Outcome measures to assess walking ability following stroke: a systematic review of the literature

Objectives

The recovery of independent walking is an important goal in stroke rehabilitation. The objective of this systematic review was to identify all outcome measures used in the stroke research literature that included an evaluation of walking ability and evaluate the concepts contained in these measures with reference to the International Classification of Functioning, Disability and Health (ICF) framework.

Data sources

Searches were conducted of MEDLINE, CINAHL, EMBASE and PsycINFO databases for the time period January 1990-December 2005 using appropriate keywords.

Review methods

Studies were selected for further analysis if they used one or more standardized outcome measure incorporating an aspect of walking defined by the ICF. The outcome measure had to have published psychometric properties and specifically measure walking rather than mobility. The content of each outcome measure was classified with reference to the ICF subcategories for walking. The number of times each outcome measure was used was calculated.

Results

Three hundred and fifty-seven studies met the selection criteria. Sixty-one different outcome measures were used a total of 848 times to measure walking ability. Six of the outcome measures reflected impairment and 52 reflected limitations of activity and participation. The other three outcome measures showed overlap between domains, reflecting aspects of both impairment and limitations in activity and participation. The three most frequently used measures (self-paced gait speed measured over a short distance, spatiotemporal parameters and fast gait speed) were used 350 times but only assessed one ICF subcategory. The Rivermead Mobility Index and the Adapted Patient Evaluation Conference System assessed the greatest number of ICF subcategories but were used only 19 times and once respectively.

Conclusions

The most frequently used outcome measures reflect only one aspect of walking ability: walking short distances. Mobility tasks related to function in the community, like walking long distances, around obstacles and over uneven ground, and moving around outside or in buildings other then the home are not well represented by outcome measures used in most studies.     

Reliability and validity of the dynamic gait index in persons with chronic stroke

Jonsdottir J, Cattaneo D. Reliability and validity of the Dynamic Gait Index in persons with chronic stroke.

Objective

To establish the test-retest and interrater reliability as well as the concurrent construct validity of the Dynamic Gait Index (DGI) as a measure for dynamic balance in people with chronic stroke.

Design

Cohort study.

Setting

Day hospital and ambulatory care at a rehabilitation center.

Participants

A consecutive sample of 25 participants, at least 3 months poststroke and able to walk at least 10m with or without a walking aid, participated in the study. Two independent raters rated performances on the DGI.

Interventions

Not applicable.

Main Outcome Measures

The DGI was administered in 2 testing sessions 3 days apart. In the second session, the participants were rated by 2 raters. Intraclass correlation coefficients (ICCs), model 2,1, and the Bland and Altman method were used to analyze total scores and item scores. Concurrent construct validity was tested by correlating results to the Berg Balance Scale, the timed walking test, the Timed Up & Go test, and the Activities-specific Balance Confidence Scale.

Results

ICCs for test-retest and interrater reliability of total scores were good (.96, .96, respectively) whereas reliability for single item scores was moderate to good (range, .55−.93). The hypotheses for concurrent construct validity were confirmed with all measures (range, .68−.83).

Conclusions

The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with chronic stroke.     

Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement

Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.

Objective

To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.

Design

Case control.

Setting

Sports medicine research laboratory.

Participants

Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.

Interventions

Not applicable.

Main Outcome Measures

Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.

Results

The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).

Conclusions

The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat.     

Effects of Motor Imagery on Hand Function During Immobilization After Flexor Tendon Repair

Stenekes MW, Geertzen JH, Nicolai J-P, De Jong BM, Mulder T. Effects of motor imagery on hand function during immobilization after flexor tendon repair.

Objective

To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function.

Design

Randomized controlled trial.

Setting

Tertiary referral hospital.

Participants

Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group.

Intervention

Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period.

Main Outcome Measures

The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength.

Results

After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period (P≤.001).

Conclusions

Motor imagery significantly improves central aspects of hand function, namely movement preparation time, while other modalities of hand function appear to be unaffected.     

Validation of the Revised Quick Cognitive Screening Test

Mate-Kole CC, Conway J, Catayong K, Bieu R, Sackey NA, Wood R, Fellows R. Validation of the revised Quick Cognitive Screening Test.

Objective

To validate the revised version of the Quick Cognitive Screening Test (QCST).

