bluuebunny/crossref_metadata_2025 huggingface dataset:
Target board test for the quantification of ataxia in tremulous patients
Authors: Alusi S H , Glickman S , Patel N , Worthington J , Bain P G
Published: November 2003

Objective: The objective was to develop and assess the validity and reliability of a target board test (TBT) for quantifying ataxia and measuring dysmetria in the presence of tremor.

Design: Each subject was instructed to reach out and mark a target placed at arm's length with a pen (10 times with each hand). Ten patients performed the test twice.

Setting: A hospital-based multiple sclerosis (MS) unit.

Subjects: Fifty-three patients with MS and upper limb tremor/ataxia and 20 healthy control subjects. The MS patients were classified into four subgroups: MS control group ( n = 13), MS tremor group ( n = 9), MS dysmetria group ( n = 6), MS mixed (tremor and dysmetria) group ( n = 25).

Main outcome measures: The main outcome measures were the average radial distance away from the target (mean R) and the mean directional error (mean V) of the 10 contact points from the target. From these a dysmetria tremor index (DTI) was calculated by dividing mean V by mean R. Also used were a dysmetria scale, a dysdiadochokinesia scale and a fingertapping test.

Results: Mean R correlated significantly with dysmetria, dysdiadochokinesia, kinetic tremor and (inversely) with the finger-tapping test (all p < 0.005). The median difference between two measurements of mean R for all 10 contact points was 11.3% and 19.0% and for mean V 48.3% and 63.4% and DTI 57.2% and 50.5% for the right- and left-hand sides respectively, indicating the considerable directional variability within ataxia.

Conclusion: The TBT provides simple quantitative objective measurements of upper limb ataxia.
Life goals: the concept and its relevance to rehabilitation
Authors: Nair K P Sivaraman
Published: November 2003

Objective: Life goals are desired states that people seek to obtain maintain or avoid. These goals may influence motivation to participate in the rehabilitation process. The aim of this paper is to review the literature on life goals and the influence of life goals on the rehabilitation process.

Methods: The MEDLINE, EMBASE, Psychlit and CINAHL databases were searched with the keywords goals, life goals, aim of life, meaning of life, motivation, assessment (identification) of life goals, goal planning, disability, coping and rehabilitation.

Results: The initial search produced 917 abstracts. After going through these abstracts, 39 articles were selected for inclusion in the review. Age, gender, personality, experiences and society and environment influence life goals. Pursuit and attainment of life goals affect sense of well-being. Life goals are accessible to conscious awareness and can be identified. Several questionnaires are available for assessment of life goals. Different questionnaires assess different aspects of life goals. All except one of these questionnaires need to be tested for validity and reliability in a rehabilitation setting. Disabilities interfere with goal striving and result in emotional distress. Motivation to participate in a rehabilitation programme depends on concurrence between a patient's life goals and treatment goals. Incorporation of a subject's life goals into a management programme resulted in better outcomes in various physical and psychiatric disorders. There are no data on the efficacy of life goal-orientated rehabilitation programmes.

Conclusions: Life goals influence patients’ motivation to participate in and compliance with treatment programmes. We still do not know whether rehabilitation programmes focusing on life goals make any difference in outcome. There is need for further studies in this area.
Use of unconventional therapies by individuals with multiple sclerosis
Authors: Nayak Sangeetha , Matheis Robert J , Schoenberger Nancy E , Shiflett Samuel C
Published: November 2003

Objective: To examine the prevalence and patterns of use of complementary and alternative medicine (CAM) among individuals with multiple sclerosis (MS) in the USA and to explore the reasons for use, symptoms treated and perceived effectiveness of these therapies.

Methods: Surveys were mailed to the entire mailing list of the MS Foundation, constituting 11 600 individuals with MS or their family members; 3140 adults with MS returned surveys, yielding a response rate of 27.1%.

Results: More than half of the responding sample (57.1%) had used at least one CAM modality. The longer that people had MS and the less satisfied they were with conventional health care the more likely they were to use CAM therapies. The most common reasons for using CAMs were the desire to use holistic health care (i.e., treatments that recognized the interrelatedness of mind, body and spirit) and dissatisfaction with conventional medicine. Ingested herbs were the most frequently used CAM modalities (26.6%), followed by chiropractic manipulation (25.5%), massage (23.3%) and acupuncture (19.9%). Women were 25% more likely than men and whites were 30% more likely than non-whites to use CAM therapies. There was no significant relationship between the frequency of use and the reported efficacy of the CAM techniques ( r = 0.17, p > 0.10).

