bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of increased rehabilitation therapy after brain injury: results of a prospective controlled trial
Authors: Shiel A , Burn J PS , Henry D , Clark J , Wilson B A , Burnett M E , McLellan D L
Published: May 2003

Objective: The objective was to investigate the effect of increased intensity of rehabilitation therapy provided to brain-injured subjects on the rate at which independence was regained and the duration of hospital admission.

Design: A two-centre, prospective, controlled study with random allocation to groups.

Setting: Two district general hospitals on the south coast of England.

Subjects: Fifty-six people with moderate and severe head injury consecutively admitted to Southampton and Poole hospitals between June 1995 and September 1997.

Interventions: Increased intensity of rehabilitation therapy input without change in content.

Results: Subjects receiving more intensive therapy made more rapid progress and were discharged home sooner. The different intensities of therapy employed in this study showed no evidence of a ‘ceiling’ effect and the ‘intervention group’ made significantly more rapid progress on tests of dependency during the period of admission. A clear response to increased therapy input was seen in one of the centres with more rapid functional improvement and a shorter length of hospital stay. This centre already had more therapy and better community facilities. No such benefits were seen at the other centre where the intervention group had a longer hospital stay than the routine group.

Conclusion: Increasing the hours per week of therapy given to adults recovering from brain injury in hospital can accelerate the rate of recovery of personal independence and result in their being discharged from hospital sooner. Increased rehabilitation therapy after brain injury is associated with enhanced functional recovery and shorter hospital stay if provided in the context of an integrated service that can provide ongoing community support. There is no evidence of any ceiling effect of therapeutic intensity beyond which no further response is observed.
Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground
Authors: Nilsson Lena , Carlsson Jane , Danielsson Anna , Fugl-Meyer Axel , Hellström Karin , Kristensen Lena , Sjölund Bengt , Sunnerhagen Katharina Stibrant , Grimby Gunnar
Published: May 2003

Objective: To compare the effect of walking training on a treadmill with body weight support (BWS) and walking training on the ground at an early stage of rehabilitation in patients with hemiparesis after stroke.

Design: Randomized controlled experimental study.

Setting: Multicentre design; three departments of rehabilitation medicine.

Subjects: Seventy-three consecutive first stroke patients admitted to a rehabilitation clinic were randomized into a treatment group and a control group.

Interventions: The treatment group received walking training on a treadmill with BWS for 30 minutes, 5 days a week. The control group received walking training according to the Motor Relearning Programme (MRP) on the ground for 30 minutes 5 days a week, not including treadmill training. During the time in the rehabilitation department (about two months), all patients in the study also received professional stroke rehabilitation besides the walking training in the two groups.

Main outcome measures: Functional Independence Measure (FIM), walking velocity for 10 m, Functional Ambulation Classification (FAC), Fugl-Meyer Stroke Assessment and Berg's Balance Scale. The assessments were performed at admission, at discharge and at 10-month follow-up.

Results: There were no statistically significant differences between the groups at discharge or at the 10-month follow-up with regard to FIM, walking velocity, FAC, Fugl-Meyer Stroke Assessment, and Berg's Balance Scale. Patients in both groups improved in these variables from admission to the 10-month follow-up.

Conclusions: Treadmill training with BWS at an early stage of rehabilitation after stroke is a comparable choice to walking training on the ground.
Disability test 10 days after acute stroke to predict early discharge home in patients 65 years and older
Authors: Sommerfeld Disa K , von Arbin Magnus H
Published: May 2003

Objective: To identify prognostic instruments for the planning of care after acute stroke.

Design: Prospective study.

Setting: Stroke unit and geriatric rehabilitation unit.

Subjects: One hundred and fifteen consecutive acute stroke patients ≥65 years old.

Main outcome measures: Univariate and multivariate survival analyses. Length of hospital stay and residential form up to three months after onset.

Results: The average length of stay was significantly shorter if age <80 years, male, living with another person, normal sensory ability, Barthel Index (BI) score ≥35 and Rivermead Mobility Index (RMI) score ≥4, assessed 10 days after onset. Multivariate analysis, also including BI subtests, showed that RMI score ≥4, which corresponds to the ability to rise from a chair in less than 15 seconds and remain erect for 15 seconds with or without aid, 10 days after onset, had the greatest impact on early discharge home after acute stroke, together with normal bladder function (BI subtest six), normal sensory ability and living with another person.

Conclusion: The best predictor of early discharge home, 10 days after stroke onset, was the ability to rise from a chair with or without aid. This simple and quickly conducted test requires no special equipment and in the present study had a very high predictive value.
Can brain-injured patients participate in an aerobic exercise programme during early inpatient rehabilitation?
Authors: Jackson Diana , Turner-Stokes Lynne , Culpan Jane , Bateman Andrew , Scott Oona , Powell Jane , Greenwood Richard
Published: May 2003

Objective: We investigated the capacity of brain-injured patients to participate in an aerobic exercise programme early after injury.

