bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Delphi study of self-care in a community population of people with multiple sclerosis
Authors: O'Hara Louise , De Souza Lorraine H , Ide Lorely 
Published: May 2003

Objective: The aim of the study was to obtain the views and priorities of people with multiple sclerosis (MS) to inform the design of a professionally guided self-care programme. Design: A three-round postal Delphi survey was used as a research tool. Setting: The study was conducted at the Centre for Research in Rehabilitation at Brunel University in London. Subjects: The respondent panel consisted of 200 volunteers with MS of whom 136 responded to the survey (68%). Respondents were recruited through voluntary organizations throughout the UK. The only selection criterion was that the diagnosis of MS was confirmed by the general practitioner. Main outcome measures: The results from each of the three rounds of the Delphi survey were the outcome measures. Results: One hundred and one people used ten or more self-care strategies (74%). Round 1 data revealed the diversity of practices reported, crossing many domains of life such as daily chores, leisure, relationships and physical and mental health. The top five priorities identified in rounds 2 and 3 concerned coping strategies, social support, independence in daily living, rest and mobility. Complete consensus about priorities was not achieved. However, agreement about priorities approached stability across rounds 2 and 3 and a highly significant Kendall's coefficient of concordance indicated there was good agreement within round 3 group rankings (W = 0.46, chi-squared = 499.37, df = 9, p<0.001, N = 122). Conclusion: Self-care practices were widespread, and those most commonly used could be identified. This survey method allows the views and priorities of this consumer group to be revealed. The information obtained can be used to develop services where the professional guides and encourages appropriate self-management based upon the issues that people with MS consider to be most important.
A questionnaire assessment of unmet needs for rehabilitation services and resources for people with multiple sclerosis: results of a pilot survey in five European countries
Authors: Kersten P , McLellan D L , Gross-Paju K , Grigoriadis N , Bencivenga R , Beneton C , Charlier M , Ketelaer P , Thompson A J 
Published: May 2003

Objective: To develop an international services and needs assessment instrument (SUN) for people with multiple sclerosis and their carers and to pilot this in different countries of the European Community. Design: Interview study of people with multiple sclerosis, their carers and nominated key professionals examining the unmet needs of patients and carers. Setting: Belgium, Estonia, Greece, Italy and the United Kingdom. Main outcome measures: Needs assessment questionnaire. Results: The study comprised 137 people with multiple sclerosis, 125 carers and 111 professionals. Patients reported on average 2.9 unmet needs for themselves; their carers and professionals reported on average 2.4. Needs were categorized into seven broad categories. Due to difficulties experienced by the local researchers in distinguishing between needs and objectives a large proportion of needs had to be assigned to the ‘other’ category. Conclusions: The SUN is a valuable and practicable tool for the identification of unmet needs for people with multiple sclerosis and their carers. Formal validation and reliability testing of the different language versions is recommended.
Change in identity and self-concept: a new theoretical approach to recovery following a stroke
Authors: Ellis-Hill Caroline S , Horn Sandra 
Published: May 2003

Objective: To determine whether respondents reported a change in identity following stroke. Design: A cross-sectional comparison study of perceived changes in the self-concept of stroke respondents and matched hospital volunteers. A questionnaire was administered to stroke respondents in their own homes and to hospital volunteers in their work setting. Participants: Twenty-six first-time stroke survivors who had no severe communication, cognitive or perceptual difficulties or previous physical disability, and who had returned home from hospital up to two years previously. The comparison group were 26 hospital volunteers matched for age, gender and the time from which past self-concept was considered. Main outcome measures: Included the Hospital Anxiety and Depression Scale, Frenchay Activity Index and the Head Injury Semantic Differential Scale to assess past and present self-concept. Results: Overall, individuals described themselves in more negative terms than prior to their stroke. They saw themselves as less interested, capable and independent, (p < 0.001) and less in control, satisfied and active (p < 0.05). They still saw themselves as friendly, calm, caring, hopeful and talkative. The overall self-concept of the comparison group remained positive and stable over a comparable time period. Conclusions: The stroke respondents reported a negative sense of self, reduced social activity and psychological morbidity despite inpatient and outpatient rehabilitation. Individuals following stroke may settle for a restricted future because of their expectations of life with a disability. Clinicians need to be aware of the meaning of the stroke within the life of each individual.
Unpacking the ‘black box’ of a nurse-led stroke support service
Authors: Dowswell George , Lawler John , Young John 
Published: May 2003

