bluuebunny/crossref_metadata_2025 huggingface dataset:
Heparin monitoring during cardiac surgery. Part 1: validation of whole-blood heparin concentration and activated clotting time
Authors: Raymond P D , Ray M J , Callen S N , Marsh N A
Published: November 2003

There is limited published data on the agreement between techniques for monitoring heparin levels. The aim of this study was to validate the Hepcon/HMS, with particular focus on the agreement with laboratory anti-Xa assay. The performances of two ACT instruments - Hemochron and HemoTec - were also evaluated, including an assessment for interchangeability. Blood samples from 42 adult cardiopulmonary bypass (CPB) patients were analysed for activated clotting time (ACT), whole-blood heparin concentration (Hepcon/HMS) and anti-factor Xa (anti-Xa) plasma heparin concentration. Agreement between measures was determined using the method of Bland and Altman. Simple analysis of agreement between the Hepcon and anti-Xa heparin revealed the Hepcon has a mean bias of -0.46 U/mL, with the limits of agreement ±1.12 U/mL. The comparison between ACT instruments indicated a mean difference of -96 seconds for the HemoTec, with limits of ±265 seconds. The Hepcon/HMS instrument displayed satisfactory agreement with anti-Xa plasma heparin concentration, as the expected variation would not be expected to cause problems in the clinical setting. Agreement between the two measurements of ACT may be satisfactory, provided each is assigned a different target value.
Heparin monitoring during cardiac surgery. Part 2: calculating the overestimation of heparin by the activated clotting time
Authors: Raymond P D , Ray M J , Callen S N , Marsh N A
Published: November 2003

Activated clotting time (ACT) values were converted to heparin concentration, enabling an assessment of the accuracy of the ACT and a quantification of the prolongation imposed by bypass. Blood samples were obtained from 42 adult cardiopulmonary bypass (CPB) patients before and during bypass surgery. Samples were analysed for ACT (HemoTec ACT) and anti-factor Xa (anti-Xa) plasma heparin concentration. The mean heparin concentration calculated before bypass was an accurate reflection of plasma heparin; however, calculated values rose to around 170% of anti-Xa values upon connection to bypass. By adjusting for this rise, for 95% of cases the calculated heparin concentration would vary between 0.60 and 1.65 times anti-Xa values. Without accounting for artificial prolongation or individual sensitivities, the ACT may give values between 0.8 and 3.0 times that indicated by the anti-Xa assay. When both individual heparin sensitivities and the effects of bypass are considered, the ACT may provide a more suitable indication of heparin levels; however, typical use may overestimate heparin up to threefold.
Miniaturization in cardiopulmonary bypass
Authors: von Segesser Ludwig K , Tozzi Piergiorgio , Mallbiabrrena Iker , Jegger David , Horisberger Judith , Corno Antonio
Published: November 2003

Cardiopulmonary bypass (CPB) remains the key technology for more complex cardiac operations. The perfusion equipment used nowadays has seen tremendous progress since its introduction into clinical practice 50 years ago. However, overall, CPB is still far from perfect. Major haemodilution is not only a problem for red cell-dependent gas transport, but also for the platelet and humeral factor-dependent coagulation, the protein-dependent intravascular oncotic pressure and so forth. Reduction of the priming volume through further miniaturization of CPB equipment is, therefore, the most obvious next step. A systematic approach needs to optimize all CPB components, including pumps, oxygenator/heat exchanger structures, filters, reservoirs, cardiotomy suction, tubings and cannulas. This report provides an update of already commercially available low prime perfusion devices (e.g., the CORx integrated pump-oxygenator) as well as promising prototypes like the smart suction system and the smartcanula.™
The dynamic bubble trap reduces microbubbles in extracorporeal circulation and high intensity transient signals in the middle cerebral artery: a case report
Authors: Perthel Mathias , Kseibi Samer , Bendisch Andreas , Laas Joachim
Published: November 2003

Microemboli during extracorporeal circulation (ECC) might be a reason for postoperative neuropsychological dysfunction. This case report shows that reduction of microbubbles in the arterial line, as well as high intensity transient signals (HITS) in the middle cerebral artery (MCA), could be accomplished by use of a dynamic bubble trap (DBT) during routine coronary artery bypass graft (CABG) surgery in a 63-year-old male. The DBT was placed after the arterial filter, an ultrasound Doppler device was used for detection of microemboli before and after the DBT. HITS were measured by a transcranial ultrasound Doppler in both MCAs. For first 32 min of ECC, the DBT was excluded; 54 916 microbubbles and 507 HITS were counted. In the next 30 min, blood flow was directed through the DBT. This led to a significant reduction of microbubbles from 55 888 to 18 237; accordingly, only 120 HITS were registered. A DBT, integrated in ECC for routine CABG, effectively reduces air bubbles, thus protecting the cerebrovascular system from micro-embolization, as demonstrated by lower HITS counts.
New technologies for respiratory assist
Authors: Matheis Georg
Published: November 2003

