Functional Capacity Index Research Articles

Manual therapy and therapeutic exercise in patient with symptomatic cervical spondylotic myelopathy: A case report

Cervical spondylotic myelopathy (CSM) is caused by narrowing of the cervical spinal canal, although surgical decompression is an obvious indication for spinal cord stenosis, there are not enough data to determine that surgery is the most indicated intervention for milder forms. The purpose of the present case report was to describe the outcomes results of the physical therapy treatment with emphasis on manual therapy and therapeutic exercise for a patient with CSM. A 58-year-old male patient attended the physical therapy clinic due to pain and paresthesia in the upper and lower limbs. The magnetic resonance imaging was compatible with spondylotic myelopathy. Following physical therapy treatment, the patient exhibited an improvement in functional capacity (triangle step test and timed 10-m walk), pain, paresthesia, mJOA scale and Neck Disability Index. Based on the lack of rapid evolution of neurological impairment, physical therapy treatment was indicated, which achieved satisfactory results.

A25 Functional residual capacity (FRC) and lung clearance index (LCI) in mechanically ventilated infants: application in newborn with congenital diaphragmatic hernia (CDH)

A25 Functional residual capacity (FRC) and lung clearance index (LCI) in mechanically ventilated infants: application in newborn with congenital diaphragmatic hernia (CDH)

Hydrogeomorphic (HGM) Assessments of Mitigation Sites Compared to Natural Reference Wetlands in Pennsylvania

The U.S. Environmental Protection Agency and U.S. Army Corps of Engineers completed revisions to the Mitigation Rule of the Clean Water Act in 2008. These revisions encourage states to carry out mitigation in a watershed context, prioritizing mitigation site design and placement by overall watershed need, to the extent appropriate and practicable (33 C.F.R. 332.3(c)). States are expected to establish monitoring programs and measureable performance standards for mitigation wetlands. In Pennsylvania, hydrogeomorphic (HGM)-based assessments involving 222 reference wetlands were used to compare mitigation wetland performance. For this study, 72 mitigation wetlands were sampled in 2007 and 2008 from three categories – Pennsylvania Wetland Replacement Program sites, Pennsylvania Department of Transportation mitigation banks, and permit required compensatory mitigation sites. Mitigation wetlands were intensively sampled using a Level 3 - Intensive methodology developed by Riparia. Field data and GIS computed variables were used to derive the scores of 10 HGM functional capacities. Overall, mitigation sites displayed lower potential to perform a characteristic wetland function than reference wetlands. Depressions show the greatest discrepancy, while fringing sites showed the least amount of difference from reference scores. Mitigation site size, age, and type were not significant factors in functional capacity index scores.

Beyond the fireground: injuries in the fire service

BackgroundAlthough firefighting and emergency medical services are high-risk professions, few studies have identified the aetiology of injury in the fire service beyond the fireground.MethodsData were collected for work-related injuries in...

Injuries among powered two-wheeler users in eight European countries: A descriptive analysis of hospital discharge data

Powered two-wheelers (PTWs – mopeds, motorcycles, and scooters) remain the most dangerous form of travel on today's roads. This study used hospital discharge data from eight European countries to examine the frequencies and patterns of injury among PTW users (age≥14 years), the predicted incidence of the loss of functional ability, and the mechanisms of the head injuries observed (all in light of increased helmet use). Of 977,557 injured patients discharged in 2004, 12,994 were identified as having been injured in PTW collisions. Lower extremity injuries accounted for 26% (25.6–26.7, 95% C.I.) of the total injuries, followed by upper extremity injuries (20.7%: 20.3–21.2), traumatic brain injuries (TBI) (18.5%: 18–19), and thoracic injuries (8.2%: 7.8–8.5). Approximately 80% of the lower extremity injury cases were expected to exhibit some functional disability one year following discharge (predicted Functional Capacity Index, pFCI-AIS98<100), compared to 47% of the upper extremity injury cases and 24% of the TBI cases. Although it occurred less frequently, patients that were expected to experience some functional limitation from TBI were predicted to fair worse on average (lose more functional ability) than patients expected to have functional limitations from extremity injuries. Cerebral concussion was the most common head injury observed (occurring in 56% of head injury cases), with most concussion cases (78%) exhibiting no other head injury. Among the AIS3+ head injuries that could be mapped to an injury mechanism, 48% of these were associated with a translational-impact mechanism, and 37% were associated with a rotational mechanism. The observation of high rates of expected long-term disability suggests that future efforts aim to mitigate lower and upper extremity injuries among PTW users. Likewise, the high rates of concussion and head injuries associated with a rotational mechanism provide goals for the next phase of PTW user head protection.

