bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Barthel Index: an ordinal score or interval level measure?
Authors: Tennant Alan , Geddes Joanna ML , Chamberlain M Anne 
Published: July 2008

The Barthel Index is one of the most widely used activities of daily living (ADL) measures in stroke rehabilitation and there has been some debate recently about whether or not the Index is an ordinal score or an interval level measure. An audit of 192 consecutive patients undergoing inpatient rehabilitation following stroke has provided the opportunity to examine this question with recently developed mathematical techniques based on the work of George Rasch. Rasch models define the criteria which data must follow to produce an interval level measure. It thus becomes possible to test the data derived from the audit against the Rasch model. Calibration of the 10 items in the Index shows considerable differences in the degree of difficulty (weight), and these differences are not compensated for by the current scoring. Thus adding together the items produces a scale whose intervals vary considerably, particularly between intervals at the lower or upper ends of the scale, and those at the centre. This can give rise to considerable differences between the change score based on the Rasch transformation (taking into account item difficulty) and the change score based on raw scores. These findings confirm the ordinal nature of the Barthel Index. Further questions are raised about the unidimensionality of the Index, and the context in which it should be used.
Identification of stroke carers 'at risk': a preliminary study of the predictors of carers' psychological well-being at one year post stroke
Authors: Hodgson Susan P , Wood Victorine A , Langton-Hewer Richard 
Published: July 2008

Background: A third of carers of people who have had a stroke experience poor psychological health. Early prediction of carers' later well-being would allow interventions to be targeted at carers most at risk of a poor outcome. Aim: To develop a predictive model for the identification of stroke carers at risk of developing poor psychological well-being in the first year post stroke. Method: Fifty consecutive one-year survivors of a stroke and their carers were assessed on a range of demographic, environmental and psychosocial variables at three months post stroke. The carers' psychological well-being at 12 months post stroke was assessed using the General Well-Being Index (GWBI). Multiple regression analysis was performed to identify the best early predictors of carers' later well-being. Results: The regression analysis identified three significant predictors of carers' well-being: carers' appraisal of caregiving stress; carers' physical health; and carers' satisfaction with service provision ( r2 = 0.53). Using this model, 72% of carers' predicted well-being scores fell within nine points of their actual 12-month GWBI score. Conclusion: Findings from this preliminary study indicate that it may be possible to identify carers most likely to experience poor psychological well- being. In order to develop a clinically usable 'carer risk prediction instrument' further research to test this model is essential.
An evaluation of the Alexander Technique for the management of disability in Parkinson's disease- a preliminary study
Authors: Stallibrass C. 
Published: July 2008

Objective: To test the effect of the Alexander Technique (AT) on the management of disability and feelings of depression in patients with Parkin son's disease (PD). Design: Subjects completed four self-report questionnaires, one set before the course of lessons and a repeat set when the lessons were ended. The postal questionnaires were mailed directly to the subject's home from the university with a stamped addressed envelope. Subjects: Seven volunteers, with no previous experience of the Alexander Technique, diagnosed by consultant neurologists to have idiopathic Parkin son's disease. Setting: The subjects were contacted by the nearest registered AT teacher and were taught in the individual teacher's practice rooms, in the same way as other pupils. Interventions: Subjects received a median of 12 lessons. Main outcome measures: The self-report measures were the BECK Depression Inventory, activities in daily living, body concept, and social functioning disability questionnaires. Results: Post-lessons the subjects were significantly (p < 0.05) less depressed. They had a significantly more positive body concept and had significantly less difficulty in performing daily activities, and significantly less difficulty on the fine movement and gross movement subscales of the activities in daily living questionnaire. Conclusions: The statistically significant results are consistent with the hypothesis that for PD patients on drug therapy, the Alexander Technique reduces depression and improves the management of disability, but in the absence of a control group and a larger sample, they cannot be said to confirm the hypothesis. The likelihood of the AT being effective in the management of disability for many PD patients, as shown in this study, makes further controlled research desirable.
Test-retest and inter-method reliability of the self-rating Barthel Index
Authors: Hachisuka Kenji , Ogata Hajime , Ohkuma Hidenobu , Tanaka Shoichi , Dozono Koichiro 
Published: July 2008

