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Biomedical subjects

Derick T Wade

Publications and source records attributed to Derick T Wade.

At least 19 recordsLinked to original sources
PubMed2006

Exertional symptoms and exercise capacity in individuals with brain injury.

PURPOSE: To examine factors affecting cycling exercise performance in individuals with acquired brain injury. METHODS: Thirty individuals with acquired brain injury and 18 sedentary controls (SC) participated. Heart rate, bicycle power output and rating of perceived exertional (RPE) were recorded, throughout incremental cycle ergometer exercise. The SC group and 18 moderately impaired individuals from the ABI group performed a 25-W (B25) protocol. The remaining 12 individuals performed a 10-W protocol (B10). RESULTS: The B10 group terminated exercise at the lowest RPE, percentage age predicted maximal heart rate (% APMHR) and bicycle power output, followed by the B25 and then the SC group (RPE: Kruskal - Wallis test P < 0.001, %APMHR and bicycle power output: one-way ANOVA P < 0.01). RPE was correlated with %APMHR and percentage of peak bicycle output (B10 group: R2 0.1 to 0.67; B25 group: 0.69 - 0.83; SC group: 0.76 - 0.91). There was no difference in RPE at the same relative work intensity between the B25 and the sedentary control group (P > 0.05). Forward regression analysis revealed fatigue levels were predictive of %APMHR at test termination (beta = -0.411, P < 0.05) and quadriceps strength was predictive of peak bicycle power output (beta = 0.612, P < 0.05). CONCLUSIONS: Individuals with brain injury terminated exercise at lower exercise intensities but rated exertion no differently from healthy individuals. General fatigue levels predicted %APMHR and quadriceps strength predicted peak bicycle power output.

Adult↗
PubMed2006

Cluster randomized pilot controlled trial of an occupational therapy intervention for residents with stroke in UK care homes.

BACKGROUND AND PURPOSE: A pilot evaluation of an occupational therapy intervention to improve self-care independence for residents with stroke-related disability living in care homes was the basis of this study. METHODS: A cluster randomized controlled trial with care home as the unit of randomization was undertaken in Oxfordshire, UK. Twelve homes (118 residents) were randomly allocated to either intervention (6 homes, 63 residents) or control (6 homes, 55 residents). Occupational therapy was provided to individuals but included carer education. The control group received usual care. Assessments were made at baseline, postintervention (3 months) and at 6-months to estimate change using the Barthel Activity of Daily Living Index (BI) scores, "poor global outcome", (defined as deterioration in BI score, or death) and the Rivermead Mobility Index. RESULTS: At 3 months BI score in survivors had increased by 0.6 (SD 3.9) in the intervention group and decreased by 0.9 (2.2) in the control group; a difference of 1.5 (95% CI allowing for cluster design, -0.5 to 3.5). At 6 months the difference was 1.9 (-0.7 to 4.4). Global poor outcome was less common in the intervention group. At 3 months, 20/63 (32%) were worse/dead in the intervention group compared with 31/55 (56%) in the control group, difference -25% (-51% to 1%). At 6 months the difference was similar, -26% (-48% to -3%). Between-group changes in Rivermead Mobility Index scores were not significantly different. CONCLUSIONS: Residents who received an occupational therapy intervention were less likely to deteriorate in their ability to perform activities of daily living.

Activities of Daily Living↗
PubMed2006

The effects of mental practice in stroke rehabilitation: a systematic review.

