bluuebunny/crossref_metadata_2025_split huggingface dataset:
Walking speed on parquetry and carpet after stroke: effect of surface and retest reliability
Authors: Stephens Joan M , Goldie Patricia A 
Published: May 2003

Objective: At the transition stage from rehabilitation to home this study aimed to (1) investigate the effect of floor surface (carpet and parquetry) on walking speed; (2) investigate whether there was a difference between these surfaces as stroke patients voluntarily increased from comfortable to fast pace; (3) investigate whether walking speed on parquetry was a predictor of walking speed on carpet at the two paces; (4) investigate whether walking speed at a comfortable pace was a predictor of walking speed at a fast pace on the two surfaces; and (5) quantify systematic and random error in repeated measurements for fast-paced walking trials. Design: Subjects walked 10 metres at comfortable and fast paces on carpet and parquetry on two consecutive days. Setting: Inpatient rehabilitation centre. Subjects: Twenty-four stroke patients. Main outcome measure: Walking speed. Results: Two-way analysis of variance confirmed that patients walked more slowly on carpet than parquetry (F(1,23) = 5.3, p<0.05) at both paces; the interaction effect was not significant (p>0.05). Walking speed on parquetry was a strong predictor of walking speed on carpet at a comfortable (r= 0.92), and fast pace (r= 0.97). Walking speed at comfortable pace was a moderately strong predictor of walking speed at fast pace on parquetry (r= 0.84),and on carpet (r= 0.88). Random error in repeated measurements was higher when walking fast on carpet (7.21 m/min) and parquetry (8.32 m/min) than when walking at a comfortable pace on carpet (4.63 m/min) and parquetry (3.48 m/min). Systematic error was negligible (p<0.05). Conclusion: Carpet surface was more challenging than parquetry surface, as evidenced by the systematic decrease in walking speed. This may have been due to lack of familiarity. Relative to the wide range of scores in the group, stroke patients showed consistency of walking speed across both surfaces. Likewise, stroke patients retained their relative position in the group as they changed from a comfortable to a fast walking pace. The difference in random error between comfortable and fast-paced trials highlights the need to quantify error in the repeated measurement situation according to specific test conditions.
Development of a scale to assess nurses' knowledge of stroke: a pilot study
Authors: Thomas Lois , Harrington Kate , Rogers Helen , Langhorne Peter , Smith Monica , Bond Senga 
Published: May 2003

Objective: To develop and test an evidence-based scale to assess nurses' knowledge of stroke. Design: Question development by a multidisciplinary group of experts in stroke. Two self-completion questionnaire surveys. Setting: Two stroke units, one general medical and two elderly care wards in three hospitals in the North-East of England. Subjects: Fifty-eight qualified nurses. Interventions: Scale to assess nurses' knowledge of stroke. Results: The overall response rate was 60%. Nurses on stroke units knew more about stroke than those in medical/elderly care wards. The scale was capable of discriminating between stroke units and medical /elderly care wards: mean difference was 4.18 (95% confidence intervals 1.68–6.69; p <0.001). Cronbach's α was 0.7 indicating adequate internal consistency. Item non-response did not exceed 10% for any question. Conclusions: We have developed a knowledge of stroke scale capable of discriminating between nurses based in stroke units and medical/elderly care wards, with low item non-response and adequate internal consistency. The scale is suitable for use as a component of studies evaluating the nursing of stroke patients.
Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support
Authors: Hesse S , Uhlenbrock D , Sarkodie-Gyan T 
Published: May 2003

