bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Subjective Index of Physical and Social Outcome (SIPSO): a new measure for use with stroke patients
Authors: Trigg Richard , Wood Victorine A 
Published: May 2003

Objective: To develop a measure of social integration following stroke. Design: Question and response scale generation from qualitative interview-based work followed by item and factor analytic methods of test construction. Analysis of the psychometric properties of final index. Measures: Frenchay Activities Index, Nottingham Health Profile, Wakefield Depression Inventory, Barthel Index. Setting: Community setting, Bath, UK. Subjects: Two hundred and sixty survivors of stroke, discharged at least six months previously from a general hospital. Results: A 10-item Subjective Index of Physical and Social Outcome (SIPSO) was developed. Each question is scored on a scale of 0–4 with a low score indicating a poor level of integration. From the 157 completed questionnaires, total scores ranged from 0 to 40 with a median of 24 (interquartile range 15–32). Initial testing of the psychometric properties of the SIPSO suggest that it is able to provide assessment of two distinct areas of patient integration. From analysis of completed questionnaires it is suggested that questions 1–5 on the SIPSO measure a factor related to physical functioning/mobility whilst questions 6–10 measure a factor related to social/emotional functioning. Internal consistency, test–retest reliability and construct validity were established. Conclusions: The SIPSO provides a brief, valid and reliable assessment of an individual's ability to reintegrate to a ‘normal’ lifestyle. The SIPSO differs from other measures in that it provides assessment of both quantity and quality of activities and interaction, reflecting an individual’s ability to reintegrate to his/her own satisfaction. As a 10-item self-report questionnaire the SIPSO can be administered quickly and cheaply to large numbers of patients.
Quadriceps muscle weakness following acute hemiplegic stroke
Authors: Harris M L , Polkey M I , Bath P MW , Moxham J 
Published: May 2003

Objective: To determine whether quadriceps muscle weakness develops on the side ipsilateral to the brain lesion in the first week following acute ischaemic hemiplegic stroke. Design: A prospective study of muscle strength. Setting: Acute stroke unit (ASU) in a teaching hospital. Subjects: Ten patients admitted within 48 hours of stroke onset, and 10 healthy age-matched controls. Interventions: Repeat nonvolitional measurements of quadriceps muscle strength of the unaffected limb in patients and the right leg in normal subjects using magnetic femoral nerve stimulation (MS), prospectively one week apart. In addition the level of voluntary activation was assessed during a maximum voluntary contraction (MVC) manoeuvre. The Trunk Control Test (TCT) was measured in the patients. Results: The median (95% confidence interval, (CI)) baseline quadriceps twitch tension (Tw Q) and MVC in the control group were 9.4 kg (6.1–12.5 kg) and 37.2 kg (23.8–54.6 kg), and in the stroke group were 7.6 kg (4.4–9.9 kg) and 12.15 kg (7.9–30.8 kg). The median (95% CI) change in Tw Q and MVC respectively between baseline and one week later were 1.75% (–9.8 to 8%) and 5.45% (–15.1 to 22.7%) (NS) in the control group and –16.2% (–6 to –25.9%) and –30.45% (0 to –78.6%) (p < 0.01) in the stroke patients. There was a significant correlation between the percentage fall in Tw Q and both change in TCT (rs = 0.83, p < 0.01) and percentage change in body weight (rs = 0.83, p < 0.01). Conclusion: In the first week after acute hemiplegic stroke, weakness develops in the unaffected leg.
Too many pre-discharge home assessment visits for older patients? A postal questionnaire survey
Authors: Patterson C J , Viner J , Saville C , Mulley G P 
Published: May 2003

