bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric properties of the Rivermead Mobility Index in Italian stroke rehabilitation inpatients
Authors: Franchignoni Franco , Tesio Luigi , Benevoloand Emilio , Ottonello Marcella
Published: November 2003

Objective: To examine the internal consistency, validity, responsiveness and test scalability of the Rivermead Mobility Index (RMI) in Italian rehabilitation inpatients recovering from stroke.

Design: Seventy-three stroke inpatients undergoing rehabilitation were assessed at admission ( T0) and five weeks later ( T1), using RMI, the motor (motFIM) and cognitive (cognFIM) subscales of the Functional Independence Measure, the ‘leg’ section of the Motricity Index and Trunk Control Test.

Results: Cronbach's alpha of the RMI was 0.92. The item-to-total correlation coefficients ( rrb) ranged from 0.36 to 0.83, all p < 0.003. All correlations between RMI scores and the other instruments, both at T0 and T1, were statistically significant ( r3 0.49, all p < 0.0001), except those with cognFIM. The difference in RMI scores over the testing period was statistically significant (sign test: z = 7.1, p < 0.0001) and the effect size was 0.89. The coefficient of reproducibility was 0.95 at T0 and 0.93 at T1, and both coefficients of scalability were 0.67.

Conclusions: The study confirms the internal consistency, construct validity and responsiveness of the RMI, according to the classic psychometric indexes. However, some minor concerns arise regarding: (a) a floor effect of RMI in subacute rehabilitation stroke inpatients at admission and; (b) one item (‘bathing’) that seems sensitive to cultural and environmental factors. Moreover, even though RMI met the scaling criteria, the item hierarchy is not coincident with the one originally postulated. So, RMI should be considered only as a summated index with ordinal properties, and not a hierarchically ranked scale.
The validation of the Subjective Index of Physical and Social Outcome (SIPSO)
Authors: Trigg Richard , Wood Victorine A
Published: November 2003

Objective: To validate the Subjective Index of Physical and Social Outcome (SIPSO) in its final 10-item version as a measure of reintegration to pre-stroke lifestyle.

Design: Postal and interview administration of questionnaires.

Measures: SIPSO, Functional Limitations Profile (FLP), Reintegration to Normal Living Index (RNLI).

Setting: Community setting, Bath, UK.

Subjects: Two hundred and sixty-one survivors of stroke discharged from a district general hospital.

Results: Internal consistency (item-total correlations >0.6) and test–retest reliability (intraclass correlation coefficient (ICC) = 0.96) of the measure were confirmed. Construct validity was confirmed through significant correlations with the six subsections of the FLP and the RNLI. Confirmatory factor analysis of the measure found that the first five items form a robust subscale that clearly relates to physical function. The items within the second subscale (questions 6–10) measure several domains (social, leisure, self-image) and do not form a homogeneous group.

The SIPSO was able to detect an improvement in integration within a sample of patients over a three-month period soon after discharge (effect size = 0.26). The hypothesis that the degree of improvement experienced by patients following discharge from hospital would be small, but should be detectable was confirmed. The agreement between proxy and patient on the SIPSO was acceptable for individual items (kappa value range = 3.1–5.8) and total score (ICC = 0.96).

Conclusions: The SIPSO is a brief self-complete measure, with proven validity and reliability, which addresses both quantitative and qualitative aspects of activities and interaction. It provides a useful measure for evaluating rehabilitation programmes that aim to reintegrate patients to their pre-stroke lifestyle. The authors suggest that the SIPSO should be used as a 10-item measure.
Multiple sclerosis in Stockholm County. A pilot study exploring the feasibility of assessment of impairment, disability and handicap by home visits
Authors: Einarsson U , Gottberg K , Fredrikson S , Bergendal G , von Koch L , Holmqvist L Widén
Published: November 2003

Objective: A pilot study performed within Stockholm County to evaluate the feasibility of collecting data using a comprehensive evaluation package administered in the home environment to assess impairment, disability and handicap in order to explore the consequences of multiple sclerosis (MS). Design: Home visits to 26 purposefully selected MS patients with different levels of disability, in both ordinary and sheltered living. The comprehensive evaluation package included: biographical data, Mini-Mental State Examination, Free Recall and Recognition of 12 Random Words Test, Symbol Digit Modalities Test, Beck Depression Index, Lindmark Motor Capacity Assessment, time to walk 10 metres, Nine-hole Peg Test, Barthel ADL Index, Katz Extended ADL Index, Frenchay Activities Index, Sickness Impact Profile and frequency of falls and injurious falls.

Results: This pilot study demonstrates that the proposed methods can be used to evaluate MS patients differing in levels of disability and forms of living. The data collection method, based on home visits, was well accepted by the patients, their spouses and salaried personal assistants and could be performed within 2–21/2 hours.

Conclusions: The evaluation package used in this pilot study is suitable for use in population-based studies and it should provide comprehensive information on the impact and consequences of MS on patients, and should contribute to the identification of areas in which the provision of rehabilitation and health care services needs to be improved.
Co-ordination of patient care in inpatient rehabilitation
Authors: Pryor Julie
Published: November 2003

Objective: To evaluate the effectiveness of a new patient care co-coordinator position in an inpatient rehabilitation setting.

