Measures Of Function In Patients Research Articles

Dynamic cardiophysiologic variables correlate with lesion location and FIMTM in patients with ischemic stroke.

To examine the correlation between a clinical measure of function in patients undergoing rehabilitation who had recently had an ischemic stroke and to examine cardiophysiologic measures registered during effort. A cohort study comprising a sample of consecutive patients, without a history of cardiac disease or rhythm disturbances, admitted for rehabilitation after an ischemic supratentorial stroke. All patients were examined for the FIM trade mark score and dynamic cardiophysiologic variables. Results were analyzed in relation to stroke location. Thirty-eight patients participated in the study. Ten patients had a superficial lesion, 20 had a deep brain lesion, and eight had no noticeable lesion by computed tomographic imaging. Function was measured with the FIM instrument 48-72 hr after admission and repeated at 1 wk before discharge. Electrocardiographic activity was recorded during physiotherapy treatment. The relationship between the RR and QT intervals in the electrocardiographic waveforms was found to estimate two cardiophysiologic variables, the constant (a) and the slope (b) values, reflecting the dynamic change of QT during physiotherapy effort. Only for the subgroup of patients who sustained a deep brain lesion did the motor items in the FIM instrument on admission and discharge scores have a statistically significant relationship with the slope variable (b) and an inverse statistically significant relationship with the constant variable (a). Deep brain infarction seems to result in a significant dysfunction of the autonomic nervous system, manifesting itself as distorted dynamic behavior of the QT interval and with impaired functional performance.

Resistance training improves strength and functional measures in patients with end-stage renal disease

Background: The current study was designed to examine the effect of 12 weeks of resistance training on strength and functional ability in 10 medically stable hemodialysis patients (age, 42.8 ± 4.4 years). Methods: Subjects were tested on four separate occasions, each separated by 6 weeks. The first (T1) and second tests (T2) were controls with no exercise intervention between them. T3 followed 6 weeks of resistance training, and T4 occurred after 12 weeks of training. Variables tested included percentage of body fat, distance covered in the 6-minute walk test, peak torque of quadriceps muscles of the dominant leg, maximal handgrip strength, normal and maximal walking speeds, and time to complete 10 repetitions of the sit-to-stand-to-sit test. Data were analyzed by means of a one-way repeated-measures analysis of variance procedure. Results: Results indicate that after 12 weeks of training, there was a significant (P < 0.05) increase (12.7%) in peak torque at 90°/s (139.1 ± 19.3 nm) compared with T1 and T2 (mean, 124.1 ± 18.7 [SEM]; 123.5 ± 16.9 Nm), respectively. The distance covered during the 6-minute walk was increased (~5%; P < 0.05) compared with baseline (T1, 522.1 ± 46.2 m; 521.9 ± 48.5 m) after 6 weeks of training (548.3 ± 52.1 m) and remained elevated at week 12 (546.5 ± 54.2 m). Maximal walking speed was increased (P < 0.05) by week 12 (195.9 ± 15.4 cm/s) compared with baseline (T1, 182.9 ± 12.7; 185.5 ± 13.0 cm/s). Time to complete 10 repetitions of the sit-to-stand-to-sit test decreased at 12 weeks (17.8 ± 1.9 seconds) versus baseline (T1, 20.3 ± 1.5 seconds; T2, 20.6 ± 5.5 seconds). Conclusion: Resistance training can be used safely to increase strength and functional capacity in stable hemodialysis patients. © 2002 by the National Kidney Foundation, Inc.

The impact of diabetes on functional measurements in patients referred for stress testing

The impact of diabetes on functional measurements in patients referred for stress testing

Spirometer-triggered high-resolution computed tomography and pulmonary function measurements during an acute exacerbation in patients with cystic fibrosis

Objective: To evaluate a high-resolution computed tomography (HRCT) scoring system, clinical parameters, and pulmonary function measurements in patients with cystic fibrosis (CF) before and after therapy for a pulmonary exacerbation. Study design: Patients (n = 17) were evaluated by spirometer-triggered HRCT imaging, clinical parameters, and pulmonary function tests (PFTs) before and after treatment. HRCT scans were reviewed by 3 radiologists using a modified Bhalla scoring system. Results: Bronchiectasis, bronchial wall thickening, and air trapping were identified in all subjects on initial evaluation. The initial total HRCT score correlated significantly with the Brasfield score (r = –.91, P < .001) and several PFT measures. After treatment, there were improvements in the acute change clinical score (ACCS) (P < .001), most pulmonary function measurements, and total HRCT score (P < .05). Bronchiectasis, bronchial wall thickening, and air trapping did not significantly change. Mucus plugging subcomponent HRCT score, slow vital capacity (SVC), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) (percent predicted) and reversible and total HRCT scores were most sensitive to change by effect size analysis. Conclusions: Improvements occurred with treatment in total and reversible HRCT scores, PFTs, and ACCS. Total and reversible HRCT scores and percent predicted SVC, FEV1, and FVC were the most sensitive to change. The greatest change was seen in the mucus plugging subcomponent HRCT score. (J Pediatr 2001;138:553-9)