Objectives: To describe in detail the nature of the specialist nurse interventions; to increase understanding of the principal problems facing stroke patients and their care-givers in the first year following stroke and to demonstrate how these problems may change over time; and to investigate the value of qualitative research methodologies within the context of a randomized trial. Methods: Specialist nurses providing support in the year following stroke were asked to maintain comprehensive written records of their involvement with all patients and care-givers participating in a randomized controlled trial. Qualitative methods were used to examine the problems faced by stroke patients and their care-givers, and the actions taken by nurses in response. Results: Specialist nurses commenced 120 records. As 19 patients died or left the area during the year-long interventions, we obtained 101 complete records. The problems encountered by stroke patients and their care-givers were numerous, diverse, complex and changed over time. Initially, practical difficulties were noted; over time, these were accompanied by growing numbers of psychological needs. The nurses responded by providing information, advice, support and monitoring using a flexible, individualized approach. The nurses also collaborated or liaised with 17 other professional groups and provided direct support to care-givers. Conclusion: The need for many stroke patients and their care-givers to be professionally supported during the stages of stroke adjustment, for at least the first year and probably beyond, was emphasized by this study.
A randomized controlled trial of the Geriatric Depression Scale in an inpatient ward for older adults
Authors: Weatherall Mark 
Published: May 2003

Objectives: To measure the prevalence of high scores on the Geriatric Depression Scale in an inpatient unit for older people and assess whether administration of this instrument increased the use of antidepressant medication. Design: Randomized controlled trial. Setting: Inpatient unit for assessment, treatment and rehabilitation of older adults in a district hospital. Subjects: Consecutive admissions to the inpatient unit were approached. Of 198 people, 100 gave consent and were randomized to receive the intervention. Interventions: The Geriatric Depression Scale and the Folstein Mini-mental State Examination were administered to the intervention group. The Nottingham Instrumental Activities of Daily Living questionnaire and the Folstein Mini-mental State Examination were administered to the placebo group. The scores of these instruments and a copy of the completed instrument were placed in the subject's case notes. For those subjects randomized to receive the Geriatric Depression Scale an interpretation of the score was written in the case notes. Main outcome measures: The primary outcome measure was whether antidepressant medication was listed on the discharge summary for the admission. Other outcome measures were death, readmission and use of antidepressant medication three months after administration of the instruments. Results: There was a prevalence of Geriatric Depression Scale scores greater than 10 of 52% in the 50 people administered this instrument. Six out of 46 people administered the Geriatric Depression Scale, who were discharged in the study period, were on antidepressant medication at discharge. Three out of 47 people administered the placebo instrument were on antidepressant medication at discharge. The absolute difference in proportions was 6.7%, 95% confidence interval 19 to – 5.3%. Conclusions: A high proportion of patients admitted to an inpatient unit for assessment, treatment and rehabilitation scored in the depressed range on the Geriatric Depression Scale; however, use of the Geriatric Depression Scale in this clinical setting did not increase the use of antidepressant medication. This may be because the instrument is too nonspecific.
Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights
Authors: Laufer Yocheved , Dickstein Ruth , Resnik Sarit , Marcovitz Emanuel 
Published: May 2003

Objective: To examine and compare the effect of stepping on stairs of various heights on lower extremity weight bearing in hemiparetic patients. Setting: Flieman Geriatric Rehabilitation Hospital, Haifa, Israel. Subjects: Fifteen ambulatory hemiparetic patients following an acute cerebrovascular accident, and 16 age-matched healthy controls. Interventions: Each subject was tested twice on two consecutive days in five weight-bearing positions which included level stance and stepping with either leg on 10-cm- and 17-cm-high steps. Data concerning weight distribution on the lower extremities were collected by two computerized forceplates. Main outcome measure: Weight borne by each foot expressed as percentage of overall body weight. Results: In the attempted symmetrical level stance, the percentage of body weight borne by the paretic limb of the stroke patients was significantly lower than that of the nonparetic limb. Placing one foot on a step induced a weight shift to the foot placed on the floor regardless of step height. Weight shifting to the paretic limb was, however, significantly lower than to the nonparetic limb. Weight shifting to the nonparetic limb was significantly lower than to the corresponding limb of healthy individuals. Step height had no significant effect on weight distributions on the feet. Conclusions: Raising a foot on a step appears to be an appropriate strategy for weight shift training of stroke patients. Since weight shifting to both the paretic and nonparetic limb of stroke patients is impaired, treatment strategies should include training in weight shifting to both lower extremities.
Accuracy of physical and occupational therapists' early predictions of recovery after severe middle cerebral artery stroke
Authors: Kwakkel Gert , van Dijk Gabriella M , Wagenaar Robert C 
Published: May 2003

