Functional Limitations Profile Research Articles

Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness: a randomised controlled trial (the REVIVE trial)

ObjectiveTo investigate the effectiveness of a 6-week exercise programme in patients discharged home following critical illness compared with standard care.DesignMulticentre prospective phase II randomised controlled trial, with blinded outcome assessment...

The role of emotion regulation on social participation following stroke

Following stroke, individuals often experience reduced social participation, regardless of physical limitations. Impairments may also occur in a range of cognitive and emotional functions. Successful emotion regulation, which has been identified as important in psychological adaptation to chronic illness, is associated with better perceived psychological well-being and social functioning. However, there is little evidence about the effect of stroke on emotion regulation difficulties, and associated impact on important outcomes in recovery from stroke. The objectives were (1) to determine whether people who have had a stroke reported greater difficulties in emotion regulation than controls and (2) to establish whether emotion regulation difficulties relate to social participation. 75 stroke and 40 healthy participants completed measures of emotion regulation (DERS), social participation (Modified Functional Limitation Profile [mFLP], WHOQoL-Bref) and activity limitations (mFLP). Stroke participants were seen at the acute stage (63 days post-stroke) for Study 1 and 18 months post-stroke for Study 2. In Study 1, acute-stage stroke patients had significant impairments on impulse control, awareness of emotions, and strategies for emotion regulation. There was also evidence that emotion regulation difficulties (impulse control, awareness and clarity about emotions) were associated with social participation in the stroke sample, even after controlling for potential confounders. In Study 2, there was evidence that, in the chronic-stage post-stroke, difficulties with strategy and acceptance of emotions were associated with social participation restrictions. Whilst emotion regulation as a whole in the acute phase predicted social participation in the chronic phase of stroke, no one domain of emotion regulation was a significant predictor of social participation >1 year later. These results indicate that multiple aspects of emotion regulation are impaired following stroke, with implications for social participation and recovery. This research highlights the following important clinical implications: Following a stroke, emotion regulation can be immediately and persistently affected, with post-stroke individuals experiencing greater difficulties with their emotion regulation than control participants. Emotion regulation can significantly predict important stroke outcomes including social participation and quality of life, over and above physical limitations and other post-stroke confounders. This study highlights the potential for developing a behaviour change intervention to address emotion regulation difficulties and thus ensuring individuals maximize their potential rehabilitation outcome. Cautions of the study for consideration: Emotion regulation was a self-report measure, and proxy measures would have been desirable. We are unable to establish if the post-stroke individuals differed from the controls on their emotion regulation prior to stroke.

Effect of Spironolactone on Physical Performance in Older People with Self-reported Physical Disability

BackgroundInterventions that improve muscle function may slow decline in physical function and disability in later life. Recent evidence suggests that inhibition of the renin-angiotensin-aldosterone system may maintain muscle function. We evaluated the effect of aldosterone blockade on physical performance in functionally impaired older people without heart failure. MethodsIn this parallel-group, double-blind, randomized, placebo-controlled trial, community-dwelling participants aged ≥65 years with self-reported problems with activities of daily living were randomized to receive 25 mg spironolactone or identical placebo daily for 20 weeks. The primary outcome was change in 6-minute walking distance over 20 weeks. Secondary outcomes were changes in Timed Up and Go test, Incremental Shuttle Walk Test, Functional Limitation Profile, EuroQol EQ-5D, and Hospital Anxiety and Depression Scale over 20 weeks. ResultsParticipants’ mean (standard deviation) age was 75 (6) years. Of the 93% of participants (112/120) who completed the study, 106 remained on medication at 20 weeks. There was no significant difference in change in 6-minute walking distance at 20 weeks between the spironolactone and placebo groups (mean change, −3.2 m; 95% confidence interval, −28.9 to 22.5; P = .81). Quality of life improved significantly at 20 weeks, with an increase in EuroQol EQ-5D score of 0.10 (95% confidence interval, 0.03-0.18; P < .01) in the spironolactone group relative to the placebo group. There were no significant differences in between-group change for other secondary outcomes. ConclusionsSpironolactone was well tolerated but did not improve physical function in older people without heart failure. Quality of life improved significantly, and the possible mechanisms for this require further study.