Design: Retrospective analysis of exercise achievements in patients participating in a randomized controlled trial.

Setting and subjects: Ninety patients participated in an exercise training programme on a cycle ergometer at four inpatient neurological rehabilitation units for younger patients. At intake, impairments and function were rated on: Motricity Index, Ashworth Scale, Berg Balance Scale, Barthel Index and Functional Independence Measure.

Interventions: Patients cycled for up to 30 minutes three times weekly for 24–36 sessions over 12 weeks.

Main outcome measures: Exercise performance was measured by: (a) number of sessions to achieve a cycling time of 30 minutes, (b) overall mean cycling time per session over 24 sessions and (c) mean time per session cycling at >60% of age predicted maximum heart rate (HR max) over 24 sessions.

Results: Fifty-five patients completed 24 sessions. Thirty-five withdrew, largely for logistic reasons, before completing training; they were significantly less disabled than the 55 who remained. Forty-four of the 55 patients trained for an average of at least 20 minutes per session, 18 training at >60% HR max for this time. There were no differences in performance on the three exercise parameters between two groups of patients with baseline Barthel scores of ≤12 and ≥13.

Conclusions: Brain-injured patients with a range of disabilities have the capacity to participate in an exercise programme during early inpatient rehabilitation, though some may take longer to achieve adequate intensity of aerobic exercise.
Cognitive deficits following stroke in the basal ganglia
Authors: Hochstenbach Jacqueline , van Spaendonck Karel PM , Cools Alexander R , Horstink Martin WIM , Mulder Theo
Published: May 2003

Objective: To examine the effect of a stroke in the basal ganglia on cognitive functioning.

Design: As part of a larger prospective study on the neuropsychological and psychosocial consequences of stroke, 12 patients with a stroke confined to the basal ganglia were examined.

Setting: The patients were assessed in one of the three participating hospitals.

Subjects: The results of 12 patients with a stroke in the basal ganglia (mean age 55 years), were compared to 24 controls (mean age 54.3 years).

Main outcome measures: Different aspects of memory, attention and concentration, visuospatial and visuoconstructive functions, language and arithmetic were assessed using neuropsychological tests.

Results: The data show a significant abnormality in cognitive functioning on all cognitive domains.

Conclusions: The results stress the notion that subcortical damage may lead to substantial neuropsychological disorders and have clear implications for neurological rehabilitation.
Predictive factors for the outcome of a multidisciplinary pain rehabilitation programme on sick-leave and life satisfaction in patients with whiplash trauma and other myofascial pain: a follow-up study
Authors: Heikkilä Hannu , Heikkilä Eva , Eisemann Martin
Published: May 2003

Objective: To evaluate the effects of a multidisciplinary rehabilitation programme on sick-leave, coping resources and life satisfaction in whiplash patients and other pain patients.

Subjects: Forty patients suffering from symptoms after whiplash trauma and 33 patients with musculoskeletal pain in the neck or back were recruited for this study. Ninety-seven consecutive patients admitted to the Department of Neurosurgery with cervical pain, cervical disc herniation or symptomatic spondylosis served as a control group.

Results: Decreased coping resources and poorer life satisfaction were observed for whiplash subjects at the beginning of the rehabilitation programme compared to the control group from the Department of Neurosurgery. After the rehabilitation period 49% of the patients had improved their coping resources totalling to 63% after 2 years. At that follow-up 46% of patients had increased their life satisfaction. Furthermore, the group with whiplash injury showed a significant increase in sick absenteeism whereas the group without whiplash trauma had decreased their sick-leave. Eighty-eight per cent of the subjects could be correctly classified according to their vocational outcome by means of discriminant function. The elapse of time since working, low life satisfaction, lack of increase in coping resources during the rehabilitation programme, ethnic origin of the patient and living in the countryside predicted poor vocational outcome.

Conclusion: Our results suggest variables from the social environment and coping resources as useful predictors for treatment outcome.
Environmental control systems – an audit of existing provision in three inner London districts
Authors: Novak S A
Published: May 2003

Objective: To undertake an audit of existing environmental control system (ECS) provision to see what lessons could be applied to developing a new model of service.

Design: Structured interviews and assessments making use of questionnaires and algorithms.

Subjects: Users of environmental control systems in the inner London boroughs of Lambeth, Southwark and Lewisham (population 720 000) supplied with equipment prior to April 1996 out of National Health Service funds.

Setting: All users were assessed and interviewed in their own homes.

Results: In all, 29 users of ECSs were surveyed. Six users were found to have systems either so outdated or poorly planned as to be nearly useless. Seven users were felt not to justify an ECS and many systems were felt to be over specified, leading to wastage of equipment. Many medical and nonmedical needs, not directly related to the users' ECSs, were identified.