Design: Pre and post test using a 42-item staff survey.

Setting: One inpatient rehabilitation service in rural New South Wales, Australia.

Subjects: Members of the multidisciplinary team.

Intervention: A new patient care co-coordinator position.

Outcome measures: Comparison of trends in staff responses to pre and post test surveys.

Findings: The post test survey demonstrated an overall increase in the reported frequency of desirable rehabilitation practices and increased staff satisfaction with those practices.

Conclusions: A patient care co-coordinator may contribute to improving the processes and practices of inpatient rehabilitation and staff satisfaction.
The effect of a perceptual cognitive task on exercise performance: the dual-task condition after brain injury
Authors: Dawes Helen , Cockburn Janet , Roach N K , Wade Derick T , Bateman Andrew , Scott Oona
Published: November 2003

Objective: To examine the effect of additional cognitive demand on cycling performance in individuals with acquired brain injury (ABI).

Design: Prospective observational study.

Setting: Rivermead Rehabilitation Centre.

Participants: Ten individuals with ABI (7 men, 3 women) (traumatic brain injury 7, tumour 1, stroke 2) and 10 healthy controls (6 men, 4 women).

Intervention: Individuals were asked to maintain a set cadence during a three-stage incremental cycling test in both single-task (no additional task) and dual-task (whilst performing an additional cognitive task) conditions.

Results: The ABI group showed a slight slowing in cadence in stages 1 and 3 of the graded exercise test from the single-to the dual-task condition, although this was not significant ( p £ 0.05). The control group showed no slowing of cadence at any incremental stage. When directly comparing the ABI with the control group, the change in cadence observed in dual-task conditions was only significantly different in stage 3 ( p £ 0.05).

Conclusions: Clinicians should be aware of the possibility that giving additional cognitive tasks (such as monitoring exercise intensity) while individuals with acquired brain injury are performing exercises may detrimentally affect performance. The effect may be more marked when the individuals are performing exercise at higher intensities.
Early mobilization with walking aids following hospital admission with acute exacerbation of chronic obstructive pulmonary disease
Authors: Yohannes Abebaw M , Connolly Martin J
Published: November 2003

Objective: We hypothesized that early ambulation with a gutter frame (GF) in elderly patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may reduce physical disability and allow earlier discharge.

Design: Blinded, randomized parallel groups trial.

Subjects: One hundred and ten consecutive AECOPD inpatients.

Interventions: Participants were recruited two days post admission and randomly allocated to four groups: GF with supplemental oxygen (GFSO), GF with supplemental air (GFSA), rollator with supplemental air (RSA) and rollator with supplemental oxygen (RSO) (air/oxygen was double-blinded to patients and investigators). Patients exercised three times daily (maximum of 15 minutes per session) with a physiotherapist or nurse.

Outcome measures: Physical disability measured by Barthel Index and perceived respiratory effort by Borg Scale.

Results: After intervention no significant difference was observed between the four groups in length of hospital stay ( F = 0.78; p = 0.50), changes in mean Barthel score ( F = 2.08; p = 0.11) and Borg score ( F = 0.35; p = 0.79). However, improvement in Barthel score (mean 1.22 combined gutter frame group air/oxygen) was greater than the combined rollator group (mean 0.55; p = 0.003). Baseline Barthel score and nurses’ assessment of compliance were associated with improvement in Barthel score ( p < 0.0001 and p < 0.002). Barthel score was predicted by use of gutter frame ( F = 6.17; p = 0.01), not by use of rollator. Use of air/oxygen group was not related to improvement in Barthel score.

Conclusion: Short-term exercise therapy with gutter frame after AECOPD admission reduces physical disability in older patients but does not affect length of hospital stay. Use of supplemental oxygen during exercise has no additional benefits.
Long-term outcome of sports injuries: results after inpatient treatment
Authors: Dekker R , van der Sluis C K , Groothoff J W , Eisma W H , Duis H J ten
Published: November 2003

Objective: To investigate whether sports injuries result in long-term disabilities and handicaps and to establish variables with a prognostic value for the occurrence of these long-term consequences.

Materials and methods: All patients older than 17 years of age and admitted to the University Hospital Groningen because of a sports injury were entered in the study. By filling in a questionnaire 1–4 years after the injury an inventory was made of the long-term consequences.

Main outcome measures: Absenteeism from work and sports, experienced disabilities or handicaps and the Sickness Impact Profile 68 (SIP68).

Results: Out of 306 patients 229 (75%) returned a completed questionnaire. Sixty-seven per cent of the working population had been unfit for work up to one year, whereas 4% still had not resumed work. Absenteeism from sports was also considerable; nearly half of the population did not participate in sports for more than a year. Furthermore, 32% of the patients still experienced disability or handicap following the injury. This finding is in agreement with the results of the SIP68 (odds ratio 6.8; confidence interval (95% CI): 3.51–13.08). Two prognostic variables could be distinguished: ‘gender’ and ‘type of sport’. Long-term consequences occur more often in women ( p < 0.03) and with playing outdoor soccer, horse riding or skiing ( p < 0.01).