Generalized assessment of the impact of Parkinson’s disease on functional condition

Individuals who develop Parkinson's disease are confronted not only with the physical manifestations of the disorder, but also with the psychosocial issues that impact on quality of life. The aim of the current work was to assess the level of psychosocial and physical functioning impairment in 95 patients with Parkinson’s disease (48 men and 47 women aged 65–79, average age 70.3±0.5, stages of Parkinson’s disease acсording to Hoehn and Yahr scale - 2–2.5). This research was carried out with the help of “Functional Limitation Profile” and “Sickness Impact Profile – 68” tests.According to the “Functional Limitation Profile” test, the patients with a diagnosis of Parkinson’s disease most commonly showed functional condition impairment in 3 categories: “walk” (92% of cases), “social interaction” (85% of cases) and “clarity of mind” (79% of cases). Less frequent condition impairments were changes in the categories “body care and motion” (72% of cases), “emotions” (65% of cases) and “work” (56% of cases). The least impaired were the categories “communication” (22% of cases), “leisure and entertainment” (24% of cases) and “food” (19% of cases). According to the “Sickness Impact Profile – 68” test, patients with Parkinson’s disease showed functional condition impairment most often in the categories “mobility control”, “social behavior” and “degree of mobility”. Patients showed impairment less frequently in the categories “somatic autonomy”, “psychic autonomy and communication”. The least impaired category was “emotional stability”. The highest percent in relation to the maximum possible point was shown in the category “mobility control”, and the lowest in the category “emotional stability”.Thus, this study demonstrates significant impact of the disease on the functional condition of these patients. Functional limits, connected with the disease appearance, are most often present in the motion and social sphere of patients’ life and less frequently in the emotional sphere.

144 Nurses meet the challenge of helping high CVD risk smokers to quit with the help of varenicline in a preventive cardiology programme

BackgroundThe EUROACTION plus study aimed to assess effectiveness of a nurse-led preventive cardiology programme for high CVD risk smokers willing to make a quit smoking attempt compared to usual care...

The Effects of Vitamin D Supplementation on Physical Function and Quality of Life in Older Patients With Heart Failure

Background— Low 25-hydroxyvitamin D levels, commonly found in older patients with heart failure, may contribute to the chronic inflammation and skeletal myopathy that lead to poor exercise tolerance. We tested whether vitamin D supplementation of patients with heart failure and vitamin D insufficiency can improve physical function and quality of life. Methods and Results— In a randomized, parallel group, double-blind, placebo-controlled trial, patients with systolic heart failure aged ≥70 years with 25-hydroxyvitamin D levels &lt;50 nmol/L (20 ng/mL) received 100 000 U of oral vitamin D2 or placebo at baseline and 10 weeks. Outcomes measured at baseline, 10 weeks, and 20 weeks were 6-minute walk distance, quality of life (Minnesota score), daily activity measured by accelerometry, Functional Limitations Profile, B-type natriuretic peptide, and tumor necrosis factor-α. Participants in the vitamin D group had an increase in their 25-hydroxyvitamin D levels compared with placebo at 10 weeks (22.9 versus 2.3 nmol/L [9.2 versus 0.9 ng/mL]; P &lt;0.001) and maintained this increase at 20 weeks. The 6-minute walk did not improve in the treatment group relative to placebo. No significant benefit was seen on timed up and go testing, subjective measures of function, daily activity, or tumor necrosis factor. Quality of life worsened by a small, but significant amount in the treatment group relative to placebo. B-type natriuretic peptide decreased in the treatment group relative to placebo (−22 versus +78 pg/mL at 10 weeks; P =0.04). Conclusions— Vitamin D supplementation did not improve functional capacity or quality of life in older patients with heart failure with vitamin D insufficiency. Clinical Trial Registration— www.controlled-trials.com. Identifier: ISRCTN51372896.

Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial

To estimate the clinical effectiveness and cost-effectiveness of three methods of ankle support compared with double layer tubular compression bandage. A randomised controlled trial, designed to reflect practice in UK hospital emergency departments. Eight emergency departments in England. Aged 16 or over with acute severe ankle sprain, unable to weight bear, no fracture. 584 participants were randomised to one of four treatment arms: tubular bandage, below knee cast, Aircast ankle brace or Bledsoe boot, all applied 2-3 days after presentation to allow swelling to resolve. Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures (Functional Limitations Profile, SF-12 and EQ-5D). When adjusted for age, sex and baseline scores, the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain (FAOS pain difference 5.1; 95% CI 0.4-9.8), foot- and ankle-related quality of life (QoL) (FAOS QoL difference 5.9; 95% CI 0.1-11.8) and the physical component of the SF-12 (SF-12 score difference 2.2; 95% CI 0.0-4.4). Neither the Aircast brace nor the Bledsoe boot was statistically or clinically better. At 12 weeks the below knee cast was significantly better than tubular bandage in terms of pain (FAOS pain difference 5.1; 95% CI 0.3-10.0), activities of daily living (FAOS ADL difference 3.5; 95% CI 0.4-6.6), sports (FAOS sports difference 8.7; 95% CI 1.6-15.7) and QoL (FAOS QoL difference 8.7; 95% CI 2.4-15.0), and the Aircast brace was better only in terms of ankle-related QoL and mental health. The Bledsoe boot conferred no significant advantage over tubular bandage. By 9 months there were no significant differences. Based on mean direct health-care costs per participant, the Bledsoe boot was the most expensive (215 pounds) and tubular bandage the least so (1 pound 44 pence). Inclusion of indirect costs (sick leave) raised overall costs substantially and removed any significant differences between the therapies. Cost-utility analysis demonstrated that the Aircast brace [301 pounds per quality-adjusted life-year (QALY)] and below knee cast (339 pounds per QALY) were more cost-effective than the Bledsoe boot (2116 pounds per QALY). However, inclusion of indirect costs produced different rank orders, depending on the assumptions made, and results should be treated with caution. The below knee cast and the Aircast brace offered cost-effective alternatives to tubular bandage for acute severe ankle sprain, the former having the advantage in terms of overall recovery at 3 months. As there were no differences in long-term outcome, practitioners should consider likely compliance and acceptability to patients when choosing a brace.

Pilot Study of an Exercise Intervention Suitable for Older Heart Failure Patients with Left Ventricular Systolic Dysfunction

Most studies of exercise training for heart failure have been conducted on relatively young patients with little comorbidity. Such programmes are unsuitable for the majority of older frail heart failure patients. To test the acceptability and tolerability of an outpatient exercise programme in older heart failure patients with comorbid disease. 17 patients aged 70 years and over with left ventricular systolic dysfunction attended twice weekly group exercise classes for 12 weeks, focussing on endurance exercise and everyday functional tasks. Outcome measures were proportion of sessions attended; adverse events and reasons for non-attendance; six-minute walk, accelerometry, hospital depression and anxiety score, Guyatt quality of life scale, carer strain and satisfaction scores. 83% of sessions were attended; 80% of subjects attended at least 80% of allocated sessions. One adverse incident occurred in 324 person-sessions. Encouraging improvements were seen in six minute walk test (+19 m, p=0.14) and in Functional Limitation Profile score (-82 points, p=0.02). 50% of informal carers attended at least one session. No increase in carer strain was noted. Twice-weekly group exercise focussing on aerobic endurance and everyday functional tasks was acceptable and well-tolerated in this patient group.

Spousal caregiver confidence and recovery from ambulatory activity limitations in stroke survivors.

This study examined whether spousal confidence in care-recipient recovery can predict recovery from activity limitations following stroke and how spousal confidence relates to stroke survivor self-efficacy for recovery. A prospective design was used. Measures were gathered from stroke survivor/spouse dyads at two time points, both postdischarge from the hospital following stroke (N=109). The dependent variable was recovery from ambulatory activity limitations over 6 weeks, as measured by the Functional Limitations Profile. A single spousal confidence item was tailored to an ambulatory behavior that the stroke survivors could not perform at Time 1. Spousal confidence was correlated with ambulation recovery (r=-0.23, p<.05) and stroke survivor self-efficacy for recovery (r=.25, p<.05). Higher spousal confidence was associated with a better recovery and greater stroke survivor self-efficacy for recovery, but not with initial health status or practical support received. The relationship between caregiver confidence, care-recipient self-efficacy for recovery, and recovery outcomes needs further elucidation.

Validation of an individualised quality of life measure in older day hospital patients.