Conclusions: The prevalence of CAM use in this population warrants more research on the efficacy and safety of these therapies, especially those with high usage or high efficacy ratings, such as herbs, chiropractic manipulation and massage, but for which there is little or no research evidence for efficacy or safety.
Effects of ankle-foot orthoses on hemiparetic gait
Authors: Gök Haydar , Küçükdeveci Ayse , Altinkaynak Haydar , Yavuzer Günes , Ergin Süreyya
Published: November 2003

Objective: Ankle-foot orthoses (AFOs) are widely used to provide optimal ambulation in people with hemiplegia. In this study we evaluated the mechanical effects of metallic and plastic AFOs on severely hemiparetic stroke patients.

Methods: Twelve hemiparetic patients were analysed on a Vicon 370 Motion Analysis System. Spatiotemporal, kinematic and kinetic parameters were measured.

Results: The two types of orthoses generally had similar positive effects on hemiplegic gait parameters, increasing cadence, walking speed, single and double step length, ankle dorsiflexion angle at heel strike and swing. The metallic AFO was better at increasing the ankle dorsiflexion angle than the plastic AFO.

Conclusion: Hemiplegic gait was improved by both orthoses. However, metallic AFOs provided better stabilization of the ankle, allowing improved heel strike and push-off.
Agreement between physiotherapists on quality of movement rated via videotape
Authors: Pomeroy V M , Pramanik A , Sykes L , Richards J , Hill E
Published: November 2003

Background: Although achieving quality of movement after stroke is an important aim of physiotherapy it is rarely measured objectively or described explicitly.

Objective: To test whether physiotherapists agree on a composite measure of quality of movement.

Setting: A movement analysis laboratory Subjects: Ten stroke patients and 10 healthy age-matched volunteers.

Design: Prospective correlational.

Procedure: All subjects were videofilmed performing three trials of six standardized functional tasks. Two videotapes were made, each with a different randomized order of appearance of the trials. Ten senior physiotherapists independently rated the videotapes twice using a 100-mm visual analogue scale.

Analysis: Analysis of variance models were fitted to transformed data. Estimates of components of variance were calculated and presented as a percentage of the total variance for differences, within subjects (intra-subject), between raters (inter-rater) and within raters (intra-rater). An acceptable percentage was set at less than 10%.

Results: The percentage of intra-subject variance ranged from 1% (pick up box and walking) to 9% (step on block). The percentage of inter-rater variance ranged from 18% (pick up pencil) to 38% (sit to stand). The percentage of intra-rater variance was less than 1% for all tasks.

Conclusions: Although physiotherapists disagreed with each other on quality of movement they were more consistent in their own scoring.
A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity
Authors: Pandyan Anand D , Price Christopher IM , Barnes Michael P , Johnson Garth R
Published: November 2003

Objective: To investigate the criterion validity of the modified Ashworth Scale.

Population: Volunteers from a stroke population admitted to a district general hospital stroke unit diagnosed with a first ever stroke less than 26 weeks previously.

Outcome measures: Resistance to passive movement about the elbow was simultaneously quantified (biomechanically) and graded (modified Ashworth Scale). Passive range of movement and peak instantaneous velocity during passive movement were also measured.

Analysis: Criterion validity was investigated as convergent construct validity (using the Spearman's correlation coefficient) and concurrent validity (using analysis of variance).

Results: One hundred measurements were taken on 63 subjects. Correlation between the modified Ashworth Scale and resistance to passive movement was 0.511. Resistance to passive movement and velocity showed significant differences between the modified Ashworth score of ‘0’ and a modified Ashworth score greater than ‘0’ ( p < 0.01). There were no significant differences between MAS ‘1’, ‘1+’ and ‘2’. Resistance to passive movement in the impaired arm was significantly higher than in the nonimpaired arm ( p < 0.01).

Conclusion: The modified Ashworth Scale does not provide a valid measure of spasticity at lower grades but it may provide a measure of resistance to passive movement.
Shoulder pain in people with a stroke: a population-based study
Authors: Ratnasabapathy Yogini , Broad Joanna , Baskett Jonathan , Pledger Megan , Marshall Jane , Bonita Ruth
Published: November 2003

Objective: To measure the occurrence of shoulder pain after stroke. To identify the factors that predict risk of shoulder pain after stroke. Design: Auckland Stroke Study, population-based case-cohort study.

Setting and subjects: All cases of stroke, including those managed outside hospital, over a 12-month period ending February 1992 were considered in Auckland.

Outcome measures: Self-reported shoulder pain at one week, one month and six months after the onset of stroke for each person.

Results: A total of 1761 stroke events were identified. Self-reported shoulder pain among survivors increased from 256/1474 (17%) at one week, to 261/1336 (20%) at one month and 284/1201 (23%) at six months. Shoulder pain was positively associated with motor deficit, side of deficit and severity of deficit. In those surviving to six months after stroke, the risk of shoulder pain was higher in those with severe upper limb motor deficit (odds ratio (OR) 4.94; 95% confidence interval (CI) 3.06–7.98) and in diabetics (OR 1.57, 95% CI 1.15–2.14). Risk of shoulder pain increased with time and was lower for those in institutional care.