Conclusions: Sports injuries can lead to long-term disabilities and handicaps. The variables ‘gender’ and ‘type of sport’ were of prognostic significance.
The use of a new overlay mattress in patients with chronic pain: impact on sleep and self-reported pain
Authors: Price P , Rees-Mathews S , Tebble N , Camilleri J
Published: November 2003

Objective: To evaluate the use of an air flotation mattress overlay in patients with chronic pain.

Design: Four-week prospective AB design.

Setting: The mattress overlay was used in a community setting.

Subjects: Adult patients attending an outpatients clinic in a department of rheumatology, with chronic pain plus sleep problems, or pain sufficient to disturb sleep.

Interventions: An inexpensive low-pressure inflatable mattress overlay (ReposeTM), which is readily portable and has no electrical supply, was introduced to the patients. They were encouraged to use the support surface every night.

Main outcome measures: The primary outcome was measured by self-reported changes in sleep quantity and frequency of sleep disturbance. Secondary outcomes were self-reported changes in pain and use of analgesia, verified by medical notes.

Results: Nineteen female patients (mean age 61 years) completed the study. At baseline, mean length of sleep time was 3.8 h, with mean of 4.9 interruptions of mean 25.3 min: week 4, mean sleep time = 6.4 h, with a mean of 2.3 interruptions for mean 14.2 min (all measures p < 0.001). At baseline, median pain during the day was 6 and at night-time was 7; by week 4 a reduction in pain was reported both for the day (median = 5) and the night (median = 5) (both p < 0.001). Thirteen patients reported a reduction in the use of analgesia during the study.

Conclusions: In this pilot study of a new mattress overlay, statistically significant improvements in sleep and pain were noted over a four-week period.
Do psychological measures predict the ability of lower limb amputees to learn to use a prosthesis?
Authors: Larner Stuart , van Ross Ernest , Hale Carolyn
Published: November 2003

Objective: Can psychological tests predict whether, on admission to a rehabilitation ward post amputation, a lower limb amputee will learn to use a prosthesis during the ensuing inpatient rehabilitation programme?

Design: A one-sample design in which psychological variables, and transfemoral/transtibial amputation site were tested as predictors of outcome.

Setting: An inpatient rehabilitation unit in the UK offering prosthetic provision.

Subjects: Forty-three consecutive patients with peripheral vascular disease (mean age 66.35 years, standard deviation 14.99) who had received an amputation on average 19 days previously on a surgical ward and were transferred to the unit for rehabilitation including assessment for prosthetic provision.

Main outcome measure: Whether the patient learnt to use a prosthesis independently during the stay on the rehabilitation unit.

Results: During their stay in the rehabilitation unit (mean length of stay = 42 days), 31 patients learnt to use a prosthesis and 12 did not. A forward stepwise logistic regression revealed that the Kendrick Object Learning Test score on admission correctly predicted outcome in 70% of cases. The predictive power rose to 81% correct when the amputation site (transfemoral or transtibial) was included amongst the predictors. Anxiety, depression and recovery locus of control scores were not significant predictors of functional prosthetic use in this study.

Conclusion: A simple test of learning ability and the amputation site can help to predict the patient's ability to learn to use a prosthesis following amputation and is recommended as part of the assessment process.
Variability in the measurement of uptime in children: a preliminary study
Authors: Eldridge B , McCoy A , Galea M , Wolfe R , Graham H K
Published: November 2003

Objective: To examine variability in ‘uptime’ (the amount of time spent in the upright position).

Design: An observational study. Setting: The community (i.e., homes and schools in the Melbourne metropolitan area).

Subjects: Normal children between 8 and 15 years of age (18 girls and 8 boys).

Equipment: An ‘uptimer’, a lightweight, battery-operated remote monitor, was used to record uptime.

Procedure: Each child in the study wore the uptimer continuously over a 24-hour period, which included a typical day at school, on four separate occasions, one week apart.

Results: The variability in repeated measures of uptime in the same child (standard deviation 0.8 hours in 24 hours) was lower than the variability between the children (standard deviation 1.1 hours in 24 hours). We estimate that a single uptime measurement has reliability given by an ICC of 0.65 (95% confidence interval 0.49–0.82), which is calculated by dividing the between-child variability by the total variability (within-child and between-child variability). There were no systematic differences in mean uptime between occasions of measurement.

Conclusion: As an estimate of the time that a child spends in the upright position, a single 24-hour period of measurement of uptime may vary considerably from one occasion to the next. However, this within-child variability is less than the variability between children. In large-scale field studies a one-off measurement of uptime may be acceptable, but in small rehabilitation studies uptime should be measured on at least three occasions.
Life goals of people with disabilities due to neurological disorders
Authors: Nair K P Sivaraman , Wade Derick T
Published: November 2003

Objective: To identify the life goals of people with long-term neurological disabilities and to correlate them with measures of disability.