Comparative Therapeutic Effi cacy of Adenocin and Non-Glycoside Cardiotonic Drugs in Chronic Heart Failure at Rest and under Conditions of Heart Overload

Experiments were performed on the model of chronic heart failure. Functional capacity of myocardial structures under conditions of maximum pressure overload was within the upper limit of normal after treatment with Adenocin. The myocardial functional reserve and potential capacity index were shown to increase to normal under these conditions. Dobutamine, levosimendan, and milrinone increased functional capacity under conditions of maximum pressure overload. Treatment with adenocin restored diastolic function of the heart under conditions of maximum pressure overload. The end-diastolic pressure increased, but remained 1.7 times below the level observed in heart failure. After treatment with dobutamine and milrinone, the end-diastolic pressure (8th episode of ligation) did not differ from the level observed in heart failure, while after administration of levosimendan this parameter decreased by 31%. Contraction-relaxation coupling was completely restored under the influence of Adenocin in all episodes of ligation both before and after removal of the ligature. Nearly all animals with heart failure were resistant to 8 episodes of ligation after treatment with Adenocin (89 vs. 96% under normal conditions). Under these conditions, the survival rate of animals after administration of levosimendan, milrinone, and dobutamine was 65, 60, and 61%, respectively, (the mortality rate of animals with heart failure was 75%). Adenocin, a cardiotonic drug with cardioprotective properties, in contrast to other cardiotonic drugs, has a modulatory effect on the system of cell energy supply, restores myocardial reserves, and improves myocardial function under conditions of overload.

Pedestrian injuries in eight European countries: An analysis of hospital discharge data

Out of the 50,000 yearly road traffic deaths in the European Union (formed by 27 European countries and commonly designated as EU-27), some 8500 are pedestrians. While some studies focus on the increased risk for pedestrian mortality compared to other road users, there is a dearth of information on injury patterns that could be used to prioritize injury prevention measures. Hospital discharge data from eight European countries have been used in this study. Injury information from 10,341 pedestrians sustaining 19,424 injuries has been analyzed. Data have been augmented with Abbreviated Injury Scale, Functional Capacity Index and Injury Severity Score codes, and have been categorized into the Barell Matrix. Fractures (51.1%, 50.3–51.8) and internal injuries (21.3%, 20.7–21.9) are the most frequently found in the data; however, blood vessel injuries and internal injuries are the ones associated with the highest risk of death. Head and lower extremities account for 26% of the injuries each, being spinal and thoracic injuries those showing the highest threat to life risk. Hip and lower extremities injuries are the most frequent cause of functional limitation 1 year after discharge. Due to its intrinsic importance, different injury causation mechanisms for head injuries have been analyzed. Though current standards and regulations consider Head Injury Criterion (HIC) as the only tool to assess the risk of injuries to the head, real world injury data show that only 12.1% (11.0–13.2) of these injuries can be attributed to a pure translational mechanism and therefore susceptible to be predicted by HIC. Design of prevention strategies, particularly from the engineering point of view, should benefit from this information.