BackgroundTo test the ease of use, reliability, responsiveness and construct validity of the Patient Generated Index, an individualised quality of life score, in older people attending a Medicine for Older People Day Hospital.MethodsProspective longitudinal study in patients attending a specialist Medicine for Older People Day Hospital in Scotland. The Patient Generated Index was administered at baseline, one week later, and at the end of Day Hospital attendance. Functional Limitations Profile, Hospital Anxiety and Depression Score, Barthel index and global subjective impressions of change were also collected and compared with baseline scores and change in Patient Generated Index scores. Reliability was assessed using intraclass correlation coefficients in subjects reporting no change in global quality of life; responsiveness was assessed using effect size and Guyatt coefficients in subjects reporting change in global quality of life. External validity was assessed via correlation with measures of physical function, comorbid disease and psychological state.Results75 patients were enrolled, mean age 81 years. Mean completion time was 5.0 minutes at baseline. Reliability was moderate (intraclass correlation coefficient 0.72) but there were weak and inconsistent responses to change (effect sizes 0.02 to 0.15; Guyatt responsiveness coefficient 0.29). Patient Generated Index scores correlated with Functional Limitation Profile scores (r = 0.51, p < 0.001), baseline anxiety score (r = -0.25, P = 0.039) and baseline depression score (r = -0.37, P = 0.002) but displayed only weak, non-significant correlation with number of comorbid diseases (r = -0.22, P = 0.07), number of medications (r = -0.21, P = 0.08) and Barthel score (r = 0.09, p = 0.45).ConclusionThe Patient Generated Index appears moderately reliable and easy to complete, but is poorly responsive to change, limiting its usefulness in clinical practice or research.

Measuring autonomy in disabled people: validation of a new scale in a UK population

Objective: To evaluate the validity and reliability of an English version of the Impact on Participation and Autonomy Questionnaire (IPA). The original Dutch IPA has been shown to load onto five factors. Design: A validation study. Setting: Outpatients clinics and people’s homes. Subjects: Two hundred and thirteen people with multiple sclerosis, rheumatoid arthritis, spinal cord injury, and general practice attendees, stratified by level of disability (median age 54, 42% male, 58% female). Inclusion criteria: English as first language, aged 18-75, Mental Status Questionnaire score >6. Interventions: Self- and interviewer-administered outcome measures. Main measures: IPA, including one new item (66 participants completed the IPA on a second occasion). Other measures: Short Form-36 Health Survey (SF-36), London Handicap Scale, three domains of the Functional Limitations Profile (FLP): household management, social integration, emotion. Results: Confirmatory factor analysis confirmed the construct validity of the IPA (Normal Fit Index=0.98, Comparative Fit Index=0.99), indicating a good fit to the model. Convergent and discriminant validity were confirmed by the predicted associations, or lack of, with the exception of a poor association between the ‘social life/relationships’ IPA subscale and FLP-emotion. Internal reliability of the IPA was confirmed (Cronbach alphas >0.8; item-total correlations for all subscales >0.5). Test-retest reliability was confirmed for all items (weighted kappas >0.6) and subscales (intraclass correlation coefficients >0.90). Conclusions: The English IPA is a valid, reliable and acceptable measure of participation and autonomy in people with a range of conditions and can make a unique and fundamental contribution to outcome assessment. Further research is required to examine the responsiveness of the IPA to change over time, its clinical utility and suitability for use with people from ethnic minorities and with older people.

Proceedings of SRR

Background: This study evaluated the validity and reliability of a new measure: Impact on Participation and Autonomy Questionnaire, English Version (IPA-E). The IPA has shown to load onto five factors. Method: Two hundred and thirteen people with multiple sclerosis, rheumatoid arthrites spinal cord injury and GP attendees were recruited and stratified by level of disability (median age 54). Inclusion criteria: English as first language, aged 18-75, score> 6 on Mental Status Questionnaire. A sample size calculation was conducted. Sixty-six Participants completed the IPA-E on a second occasion. Other measures: SF-36, London Handicap Scale, three domains of the Functional Limitations Profile (household management, social integration, emotion). Results: Confirmatory Factor Analysis confirmed the construct validity of the IPA-E normal fit index (NFI) = 0.98, (comparative fit index (CFI) = 0.99), indicating a good fit to the model. Convergent and discriminant validity was confirmed by the predicted associations, or lack of, with the exception of a poor association between the 'social life/relationships' IPAE subscale and 'FLP-emotion'. Internal reliability of the IPA was confirmed (Cronbach alphas > 0.8 and item-total correlations for all subscales > 0.5). Test-retest reliability was confirmed for all but one item (weighted kappas > 0.6) and subscales (ICCs > 0.90). Discussion: Further research is required to examine the responsiveness of the IPA to change over time, its clinical utility and suitability for use with people from ethnic minorities and with older people. Conclusion. The IPA is a valid, reliable and acceptable measure of participation and autonomy in people with a range of conditions and can make a unique and fundamental contribution to outcome assessment.

