bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation
Authors: Turner-Stokes Lynne , Tonge Pauline , Nyein Kyaw , Hunter Maggie , Nielsona Stuart , Robinson Ian 
Published: May 2003

Background: Disability scores, such as the Functional Independence Measure (FIM) and Barthel Index, have been shown to correlate with care needs but cannot be used to assess them directly, as they do not indicate the number of people required to help with a task, nor the time taken. The Northwick Park Dependency Score (NPDS) is an ordinal scale that can be used to assess impact on nursing time. It takes 3–5 minutes to complete. Together with a short set of additional questions, it may be used directly to assess care needs in the community and to facilitate discharge planning. Aims: To develop and evaluate the NPDS for use in a rehabilitation setting. Methods: (1) Development: Following a survey of existing instruments, tasks were selected on the basis of their impact on nursing time and divided into Basic Care Needs (BCN) and Special Nursing Needs (SNN). Cut-off points were devised to reflect the number of helpers needed and time taken. Following evaluation of the NPDS version 5, minor changes were made to produce version 6 which was re-evaluated on a smaller scale. (2) Evaluation: Inter-rater and intra-rater reliability were tested in a cohort of 23 inpatients using five senior nurses. Analysis included assessment of degree of association, significant differences, absolute agreement, and agreement ±1 level. Although there is no gold standard, the BCN section should correlate inversely with independently assessed Barthel scores. Re-evaluation of version 6 was undertaken using the same method of analysis in a cohort of 21 patients using three senior nurses. Results: On initial evaluation inter-rater reliability testing showed an excellent level of association in total composite score between each pair of nurses (rho = 0.73–0.92, p <0.01) and agreement ±1 level for individual items ranged from 73 to 100%. Significant disagreements were in six items. On reevaluation following minor modification, high levels of association were still seen for total BCN, SNN and composite scores both between and within raters, with very satisfactory levels of agreement for individual items. The BCN section of the NPDS showed good inverse correlation with Barthel scores (rho = 0.91, p <0.01).
Reliability of stroke patients' reports on rehabilitation services received
Authors: Luther A , Lincoln N B , Grant F 
Published: May 2003

Objective: To compare stroke patients' reports with service providers' reports on the rehabilitation services patients receive. Setting: Community, predominantly urban. Subjects: Ninety-three stroke patients who had not been admitted to hospital. Method: Between August 1994 and August 1996, 54 general practitioner practices in Nottingham (population 344 200) were requested to notify the Nottingham Community Stroke Project of all cases of stroke. Patients were visited one month after stroke and asked to report on whether they had received any hospital, social, community or voluntary services. Some departments were contacted and asked if the patients were known to them and whether they had been seen. Results: Patients reported having little contact with hospital or social services. Comparison of patients' reports with that of the appropriate service department showed poor agreement for community care assistants (kappa = 0.18), fair agreement for social workers (kappa = 0.59), speech therapy (kappa = 0.48), hospital outpatient appointments (kappa = 0.55) and admissions to hospital (kappa = 0.48) and good agreement for social services occupational therapists (kappa = 0.64). Conclusion: Stroke patients' and service providers' reports on rehabilitation services may not always agree. Care should be taken when interpreting information on service provision.
Neck semispinalis capitis muscle size in sitting and prone positions measured by real-time ultrasonography
Authors: Rezasoltani Asghar , Kallinen Mauri , Mälkiä Esko , Vihko Veikko 
Published: May 2003

