bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower abdominal pressure versus external bladder stimulation to aid bladder emptying in multiple sclerosis: a randomized controlled study
Authors: Prasad R S , Smith S J , Wright H 
Published: November 2003

Objective: To investigate the change in post-void residual bladder volumes (PVR) with ‘abdominal vibration’ using a percutaneous bladder stimulator in multiple sclerosis (MS) patients compared with either ‘no treatment’ or ‘abdominal pressure’. Design: Randomized controlled cross-over study. Setting: Regional neurorehabilitation clinics. Subjects: Twenty-eight MS patients with urinary symptoms and PVR > 100 ml. Twelve patients had urinary incontinence. Methods: MS patients with voiding dysfunction and elevated PVR of 100–500 ml on BVI-3000 Ultrasound Scanner were randomized to either ‘abdominal pressure’ or ‘vibration’ by a portable, percutaneous, vibrating device (Queen Square Bladder Stimulator; Malem Medical) or to ‘no treatment’. PVR was assessed at the end of each two-week phase. Outcome measure: PVR reduction by greater than 100 ml. Results: The 28 patients ranged in age from 29 to 71 years with a mean age of 49 years and a mean duration of MS of 12 years (range 1–37 years). The PVR decreased from 231 (SD 119) ml during no treatment to 191 (SD 132) ml with abdominal pressure ( p = 0.242). Using suprapubic vibration the PVR reduced further to 126 (SD 121) ml, which was highly significant ( p = 0.002) compared with no treatment. The difference between abdominal pressure and vibration just failed to reach significance ( p = 0.059). There was no significant reduction in either the frequency of micturition or episodes of incontinence. The device was well-tolerated by patients. Conclusion: Abdominal vibration is an effective method of reducing PVR in MS patients and appears more effective than abdominal pressure alone.
Can the repetition effect maximize learning in multiple sclerosis?
Authors: Chiaravalloti Nancy D , Demaree Heath , Gaudino Elizabeth A , DeLuca John 
Published: November 2003

Objective: The ‘repetition effect’ stipulates that recall ability improves as the number of learning trials that a person receives increases. While the repetition effect has been supported through many empirical investigations in healthy individuals, it has not yet been applied to clinical populations. The present study tested the hypothesis that an increased number of learning trials improves recall ability in persons with a neurological disorder, namely multiple sclerosis (MS). Design: Prospective between-group design with 30-minute, 90-minute and one-week assessments. Setting: Private, nonprofit, research facility. Subjects: Sixty-four MS subjects; 20 healthy control subjects (HC). Interventions: Subjects were given a modified Selective Reminding Test (SRT), a list of 10 words to remember in a selective reminding format. To control for the amount of information initially learned, the learning trials were repeated until the subject recalled all 10 words on two consecutive trials. Main outcome measures: SRT word recall and recognition was tested 30 minutes, 90 minutes and one week subsequent to initial acquisition. Results: Interestingly, the antithesis of our hypothesis was found. That is, persons with MS who required more learning trials to reach the perfect learning criterion performed significantly worse on the recall trials. However, this was not the case in a sample of healthy individuals undergoing the same protocol. Conclusions: These results indicate that individuals with MS may not benefit from repetition in isolation, but rather require the use of more intensive cognitive rehabilitation strategies (i.e., increased organization) to help improve their depth of encoding of new information.
Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis
Authors: Baskurt Ferdi , Özcan Ayse , Algun Candan 
Published: November 2003

Objective: The aim of this study was to compare the effectiveness of naproxen (10%) applied by topical iontophoresis or by phonophoresis in the treatment of lateral epicondylitis. Design: Randomized controlled trial. Setting: Dokuz Eylül University School of Physical Therapy and Rehabilitation. Subjects: This study was carried out with 61 patients who had lateral epicondylitis. They were randomized into two groups. Interventions: Naproxen was applied to the first group using phonophoresis (29 patients – 33 extremities) and to the second group using iontophoresis (32 patients – 34 extremities). Patients in both groups were treated by other physiotherapy methods (cold pack, progressive strengthening and stretching exercises). Outcomes: Pain scores (at rest, during motion, with pressure, weight lifting), grip strength and Nirschl–Petterone Grading System were evaluated before and after treatment. Results: Pain scores decreased, grip strength and Nirsch–Petterone Grading System statistically significantly increased in both groups after treatment ( p < 0.05), but there were no statistical differences between groups before or after treatment ( p > 0.05). Conclusion: The results suggest that iontophoresis and phonophoresis of naproxen are equally effective electrotherapy methods in the treatment of lateral epicondylitis.
Obstacle training programme for individuals post stroke: feasibility study
Authors: Bassile Clare C , Dean Catherine , Boden-Albala Bernadette , Sacco Ralph 
Published: November 2003