Conclusions: While the recommendations of the British Society of Rehabilitation Medicine special interest group on ECS are welcomed, it is thought that these do not go far enough. In particular the role of the environmental control assessor needs to extend to participation in the case conference where the exact equipment requirements of the prescribed ECS is agreed, and thereafter to include responsibility for ensuring regular review of users. In such a model of service the current single payment for a one-off assessment is felt to be inappropriate.
The treatment of lateral epicondylitis by iontophoresis of sodium salicylate and sodium diclofenac
Authors: Demirtaş R Nesrin , Öner Cengiz
Published: May 2003

Objective: To investigate the effectiveness of sodium diclofenac and sodium salicylate applied by topical iontophoresis and to compare them in the treatment of lateral epicondylitis.

Subjects: Forty patients with lateral epicondylitis were randomized into two groups of 20 patients who were matched for age and sex.

Interventions: The patients in one group were treated by iontophoresis of sodium diclofenac and the other group were treated by iontophoresis of sodium salicylate. Then infrared treatment was applied to patients in both groups.

Main outcome measures: Pain scores obtained before and after treatment were compared.

Results: Pain produced by pressure on the lateral epicondyle, on resisting wrist extension, during function and spontaneous pain at rest significantly decreased in both groups after treatment ( p <0.001). When pain scores obtained after treatment were compared, greater decrease was observed in the pain produced on resisting wrist extension ( p <0.01) and by pressure on the lateral epicondyle ( p <0.05) in the group treated with sodium diclofenac than in the group treated with sodium salicylate.

Conclusions: The results suggest some benefits from the process of iontophoresis and the use of infrared in the treatment of lateral epicondylitis and indicate that iontophoresis of sodium diclofenac is more effective than that of sodium salicylate.
Medical opinions, beliefs and prescription of orthopaedic footwear: a survey of Dutch orthopaedists and rehabilitation practitioners
Authors: Boer H , Seydel E R
Published: May 2003

Objectives: To get insight into medical opinions about the use of orthopaedic footwear and the medical and social factors related to the prescription of orthopaedic footwear by orthopaedists and rehabilitation practitioners.

Methods: In this study 85 orthopaedists and 96 rehabilitation practitioners filled out a questionnaire measuring perceived desirability of prescribing orthopaedic footwear in specific medical conditions, the perceived advantages of orthopaedic footwear, the perceived disadvantages of orthopaedic footwear, the attitude to orthopaedic footwear and satisfaction with the co-operation with the pedorthist. Clinicians were asked to estimate their referral rate of orthopaedic footwear.

Results: Orthopaedists and rehabilitation practitioners agree that the prescription of orthopaedic footwear should be considered in the case of rheumatoid arthritis, amputation of the foot and diabetic foot and not be considered in the case of sprain and back pain. In the case of hallux valgi, dermatological problems and clavus (severe corn) a reticent prescription policy seems to be the optimal choice. In the other medical conditions studied no unequivocal prescription policy could be derived. Respondents who prescribed orthopaedic footwear more than the median (more than 50 prescriptions per year) were more often rehabilitation practitioner, perceived more advantages of prescription footwear, perceived less disadvantages of prescription footwear and were more satisfied about the co-operation with the pedorthist.

Conclusion: In some medical conditions orthopaedists and rehabilitation practitioners agree about the optimal use of orthopaedic footwear. In some other medical conditions orthopaedists and rehabilitation practitioners are divided about the use of orthopaedic footwear. Reported rate of prescription was not related to desirability of prescription, but was related to beliefs such as perceived advantages, perceived disadvantages and satisfaction with co-operation with the pedorthist, underlining the importance of cognitive factors in prescription style.
Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens
Authors: de Jong B A , Dahmen R , Hogeweg J A , Marti R K
Published: May 2003

Background and purpose: Although corticosteroid injections have been reported to be effective in capsulitis of the shoulder, the optimal dose has not been established. The purpose of this study was to compare relief of symptoms following a lower dose with that following a higher dose of triamcinolone acetonide given intra-articularly.

Subjects: Thirty-two patients were given low dose suspension; 25 patients were given high dose suspension.

Method: Randomized, double-blind clinical trial. Each patient was given a course of three injections. Pain, sleep disturbance, functional impairment and passive range of motion (ROM) were assessed at intake and at one, three and six weeks after the initial injection. Data were analysed by independent sample t-tests and nonparametric Mann–Whitney U-tests.

Results: The group which received the 40 mg dose showed significantly greater improvement than the group receiving the 10 mg dose.

Conclusions: The study shows that in the treatment of frozen shoulder greater symptom relief is obtained with a dose of 40 mg triamcinolone acetonide intra-articularly than with a dose of 10 mg. The effect on pain and sleep disturbance was more marked than on ROM. Intra-articular injections with triamcinolone acetonide appear to be an effective method to obtain symptom relief for patients with painful capsulitis of the shoulder.
Techniques for measurement and assessment of mobility in rehabilitation: a theoretical approach
Authors: Bussmann J BJ , Stam H J
Published: May 2003

Objective: Mobility is an important construct in rehabilitation; many instruments have emerged which measure or assess (aspects of) mobility. In the selection or development of an appropriate technique, knowledge about the fundamentals of rehabilitation medicine is needed, as well as about essential characteristics of techniques and fundamental differences between them. The aim of this paper is to classify, assess and discuss current techniques which are or can be used to measure aspects of mobility.

