Reliability of the Gross Motor Performance Measure

BACKGROUND AND PURPOSE

The reporting of reliability coefficients and the method of their determination is expected of test developers. The purpose of this study was to estimate the interrater, intrarater, and test-retest reliability of the Gross Motor Performance Measure, a measure of quality of movement designed to accompany the Gross Motor Function Measure.

SUBJECTS

Subjects were 28 children (25 with cerebral palsy, 2 nondisabled, 1 with head injury) between the ages of 1 and 10 years.

METHODS

Reliability data were obtained from assessments of 19 therapists.

RESULTS

Intraclass correlation coefficients for reliability varied from .92 to .96 for the total scores and from .84 to .94 for the five attribute scores.

CONCLUSION AND DISCUSSION

When the Gross Motor Performance Measure was administered by therapists who are familiar with the Gross Motor Function Measure and had a 1-day training workshop, reliability of the total scores was above recommended minimums. Scores of single attributes were less reproducible.

Historical overview of non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are efficacious in the control of arthritis symptoms and have become the mainstay of arthritis therapy. While NSAIDs' chief mechanism of action has long been assumed to be the inhibition of prostaglandin synthesis, further investigation has implicated additional mechanisms, and shed light upon additional side-effects. Adverse renal effects and effects on bone and cartilage metabolism are counted among worrisome NSAID-induced side-effects, but gastrointestinal side-effects represent the greatest threat to chronic NSAID users. It is important that we combine documented experience of side-effect risk with our growing knowledge of potential risk to frame a prescriptive approach to the arthritis patient that encompasses symptom management as well as patient protection.

Simultaneous assessment of cell kinetics and programmed cell death in bone marrow biopsies of myelodysplastics reveals extensive apoptosis as the probable basis for ineffective hematopoiesis

Despite hypercellular bone marrows (BM), peripheral cytopenias are the rule in patients with myelodysplastic syndromes (MDS). This study examined the roles played by cell birth and cell death rates in generating this paradox. Cell kinetics from BM biopsies of 35 MDS patients were measured using intravenous infusions of either iododeoxyuridine or bromodeoxyuridine, or both. Degree of apoptosis or programmed cell death (PCD) was estimated using in situ end-labeling of DNA directly from BM biopsies, which were simultaneously double-labeled from proliferation/PCD. MDS were found to be highly proliferative disorders with large numbers of myeloid, erythroid, and megakaryocytic cells synthesizing DNA. Median cycling time (Tc) of myeloblasts was more rapid than that of patients with acute myeloid leukemia (44.1 hr vs. 56.0 hr). Interestingly, most marrow cells of all three lineages in 32 of 34 evaluable cases were undergoing PCD. In 19 of 32 patients, greater than 75% cells were apoptotic. Surprisingly, large numbers of S-phase cells were found to be simultaneously undergoing PCD, as were stromal cells of the BM microenvironment. We conclude that the extensive apoptosis in hematopoietic cells effectively cancels the high birth rate resulting in ineffective hematopoiesis and accounting for deficient bone marrow function.

Nail biting in rheumatic diseases

To ascertain if nail biting (usually considered a manifestation of emotional tension) was associated with fibromyalgia, 387 patients attending the Rheumatism Clinic at the Leeds General Infirmary were studied prospectively. Bitten nails appeared to be a feature of youth rather than of fibromyalgia. Patients with a full set of dentures were less likely to bite their nails than others, but it can and was done by 7%. Posing the question about nail biting worried several patients, indicating the wisdom of seeking ethical approval even for "noninvasive" studies.

The effect of sleep and nocturnal movement on stiffness, pain, and psychomotor performance in ankylosing spondylitis

OBJECTIVE

This study was carried out in order to assess whether AS patients are adversely affected by a "good" night's sleep accompanied by little nocturnal movement.

METHODS

Objective and subjective nocturnal movement, flexibility, stiffness, pain and psychomotor performance were measured in 22 subjects, 11 with ankylosing spondylitis and 11 controls.

RESULTS

A better sleep integrity with little nocturnal movement was related to a decrease in lumbar flexibility. Difficulty in awakening and feeling tired and clumsy in the morning correlated with stiffness. Pain was correlated with a subjective difficulty in getting to sleep and a worse quality of sleep, but was also correlated with less objective sleep disruption. In the control group a better sleep integrity was correlated with an overnight decrease in psychomotor performance. In the spondylitic group a significant increase in performance occurred. Stiffness and pain did not correlate with performance.

CONCLUSION

Sleep in ankylosing spondylitis differs from sleep in normals.

