bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of mobility assessments in a geriatric day hospital
Authors: Spilg Edward G , Martin Brendan J , Mitchell Sarah L , Aitchison Tom C 
Published: May 2003

Objective: To assess the sensitivity of the Elderly Mobility Scale (EMS) to detect improvements in mobility after physiotherapy in comparison with the Barthel Index (BI) and Functional Ambulation Category (FAC) in routine clinical day hospital practice. Subjects: Eighty-three patients who completed a course of physiotherapy were studied. Methods: Each was assessed by an independent physiotherapist before and after a programme of physiotherapy, using the EMS, BI and FAC. Results: The mean age was 79 years (SD 7.7). Fifty-three out of 83 (64%) patients were female and 92% were community dwelling. The median number of physiotherapy sessions undergone by each patient was 9 (range 3–51). All three scales detected an improvement in mobility with physiotherapy (p < 0.001). However, using the EMS, 68 out of 82 (83%) patients had a detectable improvement in mobility compared with only 34 out of 80 (42%) using the BI and 28 out of 81 (35%) using the FAC. Using a matched-pairs comparison, the EMS was significantly more likely to detect an improvement in mobility following physiotherapy within the study group than the BI (p < 0.001) or the FAC (p < 0.001). Conclusion: Although all three scales detected improvements in mobility, the EMS detected mobility improvements in a significantly greater number of patients.
Adaptation of the Functional Independence Measure for use in Turkey
Authors: Küçükdeveci Ayse A , Yavuzer Günes , Elhan Atilla H , Sonel Birkan , Tennant Alan 
Published: May 2003

Objective: To adapt the Functional Independence Measure (FIM) for use in Turkey and to assess its validity and reliability. Design: After the translation procedure, reliability was assessed using internal consistency, inter-rater reliability (kappa) and the intraclass correlation coefficient (ICC). Construct validity was tested by association with impairments and by fit of data to the Rasch model. Setting: The study was undertaken in an inpatient rehabilitation unit of the Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara. Subjects: Consecutive stroke (n = 51) and spinal cord injury (SCI) (n = 62) patients admitted for rehabilitation over a period of three years were assessed at admission and discharge. Results: Internal consistency was good for stroke, and for SCI. The level of agreement between two raters was sufficient with kappa levels of above 0.48 for SCI and above 0.44 for stroke. Minimum ICC found was 0.90. Construct validity showed expected associations with the impairment scales. However, Rasch analysis showed that bladder and bowel items compromise unidimensionality in the motor scale. Conclusion: Adaptation of the FIM has been successful and it can be used in Turkey as long as the limitations are recognized.
Nurses’ perceptions of physiotherapists as rehabilitation team members
Authors: Dalley Jayne , Sim Julius 
Published: May 2003

Objective: To investigate nurses’ perceptions of physiotherapists as members of the rehabilitation team. This study arose from the current emphasis that is placed on good multidisciplinary teamwork for effective rehabilitation and the awareness that different team members often have different perceptions of their respective roles within the team. Design: Semi-structured interviews, the results of which were then subject to content analysis. Setting and subjects: Experienced rehabilitation nurses in two rehabilitation wards within a National Health Service Trust. Results: Nurses perceived the role of physiotherapists as being concerned with mobility and movement, and valued the therapists’ knowledge and skills in these areas. They felt, however, that physiotherapists had insufficient understanding of the demands and pressures of nursing practice and lacked recognition of the nurses’ professional autonomy in decision-making in rehabilitation. Nurses viewed nursing and physiotherapy as two quite distinct and different roles within rehabilitation, despite some role overlap. Physiotherapy was perceived as specific and measurable, while nursing was perceived as generalized and undefined. These perceptions extended to their views on patient–staff interactions and organizational structures. Some of the differences, such as organizational structures, created barriers to rehabilitation. Others, such as physiotherapy expertise in mobility, were valued for their contribution to rehabilitation. Areas were identified where the two professions can assist each other in professional skills. Conclusion: Nurses valued the role and contribution of physiotherapists, but identified areas in which barriers existed to effective interprofessional working, particularly in relation to organizational factors and interprofessional relationships.
Stroke: an exploration of the experience of informal caregiving
Authors: Kerr Susan M , Smith Lorraine N 
Published: May 2003