Design: Eight techniques (physical science techniques, clinimetry, observation, diaries, questionnaires, actigraphy, physiological techniques and activity monitors) are classified, assessed and discussed, based on the level of outcome measures, the aspect of mobility they measure, and methodological and practical criteria.

Results and conclusions: Rehabilitation medicine has a particular need for instruments that enable measurement of outcome measures on the level of activity and role fulfilment. Techniques differ in the type and number of mobility aspects they measure. Furthermore, important differences exist based on methodological and practical criteria. One optimal technique does not exist: the choice of a technique always depends on a complexity of factors, such as clinical problem, research questions, the mobility aspect of interest, required methodological strength, costs and availability.
An evaluation of current risk assessment scales for decubitus ulcer in general inpatients and wheelchair users
Authors: Anthony Denis , Barnes Joanne , Unsworth Jim
Published: May 2003

Objectives: To study the components of two risk assessment scales for decubitus ulcer risk, Waterlow and Braden, and of the Chailey score for the same purpose.

Design: Experimental study of patients at risk of developing decubitus ulcers.

Setting: The West Midlands and Yorkshire.

Subjects: One hundred and fifty wheelchair users from the West Midlands and 9022 patients from a District General Hospital in York, the latter consisting of all admissions to the hospital in a four-month period.

Interventions: Braden, Chailey scores (wheelchair users) and Waterlow scores (all subjects) measured.

Main outcome measures: Development of a pressure sore, receiver operating characteristic (ROC) curves.

Results: Waterlow outperformed Braden for classification of wheelchair patients with respect to decubitus ulcer. The Chailey score performed randomly in this group. The sensitivity and specificity as seen in ROC curves was different for Waterlow scores for wheelchair users and general patients, the latter being much better classified. Only three items out of 11 in the Waterlow score appeared to have any classification ability in the wheelchair group.

Conclusions: Risk indicators used for general patients are probably poorly suited for wheelchair users. There is a need for large-scale predictive studies of wheelchair users and other groups to allow regression analysis of the subscales of risk indicators. From the provisional data of this study it appears that splitting patients by gender and into full and part-time wheelchair users classifies almost as well the much more complicated risk assessment tools currently available.
Electromyographic biofeedback for gait training after stroke
Authors: Bradley Lesley , Hart Barry B , Mandana Suniti , Flowers Kenneth , Riches Mary , Sanderson Peter
Published: May 2003

Objective: To examine the effects of electromyographic (EMG) biofeedback training on the recovery of gait in the acute phase post stroke.

Design: Patients were randomly assigned to EMG biofeedback or control groups. They received treatment three times a week for six weeks. All patients were assessed prior to treatment, after 18 treatment sessions, and at three months follow-up.

Setting: The study was carried out at Scunthorpe General Hospital in North Lincolnshire. The subjects were acute stroke patients who had been admitted on to the medical and elderly wards.

Interventions: The EMG biofeedback group were treated using EMG as an adjunct to physiotherapy. The patients were encouraged to facilitate or inhibit abnormal muscle tone via auditory or visual signals transmitted from electrodes placed over the appropriate muscles. The control group were treated using the same techniques, electrodes were used with this group of patients, but the EMG machine was turned off and faced away from the patient and the therapist to control the placebo effect.

Outcome measures: A large battery of outcome measures was used for physical and psychological assessment. The physical measures consisted of active movement, muscle tone, sensation, proprioception, mobility and activities of daily living (ADL). The psychological measures included orientation, memory, spatial performance, language and IQ.

Results: Twenty-one patients were included in the study. Scores were combined into four groups: mild EMG, severe EMG, mild control and severe control. Results showed that there was an improvement in physical scores for active movement, mobility and ADL over time, but there was no significant difference between the EMG and control groups. Scores on the psychological tests were within normal limits, and there was no difference in performance between the EMG and control groups.

Conclusions: This study showed no significant differences in the rate of improvement after stroke between the two groups. Although EMG biofeed-back was used as an adjunct to physiotherapy and represented clinical practice, the results provide little evidence to support the clinical significance of using EMG biofeedback to improve gait in the acute phase after stroke.
More than a sympathetic ear? A report on the first year of a writer in residence in a unit for young, physically disabled people
Authors: Chesson Rosemary , Moir Eileen , Tavendale Alison
Published: May 2003

Objective: To describe a writer in residence scheme and report the views of patients and staff.

Design: Qualitative study including interviews with patients, a questionnaire survey of staff, and dialogue with the writer.

Setting: A unit for young people with physical disability.

Subjects: A convenience sample of patients admitted to the unit and members of the multidisciplinary rehabilitation team.

Intervention: A writer in residence working 15 hours per week in the unit.

Results: A small number of patients worked regularly with the writer and this led to the publication of a play, short stories and poems. Patients described wide ranging benefits including improvements in mood state. Staff regarded the writer in residence scheme as enhancing their treatment and care and thought it helpful in addressing their own psychological needs. The writer saw herself as a catalyst ‘for the creativity of others'.

