Blending activity and participation sub-domains of the ICF

Objective. The objective of the study was to test the supposition that distinct Activity and Participation sub-domains of the International Classification of Functioning, Disability, and Health (ICF) could be identified using physical function questionnaire items drawn from the Activity and Participation Measures for Post Acute Care.

Design. A cross-sectional survey design was employed.

Subjects. The sample consisted of 272 patients who had received post acute care across inpatient and community care settings during the previous year.

Methods. Exploratory factor analysis with oblique rotation was used to identify interpretable dimensions underlying 83 physical functioning questionnaire items.

Results. Factor analysis findings revealed five distinct ICF conceptual sub-domains that explained 61% of the total variance of the data, with root mean square residual equal to 0.089. These domains were labeled: (i) Daily activity, (ii) Applied cognitive, (iii) Role participation, (iv) Mobility, and (v) Social participation. These five factors were correlated to varying degrees and achieved acceptable levels of internal consistency with coefficient alphas from 0.59 – 0.93.

Conclusion. These analyses suggest that clear distinctions between Activity and Participation sub-domains of the ICF could not be identified in a sample of adults who had recently received post acute care. We believe this is important evidence of the ability to measure blended Activity and Participation sub-domains that cut across distinct and interpretable areas of life functioning.     

Systemic T-cell activation in acute clinically isolated optic neuritis

We examined untreated 60 patients with acute monosymptomatic optic neuritis (ON). Patients examined early after onset showed increased expression of HLA-DR and CD45R0 on CD4 and CD8 T cells. Expression of HLA-DR on CD4 T cells was higher in patients without IgG oligoclonal bands. Expression of HLA-DR on CD4 and CD8 T cells correlated negatively with measures of disease activity and positively with measures of good visual function, and expression of CD45R0 on CD4 T cells correlated negatively with measures of disease activity. We hypothesize that HLA-DR expression may characterize a protective T-cell subset in ON.     

Comet assay on gill cells and hemocytes from the blue mussel Mytilus edulis

Gill cells and hemocytes from the blue mussel Mytilus edulis were examined for DNA damage using the comet assay after laboratory exposure in vitro and in vivo to methyl methansulfonate (MMS). Hydrogen peroxide and UV radiation were used as positive control. Comet assay was also carried out on hemocytes from blue mussels sampled at polluted and unpolluted coastal areas. After 60 min in vitro exposure of gill cells to MMS, the highest response, a tail moment of 6.70+/-4.25, was obtained at 1.0mg/L. At higher doses the response decreased. After 2 days in vivo exposure a dose response was seen at concentrations between 1.0 and 33.0mg/L MMS for both gill cells and hemocytes. However, after 4 days in vivo exposure using the same concentrations of MMS, a maximum effect was seen at a 10 times lower concentration of 3.3mg/L. At the higher doses, the effect decreased. Hemocytes from blue mussels sampled at four polluted sites in K?ge Bay had a great variation in tail moments with the highest value of 5.38+/-4.39. The average of all samples from K?ge Bay had tail moments of 2.75+/-1.00(n=19), which was significantly higher (P<0.05) than the average, 1.72+/-1.16(n=10), of samples from unpolluted coastal waters.     

Interpreting rehabilitation outcome measurements.

OBJECTIVE: With the increased use of standardized outcome instruments in rehabilitation, questions frequently arise as to how to interpret the scores that are derived from these standardized outcome instruments. This article uses examples drawn from the Activity Measure for Post Acute Care to illustrate 4 different data analysis and presentation strategies that can be used to yield meaningful outcome data for use in rehabilitation research and practice. DESIGN: A prospective cohort study in patients recruited at the point of discharge from a large acute care hospital or on admission to 1 of 2 rehabilitation hospitals after discharge from an acute care hospital in the greater Boston, MA region. SAMPLE: A total of 516 subjects in the Rehabilitation Outcome Study. RESULTS: Four distinct approaches to analyzing and reporting outcome data are described to derive more meaningful outcome measurements: interpreting a single scale score; interpreting clinical significance of score changes; a percentile ranking method; and a functional staging approach. The first 3 methods focus on interpreting the numeric property of individual measurements and are best suited to assess individual outcomes and for detecting change. The fourth, a functional staging approach, provides an attractive feature of interpreting the clinical meaning provided by a particular quantitative score without sacrificing the inherent value of a quantitative scale for tracking change over time. CONCLUSION: Users are encouraged to consider the range of analysis and presentation strategies available to them to evaluate a standardized scale score, both from a quantitative and a content perspective.     

Spontaneous rupture of the Achilles tendon is preceded by widespread and bilateral tendon damage and ipsilateral inflammation: A clinical and histopathologic study of 60 patients

60 consecutive patients with spontaneous rupture of the Achilles tendon (AT) underwent surgery. Biopsies were taken at the operations from the site of the rupture, the proximal part, the calcaneal insertion, and the peritendium of the injured tendon. A percutaneous needle biopsy was taken from the contralateral (uninjured) AT. On histological examination, collagen degeneration, tenocyte necrosis, and acute inflammation were found at the rupture site in all cases. In the proximal part and at the insertion, degeneration was present in 56/56 and 51/55 of the cases, necrosis in 55/56 and 50/55, and acute inflammation in 49/56 and 35/55, respectively. The severity of the histological changes decreased from the rupture site to the proximal part to the site of insertion, and showed no relation to the age of the patients or the time from the rupture to the operation. Peritendineal vascular changes were minor. In the contralateral AT, degeneration and necrosis were present in 47/50 and 42/50 of the cases, respectively, but the severity of the changes was less than in the injured tendon. Acute inflammation was present in only 1 case. Spontaneous rupture of AT seems to be preceded by widespread, bilateral damage of the tendon and widespread ipsilateral acute inflammation.