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Biomedical subjects

L Turner-Stokes

Publications and source records attributed to L Turner-Stokes.

At least 37 records · Page 2Linked to original sources
PubMed1999

The Northwick Park Care Needs Assessment (NPCNA): a measure of community care needs: sensitivity to change during rehabilitation.

OBJECTIVES: To determine whether the Northwick Park Care Needs Assessment (NPCNA) is sensitive to change occurring during rehabilitation and provides a reliable estimate of care needs in the community, and to compare the NPCNA with the Functional Independence Measure (FIM). DESIGN: Prospective cohort study. SETTING: Postacute neurorehabilitation unit for young patients with complex disabilities. SUBJECTS: Thirty-nine consecutive patients with brain injury admitted over six months. MEASUREMENTS AND METHODS: The NPCNA was assessed on admission and at discharge. Two subsets of patients were also assessed (a) at three-month follow-up in the community (n = 15), and (b) both in hospital and in the home environments at the discharge time point (n = 28). Data were compared with FIM scores on admission and discharge. RESULTS: The median total weekly care hours fell from 52 hours (interquartile range (IQR) 25-66) on admission, to 17 hours (IQR 6-46) on discharge (p<0.001). There was a median reduction of approximate weekly cost of care from 600 pound sterling (IQR 224-824 pound sterling) to 168 pound sterling (IQR 56-280 pound sterling) (p<0.001). These benefits were sustained at follow-up, and the NPCNA measured in hospital at discharge gave a good estimation of the care hours and weekly cost of care in the community at three months after discharge. There was no significant correlation with FIM gain. CONCLUSIONS: In this study the NPCNA, measured while the patient was still in hospital, gave a good estimation of care needs in the community and was sensitive to change occurring during rehabilitation in patients with severe complex disabilities.

Activities of Daily Living↗
PubMed1999

The UK FIM+FAM: development and evaluation. Functional Assessment Measure.

BACKGROUND AND AIMS: The aim of this study was to develop and evaluate the UK version of the Functional Assessment Measure (UK FIM+FAM). DESIGN: Before and after evaluation of inter-rater reliability. DEVELOPMENT: Ten 'troublesome' items in the original FIM+FAM were identified as being particularly difficult to score reliably. Revised decision trees were developed and tested for these items over a period of two years to produce the UK FIM+FAM. EVALUATION: A multicentre study was undertaken to test agreement between raters for the UK FIM+FAM, in comparison with the original version, by assessing accuracy of scoring for standard vignettes. METHODS: Baseline testing of the original FIM+FAM was undertaken at the start of the project in 1995. Thirty-seven rehabilitation professionals (11 teams) each rated the same three sets of vignettes - first individually and then as part of a multidisciplinary team. Accuracy was assessed in relation to the agreed 'correct' answers, both for individual and for team scores. Following development of the UK version, the same vignettes (with minimal adaptation to place them in context with the revised version) were rated by 28 individuals (nine teams). RESULTS: Taking all 30 items together, the accuracy for scoring by individuals improved from 74.7% to 77.1% with the UK version, and team scores improved from 83.7% to 86.5%. When the 10 troublesome items were taken together, accuracy of individual raters improved from 69.5% to 74.6% with the UK version (p <0.001), and team scores improved from 78.2% to 84.1% (N/S). For both versions, team ratings were significantly more accurate than individual ratings (p <0.01). Kappa values for team scoring of the troublesome items were all above 0.65 in the UK version. CONCLUSION: The UK FIM+FAM compares favourably with the original version for scoring accuracy and ease of use, and is now sufficiently well-developed for wider dissemination.

Activities of Daily Living↗
PubMed1999

The Northwick Park Care Needs Assessment (NPCNA): a directly costable outcome measure in rehabilitation.