‘The artificial lung especially has lingered behind progress with artificial hearts and ventricular assist devices, not because the need for lungs has not been recognized, but because we have not had a full understanding of the engineering problems and the unique material requirements until recent years.’1

Brack Hattler, MD PhD

The development from the first clinical use of haemo-dialysis over five decades ago to widespread chronic treatment took more than two decades. The histories of other artificial organ technologies, such as artificial hearts, follow similar long development paths. For five decades, due to a lack of technology, artificial lungs have been limited to use with a heart-lung machine for cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO). The advent of pumpless biocompatible artificial lungs will open new treatment options for patients with acute or chronic lung failure.
Do static or dynamic AFOs improve balance?
Authors: Cattaneo D , Marazzini F , Crippa A , Cardini R
Published: November 2003

Objective: To verify if partial or total limitation of degrees of freedom at ankle joints could help patients with balance disorders in standing and walking.

Design: A cross-over design was chosen. Patients with multiple sclerosis (MS) were tested in three experimental conditions: barefooted, wearing ankle foot orthoses (AFOs), and wearing AFOs that allowed plantar flexion.

Setting: Neurorehabilitation unit in a rehabilitation centre.

Subjects: Fourteen patients suffering from MS with mild strength problems and balance disorders that required them to use walking aids outside.

Main outcome measures: Tests inferring static and dynamic skills were carried out in the three experimental conditions described above.

Results: Improvements were obtained in static balance tests especially wearing dynamic AFOs; the number of patients who were able to pass tasks on balance in upright position such as flstanding with feet together, head extended' increased from three to nine. Dynamic balance was impaired especially with static AFOs; the time spent walking 10 metres with these orthoses increased by 172% with respect to barefoot; less difference (113%) has been reported wearing dynamic AFOs.

Conclusion: Static and dynamic AFOs improved static balance, while dynamic balance was impaired especially by static AFOs; less negative influence on dynamic balance has been found while wearing dynamic AFOs.
Goal attainment scaling in evaluating a multidisciplinary pain management programme
Authors: Fisher K , Hardie R J
Published: November 2003

Objective: To examine the value of Goal Attainment Scaling (GAS) as a therapeutic tool and an outcome measure in a rehabilitation programme in the management of chronic pain.

Design: A prospective observational study.

Setting: A 15-day pain management programme, day case or residential, in an NHS Regional rehabilitation centre.

Subjects: One hundred and forty-nine consecutive patients enrolled during a 15-month period.

Interventions: Multidisciplinary structured educational programme of physiotherapy, occupational therapy and clinical psychology.

Main outcome measures: GAS; timed tests of physical mobility measures; McGill Pain Questionnaire (MPQ); Pain Intensity Numerical Rating Scale (NRS); Oswestry low back pain Disability Questionnaire (ODQ); General Health Questionnaire (GHQ); Pain and Impairment Relationship Scale (PAIRS). GAS and physiotherapy measures were compared with baseline data at enrolment and at discharge 15 days later. At six-month follow-up all measures were repeated.

Results: significant improvements at discharge were found for GAS, and physiotherapy measures. One hundred and twelve patients returned for review at six months, when improvements were maintained for GAS, sit/stand, Pain, ODQ and GHQ. GAS was shown to be a valid measure of ability, correlating significantly with walking improvement and somewhat less with a therapist-defined measure, suggesting some ability to discriminate.

Conclusions: The improvement measured by GAS showed that patients were enabled by the programme to achieve personally valued goals over a six-month period and to improve on these more than on other more conventional outcome measures.
Bone density in chronic low back pain: a pilot study
Authors: Gaber TA-ZK , McGlashan K A , Love S , Jenner J R , Crisp A J
Published: November 2003

Background and objective: Levels of physical activity in chronic low back pain patients are relatively low due to their fear of provoking pain. This may have a secondary impact on maintenance of bone mass. The objective of this study is to determine if patients with chronic low back pain are at a higher risk of bone demineralization.

Design: Bone mineral density (BMD) was measured in 25 chronic low back pain patients at the lumbar spine, hip and distal forearm.

Setting: A university hospital.

Subjects: Twenty-five chronic low back pain patients (mean age 45 years) enrolled on a residential back pain rehabilitation programme.

Results: Thirteen patients (52%) were osteopenic or osteoporotic in one or more sites. BMD at the lumbar spine was generally lower than the mean BMD of age-matched subjects ( p = 0.04). There was no significant relationship between BMD and duration of pain, disability, sex or previous surgical intervention.

Conclusions: Chronic low back pain patients have an increased incidence of osteopenia and osteoporosis. This finding reinforces the importance of motivating patients to incorporate exercise into daily life. Given the limited set of subjects used in the present study, further studies are required.
Use of cognitive-behavioural arthritis education programmes in newly diagnosed rheumatoid arthritis
Authors: Freeman K , Hammond A , Lincoln N B
Published: November 2003

Objective: To identify the effect of attending a cognitive-behavioural arthritis education programme on the health status of participants with newly diagnosed rheumatoid arthritis (RA) compared with a control group.