Conclusion: Such schemes have an important role to play in rehabilitation settings.
Walking speed on parquetry and carpet after stroke: effect of surface and retest reliability
Authors: Stephens Joan M , Goldie Patricia A
Published: May 2003

Objective: At the transition stage from rehabilitation to home this study aimed to (1) investigate the effect of floor surface (carpet and parquetry) on walking speed; (2) investigate whether there was a difference between these surfaces as stroke patients voluntarily increased from comfortable to fast pace; (3) investigate whether walking speed on parquetry was a predictor of walking speed on carpet at the two paces; (4) investigate whether walking speed at a comfortable pace was a predictor of walking speed at a fast pace on the two surfaces; and (5) quantify systematic and random error in repeated measurements for fast-paced walking trials.

Design: Subjects walked 10 metres at comfortable and fast paces on carpet and parquetry on two consecutive days.

Setting: Inpatient rehabilitation centre.

Subjects: Twenty-four stroke patients.

Main outcome measure: Walking speed.

Results: Two-way analysis of variance confirmed that patients walked more slowly on carpet than parquetry (F(1,23) = 5.3, p<0.05) at both paces; the interaction effect was not significant (p>0.05). Walking speed on parquetry was a strong predictor of walking speed on carpet at a comfortable (r= 0.92), and fast pace (r= 0.97). Walking speed at comfortable pace was a moderately strong predictor of walking speed at fast pace on parquetry (r= 0.84),and on carpet (r= 0.88). Random error in repeated measurements was higher when walking fast on carpet (7.21 m/min) and parquetry (8.32 m/min) than when walking at a comfortable pace on carpet (4.63 m/min) and parquetry (3.48 m/min). Systematic error was negligible (p<0.05).

Conclusion: Carpet surface was more challenging than parquetry surface, as evidenced by the systematic decrease in walking speed. This may have been due to lack of familiarity. Relative to the wide range of scores in the group, stroke patients showed consistency of walking speed across both surfaces. Likewise, stroke patients retained their relative position in the group as they changed from a comfortable to a fast walking pace. The difference in random error between comfortable and fast-paced trials highlights the need to quantify error in the repeated measurement situation according to specific test conditions.
Development of a scale to assess nurses' knowledge of stroke: a pilot study
Authors: Thomas Lois , Harrington Kate , Rogers Helen , Langhorne Peter , Smith Monica , Bond Senga
Published: May 2003

Objective: To develop and test an evidence-based scale to assess nurses' knowledge of stroke.

Design: Question development by a multidisciplinary group of experts in stroke. Two self-completion questionnaire surveys.

Setting: Two stroke units, one general medical and two elderly care wards in three hospitals in the North-East of England.

Subjects: Fifty-eight qualified nurses.

Interventions: Scale to assess nurses' knowledge of stroke.

Results: The overall response rate was 60%. Nurses on stroke units knew more about stroke than those in medical/elderly care wards. The scale was capable of discriminating between stroke units and medical /elderly care wards: mean difference was 4.18 (95% confidence intervals 1.68–6.69; p <0.001). Cronbach's α was 0.7 indicating adequate internal consistency. Item non-response did not exceed 10% for any question.

Conclusions: We have developed a knowledge of stroke scale capable of discriminating between nurses based in stroke units and medical/elderly care wards, with low item non-response and adequate internal consistency. The scale is suitable for use as a component of studies evaluating the nursing of stroke patients.
Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support
Authors: Hesse S , Uhlenbrock D , Sarkodie-Gyan T
Published: May 2003

Objectives: To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer.

Design: Open study comparing the movement on the gait trainer with assisted walking on the treadmill.

Setting: Motion analysis laboratory of a rehabilitation centre.

Subjects: Fourteen chronic, nonambulatory hemiparetic patients.

Intervention: Complex gait analysis while training on the gait trainer and while walking on the treadmill.

Main outcome measures: Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance.

Results: Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking ( p <0.01). The pattern and amount of activation of relevant weight-bearing muscles was comparable with an even larger activation of the M. biceps femoris on the gait trainer ( p <0.01). The tibialis anterior muscle of the nonaffected side, however, was less activated during swing ( p <0.01). Two therapists assisted walking on the treadmill while only one therapist was necessary to help with weight shifting on the new device.

Conclusion: The newly developed gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.
The Northwick Park Care Needs Assessment (NPCNA): a measure of community care needs: sensitivity to change during rehabilitation
Authors: Nyein Kyaw , Turner-Stokes Lynne , Robinson Ian
Published: May 2003

Objectives: To determine whether the Northwick Park Care Needs Assessment (NPCNA) is sensitive to change occurring during rehabilitation and provides a reliable estimate of care needs in the community, and to compare the NPCNA with the Functional Independence Measure (FIM).

Design: Prospective cohort study.

