Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment

BACKGROUND AND PURPOSE

The Chedoke-McMaster Stroke Assessment measures the physical impairments and disabilities that impact on the lives of individuals with stroke. This measure has three overall purposes: 1) to stage motor recovery to classify individuals in terms of clinical characteristics, 2) to predict rehabilitation outcomes, and 3) to measure clinically important change in physical function. This study was carried out to evaluate the ability of this measure to yield reliable and valid results.

METHODS

Thirty-two subjects from a stroke rehabilitation treatment unit were assessed by research and treating physical therapists using multiple measures on multiple occasions. The measure's three purposes dictated the study objectives and design.

RESULTS

Intrarater, interrater, and test-retest reliabilities of the impairment and disability inventories were estimated. Reliability coefficients for the total scores ranged from 0.97 to 0.99. Construct and concurrent validities were studied by examining the correlations between this and other measures. A priori hypothetical constructs stated that these correlations should exceed 0.60. These constructs were confirmed; the impairment inventory total score was found to correlate with the Fugl-Meyer Test (r = 0.95, p < 0.001) and the disability inventory with the Functional Independence Measure (r = 0.79, p < 0.05). Additional study hypotheses were also substantiated.

CONCLUSIONS

This study confirms that the Chedoke-McMaster Stroke Assessment yields both reliable and valid results. With the evaluation study now completed, the Chedoke-McMaster Stroke Assessment can be used with confidence as both a clinical and a research tool that can discriminate among subjects and evaluate patient outcomes.

Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke

BACKGROUND AND PURPOSE

The purpose of this study was to establish the interrater reliability of assessments made with the Fugl-Meyer evaluation of physical performance in a rehabilitation setting.

SUBJECTS

Twelve patients (7 male, 5 female), aged 49 to 86 years (mean = 66), who had sustained a cerebrovascular accident participated in the study. All patients were admitted consecutively to a rehabilitation center and were between 6 days and 6 months poststroke.

METHODS

Three physical therapists, each with more than 10 years of experience, assessed the patients in a randomized and balanced order using this assessment. The therapists standardized the assessment approach prior to the study but did not discuss the procedure once the study began.

RESULTS

The overall reliability was high (overall intraclass correlation coefficient = .96), and the intraclass correlation coefficients for the subsections of the assessment varied from .61 for pain to .97 for the upper extremity.

CONCLUSION AND DISCUSSION

The relative merits of using the Fugl-Meyer assessment as a research tool versus a clinical assessment for stroke are discussed.

Defining the minimum level of detectable change for the Roland-Morris questionnaire

BACKGROUND AND PURPOSE

The Roland-Morris Questionnaire (RMQ) is a self-administered disability measure in which greater levels of disability are reflected by higher numbers on a 24-point scale. The RMQ has been shown to yield reliable measurements, which are valid for inferring the level of disability, and to be sensitive to change over time for groups of patients with low back pain. Little is known about the usefulness of this instrument in aiding decision making regarding individual patients. The purpose of this study was to determine the minimum level of detectable change when the RMQ is applied to individual patients.

SUBJECTS

The study sample consisted of 60 outpatients with low back pain.

METHODS

The RMQ was administered at the subjects' initial visit and again 4 to 6 weeks later. Conditional standard errors of measurement (CSEMs) were computed for initial and follow-up RMQ scores, and these values were used to estimate the minimum level of detectable change. Results. Minimum levels of detectable change at the 90% confidence level varied from 4 to 5 RMQ points.

CONCLUSION AND DISCUSSION

The magnitude of CSEMs is sufficiently small to detect change in patients with initial scores in the central portion of the scale (4-20 RMQ points); however, the magnitude is too large to detect improvement in patients with scores of less than 4 and deterioration in patients who have scores greater than 20.

Identification and characterization of a pro-tumor necrosis factor-alpha-processing enzyme from the ADAM family of zinc metalloproteases

Tumor necrosis factor-alpha (TNF) is initially expressed as a 26-kDa membrane-bound precusor protein (pro-TNF) that is shed proteolytically from the cell surface, releasing soluble 17-kDa TNF. We have identified human ADAM 10 (HuAD10) from THP-1 membrane extracts as a metalloprotease that specifically clips a peptide substrate spanning the authentic cleavage site between Ala76 and Val77 in pro-TNF. To confirm that HuAD10 has TNF processing activity, we cloned, expressed, and purified an active, truncated form of HuAD10. Characterization of recombinant HuAD10 (rHuAD10) suggests that this enzyme has many of the properties (i.e. substrate specificity, metalloprotease activity, cellular location) expected for a physiologically relevant TNF-processing enzyme.