Design: Randomized controlled trial.

Setting: Hospital based.

Subjects: Newly diagnosed with RA.

Intervention: Participation in either a cognitive-behavioural arthritis education programme or a standard arthritis education programme (control group). Sessions for both groups lasted for 2 hours per week for four weeks. Subjects were examined at home by an assessor blinded to group allocation, prior to and three and six months following attendance.

Outcome measures: The main outcome measure was the Physical Function subscale of the Arthritis Impact Measurement Scale Two. Other outcome measures included erythrocyte sedimentation rate (ESR), joint count scores, assessments of pain and psychological status.

Results: Fifty-four subjects (mean time since diagnosis 4.5 months) took part. Baseline analysis revealed that the control group had significantly better levels of functional ability ( U = 185; p = 0.009) and lower levels of helplessness ( U = 168; p = 0.002) prior to intervention. This difference remained unchanged three months later. Six months following the intervention no significant differences were noted between the groups for any measure of health status. There were no significant changes in health status over time in either group.

Conclusion: Attending a cognitive-behavioural arthritis education programme had no significant effect on the health status of individuals newly diagnosed with RA. The move to early use of these programmes should be examined further, with a larger sample size and longer duration of follow-up.
The Standardized Three-metre Walking Test for elderly people (WALK3m): repeatability and real change
Authors: Simpson Janet M , Valentine John , Worsfold Christian
Published: November 2003

Objectives: (i) To examine the relative and absolute retest within-session reliability of the Standardized Three-metre Walking Test for elderly people (WALK3m), using walking time and number of steps as measures. (ii) To give clinicians details of how they can use the minimal detectable change in order to decide whether a patient's WALK3m performance has really changed. (iii) To give rules to decide whether one trial rather than three is sufficient.

Design and analysis: Subjects made three trials of WALK3m in the same session. Variability and level of performance were related so the data were log (ln) transformed. Relative reliability was measured by the intraclass correlation coefficient (ICC) then absolute reliability by the repeatability factor (RF) and minimal detectable change (MDC) (one-tailed and two-tailed) was derived from the within-subjects standard deviation.

Setting: Rehabilitation areas in the acute geriatric medical units at three south-west London hospitals.

Subjects: The standardizing sample consisted of 81 inpatients approaching discharge to their own homes.

Results: The ICC for walking time was 0.97 and for step counts 0.96. The MDC for walking is a 36% decrease between first and second measurements. The corresponding value for step counts is 21%.

Conclusion: WALK3m, whether measured by time or by step counts has excellent repeatability. Knowing the minimal detectable change can be of great value to clinicians who can calculate whether their patient is really making progress.
Electrically induced and voluntary activation of physiologic muscle pump: a comparison between spinal cord-injured and able-bodied individuals
Authors: Faghri Pouran D , Yount John
Published: November 2003

Objective: To evaluate the central haemodynamic responses during position changes from supine to sitting and during 30 min of standing between able-bodied and spinal cord-injured subjects. Also to assess the effects of the physiologic muscle pump in both groups during 30 min of standing.

Design: A repeated measure design. Both groups were tested on two different days under two conditions of 30 min of stationary standing and 30 min of dynamic standing (voluntary activation of the lower leg muscles in able-bodied and FES-induced activation of these muscles in spinal cord injured). The order of testing was random.

Setting: Rehabilitation hospital.

Subjects: Fifteen healthy able-bodied and 14 healthy spinal cord-injured subjects.

Main outcome measured: Stroke volume, cardiac output, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and total peripheral resistance during supine–pre sitting, sitting–pre standing and during 30 min of standing.

Results: Significant reductions ( p< 0.05) in systolic blood pressure, diastolic blood pressure and mean arterial pressure were found when spinal cord-injured subjects moved from sitting to standing during stationary standing; these values were maintained during dynamic standing. These values were maintained during both standing sessions in able-bodied subjects. During 30 min of stationary standing, there were significant reductions in stroke volume, cardiac output in both able-bodied and spinal cord-injured while their total peripheral resistance increased ( p< 0.05). During 30 min of dynamic standing, both groups maintained their haemodynamics at pre-standing values with the exception of significant reduction in stroke volume at 30 min of standing.

Conclusion: FES-induced activation of the physiologic muscle pump during change in position from sitting to standing prevented orthostatic hypotension in spinal cord-injured subjects. During standing it had equal or even greater effect on improving blood circulation when compared with voluntary activation in able-bodied subjects. The use of FES during standing and tilting in spinal cord-injured individuals may prevent orthostatic hypotension and circulatory hypokinesis and improve tolerance to tilting and standing.
Prediction of outcome of physiotherapy in advanced Parkinson's disease
Authors: Nieuwboer Alice , De Weerdt Willy , Dom René , Bogaerts Kris
Published: November 2003

Objective: Prediction of the effect of a home physiotherapy intervention on the basis of four clinical characteristics of patients with advanced Parkinson's disease.