Setting: Postacute neurorehabilitation unit for young patients with complex disabilities. Subjects: Thirty-nine consecutive patients with brain injury admitted over six months.

Measurements and methods: The NPCNA was assessed on admission and at discharge. Two subsets of patients were also assessed (a) at three-month follow-up in the community (n = 15), and (b) both in hospital and in the home environments at the discharge time point (n = 28). Data were compared with FIM scores on admission and discharge.

Results: The median total weekly care hours fell from 52 hours (interquartile range (IQR) 25–66) on admission, to 17 hours (IQR 6–46) on discharge (p<0.001). There was a median reduction of approximate weekly cost of care from £600 (IQR £224–824) to £168 (IQR £56–280) (p<0.001). These benefits were sustained at follow-up, and the NPCNA measured in hospital at discharge gave a good estimation of the care hours and weekly cost of care in the community at three months after discharge. There was no significant correlation with FIM gain.

Conclusions: In this study the NPCNA, measured while the patient was still in hospital, gave a good estimation of care needs in the community and was sensitive to change occurring during rehabilitation in patients with severe complex disabilities.
The process of stroke rehabilitation: what happens and why
Authors: Tyson Sarah F , Turner Gill
Published: May 2003

Objective: To assess the process of hospital-based stroke rehabilitation.

Design: A criterion-based process audit, combined with surveys of patient and staff opinions and basic outcome measures.

Setting: All wards and units treating stroke patients in a health care district, including an acute and a community National Health Service (NHS) trust.

Subjects: Process audit: documented notes of 115 stroke patients admitted over a four-month period. Patient satisfaction survey: 93 surviving stroke patients. Staff opinion survey: Hospital doctors, therapists and nurses treating stroke patients throughout the district.

Results: A disappointingly poor level of service. The main shortcomings were poor assessment of impairment (pass rate, 46%), inadequate communication between staff and with patients and carers (pass rate, 43%), and an absence of rehabilitation beyond the basic of activities of daily living and indoor mobility (pass rate for assessment of disability and emotional need, 50%). Thirty-three per cent of patients were dissatisfied with the hospital-based service they received, particularly lack of therapy, information and recovery. The main reasons for these shortcomings were low priority given to stroke patients, lack of time, shortage of staff, and lack of knowledge and awareness of stroke amongst the staff. Rehabilitation units and elderly care tended to perform better than general medical units in areas of assessment of impairment, self-care skills and mobility, and wheelchair provision.

Conclusions: Evidence from previous publications suggests that this service was no worse than in other districts, but this audit methodology, by comprehensively examining many aspects of a service together, is better able to reveal inadequacies.
The Functional Assessment Measure (FIM + FAM) as part of the hospital discharge summary after brain injury rehabilitation
Authors: Pentland Brian , Hellawell Deborah J , Benjamin Jacob
Published: May 2003

Objective: To assess the value of providing Functional Assessment Measure (FIM + FAM) data as part of the hospital discharge information after brain injury rehabilitation.

Design: Postal survey of general practitioners (GPs) and consultants. Subjects: Consecutive discharges (n = 117) from an early brain injury rehabilitation unit over one year.

Results: Response rates were 81% from GPs and 54% from consultants. Eighty-four (89%) of GPs and 57 (82%) of consultants rated the information as useful; 87 (92%) and 51 (84%) respectively described the accompanying notes as easy to understand.

Conclusions: The incorporation of FIM + FAM data in discharge summaries is worthwhile but the utility of this practice is still to be established.
The effectiveness of predischarge home assessment visits: a systematic review
Authors: Patterson C J , Mulley G P
Published: May 2003

Objective: To evaluate the effectiveness of predischarge home assessment visits for elderly patients.

Design: Systematic review.

Methods: A computer-aided search was conducted using the databases of Medline and Cinahl. Any studies investigating predischarge home assessment visits were included in the analysis.

Results: No randomized controlled trials were found. Only five studies (two retrospective surveys, three observational surveys) were identified. In four of these, a possible benefit for home visiting was suggested.

Conclusions: Little evidence exists for the effectiveness of predischarge home assessment visits. Further research is needed to establish their value.
A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity
Authors: Pandyan A D , Johnson G R , Price C I M , Curless R H , Barnes M P , Rodgers H
Published: May 2003

Background: The Ashworth Scale and the modified Ashworth Scale are the primary clinical measures of spasticity. A prerequisite for using any scale is a knowledge of its characteristics and limitations, as these will play a part in analysing and interpreting the data. Despite the current emphasis on treating spasticity, clinicians rarely measure it.

Objectives: To determine the validity and the reliability of the Ashworth and modified Ashworth Scales.

Study design: A theoretical analysis following a structured literature review (key words: Ashworth; Spasticity; Measurement) of 40 papers selected from the BIDS-EMBASE, First Search and Medline databases.

