1,721,005 research outputs found
Taking Charge of the Lower Limb Amputee Patient: Evaluation Measures, Scales, and the Clinical Approach
No full textIs the Rivermead Mobility Index a suitable outcome measure in lower limb amputees? - A psychometric validation study
No full textObjective: To examine the internal consistency, validity, responsiveness and test scalability of the Rivermead Mobility Index. Design: Methodological research (consecutive sampling, prospective longitudinal study). Patients: 140 unilateral lower limb amputees (79 above-knee and 61 below-knee). Methods: The Rivermead Mobility Index was administered to all patients at the beginning (T0) and at the end (T2) of the prosthetic training. In 70 of the patients, the Functional Independence Measure and a timed walking test were also carried out. Results: The Cronbach's alpha of the Rivermead Mobility Index was 0.85 and the item-to-total correlation coefficients rpb ranged from 0.33 to 0.74 (p < 0.0001), for the items considered, at T0; 4 correlations were not calculated due to the extremely low variability of some item responses (mode ≥98%). The correlation (rs) of Rivermead Mobility Index score with the motor subscale of the Functional Independence Measure was 0.83 at T0 and 0.69 at T2 (p < 0.0001, for both) and that with timed walking test -0.70 (p < 0.0001) at T2. The effect size was 1.35. The scalability coefficients were below the limits of acceptability. Conclusion: When applied in lower limb amputees, the Rivermead Mobility Index is an ordinal measure with adequate levels of a series of psychometric properties, which seems more useful for epidemiological studies than for clinical decision-making in single patients. Further steps should be considered to improve its item selection, response format and scaling properties
Functional outcome after lower limb amputation: is hyperhomocysteinemia a predictive factor? an observational study
Full text linkLower limb amputation (LLA) is the drastic stage of peripheral arterial disease (PAD) where the hyperhomocysteinemia (H-HCY) seems to be a risk factor. Surprisingly, in literature the levels and the role of homocysteinemia (HCY) in persons with LLA are understudied. This study aims to investigate the level of HCY and its correlation with the functional outcomes after LLA.A case-control study to analyze HCY levels in amputees admitted in a rehabilitation hospital during an investigation period of 1.5 years. Barthel Index was used to assess the functional outcome.We enrolled 91 dysvascular amputees and 44 amputees for other reasons than PAD (controls). The mean level of HCY was found higher in dysvascular amputees (15.27.5) compared to controls (11.0 +/- 5.0, P<0.0001) with a risk related ratio of 4.78. Normal Gaussian distribution of HCY was observed in controls, whereas in dysvascular amputees the data follow a double Gaussian distribution. Finally, a significant negative correlation was found between HCY and the effectiveness of rehabilitation (R=-0.37, P=0.001) only in dysvascular amputees.Dysvascular amputees had a level of HCY significantly higher than amputees without PAD. H-HCY seems to influence the functional outcomes of the rehabilitative treatment only in LLA due to PAD
Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: A randomized controlled trial
No full textTo evaluate the reduction in phantom pain and sensation with combined training of progressive muscle relaxation, mental imagery, and phantom exercises
Concurrent Validity of Physiological Cost Index in Walking over Ground and during Robotic Training in Subacute Stroke Patients
Full text linkPhysiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p < 0.001); in CG Pearson correlation was 0.852 (p < 0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients
Post-stroke rehabilitation: An economic or medical priority? Current issues and prospects in light of new legislative regulations
No full textThe aim of this study was to evaluate: 1) whether the reduction in duration of in-patient rehabilitation imposed by the Italian Ministry of Health's circular of 29/6/95 has been accompanied by a decline in the results achieved; and 2) whether the system of basing payments on diagnosis related group (DRG) criteria is capable of correctly evaluating differences in post-stroke clinical pictures. The study involved 461 of 497 patients consecutively admitted between 1991 and 1996 for rehabilitation after a first stroke. The average duration of hospitalisation for the period 1995-1996 was significantly shorter (/?<0.001) than that of the previous years; at the same time, there was a significant increase (/?<0.05) in the number of poor responders in both neurological and functional (mobility) terms. Furthermore, the early discharge after 60 days of the 1995-1996 patients compromised the stabilisation of recovery and led to a subsequent functional decline. It is therefore hoped that the current regulations will be revised and that payments based on a functional related group (FRG) criterion will be introduced. © Springer-Verlag 1998
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Poststroke late seizures and their role in rehabilitation of inpatients
No full textPURPOSE:
This study was designed to (a) identify the prevalence of poststroke late seizures in a population of patients admitted to rehabilitation of neurologic sequelae of their first stroke, (b) recognize reliable prognostic factors associated with the occurrence of poststroke late seizures, and (c) evaluate the impact of seizures on the results of rehabilitation treatment.
METHODS:
In a prospective study of 306 consecutive patients admitted to a rehabilitation hospital for sequelae of their first stroke, we assessed the relation among 15 independent variables and the development of seizures by using multiple regression analysis (forward stepwise). In addition, we evaluated the impact of occurrence of poststroke seizures on both efficiency and effectiveness of rehabilitation and length of stay.
RESULTS:
Poststroke late seizures occurred in 46 (15.03%) patients, with a mean interval from stroke of 101.98 +/- 37.96 days. In multiple regression analysis, putaminal and lobar hemorrhages showed a significant positive association with the development of seizures (p < 0.005), whereas high scores on the Canadian Neurological Scale (CNS) (indicating less severe strokes) and increasing age were negatively associated (p < 0.01 and p < 0.05, respectively). Patients with putaminal and lobar hemorrhages and patients with severe stroke (CNS score at admission, <7) were at significantly greater relative risk of seizures [relative risk (RR) = 1.99, 95% confidence interval (CI), 1.11-1.39; RR = 3.00, CI, 1.06-1.13; and RR = 2.41, CI, 1.01-1.27, respectively). No significant association was found between poststroke seizures and results of rehabilitation.
CONCLUSIONS:
Poststroke late seizures occurred mainly in patients with putaminal and lobar hemorrhagic strokes but, if treated, did not affect rehabilitation therapy
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