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Objective: To evaluate the effect of an extended stroke unit service with early supported discharge on balance and walking speed, and to explore the association between initial leg paresis, initial movement ability and balance one year after stroke.Design: A randomized controlled trial comparing early supported discharge with ordinary stroke unit service. Patients: A total of 62 eligible patients after stroke.Methods: The outcome measures were Berg Balance Scale and walking speed at 1, 6, 26 and 52 weeks after stroke.Results: We found no significant differences between the 2 groups during follow-up. There was a significant improvement on Berg Balance Scale (p=0.013) and walking speed (p=0.022) in the early supported discharge group, but not in the ordinary service group, from 1 to 6 weeks' follow-up. All patients with initial severe leg paresis suffered from poor balance one year after the stroke. The odds ratio for poor balance was 42.1 (95% confidence interval; 3.5–513.9) among patients with no initial walking ability.Conclusion: These results do not conclusively indicate that early supported discharge has an effect on balance. A strong association was found between initial severe leg paresis, initial inability to walk and poor balance after one year. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether vestibular rehabilitation for patients with whiplash-associated disorder and dizziness had any effect on balance measures and self-perceived handicap.Design: Randomized, controlled trial.Subjects: Twenty-nine patients, 20 women and 9 men, age range 22–76 years.Methods: The patients were randomized to an intervention group or a control group. The intervention comprised vestibular rehabilitation. All patients were assessed at baseline, after 6 weeks and after 3 months with 4 different balance measures and the Dizziness Handicap Inventory.Results: After 6 weeks, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.02), blindfolded tandem stance (p=0.045), Dizziness Handicap Inventory total score (p=0.047), Dizziness Handicap Inventory functional score (p=0.005) and in Dizziness Handicap Inventory physical score (p=0.033). After 3 months, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.000), tandem stance (p=0.033) and Dizziness Handicap Inventory physical score (p=0.04).Conclusion: Vestibular rehabilitation for patients with whiplash-associated disorder can decrease self-perceived handicap and increase postural control. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this study was to compare the motor performance of physically well-recovered men with traumatic brain injury with that of healthy men. Design: Cross-sectional study in a national rehabilitation centre. Methods: Static and dynamic balance, agility and rhythm co-ordination of men with traumatic brain injury ( n =34) and healthy controls ( n =36) were assessed. Between-group differences in dynamic balance and agility were analysed by analysis of covariance and differences in static balance and rhythm co-ordination by logistic regression analysis. Cut-off points for clinical screening were determined by receiver operating characteristics analyses. Results: Men with traumatic brain injury had impaired balance and agility compared with healthy men and in a rhythm co-ordination test they had difficulties in starting and sustaining simultaneous rhythmical movements of hands and feet. In receiver operating characteristics analyses a running figure-of-eight test (agility), tandem walking forwards (dynamic balance) and rhythm co-ordination test with fast tempo were found the most sensitive and specific for distinguishing between men with traumatic brain injury and the healthy men. Conclusions: The impairments in motor performance of physically well-recovered patients with traumatic brain injury were obvious. The results of this study extend the knowledge of problems in motor performance among patients with traumatic brain injury and provide further information for clinical rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: To examine feasibility and acceptability issues and to gather preliminary outcome data to ascertain the numbers needed for a trial of Marma massage therapy for stroke rehabilitation. Design: Pilot non-randomized controlled trial, comparing standard care with standard care plus Marma therapy in post-stroke patients with a nested qualitative study. Participants: Adult patients who had an infarction or haemorrhage at any brain location with a Barthel Index score of 75/100 or less. Methods: Feasibility was assessed in terms of recruitment and response rates and loss to follow-up, and acceptability was assessed by patient interviews ( n =13). The main outcome measure was the Barthel Index. Results: The recruitment rate was 0.53 patients per week in a stroke unit with an admission rate of 15.1 per week, the response rate was 91% and the loss to follow-up 30%. Most patients believed that the massage was beneficial, and although some reported pain, all interviewed would choose it again. The effectiveness data showed no significant differences in changed scores. However, the secondary measure follow-up score differences of the Motricity Index at 6 and 12 weeks and the trunk control test at 6 weeks suggest a possible greater improvement in the intervention group ( p <0.05, p <0.01). Conclusion: There are grounds for a future trial of Marma therapy ( n =172), which would be feasible and acceptable to patients. [ABSTRACT FROM AUTHOR]

Objective: To examine the sensitivity of the Short Form Activity Measure for Post-Acute Care (AM-PAC) in comparison to the Functional Independence Measure (FIM™) across a 12-month period after discharge from rehabilitation hospital. Design: Prospective longitudinal study. Patients were recruited while receiving inpatient services from facilities in the north-east USA and interviewed 1, 6 and 12 months thereafter. Patients: Convenience sample of 516 patients at baseline (65% retention at the final follow-up) receiving rehabilitation services for neurological, lower extremity orthopedic, or complex medical conditions. Mean age 68.3 years; 47% male. Main outcome measures: AM-PAC Physical and Movement, Personal Care and Instrumental, and Applied Cognitive Activity scales; FIM ™ Motor and Cognitive scales. Results: All 3 AM-PAC scales were sensitive to both positive and negative change across the follow-up period. Standardized response means for the AM-PAC were consistently larger than for the FIM ™ across patient and severity groups. A greater percentage of patients showed positive change that exceeded the minimal detectable change on the AM-PAC than on the FIM ™ at both 6- and 12-month follow-ups. Conclusion: The short-form AM-PAC scales are more sensitive measures of change in functional activity performance over time in the general population of persons who receive inpatient rehabilitation services compared to the FIM ™ . Thus, the AM-PAC offers a short, comprehensive, and sensitive measure of positive and/or negative change in patients’ ability to perform important activities of daily life. [ABSTRACT FROM AUTHOR]

