bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adapting the Nottingham Health Profile for use in people with severe physical disabilities
Authors: Post Marcel W M , Gerritsen Johan , van Leusen Natascha D M , Paping Marieke A , Prevo Arie J H 
Published: May 2003

Background: The Nottingham Health Profile (NHP) is a well-known quality of life questionnaire. However, wheelchair-bound patients might obtain misleading scores on the scales Physical mobility, Pain and Emotional reactions. We tested three possible adaptations of the Dutch NHP to overcome this problem. Methods: Respondents were 111 wheelchair-using people (walking ability maximum 5 m) with spinal cord injury, rheumatic diseases and other diagnoses. Adaptation methods were formulation of new questions (Q-NHP), a recoding procedure (R-NHP) and deleting items (D-NHP). Internal consistency, correlations between original and adapted scales and correlations with upper and lower extremity function and social functioning (NHP part II) were computed. Results: All adapted Pain and Emotional reactions scales were close to the original ones. The original Physical mobility scale proved invalid, resulting in better median scores for those patients who could not walk at all (38.7) than for patients who could walk a bit (50.0). The Q-NHP performed little better than the original one and suffered from greater complexity. The R-NHP showed better internal consistency (0.69 versus 0.49) and construct validity than the D-NHP. Conclusion: An uncomplicated recoding procedure, scoring five questions about walking problems as ‘yes’ if respondents confirmed the question ‘I cannot walk at all’, improved reliability and validity of the Dutch NHP. Use of this recoding procedure in future research using the NHP is recommended, although its applicability in other language versions has to be proven in future research.
Randomized controlled trial of quadriceps training after proximal femoral fracture
Authors: Mitchell Sarah L , Stott David J , Martin Brendan J , Grant Stanley J 
Published: May 2003

Objective: To determine whether systematic progressive high-intensity quadriceps training increases leg extensor power and reduces disability in patients rehabilitating after proximal femoral fracture. Design: Open parallel group randomized controlled trial comparing the addition of six weeks quadriceps training (40 patients) with standard physiotherapy alone (40 patients). The training group exercised twice weekly, with six sets of 12 repetitions of knee extension (both legs), progressing up to 80% of their one-repetition maximum. Setting: Orthogeriatric unit, and community follow-up. Subjects: Eighty patients rehabilitating after proximal femoral fracture. Main outcome measures: Measurements of leg extensor power (Nottingham Power Rig), functional mobility (elderly mobility score), disability (Barthel Index) and quality of life (Nottingham Health Profile) were made at baseline, after six weeks (at the end of the intervention) and at 16 weeks. Results: Leg extensor power increased significantly in the quadriceps training group (fractured leg mean improvement at six weeks 157% (standard error 16), nonfractured leg 80% (12)) compared with the control group (63% (11) and 26% (8) respectively, unpaired Student's t-test p = 0.007 and p = 0.01 for between-group comparisons). Significant benefits were maintained at 16 weeks. Quadriceps training resulted in a greater increase in elderly mobility scale score compared with standard rehabilitation (between-group difference of 2.5 (95% CI 1.1,3.8) at week 6 and 1.9 (0.4,3.4) at week 16). Barthel score increased significantly from week 0 to 6 in the quadriceps training group compared with controls (Mann–Whitney U-test p = 0.05). Patients in the quadriceps training group scored significantly better in the energy subscore of the Nottingham Health Profile at the end of follow-up (Mann–Whitney U-test p = 0.0185). Conclusions: Progressive high-intensity quadriceps training in elderly proximal femoral fracture patients increased leg extensor power and reduced disability. This was accompanied by an increase in energy as measured by the Nottingham Health Profile. This intervention may provide a simple practical way of improving outcome in these patients.
Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness
Authors: Kammerlind Ann-Sofi C , Håkansson Jenny K , Skogsberg Maria C 
Published: May 2003

Objective: To evaluate the effect of balance training in group in elderly people with nonperipheral vertigo and unsteadiness. Design: Randomized controlled study. Setting: Ear, nose and throat department, University Hospital, Sweden. Subjects: Twenty-three elderly subjects with nonperipheral vertigo and/or unsteadiness randomized into training group and control group. Intervention: The training group attended balance training in group twice a week for eight weeks. Main outcome measures: Timed static balance tests, walking tests and six sensory organization tests on EquiTest dynamic posturography were performed before and after the training period. Besides, the patients estimated their vertigo and unsteadiness on a visual analogue scale (VAS) before and after the training period. Results: The training group improved significantly in standing on one leg with eyes open, walking forward on a line, walking speed, in three out of six tests on dynamic posturography and estimated less vertigo and unsteadiness measured with VAS. No changes were seen in the control group. Conclusion: Balance training in elderly people with nonperipheral vertigo and unsteadiness seems to improve both objective and perceived balance.
Factors determining participation in young adults with a physical disability: a pilot study
Authors: Bent N , Jones A , Molloy I , Chamberlain M A , Tennant A 
Published: May 2003