OBJECTIVE: To assess the effects of a mental practice intervention on recovery in stroke patients. DATA SOURCES: A systematic literature search of the Cochrane Database of Systematic Reviews, PubMed/Medline, PsycINFO, Pedro, Rehadat, and RehabTrials was performed by 2 researchers independently. Eligible studies published through August 2005 were selected. STUDY SELECTION: Four randomized controlled trials (RCTs), 1 controlled clinical trial (CCT), 2 patient series, and 3 case reports that investigated the effects of a mental practice intervention on recovery of stroke patients were included. DATA EXTRACTION: The selected RCTs and CCT were assessed on a methodologic quality rating scale. Important characteristics and outcomes were extracted and summarized. Results and characteristics from the patient series and case reports were only provided if they added information. DATA SYNTHESIS: Included studies differed clearly from one another with regard to patient characteristics, intervention protocol, and outcome measures. Four different mental practice strategies were used. Most tasks involved mentally rehearsing movements of the arm. Intervention periods varied from 2 to 6 weeks, frequencies ranged from multiple sessions per day to 3 times a week. Studies were limited in size. Power could not be increased by pooling or meta-analysis because studies were not comparable. Three of the 4 RCTs were of reasonable methodologic quality. There was some evidence that mental practice as an additional therapy intervention had positive effects on recovery of arm function after stroke. Two mental practice techniques appeared to be effective-tape instruction and self-regulation. Results from the single case studies indicate that mental practice is also promising for improvement of leg function. CONCLUSIONS: No definite conclusions could be drawn except that further research, using clear definitions of the content of mental practice and standardized measurement of outcome, are needed.

Activities of Daily Living↗
PubMed2006

Manifestations of mental slowness in the daily life of patients with stroke: A qualitative study.

OBJECTIVE: To explore the consequences of mental slowness in the daily life of patients with stroke. DESIGN: In a cross-sectional survey semi-structured interviews were completed. Interviews were transcribed and coded by two independent reviewers. Qualitative analysis was done by means of the 'constant comparison method'. SETTING: Three rehabilitation centres in the Netherlands. PARTICIPANTS: A convenience sample of 13 patients with stroke, suffering from mental slowness, was derived from December 2003 to May 2004. MAIN OUTCOME MEASURES: Interview descriptions of the everyday consequences of mental slowness. RESULTS: Patients experienced many problems in daily life due to mental slowness. These could be divided into two main groups: (1) problems in cognitive functioning; (2) psychological and somatic complaints. In response to these problems, some patients mentioned the use of compensation strategies in order to reduce the demands on their information processing capacity. CONCLUSIONS: Mental slowness in cognitive functioning affects a wide range of activities, causing emotional symptoms in many patients and stimulating the spontaneous use of compensation strategies in some patients.

Activities of Daily Living↗
PubMed2005

Randomized clinical trials in Clinical Rehabilitation.

A randomized clinical trial (RCT) is currently the strongest method for evaluating interventions in clinical practice. RCTs also provide the politically most powerful form of evidence. However it is not necessarily agreed what constitutes an RCT. This editorial explores what might be included within the rubric of 'randomized clinical trial' (and randomized controlled trial) by considering the reasons for using randomization and controls, and by discussing the definitions of clinical and trial. It suggests that the definition used in the Cochrane Glossary is too restricted and needs revision.

Bias↗
PubMed2004

Assessment, measurement and data collection tools.

The terms 'measurement' and 'assessment' are often used interchangeably, especially when referring to the tools used to collect information. This leads to unclear thinking, and often to poor selection of a 'measure' or 'assessment'. This editorial suggests that we should distinguish between the identification of the data needed for some purpose, the methods used to collect data, and the use made of (interpretation of) the data collected. This would focus more attention on the three most important questions to consider when collecting data, whether in day-to-day clinical practice or in research: Why should the data be collected? How should the data be collected? and How should the results be interpreted?

Data Collection↗
PubMed2004

Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients.