BACKGROUND: The Northwick Park Dependency Score (NPDS) has been shown to be valid, reliable and practical to use. It was designed to be used together with a short set of additional questions to inform care needs in the community and facilitate discharge planning. AIM: To develop a conversion formula to translate information derived from the NPDS into a generic assessment of care needs in the community -- the Northwick Park Care Needs Assessment (NPCNA) -- and to evaluate its potential as a directly costable measure of outcome in rehabilitation. SETTING: An inpatient neurorehabilitation unit for young patients with brain injury. METHOD: Part 1, DEVELOPMENT: For each task in the NPDS, a set of assumptions was developed to reflect the number of people, the time taken and the frequency of help required. Tasks were collected into a daily timetable and minimum and maximum allocations made for each time slot. From this the weekly care hours can be calculated. A range of care package categories and their approximate costs were identified, and a simple set of criteria developed with experienced community care planners to determine the circumstances under which each category is applied. Part 2, EVALUATION: The assumptions and derived care package were evaluated in a prospective comparative study in 35 cases. Timetables of care needs were drawn up using (a) the NPDS-derived Care Needs Assessment (NPCNA) and (b) detailed structured interview with an independent assessor. The weekly hours of care, care package and approximate cost were then determined for each set of timetables, by a third independent assessor, applying the formula described according to strict rules. RESULTS: Assessment of the total weekly hours of care showed an excellent correlation between the two methods (rho 0.90, p <0.01) with no significant differences. There was also a high correlation in the category of care package allotted and thus the weekly cost of care (rho 0.73, p <0.01). CONCLUSION: The NPCNA provides a simple measure of care needs in total care hours, as well as a timetable of care from which a care package can be directly planned and costed. It has potential use, therefore, as an instrument that can demonstrate directly the effectiveness of rehabilitation in reducing the cost of continuing care in the community.

Activities of Daily Living↗
PubMed1999

Can a Barthel score be derived from the FIM?

OBJECTIVE: To establish whether a Barthel score derived by translation from the motor items of the Functional Independence Measure (FIM) would equate to the directly scored measure. DESIGN: Conversion criteria for motor item scores on the FIM scale to Barthel scores were first developed. To test these criteria, 40 consecutive patients were assessed for Barthel and FIM scores by the multidisciplinary team who were unaware of the conversion criteria. The derived Barthel score was compared with the directly scored Barthel Index. RESULTS: A very high degree of correlation was observed between total scores of the direct and derived Barthel (Spearman's rho = 0.99), which is highly significant, and no significant differences were seen between scores for any of the individual items (Wilcoxon signed rank test). Item by item analysis across the study population was undertaken to confirm the conversion criteria. Absolute agreement between the two methods ranged from 75 to 100% and kappa values from 0.53 to 1.0. CONCLUSIONS: This study demonstrates that a Barthel Index can be derived from the motor items of the FIM and there is a good agreement with the directly assessed Barthel score. Although a larger study may help to delineate the exact conversion criteria for one item, the current system provides an accurate and usable translation of the total score and serves as a major step towards achieving a common language in outcome measurement for rehabilitation.

Activities of Daily Living↗
PubMed1998

The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation.

BACKGROUND: Disability scores, such as the Functional Independence Measure (FIM) and Barthel Index, have been shown to correlate with care needs but cannot be used to assess them directly, as they do not indicate the number of people required to help with a task, nor the time taken. The Northwick Park Dependency Score (NPDS) is an ordinal scale that can be used to assess impact on nursing time. It takes 3-5 minutes to complete. Together with a short set of additional questions, it may be used directly to assess care needs in the community and to facilitate discharge planning. AIMS: To develop and evaluate the NPDS for use in a rehabilitation setting. METHODS: (1) DEVELOPMENT: Following a survey of existing instruments, tasks were selected on the basis of their impact on nursing time and divided into Basic Care Needs (BCN) and Special Nursing Needs (SNN). Cut-off points were devised to reflect the number of helpers needed and time taken. Following evaluation of the NPDS version 5, minor changes were made to produce version 6 which was re-evaluated on a smaller scale. (2) EVALUATION: Inter-rater and intra-rater reliability were tested in a cohort of 23 inpatients using five senior nurses. Analysis included assessment of degree of association, significant differences, absolute agreement, and agreement +1 level. Although there is no gold standard, the BCN section should correlate inversely with independently assessed Barthel scores. Re-evaluation of version 6 was undertaken using the same method of analysis in a cohort of 21 patients using three senior nurses. RESULTS: On initial evaluation inter-rater reliability testing showed an excellent level of association in total composite score between each pair of nurses (rho = 0.73-0.92, p <0.01) and agreement +1 level for individual items ranged from 73 to 100%. Significant disagreements were in six items. On re-evaluation following minor modification, high levels of association were still seen for total BCN, SNN and composite scores both between and within raters, with very satisfactory levels of agreement for individual items. The BCN section of the NPDS showed good inverse correlation with Barthel scores (rho = 0.91, p <0.01). CONCLUSION: The NPDS is simple and practical to use in a busy setting. It is shown to be reliable and valid in its assessment of nursing dependency on the ward. Its translation into a directly costable measure of continuing care needs in the community now requires evaluation.