A randomized, double-blind, crossover study of the use of transcutaneous spinal electroanalgesia in patients with pain from chronic critical limb ischemia

Transcutaneous spinal electroanalgesia (TSE) uses two electrodes placed over the skin of the dorsal spine to deliver pulses of short wavelength, high frequency, and relatively high voltage to the spinal cord without causing paresthesia. TSE has been used to treat pain and may improve limb blood flow. This randomized, double-blind, crossover study assessed the effect of TSE on microcirculation, pain, and activity in 8 patients (3 men, 5 women, median age 66.5 years, range 62–76 years) with chronic critical limb ischemia (CLI). After a one-week baseline period, patients used an active or inactive TSE machine for one hour daily for one week. Following a week of no stimulation, patients repeated the week of treatment with an identical matched machine. Daily use of TSE for one week did not improve microcirculatory perfusion (transcutaneous oxygenation), pain (verbal rating scale, McGill Pain Questionnaire), physical function (Functional Limitations Profile), mood (Beck Depression Inventory, Beck Anxiety Inventory), or sleep. There was no patient preference for the active TSE machines. This study showed that TSE administered daily for one week did not improve microcirculation, pain, or activity in patients with chronic CLI.

Comparison of the quality of life of patients with lumbar and cervical disc herniation

AbstractLumbar and cervical disc herniations are medical problems that affect the quality of life. The purpose of this study was to compare the quality of life in patients with lumbar and cervical disc herniations. The degree of pain in all patients was assessed by the Million visual analogue scale, disability in patients with lumbar disc herniation by the Oswestry low back pain disability questionnaire, disability in patients with cervical disc herniation by the neck disability index, quality of life by functional limitation profile, occupational handicap in all patients by the occupational handicap scales of the World Health Organization and status of depression in all patients by the Zung depression scale. Quality of life was lower and occupational handicap was greater in the patients with lumbar disc herniation than in those with cervical disc herniation. Intensity of pain and depression and disability were not significantly different in the two groups.

A randomised, controlled, triple-blind trial of the efficacy of homeopathic treatment for chronic fatigue syndrome

Objective: There is no management regime for chronic fatigue syndrome (CFS) that has been found to be universally beneficial and no treatment can be considered a “cure” [1]. Patients with CFS may use complementary and alternative medicine (CAM) [1]. Our aim was to evaluate homeopathic treatment in reducing subjective symptoms of CFS. Method: Using a triple-blind design (patient and homeopath blind to group assignment and data analyst blind to group until after initial analyses to reduce the possibility of bias due to data analyst), we randomly assigned patients to homeopathic medicine or identical placebo. One hundred and three patients meeting the Oxford criteria for CFS were recruited from two specialist hospital out patient departments. Patients had monthly consultations with a professional homeopath for 6 months. Main outcome measures were scores on the subscales of the Multidimensional Fatigue Inventory (MFI) and proportions of each group attaining clinically significant improvements on each subscale. Secondary outcome measures were the Fatigue Impact Scale (FIS) and the Functional Limitations Profile (FLP). Ninety-two patients completed treatment in the trial (47 homeopathic treatment, 45 placebo). Eighty-six patients returned fully or partially completed posttreatment outcome measures (41 homeopathic treatment group who completed treatment, 2 homeopathic treatment group who did not complete treatment, 38 placebo group who completed treatment, and 5 placebo group who did not complete treatment). Results: Seventeen of 103 patients withdrew from treatment or were lost to follow-up. Patients in the homeopathic medicine group showed significantly more improvement on the MFI general fatigue subscale (one of the primary outcome measures) and the FLP physical subscale but not on other subscales. Although group differences were not statistically significant on four out of the five MFI subscales (the primary outcome measures), more people in the homeopathic medicine group showed clinically significant improvement. More people in the homeopathic medicine group showed clinical improvement on all primary outcomes (relative risk=2.75, P=.09). Conclusions: There is weak but equivocal evidence that the effects of homeopathic medicine are superior to placebo. Results also suggest that there may be nonspecific benefits from the homeopathic consultation. Further studies are needed to determine whether these differences hold in larger samples.