Functional correlates with left-right asymmetry of visual evoked potentials in stroke patients: Modeling and experimental results

Objective: To determine the correlation between a clinical measure of function in patients after first stroke and left-right scalp amplitude of visual evoked potentials using a theoretical model of the head. Design: A random sample of first-stroke patients underwent routine function measurement and investigation of left-right scalp potential asymmetry. Results of the encephalographic tests were compared with those of a healthy subject. To examine the effect of the conductivity in the damaged area on the potential asymmetry, numerical calculations were performed on a model, with four concentric circular compartments representing the brain, cerebrospinal fluid layer, skull, and scalp. The damaged region was modeled as a circular section. Setting: Neurologic rehabilitation ward of a major rehabilitation hospital and university-affiliated biomedical engineering laboratory. Patients: Four men aged 58 to 71 years, 3 with brain thrombosis and 1 with hemorrhagic stroke. The patients were admitted for rehabilitation an average of 3 weeks after the stroke and stayed for an average of 137 days. Damage was confined to the right brain in all cases; three of the patients had neglect syndrome and/or sensory disturbances. A healthy subject without stroke was also examined. Measures: Function was measured with the Functional Independence Measure (FIM) at 48 to 72 hours from admission and during the last week before discharge. Functional gain was calculated by subtracting the FIM admission score from the discharge score. Left-right scalp visual evoked potential amplitude was studied with flash stimuli according to the 10–20 international system and a theoretical model of the head based on two-dimensional computed tomography images; the volume conductor equation was solved numerically using the finite volume method. Left-right potential asymmetry and the damaged-region-to-brain-area ratio were calculated and correlated with the FIM values by linear regression analysis. Negative asymmetry indicates that the activity in the right damaged hemisphere is lower than in the undamaged one. Results: A negative correlation was noted between the FIM score on admission and the left-right scalp potential amplitude asymmetry, and between the FIM gain and the damaged-region-to-brain-area ratio obtained from the computed tomography image. Asymmetry was negative in the thrombotic patients and positive in the hemorrhagic one. The healthy subject showed nonsignificant asymmetry. Conclusion: A relationship might exist between the left-right asymmetry of the scalp visual evoked potential and both the damaged-region-to-brain-area ratio and the functional outcome of rehabilitation in poststroke patients. The modeling study shows that the left-right asymmetry is most likely the result of changes in the conductivity at the damaged area, which, in turn, are probably associated with patient functional status and evolution. Further validation in larger groups of patients and normal subjects is needed before these parameters can serve as useful indices for clinical purposes.

Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain

When patients find their pain unacceptable they are likely to attempt to avoid it at all costs and seek readily available interventions to reduce or eliminate it. These efforts may not be in their best interest if the consequences include no reductions in pain and many missed opportunities for more satisfying and productive functioning. The purpose of this study was to examine acceptance of pain. One hundred and sixty adults with chronic pain provided responses to a questionnaire assessing acceptance of pain, and a number of other questionnaires assessing their adjustment to pain. Correlational analyses showed that greater acceptance of pain was associated with reports of lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime, and better work status. A relatively low correlation between acceptance and pain intensity showed that acceptance is not simply a function of having a low level of pain. Regression analyses showed that acceptance of pain predicted better adjustment on all other measures of patient function, independent of perceived pain intensity. These results are preliminary. Further study will be needed to show for whom and under what circumstances, accepting some aspects of the pain experience may be beneficial.

The chronic pain coping inventory: development and preliminary validation

This paper describes the development and validation of a measure of strategies used by patients to cope with chronic pain, the Chronic Pain Coping Inventory (CPCI). A 104-item measure of pain coping responses and 3 measures of functioning were completed by 176 chronic pain patients. Two-week retest data were provided by 111 of these patients. Item and scale analyses resulted in a 65-item measure that assessed 11 pain coping dimensions. This inventory was then cross-validated in a second sample of chronic pain patients (n = 78), who also completed a measure of pain-related distress. The significant others (typically, spouses) of patients in the second sample rated patients on a significant-other version of the CPCI and on other measures of patient functioning. The results support the reliability of the CPCI scales. Four scales (Guarding, Resting, Asking for Assistance, and Task Persistence) predicted patient- and significant other-reported patient adjustment. Eight scales (Guarding, Opioid Medication Use, NSAID Use, Sedative-Hypnotic Medication Use, Resting, Asking for Assistance, and Exercise/ Stretch) demonstrated moderate-to-strong relationships between patient and significant-other versions, further supporting their validity.