Soft Tissue Biomechanics

This overview paper summarizes recent work on the biomechanics of soft tissues relevant to biomedical problems, prosthesis design and interventions, with reports on the papers presented at the Nineteenth Annual Day Conference, held in Leeds on 7 January 1994, by the Bioengineering Group for the Study of Human Joints in association with the Biological Engineering Society.

The Contribution of Different Tissues to Stiffness of the Wrist Joint

Passive articular stiffness is not only a function of articular tissues, but also tissues associated with movement, such as muscles and tendons. Allowance has been made for the relative contribution of these extra-articular tissues in comparing the resting stiffness of normal subjects and patients with rheumatoid arthritis. In addition, the stiffness of the muscle-joint complex with agonist/antagonist muscles co-contracting has been measured. Significant muscle wasting was found in rheumatoid arthritis (forearm muscle cross-sectional area for normals: 30.9 cm2, for rheumatoid arthritis: 22.7 cm2, p = 0.002). Allowing for this, there was a significant difference in resting stiffness between normals and rheumatoid arthritis subjects (adjusted resting stiffness normals: 90.8 × 10-3Nm/deg, rheumatoid arthritis: 120.3 × 10-3Nm/deg, p = 0.015). There was no difference between the groups in terms of the relationship between stiffness and grip at different levels of muscle co-contraction, suggesting the muscles are qualitatively normal in rheumatoid arthritis.

Psoas abscess in rheumatoid arthritis--an inperspicuous diagnosis

Primary or secondary psoas abscess is infrequently seen but should not be forgotten. We report on two patients with RA who presented predominantly with back pain and who subsequently developed pyrexia. The correct diagnosis of psoas abscess was not immediately apparent. These cases and the discussion and comments which follow illustrate the difficulties that may be encountered and remind readers of this inperspicuous diagnosis.

Radiographic changes in the hands of rock climbers

Radiographs of the hands of 36 rock climbers were compared with radiographs of the hands of controls matched for age and sex. Subchondral cysts were present in the hands of 17 climbers and only two controls. Osteophytes or bony spurs were present in 14 climbers but not in any of the controls, and the only two cases of frank osteoarthrosis were in the hands of climbers. Cortical thickness of the proximal and middle phalanges was significantly greater in the hands of climbers (P = < 0.01). Pronounced 'scalloping' of the necks of the proximal phalanges was only seen in climbers, and is due to thickening of the attachment of the distal end of the fibrous A2 pulley of the flexor sheath.

Growth characteristics and Ha-ras mutations of cell cultures isolated from chemically induced mouse liver tumours

Cells have been isolated from liver tumours that have arisen in control C3H/He mice, in mice given 10 micrograms diethylnitrosamine (DEN) during the neonatal period or in mice given a diet containing phenobarbitone (PB) to allow a daily intake of 85 mg/kg/day. The cells were grown to the 8 degrees subculture when their growth characteristics were investigated in monolayer culture and following suspension in soft agar and on transplantation into nude mice. In addition, DNA was isolated from the cultures and from tumours that grew in nude mice and analysed for mutations at codon 61 of the Ha-ras oncogene. All cells derived from DEN-induced hepatocellular carcinomas (HCC) demonstrated a lack of density inhibition of growth in monolayer culture, grew in soft agar and formed tumours in nude mice with an average mean latency of 29 days. Three of the seven lines showed mutations in Ha-ras: two were CAA-->AAA transversions and one showed a CAA-->CTA transversion. In contrast, cells isolated from eosinophilic nodules in mice given PB showed inhibition of growth at confluence, did not grow in soft agar and only four of eight formed tumours in nude mice with a mean average latent period of 181 days. Cells grown from HCC in mice given PB showed a lack of density inhibition of growth, however, they did not grow in soft agar nor did they form tumours in nude mice. A single spontaneous HCC from a control mouse showed a similar growth pattern to HCC cells isolated from mice given PB. Cells from a basophilic nodule, taken from a control untreated mouse grew vigorously in culture and in soft agar and formed tumours in nude mice with a latency of 6 days. None of the cells isolated from control mice or from mice given PB showed evidence of mutations at codon 61 of Ha-ras. These data confirm that there are fundamental differences in the biology of cells grown from tumours that develop in mice under different treatment regimes. These studies also demonstrate the utility of cell culture and molecular biology in addressing the fundamental mechanism of mouse hepatic neoplasia.