Conclusion: Shoulder pain after stroke is common, especially in patients with severe sensorimotor deficits, diabetics and those living at home. Appropriate management may reduce the rate of occurrence.
Caregiver strain in spouses of stroke patients
Authors: Blake Holly , Lincoln Nadina B , Clarke David D
Published: November 2003

Objective: To test the ability of a previously generated logistic regression model to predict caregiver strain from carer mood, negative affectivity and perceived patient functional ability.

Design: Postal prospective survey.

Setting: Spouses of community-residing patients identified from hospital stroke registers.

Method: Spouses were assessed at three and six months after stroke. A previously derived equation was used to make predictions at three months of their level of strain at six months, which were compared with observed outcomes.

Measures: Spouses were asked to complete the Caregiver Strain Index (CSI), the General Health Questionnaire (GHQ-12), the Positive and Negative Affectivity Schedule (PANAS) and to assess patients' independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL).

Results: Of 409 stroke patients, 276 had an identifiable co-resident spouse and 116 (42%) completed the measures. At three months after stroke, 39 carers (34%) were under significant strain with 40 (35%) under strain at six months. The predictive model using the GHQ-12, PANAS and EADL at three months was 78% accurate in predicting levels of caregiver strain at six months.

Conclusion: Carers at risk of later strain could be identified for further followup. Services to provide emotional support to carers might be effective in the reduction of carer strain.
An exploratory study of the consistency of balance control and the mobility of people with Parkinson's disease (PD) between medication doses
Authors: Campbell F , Ashburn A , Thomas P , Amar K
Published: November 2003

Objective: To evaluate the consistency of balance control, mobility and perceived difficulties with functional tasks by people on carefully controlled anti-parkinsonian medication programmes, between doses on a single day and across days using standard clinical measures.

Design: Small group prospective study.

Setting: A hospital outpatient physiotherapy department.

Subjects: Subjects, recruited from a specialist Parkinson's disease (PD) clinic, had to be independently mobile, diagnosed with PD at least five years previously and on a stable drug regime.

Method: Assessments (timed up and go, functional reach and a tap test) were completed 30 minutes prior to medication and hourly for 4 hours. They were repeated on a second day within a seven-day period. The self- assessment of functional disability was completed during the worst and best periods of the drug cycle. A general linear model (repeated measures analysis of variance) was used to analyse the data.

Results: Nine subjects (8 males) with PD (grade III Hoehn and Yahr, average duration of symptoms eight years), average age 72 years, were recruited to the study. Four subjects had worse Hoehn and Yahr scores (grade 4) during the worst phase of the L-dopa cycle. Balance and mobility data did not change significantly over the medication cycle. Tests on day 2 were similar to day 1 with only the tap test showing a significant mean difference ( p = 0.02) (2.6, 95% confidence interval (CI) 0.5–4.8). Individuals perceived significantly greater difficulty (mean difference = 7.9, 95% CI 3.6–12.2) ( p < 0.001) in achieving functional tasks at the end of dose than peak dose of the medication cycle.

Conclusion: Measures of balance and mobility remained stable over the cycle. Fluctuations in the perception of difficulties with daily functional tasks were not accompanied by observed fluctuations in performance. The improvement in the mean of the tap test over the days could reflect a learning effect.
Falls risk following discharge from a geriatric day hospital
Authors: Spilg Edward G , Martin Brendan J , Mitchell Sarah L , Aitchison Tom C
Published: November 2003

Objective: To assess the predictive validity of the Elderly Mobility Scale (EMS), Functional Reach (FR) and the Barthel Index (BI) in identifying recurrent fallers following discharge from a geriatric day hospital (GDH).

Subjects: Seventy-six GDH patients with identified mobility problems.

Methods: Each patient was assessed by an independent physiotherapist before and after a programme of physiotherapy using the EMS, FR and BI and a ‘falls follow-up’ assessment was performed after four months.

Results: Fifty-four per cent (29 out of 54) of patients had reduced mobility at follow-up. Twenty-five per cent (18 out of 71) of patients had two or more falls post discharge. Using logistic regression analysis for EMS, FR and BI at discharge, each of these variables individually was significantly associated with the risk of having two or more falls ( p = 0.008, 0.017 and 0.031 respectively). A prognostic tree was developed for GDH patients identifying high-risk and low-risk groups.