Objective: To explore the experience of caregiving in informal carers of stroke patients. Design: The research approach was qualitative. Data were collected one year after the stroke occurred using a semi-structured interview. The audio-taped interviews were transcribed and following this process were analysed thematically using constant comparative procedures. Setting: West of Scotland. Subjects: Twenty-two informal carers of stroke patients. Results: The results are presented under the headings: Preparation for discharge/feelings about discharge; The early weeks/months at home; A year of caring; and The future. The main themes identified within these broad areas were as follows: physical preparation; emotional support; the supply of information and advice; and the provision of appropriate services (both social and health service provision). Conclusions: The data gathered in this small-scale study suggest that the physical and emotional toll associated with caregiving was great. Unfortunately, the help and support provided by the health and social services was often inadequate, inappropriate and poorly tailored to their individual needs. There was little evidence of a seamless flow of care between the secondary and primary care settings.
Reality Orientation Therapy to delay outcomes of progression in patients with dementia. A retrospective study
Authors: Metitieri Tiziana , Zanetti Orazio , Geroldi Cristina , Frisoni Giovanni B , De Leo Diego , Buono Marirosa Dello , Bianchetti Angelo , Trabucchi M 
Published: May 2003

Objective: To evaluate the impact of continued Reality Orientation Therapy (ROT) in delaying the outcomes of dementia progression. Design: Retrospective study. Data collection was based on review of clinical charts and on telephone interviews performed with patients or primary caregivers. Setting: Day hospital of the Alzheimer's Disease Unit, Brescia (Italy). Subjects: Seventy-four patients enrolled in at least one cycle of ROT from 1994 to 1998 were studied. Interventions: Rehabilitative intervention based on formal ROT. Main outcome measures: This study analysed the time to the occurrence of any of the following: cognitive decline on Mini-Mental State Examination scores, urinary incontinence as an index of functional decline, institutionalization, and death. Results: Data on a 30-month period after the first ROT session were analysed. We compared 46 patients (treatment group) who completed from 2 to 10 ROT cycles (corresponding to 8–40 weeks of training; mean = 15.48) with 28 patients (control group) who completed only one ROT cycle (4 weeks). Treatment group showed higher estimated survival rates than control group on cognitive decline (p = 0.022) and institutionalization (p = 0.002). The relative risks for cognitive decline and institutionalization in the control group compared with treatment group were 0.60 (p = 0.014), and 0.42 (p = 0.021), respectively. Conclusions: Continued ROT classes during the early to middle stages of dementia may delay nursing home placement and slow down the progression of cognitive decline.
Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q)
Authors: Middel Berrie , Bouma Jelte , de Jongste Mike , van Sonderen Eric , Niemeijer M G , van den Heuvel Wim 
Published: May 2003

Objective:To evaluate the psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q) in patients with atrial fibrillation. Design: A prospective study of the patients who underwent DC electrical cardioversion. Setting: Clinics of cardiology and thoracic surgery of the University Hospital in Groningen, the Netherlands. Main outcome measures: The disease-specific MLHF-Q and generic measures of quality of life were administered. The sensitivity to change over time was tested with effect sizes (ES). Internal consistency of MLHF-Q scales was estimated with Cronbach's alpha. To evaluate the construct validity multitrait–multimethod analysis was applied. The ‘known group validity’ was evaluated by the comparison of mean scores and effect sizes between two groups of the New York Heart Association (NYHA) classification (NYHA I versus II–III). Stability of MLHF-Q scales was estimated in a subgroup of patients who remained stable. Perfect congruence analysis and factor analysis were applied to confirm the a priori determined structure. Results: Cronbach's alpha was ≥0.80 of the MLHF-Q scales. Perfect congruence analysis (PCA) showed that the results resemble quite well the a priori assumed factor structure. Multitrait–multimethod analysis showed convergent validity coefficients ranging from 0.59 to 0.73 (physical impairment dimension) and 0.39 to 0.69 (emotional dimension). The magnitude of change can be interpreted as medium (ES = 0.50). The results of a ‘test–retest’ analysis in a stable group can be valued as satisfactory for the MLHF-Q scales (Pearson's r > 0.60). The physical dimension and the overall score of the MLHF-Q discriminated significantly between the NYHA I and II–III groups (p < 0.001) with large effect sizes (ES > 1.0). Conclusions: The MLHF-Q has solid psychometric properties and the outcome of the current study indicates that the MLHF-Q is an effective and efficient instrument.
A preliminary report on the effectiveness of trunk targeting in achieving independent sitting balance in children with cerebral palsy
Authors: Butler Penelope B 
Published: May 2003