An evaluation of the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic

Seventy patients with RA were randomly allocated to either a Rheumatology Nurse Practitioner (RNP) or Consultant Rheumatologist (CR) clinic. They were seen on six occasions in 1 year. Effectiveness and safety were assessed by biochemical, clinical, psychological and functional variables; patient knowledge and satisfaction were measured by questionnaire. At week 0 the groups were well matched clinically and demographically. By week 48 significant improvements had occurred in plasma viscosity and articular index within both groups. In patients managed by the RNP, pain, morning stiffness, psychological status, patient knowledge and satisfaction had all improved significantly (P = 0.001; P = 0.028; P = 0.0005; P < 0.0001; P < 0.0001 respectively), improvements not mirrored by the CR cohort. Between group comparisons also showed significant differences by the end of the study. Compared to the CR patients, the RNP suffered from lower levels of pain (P < 0.05), had acquired greater levels of knowledge (P < 0.0001) and were significantly more satisfied with their care (P < 0.0001).

Endocrine disorders

The effect of endocrine disorders on bone mass is being increasingly studied. It is suggested that the preceding thyroid disorder, rather than thyroxine replacement itself, may reduce bone mass. Fracture rate does not appear to be increased in primary hyperparathyroidism once the condition is diagnosed. Although osteopenia is widely accepted to be associated with diabetes mellitus, two studies report increased bone mass in this condition. However, diabetes appears to adversely affect bone formation and urinary calcium excretion. Osteopenia is not a problem in acromegaly despite that patients are often hypogonadal. The possible associations of thyroid disease with connective tissue disorders are discussed, and the role of androgens in the pathogenesis of connective tissue disease is debated.

The straight cervical spine: does it indicate muscle spasm?

The loss of cervical lordosis in radiographs of patients presenting with neck pain is sometimes ascribed to muscle spasm. We performed a cross-sectional study of the prevalence of 'straight' cervical spines in three populations: 83 patients presenting to an accident department with acute neck pain, 83 referred to a radiology department with chronic neck problems, and 80 radiographs from a normal population survey carried out in 1958. Curvature was assessed on lateral radiographs both subjectively and by measurement. The prevalence of 'straight' cervical spines was 19% in the acute cases and 26% in the chronic cases. The 95% confidence interval for the difference was -6.4% to +19.3%. In the normal population 42% showed a straight spine, but a further third of these films had been taken in a position of cervical kyphosis; this probably reflects a difference in positioning technique. Women were more likely than men to have a straight cervical spine, with an odds ratio of 2.81 (95% CI 1.23 to 6.44). Our results fail to support the hypothesis that loss of cervical lordosis reflects muscle spasm caused by pain in the neck.

The straight cervical spine: does it indicate muscle spasm?

The loss of cervical lordosis in radiographs of patients presenting with neck pain is sometimes ascribed to muscle spasm. We performed a cross-sectional study of the prevalence of 'straight' cervical spines in three populations: 83 patients presenting to an accident department with acute neck pain, 83 referred to a radiology department with chronic neck problems, and 80 radiographs from a normal population survey carried out in 1958. Curvature was assessed on lateral radiographs both subjectively and by measurement. The prevalence of 'straight' cervical spines was 19% in the acute cases and 26% in the chronic cases. The 95% confidence interval for the difference was -6.4% to +19.3%. In the normal population 42% showed a straight spine, but a further third of these films had been taken in a position of cervical kyphosis; this probably reflects a difference in positioning technique. Women were more likely than men to have a straight cervical spine, with an odds ratio of 2.81 (95% CI 1.23 to 6.44). Our results fail to support the hypothesis that loss of cervical lordosis reflects muscle spasm caused by pain in the neck.

Primary generalized osteoarthritis and bone mass

The association of OA with increased bone mass is controversial. This study measured BMD at the hip and spine and total body bone mineral (TBBM) by dual energy X-ray absorptiometry, and BMD at the distal forearm by single photon absorptiometry in 20 post-menopausal women with primary generalized OA. The data were compared with those from 89 normal controls. Osteoarthritic women had significantly increased BMD at the spine (P < 0.001), distal forearm (P < 0.05) and increased TBBM (P < 0.01), but no difference was seen at the femoral neck. These differences were not explained by obesity. The influence of mobility is discussed.

Relationships between habitual physical activity and osteoarthrosis in ageing women

The examination of middle-aged women specialist teachers of physical education, who have undertaken habitual physical activity over many years, demonstrated a lower prevalence of osteoarthrosis in the knee joints, a greater prevalence of degenerative joint disease in the lumbar spine and a similar prevalence of osteoarthrosis in the hips, compared with a closely age-matched group. A further review 12 years later revealed significantly less joint pain and joint stiffness in active women compared with less active controls.