bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seating in the outpatient clinic: the elderly patient's perspective
Authors: Hanger HC , Ball MC , Mulley GP 
Published: July 2008

To assess the adequacy of seating provided for elderly outpatients, 97 subjects attending Medicine for the Elderly clinics were interviewed. Most patients rated the chairs of average or better comfort and seat height was judged to be appropriate by 77 (79%) patients. However, over one half (54%) had difficulty when attempting to stand. Ten patients could not stand without assistance from another person. There were no significant differences in the ease of rising from those chairs with and those without armrests ( p > 0.10). Despite this, many subjects appeared to benefit from the use of armrests and 25% of subjects thought that all of the chairs provided should have armrests. We recommend that all chairs in an outpatient clinic for elderly people should have armrests of appropriate design and height. This may prevent many elderly patients being unnecessarily dependent on others when attending hospital clinics.
Acupuncture in the treatment of hand paresis in chronic and acute stroke patients - improvement observed in all cases
Authors: Naeser Margaret A , Alexander Michael P , Stiassny-Eder Denise , Lannin Linda Nobles , Bachman David 
Published: July 2008

This study reports the effect of acupuncture on the treatment of hand paresis in stroke patients who had no other proximal arm or leg paresis following stroke. The location of the area of infarction on a chronic CT scan was analysed in all cases. Eight chronic stroke patients were treated with acupuncture beginning after six months to eight years following stroke; and three acute stroke patients were treated with acupuncture beginning after two months following stroke. Patients received 20 or 40 acupuncture treatments over a two- or three-month period. All patients had good response defined as improvement on at least four of six hand tests after 20 or 40 acupuncture treatments. Among the eight chronic cases, significant improvement was observed in timed hand dexterity tests, as well as pinch and grip strength tests. Most of the improvement was sustained for at least two months after the completion of acupuncture treatments. All patients had lesion in only half, or less than half of the motor pathway areas on CT scan. Results suggest that acupuncture may be an additional beneficial treatment modality for stroke patients with hand paresis, even when started as late as five to eight years following stroke. The CT scan findings and results from this study support those from our previous acupuncture research with stroke patients where good response was observed in patients with lesion in less than half of the motor pathway areas and in patients with only mild/moderate hemiparesis. More controlled research with a larger number of patients appears warranted.
Problems of vocational integration after cancer
Authors: Weis Joachim , Koch Uwe , Kruck Peter , Beck Andreas 
Published: July 2008

The study aimed to provide a descriptive analysis of work-related problems and problems of occupational integration following cancer, in the view of patients. Cancer patients ( n = 566) of two rehabilitation clinics were asked by questionnaire for their work-related problems and changes in work situation due to cancer as well as their evaluation of outcome of medical rehabilitation with regard to their occupational situation. The results show that in general, most patients seem either to take recourse to early retirement or are able to resume their occupational activity without special occupational training. Specific measures in vocational rehabilitation played almost no part in the experience of our survey population. From the point of view of patients, medical rehabilitation had a negligible influence on vocational integration. We found no significant differences between different cancer diagnostic groups, with regard to restrictions in work performance and other work-related problems. However, in line with similar results reported in the literature, blue-collar workers in our study returned less frequently to their former places of work, being more likely to take early retirement. The results are discussed concerning the methodological problems of the study.
Process and outcome of care: comparison of two inpatient geriatric rehabilitation settings
Authors: Bentur Netta , Eldar Reuben , Davies Michael A 
Published: July 2008