Objectives: To investigate to what extent and with how much therapeutic effort nonambulatory stroke patients could train a gait-like movement on a newly developed, machine-supported gait trainer. Design: Open study comparing the movement on the gait trainer with assisted walking on the treadmill. Setting: Motion analysis laboratory of a rehabilitation centre. Subjects: Fourteen chronic, nonambulatory hemiparetic patients. Intervention: Complex gait analysis while training on the gait trainer and while walking on the treadmill. Main outcome measures: Gait kinematics, kinesiological EMG of several lower limb muscles and the required assistance. Results: Patients could train a gait-like movement on the gait trainer, characterized kinematically by a perfect symmetry, larger hip extension during stance, less knee flexion and less ankle plantar flexion during swing as compared to treadmill walking ( p <0.01). The pattern and amount of activation of relevant weight-bearing muscles was comparable with an even larger activation of the M. biceps femoris on the gait trainer ( p <0.01). The tibialis anterior muscle of the nonaffected side, however, was less activated during swing ( p <0.01). Two therapists assisted walking on the treadmill while only one therapist was necessary to help with weight shifting on the new device. Conclusion: The newly developed gait trainer offered severely disabled hemiparetic subjects the possibility of training a gait-like, highly symmetrical movement with a favourable facilitation of relevant anti-gravity muscles. At the same time, the effort required of the therapists was reduced.
The Northwick Park Care Needs Assessment (NPCNA): a measure of community care needs: sensitivity to change during rehabilitation
Authors: Nyein Kyaw , Turner-Stokes Lynne , Robinson Ian 
Published: May 2003

Objectives: To determine whether the Northwick Park Care Needs Assessment (NPCNA) is sensitive to change occurring during rehabilitation and provides a reliable estimate of care needs in the community, and to compare the NPCNA with the Functional Independence Measure (FIM). Design: Prospective cohort study. Setting: Postacute neurorehabilitation unit for young patients with complex disabilities. Subjects: Thirty-nine consecutive patients with brain injury admitted over six months. Measurements and methods: The NPCNA was assessed on admission and at discharge. Two subsets of patients were also assessed (a) at three-month follow-up in the community (n = 15), and (b) both in hospital and in the home environments at the discharge time point (n = 28). Data were compared with FIM scores on admission and discharge. Results: The median total weekly care hours fell from 52 hours (interquartile range (IQR) 25–66) on admission, to 17 hours (IQR 6–46) on discharge (p<0.001). There was a median reduction of approximate weekly cost of care from £600 (IQR £224–824) to £168 (IQR £56–280) (p<0.001). These benefits were sustained at follow-up, and the NPCNA measured in hospital at discharge gave a good estimation of the care hours and weekly cost of care in the community at three months after discharge. There was no significant correlation with FIM gain. Conclusions: In this study the NPCNA, measured while the patient was still in hospital, gave a good estimation of care needs in the community and was sensitive to change occurring during rehabilitation in patients with severe complex disabilities.
The process of stroke rehabilitation: what happens and why
Authors: Tyson Sarah F , Turner Gill 
Published: May 2003

Objective: To assess the process of hospital-based stroke rehabilitation. Design: A criterion-based process audit, combined with surveys of patient and staff opinions and basic outcome measures. Setting: All wards and units treating stroke patients in a health care district, including an acute and a community National Health Service (NHS) trust. Subjects: Process audit: documented notes of 115 stroke patients admitted over a four-month period. Patient satisfaction survey: 93 surviving stroke patients. Staff opinion survey: Hospital doctors, therapists and nurses treating stroke patients throughout the district. Results: A disappointingly poor level of service. The main shortcomings were poor assessment of impairment (pass rate, 46%), inadequate communication between staff and with patients and carers (pass rate, 43%), and an absence of rehabilitation beyond the basic of activities of daily living and indoor mobility (pass rate for assessment of disability and emotional need, 50%). Thirty-three per cent of patients were dissatisfied with the hospital-based service they received, particularly lack of therapy, information and recovery. The main reasons for these shortcomings were low priority given to stroke patients, lack of time, shortage of staff, and lack of knowledge and awareness of stroke amongst the staff. Rehabilitation units and elderly care tended to perform better than general medical units in areas of assessment of impairment, self-care skills and mobility, and wheelchair provision. Conclusions: Evidence from previous publications suggests that this service was no worse than in other districts, but this audit methodology, by comprehensively examining many aspects of a service together, is better able to reveal inadequacies.
The Functional Assessment Measure (FIM + FAM) as part of the hospital discharge summary after brain injury rehabilitation
Authors: Pentland Brian , Hellawell Deborah J , Benjamin Jacob 
Published: May 2003