Methods: Within the second and fifth week after stroke onset, 364 predictions were made by 59 PTs and 47 OTs about walking ability, dexterity, activities of daily living (ADL), need for additional care in ADL, time required to achieve independent walking ability and maximal level of ADL, and destination of discharge at six months after stroke. The functional recovery patterns of stroke patients were assessed by an independent observer. The accuracy of the therapists' predictions was compared with that of derived prediction models. In addition, the influence of characteristics of patients and therapists on the accuracy of the predictions was investigated. Results: Compared to observed outcomes at six months after stroke, therapists' lowest accuracies of prediction were found for the moment at which maximal ADL score was achieved (rs = 0.07; p = NS), and highest accuracy was for level of dexterity of the hemiplegic arm (rs = 0.78; p <0.01). Therapists' predictions of functional outcome at six months tended to be too pessimistic. No significant differences were observed for dexterity and walking ability when the predictions by PTs and OTs were compared with those of regression models, whereas significant differences were found for the accuracies of OTs and PTs’ first prediction of destination of discharge and second predictions of outcome in ADL and need for additional care in ADL. No significant differences were found between the accuracy of PTs' and OTs' predictions, and their ability to predict functional outcome was not significantly influenced by the characteristics of patient and therapists. Conclusions: At two and five weeks after stroke, OTs and PTs can accurately predict level of walking ability and dexterity at six months. The prediction of time required for achieving maximal level of recovery, destination of discharge, outcome of ADL as well as need for additional care in ADL leaves room for improvement.
Evaluation of three methods to rate impairment in patients with complex regional pain syndrome I of one upper extremity
Authors: Oerlemans H Margreet , Oostendorp Rob Ab , de Boo Theo , Goris R Jan A 
Published: May 2003

Objective: To gain insight into the best way of obtaining an impairment rating in complex regional pain syndrome I (CRPS I) of the upper extremity. This syndrome can potentially result in permanent impairment. Design: Comparison of three evaluation methods to obtain impairment scores. Each patient was seen by one tester; two testers in total participated in the research. Setting: Outpatient clinic of a university hospital. Subjects: Seventy-four patients (27 men, 47 women, mean age 52 years) with CRPS I of one upper extremity. Main outcome measures: Methods I and II were conducted according to the American Medical Association's Guides to the evaluation of permanent impairment: method I according to the general guidelines, and method II according to the methodology specificially described for CRPS I. Method III was developed by the Dutch Association of Neurologists. For comparison, differences between methods were plotted against their mean ratings, with the limits of agreement. Also the paired t-statistics were calculated (= 0.05/3). Results: The mean difference between methods I and II was – 0.7% whole body impairment, between methods II and III 8.1% and between methods I and III 7.3%. Outcomes obtained with method III differed significantly from the other outcomes. Conclusions: Method I most accurately and objectively reflected the permanent impairment level resulting from CRPS I.
A comparison of three measures of progress in early lower limb amputee rehabilitation
Authors: Panesar B S , Morrison P , Hunter J 
Published: May 2003

Objective: To assess the responsiveness to change and validity of three established outcome measures in relation to early lower limb vascular amputee rehabilitation: the Functional Independence Measure (FIM), the Office of Population Censuses and Surveys Scale (OPCS) and the Amputee Activity Score (AAS). Design: Prospective observational study. Setting: Inpatient amputee rehabilitation unit. Subjects: Fifty-one consecutive patients admitted for rehabilitation following lower limb amputation for vascular disease. Procedure: To study the responsiveness to change differences between total scores and between subsection scores at different times were analysed. To assess validity, comparisons of the total scores of the measures were made with each other, and the total scores for each measure were compared with other outcomes. Results: Complete scores were obtained on 34 subjects. All measures showed significant change between admission and discharge (p < 0.00001) but only the AAS showed change between discharge and follow-up (p < 0.0001). Subsection analysis revealed expected improvements in mobility. During the inpatient stage progress was also detected in certain activities of daily living in the FIM and OPCS. The measures correlated with each other (p < 0.001). All of the measures’ admission scores correlated with duration of stay (OPCS p < 0.005, AAS p < 0.006, FIM p < 0.009) and admission OPCS also correlated with discharge placement (p < 0.036). Conclusion: The FIM and OPCS are suitable for the inpatient stage but the AAS would appear to be the best measure at time of discharge and thereafter, and further studies are justified.
Cross-cultural validation of the London Handicap Scale in Hong Kong Chinese
Authors: Lo Raymond , Harwood Rowan , Woo Jean , Yeung Fai , Ebrahim Shah 
Published: May 2003