Conclusion: EMS, FR and BI were all significantly associated with GDH patients with mobility problems having two or more falls. A prognostic tree identified high and low-risk groups of GDH patients and should now be tested prospectively. Introduction
Assessing qualitative research in rehabilitation: guidelines from the Society for Research in Rehabilitation
Authors: Parry R H
Published: November 2003

There are numerous contested issues in qualitative research, and its findings are difficult to condense. Thus, short, qualitative research abstracts are difficult both to compile and evaluate. The Society for Research in Rehabilitation has produced guidelines that aim to illuminate and inform the development and judging of such abstracts. These draw on an extensive Health Technology Assessment review of qualitative methods in health services research.
The needs and experiences of caregivers of individuals with multiple sclerosis: a systematic review
Authors: McKeown L P , Porter-Armstrong A P , Baxter G D
Published: November 2003

Primary objective: To appraise recent studies regarding the needs and experiences of caregivers of individuals with multiple sclerosis (MS).

Design: The following computerized databases were searched: CINAHL, BIDS IBSS, ASSIA, MEDLINE, PSYCHINFO, British Nursing Index, ISI Web of Science, Zetoc, AMED (1990–April 2002). The computer-based search was supplemented by manual searches of the reference lists of all retrieved studies and review articles. Inclusion and exclusion criteria were formulated.

Results: Twenty-four studies from across the world that met the inclusion criteria were reviewed. The majority of studies were descriptive in nature. The studies covered a variety of topics, including how carers assist people with MS, the effect of providing care on a carer's physical and psychological wellbeing, social life, financial situation and overall quality of life, and how carers cope with the stresses of providing care.

Conclusions: Providing care for a person with MS has a major impact on all areas of the caregiver's life. Perceived social support has been shown to have a beneficial impact on the caregiver. Limitations in design and variation in methodology of studies limits the generalizability of findings. There is a need for further research, in particular the development of reliable and valid disease-specific caregiver assessment instruments.
Specific effects of balance and gait exercises on physical function among the frail elderly
Authors: Shimada Hiroyuki , Uchiyama Yasushi , Kakurai Shuichi
Published: November 2003

Objective: To evaluate the specific effects of balance and gait exercises among frail elderly individuals.

Design: A randomized three-group parallel controlled study.

Setting: Geriatric health services facility in Japan.

Subjects: Thirty-four frail elderly subjects attending the care facility were randomized into a control group, an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education.

Interventions: The two exercise groups received balance or gait exercise for 40 minutes, 2–3 times weekly, for 12 weeks.

Main outcome measures: One Leg Standing Test, Functional Reach Test, Manual Perturbation Test, Functional Balance Scale, Performance-Oriented Mobility Assessment, Timed ‘Up and Go’ Test and Stair Climbing/Descending Test. These assessments were performed before and after 12-week intervention.

Results: Comparison of the performance before and after intervention demonstrated significant improvement in One Leg Standing Test, Functional Reach Test and Functional Balance Scale in the balance exercise group, and Functional Balance Scale, Timed ‘Up and Go’ Test and Stair Descending Test showed improvement in the gait exercise group. All test items showed no significant differences in the control groups. Among the three groups, the balance exercise group showed more significant improvement in Functional Balance Scale, and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group. The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group.

Conclusions: Balance exercises led to improvements in static balance function, and gait exercises resulted in improvements to dynamic balance and gait functions in the very frail elderly.
Pressure mapping systems: reliability of pressure map interpretation
Authors: Stinson M D , Porter-Armstrong A P , Eakin P A
Published: November 2003

Background: Pressure mapping systems offer a new technology to assist with pressure care assessment. Data output from such systems can be presented in three forms: numerical data, a three-dimensional grid and a colour-coded pressure map.

Objectives: To (1) investigate whether sole use of the pressure map was a reliable method of interpreting interface pressures when compared with use of the numerical data; (2) establish the inter and intra-rater reliability of using pressure maps to assess pressure and determine whether reliability depended upon system operator experience; and (3) examine whether reliability extended to the range of seating surfaces being tested.

Design: A reliability study assessing the ranking of pressure maps recorded by the Force Sensing Array pressure mapping system.

Setting: A university occupational therapy department and a community NHS trust.

Subjects: Fifteen occupational therapists with experience in pressure mapping and 50 occupational therapy students with no practical experience of pressure mapping.

Interventions: Two sets of pressure maps were pre-recorded with an able-bodied adult seated on a variety of surfaces, with maps on each individual surface recorded over a 20-minute period at 2-minute intervals. Subjects ranked both sets of maps in terms of ‘best to poorest’ distribution of pressure.

Main outcome measures: Rank orders of (1) pressure maps; (2) average interface pressures (mmHg); (3) maximum interface pressures (mmHg). Results: The use of pressure maps to interpret interface pressures was a reliable method. Significant agreement existed within ( p < 0.001) and between groups of operators and reliability extended over the range of seating surfaces tested.

Conclusions: The practice of using pressure maps to interpret interface pressures in seating as opposed to using the associated numerical data can be supported. This was shown to be a reliable method of assessment by both experienced and less experienced operators across a range of seating surfaces.
Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature
Authors: Meijer R , Ihnenfeldt D S , van Limbeek J , Vermeulen M , de Haan R J
Published: November 2003

Objective: To identify evidence-based prognostic factors in the subacute phase after a stroke for future residence at six months to one year post stroke.