Objective: To examine the reliability of measurements of semispinalis capitis muscle (SECM) cross-sectional area (CSA) in prone and sitting positions, and to compare the muscle size in these two positions. Design: Semispinalis capitis CSA was measured twice a day on two successive days with a real-time ultrasound apparatus. Subjects: Eighteen males (aged 19–34 years) and 28 females (aged 19–34 years) were studied for the reliability test. Seven males and 12 females were randomly selected to compare SECM size in sitting and prone positions. Results: The intraclass correlation coefficient (ICC) for repeatability measurements was r = 0.98 for the two positions. The correlation of the CSA in sitting and in prone positions was r = 0.93 ( p <0.01). There were no significant differences between CSA, linear dimensions and shape ratio of SECM in the two positions. Conclusions: In this study SECM ultrasonography appeared to be an accurate method in both positions, and position as such had no significant effects on the SECM cross-sectional size. Such accuracy allows neck muscle evaluation in clinical diagnosis and in follow-up studies during neck rehabilitation programmes.
Clinical applications of the Adelaide Activities Profile
Authors: Bond Malcolm J , Clark Michael S 
Published: May 2003

Objective: The Adelaide Activities Profile (AAP) was developed from the Frenchay Activities Index, and has been shown to be a valid measure of the lifestyle activities of elderly people. The goals of the current study were to illustrate the value of applying the AAP in the clinical setting, and to demonstrate the relationship of the AAP to the use of formal services. Design: Data were collected as part of the Australian Longitudinal Study of Ageing (ALSA). A community sample, stratified by age and sex, was chosen to be representative of the elderly population of Adelaide, South Australia. Participants: A sample of 1799 community-dwelling people aged 70 years and over. Measures: Lifestyle activities were assessed with the AAP, which provides measures of activity on four scales: domestic chores, household maintenance, service to others, and social activities. Participants were defined as users of formal services if they were active clients of any of the Domiciliary Care and Rehabilitation Services, Meals-on-Wheels, or the Royal District Nursing Society. Results: Age and sex norms for the AAP were provided, and the clinical value of using these norms was illustrated by two contrasting case studies. Users of formal services had lower activity levels than nonusers for all AAP scales, particularly household maintenance and domestic chores. Conclusions: The AAP is a valuable addition to the standard battery of instruments used in the assessment of elderly people, and has clinical application as both a health outcome measure and an indicator of the need for intervention.
A patient-centred study of the consequences of stroke
Authors: Pound Pandora , Gompertz Patrick , Ebrahim Shah 
Published: May 2003

Objective: To explore subjective accounts of the consequences of stroke. Design: Qualitative methods using depth interviews. Participants and setting: Forty people sampled ten months post stroke from a hospital stroke register which was established in two adjacent health districts in North Thames Regional Health Authority. Results: Interviewees reported a number of ways in which the stroke had affected their daily lives, including difficulty with leaving the house, doing the housework, pursuing former leisure activities, inability to walk in the way they wanted, problems with communicating, washing, bathing and dressing, and with confusion and deteriorating memory. In all these areas people described the loss of social contact that accompanied these changes, and the loss of valued roles which had been embedded in the everyday functions they had previously performed. In general, people over the age of 70 were more seriously affected. Conclusion: The type of changes which people reported would not easily have been captured using standardized outcome measures, pointing to the value of qualitative methods in providing subjective accounts. In terms of clinical practice, there is a need to reduce people's isolation after stroke by providing home visits after discharge, particularly to those living alone, and also by reducing disability through rehabilitation and by tackling the environmental obstacles which can imprison people in their homes. The findings suggest that many people with stroke would benefit from being able to talk about the changes which have occurred. Imaginative proposals are needed to develop ways to help replace the loss of activities, social contacts and social roles, particularly among older people with stroke.
The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA)
Authors: Cardol Mieke , de Haan Rob J , van den Bos Geertrudis A M , de Jong Bareld A , de Groot Imelda J M 
Published: May 2003

