Home About us Contact
|
Home About us Contact | ||
|
|
||
Disability Scores (disability + score)
Selected AbstractsAssessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2000E. M. Khedr This study investigates the effect of stroke on the corticodiaphragmatic pathway and attempts to clarify the relationship between neurophysiological data and degree of motor disability, site of infarction in computerized tomography (CT) scan, diaphragmatic excursion, blood gases and pulmonary function in stroke patients. Using magnetic stimulation of the scalp sites and cervical roots, an assessment of corticodiaphragmatic pathway was made. The study included 34 sequentially selected patients from a total of 250 patients with acute ischemic stroke. Twenty-five (age- and sex-matched) volunteers served as controls. Sixteen patients had cortical infarction, 13 had subcortical infarction and five had both cortical and subcortical infarction. The mean according to the Scandinavian Stroke Scale was 32.2. Decreased diaphragmatic excursion was observed in 41% of the patients. Twenty-four patients (70.5%) had abnormal magnetic evoked potentials (MEPs) in the affected hemisphere. In five patients MEPs could not be elicited from the affected hemisphere; the remaining 19 patients had abnormal values of both cortical latency and central conduction time (CCT). Cortical latency, CCT, amplitude of compound muscle action potentials (CMAPs) and excitability threshold of the affected hemisphere were significantly altered compared with both the unaffected hemisphere and the control group. Those patients with hemiplegia had a greater degree of hypoxia, hypocapnia and decreased serum bicarbonate level compared with the control group. Also, hemiplegic patients had different degree of respiratory dysfunction. A statistically significant association was found between neurophysiological data and disability score, diaphragmatic excursion, site of infarction in CT scan and degree of respiratory dysfunction. Central diaphragmatic impairment may occur in acute stroke and could contribute to the occurence of hypoxia in those patients. [source] Electroacupuncture for Tension-type Headache on Distal Acupoints Only: A Randomized, Controlled, Crossover TrialHEADACHE, Issue 4 2004C. C. L. Xue PhD Objective.,To investigate the efficacy of electroacupuncture, applied to distal acupoints only, for tension-type headache. Background.,Electroacupuncture is commonly used for tension-type headache, but when applied to distal acupoints only, evidence of its efficacy is lacking. Design.,A randomized, single-blinded, sham-controlled, crossover clinical trial. Methods.,The trial had 5 stages: baseline (2 weeks), phases I and II (each 4 weeks), washout period (2 weeks), and follow-up (3 months after phase II). Forty patients were randomly assigned to either group A or group B. Group A received real electroacupuncture during phase I, then sham electroacupuncture in phase II. Group B received the treatments in reverse order. Outcome measures were headache frequency and duration, pain intensity using a visual analog scale, mechanical pain threshold, headache disability, and sickness impact. Data were analyzed by univariate 2-way analysis of variance. Results.,Thirty-seven patients completed the trial. There were no significant differences between the 2 groups at baseline. At the end of phase I, group A, but not group B, demonstrated significant improvement in mean (standard error of the mean [SEM]) headache frequency (3.0 per month [0.3] versus 12.0 per month [1.7]), duration (13.3 hours [3.5] versus 32.0 hours [6.2]), pain intensity (32.8 mm [4.1] versus 47.5 mm [2.7]), pain threshold (right side, 2.9 kg/second [0.1] versus 0.9 kg/second [0.1]; left side, 2.4 kg/second [0.1] versus 1.1 kg/second [0.1]), headache disability score (6.0 [1.0] versus 16.3 [1.6]), and sickness impact score (288.7 [48.0] versus 687.1 [77.2]). For each parameter, significant differences also were demonstrated for both groups between baseline and phase II, and baseline and follow-up. There were no significant differences between the groups at the end of follow-up (P > .05). Conclusion.,Electroacupuncture to distal points alone is effective for short-term symptomatic relief of tension-type headache. [source] Bilateral deep brain stimulation of the globus pallidus internus in tardive dystonia,MOVEMENT DISORDERS, Issue 13 2008Wataru Sako MD Abstract Tardive dystonia is a disabling movement disorder as a consequence of exposure to neuroleptic drugs. We followed 6 patients with medically refractory tardive dystonia treated by bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) for 21 ± 18 months. At last follow-up, the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor score improved by 86% ± 14%, and the BFMDRS disability score improved by 80% ± 12%. Bilateral GPi-DBS is a beneficial therapeutic option for the long-term relief of tardive dystonia. © 2008 Movement Disorder Society [source] Prospective comparison of course of disability in antipsychotic-treated and untreated schizophrenia patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009J. Thirthalli Objective:, To compare the course of disability in schizophrenia patients receiving antipsychotics and those remaining untreated in a rural community. Method:, Of 215 schizophrenia patients identified in a rural south Indian community, 58% were not receiving antipsychotics. Trained