Design: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, PsycLIT and Sociological Abstracts. (2) Reference lists, personal archives and consultation of experts in the field. (3) Guidelines.

Methods: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for future residence; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration.

Results: From 1027 potentially relevant studies 10 studies involving a total of 3564 patients met the inclusion criteria. No prognostic factor was identified in at least two level A (i.e., a good level of scientific evidence according to the methodological score) studies, our standard for scientific proof. The following factors were found in at least one level A study: low initial ADL functioning, high age, cognitive disturbance, paresis of arm and leg, not alert as initial level of consciousness, old hemiplegia, homonymous hemianopia, visual extinction, constructional apraxia, no transfer to the stroke unit, nonlacunar stroke type, visuospatial construction problems, urinary incontinence and female gender.

Conclusions: At present there is insufficient evidence concerning possible predictors in the subacute stage of stroke to make an evidence-based prediction of the future residence. In the scientific research until now social factors and their contribution to the possibility of living independently have not been investigated, or at least less well. None of the studies in this review described a conceptual framework as basis for the choice of the examined prognostic factors.
A qualitative study of stroke patients' and carers' perceptions of the stroke family support organizer service
Authors: Lilley Steven A , Lincoln Nadina B , Francis Valerie M
Published: November 2003

Objective: To investigate stroke patients’ and carers’ perceptions of the family support organizer (FSO) service in order to highlight its value for potential purchasers and to help shed light on findings from randomized controlled trials.

Design and subjects: Twenty semi-structured interviews were undertaken with a sub sample of stroke patients and their primary informal carers after completion of nine-month outcome assessments as part of a randomized controlled trial.

Setting: Community stroke services in North Nottinghamshire, UK.

Results: Interviewees who received the service reported that the presence of an FSO was valuable in many respects, including helping to claim benefits, as a source of information on stroke, and providing continuity between stroke services. Emotional support was only described by a few. Interviewees who did not receive the service described feelings of isolation and being let down by other stroke services after discharge. They also reported problems accessing information. Help needed to address the practical problems after stroke was commonly reported. For those who did not receive the FSO service, access to support appeared to be found through other channels.

Conclusion: The FSO service appeared to be an information service. In order to evaluate community stroke services, a mixture of qualitative and quantitative outcome measures are necessary.
Measurement of isometric wrist muscle strength – a systematic review of starting position and test protocol
Authors: Bialocerkowski Andrea E , Grimmer Karen A
Published: November 2003

Background: Isometric strength of the wrist musculature is frequently used in the clinical setting as a primary outcome measure following a wrist disorder.

Objective: A systematic search of the literature was undertaken to review published starting positions and test protocols used in assessing isometric strength of the wrist musculature.

Methods: AMED, CINAHL, Current Contents, EMBASE and MEDLINE computerized databases were searched for literature published between January 1980 and September 2002 that described the methodologies used to assess isometric wrist muscle strength. Papers were excluded if they explored motor unit recruitment, strength was assessed via manual muscle testing or no information regarding starting position or test protocol was included.

Results: A total of 15 papers met the inclusion criteria. Starting position varied between papers, with little justification for the positions assumed. Test protocols used also were variably described, with some not meeting accepted standards for the assessment of isometric strength. Many of the reports lacked information regarding starting position and test protocol used, which precluded replication of the methodology.

Conclusions: Further research is required to determine the optimum starting position and test protocol for the assessment of isometric wrist muscle strength. These should subsequently be assessed for reliability, to ensure that consistent results are produced over different occasions of testing.
Is the repetitive training of complex hand and arm movements benefi cial for motor recovery in stroke patients?
Authors: Woldag Hartwig , Waldmann Guido , Heuschkel Gabriele , Hummelsheim Horst
Published: November 2003

Objective: To determine whether a repetitive training of complex movements of arm and hand contributes to functional recovery in stroke patients.

Design: Prospective, longitudinal, multiple baseline design across individuals. Setting: Neurological rehabilitation centre.

Subjects: Twenty-one patients with stroke in the middle cerebral artery territory.

Interventions: Baseline phase: ‘house-typical’ occupational and physiotherapy; training phase: ‘house-typical’ therapy supplemented by repetitive training of (1) grasping and transport movements and (2) sawing movements of the affected arm over 10 minutes each, twice daily, five days per week.

Main outcome measures: Rivermead Motor Assessment (RMA, arm section), grip strength, rapid isotonic hand extension, three-dimensional motion analysis.

Results: Patients experienced a continuous functional improvement of the affected arm (RMA score from initial 4.9 ± 2.1 to 8.0 ± 4.6, p < 0.001) and an increase of grip strength during the baseline and the training phase (from initial 102.4 ± 43.3 N to 150.6 ± 118.9 N, p < 0.05). Movement analysis revealed a trend to a more precise movement execution. The repetitive training of complex movements did not result in an additional benefit.

