bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of hemiparesis recovery in lacunar and partial anterior circulation infarct stroke syndromes
Authors: Smith Jane , Brotheridge Sean , Young John 
Published: May 2003

Objective: To investigate patterns of hemiparesis recovery in lacunar (LACI) and partial anterior circulation infarct (PACI) stroke syndromes. Design: Prospective observational study. Setting: District general hospital and stroke rehabilitation ward. Subjects: Forty-seven patients (25 LACI and 22 PACI) with a first-ever stroke causing a hemiplegia. Average age 76.4 years (range 59–88). Measures: Outcome measures assessed disability (Barthel Index), limb power (Motricity Index) and mobility (Rivermead Mobility Index) at baseline and 3, 6, 9, 12, 16 and 24 weeks post stroke onset. Results: The time to maximum recovery, time to 50% recovery and area under the recovery curve was determined for each of the outcome measures. There were no statistical differences between these recovery parameters between the PACI and LACI stroke syndromes. Conclusion: Classification of hemiplegic stroke into PACI or LACI syndromes does not distinguish distinctive recovery patterns.
Reliability of an interview approach to the Functional Independence Measure
Authors: Daving Yvonne , Andrén Eva , Nordholm Lena , Grimby Gunnar 
Published: May 2003

Objective: To establish the reliability of an interview approach to the Functional Independence Measure (FIM). Design: Two raters were present at the same time during the interviews in the home and did independent ratings of the 18 FIM items. The interview procedure was repeated within a week by another two raters in the clinic. Subjects: Sixty-three stroke survivors (median age 63 years, range 18–71 years) were studied approximately two years after onset. Raters: Three occupational therapists and one nurse. Methods: Reliability was calculated as unweighted kappa statistics, percentage agreement (PA), and intraclass correlation coefficient (ICC). Results: Best agreement was found in the motor items of FIM. The kappa statistics showed good to excellent inter-rater values during the same interview except for the Social interaction item. The ICCs based on sum-score for motor (0.92) and social–cognitive items (0.75) respectively, were similar to those reported in the literature. The repeated interview by different raters showed less stable agreement according to kappa values for the items dealing with transfers, locomotion and social–cognition. Conclusions: FIM assessments showed high inter-rater agreement for the same interview setting (home as well as clinic), but the stability of the measure over time with a repeated interview by different raters was somewhat less satisfactory.
Muscle strength, pain and disability in patients with osteoarthritis
Authors: M Martijn P , Dekker Joost , van Baar Margriet E , B Rob A , J Johannes W 
Published: May 2003

Objective: Reduced muscle strength is regarded as a risk factor for pain and disability in osteoarthritis (OA). Currently, various indices for muscle strength are used when assessing determinants of pain and disability. The goal of the present study was to evaluate these indices of muscle strength. Design: Isometric muscle strength was measured for 16 muscle actions around the knees and hips in 52 patients with OA of the hip and 70 patients with OA of the knee. Various indices of muscle strength were derived from these measurements, applying five alternative approaches. These approaches ranged from a single overall index to a set of 16 separate indices. The internal consistency of these indices was determined (Cronbach's α), and it was determined to what extent they could reveal the association between reduced muscle strength on the one hand and pain and disability on the other hand. Results: Internal consistency was satisfactory for all indices (Cronbach's α >0.74). As expected, reduced muscle strength was associated with increased disability, but no clear relationship could be established between muscle weakness and pain. The strength of these associations did not depend on the approach used to derive the indices for muscle strength. Conclusions: The indices did not show major differences with regard to internal consistency or the extent to which the association with pain and disability could be revealed. For reasons of parsimony, approaches resulting in few indices appear to be most useful. However, muscle strength was found to be significantly reduced around affected joints, compared with muscle strength around unaffected joints. Therefore, the most suitable approach for reducing muscle strength data into indices is one that results in as few indices as possible, but with separate indices for muscle strength around affected and unaffected joints.
Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials
Authors: van der Lee Johanna H , Snels Ingrid AK , Beckerman Heleen , Lankhorst Gustaaf J , Wagenaar Robert C , Bouter Lex M 
Published: May 2003