The validation of the Subjective Index of Physical and Social Outcome (SIPSO).

To validate the Subjective Index of Physical and Social Outcome (SIPSO) in its final 10-item version as a measure of reintegration to pre-stroke lifestyle. Postal and interview administration of questionnaires. SIPSO, Functional Limitations Profile (FLP), Reintegration to Normal Living Index (RNLI). Community setting, Bath, UK. Two hundred and sixty-one survivors of stroke discharged from a district general hospital. Internal consistency (item-total correlations >0.6) and test-retest reliability (intraclass correlation coefficient (ICC) = 0.96) of the measure were confirmed. Construct validity was confirmed through significant correlations with the six subsections of the FLP and the RNLI. Confirmatory factor analysis of the measure found that the first five items form a robust subscale that clearly relates to physical function. The items within the second subscale (questions 6-10) measure several domains (social, leisure, self-image) and do not form a homogeneous group. The SIPSO was able to detect an improvement in integration within a sample of patients over a three-month period soon after discharge (effect size = 0.26). The hypothesis that the degree of improvement experienced by patients following discharge from hospital would be small, but should be detectable was confirmed. The agreement between proxy and patient on the SIPSO was acceptable for individual items (kappa value range = 3.1-5.8) and total score (ICC = 0.96). The SIPSO is a brief self-complete measure, with proven validity and reliability, which addresses both quantitative and qualitative aspects of activities and interaction. It provides a useful measure for evaluating rehabilitation programmes that aim to reintegrate patients to their pre-stroke lifestyle. The authors suggest that the SIPSO should be used as a 10-item measure.

Anxiety, depression and functional capacity in older women with mitral valve stenosis.

Mitral valve stenosis can lead to a range of symptoms that affect daily life. As many of the people with this problem are elderly, the difficulties resulting from age can be exacerbated by illness. A pilot descriptive study was designed to examine the differences in anxiety, depression and functional capacity in women with mitral valve stenosis who were aged over 60 years when compared to a similar group of volunteers who did not have any cardiac disease. Measurement was undertaken using the Hospital Anxiety and Depression scale, the SF-36 Health Status questionnaire and the Functional Limitations Profile. Forty women were recruited to the study: 20 women with mitral valve stenosis and 20 volunteers. Each person was asked to complete the three questionnaires on one occasion only. Non-parametric statistics were used for analysis. Patients fared worse than volunteers with significant differences between groups in respect of anxiety (P = 0.03), depression (P = 0.02) and overall function (P < 0.001), but not in physical (P = 0.52) or mental health (P = 0.32). Future research could focus on strategies that would help alleviate anxiety and depression and improve functional capacity in older women with mitral valve stenosis.

Implications of Health Related Quality of Life and Functional Profile in Patients with Restrictive and Obstructive Ventilatory Disorders on the Content of a Pulmonary Rehabilitation Programme

A Hunt, P Roberts, A Harvey, A K Simonds Sleep and Ventilation Unit, Royal Brompton and Harefield Trust, London Anxiety, depression and reduced quality of life are well documented in chronic obstructive pulmonary disease (COPD). Comprehensive pulmonary rehabilitation (PR) programmes include intervention strategies to address these issues. Patients with conditions other than COPD are participating in PR, and quality of life in some patient groups is not documented. As part of an ongoing study investigating the effects of PR in patients with restrictive ventilatory disorders, baseline quality of life and functional assessments were performed in 20 patients with restrictive and 20 with obstructive ventilatory disorders. All subjects were > 65 years, with FEV1 or FVC < 50% predicted (FEV1/FVC; obstructive 0.75/2.33, restrictive 0.78/1.146). Restrictive ventilatory disorders included early onset scoliosis and thoracoplasty. Shuttle walking distance did not differ between groups (obstructive = 198.5 m (92.9 m), restrictive = 223 m (134.6 m)). Assessment tools used were the Chronic Respiratory Disease Questionnaire (CRDQ), MOS 36-item short-form health survey (SF-36), Hospital Anxiety and Depression scale (HAD) and Functional Limitation Profile (FLP). Patients with long-term restrictive ventilatory disorders do not have the same quality of life and functional profiles as those with more recently acquired disorders such as COPD, and appear to have a better command of their disease. Completion of the current study will demonstrate whether restrictive patients gain similar improvements in quality of life following pulmonary rehabilitation compared with obstructive patients. However, these initial findings should be considered when planning the content and assessing the outcome of PR programmes for patients with restrictive ventilatory disease.