Conclusion: The repetitive training of complex movements does not further enhance the functional recovery of the affected arm and hand in stroke patients compared with functionally based occupational and physiotherapy.
Bobath or Motor Relearning Programme? A follow-up one and four years post stroke
Authors: Langhammer Birgitta , Stanghelle Johan K
Published: November 2003

Objective: The purpose of this follow-up one and four years post stroke was to find out whether the initial physiotherapy approach had had any long-term effects on mortality, motor function, postural control, activities of daily living, life quality, follow-up from community services and living conditions.

Design: A randomized controlled trial of first time ever stroke patients. Group 1 ( n = 33) and group 2 ( n = 28) had initial physiotherapy according to the Motor Relearning Programme and Bobath, respectively.

Main outcome measures: The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL Index, the Nottingham Health Profile (NHP) and Berg Balance Scale were used. The following parameters were also registered: incidence of new strokes, other diseases, use of assistive devices, the patient's accommodation and use of services from the community.

Results: The mortality rates were similar in the two groups. In both groups the motor function, postural control and ADL had decreased rapidly, leaving many of the patients dependent and with a high risk of falling. Life quality had increased compared to the acute stage, but was still low in comparison with healthy persons. Patients in both groups lived at home, but were dependent on help from relatives and community services. Physiotherapy as follow-up service was seldom used. The initial physiotherapy approach did not seem to have a major in‘uence on the patients' ability to cope in the long term.

Conclusion: This follow-up at one and four years post stroke showed no major in‘uence of two different initial physiotherapy regimens on long-term function. The study confirmed a rapid deterioration of ADL and motor function and an increased dependence on relatives. The study reveals a gap between the intense treatment in the acute phase and little or no follow-up of physiotherapy treatment or other rehabilitation activities later.
Programme evaluation of a geriatric rehabilitation day hospital
Authors: Hershkovitz Avital , Gottlieb Daniel , Beloosesky Yichayaou , Brill Shai
Published: November 2003

Objective: To evaluate the rehabilitation programme in a geriatric day hospital.

Design: An observational study.

Setting: An urban geriatric rehabilitation day hospital.

Subjects: Three hundred and fifty-three older patients admitted to a rehabilitation day hospital during 2000: 163 post stroke, 113 with deconditioning and 77 post orthopaedic surgery (hip fracture and joint replacement).

Main outcome measures: Functional Independence Measure (FIM), Nottingham Extended ADL Index, timed ‘get up and go’ test.

Results: The mean discharge scores of all FIM items were significantly higher than the mean admission scores. Mean score change, however, for each item was less than one point. Most of the patients (70%) improved by less than 5 points, regardless of main admission diagnoses. Patients with a lower admission FIM score improved more than those with a higher admission score. The majority of the enrolled patients (92%) showed an improvement in their Nottingham Extended ADL Index score. The mean (SD) score on admission was 21 (11.9) and at discharge 31 (14.6). In all but three items (self-feeding, using a telephone and driving a car), mean scores at discharge were significantly higher than admission scores ( p < 0.001). A significant improvement in timed ‘get up and go’ score was found for all patients regardless of main diagnosis. Performance time decreased by 33% and discharge scores for all patient groups were approximately 20 seconds.

Conclusions: The notable improvement in mobility and instrumental activities of daily living on the one hand, and the minor improvements achieved in basic activities of daily living on the other, suggests a need to revise treatment goals of day hospitals.
Verbal fluency assessment of patients with multiple sclerosis: test–retest and inter-observer reliability
Authors: Vlaar A M M , Wade D T
Published: November 2003

Objective: To establish the reliability and validity of verbal ‘uency testing in patients with multiple sclerosis (MS).

Design: Each patient was assessed twice 7–14 days apart on a test of phonological ‘uency and again 7–14 days later when half of the patients were assessed for phonological ‘uency by a second assessor while the other half was assessed by the first assessor using a test of semantic ‘uency.

Setting: A specialist young disabled unit.

Subjects: Thirty-five patients with multiple sclerosis.

Measures: Phonological ‘uency (PF) was tested giving the patient 60 seconds to generate words starting with ‘F’ ‘A’ and ‘S’; semantic ‘uency (SF) with names of animals and fruits. Also used were the Short Orientation–Memory–Concentration Test and the Barthel ADL Index.

Results: On the first occasion 31/35 patients could be tested, and the average (SD) score of the PF was 21.9 (12.1), median 18. The test–retest reliability ( n = 30/35) of the PF was good (Pearson r = 0.85). The score difference between the first two occasions ranged from +17 to –15 (median –3, mean –2.9, SD 6.7). The inter-observer reliability ( n = 13/16) of the PF was good (Pearson r = 0.90). The difference of the score between the two assessors ranged from –9 to +6 (median 0, mean –1.2, SD 4.9). The correlation (Pearson) of the PF score with the SF, Barthel and SOMC was respectively r = 0.59, r = 0.27 and r = 0.63.