Design: A repeated measures design comparing six weeks without treatment with six weeks of physiotherapy and a follow-up of 12 weeks.

Subjects: Persons with Parkinson's disease without dementia and suffering from considerable functional disability.

Intervention: Community physiotherapists treated patients in the home situation three times a week teaching cueing and conscious movement control for walking and carrying out transfers in and out of beds and chairs.

Main outcome measures: Mental status, disease severity, age and mood were included as predictor variables. A new functional scale developed as part of a previous study was used as the dependent variable administered in both the hospital and the home to determine whether the outcome generalized from the learning to a different environment.

Results: Only disease severity was a negative predictor of treatment outcome at home. In the hospital setting none of the factors predicted the immediate effect of treatment but cognitive ability and age were determinants of whether the treatment effects were maintained in the long term.

Conclusions: Using cueing and cognitive strategies benefited younger and older patients with Parkinson's disease alike. However, the findings indicate targeting of treatment at patients with milder disease severity and providing follow-up treatment for older and cognitively less able patients.
Whiplash-associated disorders – predicting disability from a process-oriented perspective of coping
Authors: Söderlund Anne , Lindberg Per
Published: November 2003

Objective: To describe the coping process over time for patients with whiplash-associated disorders (WAD).

Design: The study was conducted by following patients prospectively for 12 months.

Settings: The orthopaedic clinic at a university hospital.

Subjects: Fifty-three patients out of 59 had complete data-sets.

Main outcome measures: Two measures were used: the Pain Disability Index (PDI) and the Coping Strategies Questionnaire (CSQ).

Results: The results showed that the proportion of variance in disability shared with coping increased over time.

Conclusion: The importance of coping as an explanatory factor for disability increased during the one year follow-up. Thus, coping has a crucial role for disability. The possibility of a positive long-term outcome could therefore be improved by teaching patients to use active and adaptive coping strategies shortly after an accident.
Predictors of a nursing home placement from a non-acute geriatric hospital
Authors: Aditya B S , Sharma J C , Allen S C , Vassallo M
Published: November 2003

Background: Identifying patients who need Nursing Home (NH) care following a hospital admission is important.

Objective: To identify the factors that predispose to an NH discharge.

Design: Prospective observational study with blinded end-point evaluation.

Setting: A non-acute geriatric hospital.

Subjects: Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness.

Main outcome measures: Discharge to an NH or home.

Results: Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p < 0001). They were more likely to have visual impairment (p = 0.0009), confusion (p < 0.0001), wandering behaviour (p = 0.003), incontinence (p < 0.0001 or unsafe gait (p = 0.0005), to be on tranquillizers (p = 0.003), to be at risk of falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p < 0.001), tranquillizers (p < 0.001), impaired distant vision (p = 0.01) and living alone (p < 0.001) as independently associated with the risk of an NH discharge. This risk proportionately increased with the number of risk factors present: 4.28% for 0–2 factors, 25.8% for 3–4 factors and 81.8% for 5–6 factors (p < 0.0001).

Conclusion: These factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.
The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis
Authors: Varjú Cecília , Pethö Edit , Kutas Réka , Czirják László
Published: November 2003

Objective: To study the effect of physical exercise shortly after an acute episode of dermato/polymyositis (DM/PM).

Design: Pilot study of a descriptive nature.

Setting: Rehabilitation unit of a large general hospital.

Subjects: Ten patients 2–3 weeks after an acute phase of DM/PM (early recovery group) and 11 patients in the inactive stage of DM/PM for at least three months (chronic stage group).

Interventions: Isotonic muscle training consisted of several series of different repeated movements at 65–70% of individual maximal repetition limit. Special training was applied for the respiratory muscles. Relaxing baths, mud packs and massages were also applied.

Outcome measures: Dynamometer and spirometer were used for measuring the changes in muscle strength and respiratory function. Disability tests were done before and after therapy.

Results: No disease relapses or decreases in muscle function were seen. In the early recovery group, the average muscle strength improvement was 17 ± 31% ( p > 0.05) in the proximal muscles and 37 ± 23% ( p < 0.05) in the distal muscles, while the vital capacity also increased by 17 ± 21% ( p < 0.05). In the chronic stage group the average improvement in muscle strength was 46 ± 34% ( p < 0.05) in the proximal muscles and 37 ± 29% ( p < 0.05) in the distal muscles. By the end of the therapy both groups showed improvements in disability tests ( p < 0.05).

Conclusions: Physical training started 2–3 weeks following an acute exacerbation of the disease seems to be useful and safe. Some improvement in muscle strength and respiratory function can be obtained, muscle atrophy due to inactivity may be partially prevented and the level of disability can be decreased.
A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms
Authors: Wade Derick T , Robson Philip , House Heather , Makela Petra , Aram Julia
Published: November 2003

Objectives: To determine whether plant-derived cannabis medicinal extracts (CME) can alleviate neurogenic symptoms unresponsive to standard treatment, and to quantify adverse effects.