Objective: To investigate current practice of pre-discharge home assessment visits for older patients. Design: Postal questionnaire survey. Setting: NHS Trust hospitals in the United Kingdom. Subjects: Occupational therapy departments in 265 NHS Trust hospitals which admit acutely ill older patients. Main outcome measures: The number of pre-discharge home visits done, who went, and therapy time spent on home visits. Results: Of 265 NHS Trusts contacted, 239 (90%) replied. Of 238 units, 155 (65%) do between 11 and 40 visits per month, with 25 (11%) doing more than 60. The equivalent of one day per week or more is spent doing home visits by Senior I occupational therapists in 107 (45%) units and by Senior II staff in 126 (53%) units. Carers or relatives, unqualified occupational therapists, social workers and home care managers accompany the patient and occupational therapist on most home visits. Conclusion: Therapy perception is that pre-discharge home assessment visits are increasing in number, complexity and involvement of professional time despite little evidence for their effectiveness. Controlled trials are required to assess which patients are likely to benefit.
The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users' opinions
Authors: Tyson S F , Thornton H A 
Published: May 2003

Objective: To assess the effect of a hinged ankle foot orthosis (AFO) on functional mobility and gait impairments in people with a severe hemiplegia undergoing rehabilitation, and to investigate the patients' views of the hinged AFO. Design: With/without group comparison, and face-to-face questionnaire. Subjects and setting: Twenty-five subjects over 18 years, with a hemiplegia following cerebrovascular accident (CVA) undergoing rehabilitation in a regional rehabilitation unit. Outcome measures: Functional Ambulation Categories as a measure of disability. Paper walkways to measure gait impairments – stride length, step length, symmetry, cadence and velocity. Face-to-face questionnaire to determine the users' opinion of the hinged AFO. Results: Comparison of gait with and without the hinged AFO showed significant improvements in functional mobility (p = 0.000) and in some gait impairments; stride length of the weak (p < 0.005, 95% CI –8.1, –1.6) and sound legs (p < 0.014, 95% CI –8, –1), velocity (p = 0.00, 95% CI –0.1, –0.03) and cadence (p < 0.002, 95% CI –15.1, –3.8). No effect was found for step length in the weak or sound leg or symmetry. The subjects' response was positive, 24 (96%) felt they walked better with the AFO and found it comfortable. Twenty-three (92%) were unbothered by the appearance and 16 (64%) could doff and don it. Conclusion: The hinged AFO improved objective measures of gait impairments and disability and patients were positive about it.
Base rate of post-concussion symptoms among normal people and its neuropsychological correlates
Authors: Chan Raymond CK 
Published: May 2003

Objective: To explore the base rate of symptoms similar to those of post-concussion symptoms (PCS) among a group of participants without head injury. The effect of subjective complaints upon cognitive functioning was also examined. Design: A cross-sectional study. Participants: A total of 85 participants without head injury, other identifiable neurological diseases or psychiatric diseases were recruited. Outcome measures: These included Rivermead Post-concussion Symptoms Checklist, Cognitive Failures Questionnaire, Colour Trails Test, Stroop Word-Colour Test, Paced Auditory Serial Addition Test, Symbol Digits Modality Test, Word Fluency Test, Design Fluency Test, Digits Forward and Backward Span Test, and Modified Six Elements Test. Results: A relatively high proportion of the participants reported symptoms similar to those of patients with PCS. These included longer time to think (65.9%), forgetfulness (58.9%), poor concentration (58.9%), fatigue easily (53.5%), and sleep disturbances (50.6%). Gender effect was not significant for either the individual item or the total score of the Rivermead Post-concussion Symptoms Checklist. Moreover, there was no difference found between low symptom reporters and high symptom reporters in terms of attention, working memory, mental fluency, and strategy allocation. Conclusion: The base rates of symptoms were consistent with previous studies among the nonclinical groups. However, persons reporting a high score of concussion-like symptoms did not perform less well than those reporting a low score of symptoms in attention, working memory, mental fluency and strategy allocation.
Weight-bearing, pain and walking velocity during primary transtibial amputee rehabilitation
Authors: Jones M E , Bashford G M , Bliokas V V 
Published: May 2003