Design

Cross-sectional.

Setting

Senior homes; hospital; college campus.

Participants

Participants (N=377; 114 men, 263 women) were recruited comprising healthy controls (n=201; 40 men, 161 women), subjects with dementia (n=93; 34 men, 59 women) including Alzheimer disease (n=73) and vascular dementia (n=20); subjects with psychiatric illness (n=35, 15 men, 20 women), specifically schizophrenia or bipolar disorder; and subjects with other neurologic conditions (n=48, 25 men, 23 women) such as traumatic brain injury (n=12) and cerebrovascular disease (n=31). Diagnoses were confirmed by physicians using appropriate criteria. Recruitment was done in the northeastern region.

Interventions

Not applicable.

Main Outcome Measures

In an effort to examine the reliability and validity of the revised QCST, participants were administered the revised QCST with a number of standardized measures (ie, Alzheimer's Disease Assessment Scale-Cognitive, Mini-Mental State Examination, Tests of Oral Fluency, Trail-Making Test, and Functional Activities Questionnaire).

Results

The results revealed that the revised QCST discriminated between healthy controls and the neuropsychiatric participants. Additionally, the revised QCST significantly correlated with other standardized measures, confirming the revised QCST's reliability and validity as a screening instrument for subjects with cognitive deficits.

Conclusions

The revised QCST provides the clinician with a short yet reliable screening instrument in detecting cognitive deficits in subjects with dementia and other neurologic conditions.     

Validation of the comprehensive ICF core set for osteoarthritis: the perspective of physical therapists

Background and purpose

Osteoarthritis is a common chronic disease associated with functional impairments and activity limitations, as well as participation restrictions. The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Osteoarthritis is an application of the ICF and represents the typical spectrum of problems in functioning of patients with osteoarthritis.

Objective

To validate the Comprehensive ICF Core Set for Osteoarthritis from the perspective of physical therapists.

Methods

Physical therapists experienced in the treatment of patients with osteoarthritis were asked about patients’ problems, resources and aspects of the environmental factors treated by physical therapists in patients with osteoarthritis in a three-round, electronic-mail survey using the Delphi technique. Responses were linked to the ICF.

Results

Seventy-two experts from 22 countries named 744 meaningful concepts that covered all ICF components. One hundred and fifty-two ICF categories were linked to these answers, 32 concepts were linked to the not-yet-developed personal factors component, and 14 issues were not covered by a single ICF category. Twelve ICF categories were not represented in the Comprehensive ICF Core Set for Osteoarthritis, although at least 75% of the participants rated them as important.

Discussion and conclusion

The content validity of the ICF was widely supported by the physical therapists. However, several issues were raised that were not covered and need to be investigated further.     

Goals of physiotherapy interventions can be described using the International Classification of Functioning, Disability and Health

Objective

To provide an example of how goals of physiotherapy interventions and their typical patterns can be described using the International Classification of Functioning, Disability and Health (ICF).

Design

Cross-sectional study.

Setting

Acute hospital.

Participants

One hundred patients with neurological, musculoskeletal or cardiopulmonary conditions requiring physiotherapy interventions in University Hospital Zurich between January 2003 and October 2003.

Main outcome measures

The case record form consisted of two parts: a standardised questionnaire for functioning and health of the patient; and a standardised record form for physiotherapy interventions. Both parts were based on the ICF.

Results

The mean age of the subjects was 58.2 years (standard deviation 15.9), the median age was 60.5 years and 44% were female. The most frequent intervention goals in patients with neurological conditions were: muscle power functions; muscle tone functions; control of voluntary movement functions; changing basic body position; maintaining a body position; and transferring oneself. The most frequent intervention goals for cardiopulmonary patients were: functions of the cardiovascular system; and respiration functions. The most frequent intervention goals in patients with musculoskeletal conditions were: sensation of pain; stability of joint functions; muscle power functions; muscle tone functions; and muscle endurance functions.

Conclusion

By using the ICF as a framework and linguistic support, intervention goals can serve as standardised documentation for physiotherapy interventions, their evaluation and planning.     

The Impact of Adaptive Seating Devices on the Lives of Young Children With Cerebral Palsy and Their Families

Ryan SE, Campbell KA, Rigby PJ, Fishbein-Germon B, Hubley D, Chan B. The impact of adaptive seating devices on the lives of young children with cerebral palsy and their families.