Objective: To report on the feasibility and psychometric properties in terms of homogeneity and construct validity of a newly developed handicap questionnaire focusing on person-perceived handicaps: the Impact on Participation and Autonomy (IPA). Design: Cross-sectional. Setting, subjects and outcome measure: One hundred consecutive individuals from the outpatient clinic of the department of rehabilitation of an academic hospital administered the new questionnaire IPA. Results: The results show good homogeneity and construct validity of the IPA. Factor analysis showed that the scale consists of four factors, explaining 68% of the total variance: social relationships, autonomy in self-care, mobility and leisure, and family role. Homogeneity of the four subscales was considered good, Cronbach's α ranged from 0.84 (family role) to 0.87 (social relationships). Feasibility in terms of the number of missing values and administration time needed was satisfactory. Conclusion: The first results suggest that the IPA promises to be a useful handicap questionnaire. Further research is needed to establish test–retest reliability, convergent validity and responsiveness to change.
Persisting symptoms and carers' views of outcome after subarachnoid haemorrhage
Authors: Hellawell Deborah J , Taylor Robert , Pentland Brian 
Published: May 2003

Objective: To report the outcome of aneurysmal subarachnoid haemorrhage (SAH) in terms of subjective symptoms and carers' perspective over a period of two years. Design: Forty-four consecutive patients admitted to a Regional Neurosurgical Unit and who survived aneurysmal SAH were invited for outpatient assessment at 6, 12 and 24 months post haemorrhage. Measures: The Glasgow Outcome Scale (GOS) was used to measure global outcome; the Hospital Anxiety and Depression Scale (HAD) to screen for affective symptoms; the Head Injury Symptom Checklist (HISC) to detect symptoms commonly reported after head trauma; and information was collected from a close friend or relative of the patient using the Relative's Questionnaire (RQ). Results: GOS outcome was significantly related to the severity of the original haemorrhage, as classified by the World Federation of Neurological Surgeons (WFNS) Grading Scale, on admission to hospital. However, even in cases where patients had made a good recovery according to the GOS, a variety of problems were frequently reported by patients and relatives, and many of these persisted for the duration of the study. The three most common and persistent symptoms were tiredness (63%, 59% and 59% at 6, 12 and 24 months respectively), memory disturbance (50%, 52% and 56%) and passivity (61%, 47% and 46%). In contrast, the prevalence of disturbed mood, as reported using the HAD, was similar to that of the general population. Conclusions: Studies of outcome following SAH should address these subtle disturbances, and information pertaining to potential long-term problems should be provided to patients and relevant others.
Predictive model of functional independence in stroke patients admitted to a rehabilitation programme
Authors: Sánchez-Blanco I , Ochoa-Sangrador C , López-Munaín L , Izquierdo-Sánchez M , Fermoso-García J 
Published: May 2003

Objective: To develop a prognostic model to estimate the probability of patients being independent in ambulation and in activities of daily living (ADL) after six months of stroke. Design: Cohort analytical study. Setting: Rehabilitation departments of two district general hospitals. Subjects: Ninety-two consecutive stroke patients admitted to a rehabilitation programme. Main outcome measures: Independent ambulation was defined as a Functional Ambulation Classification (FAC) ≥4, and the independence in ADL as a Barthel Index (BI) ≥85. All patients were assessed on admission to rehabilitation, and in the first, second, third, fourth and six months after stroke. Results: Prognostic factors were identified by means of a multivariate survival analysis using Cox regression. Three variables were predictors for a FAC ≥4: (1) The patients in the motor (M), motor-sensitive (MS) and motor-sensitive with hemianopsia (MSH) groups (relative risk (RR) 5.43 of M with respect to MSH, and 2.41 of MS to MSH). (2) A Motricity Index >25 (RR 3.19). (3) An age <70 years old (RR 1.99). For a BI ≥85 three predictors were selected: (1) The classification M–MS–MSH (RR 6.02 M to MSH, and 1.52 MS to MSH). (2) An initial BI >20 (RR 3.45); the highest contribution in the achievement of an initial BI >20 was bowel and bladder continence. (3) The antecedent of previous independence (RR 2.68). The predictive models, constructed by means of multiple logistic regression correctly classified 77% and 79% of the patients who obtained FAC ≥4 and a BI ≥85 respectively. Conclusions: The syndromic classification M, MS and MSH, together with other routinely available data, such as the Motricity Index, BI, the age and the previous functionality, can be used to obtain a patient prognosis level with regard to ambulation and ADL independence.
Unpacking the black box of therapy – a pilot study to describe occupational therapy and physiotherapy interventions for people with stroke
Authors: Ballinger C , Ashburn A , Low J , Roderick P 
Published: May 2003