Objective: To develop a prognostic model to predict mobility outcome one year post-stroke. Design: Prospective cohort study in patients with a first-ever stroke admitted for inpatient rehabilitation. Patients: A total of 217 patients with stroke (mean age 58 years) following inpatient rehabilitation in 4 rehabilitation centres across the Netherlands. Methods: Mobility was measured using the Rivermead Mobility Index at one year poststroke. Included independent variables were: patient and stroke characteristics, functional status, urinary incontinence, sitting balance, motor and cognitive function. Univariate and multivariate linear regression analyses were performed in a model-developing set ( n =174) and the model was validated in cross-validation set ( n =43). Results: Total Rivermead Mobility Index score at one year post-stroke was predicted by functional status, sitting balance, time between stroke onset and measurement, and age. The derived model predicted 48% of the variance, while validation in the cross-validation set resulted in an adjusted R 2 of 0.47. Conclusion: The present prospective study shows that outcome of mobility one year after stroke can be predicted validly by including functional status, sitting balance, moment of admission to the rehabilitation centre after stroke onset and age. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe general characteristics of patients with stroke who have a tendency to fall and to determine whether certain test instruments can identify fallers. Methods: Patients treated in a stroke unit during a 12-month period were included. At inclusion assessments were made with Berg Balance Scale Berg Balance Scale, Stops Walking When Talking, Timed Up & Go (TUG) and diffTUG. At follow-up 6 or 12 months later, patients who had fallen were identified. Results: During the time from discharge to follow-up on 159 patients, 68 patients fell and 91 did not. Fallers fell more often during their initial hospital stay, used sedatives more often and were more visually impaired, compared with non-fallers. The Berg Balance Scale, Stops Walking When Talking and TUG results differed between fallers and non-fallers. The combined results of Berg Balance Scale and Stops Walking When Talking increased the possibility of identifying fallers. Conclusion: Berg Balance Scale, Stops Walking When Talking and TUG can be used to evaluate which patients have a tendency to fall in order to carry out preventive measures. Berg Balance Scale can be used in all patients. Stops Walking When Talking can give additional information if the patient is able to walk. TUG is a possible choice, but fewer patients can perform it. [ABSTRACT FROM AUTHOR]

Objective: To explore adaptation, by examining the occupational gaps occurring between what individuals want to do and what they actually do in terms of their everyday activities before and after brain injury. In addition, the relationships between occupational gaps and impairment/activity limitations and the time lapse since the brain injury were explored. Design: A cross-sectional study. Subjects: A total of 187 persons, affected by traumatic brain injury or subarachnoid haemorrhage 1–4 years previously. Methods: A postal questionnaire encompassing questions concerning gaps in the performance of activities in everyday life before and after the brain injury and perceived impairment/activity limitations. Results: The numbers of occupational gaps increased after the injury, with the number of gaps having increased from 46% to 71%. The number of occupational gaps was significantly related to executive impairment/activity limitations, and motor impairment/activity limitations and other somatic impairments, such as headache, also had an impact. The time lapse since the brain injury had no significant effect on the number of occupational gaps. Conclusion: The results suggests that there is a need for adaptation in everyday activities, even several years after a brain injury, which indicates that follow-up and access to individualized rehabilitation interventions in the long-term are required. [ABSTRACT FROM AUTHOR]

Objective: To assess whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality, mood, life satisfaction, health-related quality of life, sense of coherence and pain for patients with a spinal cord injury and neuropathic pain. Design: A prospective intervention study. Patients: Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme in parallel with 11 patients in a control group. Methods: A comprehensive pain management programme comprising educational, cognitive, and behavioural interventions was created for patients with spinal cord injury and neuropathic pain. The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions, behavioural therapy, relaxation, stretching, light exercise and body awareness training. All patients were followed-up 3, 6 and 12 months after completion of the programme. Results: At the 12-month follow-up, levels of anxiety and depression in the treatment group decreased compared with baseline values, and a tendency towards better quality of sleep was seen. In comparison with the control group, patients in the treatment group improved regarding sense of coherence and depression. Conclusion: This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain. [ABSTRACT FROM AUTHOR]

Objective: To study injury-related and individual factors as predictors of work participation in persons with traumatic and congenital spinal cord injury. Design: Cross-sectional questionnaire study. Subjects: One hundred and eighty-two persons with traumatic spinal cord injury treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, Göteborg, Sweden, and 48 persons with meningomyelocele admitted to the Young Adult Teams in Göteborg, Borås and Skövde, Sweden. Methods: A structured questionnaire was sent by post. Main outcome variable was participation in work. Logistic regression modelling was used to study the associations between the potential predictors and work participation. Results: Employment rates were 47% in the traumatic spinal cord injury group and 38% in the meningomyelocele group. The presence of other somatic or mental disorder, and neuropathic pain decreased work participation among the men with traumatic spinal cord injury. Among persons with meningomyelocele, better ambulatory status and higher educational level increased work participation. In all groups higher independence in daily activities increased the probability of work participation. According to multivariable modelling carried out for the men with traumatic spinal cord injury, age over 55 years and the presence of mental disorder decreased work participation. Conclusion: Our data show that work participation is affected by individual and injury-related factors. Of the latter, many can be affected by rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Analysis of the effects of a comprehensive focal spasticity program in adult patients. Design: Retrospective study of an out-patient cohort. Patients: One hundred patients were enrolled in the study (54 men and 46 women, mean age 41 years (SD 14). Cerebral palsy and stroke were equally common (80% in total). The remaining patients had miscellaneous diagnoses, including traumatic brain injury. Methods: On average 230 units (SD 101) of botulinum toxin A Botox® was given for 227 principal therapy targets chosen by the patient or the caregiver. One patient could have several targets for therapy. Administration of botulinum toxin was combined with 260 additional therapeutic interventions, most of which were forms of physical therapy. The effects were assessed after 6 weeks and compared with baseline functional abilities 1–2 weeks prior to therapy. Results: Improvement was observed for 211 (93%) therapy targets, no change in 15 (7%), and impairment in 1, corresponding to an overall improvement in 90 patients (90%), 9 unchanged (9%) and worsening in 1. Spasticity assessment (Ashworth scale 0–4; 30 patients) showed a statistically significant improvement (median at baseline was 3 vs 2 after therapy, mean difference 1.2, p <0.001). Conclusion: Improvement was observed in ≥90% of patients and in their principal therapeutic targets in a cohort receiving their first focal spasticity treatment with botulinum toxin A and additional therapy. A strict strategy for patient selection and comprehensive management was followed. [ABSTRACT FROM AUTHOR]

Carers of stroke patients provide informal care ranging from physical help to psychosocial support. As a result, these carers may experience high levels of burden, associated with characteristics of the patients and of the carers themselves. This burden can result in a deterioration of the carers’ health status, social life and well-being. The carers may thus be seen as colleagues of professional carers in sharing the care for the patient, but they should also be seen as “patients” having problems and special needs themselves. In this paper new Dutch clinical practice guidelines are presented. These guidelines are formulated in response to an expressed need to improve professional support for this group. We believe these guidelines are also relevant for other countries, since the evidence was gathered through systematic searches of international literature and none of the guidelines that we were able to find in other countries already included this evidence. New, or more detailed topics in the Dutch guidelines, in comparison with existing international guidelines, are added (e.g. young children). Three topics concerning carer burden are presented in more detail in this paper, which are based on systematic literature searches: partners at risk of burden, assessing burden in carers and interventions for carers. [ABSTRACT FROM AUTHOR]