The objective of this study was to compare the process of care and outcome of rehabilitation in geriatric hospitals and in geriatric wards of general hospitals. It was longitudinal in design. Patients were interviewed on admission and on discharge. Data were retrieved from medical records and a questionnaire on the process of care was administered to staff members. Geriatric wards in four general hospitals and four independent geriatric hospitals in Israel provided the setting and approximately 50 consecutive admissions of patients with hip fracture or stroke, a total of 410 patients, were recruited from each setting. Four process indices and three outcome indices were used to measure quality of care. % The main outcome showed that the functional status of the study population was higher on discharge than on admission and most patients were discharged to their former residence. When controlling for other variables, geriatric hospitals contributed more to higher functional status on discharge than did geriatric wards in general hospitals. Yet satisfaction with treatment was higher in geriatric wards in general hospitals than in geriatric hospitals. The main factors affecting patient satisfaction were functional status on discharge and the amount of rehabilitative treatment given.
Determinants of rehabilitation following fracture of the hip in elderly patients
Authors: Eldar Reuben , Tamir Ada , Susak Zeev 
Published: July 2008

The objective of the study was to explore the relationships between rehabilitation outcomes in elderly patients admitted to a rehabilitation hospital following a surgically treated hip fracture and independent variables. Prefracture function, and independent patients' variables and particulars regarding the fracture were recorded. Functional and mental status as well as motivation and co-operativeness were assessed on admission to rehabilitation, during rehabilitation and six months after discharge. Data were transferred to structured questionnaires for analysis. A total of 112 patients with a mean age of 74.8 years, made up of 75% females and 25% males, were admitted consecutively for rehabilitation after a surgically treated hip fracture sustained in a fall, during a two-year period (1989-91). Of these, 11 patients (9.8 per cent) died during rehabilitation; 86% of the 101 survivors returned to their prefracture residence, but 25% of survivors had not attained their prefracture functional status by discharge. Motivation, co-operativeness and unimpaired mental function on admission to rehabilitation were found to be the most important determinants of satisfactory outcomes. It was concluded that attention should be paid to the elderly person who has sustained the fracture and not only to the fracture itself. Motivation and co- operativeness should be constantly monitored during the rehabilitation process.
Treatment of the neglect syndrome in stroke patients using a contingency electrical stimulator
Authors: Prada Gabriel , Tallis Raymond 
Published: July 2008

Two patients with major infarcts in the right middle cerebral artery territory associated with severe perceptual problems including tactile neglect were treated with a contingency electrical stimulator. This delivered electrical stimuli to the forearm skin on the neglected side whenever the patient moved the contralateral normal arm, with the intention of drawing the patient's attention to the neglected side. The effect of this treatment was assessed in a single case design using the Rivermead Perceptual Assessment Battery. Both patients had a statistically significant improvement in tests of perceptual function during the period of the study. In addition, there was a significant difference between the treatment and the baseline periods: the differences between the slopes of the regression lines fitted to the scores were statistically significant, favouring the treatment periods. This supported the inference that the changes were at least in part due to the treatment rather than merely the natural history of the disease. These results suggest that this approach to treating an otherwise intractable condition should be further investigated.
Evaluation of dressing practice for stroke patients after discharge from hospital: a crossover design study
Authors: Walker MF , Drummond Aer , Lincoln NB 
Published: July 2008

Objective: To determine whether giving dressing practice to patients at home with unresolved dressing problems following stroke reduces the problems. Design: A randomized crossover study design was used, randomly allocating patients to receive no intervention for three months followed by three months' treatment, or the reverse. Setting: All patients were at home, and treatment was given in the home. Subjects: Patients at home with problems in dressing six months after acute stroke, having been discharged from hospital. Intervention: A senior occupational therapist gave regular dressing practice to patients with their families. Specific techniques depended upon the problem. Outcome measures: An independent assessor used the Nottingham Stroke Dressing Assessment, the Rivermead ADL, self-care section, and the Notting ham Health Profile to measure outcome. Results: Fifteen patients were included in each group. Both groups showed statistically significant improvement during the treatment phase (Wilcoxon matched pairs test: z = 2.47, p = 0.01; z = 3.01, p = 0.002). Neither group showed any change during the non-treatment phase. Patients who received treatment in the first three months maintained their improvement (z= 0.90, p = 0.36). Conclusion: Dressing practice given at home to patients who have residual problems in dressing six months after acute stroke leads to a sustained reduction in their problems.
Stroke rehabilitation in the elderly: analysis of six years' experience
Authors: Friedman Paul J 
Published: July 2008