Conclusions: Phonological ‘uency testing is reliable in people with MS.
Medial–lateral postural stability in communitydwelling women over 40 years of age
Authors: Nitz J C , Choy N L Low , Isles R C
Published: November 2003

Objective: To document the change in medial–lateral balance in women aged between 40 and 80 years.

Design: A cross-sectional study of six measures of medial–lateral balance was undertaken.

Setting: The Betty Byrne Henderson Centre for Women and Ageing, Royal Women's Hospital, Australia.

Subjects: Five hundred and three community-dwelling women between 40 and 80 years of age were randomly recruited from a large metropolitan region with 366 subjects admitted after applying exclusion criteria.

Measurements: The clinical measurements included the lateral reach and step tests while laboratory measurements were gathered from the Balance Master software programs for unilateral stance and limits of stability.

Results: A significant decline in all measures ( p < 0.02) was evident between the forties and sixties age decade cohorts. The clinical step test showed a significant ( p < 0.001) decline between the forties and fifties groups. A significant correlation was shown between step test and unilateral stance ( p < 0.001) and movement velocity, reaction time and end-point excursion centre of gravity (COG) on the limits of stability test ( p < 0.001).

Conclusions: This new evidence demonstrates that there is a significant decline in medial–lateral balance in women that occurs between their forties and sixties. Suggestions for further study were made.
Inter-rater reliability and concurrent validity of walking speed measurement after traumatic brain injury
Authors: van Loo M A , Moseley A M , Bosman J M , de bie R A , Hassett L
Published: November 2003

Objective: To assess the inter-rater reliability and concurrent validity of walking speed measurement after traumatic brain injury.

Design: Twelve subjects each completed five comfortably paced and five fast-paced walking trials. Walking speed was measured simultaneously by five observers using a stopwatch (clinical procedure) and by infrared timing gates (gold standard).

Setting: Brain injury rehabilitation unit.

Subjects: People with traumatic brain injury who could walk independently and were participating in a rehabilitation programme.

Main outcome measures: Walking speed over a 10-metre distance.

Results: The inter-rater reliability of walking speed measured using a stopwatch was very high, with an intraclass correlation coefficient of at least 0.998 for both comfortable and fast-paced tests. Concurrent validity was excellent for comfortable and fast tests, with perfect correlations between the stopwatch and infrared timing gate measurement procedures.

Conclusions: Physiotherapists can use a stopwatch as a reliable and valid measurement tool to quantify walking speed over a short distance at both comfortable and fast paces in people who have sustained traumatic brain injuries.
Changes in life goals of people with neurological disabilities
Authors: Nair K P Sivaraman , Wade Derick T
Published: November 2003

Objective: To investigate the relationship between changes in life goals and progression of disabilities among subjects with neurological disorders over a period of four years.

Design: Retrospective study.

Setting: A centre for continuing disability management in the UK.

Subjects: Patients with static or progressive neurological disabilities.

Interventions: Review of rehabilitation team notes.

Main outcome measures: Barthel ADL Index and Rivermead Life Goals Questionnaire from four consecutive annual assessments from 1997 to 2000.

Results: Thirty-two subjects had progressive disabilities and 24 had static disabilities. In subjects with static disabilities there was no significant change in grades of any of the life goals over a period of four years. Among subjects with progressive disabilities, significant reductions were noted in importance given to partner ( p = 0.034), work ( p = 0.008) and leisure ( p = 0.028) over four years. While there was no significant change in number of life goals considered as extremely important in subjects with static disabilities, there was a significant reduction in number of goals considered as extremely important in subjects with progressive disabilities ( p = 0.022)

Conclusion: People with progressive disabilities tend to downgrade the significance attached to goals related to partner, work and leisure. They also reduce number of goals graded as extremely important. This change is not seen in people with static disability.
Assessing advanced locomotor recovery after total hip arthroplasty with the timed stair test
Authors: Perron Marc , Malouin Francine , Moffet Hélène
Published: November 2003

Objective: To assess advanced locomotor performance with the timed stair test (TST) and to determine if the level of performance of a group of women one year after hip replacement changed with the functional demands of the tasks.

Design: Comparison of the performance of two groups of women.

Setting: General community.

Participants: A convenient sample including 18 women who had had a total hip replacement 11 months earlier (patients) and 15 healthy age-matched women (comparison group).

Main outcome measures: Three tests were administered: the 10-m walk test, the unloaded TST and the loaded TST (10 kg). The duration of each test was recorded and transformed into speed and the level of performance was assessed by calculating percentage deficit using corresponding values from the comparison group. The TST is made of four subtasks: (1) standing up and walking, (2) ascending stairs, (3) turning and descending stairs, (4) walking back, turning and sitting down.