Objective: To assess whether mechanical traction, either alone or in combination with other treatments, improves pain, function/disability, patient satisfaction and global perceived effect in adults with mechanical neck disorders. Methods: We conducted a systematic review up to September 2004 of randomized controlled trials and used pre-defined levels of evidence for qualitative analysis. Two independent reviewers conducted study selection, data abstraction and methodological quality assessment. Using a random effects model, relative risk and standardized mean differences were calculated. The reasonableness of combining studies was assessed on clinical and statistical grounds. In the absence of heterogeneity, pooled effect measures were calculated. Results: Of the 10 selected trials, one study was of high quality. Our review revealed low-quality trials for mechanical neck disorders, showing evidence of benefit favouring intermittent traction for pain reduction. Continuous traction showed no significant difference for defined outcomes. Conclusion: Inconclusive evidence for continuous and intermittent traction exists due to trial methodological quality. Two clinical conclusions may be drawn, one favouring the use of intermittent traction and the other not supporting the use of continuous traction. Attention to research design flaws and description of traction characteristics is needed. [ABSTRACT FROM AUTHOR]

Objective: Delayed admission to rehabilitation may result in poorer outcomes by reducing exposure to therapeutic interventions at a time when the brain is primed for neurological recovery. The present study examined the effects of early vs delayed admission on functional outcome and length of stay in patients admitted to a rehabilitation unit for first-ever unilateral stroke. Design: Retrospective chart review. Methods: Differences in length of rehabilitation stay and functional outcome variables among 435 patients, grouped by interval from stroke event to rehabilitation admission (=30 days vs 31–150 days and 5 additional subgroups) were examined using a multivariate technique. Results: Admission and discharge FIM™ scores, FIM™ change and FIM™ efficiency were significantly higher among early admission patients ( p <0.01), while length of stay was significantly longer among delayed admission patients ( p <0.01). A significant association was identified between age and admission ( p <0.01) and discharge FIM™ ( p <0.01) scores as well as FIM™ change scores ( p =0.017). Subgroup analyses revealed significant differences in FIM™ scores, FIM™ change and length of stay between groups of patients admitted 0–15 and 16–30 days ( p <0.01) and between patients admitted 16–30 days and 31–60 days post-stroke ( p <0.01). No significant differences were noted between patients admitted from 31–60 and 61–90 or 61–90 and 91–150 days. Conclusion: Patients admitted to stroke rehabilitation within 30 days of first-ever, unilateral stroke experienced greater functional gains and shorter lengths of stay than those whose admission to rehabilitation was delayed beyond 30 days. [ABSTRACT FROM AUTHOR]

Objective: To assess whether liver transplant recipients have a hypoactive (sedentary) lifestyle and whether the level of everyday physical activity is related to complaints of fatigue. In addition, we explored the relationship between activity level and health-related quality of life. Design: Case comparison. Subjects. Eight persons 6–36 months after liver transplantation with varying severity of fatigue and 8 persons without known impairments (matched for gender, age, social situation and employment). Methods: Activity levels were assessed during 2 randomly selected consecutive weekdays with an accelerometry-based Activity Monitor. In the transplantation group, severity of fatigue (Fatigue Severity Scale) and health-related quality of life (RAND-36) were also assessed. Results: Five liver transplant recipients had a hypoactive lifestyle, but there was no significant difference in activity level between the transplantation group and comparison group. Severity of fatigue was correlated ( p =0.01) with both duration of dynamic activities and intensity of everyday activity ( r s =?-?0.81 and -0.84, respectively). Activity level was correlated ( p =0.05) with several domains of health-related quality of life ( r s =0.72–0.78). Conclusion: As a group, liver transplant recipients were not significantly less active than comparison subjects. Activity level was related with severity of fatigue and health-related quality of life. These findings have implications for the development of interventions needed to rehabilitate persons after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate possible gender differences regarding the effect of intervention in geriatric rehabilitation, expressed in terms of change in function-related dependence, pain and insecurity. Design: Comparative study. Participants: A total of 110 women and 44 men undergoing geriatric rehabilitation. Methods: Performance-based assessments with use of the General Motor Function assessment scale. Non-parametric statistics were mainly used. Results: The women showed higher degrees of function-related dependence, pain and insecurity on admission than the men. Both women and men displayed significant improvement in all 3 variables during the rehabilitation period. However, the positive changes regarding pain and insecurity were according to the analyses of systematic group changes, at a low degree among the men, probably because of the low levels on admission. Gender comparisons of proportions with positive intervention outcome indicated that a significantly larger proportion of the women showed a positive treatment effect after intervention, with a difference in recovery of 19% in dependence, 23% in pain and 33% in insecurity ( p?

Objective: To develop a short version of the motor Functional Independence Measure (FIM™) for use in long-term care settings. Participants: For model construction, the participants were 398 community-dwelling persons with disability (mean age 79.3 years (SD 10.3)) who were receiving visiting nurse services. For cross-validation, 169 patients with stroke (mean age 78.0 years (SD 11.2)) in the chronic phase and 187 patients with stroke (mean age 63.4 years (SD 12.7)) in the recovery phase. Design: Model construction and cross-validation study. Main outcome measures: The second power of correlation coefficient (R 2 ) was used for agreement analysis between the short and the full version. Cross-validation of the models was estimated with the intraclass correlation coefficient (ICC). Results: Five to 7 motor FIM™ items were selected for the models based on Rasch calibration and consideration of internal consistency. Total motor FIM™ was estimated with the 6-item and 7-item models with regression analysis, which yielded high correlations with the original 13-item motor FIM™ score (R 2 >0.95). Regression formulas derived from the models could estimate total motor FIM™ scores accurately in the 2 cross-validation samples (ICC?>?0.98). Conclusion: The short version of the motor FIM™ developed is a useful measure of functional status, not only in long-term care but in the recovery phase rehabilitation settings. [ABSTRACT FROM AUTHOR]

