Biomedical subjects

F M Collen

Publications and source records attributed to F M Collen.

4 recordsLinked to original sources

PubMed1992

Physiotherapy intervention late after stroke and mobility.

OBJECTIVE: To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke. DESIGN: Randomised crossover trial comparing two groups offered intervention by a physiotherapist, one immediately after entry into the trial and the other after a delay of three months. The intervention consisted of identifying problems and offering advice and help to solve the problems. SETTING: Patients' homes in Oxfordshire. SUBJECTS: Patients who had reduced mobility due to a stroke more than one year before entry; 60 were recruited from a community stroke register and 34 in other ways. MAIN OUTCOME MEASURES: Standard measures of mobility including gait speed, functional ambulation categories, the Nottingham extended activities of daily living index, and individual items from the Barthel activities of daily living index and the Frenchay activities index. Measures of manual dexterity, depression, and anxiety were used as controls. RESULTS: 94 patients entered the trial and 49 were randomised to immediate and 45 to delayed physiotherapy; 89 were compared at the crossover point. At randomisation the two groups were comparable. At three months the group given early therapy showed an improvement in gait speed whereas the untreated group had declined (differences of -3.9 v 6.4 s to walk 10 m; p less than 0.01); between three and six months the group given delayed therapy showed improvement and the previously treated group declined (differences of 6.5 v -3.9 s to walk 10 m; p less than 0.01). A 9% (95% confidence interval 0% to 18%) decrease in time taken to walk 10 m was associated with treatment and a 12% (2% to 19%) increase when patients were untreated. Other measures did not change significantly. CONCLUSION: Intervention of an experienced physiotherapist late after stroke specifically improves mobility, albeit by a small amount, but the effects do not seem to be maintained, perhaps because there is an underlying decline in mobility in these patients. Gait speed offers a simple and sensitive measure of outcome.

Activities of Daily Living↗

PubMedDate not supplied

Mobility after stroke: reliability of measures of impairment and disability.

This paper investigates the reliability of six measures of impairment and disability related to mobility after stroke: the Rivermead Motor Assessment (RMA, gross function subsection); gait speed (over 5 and 10 m); the motricity index (leg scores only); functional ambulation categories; sitting to standing (by observation); and mobility categories. Twenty-five patients who had suffered a stroke 2-6 years earlier leaving them with mobility disability were seen as part of a home-based physiotherapy trial. Assessments were made by three people on three occasions over 5 weeks. All six measures were reliable in statistical terms. A variation in gait speed of up to 25% and a difference of 3 points in the RMA were the actual limits of reliability.

Activities of Daily Living↗

PubMedDate not supplied

Residual mobility problems after stroke.

At final follow-up 2-7 years after their first stroke, 328 survivors from the Oxfordshire Community Stroke Project register were assessed for mobility disability. Patients were classified as being either mobile or immobile, according to defined criteria. Of the 190 immobile patients, only 60 could be entered into a trial of physiotherapy. The major causes of attrition were refusal to participate (97 patients) and the absence of any stroke impairment causing the immobility (18). Arthritis (67) and dementia (39) were common in patients with mobility disability. Immobile patients were older and had suffered a more severe index stroke. This study stresses the relatively low frequency of long-term immobility following stroke directly due to stroke-induced impairments.

Arthritis↗

PubMedDate not supplied

The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment.

This paper reports on a development of the Rivermead Motor Assessment Gross Function scale, the Rivermead Mobility Index (RMI), a new measure of mobility disability which concentrates on body mobility. An early development included a second scale concentrating on elective mobility, but the results showed this to be unreliable. The RMI comprises a series of 14 questions and one direct observation, and covers a range of activities from turning over in bed to running. Its inter-observer reliability was tested on two groups of patients (n = 23 and 20 respectively) and it is reliable to a limit of 2 points (out of 15). Its validity as a measure of mobility after head injury and stroke was tested by concurrent measurement of mobility using gait speed and endurance, and by standing balance. The RMI does form a scale. It is short, simple, and clinically relevant, and can be used in hospital or at home.

Activities of Daily Living↗