The Efficacy of a Topical Gel Prepared Using Lake Urmia Mud in Patients with Knee Osteoarthritis

Osteoarthritis (OA) is characterized by progressive cartilage degradation and secondary inflammation of the synovial membrane. Studies have shown that mud therapy may influence serum levels of several cytokines involved in the pathogenesis of OA and chondrocyte metabolism. The main targets of our research were to make use of Lake Urmia mud for topical gel formulation, evaluation of the possible therapeutic effects of this gel on symptoms of patients with knee OA and the evaluation of serum tumor necrosis factor-alpha (TNF-alpha) level after mud therapy in comparison with the application of a placebo. Fifty (50) patients suffering from knee OA participated in this study and randomized into two groups: case group and control group. Patients in the case group received mud therapy and the placebo was applied to patients in the control group. Three (3) parameters including pain, morning stiffness, and joint functionality were assessed in all patients. Visual analogue scale and Western Ontario McMaster Osteoarthritis index (WOMAC) were the employed scales for pain assessment. Functional capacity was evaluated by using WOMAC functional capacity and WOMAC global index. All the mentioned steps were done before and after treatment. Blood samples, in both groups, were collected for measuring tumor necrosis factor (TNF)-alpha serum level. All the differences (for three parameters), in the case group, were statistically significant. TNF-alpha serum level reduction in both groups were detected: 19.41% in the case group and 1.76% in the control group. Mud therapy using formulated gel is an effective method in knee OA treatment and pain reduction. Further studies may be needed for the evaluation of possible synergism between pharmacological treatment and mud therapy.

Late Outcomes of Trauma Patients With Infections During Index Hospitalization

Injured patients have significant risk of infection during initial hospitalization. We hypothesized that infected trauma patients would have worse late outcomes. From 69 centers, patients with moderate-severe injuries and at least one selected infection during hospitalization were compared with those without an infection. Outcomes measured at 3 months and 12 months postinjury included death, subscales on the Medical Outcomes Short Form Health Survey (SF-36), Revised Center for Epidemiologic Studies Depression Scale, the cognitive subscale of the Functional Capacity Index, the Mobility and Fine Motor subscales of the Musculoskeletal Function Assessment, return to work, and healthcare utilization postdischarge. Of 4,732 patients, 668 had >or=1 infection. Patients with hospitalizations complicated by infection had a higher risk of death within 1 year after injury, hazard ratio 1.56 (95%confidence interval [CI] 1.13-2.15). Surviving patients with infections had lower SF-36 physical function scores and patients older than 65 years also demonstrated lower scores in general health, vitality, emotional and social function. Postdischarge, infected patients were more likely to have repeat hospitalizations, need home health services (relative risk [RR] 1.19, 95% CI 1.03-1.37 and RR 1.68, 95% CI 1.12-2.52, respectively) and require 3 more hours of care from family/friends per month. They were also less likely to have returned to work (odds ratio 1.67, 95% CI 1.20-2.32). However, infected patients were at less risk of being depressed 12 months postinjury (RR 0.77, 95% CI 0.62-0.97). Trauma patients with an infection during hospitalization demonstrate worsened functional status and increased healthcare usage up to a year after injury compared with those without an infection. Future interventions need to target decreasing infection risk as well as close follow-up after discharge.

Prevalence and Predictors of Sexual Dysfunction 12 Months After Major Trauma: A National Study

To determine the prevalence and predictors of sexual dysfunction (SDF) after moderate-to-severe trauma in a large multicenter study. The National Study on the Costs and Outcomes of Trauma was a prospective cohort study involving 69 hospitals from 15 regions in 14 states. Men and women aged 18 to 84 years with moderate-to-severe injures participated in 3 and 12 month postinjury interviews. At 12 months, sexual function was assessed using the Functional Capacity Index. Predictors of SDF were determined using adjusted multivariate Poisson regression. Sensitivity analyses were conducted on patients aged 18 to 30 years. Of 10,122 weighted subjects, 3,087 (30.5%) reported some degree of SDF, with the majority reporting severe SDF. On multivariate analysis, independent predictors of SDF included increasing age (aRR 1.02 per year age), decreasing household income category (aRR 1.12-1.60), lower baseline global health status (aRR 1.27-3.54), preexisting diabetes (aRR 1.34) increasing Injury Severity Score (aRR 1.02 per point increase), pelvic fracture (aRR 1.45), lower extremity fracture (aRR 1.48), and spinal cord injury (aRR 3.73). SDF is common and usually severe after major trauma. Injury severity is a significant independent predictor of SDF. This may be due to persistent physical, psychologic, or social limitations from injury. Given the effect on quality of life, these data support the need in the clinical setting to identify and address SDF after trauma. Further investigation is necessary to determine the mechanism by which injury severity mediates SDF and whether earlier interventions can decrease the later risk of SDF.