Design: Cross-sectional descriptive study.

Setting: Centre for continuing disability management

Subjects: Patients with static or progressive neurological disorders.

Interventions: Survey using questionnaires and disability scales.

Measures: Life goals were identified with a life goals questionnaire. Subjects were also assessed using the Barthel Index, Rivermead Extended Activities of Daily Living Index, Rivermead Mobility Index, Short Orientation Memory Concentration test and Hospital Anxiety and Depression Scale.

Results: Ninety-three subjects participated in the study. The frequency with which goals were chosen as extremely important was: family 64; personal care 59; residential arrangements 58; partner 53; social contacts 30; financial status 29; leisure 26; religion 22; and work 19. Positive correlation was noted between stated importance of: personal care and independence in ADL; work and independence; partner and cognitive ability; religion and age; and financial status and anxiety. There was negative correlation between grades of personal care and depression, work and age, residential arrangements and RMI, and social contact and anxiety and depression. Depressed patients rated fewer goals as being of extreme importance.

Conclusions: People with disabilities attach great significance to relationships and personal care. Grades of life goals correlated with measures of disability, cognition and emotion.
Good inter-rater reliability of the Frenchay Activities Index in stroke patients
Authors: Post Marcel WM , Witte Luc P de
Published: November 2003

Objective: To assess inter-rater reliability of the Frenchay Activities Index (FAI) when used by occupational therapists in stroke patients.

Design: Independent administration of the FAI by occupational therapists in 45 stroke outpatients.

Setting: Outpatient departments of two Dutch rehabilitation centres.

Statistics: Agreement between pairs of raters was assessed at item level using weighted Kappa and the percentage absolute agreement and for the total score using intra-class correlations (ICC), Bland–Altman plots and computation of the smallest real difference (SMR).

Results: ICC of the total score was good (0.90; 95% confidence interval (95% CI): 0.82–0.94). The Bland–Altman plot did not reveal relationships between agreement and height of scores. Reliability at item level was good (kappa >0.60) in 11 out of 15 items. The item ‘gainful work’ showed high agreement but a low kappa due to an extremely skewed score distribution. Reliability was insufficient in three items: ‘local shopping’, ‘social occasions’ and ‘actively pursuing hobby’. Clarification of scoring instructions of these items might further improve the inter-rater reliability of the FAI.

Conclusion: The FAI is a reliable instrument to measure outcomes of outpatient rehabilitation in patients with stroke.
Relative contribution of footwear to the efficacy of ankle-foot orthoses
Authors: Churchill Andrew JG , Halligan Peter W , Wade Derick T
Published: November 2003

Objective: To examine the relative effects of footwear and an ankle-foot orthosis (AFO) on hemiplegic gait.

Design: A case series with three contrasting conditions: walking without footwear, with footwear alone, and with footwear and an AFO. Spatio-temporal parameters reflecting walking performance were analysed using an analysis of variance (ANOVA).

Patients: Five patients with hemiplegia and reduced mobility following stroke.

Setting: A specialist rehabilitation centre.

Intervention: Wearing either footwear alone, or footwear with an AFO.

Measures: Video recordings of gait were subjected to a kinematic analysis to determine spatio-temporal parameters.

Results: Stride length was increased by an average of 5 cm when wearing footwear. An additional 5-cm increase was also observed when wearing an AFO. Swing velocity was also affected by the manipulation.

Conclusions: The appropriate comparative baseline for assessing the efficacy of an AFO is subjects walking with existing footwear and not barefoot.
The Mobility Scale for Acute Stroke Patients: concurrent validity
Authors: Simondson J A , Goldie P , Greenwood K M
Published: November 2003

Objective: A new scale, the Mobility Scale for Acute Stroke Patients (MSAS), was developed to specifically discriminate between the lower levels of mobility found in acute stroke patients in the first two weeks post onset. The aim of this study was to investigate the concurrent validity of this new scale with other established scales.

Main outcome measures: Concurrent validity was assessed with respect to four other well-validated measures: Motor Assessment Scale (MAS), Functional Ambulation Classification system (FAC), Functional Independence Measure (FIM), and Barthel Index (BI). The measures selected for comparison contained items similar to those in the MSAS.

Subjects: From a total of 539 patients who were admitted over a two-year period with a primary diagnosis of stroke, 106 satisfied the criteria for inclusion in this study.

Results: The MSAS was found to have a high level of concurrent validity ( r > 0.80) when the total score was correlated with the total scores of the MAS, FAC, FIM (mobility and ADL) and BI. A high level of association was found between the nonbed mobility items (sit to stand, stand and walk) of the MSAS and the mobility items (toileting, transfers, walk and stairs) of the FIM and BI. There was a weaker association between the MSAS items and the ADL items (activities of daily living) of the BI and FIM.

Conclusion: A new scale designed specifically for acute stroke patients was found to have a high degree of concurrent validity when compared with four other scales containing similar items.
A comparison of knee kinematic characteristics of stroke patients and age-matched healthy volunteers
Authors: Richards J D , Pramanik A , Sykesand L , Pomeroy V M
Published: November 2003

Objective: To investigate which knee kinematic characteristics show the greatest differences between stroke patients with minimal residual disability and age-matched healthy volunteers as a first step towards the development of a sensitive, objective measure of performance of movement for use in the clinical setting.