Objective: To describe the components used in the practice of occupational therapy and physiotherapy for people with stroke and to examine variability between services. Design: A time-sampling strategy in which therapists recorded their face-to-face interventions with stroke patients during 12 weeks over a total of 17 months. Settings and subjects: Six occupational therapists and seven physiotherapists from four services (three day hospitals and one domiciliary stroke rehabilitation service) recorded interventions with 89 stroke patients recruited to a larger randomized controlled trial. Main outcome measures: Frequencies of use of interventions, together with other details about delivery of therapy, were recorded using a data collection booklet and coding system designed by the participating therapists. Results: The median treatment time for a session was 45 minutes. The most frequently recorded components of physiotherapy intervention were ‘walking’, ‘standing balance’ and ‘upper limb movement pattern’, and of occupational therapy ‘physical function’, ‘social and leisure activities' and ‘other’. There was variability between the services in terms of median treatment time, use of intervention codes, frequency of treatment sessions, amount of time spent working with assistance and amount of group work. Conclusions: The findings support the view that occupational therapy and physiotherapy with people with stroke are not homogeneous activities, and vary between therapists and services. Recommendations include further development of the tool, and use of other methodologies to explore the process and nature of stroke rehabilitation.
The Northwick Park Care Needs Assessment (NPCNA): a directly costable outcome measure in rehabilitation
Authors: Turner-Stokes Lynne , Nyein Kyaw 
Published: May 2003

Background: The Northwick Park Dependency Score (NPDS) has been shown to be valid, reliable and practical to use. It was designed to be used together with a short set of additional questions to inform care needs in the community and facilitate discharge planning. Aim: To develop a conversion formula to translate information derived from the NPDS into a generic assessment of care needs in the community – the Northwick Park Care Needs Assessment (NPCNA) – and to evaluate its potential as a directly costable measure of outcome in rehabilitation. Setting: An inpatient neurorehabilitation unit for young patients with brain injury. Method: Part 1, Development: For each task in the NPDS, a set of assumptions was developed to reflect the number of people, the time taken and the frequency of help required. Tasks were collected into a daily timetable and minimum and maximum allocations made for each time slot. From this the weekly care hours can be calculated. A range of care package categories and their approximate costs were identified, and a simple set of criteria developed with experienced community care planners to determine the circumstances under which each category is applied. Part 2, Evaluation: The assumptions and derived care package were evaluated in a prospective comparative study in 35 cases. Timetables of care needs were drawn up using (a) the NPDS-derived Care Needs Assessment (NPCNA) and (b) detailed structured interview with an independent assessor. The weekly hours of care, care package and approximate cost were then determined for each set of timetables, by a third independent assessor, applying the formula described according to strict rules. Results: Assessment of the total weekly hours of care showed an excellent correlation between the two methods (rho 0.90, p<0.01) with no significant differences. There was also a high correlation in the category of care package allotted and thus the weekly cost of care (rho 0.73, p<0.01). Conclusion: The NPCNA provides a simple measure of care needs in total care hours, as well as a timetable of care from which a care package can be directly planned and costed. It has potential use, therefore, as an instrument that can demonstrate directly the effectiveness of rehabilitation in reducing the cost of continuing care in the community.
Randomized controlled study of ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint
Authors: Nyanzi C S , Langridge J , Heyworth J RC , Mani R 
Published: May 2003