raters assessed the disability in 190 of these at baseline and after 1 year. The course of disability in those who remained untreated was compared with that in those who received antipsychotics. Results:, Mean disability scores remained virtually unchanged in those who remained untreated, but showed a significant decline (indicating decrement in disability) in those who continued to receive antipsychotics and in those in whom antipsychotic treatment was initiated (P < 0.001; group × occasion effect). The proportion of patients classified as ,disabled' declined significantly in the treated group (P < 0.01), but remained the same in the untreated group. Conclusion:, Disability in untreated schizophrenia patients remains unchanged over time. Treatment with antipsychotics in the community results in a considerable reduction in disability. [source] Measuring disability in older adults: The International Classification System of Functioning, Disability and Health (ICF) frameworkGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2008W Jack Rejeski Background: Despite the importance of disability to geriatric medicine, no large scale study has validated the activity and participation domains of the International Classification System of Functioning, Disability, and Health (ICF) in older adults. The current project was designed to conduct such as analysis, and then to examine the psychometric properties of a measure that is based on this conceptual structure. Methods: This was an archival analysis of older adults (n = 1388) who had participated in studies within our Claude D Pepper Older Americans Independence Center. Assessments included demographics and chronic disease status, a 23-item Pepper Assessment Tool for Disability (PAT-D) and 6-min walk performance. Results: Analysis of the PAT-D produced a three-factor structure that was consistent across several datasets: activities of daily living disability, mobility disability and instrumental activities of daily living disability. The first two factors are activities in the ICF framework, whereas the final factor falls into the participation domain. All factors had acceptable internal consistency reliability (>0.70) and test,retest (>0.70) reliability coefficients. Fast walkers self-reported better function on the PAT-D scales than slow walkers: effect sizes ranged from moderate to large (0.41,0.95); individuals with cardiovascular disease had poorer scores on all scales than those free of cardiovascular disease. In an 18-month randomized clinical trial, individuals who received a lifestyle intervention for weight loss had greater improvements in their mobility disability scores than those in a control condition. Conclusion: The ICF is a useful model for conceptualizing disability in aging research, and the PAT-D has acceptable psychometric properties as a measure for use in clinical research. [source] Factors Associated With Burden of Primary Headache in a Specialty ClinicHEADACHE, Issue 6 2003Eugene M. Cassidy MRCPsych Objective.,To examine factors associated with social, occupational, and psychological burden of common primary headache (migraine and tension-type headache). Background.,The personal and social burden of primary headache is high. Health, occupational, social, and psychological factors contributing to burden in people with disabling headache have not been fully unravelled. Methods.,One hundred eighty consecutive patients with either migraine or tension-type headache attending a specialty headache outpatient clinic for the first time were evaluated over a 9-month period. Headache subtype was operationally defined according to International Headache Society criteria. Headache frequency, duration, and severity were recorded. Occupational and social disability were quantified using the Migraine Disability Assessment questionnaire. Psychological burden was quantified using the 28-item General Health Questionnaire, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Premorbid vulnerability to life stress was quantified using the neuroticism subscale of the Eysenck Personality Inventory. Results.,Patients with frequent (chronic) headache scored higher on the Migraine Disability Assessment questionnaire and had higher Beck Depression Inventory and General Health Questionnaire depression scores than those with less frequent (episodic) headache. Frequency of headache, but not pain severity, duration, or diagnosis, predicted both Migraine Disability Assessment total disability and General Health Questionnaire/Beck Depression Inventory depression. Neuroticism was predictive of depression but not disability. Patients with chronic migraine had the highest depression and disability scores. Conclusion.,The number of days per month with headache is a key determinant of headache-related burden in those attending specialty clinics. Frequent (chronic) headache is associated with significantly higher psychopathology scores and general social impairment, but the direction of this relationship is not clear. Those with migraine and chronicity are the most impaired. [source] Depressive symptoms in late life: associations with apathy, resilience and disability vary between young-old and old-oldINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2008Mona Mehta Abstract Objective Prior research has found that disability and apathy are associated with late-life depression. However, the effect of age on these