Objective

To determine the parent-perceived effect of adaptive seating devices on the lives of young children with cerebral palsy (CP) (aged 2-7y) and their families.

Design

Baseline-intervention-baseline study.

Setting

Homes of participating families.

Participants

Thirty parents and their children with Gross Motor Function Classification System level III or IV CP.

Interventions

Two special-purpose seating devices: 1 for sitting support on the floor or on a chair and the other for postural control on a toilet.

Main Outcome Measures

Family Impact of Assistive Technology Scale (FIATS) and Impact on Family Scale (IFS).

Results

Thirty parents (29 mothers, 1 father) and their children with CP participated. Repeated-measures analysis of variance detected significant mean differences among the FIATS scores (F_1.4,40.6=19.25, P<.001). Post hoc testing confirmed significant mean differences in overall FIATS scores between baseline and intervention and intervention and postintervention phases. The test of within-subject effects did not detect a significant change among IFS mean scores.

Conclusions

The introduction of adaptive seating devices for young children who need support to sit had a meaningful, positive impact on child and family life. Removal of the study devices showed a concomitant negative impact on key aspects of child and family life. Environmental resources, such as seating and other assistive technology devices, may have an important role to play in the lives of young children with physical disabilities and their families.     

Long-Term Outcome of Patients Discharged to a Nursing Home After Aneurysmal Subarachnoid Hemorrhage

Greebe P, Rinkel GJ, Algra A. Long-term outcome of patients discharged to a nursing home after aneurysmal subarachnoid hemorrhage.

Objective

To study long-term outcome in patients with aneurysmal subarachnoid hemorrhage (SAH) who are relatively young.

Design

Retrospective cohort study.

Setting

Nursing homes.

Participants

Patients with SAH (N=92) admitted to our hospital from 1996 to 2006 who were discharged to a nursing home.

Interventions

Not applicable.

Main Outcome Measures

Death, discharge from nursing home, and functional status at end of follow-up.

Results

Of the 92 patients included, 45 had died after a median of 1.1 years (range, 0.0-8.5y), 35 were discharged to home or a sheltered housing or rehabilitation center after a median of 0.6 years (range, 0.1-9.6y), and 12 remained in a nursing home after a median of 4.8 years (range, 2.2-12.0y). Forty-four (43%) had survived longer than 5 years, and 29 (31%) had regained functional independence within the initial 2 years after admission to the nursing home. Early discharge tended to occur more often in patients admitted from 2001 to 2006 than in those admitted from 1996 to 2001 (hazard ratio=1.8; 95% confidence interval, 0.9-3.7) and in those with an aneurysm not in the anterior communicating artery (hazard ratio=1.9; 95% confidence interval, 0.9-3.9).

Conclusions

The prognosis for patients with SAH after admission to a nursing home is not gloomy. The type of rehabilitation that offers best chances to these patients needs to be investigated.     

Screening for Mild Traumatic Brain Injury in the Presence of Psychiatric Comorbidities

Chapman JC, Andersen AM, Roselli LA, Meyers NM, Pincus JH. Screening for mild traumatic brain injury in the presence of psychiatric comorbidities.

Objective

To determine whether or not a battery of neurobehavioral tests, the Brief Objective Neurobehavioral Detector (BOND), could detect mild traumatic brain injury (mTBI) among a group of psychiatric inpatients with numerous substance-related and medical comorbidities. The 16-item BOND is comprised of neurologic examination tasks and has been shown to correlate with radiologic and cognitive findings in previous studies.

Design

Masked comparison.

Setting

Inpatient psychiatric unit at the Veterans Affairs Medical Center in Washington, DC.

Participants

Patients (N=51) sequentially admitted for suicidal ideation in the context of various psychiatric disorders.

Interventions

No intervention.

Main Outcome Measure

BOND total and subtest scores.

