Functional Activity Scale Research Articles

Symptomatic therapy for knee osteoarthrosis: new possibilities

Objective: to evaluate the efficacy and safety of the zinaxin-glucosamine sulfate (ZGS) complex versus meloxicam in patients with knee osteoarthrosis (KOA). Subjects and methods. The 12-week, prospective, open-label, randomized clinical and instrumental study enrolled 40 patients with bilater al Kellgren and Lawrence stage I– IV KOA on X-ray. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and knee joint ultrasound data were assessed during the study over time (before and 4 and 12 weeks after treatment). Results. The main symptoms of KOA were considerably alleviated during the administration of ZGS and meloxicam. The same effect was achieved at week 4 of treatment and increased throughout the study. Both groups showed significantly reduced stiffness (p<0.001), which indirectly confirmed that the compared drugs had anti-inflammatory activity. The changes in the WOMAC index by the functional activity scale and the total WOMAC score suggested an increase in the positive effect of ZGS and meloxicam. The total assessment of the results of treatment with ZGS showed improvement and considerable improvement in 100% of cases; meloxicam was demonstrated to have no effect in 5.3% of the patients. The anti-inflammatory activity of ZGS and meloxicam was evidenced by knee joint ultrasonography. Conclusion. The analgesic and anti-inflammatory effects of ZGS are comparable with those of meloxicam on pain, stiffness, and functional activity. Dynamic ultrasonography of the knee joints provides support for the fact that ZGS has anti-inflammatory properties. The high effi cacy of ZGS is combined with the absence of adverse reactions. ZGS may be recommended as an alternative treatment for KOA.

Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis

To determine if repetitive task training after stroke improves functional activity. Systematic review and meta-analysis of trials comparing repetitive task training with attention control or usual care. The Cochrane Stroke Trials Register, electronic databases of published, unpublished and non-English language papers; conference proceedings, reference lists, and trial authors. Included studies were randomized/quasi-randomized trials in adults after stroke where an active motor sequence aiming to improve functional activity was performed repetitively within a single training session. We used Cochrane Collaboration methods, resources, and software. We included 14 trials with 17 intervention-control pairs and 659 participants. Results were statistically significant for walking distance (mean difference 54.6, 95% confidence interval (95% CI) 17.5, 91.7); walking speed (standardized mean difference (SMD) 0.29, 95% CI 0.04, 0.53); sit-to-stand (standard effect estimate 0.35, 95% CI 0.13, 0.56), and activities of daily living: SMD 0.29, 95% CI 0.07, 0.51; and of borderline statistical significance for measures of walking ability (SMD 0.25, 95% CI 0.00, 0.51), and global motor function (SMD 0.32, 95% CI -0.01, 0.66). There were no statistically significant differences for hand/arm functional activity, lower limb functional activity scales, or sitting/standing balance/reach. Repetitive task training resulted in modest improvement across a range of lower limb outcome measures, but not upper limb outcome measures. Training may be sufficient to have a small impact on activities of daily living. Interventions involving elements of repetition and task training are diverse and difficult to classify: the results presented are specific to trials where both elements are clearly present in the intervention, without major confounding by other potential mechanisms of action.

Dynametric assessment in CIDP

In this issue, Harbo and colleagues,3 use a number of common measures, including manual muscle testing, as done in the Neuropathy Impairment Score (NIS), attributes of nerve conduction (NCs), quantitative sensation testing (QST) using CASE IV, functional activity scales (9-hole peg and 40-meter walk), and short SF-36 quality of life scales for comparison with muscle force measurements of the Biodex System 3 PRO dynamometer (CIMP) in a trial of withholding and re-instituting IVIg treatment in patients with CIDP. They found that muscle force decreased by about 15 percent when treatment was withheld, and it improved by approximately 6 and 12 percent by days 5 and 10 after restarting IVIg treatment. These measured changes were significantly associated with “improved walking velocity and hand function.” With retreatment, the F-wave latency decreased, but manual muscle testing, NCs, QST and SF-36 did not show significant concomitant changes. They conclude that isokinetic dynamometry “…is a sensitive and clinically relevant method for monitoring the acute response to IVIG treatment in CIDP.”

Clinical correlates of depressive symptoms in familial Parkinson's disease

Depression is one of the most common nonmotor complications of Parkinson's disease (PD) and has a major impact on quality of life. Although several clinical factors have been associated with depression in PD, the relationship between depression and stage of illness as well as between depression and degree of disability remains controversial. We have collected clinical data on 1,378 PD cases from 632 families, using the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II (activities of daily living) & III (motor), the Mini-Mental State Exam, the Geriatric Depression Scale (GDS), and the Blessed Functional Activity Scale (Blessed). Analyses were performed using the 840 individuals with verified PD and without evidence of cognitive decline. Logistic regression was used to identify study variables that individually and collectively best predicted the presence of depressive symptoms (GDS >or= 10). After correcting for multiple tests, depressive symptoms were significantly associated with Hoehn and Yahr stage and other clinical measures but not with any genetic variant (parkin, LRRK2, APOE). The Blessed score, education, presence of a first degree relative with signs of depression, and UPDRS Part II were found to best predict depressive symptomatology (R(2) = 0.33; P = 4 x 10(-48)). Contrary to several reports, the results from this large study indicate that stage of illness, motor impairment, and functional disability are strongly correlated with depressive symptoms.

