Handicap Scale Scores Research Articles

The Effect of Tranexamic Acid on Functional Outcomes: An Exploratory Analysis of the CRASH-2 Randomized Controlled Trial

Tranexamic acid improves survival in severely injured adults. However, its effectiveness on overall functional outcome is unknown. We hypothesized that tranexamic acid improves overall functional outcome compared with placebo in severely injured adults and conduct an exploratory analysis of the Clinical Randomization of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) data to investigate this hypothesis. We included injured adults from the CRASH-2 trial who were randomized 3 hours or less from injury. The primary outcome measure was functional status at hospital discharge or on day 28 if the subject was still in the hospital. Functional status was measured with the modified Oxford Handicap Scale, a 6-category ordinal functional outcome scale. We conducted 3 separate analyses using 3 different outcome measures to evaluate the effectiveness of tranexamic acid versus placebo on functional outcomes, including the mean utility-weighted modified Oxford Handicap Scale score (overall functional outcome), the area under the curve (based on functional outcome and rate of recovery), and a sliding dichotomy analysis (favorable versus unfavorable functional outcome) stratified by baseline mortality risk (stratified analysis). There were 13,432 patients (6,679 randomized to placebo and 6,753 to tranexamic acid) included in the study cohort. The mean utility-weighted modified Oxford Handicap Scale score was 0.66 (SD 0.33) for patients randomized to tranexamic acid compared with a mean of 0.64 (SD 0.34) for those randomized to placebo (mean difference 0.02; 95% confidence interval [CI] 0.01 to 0.03). The area under the curve analysis demonstrated that patients randomized to tranexamic acid had a higher 28-day mean utility-weighted modified Oxford Handicap Scale score compared with those randomized to placebo (mean score 0.55 [SD 0.30] versus 0.53 [SD 0.31]; mean difference 0.02 [95% CI 0.01 to 0.03]). The sliding dichotomy analysis demonstrated heterogeneity of treatment effects across risk groups. The overall proportion of patients with favorable functional outcomes was higher in the tranexamic acid group (5,360/6,753 [79.4%]; 95% CI 78.4% to 80.3%) compared with the placebo group (5,174/6,679 [77.5%]; 95% CI 76.5% to 78.5%; difference 1.9% [95% CI 0.5% to 3.3%]; number needed to treat=52). When each risk group was tested separately, only the lowest-risk group (<6% baseline mortality risk) demonstrated a statistically significant effect of tranexamic acid toward favorable functional outcomes (tranexamic acid versus placebo adjusted odds ratio 0.78; 95% CI 0.67 to 0.90). There were no differences between tranexamic acid and placebo in the other risk groups. Across 3 exploratory analyses, severely injured adult patients randomized within 3 hours from injury demonstrated better functional outcomes with tranexamic acid compared with placebo. When heterogeneity of treatment effects across risk groups was evaluated, only the lowest-risk group demonstrated a significant effect of tranexamic acid toward favorable outcomes. Given the overall safety and cost-effectiveness of tranexamic acid use in injured adults, our results further support the use of tranexamic acid for this population. Future trauma trials that evaluate tranexamic acid use should also consider functional status as an important outcome.

Brain CT signs and the effect of alteplase after stroke

The third International Stroke Trial (IST-3) is the largest (n=3035) randomised controlled trial of intravenous alteplase for acute ischaemic stroke to date.1 Participants in IST-3 were older than in previous trials: 1617 (53%) were older than 80 years of age, whereas only 112 patients of this age were included in eight previous similar trials.2 In IST-3, participants could be treated up to 6 h after stroke onset, but 849 (28%) were treated within 3 h. No significant effect of alteplase was reported on the IST-3 primary endpoint—independence at 6 months (defined as an Oxford Handicap Scale score of 0–2).