Objective: To compare the functional, cognitive and disability status of aphasic and non-aphasic traumatic brain injury patients. Design: A prospective comparative study in which 103 patients with traumatic brain injury participated. Subjects: Fifty-one aphasic and 52 non-aphasic patients with traumatic brain injury. Methods: Functional Independence Measure and Disability Rating Scale were used to determine functional status and disability. Cognitive status was evaluated by the Mini-Mental Status Examination. Aphasic patients were evaluated using the Gülhane Aphasia Test for language disorders. Results: The most frequent type of aphasia was Broca aphasia at 26.49% followed by anomic at 19.6% and trans-cortical motor at 15.6%. Functional Independence Measure, Disability Rating Scale and Mini-Mental Status Examination scores at admission and at discharge showed significant differences in aphasic patients ( p 0.01). Conclusion: Although aphasia could be accepted as a negative prognostic indicator in patients with traumatic brain injury, we could not detect any difference in functional and cognitive gains between the aphasic and non-aphasic patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of neuromuscular electrical stimulation (NMES) on cough capacity and prevention of pulmonary complication in patients with acute cervical cord injury. Design: A randomized controlled trial. Subjects: Twenty-six tetraplegic patients with cervical spinal cord injury, 13 in the NMES therapy group and 13 in the control group. Methods: NMES was applied to the clavicular portion of the pectoralis major and abdominal muscle. Pulmonary function tests were performed before and after therapy, and at 3?months and 6?months follow-up. The pulmonary complications in this 6-month follow-up period were also recorded. Results: After the 4-week therapy, and at 3?months and 6?months follow-up testing, patients in the NMES therapy group displayed significant improvement in their peak expiratory flow, forced expiratory volume in 1?second, forced vital capacity, maximal expiratory pressure and maximal inspiratory pressure, compared with those in the control group ( p <0.05). Patients in the NMES therapy group also had fewer pulmonary complications in the follow-up period. Conclusion: NMES over the pectoralis and abdominal muscles might improve cough capacity and pulmonary function in cervical spinal cord injury with tetraplegia. This improvement might last for 6?months. With this improvement, pulmonary complications were reduced. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of a day treatment program with a comprehensive team approach for treating outpatients with acquired brain injury, which is offered by the Kanagawa Rehabilitation Hospital. Design: Non-randomized controlled study. Subjects: Twenty-five program graduates and 12 control patients with acquired brain injury. Methods: A prospective study using 25 brain-injured patients with cognitive dysfunction who were provided with a comprehensive day treatment program at Kanagawa Rehabilitation Hospital. The 25 enrolled patients had treatment sessions lasting 2–4 hours for 2 days a week over a 3–6-month period. Functional Independence Measure/Functional Assessment Measure (FIM/FAM) and the Community Integration Questionnaire (CIQ) were administered before and after the program to compare outcomes between the 25 program participants and the 12 control patients who did not receive the day treatment program. Results: Significant improvements in speech intelligibility, problem solving, memory, attention and social integration scores in the FIM/FAM and scores in social integration and productive activity in the CIQ were evident in the enrolled subjects. In addition, 9 of the 25 patients returned to work or school. Conclusion: These results demonstrate the effectiveness of this program in helping to rehabilitate patients with acquired brain injury. [ABSTRACT FROM AUTHOR]

Objective: The authors know of no controlled randomized studies on the cognitive effects of acupuncture following stroke. The aim of this study is to assess the effects of acupuncture combined with electroacupuncture and transcutaneous electrical nerve stimulation on emotional and cognitive functioning. Methods: Five to 10 days after stroke, 54 patients with moderate or severe functional impairment were randomized to 1 of 3 interventions: (i) acupuncture, including electroacupuncture; (ii) sensory stimulation with high-intensity, low-frequency transcutaneous electrical nerve stimulation that induced muscle contractions; and (iii) low-intensity (subliminal) high-frequency transcutaneous electrical nerve stimulation (control group). Twenty treatment sessions were performed over 10 weeks. Outcome measures included cognitive performance and emotional functioning. Measures were obtained prior to any stimulation treatment and at 3 and 12 months. Results: At baseline, groups were comparable with regard to demographic, medical, emotional and functional status. The control group demonstrated lower cognitive performances, but this difference did not remain at 3 or 12 months. There were no treatment effects on emotional status. When pooling treatment groups, there were significant cognitive and emotional improvements. Conclusion: Although patients from all 3 groups demonstrated cognitive and emotional improvements, the present study does not suggest any treatment effects on emotional status or cognitive functioning. [ABSTRACT FROM AUTHOR]

Objective: To study the concurrent validity and the inter-rater reliability of the Post-Concussion Symptoms Questionnaire. Design: The approach was to study the concurrent validity of the Post-Concussion Symptoms Questionnaire when used as an interview questionnaire compared with a self-report questionnaire administered by the patients. The inter-rater reliability was also studied when 2 different raters administered the Post-Concussion Symptoms Questionnaire interview. Patients: Thirty-five patients with mild traumatic brain injury were consecutively contacted by telephone and asked whether they would be willing to participate in a follow-up intervention. Methods: The Post-Concussion Symptoms Questionnaire was completed by the patients, who answered “Yes” or “No” to the standardized questions. The patients were then interviewed to check the certain “Yes” or “No” answers, 0–10 days after having completed the first Post-Concussion Symptoms Questionnaire. The raters filled in their ratings independently. Results: The concurrent validity of answers in the questionnaire compared with those in the interview ranged from 82% to 100% agreement. The inter-rater reliability results ranged from 93% to 100% agreement between the raters. Conclusion: The Post-Concussion Symptoms Questionnaire with answers of “Yes” or “No” is a valid instrument. High reliability was found between the raters. [ABSTRACT FROM AUTHOR]

Objective: To establish whether bilateral standing with visual feedback therapy after stroke improves postural control compared with conventional therapy and to evaluate the generalization of the effects of visual feedback therapy on gait and gait-related activities. Design: A systematic review. Methods: A computer-aided literature search was performed. Randomized controlled trials and controlled clinical trials, comparing visual feedback therapy with conventional balance treatments were included up to April 2005. The methodological quality of each study was assessed with the the Physiotherapy Evidence Database scale. Depending on existing heterogeneity, studies with a common variable of outcome were pooled by calculating the summary effect-sizes using fixed or random effects models. Results: Eight out of 78 studies, presenting 214 subjects, were included for qualitative and quantitative analysis. The methodological quality ranged from 3 to 6 points. The meta-analysis demonstrated non-significant summary effect-sizes in favour of visual feedback therapy for weight distribution and postural sway, as well as balance and gait performance, and gait speed. Conclusion: The additional value of visual feedback therapy in bilateral standing compared with conventional therapy shows no statistically significant effects on symmetry of weight distribution between paretic and non-paretic leg, postural sway in bilateral standing, gait and gait-related activities. Visual feedback therapy should not be favoured over conventional therapy. The question remains as to exactly how asymmetry in weight distribution while standing is related to balance control in patients with stroke. [ABSTRACT FROM AUTHOR]

Objective: To evaluate possible gender differences regarding the effect of intervention in geriatric rehabilitation, expressed in terms of change in function-related dependence, pain and insecurity. Design: Comparative study. Participants: A total of 110 women and 44 men undergoing geriatric rehabilitation. Methods: Performance-based assessments with use of the General Motor Function assessment scale. Non-parametric statistics were mainly used. Results: The women showed higher degrees of function-related dependence, pain and insecurity on admission than the men. Both women and men displayed significant improvement in all 3 variables during the rehabilitation period. However, the positive changes regarding pain and insecurity were according to the analyses of systematic group changes, at a low degree among the men, probably because of the low levels on admission. Gender comparisons of proportions with positive intervention outcome indicated that a significantly larger proportion of the women showed a positive treatment effect after intervention, with a difference in recovery of 19% in dependence, 23% in pain and 33% in insecurity ( p <0.05). Conclusions: Gender differences in disability, with higher degrees of function-related dependence, pain and insecurity among women on admission for geriatric rehabilitation, can be diminished during the rehabilitation period. These promising results may have relevance for the public health of the elderly population. [ABSTRACT FROM AUTHOR]