Objective: To evaluate changes to a system consisting of a stroke unit and a stroke registry to follow elderly stroke subjects from admission until six months poststroke. Methods: The inputs, outputs and outcomes of stroke for all persons aged 60 and above were measured over six years (1987-92). Results: An average of 212 persons with acute stroke were registered each year. Demographic features of stroke subjects did not change appreciably during the six-year study period. Indices of stroke severity and case fatality remained similar. Hospital length of stay, however, fell by 45% from 1987 to 1992 (p <0.0001) without any decline in functional outcome, as measured by Barthel ADL scores at discharge or maximal recovery and discharge residence. The percentage of subjects transferred to the stroke unit rose from 43% in 1987 to 64% in 1992. The stroke unit operated with minimal selection. Conclusions: Stroke units using minimal selection criteria warrant further study as an alternative to more highly selective stroke units.
Botulinum toxin type A for the treatment of arm and hand spasticity in stroke patients
Authors: Sampaio Cristina , Ferreira Joaquim J , Pinto Ana A , Crespo Manuela , Ferro José M , Castro-Caldas Alexandre 
Published: July 2008

Background: Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect for botulinum toxin A (BTX-A) for relief of spasticity. Objective: To evaluate the safety and efficacy of BTX-A in the treatment of spasticity in a homogeneous group of stroke patients. Methods: In this phase III open label trial 19 stroke patients stable for at least six months were enrolled (mean age 53.1 (SD 3.27) years; range 26-72). There were 16 males and 4 females. Assessments: Clinical (Ashworth spasticity rating scale, scores for joint mobility, pain and frequency of spasms, Frenchay arm test (FAT)) and subjective (semi-quantitative rating scale filled out by the patient). Only hand and finger flexors were injected. The maximum dosage was 150 U BOTOX® (25 U/muscle), the mean dosage was 92.1 ± 31.6 U BOTOX®. Results: Ashworth rating scale and joint mobility scores improved from a median value of 2 at baseline to a median value of 1 one month after treatment, FAT scores also improved from a median value of 0 at baseline to a median value of 1 one month after treatment (Kruskall-Wallis test p < 0.01). Two-thirds of the patients rated their functional improvement as none or mild. Conclusions: Our study confirmed that BTX-A has an anti-spastic effect but its functional impact needs further evaluation.
A randomized controlled trial of enhanced Social Service occupational therapy for stroke patients
Authors: Logan PA , Ahern J. , Gladman Jrf , Lincoln NB 
Published: July 2008

Objective: To determine whether stroke patients referred to the Social Service occupational therapy service would benefit from an enhanced service compared to the usual service. Design: Randomized controlled study allocating patients to the enhanced service or the usual service. Subjects: Stroke patients discharged home from hospital and referred to Social Service occupational therapy department. Outcome measures: The sections and total score from the Nottingham Extended Activities of Daily Living Scale (EADL), the Barthel Index, the General Health Questionnaire (GHQ) and the number of pieces of equipment provided were analysed. Results: One hundred and eleven stroke patients were recruited to this study. Fifty-three were randomly allocated to the enhanced service and 58 to the usual service. Patients receiving the enhanced service were seen more quickly after referral, for longer, and received significantly more visits (p <0.01 ) than those receiving the usual service. Three months after entry to the study the enhanced service group had better EADL (p <0.01 ) than the usual service group. This benefit remained significant in only the mobility section of the EADL at six months. Carers of the stroke patients in the enhanced group had lower GHQ scores (p <0.05) than those in the usual group at six months. Conclusions: This trial supports the use of domiciliary occupational therapy for stroke patients after discharge from hospital in terms of improvements in functional outcomes in the short term, but the long-term benefits remain unclear.
Setting handicap goals with elderly people: a pilot study of the Life Strengths Interview
Authors: Pomeroy VM , Conroy MC , Coleman PG 
Published: July 2008