Results

Forty-three patients were eligible and analyzed. Twenty-seven had sustained an mTBI in the distant past, and 16 had never sustained a traumatic brain injury (TBI) (non-TBI group). On average, the mTBI group demonstrated a significantly greater number of abnormal subtests on the BOND (mean, 7.22) than did the non-TBI group (mean, 4.50; P=.003). Although the BOND significantly correlated with the presence of mTBI, it did not correlate with any of the psychiatric, substance-related, or medical comorbidities. Multiple regressions indicated that the BOND total score was not explained by age, posttraumatic stress disorder diagnosis, or any combination of the psychiatric, substance-related, or medical comorbidities. High rates of sensitivity (70%) and specificity (69%) were found.

Conclusions

The results of this pilot study suggest that the inexpensive, brief, and objective BOND instrument may be a useful screening tool for the detection of subtle neurologic brain abnormalities after mTBI, even in the presence of substantial comorbidities.     

Recovery of Muscle Strength and Power After Limb-Lengthening Surgery

Barker KL, Lamb SE, Simpson HRW. Recovery of muscle strength and power after limb-lengthening surgery.

Objective

To report muscle strength, power, and function after limb-lengthening surgery performed by using the Ilizarov technique.

Design

Prospective, longitudinal observational study of a cohort of consecutive patients who underwent limb-lengthening distraction followed up for 2 years after surgery.

Setting

National Health Service hospital specializing in orthopedic surgery.

Participants

Patients (N=16) who had undergone limb-lengthening surgery performed by using the Ilizarov method (11 men, 5 women; mean age=27y; range, 13-56y).

Interventions

None.

Main Outcome Measures

Muscle strength and power were assessed by using 2 validated measures: isokinetic concentric strength of the quadriceps and hamstrings measured by using a dynamometer and leg extensor power. Measures were recorded preoperatively and at 6, 12, and 24 months after the completion of lengthening. Function was measured by 2 timed tests of functional performance: stair climbing and sit-to-stand.

Results

Overall results were good with high reports of function and satisfactory clinical examination. Both concentric muscle strength and leg power showed a clear pattern of decreased muscle strength at 6 months after frame removal, improving throughout the study period until it was within 3% of the preoperative value at 2 years. By 2 years, self-reported function and ability to complete timed functional tests had returned to or improved on the preoperative values. Muscle strength remained slightly below the preoperative value; this was more pronounced in the quadriceps than the hamstrings. There was no association between muscle strength and the amount of lengthening that had been undertaken.

Conclusions

This study suggests that there is a small residual decrease in muscle strength and power after limb-lengthening surgery but that these do not adversely impact on a patients' ability to perform everyday functional activities.     

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004;85:201-9.

Objective

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

Design

Qualitative research methodology comprising a series of semistructured interviews.

Setting

Community-based setting.

Participants

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

Interventions

Not applicable.

Main outcome measure

Accounts of personal experiences related to employment.

Results

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

Conclusions

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.     

Impact of Traumatic Brain Injury on Participation in Leisure Activities

Wise EK, Mathews-Dalton C, Dikmen S, Temkin N, Machamer J, Bell K, Powell JM. Impact of traumatic brain injury on participation in leisure activities.

Objective

To determine how participation in leisure activities for people with traumatic brain injury (TBI) changes from before injury to 1 year after injury.

Design

Prospective evaluation of leisure participation at 1 year after TBI.

Setting

Level I trauma center.

Participants

Rehabilitation inpatients (mean age, 35.3 years; 77% male; 77% white) with moderate to severe TBI (N=160).

Interventions

Not applicable.

Main Outcome Measure

Functional Status Examination.

Results

At 1 year after injury, 81% had not returned to preinjury levels of leisure participation. Activities most frequently discontinued included partying, drug and alcohol use, and various sports. The activity most often reported as new after injury was watching television. Of the small fraction who returned to preinjury levels, 70% did so within 4 months of injury. Sixty percent of those who did not return to preinjury levels were moderately to severely bothered by the changes.

Conclusions

At 1 year after injury, many TBI survivors engage in a reduced number of leisure activities, which are more sedentary and less social, with a substantial fraction dissatisfied with these changes. While discontinuing some activities may be viewed as a positive change, there are few new ones to replace them.     

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study.

Objective

To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version.

Design

Methodologic research on cross-sectional data from a convenience sample.

Setting

A free-standing rehabilitation center.

Participants

Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders.

Main Outcome Measure

The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices.

Interventions

Not applicable.

Results

Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1-5, 7-11, 16-18, 20, 21), shoulder range of motion (items 6, 12-15, 19), and symptoms and consequences (items 22-30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items.