Objective: The purposes were threefold: to develop an obstacle ambulation training programme, to recruit and retain individuals post chronic stroke and to assess the effectiveness of the obstacle ambulation training programme. Design: Intervention study; case series; baseline to post-intervention measures and one month follow-up after intervention. Setting: An outpatient department. Subjects: Five individuals with chronic stroke with mild to moderate functional limitations; convenience sample. Interventions: Therapy consisted of twice weekly sessions for four weeks during which subjects walked along a walkway and over obstacles. Main outcome measures: Motor Assessment Scale – walking section (MAS – time), Six-minute Walk Test distance, walking velocity, and Medical Outcomes Study-36 Health Status Measurement (SF-36). Results: Significant improvements were seen baseline to post intervention for walking velocity, Six-minute Walk Test, MAS and SF-36 physical function score ( p £ 0.025 for all measures). Most improvements noted at the end of training were retained one month later. The effect sizes ranged from 0.33 to 1.20. Conclusions: Substantial improvement in ambulation function and disability level were seen as a result of the obstacle training programme for individuals with chronic stroke. Further investigation is warranted.
A study of interventions and related outcomes in a randomized controlled trial of occupational therapy and leisure therapy for community stroke patients
Authors: Logan P A , Gladman J RF , Drummond A ER , Radford K A 
Published: November 2003

Objective: To undertake a detailed analysis of therapy provided in a multicentred randomized controlled trial of activities of daily living (ADL) and leisure (TOTAL), testing the hypothesis that specific interventions given in the trial affected specific aspects of outcome. Subjects: Three hundred and nine stroke patients who had been randomly allocated to receive either occupational therapy aimed at ADL activities ( n = 156) or leisure ( n = 153). Measures: Number, duration and type of activity undertaken per patient. Barthel Index, Extended Activities of Daily Living Scale (EADL) and Nottingham Leisure Questionnaire (NLQ) six months after entry to the study. Method: Activities that had been used in treatment were coded and categorized. Frequently used activities identified. These activities were matched to items from the six-month outcome measures. Patient independence in these outcome items was compared between the leisure and ADL groups. Results: Three hundred and nine therapy record forms were returned. Patients received a median of ten sessions with a median duration of 55 minutes. The ADL group received significantly more, mobility training, transfer training, cleaning, dressing, cooking and bathing training (chi-squared, p < 0.05). Sport, creative activities, games, hobbies, gardening, entertainment and shopping were used significantly more in the leisure group (chi-squared, p < 0.05) than the ADL group. Fifteen items from the outcome measures were identified as specific to these interventions. There were no statistically significant differences in outcome on these 15 items between the ADL and leisure groups (chi-squared, p > 0.05). Conclusions: We found no evidence that specific ADL or leisure interventions led to improvements in specific relevant outcomes. We believe that these findings should prompt a review of the relationship between process and outcome of occupational therapy.
Screening for ability to complete a questionnaire: a preliminary evaluation of the AbilityQ and ShoulderQ for assessing shoulder pain in stroke patients
Authors: Turner-Stokes Lynne , Rusconi Susanne 
Published: November 2003