Objective: To assess whether the Life Strengths Interview (LSI) is a useful clinical framework to identify handicap goals. Design: Clinical case studies. Settings: Two elderly care rehabilitation hospitals. Subjects: Five people, whose ages ranged from 73 to 90 years. All participants were aware of their likely resultant disability, scored 25+ out of a possible 30 with the Mini-Mental State Examination, were able to communicate effectively and were due to be discharged home in approximately one month. Interventions: Each participant undertook the LSI process with the research occupational therapist. Main outcome measures: Identified rehabilitation goals and their achievement. Results: Goals were focused around families and other support networks. Six to eight weeks following discharge, achievement of goals varied. Conclusions: This pilot study suggests that the LSI may be a useful clinical framework but further research needs to investigate whether a modified clinical version may be more suitable.
Are there gender differences in functional outcome after stroke?
Authors: Wyller Torgeir Bruun , Sødring Karen Margrethe , Sveen Unni , Ljunggren Anne Elisabeth , Bautz-Holter Erik 
Published: July 2008

Purpose: To study gender differences in functional outcome unexpectedly observed in a follow-up study of stroke patients. Design: Prospective study of hospitalized stroke patients, with evaluations in the subacute phase and after one year. Setting: Geriatric and general medical wards, and geriatric outpatient clinic of a university hospital serving as general hospital for a defined population. Subjects: All stroke patients admitted during a six-month period (n = 165) were considered for inclusion, of whom 87 could be assessed in the subacute phase and 65 after one year. Main outcome measures: Motor function assessed by the Sodring Motor Evaluation of Stroke Patients; cognitive function by the Assessment of Stroke and other Brain Damage; and activities of daily living (ADL) function by the Barthel Index. Nursing-home residency registered after one year. Results: Men achieved a significantly better score than women on most of the scales used. The age-adjusted odds for a man to have a higher Barthel score than a woman was 3.1 (95% confidence interval (CI) 1.3-7.0) in the subacute phase and 3.3 (95% CI 1.2-9.0) after one year. Differences of the same magnitude were seen on the subscales of the motor and cognitive tests. The same trend was observed on all items of the Barthel Index. The males had a lower likelihood to be permanent nursing-home residents after one year, the age-adjusted odds ratio for nursing-home residency for females versus males being 6.3 (95% CI 1.2-65.3). Conclusion: Women seem to be functionally more impaired by stroke than men.
A review of outcome indicators in the treatment of chronic limb oedema
Authors: Sitzia J. , Stanton Awb , Badger C. 
Published: July 2008

Objectives: To provide an overview of physical and psychological outcome indicators which have been used to evaluate conservative treatments for chronic oedema. Methods of finding papers: Papers were located via the MedLine, CINAHL and GEARS databases, and the British Lymphology Interest Group Key References lists. Issues reviewed: The literature reveals that only a small amount of work has addressed conceptual issues in outcome evaluation. Above all, outcome indicators have been adopted in clinical practice in a haphazard manner, with little discussion regarding the purpose of outcome assessment/measurement and little agreement on the most appropriate assessment/measurement techniques. Results: Eleven outcome indicators appear in the literature, each of which is discussed in terms of instrumentation and application in clinical practice. Practitioners have focused on objective measures, with change in limb volume the outcome measure most commonly used. Conclusion: It is concluded that more rigour is needed in many aspects of outcome evaluation. Practitioners and researchers in this field should become more questioning of existing evaluation practices, and should explore the many potential outcome indicators, such as limb movement and limb function, which have to date been neglected.
The effect of botulinum toxin on hand function after incomplete spinal cord injury at the level of C5/6: a case report
Authors: Richardson D. , Edwards S. , Sheean GL , Greenwood RJ , Thompson AJ 
Published: July 2008