Design: A consecutive series of double-blind, randomized, placebo-controlled single-patient cross-over trials with two-week treatment periods.

Setting: Patients attended as outpatients, but took the CME at home.

Subjects: Twenty-four patients with multiple sclerosis (18), spinal cord injury (4), brachial plexus damage (1), and limb amputation due to neurofibromatosis (1).

Intervention: Whole-plant extracts of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), 1:1 CBD:THC, or matched placebo were self-administered by sublingual spray at doses determined by titration against symptom relief or unwanted effects within the range of 2.5–120 mg/24 hours.

Measures used: Patients recorded symptom, well-being and intoxication scores on a daily basis using visual analogue scales. At the end of each two-week period an observer rated severity and frequency of symptoms on numerical rating scales, administered standard measures of disability (Barthel Index), mood and cognition, and recorded adverse events.

Results: Pain relief associated with both THC and CBD was significantly superior to placebo. Impaired bladder control, muscle spasms and spasticity were improved by CME in some patients with these symptoms. Three patients had transient hypotension and intoxication with rapid initial dosing of THC-containing CME.

Conclusions: Cannabis medicinal extracts can improve neurogenic symptoms unresponsive to standard treatments. Unwanted effects are predictable and generally well tolerated. Larger scale studies are warranted to confirm these findings.
Lower abdominal pressure versus external bladder stimulation to aid bladder emptying in multiple sclerosis: a randomized controlled study
Authors: Prasad R S , Smith S J , Wright H
Published: November 2003

Objective: To investigate the change in post-void residual bladder volumes (PVR) with ‘abdominal vibration’ using a percutaneous bladder stimulator in multiple sclerosis (MS) patients compared with either ‘no treatment’ or ‘abdominal pressure’.

Design: Randomized controlled cross-over study. Setting: Regional neurorehabilitation clinics.

Subjects: Twenty-eight MS patients with urinary symptoms and PVR > 100 ml. Twelve patients had urinary incontinence.

Methods: MS patients with voiding dysfunction and elevated PVR of 100–500 ml on BVI-3000 Ultrasound Scanner were randomized to either ‘abdominal pressure’ or ‘vibration’ by a portable, percutaneous, vibrating device (Queen Square Bladder Stimulator; Malem Medical) or to ‘no treatment’. PVR was assessed at the end of each two-week phase.

Outcome measure: PVR reduction by greater than 100 ml.

Results: The 28 patients ranged in age from 29 to 71 years with a mean age of 49 years and a mean duration of MS of 12 years (range 1–37 years). The PVR decreased from 231 (SD 119) ml during no treatment to 191 (SD 132) ml with abdominal pressure ( p = 0.242). Using suprapubic vibration the PVR reduced further to 126 (SD 121) ml, which was highly significant ( p = 0.002) compared with no treatment. The difference between abdominal pressure and vibration just failed to reach significance ( p = 0.059). There was no significant reduction in either the frequency of micturition or episodes of incontinence. The device was well-tolerated by patients.

Conclusion: Abdominal vibration is an effective method of reducing PVR in MS patients and appears more effective than abdominal pressure alone.
Can the repetition effect maximize learning in multiple sclerosis?
Authors: Chiaravalloti Nancy D , Demaree Heath , Gaudino Elizabeth A , DeLuca John
Published: November 2003

Objective: The ‘repetition effect’ stipulates that recall ability improves as the number of learning trials that a person receives increases. While the repetition effect has been supported through many empirical investigations in healthy individuals, it has not yet been applied to clinical populations. The present study tested the hypothesis that an increased number of learning trials improves recall ability in persons with a neurological disorder, namely multiple sclerosis (MS).

Design: Prospective between-group design with 30-minute, 90-minute and one-week assessments.

Setting: Private, nonprofit, research facility.

Subjects: Sixty-four MS subjects; 20 healthy control subjects (HC).

Interventions: Subjects were given a modified Selective Reminding Test (SRT), a list of 10 words to remember in a selective reminding format. To control for the amount of information initially learned, the learning trials were repeated until the subject recalled all 10 words on two consecutive trials.

Main outcome measures: SRT word recall and recognition was tested 30 minutes, 90 minutes and one week subsequent to initial acquisition.

Results: Interestingly, the antithesis of our hypothesis was found. That is, persons with MS who required more learning trials to reach the perfect learning criterion performed significantly worse on the recall trials. However, this was not the case in a sample of healthy individuals undergoing the same protocol.

Conclusions: These results indicate that individuals with MS may not benefit from repetition in isolation, but rather require the use of more intensive cognitive rehabilitation strategies (i.e., increased organization) to help improve their depth of encoding of new information.
Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis
Authors: Baskurt Ferdi , Özcan Ayse , Algun Candan
Published: November 2003

Objective: The aim of this study was to compare the effectiveness of naproxen (10%) applied by topical iontophoresis or by phonophoresis in the treatment of lateral epicondylitis.

Design: Randomized controlled trial.