Objectives: To assess the repeatability of the AbilityQ – a screening tool to assess technical ability to complete a questionnaire – in patients with complex disabilities following stroke. To evaluate the validity of the AbilityQ in predicting repeatability and consistency of response to verbal and visual analogue scale questions in the ShoulderQ in those with shoulder pain. Design: In a cross-sectional study, the AbilityQ and ‘ShoulderQ’ were administered on two consecutive days by a single investigator. Setting: Six regional rehabilitation centres in the UK managing patients with severe complex neurological disability. Subjects: Forty-nine patients with anterior or posterior circulation strokes: 13 (63%) had cognitive deficits and 28 (57%) had communicative deficits. Results: Thirty-one (63.3%) patients required some degree of help in completing the AbilityQ. Percentage agreement for individual questions between day 1 and day 2 ranged from 55 to 88% with kappa values from 0.07 to 0.79. Repeatability of ShoulderQ responses was 36–72% for the verbal questions (kappa values 0.16–0.56). For visual analogue scale (VAS) questions, agreement ±1 on a 10-point scale was 36–59% with intraclass correlation coefficients 0.50–0.60 ( p < 0.01). High verbal (33/4) and VAS scores (3/3) on the AbilityQ had positive predictive values for good repeatability in the ShoulderQ of 80% and 58% respectively. Mismatched AbilityQ responses to verbal and VAS questions showed a positive predictive value of 92% for similar inconsistency in the ShoulderQ and a negative predictive value of 90%. Conclusions: In this preliminary evaluation the AbilityQ and the ShoulderQ each demonstrated a moderate level of repeatability in a group of patients expected to have difficulty in completing questionnaires. The AbilityQ appears to have some clinical usefulness in identifying those able to respond to the ShoulderQ and, where responses to verbal and VAS questions conflict, may offer some guidance as to which are most likely to be accurate in that individual. Further development is underway.
Natural history of cognitive impairment after stroke and factors associated with its recovery
Authors: Patel Mehool , Coshall Catherine , Rudd Anthony G , Wolfe Charles DA 
Published: November 2003

Objectives: To describe the natural history of cognitive impairment following stroke over three years; determine factors associated with recovery of post-stroke cognitive impairment and examine the effect of this recovery on stroke outcomes. Design: Observational study. Setting: Population-based register of first-ever strokes. Measures: Mini-Mental State Examination (MMSE) for cognition (cognitive impairment: MMSE<24), Barthel and Frenchay activity indices for disability. Methods: To describe its natural history, cognition was assessed at three months, 1, 2 and 3 years after stroke in 163 subjects registered in 1995. Recovery of cognitive impairment was examined using a larger cohort registered between 1995 and 1998 ( n = 476) and 193 subjects cognitively impaired at three months were reassessed a year post stroke; 34 who had recovered cognitively (MMSE 24–30) were compared with 102 with persistent cognitive impairment in terms of demography, risk factors, initial impairments and stroke subtype. Results: At three months, 1, 2 and 3 years post stroke, the prevalence rates of cognitive impairment were 39%, 35%, 30% and 32% respectively. Multivariable analyses showed that recovery was associated with smoking (OR 3.7; 95% CI 1.2–11.8), compromised by visuospatial neglect (OR 0.27; 95% CI 0.08–0.89), and had a near-significant association with right hemispheric lesion (OR 2.87; 95% CI 0.94–8.78). Cognitive recovery was associated with less institutionalization ( p = 0.032) and being less disabled, on Barthel ( p = 0.001) and Frenchay Activity Indices ( p = 0.028). Conclusions: Cognitive impairment remains highly prevalent up to three years after first stroke. Recovery from cognitive impairment is associated with smoking and possibly right hemisphere strokes, but compromised by visuospatial neglect. These associations require further clarification.
Efficacy of a specially designed hip protector for hip fracture prevention and compliance with use in elderly Hong Kong Chinese
Authors: Woo J , Sum C , Yiu H H , Ip K , Chung L , Ho L 
Published: November 2003