Diabetic gastroparesis is associated with an abnormality in sympathetic innervation

Objective To investigate the hypothesis that diabetic gastroparesis might be associated with sympathetic, as well as parasympathetic, autonomic nervous system abnormailites. Patients We evaluated 12 consecutive patients with diabetes mellitus who presented with symptoms of gastroparesis. Methods The autonomic function tests included two measurments of sympathetic adrenergic function [reflex vasoconstriction to cold stress and the postural adjustment ratio (PAR)], and measurement of sympathetic cholinergic function (resting skin temperature) and vagal cholinergic function [EKG R-R interval (RRI)]. Gastric emptying was also measured and analysed by a power exponential model to estimate the solid gastric emptying slope. Patients were separated into delayed and nondelayed solid gastric emptying subgroups, the latter including two patients with rapid gastric emptying. Results All autonmic function measures were significantly lower in the diabetes mellitus group than in normal controls (P <0.001); diabetic patients as a group had slower solid gastric emptying slopes than nondiabetic controls (P ≤0.01). There was no significant correlation between measures of vagal cholinergic function by RRI, the sympathetic cholinergic function by PAR, or sympathetic cholinergic function by skin temperature and solid gastric emptying, but a statistically significant correlation was found between the sympathetic adrenergic measure of vasoconstriction to cold stress and the slope of solid gastric emptying (r = 0.79, P 7ge; 0.01). Diagnostic values for the autonomic function tests when compared to solid gastric emptying revealed sensitivites of 50% for the RRI, 88% for vasoconstriction, 63% for PAR and 71% for skin temperature. Conclusion We recommend that autonomic function measurements in patients with diabetes mellitus and upper gut symptoms should incude tests of sympathetic function as well as traditional tests of vagal cholinergic function.

Prediction of the safe limits of hepatectomy by combined volumetric and functional measurements in patients with impaired hepatic function.

Because of the vast functional reserve of the liver and its capacity to regenerate, an extensive hepatic resection to remove three of the four segments can be well tolerated by most patients with normal liver function. However, more than 70% of patients with hepatocellular carcinoma (HCC) have associated cirrhosis. In these patients such extensive hepatic resection has frequently resulted in fatal hepatic failure after surgery. Computed tomography (CT) has made possible a noninvasive, in-situ measurement of the volume of various organs in the body [1]. We have previously reported on our efforts to predict the safe limits of hepatectomy [2].KeywordsBorder ZoneSafe LimitSafety ZonePrediction ScoreImpaired Hepatic FunctionThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

The redox tolerance test as a measure of hepatic function in patients with obstructive jaundice

Abstract The redox tolerance test was performed before percutaneous transhepatic biliary drainage, in 15 patients with obstructive jaundice, and repeated 2 weeks after. Four patients without jaundice were evaluated as a control group. No difference was found in the redox tolerance index between the controls and the group with good bilirubin clearance. On the contrary, the redox tolerance index was significantly lower in the group with poor bilirubin clearance. No significant change in the redox tolerance index was revealed after percutaneous drainage. However, of four patients whose indices were smaller than 0.5 before biliary drainage, three died after developing cholangitis. The redox tolerance test is useful for evaluating hepatic function and predicting outcome in patients with obstructive jaundice.

Current procedural terminology coding of nuclear medicine procedures

The future of nuclear medicine is dependent on payment for new procedures. Today, the basis of payment by the federal government is a relative value unit (RVU) system; the RVUS employed in this system are for medical services and procedures listed and described in Physicians' Current Procedural Terminology, fourth edition. Current procedural terminology (CPT) is maintained by the AMA; annual revisions include adding new codes or revised or deleted old codes. This process involves all national medical specialty societies. Starting in 1992 a new process, the Relative Updating Committee, which was initiated by the AMA, organized medicine to formalize a method for recommending relative values for physician procedures and services. In this rapidly changing scenario, all nuclear medicine procedure codes are under review by the coding and nomenclature committees of the medical societies interested in imaging. Significant CPT changes and additions were made in the cardiovascular nuclear medicine codes in 1992, reflecting the current imaging protocols and pharmacological agents for performing cardiac stress testing and new codes that recognize combinations of ventricular function measurements in patients undergoing myocardial perfusion imaging with technetium-99m agents.