Conclusions: The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to passive movement, but not spasticity. The modified Ashworth Scale (MAS) will need to be treated as a nominal level measure of resistance to passive movement until the ambiguity between the ‘1’ and ‘1+’ grades is resolved. The reliability of the scales is better in the upper limb. The AS may be more reliable than the MAS. There is a need to standardize methods to apply these scales in clinical practice and research.
Quality of life and the ICIDH: towards an integrated conceptual model for rehabilitation outcomes research
Authors: Post Marcel WM , de Witte Luc P , Schrijvers Augustinus JP
Published: May 2003

Objective: The development of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) has led to the assessment of a wider range of relevant rehabilitation outcomes, but a need for a further broadening exists. In this article, a new proposal for an extended ICIDH is made.

Method: Review of the literature on quality of life and of attempts to integrate the World Health Organization (WHO) biopsychosocial model and the ICIDH.

Results: Our review shows three operationalizations of the concept of quality of life: as health, as well-being and, preferably, as a superordinate construct. None of the attempts to integrate the WHO biopsychosocial model have been entirely successful. Our new proposal is characterized by (a) incorporation of the organ, person and social levels of the ICIDH, (b) distinction between objective and subjective aspects of quality of life as a second axis in the model, resulting in somatic sensations as the subjective part of the organ level, perceived health as the subjective part of the person level and domainspecific life satisfaction as the subjective part of the social level, and (c) separation of the concept of general well-being or happiness as being distinct from the ICIDH. The proposal model is intended to serve as a framework in which different outcomes can be positioned in relation to each other.

Conclusion: Our model is intuitively appealing and remains close to familiar concepts and models. However, it is as yet far from perfect, and we hope to provoke discussion to help further refinement.
Can a Barthel score be derived from the FIM?
Authors: Nyein Kyaw , Mcmichael Linsey , Turner-Stokes Lynne
Published: May 2003

Objective: To establish whether a Barthel score derived by translation from the motor items of the Functional Independence Measure (FIM) would equate to the directly scored measure.

Design: Conversion criteria for motor item scores on the FIM scale to Barthel scores were first developed. To test these criteria, 40 consecutive patients were assessed for Barthel and FIM scores by the multidisciplinary team who were unaware of the conversion criteria. The derived Barthel score was compared with the directly scored Barthel Index.

Results: A very high degree of correlation was observed between total scores of the direct and derived Barthel (Spearman's rho = 0.99), which is highly significant, and no significant differences were seen between scores for any of the individual items (Wilcoxon signed rank test). Item by item analysis across the study population was undertaken to confirm the conversion criteria. Absolute agreement between the two methods ranged from 75 to 100% and kappa values from 0.53 to 1.0.

Conclusions: This study demonstrates that a Barthel Index can be derived from the motor items of the FIM and there is a good agreement with the directly assessed Barthel score. Although a larger study may help to delineate the exact conversion criteria for one item, the current system provides an accurate and usable translation of the total score and serves as a major step towards achieving a common language in outcome measurement for rehabilitation.
Phase I Study of an Oral Formulation of ZD9331 Administered Daily for 28 Days
Authors: Sawyer Michael B. , Ratain Mark J. , Bertucci Donna , Smith Robert P. , Schilsky Richard L. , Vogelzang Nicholas J. , Shulman Keith , Douglass Edwin C. , Fleming Gini F.
Published: April 2003

Purpose: To define the maximum-tolerated dose and dose-limiting toxicities (DLTs) of an oral formulation of ZD9331, a novel thymidylate synthase inhibitor that is not a substrate for folylpolyglutamate synthase.

Patients and Methods: Patients had Cancer and Leukemia Group B performance status ≤ 2 and refractory solid tumors. Initially, patients received ZD9331 daily for 2 weeks, with the duration of treatment escalated to a maximum of 4 weeks, followed by a 2-week rest period. Once the maximum-tolerated duration of treatment was determined, the dose of ZD9331 was increased until DLT occurred.

Results: Fifty-five patients were enrolled at eight dose levels. The DLTs were thrombocytopenia and neutropenia. At 3 mg/d, two of 19 patients developed DLT; one patient had grade 3 thrombocytopenia and grade 4 neutropenia, and the other patient had grade 3 thrombocytopenia only. Anemia was common, with a median hemoglobin nadir of 75% of baseline, before recovery or transfusion. The apparent oral clearance of ZD9931 was 11.6 ± 6.3 mL/min. Dose-limiting myelosuppression was associated with both an increased 24-hour ZD9931 concentration and blood urea nitrogen.

Conclusion: The recommended phase II dose on this schedule is 3 mg/d for 4 weeks, followed by a 2-week rest period. ZD9331 seems to have a manageable toxicity profile, although it should be used with caution in patients with renal impairment.
Phase III Double-Blind Study of Glutamine Versus Placebo for the Prevention of Acute Diarrhea in Patients Receiving Pelvic Radiation Therapy
Authors: Kozelsky Timothy F. , Meyers Gregory E. , Sloan Jeff A. , Shanahan Thomas G. , Dick Stephen J. , Moore Randy L. , Engeler George P. , Frank Albert R. , McKone Timothy K. , Urias Rodolfo E. , Pilepich Miljenko V. , Novotny Paul J. , Martenson James A.
Published: April 2003

Purpose: A phase III, randomized, double-blind study was conducted by the North Central Cancer Treatment Group to determine the efficacy and toxicity of oral glutamine for the prevention of acute diarrhea in patients receiving pelvic radiation therapy (RT).