Interrater reliability of six tests of trunk muscle function and endurance

Some studies have shown a relationship between trunk muscle strength and low back pain. Measures of trunk muscle strength and endurance, which are feasible in the clinical setting, are needed. The purpose of this study was to determine interrater reliability of six tests of abdominal and trunk extensor muscle strength and endurance. The tests included abdominal and extensor dynamic endurance, hand-held dynamometry of isometric flexion and extension, and abdominal and extensor static endurance. Thirty-nine healthy workers were recruited as subjects. Each was tested by three raters on 3 days within 1 week. Intraclass correlation coefficients (ICC) and the standard error of measurement (SEM) were calculated: abdominal dynamic endurance ICC = .89, SEM = 8 repetitions; extensor dynamic endurance ICC = .78, SEM = 9 repetitions; abdominal isometric force ICC = .25, SEM = 60 N; extensor isometric force ICC = .24, SEM = 68 N; abdominal static endurance ICC = .51, SEM = 35 seconds; extensor static endurance ICC = .59, SEM = 20 seconds. The dynamic endurance tests had acceptable interrater reliability. For the others, reliability was poor and the SEMs were large.

An observer-blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia

OBJECTIVE

To compare a supervised 12-week aerobic exercise class with unsupervised home aerobic exercises in the treatment of patients with fibromyalgia.

METHODS

This was a 48-week randomized single (observer) blind study in a teaching hospital rheumatology and physiotherapy department. The subjects were 74 patients who fulfilled the American College of Rheumatology criteria for fibromyalgia. Results and conclusions. A 12-week exercise class programme with home exercises demonstrated no benefit over a single physiotherapy session with home exercises in the treatment of pain in patients with fibromyalgia. Neither group (nor the groups combined) showed an improvement in pain compared with baseline. There was some significant benefit in psychological well-being in the exercise class group and perhaps a slowing of functional deterioration in this group.

eHealth literacy research-Quo vadis?

The concept of electronic health (eHealth) literacy evolved from the social and information sciences and describes competencies necessary to use electronic health services. As it is a rather new topic, and as there is no current overview of the state of the art in research, it is not possible to identify research gaps. Therefore, the objective of this viewpoint article is to increase knowledge on the current state of the art of research in eHealth literacy and to identify gaps in scientific research which should be focused on by the research community in the future. The article provides a current viewpoint of the concept of eHealth literacy and related research. Gaps can be found in terms of a missing "gold standard" regarding both the definition and the measurement of eHealth literacy. Furthermore, there is a need for identifying the implications on eHealth developers, which evolve from the measurement of eHealth literacy in eHealth users. Finally, a stronger inclusion of health professionals, both in the evolving concept and in the measurement of eHealth literacy, is needed in the future.

Efficacy of electromyographic biofeedback compared with conventional physical therapy for upper-extremity function in patients following stroke: a research overview and meta-analysis

BACKGROUND AND PURPOSE

The purpose of this study was to examine the efficacy of electromyographic biofeedback compared with conventional physical therapy for improving upper-extremity function in patients following a stroke.

SUBJECTS AND METHODS

A literature search was done for the years 1976 to 1992. The selection criteria included single-blinded randomized control trials. Study quality was assessed for nine criteria. For functional (disability index or stage of recovery) and impairment outcomes, meta-analyses were performed on odds ratios for improvement versus no improvement. Mann-Whitney U-Test probability values were combined across studies.

RESULTS

Six studies were selected, and outcome data were obtained for five studies. The common odds ratio was 2.2 for function and 1.1 for impairments in favor of biofeedback. The estimate of the number needed to treat to prevent a nonresponder was 11 for function and 22 for impairments. None of the meta-analyses were statistically significant.

CONCLUSIONS AND DISCUSSION

The results do not conclusively indicate superiority of either form of therapy. Although there is a chance of Type II error, the estimated size of the effect is small. Given this estimate of little or no difference, therapists need to consider cost, ease of application, and patient preference when selecting these therapies.

Fluorescence studies of the location and membrane accessibility of the palmitoylation sites of rhodopsin

Fluorescent fatty acid labels have been incorporated into the palmitoylation sites of rhodopsin and used to probe the membrane accessibility and location of these sites. The fluorescence properties of anthroyloxy and pyrenyl fatty acids bound to rhodopsin were investigated in a reconstituted vesicle system. Collisional quenching of fluorescence by stearic acid (DSA) labeled with doxyls in the 16, 12, and 5 positions was used to determine the membrane accessibility and disposition of the modifying fatty acids. To properly determine the membrane concentration of these quenchers, the dependence of the Stern-Volmer parameters on both quencher and vesicle concentration was determined. An analysis of these dependences provided a correction for partitioning of the quencher between the aqueous phase and the membrane. After this correction, the relative effectiveness of doxyl quenchers was 16-DSA > 12-DSA > 5-DSA. Parallel studies on free anthroyloxy and pyrenyl fatty acids incorporated into the reconstituted system showed the same dependence on quencher position. These results indicate that the labels at the palmitoylation sites of rhodopsin are situated in the membrane much as a free fatty acid. This anchoring of the palmitates in the membrane results in the formation of a fourth cytoplasmic loop.