Setting: Dokuz Eylül University School of Physical Therapy and Rehabilitation.

Subjects: This study was carried out with 61 patients who had lateral epicondylitis. They were randomized into two groups.

Interventions: Naproxen was applied to the first group using phonophoresis (29 patients – 33 extremities) and to the second group using iontophoresis (32 patients – 34 extremities). Patients in both groups were treated by other physiotherapy methods (cold pack, progressive strengthening and stretching exercises).

Outcomes: Pain scores (at rest, during motion, with pressure, weight lifting), grip strength and Nirschl–Petterone Grading System were evaluated before and after treatment.

Results: Pain scores decreased, grip strength and Nirsch–Petterone Grading System statistically significantly increased in both groups after treatment ( p < 0.05), but there were no statistical differences between groups before or after treatment ( p > 0.05).

Conclusion: The results suggest that iontophoresis and phonophoresis of naproxen are equally effective electrotherapy methods in the treatment of lateral epicondylitis.
Selection criteria for rehabilitation services
Authors: Wade Derick T
Published: November 2003

In an era of inadequate resources for all health services, rehabilitation services providers are frequently asked to produce criteria defining the patients they will accept. In principle rationing of services by ability to benefit is fair. In practice there are many difficulties. The evidence to allow selection of patients for rehabilitation does not exist and probably the best criterion of ability to benefit from rehabilitation ( not ‘likely to have a good outcome’) is demonstration of benefit within a rehabilitation programme. Basic considerations of epidemiological statistical facts also show that criteria are likely to select too many inappropriate patients into services or exclude too many appropriate patients from services. The solution is for purchasers and providers to develop mutual trust and, in the UK at least, to ensure that patients who do not need rehabilitation can be discharged quickly into appropriate support services.
Obstacle training programme for individuals post stroke: feasibility study
Authors: Bassile Clare C , Dean Catherine , Boden-Albala Bernadette , Sacco Ralph
Published: November 2003

Objective: The purposes were threefold: to develop an obstacle ambulation training programme, to recruit and retain individuals post chronic stroke and to assess the effectiveness of the obstacle ambulation training programme.

Design: Intervention study; case series; baseline to post-intervention measures and one month follow-up after intervention.

Setting: An outpatient department.

Subjects: Five individuals with chronic stroke with mild to moderate functional limitations; convenience sample.

Interventions: Therapy consisted of twice weekly sessions for four weeks during which subjects walked along a walkway and over obstacles.

Main outcome measures: Motor Assessment Scale – walking section (MAS – time), Six-minute Walk Test distance, walking velocity, and Medical Outcomes Study-36 Health Status Measurement (SF-36).

Results: Significant improvements were seen baseline to post intervention for walking velocity, Six-minute Walk Test, MAS and SF-36 physical function score ( p £ 0.025 for all measures). Most improvements noted at the end of training were retained one month later. The effect sizes ranged from 0.33 to 1.20.

Conclusions: Substantial improvement in ambulation function and disability level were seen as a result of the obstacle training programme for individuals with chronic stroke. Further investigation is warranted.
A study of interventions and related outcomes in a randomized controlled trial of occupational therapy and leisure therapy for community stroke patients
Authors: Logan P A , Gladman J RF , Drummond A ER , Radford K A
Published: November 2003

Objective: To undertake a detailed analysis of therapy provided in a multicentred randomized controlled trial of activities of daily living (ADL) and leisure (TOTAL), testing the hypothesis that specific interventions given in the trial affected specific aspects of outcome.

Subjects: Three hundred and nine stroke patients who had been randomly allocated to receive either occupational therapy aimed at ADL activities ( n = 156) or leisure ( n = 153).

Measures: Number, duration and type of activity undertaken per patient. Barthel Index, Extended Activities of Daily Living Scale (EADL) and Nottingham Leisure Questionnaire (NLQ) six months after entry to the study.

Method: Activities that had been used in treatment were coded and categorized. Frequently used activities identified. These activities were matched to items from the six-month outcome measures. Patient independence in these outcome items was compared between the leisure and ADL groups.

Results: Three hundred and nine therapy record forms were returned. Patients received a median of ten sessions with a median duration of 55 minutes. The ADL group received significantly more, mobility training, transfer training, cleaning, dressing, cooking and bathing training (chi-squared, p < 0.05). Sport, creative activities, games, hobbies, gardening, entertainment and shopping were used significantly more in the leisure group (chi-squared, p < 0.05) than the ADL group. Fifteen items from the outcome measures were identified as specific to these interventions. There were no statistically significant differences in outcome on these 15 items between the ADL and leisure groups (chi-squared, p > 0.05).