associations in "late-life," an ambiguous term encompassing all individuals typically older than 60 years, has not been examined. We investigated the association of depression with disability, apathy and resilience across the age range of late-life. Methods One hundred and five community-dwelling elderly with moderate levels of disability were assessed using the Geriatric Depression Scale (GDS), Hardy-Gill Resilience Scale, Starkstein Apathy Scale and IADL/ADL questionnaire. Multiple regression analysis was used to assess relationships between depression, disability, apathy and resilience, stratified by age (<80 vs. >80). Results In the <80 year old subject group, resilience, apathy and disability scores (partial type III R2,=,11.1%, 10.4% and 12.8%, respectively) equally contributed to the variability of GDS score. In contrast, in the >80 year old subject group, apathy (partial type III R2,=,18.7%) had the greatest contribution to GDS score. Conclusions In elderly persons under age 80, resilience, apathy and disability all have relatively equal contributions to depression scores, whereas in those over age 80, depression is most highly correlated with apathy. These data suggest that depressive symptoms in elderly persons have different clinical features along the age spectrum from young-old to old-old. Copyright © 2007 John Wiley & Sons, Ltd. [source] Gait Dysfunction in Mild Cognitive Impairment SyndromesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Joe Verghese MBBS OBJECTIVES: To conduct a systematic clinical and quantitative assessment of gait in older adults with mild cognitive impairment (MCI) syndromes. DESIGN: Cross-sectional. SETTING: Einstein Aging Study, a community-based longitudinal aging study. PARTICIPANTS: Fifty-four individuals with amnestic MCI (a-MCI), 62 with nonamnestic-MCI (na-MCI), and 295 healthy controls identified from the Einstein Aging Study participants. MEASUREMENTS: Comparison of clinical and quantitative gait performance in subjects with MCI subtypes with that of cognitively normal older adults. RESULTS: Neurological gaits were more common in a-MCI (31.5%, P=.008) but not in na-MCI (19.4%, P=.55), than in controls (16.3%). Quantitative gait in multiple parameters was worse in both MCI subtypes than in controls. Factor analysis revealed three independent factors representing pace, rhythm, and variability. Subjects with a-MCI had worse rhythm and variability scores than those with na-MCI and controls. Subjects with na-MCI had worse performance on the pace domain than the other two groups. Subjects with MCI and gait abnormalities had higher disability scores than subjects with MCI without gait abnormalities. CONCLUSION: Gait dysfunction is common in older individuals with amnestic and nonamnestic subtypes of MCI. [source] The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritisJOURNAL OF CLINICAL NURSING, Issue 7-8 2010Nurcan Y Aims and objectives., The aim in this study was to evaluate the effect of local heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. Background., Local heat application is used as a non-pharmacological practice for the treatment of knee osteoarthritis. On the other hand, literature reveals limited information on the effects of heat application. Design., The study was a comparative study. Methods., The patients with knee osteoarthritis were divided into two groups (23 patients in each) as intervention and control groups, and patients in the control group were applied with the routine medication of the physician. The intervention group received 20-minute heat application every other day for four weeks in addition to the routine medication. The data were collected using data collection form, Western Ontario and McMaster Universities Index and SF-36. Results., The Western Ontario and McMaster Universities pain and Western Ontario and McMaster Universities disability scores of the patients with knee osteoarthritis in control and intervention groups before and after the intervention were compared, and the differences for both scores in the change were found to be statistically significant (p < 0·05). Moreover, statistically significant differences were found between the control and intervention group patients in terms of changes in the scores for physical function, pain and general health perception (p < 0·05). Conclusions., It was found that heat application every other day decreased pain and disability of the patients with knee osteoarthritis. Also, heat application was found to improve the subdimensions of quality of life scores of physical function, pain and general health perception of patients. Relevance to clinical practice., The data obtained in this study on the efficiency of heat application on pain, stiffness, physical function and general health perception of patients with knee osteoarthritis may offer an insight into decision-making process for appropriate intervention. [source] ORIGINAL ARTICLE: Long-term outcomes of vertebroplasty for osteoporotic compression fracturesJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2010J Thillainadesan Abstract Introduction: This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Methods: Prospective assessment of short-term (,6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. Results: In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Conclusions: Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures. [source] Using the