Background: Hip protectors, while effective in prevention of hip fractures, have been designed for a Caucasian body build and may not be suitable for Asian subjects living in a subtropical climate. Objective: Hip protectors and accompanying shorts were specially designed for use for the Chinese body build and subtropical climate, and tested for compliance and efficacy in fracture prevention. Method: A pragmatic study examining compliance with the wearing of hip protectors, and effectiveness in preventing hip fractures (using a case control design), in 302 subjects wearing hip protectors and 352 control subjects. Results: Overall compliance varied from 55 to 70%. The relative risk for hip fracture was 0.18 (0.04–0.79), relative risk reduction 82%, and the number of subjects needing to wear a hip protector to prevent one fracture was 33 (19–117). Conclusion: Hip protectors adapted for use in Chinese people appear to reduce hip fractures in routine clinical practice.
Duration of condition is unrelated to health-state valuation on the EuroQoL
Authors: Myers Julia A , McPherson Kathryn M , Taylor William J , Weatherall Mark , McNaughton Harry K 
Published: November 2003

Objective: To determine whether health valuations, such as those used in economic evaluation, are affected by duration of a health condition. People with disabling health conditions tend to value health more highly than members of the general population, and one explanation for this is that over time their experience of living with a disabling illness changes the way in which they value health. If this is so, a relationship between the duration of an individual's disabling health condition and the valuation they assign to their health-state might reasonably be expected. Design: A postal survey using the EuroQoL (EQ-5D) instrument to collect descriptions and valuations for health from people who reported a diagnosis of either stroke or multiple sclerosis. Contact with participants was made through national support organizations and questionnaires were returned by mail. Results: Eight hundred and ninety-four people completed the survey. One hundred (11%) had one health-state indicating moderate problems in all five dimensions of the EQ-5D descriptive profile. For people with this health-state, analysis of covariance showed no relationship between valuation of health-state and time from onset of illness ( F = 0.38, p = 0.54). This finding applied irrespective of the diagnosis, and for some other less frequently reported health-states. Conclusion: Clinical experience suggests that over time people adapt to longterm disability. However we found no evidence to support the proposition that higher health-state valuations by people with disabling conditions are explained by the actual duration of their condition.
A regression analysis of the Waterlow score in pressure ulcer risk assessment
Authors: Anthony Denis , Reynolds Tim , Russell Linda 
Published: November 2003

Objective: To explore the predictive value of the Waterlow score, and the subscores of age and gender. Design: Logistic regression analysis was conducted on the two subscores of the Waterlow score, and the residual Waterlow score with gender and age removed. Receiver operating characteristic (ROC) analysis gave a quantitative measure of the classification ability of the Waterlow score. Setting: Burton, UK. Subjects: All admissions over a five-year period to the District General Hospital, a total of 150 015 admissions of 82 691 patients. Interventions: None. Main outcome measures: Area under the ROC curve for significant (as determined by logistic regression) variables. Results: Data were inaccurate in at least 44.7% of the records, and analysis was conducted on the 43 735 records for which no errors were apparent. Nine hundred and fifty-four patients had a pressure ulcer on admission (2.1%); 277 developed a pressure ulcer (0.6%). The Waterlow score was predictive of pressure ulcers. Age was predictive, and gender was not found to be a significant predictor. Conclusions: The Waterlow score may be improved and simplified by removing gender from the scoring system.
Use of videotape to assess mobility in a controlled randomized crossover trial of physiotherapy in chronic multiple sclerosis
Authors: Wiles C M , Newcombe R G , Fuller K J , Jones A , Price M 
Published: November 2003

Objectives: To determine to what degree assessment of mobility based on comparison of videotape recordings before and after courses of physiotherapy in patients with chronic multiple sclerosis (MS) is reliable, correlates with ‘live’ assessments and indicates benefit. Design: Prospective data collection within a randomized crossover controlled trial of physiotherapy at home, as an outpatient, or ‘no therapy’ in 40 patients. Setting: Hospital outpatients: outpatient and home physiotherapy. Outcomes: Mobility change based on a comparison of short video recordings before and after each treatment period was scored independently by two physiotherapists blinded to therapy type and other measures of outcome. Scores were compared with changes in the Rivermead Mobility Index (RMI) and other indices assessed by a physiotherapist in the patient's home. Results: The two video observers agreed substantially on patient outcome. Changes in walking based on video correlated with RMI for home treatment ( r = 0.41, p = 0.008) but not for hospital or no treatment periods ( r = 0.14 and 0.15): video changes correlated with the ‘live’ assessor's global change score inconsistently (‘no therapy’ r = 0.48, p = 0.002, hospital r = 0.30, p = 0.06 and home r = 0.17, p = 0.30 treatment periods). Based on video data alone, improved mobility was evident following home therapy for only one observer but not for the other or the averaged scores of both. Conclusion: There was substantial agreement between two observers deciding on change in mobility based on independent blinded evaluation of short video sequences. However the correlations of these with ‘live’ assessments were variable. Physiotherapy had a less clear benefit on mobility based on video analysis alone compared with ‘live’ assessments. The study highlights the need for more objective measures of habitual mobility over longer periods.
Psychometric properties of the Rivermead Mobility Index in Italian stroke rehabilitation inpatients
Authors: Franchignoni Franco , Tesio Luigi , Benevoloand Emilio , Ottonello Marcella 
Published: November 2003