Objectives: To evaluate in a pilot study the usefulness of measures of health and psychosocial status for use with young people with physical and complex disability. Also to test empirically a conceptual model of the factors determining key outcomes in young disabled adults, in particular, participation (handicap). Design: A cross-sectional study involving face-to-face interviews with young adults aged 16–28 years (n = 45) with physical and complex disabilities. A group of nondisabled college students completed the same set of questions to provide normative scores for some psychosocial measures. Setting: Young people with physical disabilities were recruited from the area of North and North East Lincolnshire, and nondisabled young people from the Leeds area. Methods: Standardized measures of impairment, disability and handicap, together with various psychosocial scales were incorporated into a structured face-to-face interview. Standardized measures included the Nottingham Health Profile (NHP), the Barthel Index, the London Handicap Scale, Rosenberg's Self-esteem Scale and the Proactive Scale. Results: Regression analysis showed the most important predictors of participation were energy and pain (NHP), disability (Barthel) and self-efficacy. Most of the health status measures were able to discriminate between disabled and nondisabled young people, but some measures lacked face validity for the ‘nonwalking’ disabled group. Conclusions: Both health status and psychosocial factors were found to impact on the participation of young people. Impairment and disability however, did not impact adversely on self-ratings of health or quality of life and it is clear from these results that having a disability may limit participation, but is not necessarily synonymous with a poorer quality of life.
Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke
Authors: Rudd Anthony G , Irwin P , Rutledge Z , Lowe D , Wade D T , Pearson M 
Published: May 2003

Study objective: To identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke. Design: Retrospective audit of case notes and service organization. Setting: Two hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland. Patients: The 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stroke Audit. Results: There are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay. Conclusions: There were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.
Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations
Authors: Kulkarni Jai , Adams Judith , Thomas Elaine , Silman Alan 
Published: May 2003

Objectives: To investigate the association between amputation, osteoarthritis and osteopenia in male war veterans with major lower limb amputations. Specific questions were to determine whether lower limb amputees following trauma are at subsequent risk of developing osteoarthritis (OA) and osteoporosis of the hip on both the amputated and nonamputated sides. Design: Retrospective cohort study in British Male Second World War veterans with major unilateral lower limb amputations. Subjects: Seventy-five male Second World War veterans with major lower limb amputations known to be alive were invited to participate from a subregional rehabilitation centre. After exclusions, 44 agreed to attend for examination and radiological screening. Methods: The presence of hip OA was determined from a single anterior posterior pelvic X-ray using two approaches: minimum joint space and the Kellgren and Lawrence (K&L) scoring system. Bone mineral density (BMD) was measured by a dual energy X-ray absorptiometry (DXA) scan and prosthetic rehabilitation outcome measures were recorded. Results: Twenty-seven (61%) hips on the amputated side and 10 (23%) on the nonamputated side were positive for OA (based on Kellgren and Lawrence grade of >2). Using a minimum joint space threshold of below 2.5 mm, 24 (55%) hips on the amputation side and 8 (18%) on the nonamputated side were also positive for OA. There was a threefold increased risk of OA for those with above-knee compared to a below-knee amputation. By contrast from published general population surveys, only 4 (11%) cases of hip OA would have been expected on both the amputated and nonamputated hips. There was a significant decrease in femoral neck BMD in the amputated side ( p< 0.0001) and significantly lower BMD in above-knee amputees than in below-knee amputees ( p = 0.0027) as compared to normal age- and sexmatched population. Conclusion: Male war veterans with unilateral major lower limb amputations develop significantly more osteoarthritis of the hip than expected on both ipsi- and contralateral sides. Amputation was also associated with loss of bone density. Above-knee amputees develop significantly more hip osteoarthritis and osteopenia of greater severity in the amputated side than below-knee amputees
Clinical experience of rehabilitation therapists with chronic diseases: a quantitative approach
Authors: Rijken P M , Dekker J 
Published: May 2003