Objective: To assess the potential of Targeted Training in initiating or accelerating improved movement control of the trunk and hip joints in children with cerebral palsy so that independent sitting balance without specialized seating could be achieved. Design: Six single case studies. Setting: Assessment and review were undertaken in a specialized centre with intervention in the subjects' home or school. Subjects: Children between the ages of two years five months and seven years five months (mean four years seven months) with an established diagnosis of cerebral palsy. None had independent sitting balance at the start of the study. Intervention: Targeted Training using specialized equipment was directed at the appropriate few joints of the trunk as determined by initial testing and progressed when control at those joints had become automatic. The equipment provided support and challenged control learning. Periods of no intervention and placebo intervention, when the equipment was inappropriately set up, were also used. Two of the children ceased their traditional physiotherapy input while Targeted Training or placebo training took place. Main outcome measure: A new test was devised and validated to determine the most caudal extent of control of the vertical posture. In addition, a functional test of independent sitting balance was defined. Results: All six children showed an increase in movement control and all gained independent sitting balance within 12–25 weeks (mean 16 weeks). This was irrespective of the continuation or cessation of traditional physiotherapy. Conclusion: These preliminary findings suggest that Targeted Training may be an effective means of promoting movement control and functional ability. Confirmation of these findings by other investigators would be of value.
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 , Kinebanian A 
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.
The effects of depression and abnormal illness behaviour on outcome following rehabilitation from stroke
Authors: Clark Michael S , Smith Dennis S 
Published: May 2003

Objective: To examine the relative effects of depression and abnormal illness behaviour (AIB) on long-term rehabilitation outcome following stroke. 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: Ninety-four twelve-month stroke survivors who had undergone an inpatient rehabilitation programme. Main outcome measures: AIB was assessed using the Illness Behaviour Questionnaire, and depression with the Zung Self-Rating Depression Scale. The General Health Questionnaire and a visual analogue mood scale were also used. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index. Results: Multivariate analysis of outcome controlled for age and stroke severity. AIB was a better predictor of functional competence and performance than either age or stroke severity, at rehabilitation discharge and both six and twelve months later. Depression was not related to functional competence and performance at any assessment, but was strongly predictive of an inactive lifestyle at both six and twelve months. By contrast, lifestyle activities were not related to AIB. Conclusions: Depression and AIB appear to have quite distinct effects on outcome. AIB emerged as a key determinant of long-term functional disability, while depression was associated with poorer social functioning. The early recognition and treatment of AIB and depression is important for the ultimate social and functional outcomes of stroke rehabilitation patients.
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.
An audit of anthropometric measurements by medical and physiotherapy staff in patients with ankylosing spondylitis
Authors: Lubrano Ennio , Butterworth Mike , Hesselden Anne , Wells Suzanne , Helliwell Philip 
Published: May 2003