Objective: To examine how financial compensation affects the outcome of vocational rehabilitation. Design: A registry-based follow-up study. Subjects: A total of 1397 rehabilitees discharged from the 5 local rehabilitation agencies in Aarhus County, Denmark from 1 July 2000 to 31 December 2001. Methods: At submission demographic data was obtained as well as data on financial compensation, i.e. compensation for industrial injury, indemnity for off-duty injury and application for disability pension. Rehabilitation outcomes were recorded at discharge. Renouncing further attempts at rehabilitation was defined as a negative outcome; education, further rehabilitation or return-to-work on normal or less demanding terms were defined as a positive outcome. Rehabilitees with and without financial compensation were compared. Results: Rehabilitees with involvement of financial compensation had an increased risk of a negative outcome compared with those without involvement of financial compensation. Adjustment for potential confounders did not change the association between financial compensation and negative outcome. The risk of a negative outcome rose with increasing age, with less than 1 year of labour market experience and with rented housing. Previous occupation as a skilled worker reduced the risk. Conclusion: Financial compensation was associated with an increased risk of a negative vocational rehabilitation outcome. [ABSTRACT FROM AUTHOR]

In this article, we review the limitations of traditional rehabilitation functional outcome instruments currently in use within the rehabilitation field to assess Activity and Participation domains as defined by the International Classification of Function, Disability, and Health. These include a narrow scope of functional outcomes, data incompatibility across instruments, and the precision vs feasibility dilemma. Following this, we illustrate how contemporary measurement techniques, such as item response theory methods combined with computer adaptive testing methodology, can be applied in rehabilitation to design functional outcome instruments that are comprehensive in scope, accurate, allow for compatibility across instruments, and are sensitive to clinically important change without sacrificing their feasibility. Finally, we present some of the pressing challenges that need to be overcome to provide effective dissemination and training assistance to ensure that current and future generations of rehabilitation professionals are familiar with and skilled in the application of contemporary outcomes measurement. [ABSTRACT FROM AUTHOR]

Objective: When comparing outcomes of the Functional Independence Measure (FIM™) between patient groups, item characteristics of the FIM™ should be consistent across groups. The purpose of this study was to compare item difficulty of the FIM™ in 3 patient groups with neurological disorders. Subjects: Patients with stroke ( n =295), multiple sclerosis ( n =150), and traumatic brain injury ( n =88). Methods: FIM™ scores were administered in each group. The FIM™ consists of a motor domain (13 items) and a cognitive domain (5 items). Rasch rating scale analysis was performed to investigate differences in item difficulty (differential item functioning) between groups. Results: Answering categories of the FIM™ items were reduced to 3 (from the original 7) because of disordered thresholds and low answering frequencies. Two items of the motor domain (“bladder” and “bowel”) did not fit the Rasch model. For 7 out of the 11 fitting motor items, item difficulties were different between groups (i.e. showed differential item functioning). All cognitive items fitted the Rasch model, and 4 out of 5 cognitive items showed differential item functioning. Conclusion: Differential item functioning is present in several items of both the motor and cognitive domain of the FIM™. Adjustments for differential item functioning may be required when FIM™ data will be compared between groups or will be used in a pooled data analysis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the psychometric properties of Mini-Mental State Examination (MMSE) in patients with acquired brain injury in Turkey. Methods: A total of 207 patients with acquired brain injury were assessed. Reliability was tested by internal consistency and the person separation index; internal construct validity by Rasch analysis; external construct validity by correlation with cognitive disability; and cross-cultural validity by differential item functioning analysis compared with Italian MMSE data. Results: Reliability was adequate with a Cronbach's alpha of 0.75 and person separation index of 0.76. After collapsing some categories, and adjustment for differential item functioning, internal construct validity was supported by fit of the data to Rasch model. Differential item functioning for culture was found in 2 items and after adjustment, data could be pooled between Turkey and Italy. External construct validity was supported by expected associations. Conclusion: The Turkish version of the Mini-Mental State Examination can be used as a cognitive screening tool in acquired brain injury. Cross-cultural validity between Italy and Turkey is supported, given appropriate adjustment for differential item functioning. However, shortfalls in reliability at the individual level, as well as the presence of differential item functioning suggest that a better instrument should be developed to screen for cognitive deficits following acquired brain injury. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and pattern of methods of outcome assessment used in Australian physical rehabilitation environments. Design: Postal survey. Methods: A questionnaire on service type, staffing, numbers of adults treated and outcome measures used for 7 conditions related to injury and road trauma as well as stroke and neuromuscular disorders was sent to 973 services providing adult physical rehabilitation treatment. Results: Questionnaires were completed by 440 service providers for a response rate of 45%, similar to that reported in a recent European survey reported in this journal. A small number of measures were reported as in use by most respondents, while a large number of measures were used by a few respondents. Measures of physical changes were used more frequently than those of generic well-being or quality of life. Ease of use and reporting to other professionals were cited as the most important reasons in selection of outcome measures. Conclusion: This Australian-wide survey detected considerable heterogeneity in outcome measurement procedures used in rehabilitation environments. While the goal of measurement may vary between providers and differ between conditions, the results highlight opportunities for harmonization, benchmarking and measurement of health-related quality of life. [ABSTRACT FROM AUTHOR]

Objective: Assessment of the available evidence regarding the effect of augmented feedback on motor function of the upper extremity in rehabilitation patients. Methods: A systematic literature search was performed to identify randomized controlled trials that evaluated the effect of augmented feedback on motor function. Two reviewers systematically assessed the methodological quality of the trials. The reported effects were examined to evaluate the effect of therapeutic interventions using augmented feedback and to identify a possible relationship with patient characteristics, type of intervention, or methodological quality. Results: Twenty-six randomized controlled trials were included, 9 of which reported a positive effect on arm function tests. Follow-up measurements were performed in 8 trials, 1 of which reported a positive effect. Different therapeutic interventions using augmented feedback, i.e. electromyographic biofeedback, kinetic feedback, kinematic feedback, or knowledge of results, show no difference in effectiveness. Conclusion: No firm evidence was found of effectiveness regarding the use of augmented feedback to improve motor function of the upper extremity in rehabilitation patients. Future studies should focus more on the content, form and timing of augmented feedback concerning the therapeutic intervention. It should be emphasized that motor learning effects can only be determined by re-examining the population after a follow-up period. [ABSTRACT FROM AUTHOR]