Conclusions

Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire.     

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis capture nursing practice? A Delphi survey

Background

The “Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)” is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA.

Objectives

The objective of this study was to validate this ICF Core Set from the perspective of nurses.

Method

Nurses experienced in RA treatment were asked about the patients’ problems, patients’ resources and aspects of environment that nurses take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF.

Results

57 nurses in 15 countries named 1170 concepts that covered all ICF components. 20 concepts were linked to the as yet undeveloped ICF component Personal Factors. 19 ICF categories are not represented in the Comprehensive ICF Core Set for RA.

Conclusion

The validity of the Comprehensive ICF Core Set for RA was largely supported by the nurses. However, a number of body functions which address side effects of drug therapies were not included in the Comprehensive ICF Core Set for RA. Furthermore, several issues arose which were not precisely covered by the ICF like “dry mucous”, “risk for decubitus ulcers” and “height” and need to be investigated further.     

Towards the Development of Clinical Measures for Spinal Cord Injury Based on the International Classification of Functioning,Disability and Health With Rasch Analyses

Objectives

To determine whether the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) can be integrated in clinical measures and to obtain insights to guide their future operationalization. Specific aims are to find out whether the ICF categories relevant to SCI fit a Rasch model taking into consideration the dimensionality found in previous investigations, local item dependencies, or differential item functioning.

Design

All second-level ICF categories collected in the Development of ICF Core Sets for SCI project in specialized centers within 15 countries from 2006 through 2008.

Setting

Secondary data analysis.

Participants

Adults (N=1048) with SCI from the early postacute and long-term living context.

Interventions

Not applicable.

Main Outcome Measures

Two unidimensional Rasch analyses: one for the ICF categories from body functions and body structures components and another for the ICF categories from the activities and participation component.

Results

Results support good reliability and targeting of the ICF categories in both dimensions. In each dimension, few ICF categories were subject to misfit. Local item dependency was observed between ICF categories of the same chapters. Group effects for age and sex were observed only to a small extent.

Conclusions

The validity of ICF categories to develop measures of functioning in SCI for clinical practice and research is to some extent supported. Model adjustments were suggested to further improve their operationalization and psychometrics.     

Discharge Destination's Effect on Bounce-Back Risk in Black, White, and Hispanic Acute Ischemic Stroke Patients

Kind AJH, Smith MA, Liou J-I, Pandhi N, Frytak JR, Finch MD. Discharge destination's effect on bounce-back risk in black, white, and Hispanic acute ischemic stroke patients.

Objective

To determine whether racial and ethnic effects on bounce-back risk (ie, movement to settings of higher care intensity within 30d of hospital discharge) in acute stroke patients vary depending on initial posthospital discharge destination.

Design

Retrospective analysis of administrative data.

Setting

Four hundred twenty-two hospitals, southern/eastern United States.

Participants

All Medicare beneficiaries 65 years or more with hospitalization for acute ischemic stroke within one of the 422 target hospitals during the years 1999 or 2000 (N=63,679).

Interventions

Not applicable.

Main Outcome Measures

Adjusted predicted probabilities for discharge to and for bouncing back from each initial discharge site (ie, home, home with home health care, skilled nursing facility [SNF], or rehabilitation center) by race (ie, black, white, and Hispanic). Models included sociodemographics, comorbidities, stroke severity, and length of stay.

Results

Blacks and Hispanics were significantly more likely to be discharged to home health care (blacks=21% [95% confidence interval (CI), 19.9-22.8], Hispanic=19% [17.1-21.7] vs whites=16% [15.5-16.8]) and less likely to be discharged to SNFs (blacks=26% [95% CI, 23.6-29.3], Hispanics=28% [25.4-31.6] vs whites=33% [31.8-35.1]) than whites. However, blacks and Hispanics were significantly more likely to bounce back when discharged to SNFs than whites (blacks=26% [95% CI, 24.2-28.6], Hispanics=28% [24-32.6] vs whites=21% [20.3-21.9]). Hispanics had a lower risk of bouncing back when discharged home than either blacks or whites (Hispanics=14% [95% CI, 11.3-17] vs blacks=20% [18.4-22.2], whites=18% [16.8-18.3]). Patients discharged to home health care or rehabilitation centers demonstrated no significant differences in bounce-back risk.