Design: A comparative study.

Setting: A movement analysis laboratory.

Subjects: Ten patients between 6 and 12 months post stroke aged between 65 and 74 years and 10 age-matched healthy volunteers. All patients had made a good recovery and were able to complete all of the functional tasks.

Interventions: Each subject had re‘ective markers placed on anatomical landmarks and was filmed performing three movement tasks: sit-to-stand, walking, and step on block.

Main outcome measures: Knee kinematic characteristics involving timing, joint angle and angular velocity at key points during each task.

Results: Significant differences were found between patients and volunteers for only some of the timing and joint angle characteristics but for all angular velocity characteristics for which the mean differences ranged from 31.85 degrees/s for sit-to-stand ( p = 0.013) to 82.5 degrees/s ( p = 0.014) for the swing phase of gait.

Conclusions: These preliminary findings suggest that angular velocity of the knee during functional tasks might have potential as a sensitive, objective measure of performance of movement after stroke for patients with minimal residual disability.
Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement
Authors: Schauer Michael , Mauritz Karl-Heinz
Published: November 2003

Objective: To demonstrate the effect of rhythmical auditory stimulation in a musical context for gait therapy in hemiparetic stroke patients, when the stimulation is played back measure by measure initiated by the patient's heel strikes (musical motor feedback). Does this type of musical feedback improve walking more than a less specific gait therapy?

Design: The randomized controlled trial considered 23 registered stroke patients. Two groups were created by randomization: the control group received 15 sessions of conventional gait therapy and the test group received 15 therapy sessions with musical motor feedback.

Setting: Inpatient rehabilitation hospital.

Subjects: Median post-stroke interval was 44 days and the patients were able to walk without technical aids with a speed of approximately 0.71 m/s.

Main outcome measures: Gait velocity, step duration, gait symmetry, stride length and foot rollover path length (heel-on–toe-off distance).

Result: The test group showed more mean improvement than the control group: stride length increased by 18% versus 0%, symmetry deviation decreased by 58% versus 20%, walking speed increased by 27% versus 4% and rollover path length increased by 28% versus 11%.

Conclusion: Musical motor feedback improves the stroke patient's walk in selected parameters more than conventional gait therapy. A fixed memory in the patient's mind about the song and its timing may stimulate the improvement of gait even without the presence of an external pacemaker.
The effect of early aerobic training on independence six months post stroke
Authors: Katz-Leurer Michal , Carmeli Eli , Shochina Mara
Published: November 2003

Objective: To investigate whether early aerobic training has a beneficial effect on stroke patients' independence in daily and social activities six months after the event.

Design: Randomized clinical trial.

Setting: Rehabilitation unit.

Subjects: Ninety-two patients after a first stroke. Interventions: Forty-six patients participated in an eight-week programme of aerobic training, using a leg cycle ergometer.

Main outcome measures: Frenchay Activities Index (FAI) measured twice, at entry to programme (pre-event score) and six months after the onset of the event.

Results: Despite the significant improvement of study group patients' functional abilities immediately after the intervention compared with controls, no significant difference was found in FAI mean score between groups six months post event. An interaction effect was noted between event severity, intervention and FAI total score. Mean FAI score declined significantly less in the less severely impaired study group patients.

Conclusions: Early, moderately intense aerobic training has no direct impact on independence in daily and social activities as measured by FAI total score six months after a stroke.
A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis
Authors: Al-Smadi J , Warke K , Wilson I , Cramp A F L , Noble G , Walsh D M , Lowe-Strong A S
Published: November 2003

Objective: To investigate the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) upon low back pain (LBP) in people with multiple sclerosis (MS).

Design: A randomized double-blind placebo controlled clinical pilot study.

Subjects and setting: Fifteen people with MS were recruited and randomly allocated to one of the following groups under double blind conditions ( n = 5 per group): TENS 1 (4 Hz, 200 µs), TENS 2 (110 Hz, 200 µs), placebo TENS.

Interventions: Treatment was applied for 45 minutes three times a week for six weeks with a four-week follow-up.

Outcome measures: The following outcome measures were taken at weeks 1, 6, and 10: visual analogue scale (VAS) (for current LBP, right leg pain, left leg pain); Leeds Multiple Sclerosis Quality of Life Questionnaire; Roland Morris Disability Questionnaire; Short Form-36 (SF-36) Version 1; and the McGill Pain Questionnaire (MPQ). VAS for current LBP, right and left leg pain were also taken before and after treatment, and once a week during the follow-up period.

Results: Analysis showed no statistically significant effects for any of the data. However, both active treatment groups showed a trend of improvement in the majority of the outcome measures.