The interval scaling properties of the London Handicap Scale: an example from the adaptation of the scale for use in Turkey

Objectives: To adapt the London Handicap Scale into the Turkish language, and to investigate the scaling properties of this version in a sample of people who have experienced a stroke. Design: After the translation process, the internal construct validity was tested by Rasch analysis and the reliability by internal consistency and intraclass correlation coefficient. The interval scaling properties were assessed by contrasting the raw and weighted London Handicap Scale scores with the Rasch latent estimates. Setting: An outpatient rehabilitation unit of a university hospital. Subjects: One hundred and eighty-eight community-dwelling post-stroke patients (mean age 63 (SD 12) years, 54% male) were assessed by the Turkish version of the London Handicap Scale. Results: After adjustment for local dependency, the data showed good fit to Rasch model expectations with a mean item fit −0.240 (SD 1.868), person fit −0.403 (SD 0.893) and chi-square interaction 8.55 (df 10, P = 0.575). The reliability was good with a Cronbach’s α and intraclass correlation coefficient of 0.845. Analysis of the scaling properties showed that either the raw London Handicap Scale score or its weighted score were non-linear with respect to the Rasch latent estimate. Conclusions: The London Handicap Scale is a valid and reliable scale for use in stroke in Turkey. Its unweighted raw scores and weighted scores are equivalent and ordinal, but a linear transformation is possible through Rasch analysis.

Goal achievement in the six months after inpatient rehabilitation for stroke

Purpose. The purpose of the project was to identify characteristics associated with successful re-integration into the community post-inpatient rehabilitation after stroke. A key issue was determining re-integration from the person's perspective, taking into account the person's preferred lifestyle choices.Method. Research design: A prospective exploratory follow up study. Participants: A consecutive sample of 45 participants discharged from IP rehabilitation following stroke and 23 carers associated with the participants. Measures: Goal attainment scaling was utilised to determine successful community integration. Factors that may have contributed to goal achievement were measured prior to discharge and at 6 months post-discharge. Scales used include the Functional Independence Measure, Mini Mental test, the CES-D depression scale and a self-efficacy scale, Strategies Used by People to Promote Health. London Handicap Scale scores and Carer Strain Index were collected at 6 months.Results. Twenty percent of participants achieved all their goals. Significant correlations were observed between goal achievement score and concurrent measures of physical function, depression and self efficacy at 6 months post-discharge.Conclusions. Stroke survivors who achieved their goals were less likely to be depressed, showed stronger self efficacy beliefs and more positive perceptions of their participation in everyday and community life.

Return to work after lower limb amputation.

This study investigated the proportion of patients who returned to work following amputation and the factors that influenced a positive or negative outcome. One hundred patients of working age who had sustained unilateral lower limb amputation at least 1 year previously and who were established prosthesis users participated in the study. A specially designed questionnaire similar to a guided interview was administered by the rehabilitation physician at the patients' routine follow-ups. The questionnaire yielded a unique score dependent on whether return to work (or a different or preferred occupation) had been achieved with good or reduced productivity. All patients were eligible for mobility benefit, including schemes to purchase suitably adapted vehicles if necessary. However, no vocational rehabilitation was available. Sixty-six per cent of patients returned to employment and this was related to mobility, time since amputation and Handicap Scale scores. Age, socket comfort, level and cause of amputation, type of previous work or the presence of other medical problems did not differ between those who did and did not return to work. The Employment Questionnaire showed good correspondence with the London Handicap Scale, indicating some concurrent validity, although future development might include consideration of psychological factors, which could explain more of the reasons for continued unemployment.