The Prevalence of Online Health Information Seeking Among Patients in Scotland: A Cross-Sectional Exploratory Study

BACKGROUND

Online health information seeking is an activity that needs to be explored in Scotland. While there are a growing number of studies that adopt a qualitative approach to this issue and attempt to understand the behaviors associated with online health information seeking, previous studies focusing on quantifying the prevalence and pattern of online health seeking in the United Kingdom have been based on Internet users in general.

OBJECTIVE

This exploratory study sought to describe the prevalence of online health information seeking in a rural area of Scotland based on primary data from a patient population.

METHODS

A survey design was employed utilizing self-completed questionnaires, based on the Pew Internet and American Life Project; questionnaires were distributed among adult patients in 10 primary care centers in a rural community in Scotland.

RESULTS

A convenience sample of 571 (0.10% of the total population in Grampian, N=581,198) patients completed the questionnaire. A total of 68.4% (379/554) of patients had previously used the Internet to acquire health information. A total of 25.4% (136/536) of patients consulted the Internet for health information regarding their current appointment on the day surveyed; 34.6% (47/136) of these patients were influenced to attend their appointment as a result of that online health information. A total of 43.2% (207/479) of patients stated the health information helped improve their health and 67.1% (290/432) indicated that they had learned something new. A total of 34.0% (146/430) of patients talked to a health professional about the information they had found and 90.0% (376/418) reported that the information was useful. In total, 70.4% (145/206) of patients were concerned about obtaining health information online from reliable sources. A total of 67.1% (139/207) of patients were concerned that a health site may sell their personal information, yet only 6.7% (36/535) checked the privacy policy of the site visited. However, 27.9% (55/197) of patients were not concerned about their employer finding out what health sites they visited, whereas 37.5% (78/208) were concerned that others would find out.

CONCLUSIONS

The results suggest that online health information-seeking behavior influences offline health-related behavior among the population surveyed. Patient attitudes to online health information seeking were focused on issues relating to trust, reliability, privacy, and confidentiality. This study provides support for the growing phenomenon of an empowered, computer-literate, health information consumer, and the impact of this phenomenon must be considered in the context of the patient-health professional dynamic. The unpredictable nature of human thought and action in relation to this field of study requires an ongoing program of ethnographic research, both physical and virtual, within a Health Web Science framework. This study has provided a baseline of the prevalence of online health information seeking in the Grampian region of Scotland.

A comparative evaluation of a fibromyalgia rehabilitation program

OBJECTIVE

To compare an evidence-based clinical fibromyalgia program, referred to as Fibro-Fit, with results of controlled clinical trials.

METHODS

An interdisciplinary group education and exercise program with 36 sessions over 12 weeks was used. Demographic, clinical, and outcome variables were collected on 149 participants, of whom 71% completed the program. Outcomes included measures of self-efficacy, pain, physical fitness, function, and coping skills.

RESULTS

Results of the prospective before-after evaluation showed statistically significant (P < 0.005) improvements in all outcomes except for grip strength. These results were comparable with controlled clinical trials found in the literature. Data suggest that smoking, fibromyalgia support groups, and medications may be important modifiable factors.

CONCLUSIONS

Results suggest that Fibro-Fit was effective in improving physical impairments and function. Further investigation is required to refine the effective components of these programs and determine how modifiable factors can be used to improve outcomes.

The program for rheumatic independent self-management: a pilot evaluation

The 'Program for Rheumatic Independent Self-Management' (PRISM) is an interdisciplinary programme that integrates group education and individualised treatment using the principles of self-management, adult learning, case management and self-efficacy enhancement. This study is a before-after evaluation of 57 individuals who attended PRISM. Outcome measures were selected to measure self-efficacy, disability, pain and ability to cope. The mean self-efficacy score increased immediately following the programme and this improvement was maintained at 6-month follow-up. Disability decreased from baseline to 6-month follow-up. There was a decrease in the mean level of pain from post-class to 6-month follow-up. All of these changes were statistically significant. These preliminary findings suggest that PRISM may be effective in enhancing self-efficacy, and reducing disability and pain.

A chip-scale atomic clock based on 87Rb with improved frequency stability

We demonstrate a microfabricated atomic clock physics package based on coherent population trapping (CPT) on the D1 line of 87Rb atoms. The package occupies a volume of 12 mm3 and requires 195 mW of power to operate at an ambient temperature of 200 degrees C. Compared to a previous microfabricated clock exciting the D2 transition in Cs [1], this 87Rb clock shows significantly improved short- and long-term stability. The instability at short times is 4 x?10-11 / tau?/2 and the improvement over the Cs device is due mainly to an increase in resonance amplitude. At longer times (tau?> 50 s), the improvement results from the reduction of a slow drift to ?5 x 10-9 / day. The drift is most likely caused by a chemical reaction of nitrogen and barium inside the cell. When probing the atoms on the D1 line, spin-exchange collisions between Rb atoms and optical pumping appear to have increased importance compared to the D2 line.