Clinimetrics in rehabilitation medicine, i.e. the field of developing, evaluating and applying measurement instruments, has undergone considerable progress. Despite this progress, however, several issues remain. These include: (i) selection of an instrument out of the wide range available; (ii) using an instrument in a variety of diagnostic groups; (iii) using an instrument in individual patients, as opposed to a group of patients; and (iv) the use of instruments in clinical practice. This paper reviews these issues, as well as current attempts at resolving them. Illustrative examples are given. It is concluded that solutions seem to be available, but considerable research effort is required to make these a reality. Clinimetrics in rehabilitation medicine remains a field with challenging opportunities for research. [ABSTRACT FROM AUTHOR]

Objective: To investigate the support given to young children of patients with stroke by rehabilitation teams and to identify characteristics of the patients, spouses and children that relate to children's adjustment 2 months after the patient's discharge. Subjects and methods: Seventy-seven children (≤18 years of age) of patients with stroke consecutively admitted to inpatient rehabilitation were included. Adjustment was measured with the Child Behaviour Check List, Child Depression Inventory and Functional Status II. Multilevel regression analyses were conducted to identify determinants of adjustment. Results: Half of the children received some form of support from a rehabilitation team. Receiving more support was related to more severe disability of the parent with stroke, but not to the child's health or behavioural problems at the start of the stroke victim's inpatient stay. At the start of rehabilitation, 54% of the children had subclinical or clinical problems. Children's adjustment 2 months after their parent's discharge was related to the strain on spouses and not to the patients' characteristics or those of the support. Conclusion: The children's adjustment was related to the strain perceived by the healthy parent. There is a need for support that focuses on the experience of children of patients with stroke, regardless of stroke severity. [ABSTRACT FROM AUTHOR]

Objectives: To compare the short-term effectiveness of 1 intensive training period in child and youth rehabilitation with Move&Walk conductive education and describe the effects of 1 intensive training period in terms of changes at 1 year. The amount and influence of additional consumption of training during the 1-year follow-up was also analysed. Design: Quasi-experimental with 2 groups: Lemo ( n =23) and Move&Walk ( n =29). Patients: A total of 52 children with cerebral palsy, age range 3–16 years. Methods: Data included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory–Functional Skills (PEDI-FS). Data on additional consumption of training was collected at the 1-year follow-up. Results: There was no difference in proportion of change on the clinical measures between the training programmes, except for a higher proportion of improvement on the GMFM total score in Lemo. At the group level, small improvements were shown on GMFM and PEDI FS in the short-term and on PEDI FS only at 1 year. A higher proportion of children who participated in repeated intensive training periods showed improved social functioning. Conclusion: No major differences were shown between the 2 training programmes. One intensive training period facilitated small improvements in gross motor function. The majority of children had a high consumption of training during the 1-year follow-up and the added value of repeated intensive training periods was limited. [ABSTRACT FROM AUTHOR]

Objective: To determine whether hemiplegic patients can propel a leg-pedalling wheelchair and whether it is easier and faster for them to pedal the wheelchair using both legs alternately than to propel an ordinary wheelchair with their unaffected hand and leg. Design: Within-subject comparison. Subjects: Subjects comprised 10 hemiplegic in-patients (8 males, 2 females), aged 63.7 (SD 12.7) years with severe or moderate gait disturbance due to stroke. Methods: Subjects were asked to practice propelling the leg-pedalling wheelchair and ordinary wheelchair on both slalom and rectangular courses for a period of 7-10 days. Once they had become skilled in this, the wheelchair speed and patient's heart rate were measured, and a physiological cost index was calculated. Results: Subjects could pedal the leg-pedalling wheelchair using both legs alternately. The speed of this wheelchair was faster than that of the ordinary wheelchair, and the physiological cost index for pedalling it was lower than that for propelling the ordinary wheelchair. However, subjects needed some help in transferring to the leg-pedalling wheelchair. Conclusion: The hemiplegic patients could pedal the leg-pedalling wheelchair using both legs alternately faster and more effectively with regard to speed and physiological cost index. [ABSTRACT FROM AUTHOR]

Objective: To assess the reliability of 6 gait performance tests in individuals with chronic mild to moderate post-stroke hemiparesis. Design: An intra-rater (between occasions) test-retest reliability study. Subjects: Fifty men and women (mean age 58&PlusMinus;6.4 years) 6-46 months post-stroke. Methods: The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, the Stair Climbing ascend and descend tests and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC 2,1 ), the Bland & Altman analysis, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). Results: Test-retest agreements were high (ICC 2,1 0.94-0.99) with no discernible systematic differences between the tests. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (<9%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual, was also small (13-23%). Conclusion: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in individuals with chronic mild to moderate hemiparesis after stroke. [ABSTRACT FROM AUTHOR]

Objective: Electrical stimulation can be applied in a variety of ways to the hemiparetic upper extremity following stroke. The aim of this review is to explore the relationship between characteristics of stimulation and the effect of electrical stimulation on the recovery of upper limb motor control following stroke. Methods: A systematic literature search was performed to identify clinical trials evaluating the effect of electrical stimulation on motor control. The reported outcomes were examined to identify a possible relationship between the reported effect and the following characteristics: duration of stimulation, method of stimulation, setting of stimulation parameters, target muscles and stage after stroke. Results: Nineteen clinical trials were included, and the results of 22 patient groups were evaluated. A positive effect of electrical stimulation was reported for 13 patient groups. Positive results were more common when electrical stimulation was triggered by voluntary movement rather than when non-triggered electrical stimulation was used. There was no relation between the effect of electrical stimulation and the other characteristics examined. Conclusion: Triggered electrical stimulation may be more effective than non-triggered electrical stimulation in facilitating upper extremity motor recovery following stroke. It appears that the specific stimulus parameters may not be crucial in determining the effect of electrical stimulation. [ABSTRACT FROM AUTHOR]

Objective: Assess the effects of daily neuroprosthetic (NESS Handmaster™) functional electrical stimulation in sub-acute stroke. Design: Controlled study, patients clinically stratified to 2 groups; no active finger movement ( 10 ), and partial active finger movements ( 12 ), and then randomized to control and neuroprosthesis groups. Observer blinded evaluations at baseline and completion of the 6-week study. Subjects: 22 patients with moderate to severe upper limb paresis 3-6 months post-onset. Methods: Patients in day hospital rehabilitation, receiving physical and occupational therapy 3 times weekly. The neuroprosthesis group used the device at home. Results: The neuroprosthesis group had significantly greater improvements in spasticity, active range of motion and scores on the functional hand tests (those with partial active motion). Of the few patients with pain and oedema, there was improvement only among those in the neuroprosthesis group. There were no adverse reactions. Conclusion: Supplementing standard outpatient rehabilitation with daily home neuroprosthetic activation improves upper limb outcomes. [ABSTRACT FROM AUTHOR]

