 5.3 with SEMs of 1.51→ 1.84 and LDDs of 4.18→5.11. The SEM of the total scores equalled 3.13 with an LDD of 8.68.

Conclusions: The total score of the Movement ABC is sufficiently sensitive to monitor individual change; the cluster scores have moderate sensitivity and individual items are inappropriate to monitor individual change. The significant effect of time is interpreted as an effect of learning.