posterior pelvic pain provocation test in pregnant Japanese womenNURSING & HEALTH SCIENCES, Issue 1 2009Fukiko Ando rn Abstract This study investigated the usefulness of the posterior pelvic pain provocation (PPPP) test for differentiating between pelvic pain and low back pain because of the different prognoses and treatment strategies. We recruited 263 Japanese women who were > 36 weeks' gestation and 213 were included. The PPPP test was applied to 154 women with self-reported lumbopelvic pain. The participants were divided into three groups: the PPPP test positive (PPPP+, n = 60) subgroup, PPPP test negative (PPPP,, n = 94) subgroup, and no pain group (n = 59). The disability scores of the PPPP+ subgroup were significantly higher than the scores of the PPPP, subgroup and no pain group. In the PPPP+ subgroup, the intensity of pelvic pain was significantly correlated with the disability scores, but that of low back pain was not. The PPPP test could be carried out by a midwife without side-effects and could detect pregnant women with impaired ability in daily life due to lumbopelvic pain. [source] Placebo-controlled trial of rituximab in IgM anti,myelin-associated glycoprotein antibody demyelinating neuropathy,ANNALS OF NEUROLOGY, Issue 3 2009Marinos C. Dalakas MD Objective Report a double-blind, placebo-controlled study of rituximab in patients with anti,MAG demyelinating polyneuropathy (A-MAG-DP). Methods Twenty-six patients were randomized to four weekly infusions of 375mg/m2 rituximab or placebo. Sample size was calculated to detect changes of ,1 Inflammatory Neuropathy Course and Treatment (INCAT) leg disability scores at month 8. IgM levels, anti-MAG titers, B cells, antigen-presenting cells, and immunoregulatory T cells were monitored every 2 months. Results Thirteen A-MAG-DP patients were randomized to rituximab and 13 to placebo. Randomization was balanced for age, electrophysiology, disease duration, disability scores, and baseline B cells. After 8 months, by intention to treat, 4 of 13 rituximab-treated patients improved by ,1 INCAT score compared with 0 of 13 patients taking placebo (p = 0.096). Excluding one rituximab-randomized patient who had normal INCAT score at entry, and thus could not improve, the results were significant (p = 0.036). The time to 10m walk was significantly reduced in the rituximab group (p = 0.042) (intention to treat). Clinically, walking improved in 7 of 13 rituximab-treated patients. At month 8, IgM was reduced by 34% and anti-MAG titers by 50%. CD25+CD4+Foxp3+ regulatory cells significantly increased by month 8. The most improved patients were those with high anti-MAG titers and most severe sensory deficits at baseline. Interpretation Rituximab is the first drug that improves some patients with A-MAG-DP in a controlled study. The benefit may be exerted by reducing the putative pathogenic antibodies or by inducing immunoregulatory T cells. The results warrant confirmation with a larger trial. Ann Neurol 2009;65:286,293 [source] Association between parasite infection and immune responses in multiple sclerosisANNALS OF NEUROLOGY, Issue 2 2007Jorge Correale MD Objective To assess whether parasite infection is correlated with a reduced number of exacerbations and altered immune reactivity in multiple sclerosis (MS). Methods A prospective, double-cohort study was performed to assess the clinical course and radiological findings in 12 MS patients presenting associated eosinophilia. All patients presented parasitic infections with positive stool specimens. In all parasite-infected MS patients, the eosinophilia was not present during the 2 previous years. Eosinophil counts were monitored at 3- to 6-month intervals. When counts became elevated, patients were enrolled in the study. Interleukin (IL)-4, IL-10, IL-12, transforming growth factor (TGF)-,, and interferon-, production by myelin basic protein,specific peripheral blood mononuclear cells were studied using enzyme-linked immunospot (ELISPOT). FoxP3 and Smad7 expression were studied by reverse-transcriptase polymerase chain reaction. Results During a 4.6-year follow-up period, parasite-infected MS patients showed a significantly lower number of exacerbations, minimal variation in disability scores, as well as fewer magnetic resonance imaging changes when compared with uninfected MS patients. Furthermore, myelin basic protein,specific responses in peripheral blood showed a significant increase in IL-10 and TGF-, and a decrease in IL-12 and interferon-,,secreting cells in infected MS patients compared with noninfected patients. Myelin basic protein,specific T cells cloned from infected subjects were characterized by the absence of IL-2 and IL-4 production, but high IL-10 and/or TGF-, secretion, showing a cytokine profile similar to the T-cell subsets Tr1 and Th3. Moreover, cloning frequency of CD4+CD25+ FoxP3+ T cells was substantially increased in infected patients compared with uninfected MS subjects. Finally, Smad7 messenger RNA was not detected in T cells from infected MS patients secreting TGF-,. Interpretation Increased production of IL-10 and TGF-,, together with induction of CD25+CD4+ FoxP3+ T cells, suggests that regulatory T cells induced during parasite infections can alter the course of MS. Ann Neurol 2007 [source] NS13P A PROSPECTIVE COMPARISON OF TWO CERVICAL INTERBODY FUSION CAGESANZ JOURNAL OF SURGERY, Issue 2007M. A. Hansen Purpose For some time the