Objective: To analyse cross-cultural validity of the Functional Independence Measure (FIM™) in patients with stroke using the Rasch model. Settings: Thirty-one rehabilitation facilities within 6 different countries in Europe. Participants: A total of 2546 in-patients at admission, median age 63 years. Methods: Data from the FIM™ were evaluated with the Rasch model, using the Rasch analysis package RUMM2020. A detailed analysis of scoring functions of the 7 categories of the FIM items was undertaken prior to testing fit to the model. Categories were re-scored where necessary. Analysis of Differential Item Functioning was undertaken in pooled data for each of the FIM motor and social-cognitive scales, respectively. Results: Disordered thresholds were found on most items when using 7 categories. Fit to the Rasch model varied between countries. Differential Item Functioning was found by country for most items. Adequate fit to the Rasch model was achieved when items were treated as unique for each country and after a few country-specific items were removed. Conclusion: Clinical collected data from FIM for patients with stroke cannot be pooled in its raw form, or compared across countries. Comparisons can be made after adjusting for country-specific Differential Item Functioning, though the adjustments for Differential Item Functioning and rating scales may not generalize to other samples. [ABSTRACT FROM AUTHOR]

Objective: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. Design: Cross-sectional. Subjects: One hundred sixty-one persons with spinal cord injury. Methods: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. Results: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. Conclusion: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of group rehabilitation and individually dosed rehabilitation in treating chronic low back pain. Design: Institutional rehabilitation intervention in 2 non-randomized groups with a 6-month post-intervention follow-up. Subjects: Persons with chronic low back pain: 64 group-rehabilitated and 66 individually rehabilitated. Methods: The rehabilitation period for all subjects was 21 days. Those being group-rehabilitated, about 10 patients per group, had a common programme including 3-5 exercise groups per day, group discussions and lectures including back and neck school. Local physical therapy was given if neeeded. The individually rehabilitated subjects had individually designed programmes: local physical therapy, muscle strengthening programme, group exercises and participating in back school. The duration of the guided programme was 62 hours for group rehabilitation and 45 hours for individual rehabilitation. Results: During the rehabilitation period the strength and flexibility of individually rehabilitated subjects improved more than that of group-rehabilitated subjects ( p < 0.05 and p < 0.01, respectively). After the 6-month follow-up period, group-rehabilitated subjects showed a decrease in the Oswestry and pain indexes, while individually rehabilitated subjects showed an increase in the Oswestry index. The group-rehabilitated subjects evaluated the goals of rehabilitation to have been attained better and considered themselves better motivated in self-care. The costs of the 2 rehabilitation programs were approximately equal. Conclusion: These tentative results suggest that group rehabilitation can compete with individual rehabilitation at least in short-term follow-up. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effect of pedal cadence upon torque production. power output and muscle fatigue rates during functional electrical stimulation evoked cycling in spinal cord injured individuals. Subjects: All subjects had complete thoracic spinal card injuries 14-19 (ASIA A) and had been functional electrical stimulation training regularly for at least 6 months. Methods: One trial (n = 8) examined a loss vs high pedal rate (20 and 50 rev · mm-1) upon isolated muscle fatigue over 5 minutes. A second trial (n = 9) investigated the effect of cadence (15 vs 50 rev · min-1) upon performance during 35-minutes of functional electrical stimulation evoked cycling. Results: Peak torque produced by left quadriceps decayed significantly faster at the higher pedal cadence, indicating a higher rate of muscle fatigue. Functional electrical stimulation cycling over 35 minutes also revealed that peak and average torques were significantly greater at the lower cadence. From 15 minutes onwards, power output was significantly higher at 50 rev · min-1 FES-cycling. compared with 15 rev · min-1. Conclusion: The higher muscle forces observed during low cadence functional electrical stimulation cycling should offer improvements over traditional pedalling velocities for training leg strength in individuals with spinal cord injury. [ABSTRACT FROM AUTHOR]

Objective: Four programmes based on educational and cognitive principles but with a variation in total length and number of staff/patient contact hours were compared in order to gain further insight into the importance of the format of the programme for the final outcome. Design: A prospective non-randomized intervention study with 191 persons with fibromyalgia. Data were collected before, after and at 1-year follow-up. Participants served as their own controls. Results within and between the programmes were calculated. Methods: Clinical investigations before and after intervention. Questionnaires were answered before, after and at 1-year follow-up. Results: Most instruments showed no significant improvements after the programme. However, some improvements were found in important variables such as attitudes, self- efficacy, vitality and "days feeling well". Results were unchanged at the 1-year follow-up and 16 persons had started working. Seven had ceased working. Participants reported frequent use of coping strategies in everyday life. No major differences could be found between the programmes. Conclusions: More comprehensive programmes did not produce better results at group level. Also short and less costly interventions based on educational and cognitive principles were valuable for persons with longstanding fibromyalgia. More attention must be given to evaluating the clinical effect of programmes. [ABSTRACT FROM AUTHOR]

Objectives: To identify the most typical and relevant categories of the International Classification of Functioning, Disability and Health (ICF) for patients with low back pain, osteoporosis, rheumatoid arthritis, osteoarthritis, chronic generalized pain, stroke, depression, obesity, chronic ischaemic heart disease, obstructive pulmonary disease, diabetes mellitus, and breast cancer. Methods: An international expert survey using the Delphi technique was conducted. Data were collected in 3 rounds. Answers were linked to the ICF and analysed for the degree of consensus. Results: Between 21 (osteoporosis, chronic ischaemic heart disease, and obstructive pulmonary disease) and 43 (stroke) experts responded in each of the conditions. In all conditions, with the exception of depression, there were categories in all ICF components that were considered typical and/or relevant by at least 80% of the responders. While all conditions had a distinct typical spectrum of relevant ICF categories, there were also some common relevant categories throughout the majority of conditions. Conclusion: Lists of ICF categories that are considered relevant and typical for specific conditions by international experts could be created. This is an important step towards identifying ICF Core Sets for chronic conditions. [ABSTRACT FROM AUTHOR]

Objective: To identify the most common patient problems in patients with 12 different chronic conditions using the ICF checklist. Methods: A multi-centre, cross-sectional study with convenient samples of patients who had received a clinical diagnosis of any of 12 different chronic conditions undergoing inpatient or outpatient rehabilitation. To describe the population, age, gender, and the SF-36 were recorded. Data for 917 patients from 33 rehabilitation centres were analysed. Results: Most of the ICF-checklist categories were common to at least 1 condition. Pain was the sole category of 125 ICF-checklist categories that was common to all chronic conditions. Patients with low back pain, rheumatoid arthritis, and diabetes mellitus did not often experience the problems listed in the ICF-checklist. Conclusion: The main finding, that in most conditions categories from each component were common, underscores the need to address all components when assessing functioning and health in patients with chronic conditions. [ABSTRACT FROM AUTHOR]