Conclusions: We found no evidence that specific ADL or leisure interventions led to improvements in specific relevant outcomes. We believe that these findings should prompt a review of the relationship between process and outcome of occupational therapy.
Screening for ability to complete a questionnaire: a preliminary evaluation of the AbilityQ and ShoulderQ for assessing shoulder pain in stroke patients
Authors: Turner-Stokes Lynne , Rusconi Susanne
Published: November 2003

Objectives: To assess the repeatability of the AbilityQ – a screening tool to assess technical ability to complete a questionnaire – in patients with complex disabilities following stroke. To evaluate the validity of the AbilityQ in predicting repeatability and consistency of response to verbal and visual analogue scale questions in the ShoulderQ in those with shoulder pain.

Design: In a cross-sectional study, the AbilityQ and ‘ShoulderQ’ were administered on two consecutive days by a single investigator.

Setting: Six regional rehabilitation centres in the UK managing patients with severe complex neurological disability.

Subjects: Forty-nine patients with anterior or posterior circulation strokes: 13 (63%) had cognitive deficits and 28 (57%) had communicative deficits.

Results: Thirty-one (63.3%) patients required some degree of help in completing the AbilityQ. Percentage agreement for individual questions between day 1 and day 2 ranged from 55 to 88% with kappa values from 0.07 to 0.79. Repeatability of ShoulderQ responses was 36–72% for the verbal questions (kappa values 0.16–0.56). For visual analogue scale (VAS) questions, agreement ±1 on a 10-point scale was 36–59% with intraclass correlation coefficients 0.50–0.60 ( p < 0.01). High verbal (33/4) and VAS scores (3/3) on the AbilityQ had positive predictive values for good repeatability in the ShoulderQ of 80% and 58% respectively. Mismatched AbilityQ responses to verbal and VAS questions showed a positive predictive value of 92% for similar inconsistency in the ShoulderQ and a negative predictive value of 90%.

Conclusions: In this preliminary evaluation the AbilityQ and the ShoulderQ each demonstrated a moderate level of repeatability in a group of patients expected to have difficulty in completing questionnaires. The AbilityQ appears to have some clinical usefulness in identifying those able to respond to the ShoulderQ and, where responses to verbal and VAS questions conflict, may offer some guidance as to which are most likely to be accurate in that individual. Further development is underway.
Natural history of cognitive impairment after stroke and factors associated with its recovery
Authors: Patel Mehool , Coshall Catherine , Rudd Anthony G , Wolfe Charles DA
Published: November 2003

Objectives: To describe the natural history of cognitive impairment following stroke over three years; determine factors associated with recovery of post-stroke cognitive impairment and examine the effect of this recovery on stroke outcomes.

Design: Observational study. Setting: Population-based register of first-ever strokes. Measures: Mini-Mental State Examination (MMSE) for cognition (cognitive impairment: MMSE<24), Barthel and Frenchay activity indices for disability.

Methods: To describe its natural history, cognition was assessed at three months, 1, 2 and 3 years after stroke in 163 subjects registered in 1995. Recovery of cognitive impairment was examined using a larger cohort registered between 1995 and 1998 ( n = 476) and 193 subjects cognitively impaired at three months were reassessed a year post stroke; 34 who had recovered cognitively (MMSE 24–30) were compared with 102 with persistent cognitive impairment in terms of demography, risk factors, initial impairments and stroke subtype.

Results: At three months, 1, 2 and 3 years post stroke, the prevalence rates of cognitive impairment were 39%, 35%, 30% and 32% respectively. Multivariable analyses showed that recovery was associated with smoking (OR 3.7; 95% CI 1.2–11.8), compromised by visuospatial neglect (OR 0.27; 95% CI 0.08–0.89), and had a near-significant association with right hemispheric lesion (OR 2.87; 95% CI 0.94–8.78). Cognitive recovery was associated with less institutionalization ( p = 0.032) and being less disabled, on Barthel ( p = 0.001) and Frenchay Activity Indices ( p = 0.028).

Conclusions: Cognitive impairment remains highly prevalent up to three years after first stroke. Recovery from cognitive impairment is associated with smoking and possibly right hemisphere strokes, but compromised by visuospatial neglect. These associations require further clarification.
Efficacy of a specially designed hip protector for hip fracture prevention and compliance with use in elderly Hong Kong Chinese
Authors: Woo J , Sum C , Yiu H H , Ip K , Chung L , Ho L
Published: November 2003

Background: Hip protectors, while effective in prevention of hip fractures, have been designed for a Caucasian body build and may not be suitable for Asian subjects living in a subtropical climate.

Objective: Hip protectors and accompanying shorts were specially designed for use for the Chinese body build and subtropical climate, and tested for compliance and efficacy in fracture prevention.

Method: A pragmatic study examining compliance with the wearing of hip protectors, and effectiveness in preventing hip fractures (using a case control design), in 302 subjects wearing hip protectors and 352 control subjects.

Results: Overall compliance varied from 55 to 70%. The relative risk for hip fracture was 0.18 (0.04–0.79), relative risk reduction 82%, and the number of subjects needing to wear a hip protector to prevent one fracture was 33 (19–117).