The relationship between depressive symptoms, health service consumption, and prognosis after acute myocardial infarction: a prospective cohort study

BackgroundThe use of cardiovascular health services is greater among patients with depressive symptoms than among patients without. However, the extent to which such associations between depressive symptoms and health service utilization are attributable to variations in comorbidity and prognostic disease severity is unknown. This paper explores the relationship between depressive symptoms, health service cardiovascular consumption, and prognosis following acute myocardial infarction (AMI).MethodsThe study design was a prospective cohort study with follow-up telephone interviews of 1,941 patients 30 days following AMI discharged from 53 hospitals across Ontario, Canada between December 1999 and February, 2003. Outcome measures were post discharge use of cardiac and non-cardiac health care services. The service utilization outcomes were adjusted for age, sex, income, comorbidity, two validated measures of prognosis (cardiac functional capacity and risk adjustment severity index), cardiac procedures (CABG or PTCA) and drugs prescribed at discharge.ResultsDepressive symptoms were associated with a 24% (Adjusted RR:1.24; 95% CI:1.19–1.30, P < 0.001), 9% (Adjusted RR:1.09; 95% CI:1.02–1.16, P = 0.007) and 43% (Adjusted RR: 1.43; 95% CI:1.34–1.52, P < 0.001) increase in total, cardiac, and non-cardiac hospitalization days post-AMI respectively, after adjusting for baseline patient and hospital characteristics. Depressive-associated increases in cardiac health service consumption were significantly more pronounced among patients of lower than higher cardiac risk severity. Depressive symptoms were not associated with increased mortality after adjusting for baseline patient characteristics.ConclusionDepressive symptoms are associated with significantly higher cardiac and non-cardiac health service consumption following AMI despite adjustments for comorbidity and prognostic severity. The disproportionately higher cardiac health service consumption among lower-risk AMI depressive patients may suggest that health seeking behaviors are mediated by psychosocial factors more so than by objective measures of cardiovascular risk or necessity.

Efficacy of the hydrogeomorphic model (HGM): A case study from western Tennessee

Abstract Hydrogeomorphic models (HGM) for wetland classification and functional assessment have been developed for several regions in the United States. However, validation of models is lacking, even though models are already in use and the general idea is that each is a working model, developing over time with new ideas and information. We examined the HGM developed for western Tennessee using novel data collected from six stream systems, two channelized, two channelized and leveed, and two unchannelized. The western Tennessee HGM has the ability to differentiate altered and unaltered rivers based mainly on changes to hydrologic floodplain functions, although functional capacity index values were validated from independent measures. Effects of channelization were confounded in western Tennessee by other disturbances, channel recovery processes, and variability due to levee construction. Levees render the greatest change to floodplains as they disconnect the channel and floodplain system, decreasing water tables and possible exchanges. One of the main factors controlling productivity along channels without levees was sedimentation. We recommend that estimated rates of sedimentation be incorporated into an updated version of the HGM. Variability of human alterations and natural floodplain heterogeneity suggest landscape factors (e.g., beta diversity, degree of ponding) and use of gradient indices may result in greater resolution for determining functional capacity of low gradient, riverine systems.