Objective: To develop a self-rating Barthel Index questionnaire (SB) for assessing stroke patients living at home, the test-retest reliability of SB versions 1 and 2 and the inter-method reliability of SB version 3 were examined. Design: Case series. Setting: Clinics of the Department of Rehabilitation Medicine at the University Hospital and two affiliated hospitals. Patients: Thirty-one, 140 and 65 chronic stroke patients living at home, being seen for regular follow-up, and having no severe aphasia for SB versions 1, 2 and 3, respectively. Main outcome measure: Kappa coefficients of items in SB versions 1 and 2 for test-retest reliability; intra-class correlation coefficients of the self-care index, mobility index and total score, kappa coefficients of items and Friedman's two-way ANOVAs of ranking in SB version 3 among the self-ratings, family ratings and occupational therapist (OT) ratings; a regression analysis of age, gender, duration, time for filling in the SB, OT ratings, Mini-Mental State score and aphasia. Results: Kappa coefficients in SB version 2 were higher than those in version 1. Intra-class correlation coefficients in SB version 3 among the three ratings were good, and kappa coefficients in each item were also good or excellent. By Friedman's two-way ANOVA, all the items except walking up/down stairs had no significant difference in ranking. Regression analysis revealed that OT ratings and time for filling in the SB affected the absolute difference of scores between the self-ratings and OT ratings. Conclusion: SB version 3 is sufficiently reliable for practical use.
Satisfaction with information and advice received by stroke patients
Authors: O'Mahony Paul G , Rodgers Helen , Thomson Richard G , Dobson Ruth , James Oliver FW 
Published: July 2008

Objective: To determine levels of satisfaction with information and advice received about stroke disease and relevant issues by community-dwelling stroke survivors. Design: An interview questionnaire survey. Setting: A family health services authority area in northern England. Subjects: Stroke survivors identified by a valid screening questionnaire from a stratified random sample of 2000 subjects aged 45 years and over. Main outcome measure: Proportion of subjects interviewed responding positively to the question 'Do you think you have received enough advice and information on ... ?' eighteen topics considered relevant to stroke survivors. Results: The screening process identified 116 stroke survivors, of whom 76 agreed to be interviewed. The majority (> 80%) of patients were satisfied with information and advice received on lifestyle and health promotion issues, incontinence and their current treatment. However, satisfaction was poor for the areas of stroke disease in general, its effects, available services, and legal and financial affairs (range, 28-75% satisfied). Conclusion: Deficits in the provision of adequate information and advice to stroke patients on relevant issues have been identified in this study of a representative sample of community-dwelling stroke survivors. These deficits need to be addressed by those providing care for stroke patients in order to improve patient satisfaction.
Aspiration following stroke: is it related to the side of the stroke?
Authors: Smithard DG , O'Neill PA , Martin DF , England R. 
Published: July 2008

Objective: To investigate the relationship between the side of stroke and the presence of aspiration on videofluoroscopy. Design: Observational prospective study. Subjects: Eighty-seven patients (50% female) admitted with an acute stroke to the University Hospital of South Manchester. Methods: Patients admitted to the study underwent brain CT scanning and repeated videofluoroscopy. Results: CT scanning was performed within a median three days (interquartile range 2-4 days) following stroke and videofluoroscopic (VF) examination (median 2, interquartile range 1-4 days following stroke) of their swallow. Seventeen (19.5%) patients were noted to be aspirating. There were no significant relationships at this time between side or site of lesion and the presence of aspiration. A second assessment was carried out at a median time of 29 days (interquartile range 26-45) following acute stroke. Nine of 69 (13.5%) patients were noted to be aspirating, seven of whom had right hemisphere lesions ( p < 0.01). Conclusions: Continuing aspiration may be related to the side of the cerebral lesion.
Evaluation of cognitive behavioural treatment for depression after stroke: a pilot study
Authors: Lincoln NB , Flannaghan T. , Sutcliffe L. , Rother L. 
Published: July 2008

Objective: To evaluate cognitive behavioural therapy in the treatment of depressed stroke patients. Design: A series of AB single case experimental design studies. Subjects: Stroke patients who had been admitted to hospital. Methods: Patients were identified from a hospital register of stroke patients and sent the Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale to determine whether they were depressed. Those who were depressed were sent the BDI weekly during a four-week baseline period. They were then treated and continued to complete the BDI weekly over a three-month treatment period. Patients were also assessed pre- and post-treatment on measures of functional independence. Intervention: Cognitive behaviour therapy. Results: Of the 626 patients on the Stroke Register, 373 returned questionnaires and 155 were identified as depressed. Of these 136 were visited and 19 agreed to take part. The outcome was evaluated using three methods: visual inspection, comparison of patients during baseline and treatment phases and proportion of scores below lowest baseline. This showed that four patients consistently showed beneficial treatment effects, six patients showed some benefit and nine no benefit. For the group as a whole there was a significant decrease in depression during the treatment period on the BDI (p = 0.02) but no significant change in functional abilities. Conclusion: Cognitive behaviour therapy is an appropriate treatment for some depressed stroke patients and beneficial for some patients. Further evaluation of this treatment with stroke patients is warranted.
Development of a neurological rehabilitation environment: an observational study
Authors: Newall Jayne T , Wood Victorine A , Hewer Richard Langton , Tinson Deborah J 
Published: July 2008