Objective: To investigate the benefits of the focal use of botulinum toxin in spasticity in the forearm seen after incomplete spinal cord injury. Design: A single case study with standardized assessment before and at three-week intervals after injection. Intervention: EMG-guided selective injection of botulinum toxin. Subject: A 23-year-old man, 18 months post injury. Measures: Rivermead Motor Assessment; grip strength; Jebsen hand tests; visual analogue scale; Ashworth spasticity scale. Results: Weakness was seen as expected with some functional losses, but the patient made gains in the areas of concern: shaking hands, typing, using the hand to drink. These gains were sustained at 12 weeks. Conclusion: Selective use of botulinum toxin to weaken muscles can lead to functional benefit.
A pilot study to determine the efficiency of lightweight carbon fibre orthoses in the management of patients suffering from post-poliomyelitis syndrome
Authors: Lewis M Heim , Yaacobi E. , Azaria M. 
Published: July 2008

Objectives: To assess the usage of carbon fibre orthoses in assisting post- polio syndrome patients who reported advancing weakness and difficulty in maintaining their independent ambulatory status. Design and interventions: Carbon fibre orthoses that are 30% lighter than metal braces were constructed. Subjects: Thirty patients who complained of difficulty in maintaining their ambulation using long-leg braces were provided with lightweight orthoses. Results: Seventy per cent of the patients reported satisfaction with their braces. There were, however, problems in construction and use. Conclusions: Ambulation can be preserved in some patients who report advancing weakness because of post-polio syndrome.
Joint angle measurement: a comparative study of the reliability of goniometry and wire tracing for the hand
Authors: Ellis Bridget , Bruton Anne , Goddard Jonathan R 
Published: July 2008

Objectives: To compare the inter- and intra-rater reliability of goniometry and wire tracing in the assessment of finger joint angles: metacarpo-phalangeal (MCPJ), proximal (PIPJ) and distal interphalangeal joints (DIPJ). Design: Twenty occupational therapists and 20 physiotherapists with a range of clinical experience were recruited from nine different centres. Using a masked goniometer and wire tracing they carried out repeated assessments of the MCPJ, PIPJ and DIPJ of a normal subject fixed in two different positions. Results: The two assessment methods did not produce comparable angle measurements. Goniometry showed greater inter- and intra-rater reliability than wire tracing. Regardless of the assessment tool, the repeatability coefficient indicated that DIPJ measurement was less reliable than the other joints. Clinical and specialist experience did not affect reliability. Conclusion: Although both goniometry and wire tracing show limitations as reliable assessment tools, it is recommended that where possible goniometry should be used.
Assessing and restoring function in elderly people — more than rehabilitation
Authors: Wilkinson TJ , Buhrkuhl DC , Sainsbury R. 
Published: July 2008

Objective: To quantify the medical component of assessing and restoring function in the elderly and to determine if a subset who did not require medical input could be identified. Design: Prospective consecutive sample. Setting: Inpatient assessment, treatment and rehabilitation unit for the elderly in New Zealand. Patients: Two hundred patients aged 60-98 years. Main outcome measures: (1) Proportion of elderly people receiving rehabilitation who also required treatment of medical problems. (2) Characteristics of those not requiring medical input. Results: One hundred and seventy-two (86%) of people required some medical input during their hospital stay for rehabilitation. Forty-nine per cent had medical conditions which had a direct impact on their rehabilitation. Rehabilitation was delayed for a mean 16.8 (13.0-20.6)% of hospital stay when significant medical problems required treatment. People with previously undiagnosed conditions affecting rehabilitation tended to be older. The referral diagnoses most likely to result in an uncomplicated inpatient stay (i.e. rehabilitation only or rehabilitation with treatment of minor medical problems) were postsurgical treatment (55% uncomplicated), stroke (47% uncomplicated) or amputation (55% uncomplicated). However, 45-53% of people with these problems had a major medical component to their stay. People with other referral diagnoses or those admitted from institutions for the elderly were more likely to have a medical component to their stay. Conclusion: Restoration of function in the elderly requires a combination of both medical and rehabilitation skills. Reliable predictors of those not requiring medical input could not be found.