A deeper level of ketamine anesthesia does not affect functional residual capacity and ventilation distribution in healthy preschool children

Ketamine is commonly used in children in the emergency setting and while undergoing diagnostic and therapeutic interventions because of its combination of hypnotic and analgesic properties. Although studies comparing various levels of ketamine anesthesia are lacking, previous work suggests that lung mechanics might only be minimally affected by ketamine. After approval from the Ethics Committee, anesthesia was induced with 2 mg.kg(-1) racemic ketamine followed by a continuous infusion of ketamine 2 mg.kg(-1) h(-1) (level I) in 26 children (2-6 years of age), and after 5 min, the first set of measurements was performed. Then, a second bolus of ketamine 2 mg.kg(-1) followed by ketamine 4 mg.kg(-1) h(-1) was administered (level II) and after 5 min, the second set of measurements was performed. Functional residual capacity (FRC) and lung clearance index (LCI) were calculated using a multibreath analysis by a blinded observer. Functional residual capacity and LCI did not change between the two levels (FRC 25.6 [4.3] ml.kg(-1) vs 25.5 [4.2] ml.kg(-1), P=0.769, LCI 10.5 [1.2] vs 10.3 [1.1], P=0.403). The minute ventilation was similar between the two levels of anesthesia. The University of Michigan Sedation Scale increased from 3 (3) to 4 (3-4) at the second level of ketamine anesthesia. A deeper level of anesthesia induced by ketamine does not affect FRC, ventilation distribution or minute ventilation suggesting that the depth of ketamine anesthesia has a minimal effect on pulmonary function.

Assessment of wetlands in the Upper Juniata watershed in Pennsylvania, USA using the hydrogeomorphic approach

This paper reports on the ecological status of wetlands in the Upper Juniata watershed in Pennsylvania, USA, as determined by employing the hydrogeomorphic (HGM) approach. HGM assessment provides a measure of the potential functional performance of a single wetland for up to 11 functions, depending on the subclass. Functional Capacity Index (FCI) scores calculated for each function range between a score of 1 (indicates the site is performing at optimum levels) and a score of 0 (indicates the site is not performing the function). Mean scores for all functions for the wetland resource in the Upper Juniata ranged from 0.48–0.63, except for Long-term Surface-Water Storage (0.39) and Characteristic Hydrology (0.85). Cumulative Distribution Function (CDF) plots were fairly linear over most of the distribution for all functions, indicating that the FCI scores were evenly distributed over the population. Several of the plots flattened at the upper and/or lower ends of the curves, indicating that a very small proportion of the wetland area had the highest and lowest scores. Clustering of the 69 riverine and slope sites using the FCI scores from the three functions with the most well-developed models resulted in the formation of four Functional Status Groups (FSGs). Groups 1 and 2 represented relatively high functioning groups of sites. They were differentiated by an exceptionally high Plant Community Function in Group 1 that differed significantly from the low value in Group 2. FSG’s 3 and 4 represented relatively low functioning groups of sites and were differentiated by a significantly high Vertebrate Community Function in Group 3. We defined three reference domains (Natural, Agricultural, and Developed) based on predominant land cover. Sites of any given FSG were distributed across the reference domains, but there were some differences in distribution. Sites in the Natural Domain were much more likely to be in the higher functioning FSGs, while the Agricultural Domain was dominated by sites with an overall low level of functioning. Sites in the Developed Domain are equally distributed across the four FSGs. In summary, we demonstrated how HGM assessment might be employed to describe the functional status of the wetland resource in a watershed. We also demonstrated how the results of the assessment could be (1) used to evaluate the efficacy of the models comprising the HGM assessment and (2) combined with other data to identify relationships that could be used to develop management approaches.