The fabrication of uniform cylindrical nanoshells and their use as spectrally tunable MRI contrast agents

A new form of tunable magnetic resonance imaging agent based on precisely dimensioned cylindrical magnetic nanoshells is introduced. Using top-down prepatterned substrates, the nanoshells are fabricated by exploiting what is usually regarded as a detrimental processing side-effect, namely the redeposition of material back-sputtered during ion-milling. The well-resolved nuclear magnetic resonance peaks of the resulting nanostructures attest to the nanoscale fabrication control and the general feasibility of such sputter redeposition for fabrication of a variety of self-supporting, highly monodisperse nanoscale structures.

A comparison of infrared ear thermometry with electronic predictive thermometry in a geriatric setting

This project had three purposes: to determine the test/retest reliability of three thermometers--an infrared ear thermometer, an oral electronic predictive thermometer, and an oral mercury-in-glass thermometer (MIGT); determine the validity (accuracy) of the first two thermometers using the MIGT as the gold standard; and calculate the thermometers' sensitivity and specificity for detecting fever using 37.5 degrees C on the MIGT as the criterion. The MIGT had the best reliability, followed by the electronic predictive and infrared ear thermometer (for validity, the former was more accurate than the latter). Little difference existed in the latter two thermometers' sensitivity and specificity. However, the confidence intervals were wide, and further studies with larger samples need to be done to elucidate the thermometers' diagnostic properties.

Investigation of cutaneous microvascular activity and flare response in patients with fibromyalgia syndrome

OBJECTIVES

To assess microvascular activity in the skin of patients with fibromyalgia syndrome (FMS) as compared with normal controls.

METHODS

Fifteen patients, who fulfilled the American College of Rheumatology criteria for FMS, and 15 age- and sex-matched healthy controls, were studied. The microvascular activity of the skin overlying the trapezius muscle was quantified using iontophoresis of acetylcholine as an endothelial-dependent vasodilator and sodium nitroprusside as an endothelial-independent vasodilator. We also studied the flare response by iontophoresing acetylcholine continuously for 10 min to stimulate a ring of nociceptor c-fibre endings in the skin.

RESULTS

There was no significant difference in cutaneous vascular responses to short-duration iontophoresis of acetylcholine and sodium nitroprusside at the three different doses used. The area under the curve (AUC) (mean+/-s.e.m.) for acetylcholine baseline, 20, 40, and 80 s were 6+/-0.7, 23+/-6, 45+/-7 and 66+/-10 AU for patients and 11+/-4, 24+/-3, 49+/-7 and 62+/-12 AU for controls, respectively (P=0.2, 0.9, 0.7, 0.8, respectively). The corresponding figures for sodium nitroprusside were 5+/-1, 18+/-7, 51+/-14 and 68+/-14 AU for patients and 8+/-3, 13+/-2, 39+/-5 and 61+/-9 AU for controls, respectively (P=0.2, 0.5, 0.4, 0.7, respectively). There was also no significant difference in the flare response in patients with FMS as compared with control subjects (119+/-15 and 131+/-13 AU, respectively; P=0.57).

CONCLUSION

There are no significant differences in cutaneous microvascular reactivity between patients with FMS and control subjects.

Integrated systems to reduce length of stay for knee and hip joint replacement surgeries

To reduce length of stay while maintaining quality of care, St. Joseph's Hospital, Hamilton, ON implemented a care path with three discharge options. Two of these discharge options were early discharge to integrated community services. Patients meeting early discharge criteria are discharged home five days post-operatively with follow-up by home care nursing and physiotherapy. Otherwise, patients are discharged on day four to a multi-disciplinary rehabilitation unit at a separate facility. Patients requiring acute medical services for complications or co-morbidity stay in the acute care hospital. A prospective cohort evaluation showed no difference in complications and similar functional outcomes for the three discharge options.

Lambda exonuclease digestion of CGG trinucleotide repeats

Fragile X syndrome and other trinucleotide diseases are characterized by an elongation of a repeating DNA triplet. The ensemble-averaged lambda exonuclease digestion rate of different substrates, including one with an elongated FMR1 gene containing 120 CGG repeats, was measured using absorption and fluorescence spectroscopy. By use of magnetic tweezers sequence-dependent digestion rates and pausing was measured for individual lambda exonucleases. Within the triplet repeats a lower average and narrower distribution of rates and a higher frequency of pausing was observed.