Conclusion: Active TENS was more effective than placebo TENS in decreasing VAS scores following each treatment although results were not statistically significant. Further work in this area is warranted and should include a larger number of participants in the form of a randomized controlled clinical trial to determine the efficacy of this modality.
A study of five cervicocephalic relocation tests in three different subject groups
Authors: Kristjansson Eythor , Dall'Alba Paul , Jull Gwendolen
Published: November 2003

Objective: To compare head relocation accuracy in traumatic (whiplash), insidious onset neck pain patients and asymptomatic subjects when targeting a natural head posture (NHP) and complex predetermined positions.

Design: A case–control study.

Setting: University-based musculoskeletal research clinic.

Participants: Sixty-three volunteers divided into three groups of similar gender and age: Group 1 ( n = 21) an asymptomatic group; group 2 ( n = 20) insidious onset neck pain; group 3 ( n = 22) a history of whiplash injury.

Intervention: Five randomly ordered tests designed to detect relocation accuracy of the head.

Outcome measures: A 3-Space Fastrak system measured the mean absolute relocation error of three trials of each relocation test.

Results: A significant difference was found between groups in one of the tests targeting the NHP ( p = 0.001). Post-hoc pairwise comparisons revealed a significant difference ( p £ 0.05) between the asymptomatic group and each symptomatic group. The difference between the symptomatic groups just failed to reach significance ( p = 0.07). None of the other four tests revealed significant differences.

Conclusion: The test of targeting the NHP indicates that relocation inaccuracy exists in patients with neck pain with a trend to suggest that the deficit may be greater in whiplash patients. Tests employing unfamiliar postures or more complex movement were not successful in differentiating subject groups.
Effects of prosthesis alignment on pressure distribution at the stump/socket interface in transtibial amputees during unsupported stance and gait
Authors: Seelen H A M , Anemaat S , Janssen H M H , Deckers J H M
Published: November 2003

Objective: To assess the effects of antero-posterior realignment of the prosthesis on pressure distribution at the stump/socket interface in unilateral transtibial amputees during unsupported stance and gait.

Design: Cross-sectional group study.

Setting: Outpatient rehabilitation clinic.

Subjects: Seventeen unilateral transtibial amputees.

Intervention: Antero-posterior prosthesis realignment using 0.5 cm heel or forefoot wedging.

Measures: Pressure distribution changes at several sites at the stump/socket interface, expressed as peak pressure, peak pressure time, sustained submaximal load (MP80+) and time period of MP80+ (TP80+).

Results: During stance, heel wedging led to a 30.4% decrease in mean pressure near the patella tendon and a 40.0% increase near the distal tibia site, whereas forefoot wedging led to a 30.0% decrease in pressure in the tibial end region. Antero-posterior ankle realignment did not lead to significant changes near the fibular head. During gait only heel wedging led to a 11.5% increase in peak pressure in the tibia end region. Mean peak pressure time increased 22.7% using heel wedging and decreased 8.8% using forefoot wedging. MP80+ increased 23.8% in the tibia end region during heel wedging and 17.0% in the subpatellar region during forefoot wedging.

Conclusions: Antero-posterior realignment of the ankle joint led to an inverse loading and unloading of the subpatellar region versus tibial end region. However, results indicate that stump/socket interface pressure during stance seems not to be highly predictive as to pressure behaviour during gait. Ankle joint realignment led to significant differences in temporal sequences of tissue (un-)loading in the subpatellar area during gait.
A randomized controlled trial of an education and counselling intervention for families after stroke
Authors: Clark Michael S , Rubenach Sally , Winsor Adrian
Published: November 2003

Objectives: To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses, and better functional and social outcomes for patients.

Design: Two-group randomized controlled trial. Data were collected on admission to and discharge from rehabilitation, and again six months later.

Setting: Rehabilitation units at Repatriation General Hospital and Griffith Hospital, in Adelaide, South Australia.

Participants: Sixty-two stroke patients and their spouses, 32 in the intervention group and 30 in the control group.

Intervention: Stroke information package and three visits from a social worker trained in family counselling.

Outcome measures: Family functioning: McMaster Family Assessment Device (FAD); functional status: Barthel Index (BI); social recovery: Adelaide Activities Profile (AAP); depression: Geriatric Depression Scale (GDS); anxiety: Hospital Anxiety and Depression Scale (HADS); mastery: Mastery Scale (MS); health status: SF-36.

Results: At six months the intervention group had better family functioning for both patients (mean FAD difference 0.19) and spouses (mean difference 0.09). A modest benefit in functional status for intervention patients (mean BI difference 1.3) was related to improved family functioning. Intervention patients reported better social recovery (mean AAP differences: domestic chores 5.7, household maintenance 4.6, social activities 11.5), but there were no significant effects on depression, anxiety, mastery or health status.