Objective: Assessment of the available evidence for the effectiveness of exercise therapy to improve arm function in patients who have suffered from a stroke. Methods: A systematic search of bibliographical databases and reference checking were performed to identify publications on randomized controlled trials (RCTs) which evaluated the effect of exercise therapy on arm function in stroke patients. The methodological quality was assessed systematically by two raters, based on a standardized list of methodological criteria. Study characteristics, such as the chronicity and severity of impairment of the patient population, the amount and duration of interventions, and specific methodological criteria, were related to reported effects. Results: Thirteen RCTs were identified, six of which reported positive results on an arm function test. In five of these six studies there was a contrast in amount or duration of exercise therapy between groups. Methodological scores ranged from 5 to 15 (maximum possible score: 19 points). Conclusion: Insufficient evidence made it impossible to draw definitive conclusions about the effectiveness of exercise therapy on arm function in stroke patients. The difference in results between studies with and without contrast in the amount or duration of exercise therapy between groups suggests that more exercise therapy may be beneficial.
Respect for autonomy: issues in neurological rehabilitation
Authors: Sim Julius 
Published: May 2003

Objective: To examine the ethical principle of respect for autonomy within the context of neurological rehabilitation. Discussion: The nature of the principle of respect for autonomy is examined, and specific difficulties to which it may give rise in this area of practice are identified. These concern difficulties of communication with neurologically impaired patients, issues of competence related to patient decision-making, problems of consensus between patient and professional, and the role of the patient's family in the rehabilitation process. Conclusion: A number of strategies, based on a client-centred model of practice, are suggested which may counteract these difficulties and assist in respecting the patient's autonomy to the appropriate degree, while seeking to attain high-quality clinical outcomes.
The assessment of depression in aphasic stroke patients: the development of the Stroke Aphasic Depression Questionnaire
Authors: Sutcliffe L M , Lincoln N B 
Published: May 2003

Objective: The Stroke Aphasic Depression Questionnaire (SADQ) was developed to detect depressed mood in aphasic patients in the community. Design: Correlation analysis between new questionnaire and established measures. Setting: Patients at home. Methods: Seventy stroke patients who had been discharged from hospital were assessed on the SADQ, the Hospital Anxiety and Depression Scale and the Wakefield Depression Inventory. The SADQ was also administered to 17 aphasic patients on two occasions at a four-week interval. Results: Results indicated that scores on the SADQ were significantly related to other measures of depression ( rs) = 0.22–0.52, p <0.05). A shortened 10-item version showed higher validity ( rs = 0.32–0.67, p <0.01). Test–retest analysis indicated the SADQ is reliable over a four-week interval ( rs = 0.72, p <0.001). Conclusions: The SADQ may be used for assessing depressed mood in aphasic patients in the community though further validation is required.
A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study
Authors: Lord S E , Wade D T , Halligan P W 
Published: May 2003

Objective: To use a pilot study to compare two physiotherapy approaches to improve walking in patients with gait disturbance due to multiple sclerosis (MS). Design: Patients were assessed and then randomly assigned to one of two groups using a block randomization technique. They were treated by the research physiotherapist for a minimum of 15 treatments over a 5–7-week period and then reassessed by an independent therapist one week after treatment. Setting: Both assessment and treatment were undertaken at a specialist rehabilitation centre. Subjects: Outpatients with clinically stable MS (chronic progressive or relapsing-remitting types) who were referred for physiotherapy to improve their mobility. Intervention: Comparison was between a facilitation (impairment-based) approach and a task-oriented (disability-focused) approach. Outcome: Mobility was assessed using four measures: the 10-metre timed walk, the Rivermead Mobility Index, stride length and the Rivermead Visual Gait Assessment. Balance was assessed using the Berg Balance Test. Results: Twenty-three patients were entered, and 10 in each group completed the study. The groups were similar on all measured items both before and after treatment. There was no significant difference in improvement between the two approaches. Following treatment, patients in both groups showed a significant overall improvement ( p <0.05) in both impairment and disability measures. Conclusions: No significant differences in effectiveness between the two methods were demonstrated. Both a task-oriented approach and a facilitation approach to the treatment of MS outpatients were associated with improved mobility.
Comparison between two devices for measuring hip joint motions
Authors: Bierma-Zeinstra S MA , Bohnen A M , Ramlal R , Ridderikhoff J , Verhaar J AN , Prins A 
Published: May 2003

Objective: To compare the reliability of measurements of hip motions obtained with two instruments, an electronic inclinometer and a two-arm goniometer, and to investigate whether the two instruments, and different body positions, produce the same measurement data. Methods: Maximal active and passive hip movements were measured simultaneously with both instruments, in nine subjects during 10 consecutive measurements at short intervals. Results: Intra-observer variability was lower with the inclinometer in measurements of passive hip rotations. The two instruments showed equal intra-observer variability for hip movements in general. The inclinometer showed lower inter-observer variability in the measurements of active internal rotation. More rotational movement was measured with the two-arm goniometer; more extension and flexion with the inclinometer. Also, more rotational movement was found in the prone position compared to sitting and supine positions. Conclusions: The inclinometer is more reliable in measurements of hip rotation. For hip movements in general the two-arm goniometer is just as accurate when used by only one observer. The two instruments, and some positions, are not interchangeable during consecutive measurements.
The effect of a joint protection education programme for people with rheumatoid arthritis
Authors: Hammond Alison , Lincoln Nadina 
Published: May 2003