Effectiveness of Ultrasound-Guided Corticosteroid Injection in the Treatment of Morton's Neuroma

The purpose of this study was to evaluate the efficacy of corticosteroid injection and determine the duration of symptom-free period after treatment with a single ultrasound-guided injection for a painful Morton's neuroma. From May 2002 to November 2003, 35 consecutive patients (7 males, 28 females) (mean age, 54; age range, 29 to 77 years) underwent a single ultrasound guided corticosteroid injection. Thirty-nine injections were performed as 4 patients had bilateral Morton's neuromas. The injection of 1.0 cc Celestone Chronodose (5.7 mg/ml) with 0.5 cc of 1% lidocaine was performed into the symptomatic intermetatarsal web-space. The efficacy of the injection was determined by the Johnson grading scale, and modified lower extremity functional scale. On the Johnson scale, 15 of 39 (38%) neuromas showed complete satisfaction 9 months after treatment and 11 of 39 (28%) were satisfied with minor reservations. A total of 26 of 39 (66%) neuromas had a positive outcome 9 months after the injection. On the functional daily activity (FDA) scale, 20 of 39 (51%) neuromas showed no difficulty and 4 of 39 (10%) indicated minor difficulties, which was considered a positive outcome 9 months after injection. Complete pain relief was achieved in 11 of 39 (28%) neuromas 9 months after treatment. Twelve of 39 (31%) neuromas did not respond to conservative treatment and required surgery. The results of treatment suggested improvement in efficacy if injection was used early. The size of the lesion measured on ultrasound showed no correlation with pain relief after injection. A single corticosteroid injection can offer short-term pain relief in the conservative management of Morton's neuroma.

Evaluating Functional Activity in Older Thai Adults

The purpose of this study was to translate the original English version of the Self-Efficacy and Outcome Expectations Scales for Exercise and Functional Activity and to establish their reliability in older Thai adults in geriatric rehabilitation. This study used a correlational design with repeated measures. Reliability of the Self-Efficacy for Exercise Scale (SEES), the Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES), and the Outcome Expectations for Functional Activity Scale (OEFAS) developed by Resnick was measured in 20 older adults aged 60 years or older after hip or knee replacement or another orthopedic surgery of their lower extremity. All scales were translated into Thai and back translated into English according to the process described by Marin and Marin. The instruments were administered twice--the 1st and 2nd day in the participants' geriatric rehabilitation program (i.e., the 4th and 5th postoperative day). Results indicated that there was sufficient evidence for internal consistency of the SEES, SEFAS, OEES, and OEFAS with alpha coefficients of 0.84, 0.86, 0.70, and 0.86 respectively. Test-retest reliability of the tools was also demonstrated with Spearman correlation coefficients of 0.84 for the SEES, 0.87 for the SEFAS, 0.61 for the OEES, and 0.54 for the OEFAS. The findings from this study provide important information for instrument adaptation and the applicability of these scales for further studies of older Thai adults.

Effectiveness of a Behavioral Change Intervention in Thai Elders After Knee Replacement

After total knee replacement, elders need an effective intervention to change exercise and physical activity behavior. This study examined the effects of a behavioral change intervention (BCI) on self-efficacy and outcome expectations for exercise and functional activity, physical activity participation, and physical performance of older adults. The study was based on the social cognitive theory (SCT), with a longitudinal quasi-experimental, pretest-posttest control group design. Sixty-three Thai elders undergoing knee replacement surgery were studied. The experimental group received a BCI based on SCT given by the investigator. Outcome measures were the Self-Efficacy for Exercise Scale (SEES) and Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES) and Outcome Expectations for Functional Activity Scale (OEFAS), the Physical Performance Test (PPT), and the Physical Activity Diary (PAD). The experimental group had significantly greater improvements in self-efficacy for exercise, outcome expectations for exercise, and functional activity, significantly more participation in exercise and walking, and significantly greater improvement in physical performance than did the control group at postoperative weeks 2 and 6. The BCI based on SCT was effective in changing the outcomes in the expected direction. This BCI may be applicable, with modifications, to elders in other situations in which changing behavior is the key to recovery.

Developing a responsive measure of change for paediatric brain injury inpatient rehabilitation

Primary objective : To describe conceptual and methodological issues to be addressed in developing a responsive clinical performance measure for paediatric brain injury inpatient rehabilitation. Selected statistical approaches used to examine responsiveness of two functional activity scales (daily and social behavioural activity) of a prototype measure are presented to illustrate these issues. Research design : Retrospective chart review. Methods and procedures : Data on 65 children, aged 6 months to 18 years (X bar = 9.5 years) were collected during 1998 and 1999 from eight sites in the USA. Responsiveness was examined using effect sizes and a number of parametric and non-parametric tests. Main outcomes and results : Significant improvements from admission to discharge were found on all item and scale scores ( p < 0.001). Moderate significant relationships were found between activity scale change scores and external ratings of change. Conclusions : Findings provide evidence that the activity scales have the potential to be responsive and point to issues that will need to be addressed in future measurement development.