Objectives: To provide an overview of the numbers of patients with selected chronic diseases treated by rehabilitation therapists (physical therapists, occupational therapists, exercise therapists and podiatrists). The study was performed to get quantitative information on the degree to which rehabilitation therapists are experienced in the treatment of chronically ill patients. Methods: Secondary analyses were performed on several databases containing representative data on patients treated by rehabilitation therapists. Rates per 1000 patients in the populations of these rehabilitation therapists and 90% confidence intervals were computed for patients with the following diagnoses: ischaemic heart diseases, stroke, rheumatoid arthritis, osteoarthritis, osteoporosis, multiple sclerosis, Parkinson's disease, epilepsy, headache syndromes, COPD/asthma, diabetes mellitus and chronic back pain (the size of the latter group could only be assessed in physical therapy in primary care). Results: The largest group of chronically ill patients treated by physical therapists in primary care are patients with chronic back pain (82 per 1000). Stroke patients are the most common chronically ill patients treated by physical therapists in institutional care (157 per 1000) and by occupational therapists in institutional (358 per 1000) and noninstitutional care (246 per 1000). These therapists also see a variety of other chronically ill patients. Exercise therapists and podiatrists treat less patients with the selected chronic diseases.
Experience of an open referral system for stroke rehabilitation in the community
Authors: Maheswaran Ravi , Davis Sue 
Published: May 2003

Objective: To examine referral patterns and characteristics of patients assessed by a community stroke rehabilitation service utilizing an open referral system. Design: Descriptive study. Setting: Two boroughs in a health district in South London, England. Subjects: Two hundred and seventy-six patients with stroke assessed by the service in its first 18 months of operation. Results: Patients were referred from a variety of sources including hospitals (38%), general practitioners (18%), district nurses (10%), social services (9%), self-referrals (8%), community physiotherapists (7%) and family or carers (2%). Referrals from hospital were younger (33% aged under 65 years) while referrals from community health and social services were older (44% aged 75–84 years) (2 = 23, df = 9, p <0.01). Fifty per cent of patients who had self-referred or had been referred by families or carers had longstanding stroke (>1 year), 46% of patients from general practitioners had acute stroke (<4 weeks) and 37% of hospital patients were seen between one and three months post stroke (2 = 50.4, df = 12, p <0.001). There was a marginally significant difference in the prevalence of incontinence and no significant differences in limb weakness, visual impairment and speech impairment. There were no significant changes in sources of referral between the first and second nine months of the service. There was a significant increase in the percentage of patients with recent stroke seen in the second nine months (2= 22.8, df = 5, p <0.001). In this period, 36% of patients assessed were seen within four weeks of their stroke compared with 15% in the first nine months. Of patients with stroke, 8.7% were considered to have been inappropriate referrals but they were not significantly associated with any particular source of referral. Conclusions: Referrals were received from a wide variety of sources with significant differences in age and duration of stroke of patients from different referral sources. The results suggest that an open referral system may make rehabilitation accessible to a broader range of patients with stroke living in the community.
Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses
Authors: Rankin Gabrielle , Stokes Maria 
Published: May 2003

Objective: To provide a practical guide to appropriate statistical analysis of a reliability study using real-time ultrasound for measuring muscle size as an example. Design: Inter-rater and intra-rater (between-scans and between-days) reliability. Subjects: Ten normal subjects (five male) aged 22–58 years. Method: The cross-sectional area (CSA) of the anterior tibial muscle group was measured using real-time ultrasonography. Main outcome measures: Intraclass correlation coefficients (ICCs) and the 95% confidence interval (CI) for the ICCs, and Bland and Altman method for assessing agreement, which includes calculation of the mean difference between measures ( d), the 95% CI for d, the standard deviation of the differences (SD diff), the 95% limits of agreement and a reliability coefficient. Results: Inter-rater reliability was high, ICC (3,1) was 0.92 with a 95% CI of 0.72 → 0.98. There was reasonable agreement between measures on the Bland and Altman test, as d was -0.63 cm2, the 95% CI for d was -1.4 → 0.14 cm2, the SDdiff was 1.08 cm2, the 95% limits of agreement -2.73 → 1.53 cm2 and the reliability coefficient was 2.4. Between-scans repeatability was high, ICCs (1,1) were 0.94 and 0.93 with 95% CIs of 0.8 → 0.99 and 0.75 → 0.98, for days 1 and 2 respectively. Measures showed good agreement on the Bland and Altman test: d for day 1 was 0.15 cm2 and for day 2 it was -0.32 cm2, the 95% CIs for d were -0.51 → 0.81 cm2 for day 1 and -0.98 → 0.34 cm2 for day 2; SDdiff was 0.93 cm2 for both days, the 95% limits of agreement were -1.71 → 2.01 cm2 for day 1 and -2.18 → 1.54 cm2for day 2; the reliability coefficient was 1.80 for day 1 and 1.88 for day 2. The between-days ICC (1,2) was 0.92 and the 95% CI 0.69 0.98. The d was -0.98 cm2, the SDdiff was 1.25 cm2 with 95% limits of agreement of -3.48 → 1.52 cm2 and the reliability coefficient 2.8. The 95% CI for d(-1.88 → -0.08 cm2) and the distribution graph showed a bias towards a larger measurement on day 2. Conclusions: The ICC and Bland and Altman tests are appropriate for analysis of reliability studies of similar design to that described, but neither test alone provides sufficient information and it is recommended that both are used.
Leg extensor power and quadriceps strength: an assessment of repeatability in patients with osteoarthritic knees
Authors: Robertson Sunita , Frost Helen , Doll Helen , J O’Connor John 
Published: May 2003