Objective: To evaluate the effects of an education programme in improving adherence with joint protection by people with rheumatoid arthritis (RA). Design: A repeated measures design. Subjects were assessed at six weeks and one week before and six and twelve weeks after education. Setting: Rheumatology unit in a large district general hospital. Subjects: Twenty-one people diagnosed with RA (mean age 48.95 years (SD 12.54) and disease duration of 6.43 years (SD 7.7)). Intervention: An 8-hour arthritis education programme delivered over four sessions, including two hours of joint protection education designed to be typical of current UK practice. Main outcome measures: The Joint Protection Behaviour Assessment (JPBA), an observational assessment of hand joint protection methods used during kitchen activities, to measure adherence with education. Other assessments included a joint protection knowledge questionnaire, hand joint counts, hand pain visual analogue scale, the Health Assessment Questionnaire (HAQ) and HAQ Pain scale to identify any short-term changes in hand pain, pain on activity and functional status. At the beginning and end of the study subjects were interviewed to obtain their self-report of joint protection behaviours and reasons for following or not following the advice given. Results: Median JPBA scores did not improve pre- to posteducation (18.4% to 23.7%; p= 0.65) and neither did hand joint count, hand pain, HAQ and HAQ Pain scores. However, joint protection knowledge improved significantly (p = 0.01) and the majority of people believed joint protection to be a beneficial strategy. Reasons for not changing behaviour included problems recalling information; joint protection being considered inappropriate as ‘hands were not that bad yet’; lack of skill; and difficulties changing habits. Conclusion: The joint protection education programme improved knowledge but not use of taught methods. Educational strategies being used by therapists need to be focused on enhancing adherence.
Objective and subjective assessments of temperature differences between the hands in reflex sympathetic dystrophy
Authors: Oerlemans H Margreet , Perez Roberto SGM , Oostendorp Rob AB , Goris R Jan A 
Published: May 2003

Objective: A difference in temperature between the affected and normal extremity is one of the signs or symptoms of reflex sympathetic dystrophy (RSD). These temperature differences are scored anamnestically, by palpation, or by measurements. We investigated the relationship between objective and subjective differences in skin temperature between the hands. Subjects and design: Fifty-one patients with RSD of one upper extremity participated (mean age 55 years, range 18–80). In the first 16 we investigated the reliability of the visual analogue scale (VAS) for recording perceived differences in skin temperature. In the remaining 35 patients the relationship between the VAS and objective infrared radiometry of the hands was investigated. Setting: Outpatients clinics of two university hospitals. Results: The VAS was found to be reliable in terms of response stability. There was no significant correlation between the objective and subjective outcomes. Conclusions: There is lack of correspondence between objective and subjective temperature measurements, which may be due to a normal discrepancy between objective and percieved temperature, and/or to alterations in perception due to RSD.
Usability of thenar eminence orthoses: report of a comparative study
Authors: Buurke J H , Grady J H , de Vries J , Baten C TM 
Published: May 2003

Objective: To determine the difference in the usability of three types of thenar eminence (TE) orthoses. Design: Prospective comparative pre-experimental study with randomized cross-over design. Setting: Rehabilitation centre. Subjects: Ten patients with osteoarthritis of the carpometacarpal I joint confirmed by X-ray. Intervention: Three types of TE orthoses, made of either supple elastic material, elastic material with a semi-rigid thumb busk or a semi-rigid (polyethylene) material. Main outcome measurements: Pain at the thenar eminence, pinch force, hand function, cosmesis, comfort and function of the TE orthosis. Results: The supple elastic TE orthosis scores significantly better than the more rigid types on the subjects ‘comfort’, ‘function’ and the Green Test, while the semi-rigid orthosis scores best on ‘cosmesis’. The score on the subject ‘pain reduction’ shows no significant difference between the three types of TE orthoses. The scores obtained correspond with the outcome of structured interviews about the usability of the TE orthoses. Conclusion: Eight out of 10 patients prefer the permanent use of a TE orthosis. Six patients chose the supple elastic orthosis and two chose the semi-rigid orthosis.
Psychological correlates of outcome following rehabilitation from stroke
Authors: Clark Michael S , Smith Dennis S 
Published: May 2003