Results: Significant differences in performance were found for all three tests with the patients showing a slower performance. The percentage deficits increased significantly from the less difficult (walking: 18%) to the more difficult conditions (unloaded TST: 23% and loaded TST: 28%), with the greatest deficits found during stair descent. Strong correlations were also found between walking deficits and TST deficits (loaded: r = 0.82; unloaded: r = 0.88).

Conclusions: By combining mobility, walking and stair activities, the TST can be used to assess various components of advanced locomotor performance. The progressive level of difficulty of the TST subtasks as well as the addition of a load make it useful to detect subtle locomotor disabilities.
Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer
Authors: Smith EM , Gomm SA , Dickens CM
Published: November 2003

Backgroung: The aim of palliative care services is to ensure the best quality of life for patients and their carers. Depression is common amongst palliative care patients and has been shown to adversely affect quality of life. This study aimed to examine the independent contribution of depression to quality of life. Objective: To investigate the hypothesis that a) illness severity, pain, anxiety and depression are all associated with impaired health-related quality of life and b) once the effects of illness severity have been adjusted for, there is further independent contribution to quality of life from anxiety and depression. Method:Consecutive patients with advanced cancer under the care of palliative care services were screened. Sixty-eight patients were evaluated for levels of anxiety and depression, severity of illness, pain severity and health-related quality of life. Results: Thirty-three males and 35 females were recruited and had an age range of 41-93 years (median 71). Seventeen (25%) of patients were anxious [anxiety score] = 11 on the Hospital Anxiety and Depression Scale (HADS)], 15 (22%) were depressed (HADS depression score] = 11). After controlling for the effects of pain and illness severity, anxiety and depression were independently associated with global health status, emotional and cognitive functioning, and fatigue. Anxiety further contributed significantly towards social functioning, nausea and vomiting. Conclusions: This study has confirmed that pain, anxiety and depression were associated with impaired quality of life. Anxiety and depression contributed independently towards various dimensions of quality of life. Longitudinal studies are required to examine the direction of the causal association between pain and depression in patients receiving palliative care.
Atitudes of patients and staff to research in a specialist palliative care unit
Authors: Ross Catriona , Cornbleet Mike
Published: November 2003

Many randomized trials in specialist palliative care (SPC) have failed to recruit sufficient numbers of patients. A questionnaire was designed to assess the attitudes of inpatients of a SPC unit to taking part in research. Only 50% of patients were considered physically and mentally fit for interview. Forty patients and 13 nurses were asked to indicate their willingness to take part, or for their patients to take part, in research in general and then in three hypothetical trials. Reasons for their responses were analysed. The patients were generally agreeable to trial participation (66% ’quite happyflor ’very happy‘). The nurses were strongly in favour of research participation for the same group of patients (92% ’quite happyflor ’very happy‘). The most invasive study involving venepuncture and random drug allocation had the least favourable response (46% of patients and 54% of nurses ’quite happyflor ’very happy‘). A trial of reflexology attracted 77% of patients, while 62% were happy to take part in a study involving mood assessment and interview. Factors deterring willingness to participate included the need for record keeping by the patient and concern about potential emotional strain. The nurses correctly identified some of the factors deterring patients, but often their willingness for trial participation did not match that of the patient. Although there is support for research among the small number of potential trial entrants in specialist palliative care units, their limited physical and emotional reserves make careful attention to appropriate trial design essential to the success of future studies.
Palliative care research protocols: a special case for ethical review?
Authors: Stevens Tony , Wilde David , Paz Silvia , Ahmedzai Sam H , Rawson Angela , Wragg Dawn
Published: November 2003

Between October 2001 and May 2002 the Chairperson and Vice-Chairperson of each Multicentre Research Ethics Committee (MREC) in England, Wales and Scotland took part in a semi-structured interview to ascertain the attitudes of MRECs to palliative care research. Interviews were transcribed and analysed using a grounded theory approach. Most respondents said each protocol was reviewed on its own merits, according to broad ethical principles, but were equivocal as to whether palliative care protocols posed particular or different challenges compared to those from other specialties. Respondents said they reviewed only a small number of palliative care protocols, and that they were less experienced with some of the study methods utilized, particularly qualitative designs. Four main themes emerged from the analysis. Respondents expressed concerns about the protocol itself – in regard to safeguarding the principles of autonomy and justice. There were concerns about how the research would be carried out, especially the protection of patients and the influence and input of the researcher in the process. The third theme concerned the impact of the research on the participant, particularly intrusion, potential distress and the existence of support mechanisms. Fourthly, respondents identified patient groups receiving palliative care (children, the elderly, bereaved families, patients in intensive therapy units, and those from ethnic groupings), who they considered might be particularly vulnerable.