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Biomedical subjects

N B Lincoln

Publications and source records attributed to N B Lincoln.

At least 19 recordsLinked to original sources
PubMed1998

Reliability of stroke patients' reports on rehabilitation services received.

OBJECTIVE: To compare stroke patients' reports with service providers' reports on the rehabilitation services patients receive. SETTING: Community, predominantly urban. SUBJECTS: Ninety-three stroke patients who had not been admitted to hospital. METHOD: Between August 1994 and August 1996, 54 general practitioner practices in Nottingham (population 344 200) were requested to notify the Nottingham Community Stroke Project of all cases of stroke. Patients were visited one month after stroke and asked to report on whether they had received any hospital, social, community or voluntary services. Some departments were contacted and asked if the patients were known to them and whether they had been seen. RESULTS: Patients reported having little contact with hospital or social services. Comparison of patients' reports with that of the appropriate service department showed poor agreement for community care assistants (kappa = 0.18), fair agreement for social workers (kappa = 0.59), speech therapy (kappa = 0.48), hospital outpatient appointments (kappa = 0.55) and admissions to hospital (kappa = 0.48) and good agreement for social services occupational therapists (kappa = 0.64). CONCLUSION: Stroke patients' and service providers' reports on rehabilitation services may not always agree. Care should be taken when interpreting information on service provision.

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PubMed1998

The assessment of depression in aphasic stroke patients: the development of the Stroke Aphasic Depression Questionnaire.

OBJECTIVE: The Stroke Aphasic Depression Questionnaire (SADQ) was developed to detect depressed mood in aphasic patients in the community. DESIGN: Correlation analysis between new questionnaire and established measures. SETTING: Patients at home. METHODS: Seventy stroke patients who had been discharged from hospital were assessed on the SADQ, the Hospital Anxiety and Depression Scale and the Wakefield Depression Inventory. The SADQ was also administered to 17 aphasic patients on two occasions at a four-week interval. RESULTS: Results indicated that scores on the SADQ were significantly related to other measures of depression (r(s) = 0.22-0.52, p <0.05). A shortened 10-item version showed higher validity (r(s) = 0.32-0.67, p <0.01). Test-retest analysis indicated the SADQ is reliable over a four-week interval (r(s) = 0.72, p <0.001). CONCLUSIONS: The SADQ may be used for assessing depressed mood in aphasic patients in the community though further validation is required.

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PubMed1998

Rehabilitation needs of community stroke patients.

PURPOSE: The aim was to identify stroke patients not admitted to hospital, to assess their disabilities and the rehabilitation provided. METHOD: Stroke patients were notified by General Practitioners, assessed a month after stroke on measures of impairment and disability and the rehabilitation received was recorded. There were 124 patients notified and 93 assessed. RESULTS: Patients showed an average decline of 1.7 on the Barthel Index and 3.6 on the Extended Activities of Daily Living scale from before to after stroke. There were 27% with severe mobility problems and 47% with clinically relevant arm impairment. Many patients had cognitive impairment with only 9% having no deficit. Mood problems were less common with 26% anxious and 13% depressed. Significant stress occurred in 15% of carers. The provision of rehabilitation was low and there was poor correspondence between impairments and services provided. CONCLUSION: There is an unmet potential for rehabilitation in stroke patients not admitted to hospital.

Activities of Daily Living↗
PubMed1997

The scalability of the Rivermead Motor Assessment in nonacute stroke patients.

OBJECTIVE: To examine the scalability of the Rivermead Motor Assessment (RMA) with nonacute stroke patients in the community. DESIGN: This was a prospective study of the patients after discharge from hospital. All subjects were assessed on the RMA at six and 12 months after discharge home from hospital. Coefficients of scalability and reproducibility were calculated for each of the three sections of the RMA at each assessment. SUBJECTS: Subjects were nonacute stroke patients aged 65 years and over, nonacute stroke patients aged under 65 years, and a selected group of those aged under 65 years. RESULTS: Only the items in the gross function section met scaling criteria with nonacute strokes in both age groups, which suggests that the items in this section were in appropriate order of difficulty. The items in the leg and trunk section were not in hierarchical order and were in fact closer to scaling if the present order were reversed. CONCLUSIONS: The clinical and research value of the RMA, as an ordered scale, are questioned. Changes in treatment styles and philosophies may mean that some of the items themselves are out-dated.