Objective: To determine the efficacy of a fixed dose of ultrasound energy to treat acute lateral ligament sprains of the ankle joint. Study design: Double-blind randomised controlled trial. Setting: Accident and Emergency department of University Teaching Hospital. Subjects: Patients presenting at Accident and Emergency with ankle injuries. Intervention: Ultrasound or placebo, and Tubigrip. Outcome measures: Pain measured with visual analogue scales, swelling using a tape measure, range of movement using a fluid-filled goniometer, and weight bearing using two scales simultaneously. Results: Patients in both groups improved symptomatically. There were no statistically significant differences between groups in any outcome measure. Within groups, statistically significant differences were detected in pain perceived, and range of movement (dorsiflexion). Conclusion: At the dose and duration used, ultrasound therapy is no better than placebo in the management of lateral ligament injuries.
Luteinizing Hormone Receptor Knockout (LuRKO) Mice and Transgenic Human Chorionic Gonadotropin (hCG)-Overexpressing Mice (hCG αβ+) Have Bone Phenotypes
Authors: Yarram S. J. , Perry M. J. , Christopher T. J. , Westby K. , Brown N. L. , Lamminen T. , Rulli S. B. , Zhang F.-P. , Huhtaniemi I. , Sandy J. R. , Mansell J. P. 
Published: May 2003

AbstractConsiderable attention has been paid to the role of sex steroids during periods of major skeletal turnover, but the interaction of the gonadotropic hormones, which include LH, FSH, and human chorionic gonadotropin (hCG), within bone tissue have been overlooked. The question is pertinent due to the recent detection of extragonadal expression of gonadotropin receptors. Western blotting, immunolocalization, and RT-PCR supported the presence of osteoblast LH receptors. However, osteoblast cells failed to bind [125I]hCG and treatment with hCG failed to generate either cAMP or phosphorylated ERK 1/2. Bone mineral density (BMD) and bone histomorphometry were examined in the following models: 1) LH receptor null mutant (LuRKO) mice; 2) transgenic mice overexpressing hCG (hCG αβ+); and 3) ovariectomized (OVX) hCG αβ+ model. Male LuRKO mice showed a decrease in BMD after 5 months, apparently secondary to suppressed gonadal steroid production. Similarly, 9- to 10-wk-old female LuRKO mice exhibited decreases in histomorphometric parameters tested. The data indicate that loss of LH signaling results in a reduction in bone formation or an increase in bone resorption. By contrast, there were significant increases in BMD and histomorphometric indices for female, but not male, hCG αβ+ mice, indicating that chronic exposure to hCG results in bone formation or a decrease in bone resorption. However, OVX of the hCG αβ+ mice resulted in a significant reduction in BMD comparable to OVX WT controls. Although gonadotropin levels are tightly linked to sex steroid titers, it appears that their effects on the skeleton are indirect.
A pragmatic approach to interactive assembly sequence evaluation
Authors: Barnes C J , Jared G E M , Swift K G 
Published: May 2003

An assembly-oriented design system has been developed which includes several analysis tools to improve product assemblability during product development. One of these tools supports the parallel development of the product design and the assembly sequence, thus exploiting the benefits of concurrent consideration of product and process. However, this approach requires some method for evaluating the sequence against requirements. Previous work on assembly sequence evaluation has concentrated on identifying the best from a set of ranked alternatives. When a single sequence is constructed, as with this tool, another method is needed. This paper reports the development of this novel methodology for evaluating individual assembly sequences. A review of the relevant literature has found several measures for identifying good assembly sequences from a ranked list and the fundamental sequence attributes extrapolated and aggregated. This leads to the proposal of four new indices: insertion index, stability index, difficulty index and complexity index. A large number of assembly sequences have been analysed to define limiting values for the indices such that they can quantify the potential of an incomplete sequence resulting in a satisfactory solution. The application of these indices in concurrent design and assembly planning is illustrated through an industrial case study.