The objective was to determine whether a cannabis-based medicinal extract (CBME) benefits a range of symptoms due to multiple sclerosis (MS). A parallel group, double-blind, randomized, placebo-controlled study was undertaken in three centres, recruiting 160 outpatients with MS experiencing significant problems from at least one of the following: spasticity, spasms, bladder problems, tremor or pain. The interventions were oromucosal sprays of matched placebo, or whole plant CBME containing equal amounts of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) at a dose of 2.5-120 mg of each daily, in divided doses. The primary outcome measure was a Visual Analogue Scale (VAS) score for each patient's most troublesome symptom. Additional measures included VAS scores of other symptoms, and measures of disability, cognition, mood, sleep and fatigue. Following CBME the primary symptom score reduced from mean (SE) 74.36 (11.1) to 48.89 (22.0) following CBME and from 74.31 (12.5) to 54.79 (26.3) following placebo [ns]. Spasticity VAS scores were significantly reduced by CBME (Sativex) in comparison with placebo (P =0.001). There were no significant adverse effects on cognition or mood and intoxication was generally mild.

Aerosols↗
PubMed2003

Community rehabilitation, or rehabilitation in the community?

PURPOSE: Political and other considerations are increasing the profile of 'community rehabilitation' but there is little agreement on the nature of community rehabilitation or its benefits and disadvantages. This paper clarifies some of the underlying conceptual and evidential matters in the context of the WHO International Classification of Functioning model of disablement. CLASSIFICATIONS: Rehabilitation services can be classified by their specialist skills (e.g. spinal injury services, wheelchair services), by the geographic location of the service (e.g. inpatient stroke service), by the organization managing the service (e.g. social services rehabilitation service), or by location of service delivery. There is no useful consistent comprehensive classificatory system, and all classificatory labels may carry hidden implications. EVIDENCE: The evidence suggests that rehabilitation is more effective when given in the patient's own environment. It also suggests that most so-called community rehabilitation teams are relatively short-lived and are not multi-disciplinary and not expert. SOLUTION: We should work towards a network of rehabilitation teams, some specialized in specific diseases or interventions, and some in longer-term involvement with patients in the community with special emphasis on increasing social participation and ensuring good support. At all times we should balance the advantages of delivering the service in the patient's home against the obvious problems concerning practicality and the equitable use of scarce specialist staff time.

Community Health Services↗
PubMed2003

Satisfaction of members of interdisciplinary rehabilitation teams with goal planning meetings.

OBJECTIVE: To study how satisfied members of interdisciplinary rehabilitation teams are with goal planning meetings. DESIGN: Survey. SETTING: A regional rehabilitation center for people with acute nonprogressive brain injuries in the United Kingdom. PARTICIPANTS: Forty-four rehabilitation professionals who participated in 31 goal-planning meetings held between January 1, 2001, and March 30, 2001. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responses to a questionnaire about staff satisfaction with rehabilitation team meetings. RESULTS: Forty-four of 46 members of 21 different rehabilitation teams completed the questionnaires. They included 12 occupational therapists, 7 physiotherapists, 7 physicians, 6 nurses, 5 clinical psychologists, 5 speech pathologists, and 2 social workers. Median scores of different domains were as follows: participation, 13; behavior, 20; outcome, 14; and process, 16. Correlations between the participation and outcome domains (rho=.731, P=.01) and the process and outcome domains (rho=.384, P=.05) were significant. None of the domain scores correlated with features of the meetings. Scores given by chairpersons for participation (P=.001) and outcome (P=.047) were significantly higher than those given by other participants. CONCLUSIONS: Professionals were satisfied with the behavior of other participants and the process of goal-planning meetings. Satisfaction with outcome was related to satisfaction with the participation in and the process of the meetings. Chairpersons were more satisfied with the participation domain.

Brain Injuries↗
PubMed2003

The Northwick Park Dependency Score and its relationship to nursing hours in neurological rehabilitation.