Objective: To assess the value of providing Functional Assessment Measure (FIM + FAM) data as part of the hospital discharge information after brain injury rehabilitation. Design: Postal survey of general practitioners (GPs) and consultants. Subjects: Consecutive discharges (n = 117) from an early brain injury rehabilitation unit over one year. Results: Response rates were 81% from GPs and 54% from consultants. Eighty-four (89%) of GPs and 57 (82%) of consultants rated the information as useful; 87 (92%) and 51 (84%) respectively described the accompanying notes as easy to understand. Conclusions: The incorporation of FIM + FAM data in discharge summaries is worthwhile but the utility of this practice is still to be established.
The effectiveness of predischarge home assessment visits: a systematic review
Authors: Patterson C J , Mulley G P 
Published: May 2003

Objective: To evaluate the effectiveness of predischarge home assessment visits for elderly patients. Design: Systematic review. Methods: A computer-aided search was conducted using the databases of Medline and Cinahl. Any studies investigating predischarge home assessment visits were included in the analysis. Results: No randomized controlled trials were found. Only five studies (two retrospective surveys, three observational surveys) were identified. In four of these, a possible benefit for home visiting was suggested. Conclusions: Little evidence exists for the effectiveness of predischarge home assessment visits. Further research is needed to establish their value.
A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity
Authors: Pandyan A D , Johnson G R , Price C I M , Curless R H , Barnes M P , Rodgers H 
Published: May 2003

Background: The Ashworth Scale and the modified Ashworth Scale are the primary clinical measures of spasticity. A prerequisite for using any scale is a knowledge of its characteristics and limitations, as these will play a part in analysing and interpreting the data. Despite the current emphasis on treating spasticity, clinicians rarely measure it. Objectives: To determine the validity and the reliability of the Ashworth and modified Ashworth Scales. Study design: A theoretical analysis following a structured literature review (key words: Ashworth; Spasticity; Measurement) of 40 papers selected from the BIDS-EMBASE, First Search and Medline databases. Conclusions: The application of both scales would suggest that confusion exists on their characteristics and limitations as measures of spasticity. Resistance to passive movement is a complex measure that will be influenced by many factors, only one of which could be spasticity. The Ashworth Scale (AS) can be used as an ordinal level measure of resistance to passive movement, but not spasticity. The modified Ashworth Scale (MAS) will need to be treated as a nominal level measure of resistance to passive movement until the ambiguity between the ‘1’ and ‘1+’ grades is resolved. The reliability of the scales is better in the upper limb. The AS may be more reliable than the MAS. There is a need to standardize methods to apply these scales in clinical practice and research.
Quality of life and the ICIDH: towards an integrated conceptual model for rehabilitation outcomes research
Authors: Post Marcel WM , de Witte Luc P , Schrijvers Augustinus JP 
Published: May 2003

Objective: The development of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) has led to the assessment of a wider range of relevant rehabilitation outcomes, but a need for a further broadening exists. In this article, a new proposal for an extended ICIDH is made. Method: Review of the literature on quality of life and of attempts to integrate the World Health Organization (WHO) biopsychosocial model and the ICIDH. Results: Our review shows three operationalizations of the concept of quality of life: as health, as well-being and, preferably, as a superordinate construct. None of the attempts to integrate the WHO biopsychosocial model have been entirely successful. Our new proposal is characterized by (a) incorporation of the organ, person and social levels of the ICIDH, (b) distinction between objective and subjective aspects of quality of life as a second axis in the model, resulting in somatic sensations as the subjective part of the organ level, perceived health as the subjective part of the person level and domainspecific life satisfaction as the subjective part of the social level, and (c) separation of the concept of general well-being or happiness as being distinct from the ICIDH. The proposal model is intended to serve as a framework in which different outcomes can be positioned in relation to each other. Conclusion: Our model is intuitively appealing and remains close to familiar concepts and models. However, it is as yet far from perfect, and we hope to provoke discussion to help further refinement.
Can a Barthel score be derived from the FIM?
Authors: Nyein Kyaw , Mcmichael Linsey , Turner-Stokes Lynne 
Published: May 2003