Conclusions

Racial/ethnic bounce-back risk differs depending on initial discharge destination. Additional research is needed to fully understand this variation in effect.     

Estimating minimal clinically important differences of upper-extremity measures early after stroke

Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. Estimating minimal clinically important differences of upper-extremity measures early after stroke.

Objective

To estimate minimal clinically important difference (MCID) values of several upper-extremity measures early after stroke.

Design

Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial, an acute, single-blind randomized controlled trial of constraint-induced movement therapy. Subjects were tested at the prerandomization baseline assessment (average days poststroke, 9.5d) and the first posttreatment assessment (average days poststroke, 25.9d). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests.

Setting

Inpatient rehabilitation hospital.

Participants

Fifty-two people with hemiparesis poststroke.

Interventions

Not applicable.

Main Outcome Measures

Estimated MCID values for grip strength, composite upper-extremity strength, Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and duration of upper-extremity use as measured with accelerometry.

Results

MCID values for grip strength were 5.0 and 6.2kg for the affected dominant and nondominant sides, respectively. MCID values for the ARAT were 12 and 17 points, for the WMFT function score were 1.0 and 1.2 points, and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides, respectively. MCID values were indeterminate for the dominant (composite strength), the nondominant (WMFT time score), and both affected sides (duration of use) for the other measures.

Conclusions

Our data provide some of the first estimates of MCID values for upper-extremity standardized measures early after stroke. Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke.     

The effects of providing pre-gastrointestinal endoscopy written educational material on patients’ anxiety: A randomised controlled trial

Background

Endoscopy is a frequently applied operation in health institutions which may cause anxiety in patients.

Objective

The objective of this study is to determine the effects of written educational material related to the endoscopy procedure on the anxiety level of the patient before gastrointestinal endoscopy.

Design

A randomised controlled trial design with two groups: case and control groups.

Participants

140 patients assigned randomly who applied for gastrointestinal endoscopy.

Methods

Intervention: the control group in our study consisted of 70 people who were briefly informed by the relevant unit about pre-endoscopy preparation. The case group consisted of 70 people who were also given brief information about the pre-endoscopy preparation by the relevant unit. Only the case group were also given written educational material and told orally by the researcher about the content. Measurements: for the collection of the data, a questionnaire form and Spielberger's State-Trait Anxiety Inventory were used.

Results

A significant difference in the average state anxiety scores was found between the case and the control group (p < 0.05). An important difference was found in the average state anxiety scores between the case and the control group who had not undergone endoscopy before our study (p < 0.05).

Conclusions

Use of written material including detailed information to inform the patient before endoscopy was useful in lessening their anxiety level. Health professionals should evaluate the anxiety level of patients before endoscopy and educational material should be given to them to read.     

A study to compare the effects of massage and static touch on experimentally induced pain in healthy volunteers

Objective

To investigate the hypoalgesic effects of massage on experimental pain.

Design

A cross-over intervention study separated by a 24-hour washout period. During each experiment, participants completed five cold-induced pain tests, two before the intervention and three during the intervention. During each test, participants immersed their hand in iced water and reported the first sensation of pain and pain intensity after a further 30 seconds.

Setting

Laboratory setting.

Participants

A volunteer sample of 30 university staff and students without known pathology, recruited from noticeboard advertisements.

Interventions

Participants received massage in one experiment and static touch in the other experiment. Interventions were administered to the ipsilateral arm for 4 minutes immediately before the hand was immersed in iced water.

Main outcome measures

Time to pain threshold and the odds of a reduction in pain intensity and an increase in pain relief.

Results

A mixed model analysis was used to establish how measures varied, according to baseline, during static touch and during massage. Massage increased the pain threshold by a factor of 1.08 (95% confidence interval 0.99-1.17) compared with static touch, but this failed to reach statistical significance (P = 0.088). Massage was more likely to result in a report of low pain intensity than static touch (odds ratio 0.26, 95% confidence interval 0.10-0.71, P = 0.007). Massage was more likely to result in a state of high pain relief than static touch (odds ratio 7.7, 95% confidence interval 3.0-19.8, P < 0.001).

Conclusion

Massage produced hypoalgesic effects on experimental pain in healthy volunteers.