The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis

Objectives Knee osteoarthritis (OA) is a common chronic degenerative disorder. There are various treatment modalities. This study was planned to investigate the efficacy of balneotherapy, mud-pack therapy in patients with knee OA. Methods A total of 80 patients with knee OA were included. Their ages ranged between 39–78. The patients were separated in to three groups. Group I ( n = 25) received balneotherapy, group II ( n = 29) received mud-pack therapy and group III ( n = 26) was hot-pack therapy group. The therapies were applied for 20 min duration, once a day, five times per week and a total of 10 session. Patients were assessed according to pain, functional capacity and quality of life parameters. Pain was assessed by using Visuel Analogue Scale (VAS) and Western Ontario McMaster Osteoarthritis Index (WOMAC) pain scale (0–4 likert scale). Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index. Quality of life was evaluated by Nottingham Health Profile (NHP) self-administered questionnaire. Also physician's global assessment and the maximum distance that patient can walk without pain, were evaluated. The assessment parameters were evaluated before and after three months. Results There were statistically significant improvement in VAS and WOMAC pain scores in group I ( p < 0.001), group II and III ( p < 0.05). The WOMAC functional and global index also decreased in group I ( p < 0.05), group II ( p < 0.001) and hot-pack group ( p < 0.05). Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups ( p < 0.05). No difference was observed in hot-pack therapy group ( p > 0.05). The maximum distance was improved both in group I and II ( p < 0.05) but not in group III. Also physician's global assessment was found to be improved in all groups ( p < 0.05). Conclusions Balneotherapy and mud-pack therapy were effective in treating patients with knee OA.

Specific Fracture Configurations Predict Sexual and Excretory Dysfunction in Men and Women 1 Year After Pelvic Fracture

We determined the prevalence and predictors of sexual and excretory dysfunction in patients 1 year after pelvic fracture. The multicenter Pennsylvania Trauma Outcomes Study enrolled 1,238 patients and contacted them 1 year after injury. Sexual limitations and excretory dysfunction (bladder/bowel incontinence) were defined based on responses from the Functional Capacity Index. Health related quality of life was determined using SF-36. The relationship between specific fracture patterns and dysfunction along with the effect of dysfunction on quality of life in patients with pelvic fracture were evaluated by multivariate analysis. Of 1,160 eligible patients 292 (26%) had pelvic fractures. Sexual dysfunction was reported in 21% vs 14% of those with vs without pelvic fractures and bowel or bladder incontinence was reported in 8% vs 4%. On multivariate analysis men with sacroiliac fractures were at higher risk for sexual (RR 4.0, 95% CI 2.3 to 6.8) and excretory (RR 4.3, 95% CI 1.4 to 13.5) dysfunction. In women symphyseal diastasis was associated with sexual (RR 4.8, 95% CI 2.0 to 11.2) and excretory (RR 12.5, 95% CI 1.9 to 80.2) dysfunction. Of patients with pelvic fractures men with sexual dysfunction and women with excretory dysfunction had significantly worse quality of life than those without dysfunction. One year after trauma men with sacroiliac fractures and women with symphyseal diastasis were at increased risk for sexual and excretory dysfunction independent of overt pelvic organ injury. In patients with pelvic fracture male sexual dysfunction and female excretory dysfunction were associated with decreased quality of life. Our data highlight the need for further study of dysfunction following pelvic trauma and interventions to decrease the risk of long-term disability.

Hydrologic modeling as a development tool for HGM functional assessment models

The hydrogeomorphic (HGM) approach to wetland classification and functional assessment was developed to facilitate the rapid assessment of wetland functions and support implementation of the 404 regulatory program in the U.S. This paper describes development of a functional assessment model for the hydrologic regime function of depressional wetlands on the Tennessee Highland Rim. Model output is a functional capacity index that ranges from 0 to 1 and indicates the level of alteration to the wetland hydrologic regime relative to the unaltered condition. The model initially includes four variables, each corresponding to an alteration type common in the study area. One variable reflects alterations to wetland morphology that increase or decrease storage capacity. Two variables reflect alterations to the wetland watershed that result in increased surface runoff. The remaining variable reflects changes in evapotranspiration losses resulting from timber harvesting. Model variable sensitivity and interaction are examined by simulating 47 years of hydrology for a single depressional wetland site. Based on the simulation of hypothetical alterations representing the range of conditions anticipated in the reference domain, three important variable interactions were identified and one variable eliminated from consideration. Several forms of the aggregation equation relating a functional capacity index to three model variables were tested by comparison to index values based on an independent quantitative measure that was simulated with a hydrologic model. Initial model forms, similar in form to many existing models, are improved by the addition of interaction terms and modification of variable weighting. This study demonstrates the utility of hydrologic modeling as a development tool for HGM functional assessment models. Even when limited field measurements are available for a rigorous calibration and validation, hydrologie modeling provides valuable insight into model variable sensitivity and interaction.