Objective: To explore the relationships between weight-bearing, pain and walking velocity in the first four weeks of prosthetic training. Subjects: Consecutively referred transtibial amputees (n = 27). Design: Longitudinal study. Setting: Inpatient rehabilitation centre. Interventions: Measurements of static weight-bearing (SWB), perceived pain during the SWB test and self-selected walking velocity (VEL) were taken at entry, and at four weeks into the prosthetic training programme. Path analysis was conducted using a series of linear regression analyses to determine predictors of walking velocity at week 4. Results: Significant improvements from week 1 to week 4 were found in SWB, reported pain and velocity. SWB at week 4, when coupled with age, predicted 66% of the variance in walking velocity at week 4. Pain did not directly predict velocity. However, SWB at entry and perceived pain at week 4 predicted 56% of the variance in SWB at week 4. Conclusions: These analyses suggested a model in which SWB and age were both significantly related to velocity, and further, that pain played a role in velocity through a relationship mediated by its direct effect on SWB. Unlike age, SWB is a predictor of velocity that might be altered through pain reduction, wound-healing and rehabilitative interventions.
Walking speed over 10 metres overestimates locomotor capacity after stroke
Authors: Dean Catherine M , Richards Carol L. , Malouin Francine 
Published: May 2003

Objective: To examine 10-m comfortable walking speed and 6-minute distance in healthy individuals and individuals after stroke and to assess the level of disability associated with poor walking endurance after stroke. Design: Descriptive study in which comfortable walking speed over 10 m and distance covered in 6 minutes (6-minute walk test) were compared between healthy subjects and subjects after stroke. Subjects: Twelve healthy subjects and 14 subjects after stroke. Main outcome measures: Walking speed and 6-minute distances were compared between groups. In addition, for each group, actual distance walked in 6 minutes was compared with the distance predicted by the 10-m walking speed test and the distance predicted by normative reference equations. Results: Subjects after stroke had significant reductions in 10-m speed and 6-minute distance compared with healthy subjects (p < 0.05). Subjects after stroke were not able to maintain their comfortable walking speed for 6 minutes, whereas healthy subjects walked in excess of their comfortable speed for 6 minutes. The average distance walked in 6 minutes by individuals after stroke was only 49.8 ± 23.9% of the distance predicted for healthy individuals with similar physical characteristics. Conclusion: In our subjects after stroke, walking speed over a short distance overestimated the distance walked in 6 minutes. Both walking speed and endurance need to be measured and trained during rehabilitation.
A pilot study of attention deficits, balance control and falls in the subacute stage following stroke
Authors: Stapleton Tadhg , Ashburn Ann , Stack Emma 
Published: May 2003

Objectives: To (1) identify and monitor changes in deficits of attention and balance in the subacute stage following stroke, (2) investigate fall events, (3) explore relationships between deficits of attention, balance and falling post stroke. Design: A prospective observational study. Setting: Hospitalized patients with stroke were recruited from a rehabilitation ward. Subjects: Fourteen subjects were recruited, 13 subjects (age 21–80 years) completed all assessments. Ten had right and three had left hemispheric lesions. Eight subjects were male. Main outcome measures: Subjects were assessed on two occasions during a six-week period. Standardized tests were used to measure unilateral visual neglect, sustained and selective attention and balance. Fall histories were collected by chart review and semi-structured interview. Results: At the initial assessment six subjects had sustained auditory attention deficit, eight had deficits of auditory selective attention, 12 had visual selective attention deficits and seven subjects presented with visual inattention. Scores for visual inattention and visual selective attention improved over time (p = 0.006, p = 0.026 respectively) as did scores for balance control (p = 0.001). Auditory selective attention scores at the first assessment were found to correlate with measures of balance (p < 0.01), subjects with normal attention scores achieved better balance scores. Four subjects fell at least once during the six weeks. Scores for attention and balance of fallers were not found to be significantly different from the scores of nonfallers. Conclusions: The sample size was small but high levels of attention deficit were identified. Findings suggest a weak or no relationship between attention deficits and falls. Further studies are required to explore the extent of attention deficits post stroke and its impact on balance control and falling.
Can the site of brain lesion predict improved motor function after Low-TENS treatment on the post-stroke paretic arm?
Authors: Sonde Lars , Bronge Lena , Kalimo Hannu , Viitanen Matti 
Published: May 2003