Patients and Methods: All 129 patients enrolled from 14 institutions between February 1998 and October 1999 were eligible. Patients received 4 g of glutamine or placebo orally, twice a day, beginning with the first or second day of RT and continuing for 2 weeks after RT. During treatment, patients were assessed weekly for toxicity, and a bowel function questionnaire was administered. The primary measures of treatment efficacy were diarrhea levels measured by maximum grade of diarrhea, incidence of diarrhea, and average diarrhea score. After completion of RT, the bowel function questionnaire was administered weekly for 4 weeks and at 12 and 24 months. Toxicity was measured by National Cancer Institute common toxicity criteria.

Results: The median age of patients was 69 years (range, 34 to 86 years). The two treatment arms were balanced with respect to all baseline factors. There were no significant differences in toxicity by treatment. Quality-of-life scores and the mean number of problems reported on the bowel function questionnaire were virtually identical for both treatment groups. The incidence of grade 3 or higher diarrhea was 20% for the glutamine arm and 19% for the placebo arm (P = .99). The maximum number of stools per day was 5.1 for the glutamine arm and 5.2 for the placebo arm (P = .99).

Conclusion: There is no evidence of a beneficial effect of glutamine during pelvic RT.
Flavopiridol in Untreated or Relapsed Mantle-Cell Lymphoma: Results of a Phase II Study of the National Cancer Institute of Canada Clinical Trials Group
Authors: Kouroukis C. Tom , Belch Andrew , Crump Michael , Eisenhauer Elizabeth , Gascoyne Randy D. , Meyer Ralph , Lohmann Reinhard , Lopez Pedro , Powers Jean , Turner Robert , Connors Joseph M.
Published: April 2003

Purpose: To determine the response rate and toxicity of flavopiridol in patients with previously untreated or relapsed mantle-cell lymphoma.

Patients and Methods: Adult patients with previously untreated or in first or second relapse of previously responsive mantle-cell lymphoma were given flavopiridol 50 mg/m2/d by intravenous bolus for 3 consecutive days every 21 days with antidiarrheal prophylaxis. Flavopiridol was continued until disease progression, unacceptable toxicity, or stable disease for four cycles. Disease was reassessed every two cycles.

Results: From 33 registered patients, 30 were eligible after pathology review, 30 were assessable for toxicity, and 28 were assessable for response. A median of four cycles of treatment was administered; 90% of patients received at least 90% of planned dose-intensity. No complete responses were seen; three patients had a partial response (11%), 20 patients had stable disease (71%), and five patients had progressive disease (18%). The median duration of response was 3.3 months (range, 2.8 to 13.2 months). The most common toxicities were diarrhea (97%), fatigue (73%), nausea (47%), and vomiting (27%). At least one nonhematologic grade 3 or 4 toxicity was seen in 14 patients (47%). Hematologic toxicity was modest.

Conclusions: Flavopiridol given as a daily bolus for 3 consecutive days every 3 weeks has modest activity as a single agent for mantle-cell lymphoma. The number of stable and partial responses that was seen indicates that it is biologically active and may delay progression. Future studies in mantle-cell lymphoma should test this agent with other active agents and using different schedules.
Monoclonal Antibody Therapy of Chronic Lymphocytic Leukemia
Authors: Mavromatis Blanche , Cheson Bruce D.
Published: April 2003

Chemotherapeutic approaches during the last decade have failed to result in major advances in the outcome of patients with chronic lymphocytic leukemia (CLL). The recent availability of an increasing number of active monoclonal antibodies, immunotoxins, and radioimmunoconjugates (RICs) has stimulated considerable interest in clinical research in CLL. Alemtuzumab was the first antibody approved for CLL on the basis of responses in one third of patients with advanced disease. However, infusion reactions and immunosuppression with opportunistic infections present a challenge that may be overcome with altered schedules and routes of administration. Rituximab has limited activity as a single agent in patients relapsed or refractory after prior chemotherapy; however, response rates seem to be higher in previously untreated patients. More importantly, combinations with chemotherapy drugs such as fludarabine are showing promise in early trials. Newer antibodies in development as single agents and in combinations include apolizumab (Hu1D10), a humanized antibody against an epitope of HLA-DR, and IDEC-152, a primatized anti-CD23 antibody. BL22, an immunotoxin with impressive activity in hairy cell leukemia, is in phase II trials in CLL as well. The safe use of RICs is complicated by the elevated peripheral blood B-cell count, and the extent of bone marrow involvement in CLL; studies will explore the use of agents to eliminate malignant cells from the bone marrow before RIC therapy. It is hoped that the rational development of combinations of the various promising antibodies with chemotherapy and each other will lead to more effective approaches for patients with CLL.