Adolescent↗
PubMed1997

The use of standardized outcome measures in rehabilitation centres in the UK.

OBJECTIVE: To ascertain which standardized instruments are currently most commonly used as outcome measures for rehabilitation in routine clinical practice in the UK. DESIGN: The study used a postal questionnaire which was sent out to members of two major societies of rehabilitation professionals in the UK. RESULTS: Of 182 rehabilitation centres represented by respondents, 140 (77%) collected at least one standardized measure and 42 did not. Principal reasons for not recording measures were lack of time and not knowing what to collect. As had been anticipated, a very wide range of different measures were used by different centres, however some clear favourites emerged including the 10 m Walk, the Motricity Index and the Nine-hole Peg Test. One hundred and twenty-three centres used one or more global disability measure of which the commonest were the Barthel index or one of its modifications and the functional Independence Measure (FIM) and/or Functional Assessment Method (FAM). Among units that used handicap or extended activities of daily living (EADL) scales, the Nottingham EADL, the London Handicap Scale and the General Health Questionnaire (GHQ-22 or 12) were most popular. Outside neurorehabilitation, the Harold Wood/Stanmore mobility grades were used by 10/18 amputee rehabilitation centres and the Health Assessment Questionnaire (HAQ) was used by 15/48 units providing musculoskeletal rehabilitation. CONCLUSIONS: It is clear that no one measure is suitable in all settings and services, but the most popular measures from this survey may reasonably form the basis for a 'basket of recommended instruments' that may help to guide units wishing to collect outcome data but not knowing which to choose.

Data Collection↗
PubMed1996

Secondary safety of car adaptations for disabled motorists.

Secondary safety--a car's ability to protect its occupants from injury during a crash--is an area of rapid development in vehicle design which is largely consumer-led. Car adaptations for disabled motorists may reduce secondary safety by presenting hard objects on which people may injure themselves, or by interfering with existing safety systems or modifying the impact zones of the car itself. This paper outlines the principles of secondary safety and presents the results of a qualitative survey comprising secondary safety assessment of 33 vehicles adapted for disabled motorists, suggesting ways in which this might be improved.

Accidents, Traffic↗
PubMed1994

The Northwick Park Neck Pain Questionnaire, devised to measure neck pain and disability.

Neck pain is common in rheumatological practice. Assessment of outcome is difficult without objective measures. A neck pain questionnaire using nine five-part sections has been devised to overcome this problem. Forty-four rheumatology out-patients with neck pain were studied. Questionnaires were completed on days 0 and 3-5, and at 1 and 3 months. There was good short-term repeatability (r = 0.84, kappa = 0.62). Mean scores of each of the nine sections tended to rise with that of the pain section showing internal consistency. Questions on duration and intensity of pain were good indicators of a patient's global assessment. The questionnaire is easy for patients to complete, simple to score and provides an objective measure to evaluate outcome in patients with acute or chronic neck pain.

Adult↗
PubMed1993

Self-referential selective memory in pain patients.

The effect of self-reference on recall bias for pain stimuli was compared in chronic pain patients and controls. It was hypothesized that self-referential encoding would result in better recall of pain stimuli in chronic pain patients. In contrast, it was predicted that a non-pain control group would display no recall bias for pain-associated stimuli, regardless of the encoding reference. Subjects were tested in two conditions. The first condition (self-referential) involved encoding a list of words constructed from sensory pain, affective and neutral words. Elaboration at the encoding stage was achieved by asking subjects to imagine themselves in situations involving these words. Subjects were also asked to rate the likelihood of these situations occurring on a scale of 1 to 5 (from 1 = 'will not happen' to 5 = 'certain to happen'). The second condition (other-person reference) repeated this task in reference to another person with a matched list of words. A 2 x 2 x 3 factorial analysis of variance based on group x reference (self and other) x word type (sensory, affective and neutral) was carried out on recall scores, with the likelihood ratings as a covariate. Results reveal a significant three-way interaction. The analysis indicated that, while pain patients show an increase in recall of sensory words and a decrease in recall of neutral words when these are encoded in reference to themselves, control subjects show no difference in recall of these word types regardless of the encoding condition. The results support the notion that pain patients selectively recall more pain-associated words in comparison with other word types. However, this effect is only true for stimuli encoded in reference to themselves. It is proposed that this processing bias may contribute to the maintenance of a sense of helplessness and exacerbate the emotional impact of the pain experience.