OBJECTIVE: To evaluate the reliability and validity of the Northwick Park Dependency Score as a measure of nursing dependency. SUBJECTS: Inpatients in a specialist neurological rehabilitation unit. METHODS: The Northwick Park Dependency Score was measured by 2 assessors and compared with nursing hours. The Barthel ADL Index and the Short Orientation Memory and Concentration test were also compared with the Northwick Park Dependency Score. Time to score the Barthel ADL Index and Northwick Park Dependency Score was recorded. Statistical analysis was carried out using Spearman's Rank Correlation Coefficient. RESULTS: There was a high correlation between the Northwick Park Dependency Score total scores of the 2 observers (rho = 0.80, p < 0.005) and a correlation of rho = 0.87 between the Northwick Park Dependency Score total score and nursing time. There was a high negative correlation between the Northwick Park Dependency Score and the Barthel ADL Index. CONCLUSION: The Northwick Park Dependency Score is a valid and reliable way to assess nursing dependency. However, total scores can obscure relevant detail and individual raters differ. The Barthel ADL Index is equally related to nursing dependency.

Activities of Daily Living↗
PubMed2003

Outcome measures for clinical rehabilitation trials: impairment, function, quality of life, or value?

Choosing outcome measures in rehabilitation research depends on the standard research skills of clear thinking, attention to detail, and minimizing the amount of data collected. In rehabilitation, outcome is more difficult to measure because (1) usually several outcomes are relevant, (2) relevant outcomes are affected by multiple factors in addition to treatment, and (3) even good measures rarely reflect the specific interest of any individual patient or member of the rehabilitation team, leading to some dissent. Measurement of general quality of life is not possible because there is little agreement as to the nature of the construct; moreover, measurement of relevant aspects of quality of life would probably give similar results. Cost in terms of resources can be estimated, but there is no validated or even widely accepted method of relating this to benefit in a fair, open, and rational way. Outcome is best measured at the level of behavior (activities), with other measures being used to aid interpretation.

Clinical Trials as Topic↗
PubMed2003

Barriers to rehabilitation research, and overcoming them.

Although rehabilitation is thought to be underresearched, some data suggest that evaluative randomized controlled trials (RCTs) form a greater proportion of studies in rehabilitation research than in the general medical literature. Various obstacles to more evaluative research are sometimes put forward. These include suggestions that it is unethical, that the personalized nature of rehabilitation coupled with the unique problems of each patient make it impossible to study groups, that patients will not agree to enter trials, and that the funding mechanisms for both service and research are not available. In practice these arguments probably reflect low self-confidence within the profession. Education of the profession, public and purchasers should help in the long term. Meanwhile rehabilitation research would benefit from the development of stable research units of adequate size conjoined with clinical units.

Humans↗
PubMed2003

A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms.

OBJECTIVES: To determine whether plant-derived cannabis medicinal extracts (CME) can alleviate neurogenic symptoms unresponsive to standard treatment, and to quantify adverse effects. DESIGN: A consecutive series of double-blind, randomized, placebo-controlled single-patient cross-over trials with two-week treatment periods. SETTING: Patients attended as outpatients, but took the CME at home. SUBJECTS: Twenty-four patients with multiple sclerosis (18), spinal cord injury (4), brachial plexus damage (1), and limb amputation due to neurofibromatosis (1). INTERVENTION: Whole-plant extracts of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), 1:1 CBD:THC, or matched placebo were self-administered by sublingual spray at doses determined by titration against symptom relief or unwanted effects within the range of 2.5-120 mg/24 hours. Measures used: Patients recorded symptom, well-being and intoxication scores on a daily basis using visual analogue scales. At the end of each two-week period an observer rated severity and frequency of symptoms on numerical rating scales, administered standard measures of disability (Barthel Index), mood and cognition, and recorded adverse events. RESULTS: Pain relief associated with both THC and CBD was significantly superior to placebo. Impaired bladder control, muscle spasms and spasticity were improved by CME in some patients with these symptoms. Three patients had transient hypotension and intoxication with rapid initial dosing of THC-containing CME. CONCLUSIONS: Cannabis medicinal extracts can improve neurogenic symptoms unresponsive to standard treatments. Unwanted effects are predictable and generally well tolerated. Larger scale studies are warranted to confirm these findings.

Administration, Oral↗