Objective: To examine the internal consistency, validity, responsiveness and test scalability of the Rivermead Mobility Index (RMI) in Italian rehabilitation inpatients recovering from stroke. Design: Seventy-three stroke inpatients undergoing rehabilitation were assessed at admission ( T0) and five weeks later ( T1), using RMI, the motor (motFIM) and cognitive (cognFIM) subscales of the Functional Independence Measure, the ‘leg’ section of the Motricity Index and Trunk Control Test. Results: Cronbach's alpha of the RMI was 0.92. The item-to-total correlation coefficients ( rrb) ranged from 0.36 to 0.83, all p < 0.003. All correlations between RMI scores and the other instruments, both at T0 and T1, were statistically significant ( r3 0.49, all p < 0.0001), except those with cognFIM. The difference in RMI scores over the testing period was statistically significant (sign test: z = 7.1, p < 0.0001) and the effect size was 0.89. The coefficient of reproducibility was 0.95 at T0 and 0.93 at T1, and both coefficients of scalability were 0.67. Conclusions: The study confirms the internal consistency, construct validity and responsiveness of the RMI, according to the classic psychometric indexes. However, some minor concerns arise regarding: (a) a floor effect of RMI in subacute rehabilitation stroke inpatients at admission and; (b) one item (‘bathing’) that seems sensitive to cultural and environmental factors. Moreover, even though RMI met the scaling criteria, the item hierarchy is not coincident with the one originally postulated. So, RMI should be considered only as a summated index with ordinal properties, and not a hierarchically ranked scale.
The validation of the Subjective Index of Physical and Social Outcome (SIPSO)
Authors: Trigg Richard , Wood Victorine A 
Published: November 2003

Objective: To validate the Subjective Index of Physical and Social Outcome (SIPSO) in its final 10-item version as a measure of reintegration to pre-stroke lifestyle. Design: Postal and interview administration of questionnaires. Measures: SIPSO, Functional Limitations Profile (FLP), Reintegration to Normal Living Index (RNLI). Setting: Community setting, Bath, UK. Subjects: Two hundred and sixty-one survivors of stroke discharged from a district general hospital. Results: Internal consistency (item-total correlations >0.6) and test–retest reliability (intraclass correlation coefficient (ICC) = 0.96) of the measure were confirmed. Construct validity was confirmed through significant correlations with the six subsections of the FLP and the RNLI. Confirmatory factor analysis of the measure found that the first five items form a robust subscale that clearly relates to physical function. The items within the second subscale (questions 6–10) measure several domains (social, leisure, self-image) and do not form a homogeneous group. The SIPSO was able to detect an improvement in integration within a sample of patients over a three-month period soon after discharge (effect size = 0.26). The hypothesis that the degree of improvement experienced by patients following discharge from hospital would be small, but should be detectable was confirmed. The agreement between proxy and patient on the SIPSO was acceptable for individual items (kappa value range = 3.1–5.8) and total score (ICC = 0.96). Conclusions: The SIPSO is a brief self-complete measure, with proven validity and reliability, which addresses both quantitative and qualitative aspects of activities and interaction. It provides a useful measure for evaluating rehabilitation programmes that aim to reintegrate patients to their pre-stroke lifestyle. The authors suggest that the SIPSO should be used as a 10-item measure.