Conclusions: An education and counselling intervention maintained family functioning, and in turn led to improved functional and social patient outcomes. This approach helps patients and their spouses to make the optimal adjustment to living with stroke.
Anti-Hu antibodies may indicate a positive response to chemotherapy in paraneoplastic syndrome secondary to small cell lung cancer
Authors: Douglas Claire A , Ellershaw John
Published: November 2003

Paraneoplastic encephalomyelitis (PEM) is a form of neurological dysfunction caused by the remote effect of small cell lung cancer (SCLC) on the brain. In certain cases it is associated with the presence of Anti-Hu antibodies. Up to 65% of patients with SCLC and PEM, who have Anti-Hu antibodies present, die of neurological complications rather than tumour progression. Chemotherapy is not believed to be beneficial. We describe a 58-year-old lady who was bed-bound and significantly disabled from paraneoplastic cerebellar degeneration. Her serology confirmed the presence of Anti-Hu antibodies and SCLC was confirmed at bronchoscopy. Following six courses of chemotherapy her neurological symptoms have remarkably improved, both subjectively and objectively, such that she is now independently mobile with a walking frame. Her tumour is still evident on bronchoscopy. We suggest that people with SCLC who are significantly disabled by neurological symptoms, should be tested for serum anti-neuronal antibodies and if Anti-Hu antibody positive, anti-neoplastic treatment should be considered despite poor performance status.
Symptoms in advanced cancer: relationship to endogenous cortisol levels
Authors: Lundström Staffan , Fürst Carl Johan
Published: November 2003

We investigated a possible relationship between levels of endogenous cortisol and severity of different symptoms in patients with advanced cancer. Twenty-three patients with predominantly gastrointestinal cancer, recruited in a palliative care unit, entered the study. Urinary free cortisol (UFC) was measured together with demographic data, blood parameters, tumour burden, concurrent illness, medication, nutritional status and quality of life. Significant positive correlations were found between levels of endogenous cortisol and appetite loss, fatigue and nausea/vomiting. The findings support the view of a chronic stress condition in advanced cancer. Interaction between cytokines and the hypothalamicpituitary-adrenal (HPA) axis may also be important in the interpretation of the results.
General practice vocational training in the UK: what teaching is given in palliative care?
Authors: Lloyd-Williams Mari , Carter Yvonne H
Published: November 2003

Background: Palliative care is an integral part of the general practitioner's role and palliative care teaching and training should be available for GP registrars during vocational training. Aim: This study was carried out to evaluate the content, amount and nature of generic palliative care teaching during vocational training in the UK. Method: A postal questionnaire survey of all course organizers enquired as to whether palliative care teaching was included in the core training sessions; professional background of the teachers; teaching methods used; whether the local hospice was used as a resource and whether GP registrars were able to choose a post in a hospice within their training scheme. Results: Three hundred and seventy-seven questionnaires were distributed and 240 were returned completed – a 64% response rate. A total of nine one-year schemes replied that they did not include any teaching in palliative care – the median amount of teaching given for one-year schemes was 4.75 hours and nine hours for the three-year schemes. Statistically significant diferences were found in teaching on psychosocial issues and bereavement between one and three-year schemes. Less than half of all schemes included teaching on financial issues related to palliative care. Several schemes cited difficulties in accessing hospice placements and in accessing hospice medical staff to provide teaching. Conclusion: There is wide disparity in both the amount and content of teaching about palliative care within UK vocational training schemes. Difficulty in accessing placements within hospices and in accessing staff from such units to undertake teaching may be a barrier to effective and comprehensive palliative care teaching for doctors working in primary care. We suggest that a national generic curriculum of palliative care within primary care be implemented.
High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer
Authors: Bagg J , Sweeney M P , Lewis M AO , Jackson M S , Coleman D , Mosaid A Al , Baxter W , McEndrick S , McHugh S
Published: November 2003

Oral fungal infections frequently develop in individuals with advanced cancer. This study examined the oral mycological flora of 207 patients receiving palliative care for advanced malignant disease. Demographic details and a clinical history were documented from each participant. A tongue swab was collected and cultured on CHROMAgar Candida® (CHROMAgar Paris, France). All yeasts were identified by germ tube test, API ID 32C profiles and, for Candida dubliniensis, by species-specific PCR. Susceptibility to fluconazole and itraconazole was determined by a broth microdilution assay according to the National Committee for Clinical Laboratory Standards (NCCLS). At time of sampling, 54 (26%) of the 207 subjects had clinical evidence of a fungal infection and yeasts were isolated from 139 (67%) individuals. In total, 194 yeasts were isolated, of which 95 (49%) were Candida albicans. There was a high prevalence of Candidia glabrata (47 isolates) of which 34 (72%) were resistant to both fluconazole and itraconazole. All nine isolates of C. dubliniensis recovered were susceptible to both azoles. No relationship was established between anti-fungal usage in the preceding three months and the presence of azole resistant yeasts. This study of patients with advanced cancer has demonstrated a high incidence of oral colonization with non- C. albicans yeasts, many of which had reduced susceptibility to fluconazole and itraconazole. The role of improved oral care regimes and novel anti-fungal drugs merits further attention, to reduce the occurrence of fungal infection in these patients.
Palliative care for patients with end-stage renal failure: reflections from Central Australia
Authors: Fried Ofra
Published: November 2003

This paper explores palliative care issues for Australian Aboriginal patients with end-stage renal failure. Renal disease is epidemic amongst Aboriginal Australians. The Central Australian Palliative Care Service, based in the remote town of Alice Springs, sees a high proportion of renal patients, with different demographic characteristics to those seen in urban palliative care services. A case history illustrates distinctive concerns for local service provision, including communication issues, cultural requirements for maximizing quality of life, and the need to provide care in remote locations. Palliation for end-stage renal failure (ESRF) patients should be based on standard principles, but modified in accordance with local practical requirements and community needs.
Palliative day care: what does it cost to run a centre and does attendance affect use of other services?
Authors: Douglas H-R , Normand C E , Higginson I J , Goodwin D M , Myers K
Published: November 2003

Aim: To describe the cost of palliative day care (PDC), assessing the value of all resources whether paid for or not. To examine different patterns of resource use resulting from attending PDC.