Objectives: Previous reports suggest that afferent stimulation improves arm motor function in patients suffering from stroke. The aim of this pilot study was to test the hypothesis that the brain lesion location determines the response to low-frequency (1.7 Hz) transcutaneous electric nerve stimulation (Low-TENS) therapy. Design: Magnetic resonance imaging (MRI) was performed on 14 patients who had previously received Low-TENS on the paretic arm after stroke. Methods: MR images were classified with two different methods. First, lesions in the cortical and the subcortical areas were registered. Secondly, any change in a described periventricular white matter (PVWM) area was recorded. Interactions between the lesion site, as detected by MRI, and response to Low-TENS treatment were analysed. Results: Arm motor function after Low-TENS treatment in relation to lesion in different brain areas showed that absence of lesions in the PVWM area increased the possibility for improved motor capacity after afferent stimulation. Conclusions: The site of lesion may play a role in prognosis/outcome after Low-TENS treatment but this hypothesis should be further tested in a larger prospective study.
Quadriceps strength and timed motor performances in myotonic dystrophy, Charcot–Marie–Tooth disease, and healthy subjects
Authors: Lindeman Eline , Leffers Pieters , Reulen Jos , Spaans Frank , Drukker Jan 
Published: May 2003

Background and purpose: The leading hypothesis was that a relation exists between muscular strength and functional abilities. Therefore a study was undertaken to quantify such a relationship in a population of subjects with different muscular strengths. This population consisted of healthy subjects and subjects with slowly progressive neuromuscular disorders. Methods: The study included 33 patients with myotonic dystrophy, 29 patients with Charcot–Marie–Tooth disease and 20 healthy subjects. Isokinetic and isometric knee torques were measured on an isokinetic dynamometer at various velocities. The following activities were timed: descending and ascending stairs, rising from a chair, rising from supine, walking at natural speed and walking at maximum speed. Results: The population covered a wide range of the variables: whereas the healthy subjects performed best (i.e. had the highest knee torques and performed the activities most quickly), the myotonic dystrophy group included the subjects with the lowest knee torques. The natural logarithms (ln) of isokinetic extension torque at the highest velocity (120°/s) and those of the time taken to perform the described activities showed the highest levels of correlation. It was found that after correction for age and weight, 56% (walking at natural speed) to 73% (descending stairs) of the variance in the ln of the time taken could be attributed to the variance in the ln of the torques. Conclusion and discussion: A strong relation between quadriceps strength and timed motor performances were demonstrated. The impact of strength reduction on time taken was most obvious in subjects with considerably decreased strength. Therefore, it is feasible to try to influence muscle strength in patients with relevant strength reduction in order to achieve better functional ability.
What do patients and their carers want to know about stroke? A two-year follow-up study
Authors: Hanger H C , Walker G , Paterson L A , McBride S , Sainsbury R 
Published: May 2003

Objective: To clarify what issues are important to stroke patients and their carers. To determine whether these issues change over time. Design: Prospective study of consecutive patients admitted to hospital with a diagnosis of an acute stroke. Each participant had interviews at six and 24 months. In addition, a subgroup of these patients (consecutive discharges over a two-month period) were also seen at two weeks post discharge. Setting and subjects: Hospital-based cohort of stroke survivors. Interviewed in their own homes. Main outcome measures: Documentation of the questions asked. Results: At two weeks, six and 24 months, a median of three, two and three questions were asked by each patient respectively. Enquiries about basic aspects of stroke were common but diminished over time. Fear of recurrence was apparent at all three interview periods. Enquiries about the psychological sequelae of stroke became more prevalent at six and 24 months. At two years, 32% of respondents asked about concentration/memory difficulties with smaller numbers commenting on tiredness, depression and frustration. At two years, 18% of the sample were still uncertain of their chances of further recovery. Conclusions: Patients with stroke continue to have unanswered questions even two years after their stroke. The types of questions asked changed over time.
The impact of an information pack on patients with stroke and their carers: a randomized controlled trial
Authors: Mant Jonathan , Carter Judy , Wade Derick T , Winner Simon 
Published: May 2003