Study objective: To investigate the cross-cultural validity of London Handicap Scale in Hong Kong Chinese. Design: Ratings of the utility of 10 hypothetical health scenarios were given by groups of HK Chinese subjects. Measured scores were compared with calculated scores from published scale weights of London Handicap Scale, which were based on utility ratings made by UK subjects. Setting: A rehabilitation hospital in Hong Kong. Subjects: A total of 164 HK Chinese, comprising doctors, medical students, nonmedical hospital staff, geriatric day hospital stroke and nonstroke patients, community day-care centre elderly, old age hostel elderly, young disabled inpatients and young community-dwelling disabled citizens. Main results: There was a close correlation between the mean scores of HK subjects and the calculated scores derived from the published UK scale weights, apart from one scenario (Pearson's correlation coefficient r = 0.87 p = 0.001). The correlations were high for all subgroups, between which there was good consensus. Measured utilities were significantly different between subgroups for only one scenario. For this scenario of moderate to severe handicap in mobility, physical dependence, occupation and social integration, but with excellent orientation and economic self sufficiency: (1) older age groups gave better scores than younger age groups (p < 0.0005); (2) subjects with poor subjective health status gave better scores than those with good subjective health status (p = 0.002); (3) subjects related to the medical or hospital field, i.e. doctors, medical students and nonmedical hospital staff, gave worse scores than other subject groups (p < 0.0005). Conclusion: The concept of handicap applies across cultures. Perception of severity of selected real life handicap scenarios by HK Chinese were well estimated using scale weights from UK populations developed for the London Handicap Scale. Significant differences in perception of certain handicap scenarios by different population subgroups deserve further study.
Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test
Authors: Wright D J , Khan K M , Gossage E M , Saltissi S 
Published: May 2003

Objective: To examine the utility of the six-minute walk test (6′WT), in assessing the effectiveness of a six-week cardiac rehabilitation programme, of which exercise training was an integral part. Setting: Royal Liverpool and Broad Green Hospitals Rehabilitation Unit. Design: Two hundred and thirty-nine consecutive patients referred for cardiac rehabilitation were allocated to one of two groups. In group A 209 entered and 159 completed the usual rehabilitation programme whilst group B patients (n = 30) acted as a control by deferring entry to the programme for six weeks, continuing only activities of daily living. Outcome measures: Both groups were assessed using the 6′WT, peak expiratory flow rate (PEFR) and isometric grip strength at enrolment and six weeks. Results: At baseline, groups A and B were demographically identical without significant differences in terms of 6′WT, PEFR or grip strength. Following the study period, group A showed a significant increase in 6′WT from 314.7 ± 76.2 to 377.3 ± 78.6 m, in PEFR from 406.9 ± 115.9 to 437.8 ± 118.6 litres per minute and in grip strength from 28.8 ± 9.31 to 30.3 ± 8.93 kg, all p < 0.001. There were no significant changes in group B. Conclusions: The 6′WT proved to be a simple and effective measurement of functional capacity in patients performing cardiac rehabilitation. The clinical programme investigated successfully increased patients' functional capacity as assessed by the 6′WT. Significant improvement in PEFR and grip strength was also demonstrated, compared with a control population.
Developing a disease-specific quality of life measure for people with multiple sclerosis
Authors: Ford H L , Gerry E , Tennant A , Whalley D , Haigh R , Johnson M H 
Published: May 2003

Objectives: To develop a patient-completed disease-specific measure of quality of life in multiple sclerosis and to validate the measure in a community-based population of people with multiple sclerosis. Methods: The items in the scale were selected in focus group sessions of people with multiple sclerosis. The initial scale included 25 items and was tested in subgroups of 150 people from a population register of people with multiple sclerosis in Leeds. Following further developmental phases, a restructured 16-item scale was tested on a random sample of 200 people with multiple sclerosis from the population register, stratified according to disease course. This led to a final eight-item unidimensional scale, the Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale. Results: After initial development a 16-item scale was found to be both reliable and valid. Cronbach' s alpha for the 16-item scale was 0.86. The test–retest correlation was 0.74, using a two-week retest interval. However, convergent validity with the General Well Being Index was 0.67 and with the SF-36 Physical Function Scale was 0.68. This suggested that the scale straddled these two concepts and was confirmed by fit of the data to the Rasch measurement model. This revealed the potential for a reduced eight-item version of the scale. The eight-item scale had a closer association to well-being (0.83) than to physical function (0.39), had good internal consistency (0.79) and test–retest reliability (0.85). There were virtually no floor or ceiling effects for the scale. Conclusions: The study presents a disease-specific measure of quality of life in multiple sclerosis, the Leeds Multiple Sclerosis Quality of Life (LMSQoL) scale. The instrument is brief, easy to use and practical to administer in clinic or as a postal questionnaire. It measures a construct related to well-being, and provides an important adjunct to the measurement of outcome in multiple sclerosis.