surgical management of chronic back pain has utilised interbody lumbar cages. Recently interbody cages for use in the cervical spine have been produced. Cervical cages provide initial stability during the fusion process. There is little literature comparing the performance of interbody cage systems due to their relative recent introduction. Methodology Patients with symptomatic cervical degeneration or traumatic lesions were treated with the dynamic ABC 2 Aesculap anterior cervical plating system and either the B-Braun Samarys or Zimmer cage systems. A single surgeon conducted all surgery. Pre- and post-operative radiological examinations were compared. Changes in disc height at affected and adjacent levels, lordosis and evidence of fusion were recorded. Patient outcome was measured with questionnaires. The modified Oswestry neck pain disability and Copenhagen neck disability scale scores were utilised to allow comparison between patients. Results A total of 43 patients were involved in the study (30 with the Zimmer cage system and 13 with the Samarys cage). Patient follow-up has been up to 12 months. Improvement in disability scores was shown in 90% of patients. Follow up imaging did not demonstrate subsidence of the cage or adjacent instability in either group. There was no statistical difference in complication rate between the two groups. Discussion Initial stability was provided by both interbody cervical spine cage system. Rates of fusion and symptomatic relief compared favourably to fusion involving autogenous bone graft without associated morbidity. Longer follow up is necessary to determine whether there is evidence of adjacent level instability or vertebral end-plate subsidence. [source] Changes in Health Assessment Questionnaire disability scores over five years in patients with rheumatoid arthritis compared with the general populationARTHRITIS & RHEUMATISM, Issue 10 2006Tuulikki Sokka Objective To analyze longitudinal data over 5 years for changes in Health Assessment Questionnaire (HAQ) scores in patients with rheumatoid arthritis (RA) and age- and sex-matched controls from the general population. Methods In 2000 and 2005, identical self-report questionnaires were mailed to a cohort of patients with RA and control cohort from the community. The questionnaire included the HAQ, which was used to assess functional status. Changes in HAQ scores over 5 years were analyzed. Results In 2000, 73% of 1,495 patients with RA and 77% of 2,000 general population controls responded to the questionnaire. In 2005, 84% of 2,022 patients with RA and 77% of 1,817 controls responded. A total of 863 patients with RA and 1,176 community controls responded in both 2000 and 2005 and were included in the analyses. Mean baseline HAQ scores were significantly higher in patients with RA than in controls (0.71 versus 0.17; P < 0.001). Over 5 years, the HAQ scores increased by 0.01 units per year in both the RA cohort and the community population; in both cohorts, the net change was primarily attributable to individuals over age 70 years. Changes in HAQ scores were similar in patients and controls who had low HAQ scores at baseline. Female patients with baseline HAQ scores of ,0.5 had less potential for improvement than did controls. Among subjects in both groups who had HAQ scores >2, death was a common outcome over the next 5 years. Conclusion Currently, progression of functional disability among patients with RA and among persons in the general population is largely explained by the aging process. Our results showing stable function scores over 5 years in most patients with RA who are younger than age 70 years provide further evidence of improved status of RA patients today compared with the major declines observed in previous decades. [source] Hematopoietic stem cell transplantation in multiple sclerosisACTA NEUROLOGICA SCANDINAVICA, Issue 6 2009C. Rogojan Intensive immunosuppresion followed by hematopoietic stem cell transplantation (HSCT) has been suggested as potential treatment in severe forms of multiple sclerosis (MS). Since 1995 ca. 400 patients have been treated with HSCT. Stabilization or improvement occurred in almost 70% of cases at least for 3 years post-transplant. Magnetic resonance revealed the capacity of autologous HSCT to suppress or markedly reduce gadolinium-enhancing lesions. The progression of brain atrophy declined after two years post-HSCT. The profound immunological changes following autologous HSCT may result in restoration of self-tolerance. Relatively young patients with active inflammatory lesions of relatively short duration and rapidly progressive disease, but still low disability scores, unresponsive to conventional therapy seem the best candidates for transplantation. Transplant-related mortality was 6% in the first EBMT report and 5.3% in the second one. No deaths were reported since 2001. Very high-intensity conditioning regimen is associated with higher risk of toxicity without significant increase in efficacy. The effects of transplantation and transplantation-related morbidity are dependent on patient-selection, time of transplantation and conditioning regimens used. This review is a comprehensive study of the results obtained in several single-center and multicenter studies. Patient characteristics, transplantations steps, toxicity and clinical outcome have been monitored and compared. [source] | |||||||||||||||||||||||||