Background: Engagement in therapeutic activity among stroke inpatients is advocated by many rehabilitation professionals. However, there is a lack of published evidence to indicate whether this is currently being achieved. Objective: To investigate the extent and types of 'rehabilitation' activities on a new neurological rehabilitation ward, and examine change in patients' behaviour related to the new environment and new initiatives. Design: Five one-week observation periods were conducted over two years, with a total of 67 patients being observed. A comparison was made with results of an earlier study of stroke patients' activities conducted at the same hospital. Results: Patients spent an average 43 min per day with therapists (9% of the working day) and this was only marginally supplemented by self-exercise (2% of the working day - approximately 10 min). However, the provision of a new rehabilitation environment was associated with a marked decrease in the time patients spent at their bedsides, and a decrease in time spent passively gazing or watching others. Conclusions: Overall there was some positive change in patients' behaviour. We suggest that structured guidance is required from the whole multidisciplinary team to stimulate more self-directed therapy practice and recreation.
Improvement in gait parameters following late intervention in traumatic brain injury: a long-term follow-up report of a single case
Authors: Butler PB , Farmer SE , Major RE 
Published: July 2008

Objective: To evaluate the effect of using an optimally adjusted fixed ankle foot orthosis to control knee pain and promote improvement in gait parameters in a subject with hemiplegia following a traumatic brain injury 11 years previously. Design: This is the report of a single case, using gait laboratory facilities to monitor force alignment relative to the knee and single leg balance time with the subject barefoot. Subject: A 35-year-old woman with a right hemiplegia seen 11 years after onset. Intervention: A polypropylene fixed ankle foot orthosis was supplied to the hemiplegic limb and shoe modifications were made to optimize the position of the ground reaction force relative to the knee during stance phase of gait. This orthosis was used on a daily basis for one year. Results: Knee pain was controlled after three months use of the orthosis. Graphical results of force alignment during stance phase of gait are presented for initial assessment and at one and four years postorthotic supply. A large knee-extending effect was noted on the hemiplegic limb at initial assessment and this was reduced by 67% of its initial value at one year. A compensatory early heel lift was initially noted on the opposite limb and this was reduced by 42% of the initial height at one year. These results were maintained at four years. Right leg standing balance was not initially possible but was recorded as 5 s duration at three months and this was maintained at one and at four years. Conclusions: The use of an optimally adjusted ankle foot orthosis was effective in controlling knee pain and improving barefoot gait parameters with maintenance of the improvement after use of the orthosis was discontinued. Further research is required to fully establish the potential of this approach in subjects with traumatic brain injury.
Community integration of wheelchair-bound athletes: a comparison before and after onset of disability
Authors: Pluym Saskia MF , Keur Tessa JA , Gerritsen Johan , Post Marcel WM 
Published: July 2008

Objectives: (1) To assess to what extent wheelchair-bound athletes living independently in the community were able to return to their premorbid level of functioning in the community; (2) to investigate how they value their current way of functioning in comparison to that before disability; and (3) to examine the factors that hamper their return to their premorbid life in four domains. Methods: Forty-four wheelchair-bound athletes participated in this study. Data were collected by means of a self-administered semi-structured questionnaire which was divided into four domains: vocational status, leisure time activities, social functioning and relationship with partner. Results: Return to premorbid level of functioning in the community in the long term was reasonably well achieved for the domains 'leisure activities', 'social contacts' and 'relationship with partners', but not for 'vocational situation'. Between 60% and 80% of the participants reported satisfaction with their current level of functioning for all domains. However, about 50% of the respondents reported that they were currently less satisfied with their functioning on the domains 'vocational situation' and 'leisure activities', compared to before the onset of disability. Factors limiting integration were principally access to buildings and physical health problems (pain and fatigue). Conclusion: It appeared that wheelchair-bound athletes were able to live a life on a level comparable to that before onset of disability for three of the four domains. It was emphasized that pain treatment in late rehabilitation and improving access for the disabled can contribute to the further integration of wheelchair-bound people into the community.
Routing through the health care system and level of functioning of lower limb amputees
Authors: Uiterwijk Aem , Remerie SC , Rol M. , Sier JC , Terburg M. 
Published: July 2008