Methods: Five PDC centres in southern England provided detailed cost and resource use data, both paid and unpaid for. The PDC group were consecutive new referrals to a PDC centre who were well enough to be interviewed. The comparison group were recruited from home care teams. Data were collected at baseline, six to eight weeks and 12–15 weeks, on health and social care utilization in the month prior to interview. Data were divided into cohorts based on time from first interview to death and analysed separately.

Main outcomes: Annual cost of running a day care centre, and cost per patient per day. Use of all health and social care resources over time, stratified by time from death. Comparison of health and social care by stage of illness, and by PDC attendance.

Results: PDC cost around £54 per person per day in 1999, rising to £75 including unpaid resources. 145 patients had data on health and social care use. The patterns of care showed that, overall, patients accessed few services other than PDC. Comparison group patients did not access similar services elsewhere. PDC might substitute home nursing and GP care for patients who attend PDC at least three months before death but this data is not conclusive. Inpatient care was negligible for both groups.

Conclusions: A full economic evaluation could not be undertaken without robust evidence of the effectiveness of PDC. PDC centres made use of resources that were not paid for and shared resources with inpatient units, reducing costs. Service use was different for patients who attended compared with patients who did not. Similar services were not accessed elsewhere in the community; PDC does not appear to replicate other services for this group of patients.
The use of zoledronic acid in the management of metastatic bone disease and hypercalcaemia
Authors: Neville-Webbe H L , Coleman R E
Published: November 2003

Zoledronic acid is a potent, third generation, nitrogen-containing bisphosphonate, licensed for the management of skeletal metastases and hypercalcaemia of malignancy, both of which cause considerable morbidity. In the preclinical setting, zoledronic acid has demonstrated superior potency regarding inhibition of osteolysis and reduction of hypercalcaemia as compared with other bisphosphonates. Clinical trials have indicated that zoledronic acid is superior to pamidronate in suppressing osteolysis and in reducing hypercalcaemia of malignancy. Its main mechanism of action is induction of osteoclast apoptosis through inhibition of the mevalonate pathway. Zoledronic acid has also demonstrated direct anti-tumour activity both in vitro and in animal models, suggesting it may be of benefit in preventing the formation of bone metastases. Clinical trials are in progress, assessing the benefit of zoledronic acid in the adjuvant setting in both breast and prostate cancer.
Perspectives on symptom control in patients receiving community palliative care
Authors: Armes PJ , Addington-Hall JM
Published: November 2003

To remain at home, terminally ill cancer patients need good symptom control and support from informal carers. Few studies have explored the influence of informal carers on symptom control and vice versa. This qualitative case study was carried out in a specialist palliative care service (SPCS) to explore the reasons why patients were admitted for inpatient care. Ten patients were systematically selected and the main carer and health professionals involved in their care were invited to participate. Semi-structured, audiotape recorded interviews were conducted and a thematic analysis performed on the transcripts, using the ’Frameworkflapproach. The results highlight the vital role that carers play in the assessment and management of symptoms in the community. However, carers reported difficulties in knowing what to monitor, how to interpret symptoms accurately and when to inform a professional. It was also reported that medication was not taken as it was prescribed and a number of reasons were given.
Difficulties encountered by nurses in the care of terminally ill cancer patients in general hospitals in Japan
Authors: Sasahara Tomoyo , Miyashita Mitsunori , Kawa Masako , Kazuma Keiko
Published: November 2003

The aim of this study was to investigate the difficulties encountered by nurses who have cared for terminally ill cancer patients at general hospitals. To collect data, a survey by questionnaire was self-administered. The respondents were 375 nurses and the response rate was 70.2%. Factor analysis was conducted on 80 items related to the difficulties encountered by nurses who have cared for terminally ill cancer patients to allow reasonable item reduction and to explore better domains. Two items were excluded and the results revealed eight underlying domains: Communication with patients and families, Knowledge and skill of nurses, Treatment and informed consent (IC), Personal issues, Collaboration as a team including patients and families, Environment and system, Collaboration among nurses, and Near-death issues. Cronbach's alpha coefficients for each domain ranged from 0.77 to 0.93. The results showed that nurses working at general hospitals have experienced a high degree of difficulty overall while caring for the dying, particularly with communication with patients and families. It was concluded that this study was useful in determining the specific areas where nursing education and research should be focused.