Adult↗
PubMed1992

Urinary incontinence among patients with arthritis--a neglected disability.

Urinary tract pathology may be no more common in patients with arthritis than among the general population, but its impact may be enhanced by disability. In this survey of 247 patients, as many as 38% of patients with rheumatoid arthritis (RA), 47% of patients with osteoarthritis (OA) and even 34% of patients with soft tissue rheumatism (STR) reported difficulty controlling their urine, confirming that incontinence is a widespread and often under-reported problem. More detailed enquiry in a sample of 90 patients with OA or RA did not suggest specific urinary tract pathology related to the underlying arthritis. Those who reported problems with urinary control were more disabled, and took longer to get to the toilet in their own environment than those without control problems. Twenty-seven per cent of patients felt that their problems would be solved by provision of a downstairs toilet. Timing of tasks performed by patients within their home is suggested as a method for assessing functional ability which encompasses both patient disability and environmental factors.

Age Factors↗
PubMed1991

Measurement of haematological indices of chronic rheumatic disease with two newer generation automated systems, the H1 and H6000 (Technicon).

Two automated counters, the H1 (Technicon) and the H6000 (Technicon), which count 10,000 cells per sample, were compared and used to examine the clinical relevance of the additional haematological information now provided to the rheumatologist in three groups of patients--38 with rheumatoid arthritis (RA), 41 with ankylosing spondylitis (AS), and 35 with systemic lupus erythematosus (SLE). The two machines agreed in their estimations of the main indices (haemoglobin, red blood cell count, and white blood cell count), but estimations of platelet count and volume were significantly lower on the H6000 machine, as were mean cell haemoglobin and monocyte count, whereas packed cell volume and red cell distribution width were higher. As expected, both machines identified pancytopenia among the group with SLE, while low haemoglobin and high platelet count were found particularly among patients with RA and AS respectively. Additional information available from these counters showed marked variability in red cell size in SLE, and also of haemoglobin content, which is only measured on the newer H1 machine. Flags for microcythaemia, anisochromasis, and white cell noise (usually due to nucleated red cells) were all more common in SLE. Interpretation of results was complicated by the inevitable difference in age and sex distribution among the disease groups, and identification of active disease was also limited by the effect of drugs. In conclusion, the increasingly widespread use of automated counters as part of the routine haematological service may provide the rheumatologist with useful information, but, as always, care should be taken in the interpretation of indices in patients receiving non-steroidal or second line agents, and also in extrapolating results from one machine to another when they are updated or when patients are monitored at more than one centre.

Adolescent↗
PubMed1990

Autoantibody and idiotype profile of lung involvement in autoimmune rheumatic disease.

Several reports have linked the presence of certain serum autoantibodies with particular clinical manifestations of autoimmune disease. For example, the Jo-1 antibody is now established as a marker for fibrosing alveolitis in polymyositis. To investigate the possible association of further autoantibodies or idiotypes with fibrosing alveolitis in autoimmune rheumatic disease a panel of autoantibodies was measured in serum samples from 28 patients with systemic lupus erythematosus (SLE) (10 with and 18 without lung involvement), 21 patients with scleroderma (12 with fibrosing alveolitis and nine without), and 41 patients with 'lone' fibrosing alveolitis. Antibodies measured were IgM and IgG anti-dsDNA and anti-ssDNA antibody; IgG and IgM anticardiolipin antibody; anti-poly (ADP-ribose) antibody; antibodies to two common idiotypes of anti-DNA antibodies, designated 134 and 16/6; and IgM, IgG, and IgA isotypes of rheumatoid factor. None of these antibodies was specifically associated with lung involvement in SLE or scleroderma, but a trend was found towards an increase in all autoantibodies in association with lung disease in SLE, while the reverse trend was seen in scleroderma.

Antibodies, Antinuclear↗
PubMed1990

Disability medicine.

Rehabilitation/disability medicine has become big business in the USA, Europe and Scandinavia but has yet to establish firm footing as a specialty in the UK. Under the reforms of the Government's White Paper, however, time in hospital becomes money. The need for early re-integration and maintenance of patients in the community may well provide the cue for disability medicine to emerge as a specialty in its own right. But what is the nature of this specialty and who should do it?

Humans↗