Objective: To assess the repeatability of two muscle function measures – leg extensor power (LEP) and isometric quadriceps force (IQF) – in a population of patients with osteoarthritis of the knee. Design: Repeat measures of LEP and IQF at 25° and 50° knee flexion were taken within seven days. Both legs were measured and a numerical rating scale was used to assess pain on the two occasions. Subjects: Patients who were on a waiting list for a primary unilateral knee replacement for osteoarthritis were invited to take part in the study. Setting: The physiotherapy department of a National Health Service Orthopaedic Hospital in Oxford, UK. Intervention: Subjects were measured using a Kin-Com dynamometer to assess maximum isometric force and a leg extensor power rig to assess maximum single leg explosive power. Results: Twenty-six patients (mean age: 72 years; SD: 8 years; range: 50–87 years) were included in the study following informed consent. A weak relationship was found between LEP, IQF and pain scores which reached the 5% significance level for the LEP measures only. The level of repeatability for both measures was found to be acceptable. Conclusion: Both LEP and IQF are recommended as repeatable measures for assessment of muscle function in patients with osteoarthitis of the knee. However, the LEP rig has the added advantage of being quicker, cheaper and simpler to use in the clinical setting.
Outcome of strategy training in stroke patients with apraxia: a phase II study
Authors: van Heugten C M , Dekker J , Deelman B G , van Dijk A J , Stehmann-Saris J C 
Published: May 2003

Objective: Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. Design: The outcome was studied in a pre–post test design. Measurements were conducted at baseline and 12 weeks later. Subjects: Thirty-three stroke patients with apraxia were treated at occupational therapy departments in general hospitals, rehabilitation centres and nursing homes. Main outcome measures: The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient. Results: The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved. Conclusions: These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.
Variation in measurements of range of motion: a study in reflex sympathetic dystrophy patients
Authors: Geertzen Jan HB , Dijkstra Pieter U , Stewart Roy E , Groothoff Johan W , Duis Henk Jan Ten , Eisma Willem H 
Published: May 2003

Objective: To quantify the amount of variation attributed to different sources of variation in measurement results of upper extremity range of motion, and to estimate the smallest detectable difference (SDD) between measurements in reflex sympathetic dystrophy (RSD) patients. Design: Two observers each measured in two sessions the range of motion of several upper extremity joints of RSD patients participating in an outcome study. Setting: Department of Rehabilitation of a university hospital. Subjects: Twenty-nine upper extremity RSD patients. Main outcome measures: The range of motion of forward flexion and external rotation of the shoulder, extension, flexion and supination of the elbow, palmar, dorsiflexion and ulnar, radial deviation of the wrist of affected and nonaffected sides, using a two-armed goniometer and an inclinometer. The measurement results were analysed using an analysis of variance according to the generalizability theory. Results: The results indicate that observer and patient–observer were important sources of variation. The random error was the most important source of variation. Averaged over all ranges of motion the observer contributed 3.9% to the total variation, patient–observer interactions contributed 5.2% and the random error 20.3%. The SDD was smallest for elbow flexion, 7.1° and 9.6° and was largest for external rotation of the shoulder, 24.8° and 28.7°. The SDD was smaller for the nonaffected side as compared to the affected side for the majority of ranges of motion except elbow extension, wrist dorsiflexion, and radial and ulnar deviation. Conclusion: Clinically, our results indicate that range-of-motion measurements in RSD patients are subject to considerable variation and indicate that results of medical examinations in order to assess disability on the basis of range-of-motion measurements are subject to the same variation.