C-reactive protein in ischemic stroke and its etiologic subtypes

The possible role of C-reactive protein (CRP) in the etiology and prognosis of ischemic stroke remains to be clearly defined. The purpose of this study was to determine whether CRP levels are elevated in patients with stroke, whether they remain persistently elevated, and whether CRP levels are higher in patients with etiologic subtypes of stroke caused by large or small artery disease (“atherogenic hypothesis”) or whether they may be higher in patients with more extensive cerebral infarction caused by large artery or cardiogenic embolism (“inflammatory hypothesis”). We conducted a case-control study of 199 hospital cases with a first-ever ischemic stroke and 202 randomly selected community controls. Cases of stroke were classified by etiologic subtype and the prevalence of conventional vascular risk factors and CRP levels were determined in cases and controls. Blood levels of CRP measured within 7 days of acute stroke were significantly higher in cases compared with controls (8.50 vs. 2.18 mg/L, P <.0001) and remained elevated in stroke survivors at 3 to 6 months of follow-up (3.35 vs. 2.18 mg/L, P =.003) although levels were significantly lower compared with the first 7 days (3.35 vs. 8.50 mg/L, P <.001-.003). Compared with the lowest quartile of CRP, the upper 3 quartiles were associated with an adjusted odds ratio (OR) of ischemic stroke of 1.9 (95% CI: 1.0-3.8) for the second quartile, 5.8 (95% CI: 2.9-11.4) for the third quartile, and 16.9 (95% CI: 7.9-36.1) for the fourth quartile (P for trend <.0001). Comparing the upper with the lower quartile, the strongest association was with etiologic stroke subtypes caused by large artery disease (OR 52.5; 95% CI: 13.4-205) and embolism from the heart (OR 56.1; 95% CI: 11.3-278), with a much weaker association with small artery disease (OR 2.4; 95% CI: 0.8-6.0). The mean Oxford Handicap Scale score was lowest in small artery, intermediate in large artery and highest in cardioembolic stroke (2.8 vs. 3.1 vs. 3.6, respectively; P =.001) while the mean Barthel Index was highest in small artery, intermediate in large artery, and lowest in cardioembolic stroke (13.5 vs. 11.5 vs. 8.6, respectively; P =.002). Furthermore, there was a significant correlation between CRP levels during the first 7 days and stroke severity, as measured by the Oxford Handicap Scale score (P =.03) and Barthel index (P =.001). We conclude that there is a strong, independent relationship between elevated blood levels of CRP and ischemic stroke, particularly because of more severe strokes caused by large artery disease and embolism from the heart, which remains evident over the long term. These results are consistent with the inflammatory marker hypothesis of CRP as a marker of the extent of ischemic cerebral injury and its complications. Copyright © 2003 by National Stroke Association.

Long-term follow-up of neurosarcoidosis.

The authors evaluated the long-term clinical outcome of neurosarcoidosis and determined predictive factors of disease course. Twenty-seven patients with neurosarcoidosis were followed for at least 5 years from the onset of neurologic symptoms. Patients with CNS involvement during the course of the disease had a higher Modified Oxford Handicap Scale score than those with peripheral nervous system involvement (p < 0.02). CNS involvement may be a predictive factor for a less favorable disease course. Early and intensive treatment should be considered in such cases.

SF36 and London Handicap Scale Scores in Patients With and Without Cognitive Impairment. Can Proxies Answer on the Patient'S Behalf?

SF36 and London Handicap Scale Scores in Patients With and Without Cognitive Impairment. Can Proxies Answer on the Patient'S Behalf?

The Hearing Handicap Scale as a Measure of Hearing Aid Benefit

Use of the Hearing Handicap Scale as a measure of hearing aid benefit was investigated. New hearing aid users with bilateral, sensorineural hearing losses ranging from 5 dB HL to 55 dB HL served as subjects. Changes in speech reception threshold, word identification, and Hearing Handicap Scale were derived by comparing data obtained prior to hearing aid use with that obtained following four weeks of hearing aid use. Results showed a significant improvement for all three measurements and indicated that improvement in word identification presented at conversational level was more related to self-reported hearing aid benefit than was improvement in speech reception threshold. Also, word identification ratings obtained with the stimuli presented at conversation speech level produced a significant correlation with Hearing Handicap Scale scores.