Lidocaine Metabolite Formation as a Measure of Liver Function in Patients with Cirrhosis

Lidocaine Metabolite Formation as a Measure of Liver Function in Patients with Cirrhosis

Assessment of myocardial systolic wall thickening using nuclear magnetic resonance imaging

A quantitative nuclear magnetic resonance (NMR) imaging method of evaluating regional left ventricular function was compared with histochemical evidence of infarction in dogs and functional measurements in patients. Short-axis images of the heart were obtained at end-diastole and at 100 ms intervals thereafter. Regional diastolic left ventricular wall thickness and maximal percent systolic wall thickening were measured at the level of the papillary muscles in each of six segments. In six normal dogs, the mean end-diastolic wall thickness was 9 ± 1.6 mm, and the mean maximal percent thickening was 61 ± 11%. In eight dogs with a 4 day old infarct, maximal percent thickening was 5 ± 8% (p < 0.001) in the infarcted segments.In 10 normal human volunteers, the mean end-diastolic wall thickness was 10.1 ± I mm, and the mean maximal percent systolic wall thickening was 60 ± 18%. Reduced maximal percent systolic wall thickening was defined as a value ≥2 SD below the mean value obtained in normal volunteers. Seven patients with regional wall motion abnormalities were independently assessed by NMR imaging and biplane ventriculography. With a sensitivity of 94% and a specificity of 80%, NMR imaging demonstrated reduced maximal percent systolic wall thickening in the same segments identified as akinetic or dyskinetic by biplane ventriculography. Thus, abnormalities of regional systolic wall thickening are accurately identified with this quantitative imaging technique.

Topical Tretinoin for Photoaged Skin-Reply

In Reply. —In answer to Dr Pazmino, laboratory and drug absorption studies were not done in our study because of the known safety of topical tretinoin. Plasma levels of tretinoin were undetectable after applications of 0.025% tretinoin cream to the arms, legs, and back twice daily for 28 days or 1.0% tretinoin cream once to the entire body. 1 Any minimal absorption of tretinoin through intact skin and any prostaglandins in the skin (which are metabolized locally) would be unlikely to affect the kidney directly. Based on our experience with retinoids 2,3 and on 17 years of safe use of tretinoin without reported vasculitis or effects on kidney function (E. G. Thorne, MD, Ortho Pharmaceutical Company, oral communication, March 1988), we conclude that it is unnecessary to perform kidney function measurements in patients using tretinoin topically. Day-to-day variation and laboratory or collection errors could account for some of the findings

How should we measure function in patients with chronic heart and lung disease?

To elucidate the characteristics of measures of function in patients with chronic heart failure and chronic lung disease we administered four functional status questionnaires, a 6-min walk test and a cycle ergometer exercise test, to 43 patients limited in their day to day activities as a result of their underlying heart or lung disease. Correlations between these measures were calculated using Spearman's rank order correlation coefficient. The walk test correlated well with the cycle ergometer ( r = 0.579), and almost as well with the four functional status questionnaires ( r = 0.473–0.590) as the questionnaires did with one another (0.423–0.729). On the other hand, correlations between cycle ergometer results and the questionnaires was in each case 0.295 or lower, and none of these correlations reached statistical significance. These results suggest that exercise capacity in the laboratory can be differentiated from functional exercise capacity (the ability to undertake physically demanding activities of daily living) and that the walk test provides a good measure of function in patients with heart and lung disease.

Burns, smoke and pulmonary function : Whitener D. R., Whitener L. M., Robertson K. J. et al (1980) Pulmonary function measurements in patients with thermal injury and smoke inhalation. Am. Rev. Resp. Dis. 122, 731

Burns, smoke and pulmonary function : Whitener D. R., Whitener L. M., Robertson K. J. et al (1980) Pulmonary function measurements in patients with thermal injury and smoke inhalation. Am. Rev. Resp. Dis. 122, 731

Pulmonary function measurements in patients with thermal injury and smoke inhalation.

We performed serial pulmonary function measurements in 28 patients with thermal injury in order to investigate the pulmonary effects of smoke inhalation, small and large surface burns, and the combination of burn and inhalation. Patients were studied at postinjury time intervals of 9.0 +/- 0.6 (M +/- SEM), 22.0 +/- 1.6, 37.3 +/- 2.2, 58.4 +/- 2.5 hours; 11.5 +/- 0.6 days; 1.1 +/- 0.1 and 5.0 +/- 0.5 months. Spirometry was found to be as useful as more sophisticated measurements in the examination of both burn and smoke inhalation groups. Smoke inhalation caused severe airway obstruction 9 h after exposure. Patients with surface burn resuscitated with 4 ml of Ringer's lactate/per cent surface area burn/kilogram developed a significant restrictive defect over the first 58 h, despite normal pulmonary capillary wedge pressures. The restrictive defect in these patients correlated with the size of surface and chest burn, degree of fluid retention, and reduction in colloid osmotic pressure. Surface burn and smoke inhalation caused the greatest deterioration in pulmonary function. These defects gradually resolved during the period of observation.

Albumin synthesis rate as a measure of liver function in patient with cirrhosis.

Albumin synthesis rate as a measure of liver function in patient with cirrhosis.