Objective: To establish whether a Barthel score derived by translation from the motor items of the Functional Independence Measure (FIM) would equate to the directly scored measure. Design: Conversion criteria for motor item scores on the FIM scale to Barthel scores were first developed. To test these criteria, 40 consecutive patients were assessed for Barthel and FIM scores by the multidisciplinary team who were unaware of the conversion criteria. The derived Barthel score was compared with the directly scored Barthel Index. Results: A very high degree of correlation was observed between total scores of the direct and derived Barthel (Spearman's rho = 0.99), which is highly significant, and no significant differences were seen between scores for any of the individual items (Wilcoxon signed rank test). Item by item analysis across the study population was undertaken to confirm the conversion criteria. Absolute agreement between the two methods ranged from 75 to 100% and kappa values from 0.53 to 1.0. Conclusions: This study demonstrates that a Barthel Index can be derived from the motor items of the FIM and there is a good agreement with the directly assessed Barthel score. Although a larger study may help to delineate the exact conversion criteria for one item, the current system provides an accurate and usable translation of the total score and serves as a major step towards achieving a common language in outcome measurement for rehabilitation.
Phase I Study of an Oral Formulation of ZD9331 Administered Daily for 28 Days
Authors: Sawyer Michael B. , Ratain Mark J. , Bertucci Donna , Smith Robert P. , Schilsky Richard L. , Vogelzang Nicholas J. , Shulman Keith , Douglass Edwin C. , Fleming Gini F. 
Published: April 2003

Purpose: To define the maximum-tolerated dose and dose-limiting toxicities (DLTs) of an oral formulation of ZD9331, a novel thymidylate synthase inhibitor that is not a substrate for folylpolyglutamate synthase. Patients and Methods: Patients had Cancer and Leukemia Group B performance status ≤ 2 and refractory solid tumors. Initially, patients received ZD9331 daily for 2 weeks, with the duration of treatment escalated to a maximum of 4 weeks, followed by a 2-week rest period. Once the maximum-tolerated duration of treatment was determined, the dose of ZD9331 was increased until DLT occurred. Results: Fifty-five patients were enrolled at eight dose levels. The DLTs were thrombocytopenia and neutropenia. At 3 mg/d, two of 19 patients developed DLT; one patient had grade 3 thrombocytopenia and grade 4 neutropenia, and the other patient had grade 3 thrombocytopenia only. Anemia was common, with a median hemoglobin nadir of 75% of baseline, before recovery or transfusion. The apparent oral clearance of ZD9931 was 11.6 ± 6.3 mL/min. Dose-limiting myelosuppression was associated with both an increased 24-hour ZD9931 concentration and blood urea nitrogen. Conclusion: The recommended phase II dose on this schedule is 3 mg/d for 4 weeks, followed by a 2-week rest period. ZD9331 seems to have a manageable toxicity profile, although it should be used with caution in patients with renal impairment.
Phase III Double-Blind Study of Glutamine Versus Placebo for the Prevention of Acute Diarrhea in Patients Receiving Pelvic Radiation Therapy
Authors: Kozelsky Timothy F. , Meyers Gregory E. , Sloan Jeff A. , Shanahan Thomas G. , Dick Stephen J. , Moore Randy L. , Engeler George P. , Frank Albert R. , McKone Timothy K. , Urias Rodolfo E. , Pilepich Miljenko V. , Novotny Paul J. , Martenson James A. 
Published: April 2003