Depressed Mood and the Incidence of Alzheimer's Disease in the Elderly Living in the Community

It remains unclear whether depression increases the risk for dementia in the elderly. We evaluated the relationship between depressed mood at baseline and the incidence of dementia, particularly Alzheimer's disease, in the elderly living in the community. A total of 1070 elderly individuals, aged 60 years or older, were identified as part of a registry for dementia in the Washington Heights community of North Manhattan, NY. In a prospective, longitudinal design with follow-up for 1 to 5 years, annual physician evaluation and neuropsychological testing were used to assess levels of cognitive impairment and to diagnose dementia. Depressive symptoms were evaluated with the 17-item Hamilton Rating Scale for Depression. Based on clinical considerations and a validity study, a positive score for the depressed mood item was used in statistical analyses. To confirm the results, the total Hamilton Rating Scale for Depression score was also evaluated as the "depression" variable. Of the 1070 subjects, 218 met criteria for dementia at baseline evaluation. In the 852 subjects without dementia, depressed mood was more common in individuals with greater cognitive impairment. In a follow-up study of 478 of these subjects without dementia (mean +/- SD, 2.54 +/- 1.12 years of follow-up), the effect of baseline depressed mood on the end-point diagnosis of dementia (93% had possible or probable Alzheimer's disease) was evaluated in a Cox proportional hazards model. Depressed mood at baseline was associated with an increased risk of incident dementia (relative risk, 2.94; 95% confidence interval, 1.76 to 4.91; P < .001). This effect remained after adjustment for age, gender, education, language of assessment, Blessed Memory Information and Concentration test scores, and Blessed Functional Activity Scale scores (relative risk, 2.05; 95% confidence interval, 1.16 to 3.62; P < .02). Similar results were obtained when the total Hamilton Rating Scale for Depression score was used as the depression variable, with the use of the same covariates (relative risk, 1.07 per point interval; 95% confidence interval, 1.02 to 1.11; P < .01). Depressed mood moderately increased the risk of developing dementia, primarily Alzheimer's disease. Whether depressed mood is a very early manifestation of Alzheimer's disease, or increases susceptibility through another mechanism, remains to be determined.

Outcome of treatment of 686 gunshot wounds of the trunk at Los Angeles County-USC Medical Center: implications for the community.

The Los Angeles County-University of Southern California (LAC-USC) Medical Center, a level I trauma center, has experienced a rapidly increasing incidence of gunshot wounds (GSWs). We sought to enumerate the annual monetary costs and medical consequences of thoracoabdominal gunshot wounds in the epicenter of urban violence. A consecutive series of patients admitted from September 1, 1989 to August 31, 1990 was studied. Their records were coded by trauma nurse reviewers and held in the Trauma Emergency Medical Information System (TEMIS) and Automated Medical Record Abstracting and Reporting System (AMRARS). Diagnoses, procedures, and complications were verified by chart review. An estimate of disability 3 months after discharge was made from the record and reported on a functional activity scale. The total number of patients with GSWs admitted to all of the level I Los Angeles County trauma centers was 2771 during the study period. The total number of patients with major gunshot injuries admitted to LAC-USC Medical Center was 1007. Thoracoabdominal wounds without any head wound component occurred in 686 gunshot patients. Three quarters of the injured patients with truncal gunshot injuries were Hispanic. Total length of stay at the LAC-USC Medical Center for those with truncal wounds was 4666 hospital bed days including 432 ICU bed days, representing a minimum estimated total medical cost of $5,441,334. Annual medical cost of all admissions including rehabilitation, however, could be as great as $12 million for the Medical Center and $53 million for the County of Los Angeles. Thirty percent of patients had MediCal insurance. Payment could not be recovered from another 57% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical results after arthroscopic meniscectomy in sportsmen

The treatment of meniscallesions has always been problem of crucial importance in the knee surgery. Now a main principle in the knee surgery; is perserving of the peripheral rim of the meniscus, included in stabilising soft tissue structures of the knee. The meniscectomy. which preserves as much functional meniscus tissue as possible is a method of choice. Within a period of four (1-4) years arthroscopic meniscectomy were performed. The functional activity scale used aspects of the knee scoring scale described by Lysholm was applied for analysing the postoperative status. The results obtained were 75% excellent, 12% good. 9% fair and 4% poor.

Six-year results of treatment with levodopa plus benzerazide in Parkinson's disease.

A combination of levodopa and a peripheral dopa-decarboxylase inhibitor, benzerazide (Ro 4-4602), was studied over a 75-month period of observation in 132 patients with Parkinson's disease. The combined therapeutic approach was without biological toxicity, was well tolerated by 95 percent of patients, and was highly effective: 72 percent of patients improved by more than 50 percent on a functional activity scale and the group as a whole improved on an objective battery by a mean of 46 percent. Neurologic side effects of abnormal involuntary movements, falls, and oscillations in performance were not improved over levodopa used alone. The combined therapy is to be preferred over the use of levodopa alone in the symptomatic management of Parkinson's disease.