To describe activity limitation of people with Duchenne muscular dystrophy who are living in the community and to correlate it with age and muscle strength. Descriptive, correlational. Twenty-seven children with Duchenne muscular dystrophy aged 7–14 years who are living in the community. There were significant correlations between age and averaged MMT score (Spearman's rho = -0.63, p < 0.01), age and Functional Independence Measure motor score (rho = -0.52, p < 0.01), and Functional Independence Measure motor score and averaged manual muscle testing (rho = 0.77, p < 0.01). At similar manual muscle testing level, children with good cognitive function (Functional Independence Measure cognitive score !26) showed significantly higher Functional Independence Measure motor scores than those with poor cognitive function (Mann-Whitney U test, p < 0.01). For individual Functional Independence Measure items, eating and bowel management were the easier, whereas transfer and stair climbing were the more difficult. Patients with mean muscle strength ≥grade 3 were rated as relatively independent, while those with a mean muscle strength >grade 3 were rated as maximal or total assistance (Mann-Whitney U test, p < 0.05). Activities of daily living in patients with Duchenne muscular dystrophy are related to age and muscle strength, and manual muscle testing grade 3 is an important cut-off point to predict their disability. [ABSTRACT FROM AUTHOR]

Objective : The aims of this study were to investigate outcomes of older people's use of powered wheelchairs and risk factors for negative outcomes. Design : The study was a cross-sectional interview-study including 111 powered wheelchair users over 65 years of age. Results : All participants used their powered wheelchair in the summer; nearly all users regarded it as important and found that it gave them independence. The wheelchair made activity and participation possible for the users. The most frequent activity in the summer was going for a ride, and in the winter it was shopping. However, some could not use the wheelchair for visits, and supplementary travel modes are called for. Users who could not walk at all or who could not transfer without assistance were more likely not to be able to carry out prioritized activities. Furthermore, other risk factors for negative outcomes and need for further research were identified. Conclusion : The use of powered wheelchairs is a relevant societal intervention in relation to older people with limited walking ability in order to make activity and participation possible. It is likely that a larger proportion of older people could benefit from this intervention, in particular if current practices are improved taking activity and participation outcomes into consideration. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to investigate whether spouses' life satisfaction changed between their life prior to their partner's stroke, and at 4 months and 1 year after stroke, and to study the association between spouses' life satisfaction and objective characteristics of the stroke patients. Subjects and methods: Sixty-seven consecutively enrolled spouses to first-ever stroke patients <75 years of age participated. Life satisfaction was measured with the Life Satisfaction Checklist (LiSat-9). Results: Compared with their life before stroke, the spouses' satisfaction with life as a whole, their leisure situation, daily occupation, sexual life, partner relationship and social contacts was lower 4 months after stroke. No significant change in life satisfaction was observed between 4 months and 1 year. Spouses of patients with sensorimotor impairment and low ability in self-care were less satisfied with their leisure situation, daily occupations, own ability in self-care, sexual life and partner relationship. Spouses of patients with cognitive or astheno-emotional impairments were less satisfied with their partner relationship, family life and sexual life. The associations were stronger at 1 year than at 4 months. Conclusion: There is a need for support over a long time period that focuses on the social, occupational and leisure situation of spouses as well as that of patients. [ABSTRACT FROM AUTHOR]

Objective: To test the outcome of active multidisciplinary treatment in an outpatient setting upon sick-leave status among patients with neck, shoulder and low back pain. Design: Multidisciplinary treatment was administered to 121 patients (intervention group) over 4 weeks of structured intervention, followed by 8 weeks of less structured consultations. Effects of treatment were compared with usual treatment (control group: n = 97). Patients: All patients were in the chronic stage of pain (average sick-leave: 6 months) with different diagnoses: neck-shoulder pain, low back pain or low back pain with radiating extremity pain. Method: The intervention group programme included posture corrections, pain perception, skills to cope with pain, aerobic and fitness-promoting activities and relaxation techniques administered to groups of 8-10 patients. The Local National Insurance Office referred the patients who were diagnosed by general practitioners. A 12-month follow-up by the Local National Insurance Office provided feedback about sick-leave status of all 218 patients. Results: There was a significant treatment difference in proportion taken off the sick list after 12 months (intervention group: 78.5%; control group: 50.5%; p < 0.001). The difference was greater among low back pain ( p < 0.001) than among neck-shoulder ( p < 0.053) and low back pain with radiating extremity pain ( p < 0.031) patients. Conclusion: Long-term effects of active multidisciplinary treatment were superior to treatment as usual in all diagnostic groups. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relative influence of demographic, injury and psychological characteristics on the labor force status of people living with spinal cord injury. Design: Cross-sectional survey. Subjects: 459 persons who had experienced a traumatic spinal cord injury. All participants were patients of 1 of 2 specialist spinal cord injury services located in south-eastern Australia. Methods: A survey, administered on average of 11.2 years after their injury, was used to collect the data. The study's main outcome measure was labor force status at the time of survey. Of those invited to participate in the study, 73% agreed to do so. Results: Demographic, injury and psychological variables were found to explain 30% of the variance in the employment criterion: "in the labor force" vs "not in the labor force". Psychological variables contributed significantly to the separation of the 2 labor force groups. Conclusion: The inclusion of the selected psychological variables has advanced the understanding of the factors related to return to work following spinal cord injury, however this understanding is still not complete. Future efforts in this field would likely benefit from the inclusion of additional psychological characteristics, as well as environmental factors. [ABSTRACT FROM AUTHOR]

Objective: It has been shown recently that neck muscle vibration in combination with an exploration training leads to lasting amelioration of spatial neglect. The present study evaluated whether vibration of the left posterior neck muscles alone has the potential to induce lasting reduction in spatial neglect. Design: A multiple baseline design was used to control for spontaneous recovery or uncontrolled change caused by external events. Patients: Six patients with spatial neglect following right hemisphere stroke. Methods: Daily vibration treatment of the left posterior neck muscles for 20 minutes on 10 consecutive days. During vibration, patients did not perform any specific activities. Results: We observed significant amelioration of spatial neglect after terminating the vibration therapy. The improvement was found to be stable at follow-up testing about 1.4 years later. Conclusion: Vibration of the left posterior neck muscles is a useful, non-invasive tool supplementing the established methods of spatial neglect treatment. It does not necessarily require the patient's co-operation, which is an important advantage especially in the early phases of rehabilitation. [ABSTRACT FROM AUTHOR]