Background: The main treatments for ankylosing spondylitis (AS) are physical (exercise and stretching), and one way of measuring the effectiveness of these therapies is to record spinal movements in a standardized way. Patients are often seen in both medical (rheumatology) and physiotherapy clinics where duplicate information on their progress may be obtained. The purpose of this study was to assess the completeness of data collection for patients attending both medical and physiotherapy clinics. Design: An audit of data recorded in medical and physiotherapy notes. Subjects: Patient records identified either from computerized databases (Huddersfield and Bradford) or from a clinic at which only AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients thus identified were then cross-matched against those patients attending for physiotherapy during the same period and, where a match occurred, the same data were retrieved from the physiotherapy notes. Minimum data set for audit: Before data collection started all participants agreed on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expansion, cervical rotation, tragus to wall, modified Schober's flexion, extension, lumbar side flexion, intermalleolar abduction, and interfingertip abduction. Results: Of 182 medical notes screened, 46 patients had not been seen in the defined period, leaving 136 notes to be reviewed. Of these, 52 patients had been seen in physiotherapy in the same period. In general, measurements were infrequently found in medical notes (only chest expansion in 58%, Schober's flexion in 48% and tragus to wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more complete (Schober's flexion and lumbar side flexion in 96%, height in 87%, intermalleolar distance in 87% and cervical rotation in 83%). Conclusions: Follow-up and monitoring of AS patients in these medical clinics is clearly inadequate. Physiotherapy-led clinics have already been started in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a combined approach to patient management.
Designing a Back Management Service: the Exeter experience and first year results
Authors: Rae S A , Smyth J Blood , Ivens M , Penney C 
Published: May 2003

Background: The recent British Clinical Standards Advisory Group report on back pain highlighted the importance of primary care in the active management of acute back pain and, at the same time, recommended the establishment of rehabilitation services for those with subacute and chronic back pain. Objective: To describe a new Back Management Service (BMS) in Exeter and to review the first year's results. Methods: Analysis of observational data collected from the clinic and therapy database. Assessments: Clinic outcome assessed by diagnostic and referral patterns as well as by general practitioner questionnaire. The Back Management Programme was assessed by Short Form 36 (SF36), Hospital Anxiety and Depression score (HAD) and Oswestry Disability Index (ODI). Results: In the first year 297 patients were seen in the clinic; clinic triage resulted in confirmation of primary care diagnosis in 235 (79%) of patients, with diagnosis revised in 62 (21%). One hundred and eighty-nine (63.6%) patients were referred for therapy. Of these, 54 were referred for one-to-one therapy and 135 were referred for multidisciplinary review with 29 patients subsequently recruited into the Back Management Programme for rehabilitation. Two out of three outcome measures were significantly improved at the end of the 36-hour, four-week course. Conclusions: A Back Management Service can provide useful diagnostic reassessment of patients with chronic low back pain, and can focus therapeutic effort for the effective management of their pain.
Cognitive assessment in elderly patients admitted to hospital: the relationship between the Abbreviated Mental Test and the Mini-Mental State Examination
Authors: Swain David G , O'Brien Alicia G , Nightingale Peter G 
Published: May 2003

Objective: To determine the relationship between Abbreviated Mental Test (AMT) and the Mini-Mental State Examination (MMSE) in elderly patients admitted to hospital. Design: Prospective study of 364 consecutive admissions to an elderly medicine unit. Eighty-eight (24.2%) patients were excluded. The AMT and MMSE were administered to the remaining 276 patients and the relationship between the two tests evaluated statistically. Setting: Inner city teaching hospital. Subjects: Two hundred and seventy-six patients admitted to the elderly medicine unit during October and November 1997. Main outcome measures: Predictive efficiency of the AMT for cognitive state by MMSE (the percentage of patients whose cognitive state by the MMSE was correctly categorized by the AMT). Association and predictive relationship between individual AMT and MMSE scores. Results: There was a significant relationship between cognitive state as determined by the AMT and MMSE:2 = 101.3, df = 1, p <0.001. The predictive efficiency of the AMT was 79.0% (218/276). A strong association was found between the AMT and MMSE (Somers' d statistic 0.75: p <0.001). Simple linear regression allowed prediction of the MMSE score from the AMT score as follows: MMSE score = 7.06 + (1.94 × AMT score); p <0.001. Conclusions: In patients admitted to the elderly medicine unit, the AMT gave predictive information about cognitive status as determined by the MMSE, and also a prediction of likely MMSE score.