Conclusion: Hip protectors adapted for use in Chinese people appear to reduce hip fractures in routine clinical practice.
Concurrent validity of an electronic descriptive pain scale
Authors: Scudds Roger A , Fishbain David A , Scudds Rhonda J
Published: November 2003

The study objective was to assess the concurrent validity of the Electronic Descriptive Pain Scale (EDPS), a pain scale built into a transcutaneous electrical nerve stimulation device. One hundred patients in an outpatient physiotherapy (PT) clinic participated (mean age 41.30 years, SD 13.95). Before and after a PT treatment, subjects rated their current pain intensity with the EDPS, a visual analogue scale, a numerical pain rating scale, and the McGill Pain Questionnaire's Present Pain Intensity. The results showed relatively high significant correlations between the EDPS and each of the other pain scales.
Duration of condition is unrelated to health-state valuation on the EuroQoL
Authors: Myers Julia A , McPherson Kathryn M , Taylor William J , Weatherall Mark , McNaughton Harry K
Published: November 2003

Objective: To determine whether health valuations, such as those used in economic evaluation, are affected by duration of a health condition. People with disabling health conditions tend to value health more highly than members of the general population, and one explanation for this is that over time their experience of living with a disabling illness changes the way in which they value health. If this is so, a relationship between the duration of an individual's disabling health condition and the valuation they assign to their health-state might reasonably be expected.

Design: A postal survey using the EuroQoL (EQ-5D) instrument to collect descriptions and valuations for health from people who reported a diagnosis of either stroke or multiple sclerosis. Contact with participants was made through national support organizations and questionnaires were returned by mail.

Results: Eight hundred and ninety-four people completed the survey. One hundred (11%) had one health-state indicating moderate problems in all five dimensions of the EQ-5D descriptive profile. For people with this health-state, analysis of covariance showed no relationship between valuation of health-state and time from onset of illness ( F = 0.38, p = 0.54). This finding applied irrespective of the diagnosis, and for some other less frequently reported health-states.

Conclusion: Clinical experience suggests that over time people adapt to longterm disability. However we found no evidence to support the proposition that higher health-state valuations by people with disabling conditions are explained by the actual duration of their condition.
A regression analysis of the Waterlow score in pressure ulcer risk assessment
Authors: Anthony Denis , Reynolds Tim , Russell Linda
Published: November 2003

Objective: To explore the predictive value of the Waterlow score, and the subscores of age and gender.

Design: Logistic regression analysis was conducted on the two subscores of the Waterlow score, and the residual Waterlow score with gender and age removed. Receiver operating characteristic (ROC) analysis gave a quantitative measure of the classification ability of the Waterlow score.

Setting: Burton, UK. Subjects: All admissions over a five-year period to the District General Hospital, a total of 150 015 admissions of 82 691 patients.

Interventions: None.

Main outcome measures: Area under the ROC curve for significant (as determined by logistic regression) variables.

Results: Data were inaccurate in at least 44.7% of the records, and analysis was conducted on the 43 735 records for which no errors were apparent. Nine hundred and fifty-four patients had a pressure ulcer on admission (2.1%); 277 developed a pressure ulcer (0.6%). The Waterlow score was predictive of pressure ulcers. Age was predictive, and gender was not found to be a significant predictor.

Conclusions: The Waterlow score may be improved and simplified by removing gender from the scoring system.
Use of videotape to assess mobility in a controlled randomized crossover trial of physiotherapy in chronic multiple sclerosis
Authors: Wiles C M , Newcombe R G , Fuller K J , Jones A , Price M
Published: November 2003

Objectives: To determine to what degree assessment of mobility based on comparison of videotape recordings before and after courses of physiotherapy in patients with chronic multiple sclerosis (MS) is reliable, correlates with ‘live’ assessments and indicates benefit.

Design: Prospective data collection within a randomized crossover controlled trial of physiotherapy at home, as an outpatient, or ‘no therapy’ in 40 patients.

Setting: Hospital outpatients: outpatient and home physiotherapy.

Outcomes: Mobility change based on a comparison of short video recordings before and after each treatment period was scored independently by two physiotherapists blinded to therapy type and other measures of outcome. Scores were compared with changes in the Rivermead Mobility Index (RMI) and other indices assessed by a physiotherapist in the patient's home.

Results: The two video observers agreed substantially on patient outcome. Changes in walking based on video correlated with RMI for home treatment ( r = 0.41, p = 0.008) but not for hospital or no treatment periods ( r = 0.14 and 0.15): video changes correlated with the ‘live’ assessor's global change score inconsistently (‘no therapy’ r = 0.48, p = 0.002, hospital r = 0.30, p = 0.06 and home r = 0.17, p = 0.30 treatment periods). Based on video data alone, improved mobility was evident following home therapy for only one observer but not for the other or the averaged scores of both.

Conclusion: There was substantial agreement between two observers deciding on change in mobility based on independent blinded evaluation of short video sequences. However the correlations of these with ‘live’ assessments were variable. Physiotherapy had a less clear benefit on mobility based on video analysis alone compared with ‘live’ assessments. The study highlights the need for more objective measures of habitual mobility over longer periods.