Purpose: A phase III, randomized, double-blind study was conducted by the North Central Cancer Treatment Group to determine the efficacy and toxicity of oral glutamine for the prevention of acute diarrhea in patients receiving pelvic radiation therapy (RT). Patients and Methods: All 129 patients enrolled from 14 institutions between February 1998 and October 1999 were eligible. Patients received 4 g of glutamine or placebo orally, twice a day, beginning with the first or second day of RT and continuing for 2 weeks after RT. During treatment, patients were assessed weekly for toxicity, and a bowel function questionnaire was administered. The primary measures of treatment efficacy were diarrhea levels measured by maximum grade of diarrhea, incidence of diarrhea, and average diarrhea score. After completion of RT, the bowel function questionnaire was administered weekly for 4 weeks and at 12 and 24 months. Toxicity was measured by National Cancer Institute common toxicity criteria. Results: The median age of patients was 69 years (range, 34 to 86 years). The two treatment arms were balanced with respect to all baseline factors. There were no significant differences in toxicity by treatment. Quality-of-life scores and the mean number of problems reported on the bowel function questionnaire were virtually identical for both treatment groups. The incidence of grade 3 or higher diarrhea was 20% for the glutamine arm and 19% for the placebo arm (P = .99). The maximum number of stools per day was 5.1 for the glutamine arm and 5.2 for the placebo arm (P = .99). Conclusion: There is no evidence of a beneficial effect of glutamine during pelvic RT.
Flavopiridol in Untreated or Relapsed Mantle-Cell Lymphoma: Results of a Phase II Study of the National Cancer Institute of Canada Clinical Trials Group
Authors: Kouroukis C. Tom , Belch Andrew , Crump Michael , Eisenhauer Elizabeth , Gascoyne Randy D. , Meyer Ralph , Lohmann Reinhard , Lopez Pedro , Powers Jean , Turner Robert , Connors Joseph M. 
Published: April 2003

Purpose: To determine the response rate and toxicity of flavopiridol in patients with previously untreated or relapsed mantle-cell lymphoma. Patients and Methods: Adult patients with previously untreated or in first or second relapse of previously responsive mantle-cell lymphoma were given flavopiridol 50 mg/m2/d by intravenous bolus for 3 consecutive days every 21 days with antidiarrheal prophylaxis. Flavopiridol was continued until disease progression, unacceptable toxicity, or stable disease for four cycles. Disease was reassessed every two cycles. Results: From 33 registered patients, 30 were eligible after pathology review, 30 were assessable for toxicity, and 28 were assessable for response. A median of four cycles of treatment was administered; 90% of patients received at least 90% of planned dose-intensity. No complete responses were seen; three patients had a partial response (11%), 20 patients had stable disease (71%), and five patients had progressive disease (18%). The median duration of response was 3.3 months (range, 2.8 to 13.2 months). The most common toxicities were diarrhea (97%), fatigue (73%), nausea (47%), and vomiting (27%). At least one nonhematologic grade 3 or 4 toxicity was seen in 14 patients (47%). Hematologic toxicity was modest. Conclusions: Flavopiridol given as a daily bolus for 3 consecutive days every 3 weeks has modest activity as a single agent for mantle-cell lymphoma. The number of stable and partial responses that was seen indicates that it is biologically active and may delay progression. Future studies in mantle-cell lymphoma should test this agent with other active agents and using different schedules.
Multiple Approach to the Exploration of Genotype-Phenotype Correlations in Familial Adenomatous Polyposis
Authors: Bertario L. , Russo A. , Sala P. , Varesco L. , Giarola M. , Mondini P. , Pierotti M. , Spinelli P. , Radice P. 
Published: April 2003

Purpose: Familial adenomatous polyposis (FAP), caused by a mutation in the APC gene, is a colorectal cancer predisposition syndrome associated with several other clinical conditions. The severity of the FAP is related to the position of the inherited mutation in the APC gene. We analyzed a large series of FAP patients to identify associations among major clinical manifestations and to correlate the mutation site with specific disease manifestations. Materials and Methods: APC mutations were identified in 953 FAP patients from 187 families. We used unconditional logistic regression models and a method involving generalized estimating equations to investigate the association between genotype and phenotype. We used multiple correspondence analysis to represent the interrelationships of a multiway contingency table of the considered variables. Results: APC germline mutations were located between codons 156 and 2011 of the APC gene. Mutations spanning the region between codons 543 and 1309 were variable, but strongly associated with congenital hypertrophy of retinal pigment epithelium. Mutations between codons 1310 and 2011 were associated with a six-fold risk of desmoid tumors relative to the low-risk reference region (159 to 495). Mutations at codon 1309 were associated with early development of colorectal cancer. Mutations between codons 976 and 1067 were associated with a three- to four-fold increased risk of duodenal adenomas. The cumulative frequency of extracolonic manifestations was highest for mutations between codons 976 and 1067, followed by mutations between 1310 and 2011. Conclusion: Analysis of the relation between APC mutation site and phenotype identifies subgroups of FAP patients at high risk for major extracolonic disease, which is useful for surveillance and prevention.