Development and validation of a questionnaire to assess disabling foot pain

This study outlines the design and validation of a new self-administered instrument for assessing foot pain and disability. The 19-item questionnaire was tested on 45 rheumatology patients, 33 patients who had attended their general practitioner with a foot-related problem and 1000 responders to a population survey of foot disorders. Levels of reported disability were found to be greatest for rheumatology patients and least for community subjects. In addition, the instrument was able to detect differences in disability levels reported by community subjects who did and did not consult with a health care professional and those who did and did not have a history of past and current foot pain. A good level of agreement was found when items on the questionnaire were compared with similar items on the ambulation sub-scale of the Functional Limitation Profile questionnaire. A Cronbach's alpha value of 0.99 and item-total correlation values between 0.25 and 0.62 confirmed the internal consistency of the instrument. Finally the results of a principal components analysis identified three constructs that reflected disabilities that are associated with foot pain: functional limitation, pain intensity and personal appearance. The design of the foot disability questionnaire makes it a suitable instrument for assessing the impact of painful foot conditions in both community and clinical populations.

Consequences of Chronic Obstructive Pulmonary Disease in Community-based Patients

Summary The impact of chronic obstructive pulmonary disease (COPD) on patients who were community based was investigated in 31 people (17 men and 14 women aged 45 to 78 years (mean age 64) recruited from six general practitioners in a small town. Basic demographic data were collected by semi-structured verbal questioning. Dyspnoea was measured using the Medical Research Council (MRC) dyspnoea scale and the Functional Limitation Profile (FLP) was used to measure functional status. Subjects were stratified according to the MRC dyspnoea scale. In each case, a higher score indicates higher disability. Analysis of data showed a direct relationship between FLP and MRC dyspnoea grades, ie the global physical score, global psychosocial score and the overall FLP scores increased as the MRC grades increased. Highly significant differences were found between subjects with lower MRC grades 2 and 3 and subjects with higher MRC grades 4 and 5 (p < 0.0001). A significant difference was found between physical and psychosocial scores of those subjects with low MRC grades (p < 0.009), while no significant difference was found between those two scores in subjects with high MRC grades (p = 0.44). Marked differences were observed in the effects of physical and psychosocial disabilities between low and high severity groups. As expected, subjects who scored high on the MRC scale were much more restricted in their daily activities. Those scoring low on the MRC scale also had considerable psychosocial disabilities which often go undetected in a community setting. The impact of chronic obstructive pulmonary disease (COPD) on patients who were community based was investigated in 31 people (17 men and 14 women aged 45 to 78 years (mean age 64) recruited from six general practitioners in a small town. Basic demographic data were collected by semi-structured verbal questioning. Dyspnoea was measured using the Medical Research Council (MRC) dyspnoea scale and the Functional Limitation Profile (FLP) was used to measure functional status. Subjects were stratified according to the MRC dyspnoea scale. In each case, a higher score indicates higher disability. Analysis of data showed a direct relationship between FLP and MRC dyspnoea grades, ie the global physical score, global psychosocial score and the overall FLP scores increased as the MRC grades increased. Highly significant differences were found between subjects with lower MRC grades 2 and 3 and subjects with higher MRC grades 4 and 5 (p < 0.0001). A significant difference was found between physical and psychosocial scores of those subjects with low MRC grades (p < 0.009), while no significant difference was found between those two scores in subjects with high MRC grades (p = 0.44). Marked differences were observed in the effects of physical and psychosocial disabilities between low and high severity groups. As expected, subjects who scored high on the MRC scale were much more restricted in their daily activities. Those scoring low on the MRC scale also had considerable psychosocial disabilities which often go undetected in a community setting.