Objectives: To assess the impact of information packs on patients with stroke and their carers, and to pilot some of the methodology for a trial of a Family Support Organiser (FSO). Subjects: Seventy-one patients admitted to Oxford hospitals with acute stroke during February–July 1995, and 49 informal carers of these patients. Design: Randomized controlled trial. Intervention group received an information pack containing various Stroke Association publications one month after their stroke, or at discharge from hospital, whichever was sooner. Control group received nothing. Follow-up was by interview at the place of residence of the patients six months after their stroke. Measures: Outcome measures assessed knowledge about stroke; satisfaction with information received; patient behaviour in terms of access to community services and benefits; and health status and quality of life. Results: Patients and carers in the intervention group tended to know more about stroke, but these differences were not significant once adjusted for age. Patients in the intervention group (but not carers) tended to be more satisfied with the information that they had received, but the differences were not significant. There were no differences with regard to any aspects of quality of life in patients in the intervention group, though carers in the intervention group were found to have significantly better mental health ( p = 0.04). Conclusions: While the study was too small to generate firm conclusions, information leaflets may lead to improved knowledge about stroke several months after they have been distributed. This finding is worth following up with larger studies. The stroke knowledge questionnaire that was piloted in this trial seems to be able to detect differences between groups.
Environmental influences on the cumulative structure of instrumental ADL: an example in osteoporosis patients in a Swedish rural district
Authors: Iwarsson Susanne 
Published: May 2003

Introduction: The ADL Staircase is a hierarchical instrument for the assessment of dependence/independence in personal and instrumental activities of daily living (P-ADL and I-ADL). Previous results indicated that environmental factors might affect assessment results, and revisions for use in rural areas have been tested with a gerontological population sample. Objective: To investigate further the cumulative structure of I-ADL in osteoporosis patients in a Swedish rural district. Method: Patients were interviewed consecutively concerning their pre-injury dependence in P-ADL and I-ADL, using a revised version of the ADL Staircase ( n = 276). Results: In contrast to results from urban areas, ‘transportation' was the activity generating the most dependence among the respondents. In addition, different gender-specific cumulative orders among I-ADL were demonstrated. Guttman's scaling analysis confirmed the cumulativity of the revised scale (C of R = 0.94/0.97, C of S = 0.77/0.88). Conclusion: Environmental factors influence the validity of instruments as well as the prevalence of disability.
The views of therapists on the use of a patient-held record in the care of stroke patients
Authors: Ayana Mulunish , Pound Pandora , Ebrahim Shah 
Published: May 2003

Objective: To explore the views of therapists working with stroke patients on the use of a patient-held record (PHR) for stroke patients. A PHR was developed in the form of a pocket-sized booklet (21 cm × 14.5 cm) in which staff recorded information relating to the patient's management. The aim of the PHR was to facilitate communication and involve patients more directly in their care. Methods: Six semi-structured group interviews were conducted with therapists (25 in total) from one inner city hospital. Results: The following themes emerged from the content analysis: (1) Therapists were supportive of plans for a PHR, citing the benefits of greater patient involvement. (2) However, they questioned its feasibility, in particular the issue of patient responsibility and its use with the cognitively impaired. (3) They also questioned its ability to facilitate communication among health professionals because of existing differences in perspectives. (4) These therapists revealed concerns about the effect that information may have on patients. (5) They also raised practical issues about finding the time to make entries, wording and content of entries in the PHR. Conclusion: Responsibility for the PHR may enhance patients' understanding and involvement in their care, yet ownership alone does not guarantee the confidence needed to encourage dialogue between patients and care providers. Furthermore, it is doubtful whether a PHR can hope to overcome the fundamental differences in the philosophies of care which the therapists reported.