Objectives: To confirm, in a new sample, the value of our previously described procedure for identifying abnormal illness behaviour (AIB) in stroke rehabilitation patients, and to examine the relative effects of AIB, depression, family functioning, knowledge of stroke, and expectations of rehabilitation on long-term rehabilitation outcome. Design: A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge. Setting: The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. Subjects: Sixty twelve-month stroke survivors, residing in a family environment, who had undergone an inpatient rehabilitation programme. Main outcome measures: AIB was assessed using the Illness Behaviour Questionnaire, depression with the Zung Self-Rating Depression Scale, family functioning with the McMaster Family Assessment Device, stroke knowledge with the Stroke Care Information Test, and expectations of rehabilitation with an open-ended question. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index. Results: Using our previously derived AIB classification rule, AIB cases scored poorly on functional, social and psychological indicators. Further, cluster analysis of discharge data replicated the rule for identifying patients with AIB. AIB was a strong predictor of functional competence and performance at rehabilitation discharge and both six and twelve months later, while depression was associated with an inactive lifestyle at both six and twelve months. Greater stroke knowledge and clearer expectations of rehabilitation were associated with better functional outcome at discharge. Family functioning was strongly associated with lifestyle activities and ADL performance at both six and twelve months. Conclusions: The procedure for identifying AIB in this rehabilitation environment appears to be robust. AIB was a key determinant of long-term functional disability, while depression was associated with poorer social functioning. Family functioning was an important determinant of social activities, and of the activities the patient actually does, rather than those the patient is capable of carrying out. Good stroke knowledge and clear expectations of rehabilitation were important determinants of rehabilitation success, and should be fostered to ensure a good rehabilitation outcome. Psychological factors are crucial in determining long-term outcome after rehabilitation from stroke.
The Short Orientation–Memory–Concentration Test: a study of its reliability and validity
Authors: Wade D T , Vergis E 
Published: May 2003

Objective: To establish the limits of intra-observer test–retest reliability of the Short Orientation–Memory–Concentration Test (SOMC), and to investigate the relationship of performance on the SOMC with a test of verbal memory. Design: Each patient was assessed twice by the same assessor over an interval of 3–7 days. Setting: Two specialist rehabilitation units concerned with patients with severe and/or complex disability arising from neurological disease. Subjects: Thirty-eight patients aged 17–63 years, 25 being men, with a variety of neurological diseases. The Barthel Activities of Daily Living Index score ranged from 0 to 20, median 10.5. Measures: The Short Orientation–Memory–Concentration Test, the Barthel Activities of Daily Living Index and the paragraph recall subtest of the Rivermead Behavioural Memory Test (RBMT). Results: There was a slight but statistically significant (p<0.01) improvement in the score of 2 points (out of 28) between the two test occasions, but this was not related to the interval between testing or to the mean score of the two tests. The scores differed by as much as +10 to –8, but most patients (n= 35; 92%) showed a difference between –2 and +6 points. The SOMC scores were correlated with the RBMT paragraph recall immediate and delayed scores (r= 0.74) but the scatterplot showed considerable variation. Conclusion: If used by the same observer, changes in the SOMC score are likely to reflect a real difference if it increases by more than 6 points or decreases by more than 2 points. The SOMC does seem to reflect verbal memory.
Joint reposition sense in subjects with unilateral osteoarthritis of the knee
Authors: Garsden L R , Bullock-Saxton J E 
Published: May 2003

Objective: To identify the sensory deficit of partial weight-bearing joint repositioning sense in subjects with unilateral osteoarthritis (OA) of the knee. The methodology was developed to incorporate measures made easily in a clinical setting. In OA, local degenerative changes can affect the function of sensory receptors and mechanoreceptors. As a result, appreciation of limb position as well as function may be compromised. Because proprioceptive sense plays an important role in reflex muscle contraction and stabilization of the joint, functional stability and joint integrity may be at risk if proprioception is impaired. Design: Twenty subjects with unilateral OA of the knee were age-matched with 20 controls for the purpose of this study. The difference in degrees between a target angle of knee flexion and a reposition angle was measured during a partial weight-bearing test. A Dualer™ (electronic dual inclinometer) was used to measure the joint reposition sense (JRS) of the knee. Both sides were tested with six repetitions on each side. A mixed-model ANOVA was applied to the data for analysis. Results: Comparison of the JRS between groups revealed a significant difference, with OA subjects having higher JRS error (JRSE) (p<0.001) than controls. There was no significant difference in JRSE for either side, regardless of group. Conclusions: Subjects with unilateral OA of the knee demonstrated poorer performance on both legs in a partial weight-bearing reposition test than did control subjects.