Objectives: To describe the routing through the health care system and the level of functioning of a consecutive series of lower limb amputees at a general Dutch hospital. Methods: A descriptive cohort study (medical records examination) with a follow-up interval of 11.7 months. All 124 major lower limb amputations (ankle to hip) between 1 July 1989 and 31 December 1992 are included in the study: 123 patients, average age 73.8 years, 96% vascular disease. Amputation levels are 55.3% transfemoral, 12.2% knee disarticulation and 32.5% transtibial. At follow-up two patients are missing. Results: Before admission to hospital 75.6% of patients are able to walk and 79.9% live independently. Discharge destinations from hospital are 22.5% home, 42.3% inpatient rehabilitation and 32.4% nursing home. At follow-up, 59% of surviving patients have a prosthesis, 47.7% are able to walk and 70.5% live independently. Mortality after one year is 28.5%. Poor preoperative walkers seem to die more often within the first year and have less chance of being fitted with a prosthesis. Poor walkers, older than 75, with diabetes mellitus and a transfemoral amputation seem to stay more often in a nursing home after one year. Discussion: Although the results are largely comparable with other studies, there appear to be differences in age, amputation level and course and duration of treatment. The predicting factors found here may help the rehabilitation specialist in advising on the best moment and level of amputation and course of treatment.
A qualitative study of specialist nurse support for stroke patients and care-givers at home
Authors: Dowswell G. , Lawler J. , Young J. , Forster A. , Hearn J. 
Published: July 2008

Background: The involvement of five specialist nurses in providing a stroke support service was evaluated quantitatively in a recent randomized controlled trial. This complementary study used qualitative methods to evaluate trial outcomes more comprehensively. Aims: To identify whether the nurses' intervention may have influenced the process of stroke recovery. Method: A purposefully selected subsample of 30 patients and 15 care-givers were interviewed within 1-3 months of their final quantitative assessment (12 months after recruitment to the randomized trial). Fifteen of the patients and eight of the care-givers had received visits from a specialist nurse. A semi- structured interview was designed to include questions on perceptions of the recovery process and evaluation of services received. Results: Some differences were evident between the accounts of control and intervention group subjects. The less tangible aspects of nurses' interventions - concern, attention, empathy and interest, when combined with sound professional knowledge, had identifiable value to the patients and care-givers. It appeared that the nurses had employed considerable sensitivity and skill in identifying and responding to particular needs at appropriate times. Conclusion: The qualitative evaluation offers a different picture to the quantitative results of the randomized controlled trial. In general, the findings of the qualitative study are more positive and encouraging than the quantitative results. The majority of patients and care-givers in the intervention group believed that they had benefited from the specialist nurse's visits.
A study of the attitudes of a rural Indian community toward people with physical disabilities
Authors: Bakheit Amo , Shanmugalingam V. 
Published: July 2008

Objective: To examine the attitudes of a rural community in southern India toward its disabled members. Design: Prospective cross-sectional study Method: One hundred and twenty randomly selected villagers around the town of Vellore in southern India were invited to take part in the study. The attitudes towards individuals with physical disabilities were examined using a modified version of the Scale of Attitudes Toward Disabled Persons (SADP). The questionnaire was administered in its original English format with simultaneous translation into Tamil. Results: Data were complete in 111 cases, 82% of whom showed a positive attitude toward people with disability. Gender and employment status did not appear to have an influence on whether the respondent regarded disabled people in a positive or negative way but most older individuals expressed prejudice and/or challenged the rights of disabled people to equal opportunities in education, employment and social integration. Further data analysis demonstrated that more subjects with than without a disabled family member supported the rights of disabled individuals to education, employment and social integration. By contrast, the items of SADP which described the personal attributes of disabled people did not discriminate between the two groups. Conclusion: The attitudes of the rural community studied toward people with disabilities were unrelated to the sex or educational status of the respondents but was influenced by their age. This suggests that older subjects in rural communities in developing countries should be the main target for educational programmes which promote positive images of disability.
Emergency day hospital assessments
Authors: Black David A 
Published: July 2008

Objective: To describe the use of a geriatric day hospital for emergency multidisciplinary assessment as an alternative to immediate hospital admission for some groups of frail older people. Design: Retrospective study of change in clinical practice. Setting: District general hospital. Intervention: Immediate multidisciplinary assessment of selected patients instead of requested emergency hospital admission. Outcomes: (1) Data were collected on 67 consecutive referrals. In 63% the patient needs could be met without emergency hospital admission on the day of assessment. (2) Of the 42 patients originally not admitted only 29% were subsequently admitted within the next three months. Conclusions: Emergency day hospital assessments can be used as an alternative to immediate hospital admission for some frail older people.
Controversies around a Universal Model
Authors: Albagli Claude 
Published: July 2008

AbstractSince Magellan's round-the-world voyage (1521), international issues have been embroiled in universalist claims. This paper investigates the controversial nature of a new economic universalism in the light of the social deficiencies and the limits of the available resources. The model of a global consumerism turns out to be inaccessible for billions of people. The market conceals a social dimension which ethics, equity, governance and identity are attempting to reintroduce. Consumerist universalism is faltering. The search for an alternative development model is crucial. It will need to be technically sustainable, socially more equitable, culturally more diverse and politically more participative.