Reliability of the Functional Independence Measure with Occupational Therapists

This paper reports an inter-rater reliability study on the Functional Independence Measure (FIM). The FIM measures inpatient burden of care, as reflected in 18 self care items, rated on a seven point scale from dependent to independent. The subjects were 40 occupational therapists, divided according to experience with the FIM and randomly assigned to a FIM training or non-training group. Subjects rated video tapes of four stroke patients on transfers, bathing, dressing, grooming, toileting and eating items from the FIM. Rater consensus was calculated using the intraclass correlation coefficient (ICC), percentage agreement and a measure of disagreement. Rating accuracy was measured by comparisons with an expert rater. Ratings were most reliable when done by clinicians with no prior FIM experience, from the FIM training group. It is strongly recommended that all clinicians undergo FIM training before using this tool to ensure acceptable reliability.     

Sperm quality in Hodgkin's disease versus non-Hodgkin's lymphoma

The study was conducted to determine the deleterious effect of lymphoma disease on spermatogenesis and to evaluate the possibility that the disease is mediated primarily by inherent mechanisms in Hodgkin's disease and non-Hodgkin's lymphoma patients. A total of 89 patients with lymphoma disease (Hodgkin's and non-Hodgkin's) were referred for sperm preservation prior to adjuvant treatments. A comparison was made of pre- and post-thaw sperm quality between lymphoma patients and healthy volunteers who applied for sperm donation. This was followed by further assessment of the differences between patients with Hodgkin's disease and non-Hodgkin's lymphoma in terms of sperm variables, clinical parameters and blood hormone concentrations. It was found that patients with lymphoma disease had significantly impaired pre-freeze and post-thaw sperm quality compared with that of healthy volunteers. Patients with non-Hodgkin's lymphoma had spermatozoa of higher quality than patients with Hodgkin's disease. No differences were found in the clinical or hormonal parameters between these two groups. As expected, reduced testicular size and abnormal testicular consistency were correlated with decreased sperm quality. The mere presence of cancer disease has a direct negative effect on spermatogenesis, which is probably not related to incidental side-effects. A variable degree of impairment should be expected with different categories of cancer.      

Agility following the application of cold therapy

Cold application is commonly used before strenuous exercise due to its hypalgesic effects. Some have questioned this procedure because of reports that cold may reduce isokinetic torque. However, there have been no investigations of actual physical performance following cold application. The purpose of this study was to determine if a 20-minute ice immersion treatment to the foot and ankle affected the performance of three agility tests: the carioca maneuver, the cocontraction test, and the shuttle run. Twenty-four male athletic subjects were tested during two different treatment sessions following an orientation session. Subjects were tested following a 20-minute 1°C ice immersion treatment to the dominant foot and ankle and 20 minutes of rest. Following each treatment, subjects performed three trials of each agility test, with 30 seconds rest between each trial, and 1 minute between each different agility test. The order in which each subject performed the agility tests was determined by a balanced Latin square. A MANOVA with repeated measures was used to determine if there was an overall significant difference in the agility times recorded between the cold and control treatments and if the order of the treatment sessions affected the scores. Although the mean agility time scores were slightly slower following the cold treatment, cooling the foot and ankle caused no difference in agility times. Also, there was no difference resulting from the treatment orders. We felt that the slightly slower scores may have been a result of tissue stiffness and/or subject's apprehension immediately following the cold treatment. Cold application to the foot and ankle can be used before strenuous exercise without altering agility.     

Cytomegalovirus retinitis after the initiation of highly active antiretroviral therapy: a 2 year prospective study

BACKGROUND/AIMS: There have been several recent reports suggesting that the natural history of cytomegalovirus retinitis (CMVR) has been significantly modified with the development of highly active antiretroviral therapy (HAART). This 2 year prospective cohort study assesses the effect of HAART on the incidence and progression of CMV retinitis in patients with CD4 cell counts below 50 cells x10(6)/l. METHODS: 63 patients, with CD4 cell counts below 50 cells x10(6)/l, who were recruited to a 2 year prospective cohort study at the commencement of combination antiretroviral therapy including the use of the proteinase inhibitor, indinavir, were reported. The response to HAART was assessed in terms of a rise in the CD4 cell count and fall in HIV viral load. An experienced ophthalmologist performed dilated funduscopy at the time of recruitment and thereafter at 2 weekly intervals and retinal photography was performed at monthly intervals in patients with CMVR. The activity and progression of CMV retinitis was assessed on the basis of the characteristic clinical and photographic findings. RESULTS: 34 patients achieved at least 50 CD4 cells x10(6)/l at 3 months after initiation of therapy. New diagnoses of CMVR were seen only in the non-responder group (p=0. 085). Overall, the relative risk of a new retinitis event in this group was 3.52 (95% CI 1.16, 10.68) at 3 months compared with those patients who were responsive to HAART. 12 of the 63 patients had previous CMVR. Disease progression was associated with non-response to therapy (p=0.182 exact). In patients with CMVR the median time to first progression was 18 days (95% CI 8, 91) in non-responders and 121 days (95% CI 0.59, 3.65) in responders. By the end of the 2 year follow up period all surviving patients had >50 CD4 cells x10(6)/l. No CMV events were seen after 8 months of therapy in either group of patients. CONCLUSIONS: These findings suggest that significant clinical immunorestoration to CMV occurs in response to HAART in patients with CMVR after a lag time of 3-8 months. Initially, a rise in CD4 count is predictive of CMVR response but after the lag period all survivors appear to have developed a clinical immunorestoration to CMV. If HAART is commenced in at risk patients before the development of CMVR the incidence of new disease falls significantly.     

Comparison of isokinetic strength and flexibility measures between hamstring injured and noninjured athletes

The purpose of this study was to compare isokinetic strength and flexibility measures between hamstring injured and noninjured athletes. Sixteen university athletes with history of hamstring injury were matched by motor dominance, sport, and position to sixteen university athletes without history of hamstring injury. Each subject was tested for concentric and eccentric quadriceps and hamstring peak torque and reciprocal muscle group ratios on a Kinetic Communicator(R) (KIN-COM) dynamometer at 60 degrees /sec and 180 degrees /sec. Each subject's hamstring flexibility was determined by passively extending the knee while the hip was maintained at 90 degrees of flexion. Analysis of variance indicated that the injured extremity was significantly less flexible than the noninjured extremity within the hamstring injured group, and the hamstring injured group was less flexible than the noninjured group. No significant strength differences existed between the hamstring injured and noninjured group on any isokinetic measure evaluated. The importance of assessing hamstring flexibility is emphasized. J Orthop Sports Phys Ther 1991;13(3):118-125.