The functional capacity index, second revision: morbidity in the first year post injury

As the field of injury outcomes measurement has moved beyond counting deaths and injuries, the need for instruments to measure long-term outcomes has increased. Early validation efforts indicated that the Functional Capacity Index (pFCI12) was a promising tool for predicting functional loss 12 months post trauma, but that the predictive validity for lower extremity fractures was low. The pFCI12 was recently revised in conjunction with the 2005 revision of the Abbreviated Injury Scale (AIS). This preliminary study was undertaken to assess the performance of the revised pFCI12 in predicting outcomes for patients with lower extremity trauma. This case review study used the Crash Injury Research and Engineering Research (CIREN) database which includes AIS codes, extensive clinical data and 3- and 12-month outcomes. Generally predicted functional loss at 12 months was greater with the pFCI12 (AIS 2005) than with the original FCI based on AIS 1990. All patients whose pFCI12 scores predicted functional loss experienced some morbidity at 1 year. The pFCI12 appears to provide improved predictions of functional outcome 12-months post-trauma for persons experiencing lower extremity trauma.

How well do anatomical-based injury severity scores predict health service use in the 12 months after injury?

There is an acknowledged need for valid and reliable injury scores, suitable for use at the population level, which can accurately predict the long-term outcome of injury. The objective was to quantify the extent to which the abbreviated injury severity score (AIS) and the functional capacity index score (FCI) predict use of health services in the 12 months following an injury event. A cohort of injured people (ICD-9-CM 800-995) aged 18–64 years was identified from Manitoba hospital discharge abstracts from January 1988 to December 1991. For each member of the cohort whose injuries could be mapped to an abbreviated injury scale unique identifier, a maximum AIS (maxAIS) and a maximum FCI (maxFCI) were obtained. The cohort was linked with hospital discharge abstracts, physicians' claims and deaths from the population registry for the 12 months following injury. Negative binomial regression was used to model the relationships between the severity scores and the three outcome measures, while controlling for potential confounding variables. In total, 20 677 (97%) eligible cases were identified, of which 16 834 (81%) could be assigned a maxAIS and 15 823 (77%) a maxFCI. MaxAIS and maxFCI were significantly associated with total days in hospital following injury, but explained little of the variation in any of the health service use outcome variables (maxAIS, partial pseudo r 2 ranging from < 0.001 to 0.041; and maxFCI, partial pseudo r 2 ranging from < 0.001 to 0.018). It was concluded that anatomical damage is only partly responsible for long-term injury outcome. Additional variables would need to be included in predictive models of health outcomes of injury before these models could be reliable.

Functional capacity and body mass index in patients with sellar masses—cross-sectional study on 403 patients diagnosed during childhood and adolescence

We analyzed the impact of tumour localization and histology on functional capacity (FC) and body mass index (BMI) in children with sellar masses. FC was evaluated using the ability scale Fertigkeitenskala Münster-Heidelberg in 403 children and adolescents with sellar masses (276 craniopharyngioma, 14 germinoma, 21 optic/chiasmatic glioma, 40 hypothalamic glioma, 13 cysts of Rathke's cleft and 39 other sellar masses). Besides tumour localization, the influence of gender, irradiation and age at diagnosis and at evaluation on FC and BMI was analyzed. General linear models with explanatory influential variables were built. In multivariate analysis, only age at diagnosis (p<0.001) and hypothalamic involvement (p=0.005) had relevant impact on FC. The second model showed BMI at diagnosis (p<0,001), hypothalamic involvement (p<0.001) and craniopharyngioma (p=0,004) to influence BMI at the latest evaluation. We conclude that hypothalamic involvement and young age at diagnosis had major impact on FC and BMI and should be considered as risk factors for impaired rehabilitation.