Activities of Daily Living↗
PubMed1997

A randomized controlled trial of enhanced Social Service occupational therapy for stroke patients.

OBJECTIVE: To determine whether stroke patients referred to the Social Service occupational therapy service would benefit from an enhanced service compared to the usual service. DESIGN: Randomized controlled study allocating patients to the enhanced service or the usual service. SUBJECTS: Stroke patients discharged home from hospital and referred to Social Service occupational therapy department. OUTCOME MEASURES: The sections and total score from the Nottingham Extended Activities of Daily Living Scale (EADL), the Barthel Index, the General Health Questionnaire (GHQ) and the number of pieces of equipment provided were analysed. RESULTS: One hundred and eleven stroke patients were recruited to this study. Fifty-three were randomly allocated to the enhanced service and 58 to the usual service. Patients receiving the enhanced service were seen more quickly after referral, for longer, and received significantly more visits (p < 0.01) than those receiving the usual service. Three months after entry to the study the enhanced service group had better EADL (p < 0.01) than the usual service group. This benefit remained significant in only the mobility section of the EADL at six months. Careers of the stroke patients in the enhanced group had lower GHQ scores (p < 0.05) than those in the usual group at six months. CONCLUSIONS: This trial supports the use of domiciliary occupational therapy for stroke patients after discharge from hospital in terms of improvements in functional outcomes in the short term, but the long-term benefits remain unclear.

Activities of Daily Living↗
PubMed1997

Evaluation of cognitive behavioural treatment for depression after stroke: a pilot study.

OBJECTIVE: To evaluate cognitive behavioural therapy in the treatment of depressed stroke patients. DESIGN: A series of AB single case experimental design studies. SUBJECTS: Stroke patients who had been admitted to hospital. METHODS: Patients were identified from a hospital register of stroke patients and sent the Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale to determine whether they were depressed. Those who were depressed were sent the BDI weekly during a four-week baseline period. They were then treated and continued to complete the BDI weekly over a three-month treatment period. Patients were also assessed pre- and post-treatment on measures of functional independence. INTERVENTION: Cognitive behaviour therapy. RESULTS: Of the 626 patients on the Stroke Register, 373 returned questionnaires and 155 were identified as depressed. Of these 136 were visited and 19 agreed to take part. The outcome was evaluated using three methods: visual inspection, comparison of patients during baseline and treatment phases and proportion of scores below lowest baseline. This showed that four patients consistently showed beneficial treatment effects, six patients showed some benefit and nine no benefit. For the group as a whole there was a significant decrease in depression during the treatment period on the BDI (p = 0.02) but no significant change in functional abilities. CONCLUSION: Cognitive behavior therapy is an appropriate treatment for some depressed stroke patients and beneficial for some patients. Further evaluation of this treatment with stroke patients is warranted.

Adult↗
PubMed1997

Single blind randomized controlled trial of visual feedback after stroke: effects on stance symmetry and function.

A number of before and after and single case design studies of visual feedback have shown improvements in stance symmetry after stroke, an associated improvement in function has been demonstrated. This study examines this promising technique further using a single-blind controlled trial. Twenty-six patients were recruited from a register of consecutive admissions and randomized into treatment and control groups. Both groups received additional therapy, only the treatment group received visual feedback. Assessments were carried out independently. Significant improvements were seen in the treatment group in measures of stance symmetry and sway and motor and ADL function. Between group differences had disappeared at three months. The results indicate that feedback training incorporated into functional physiotherapy treatment can improve stance symmetry and sway. Transfer of training was indicated by improvements in ADL and gross motor function. Three months later the improvement was maintained, but did not automatically continue without treatment.

Activities of Daily Living↗
PubMed1997

Perceptual impairment and its impact on rehabilitation outcome. SUE Study Group.

The aim of the study was to investigate the effect of perceptual assessment and treatment provided on a stroke unit by comparison with that provided on health care of the elderly and general medical wards. Stroke patients admitted to hospital were randomly allocated to a stroke unit or conventional wards. Perceptual impairment was assessed on entry to the study and at 3, 6 and 12 months after randomization. Stroke unit patients show significantly less impairment of perceptual abilities at all stages after stroke. Perceptual impairment, as assessed using the Rey figure copy, was a significant predictor of outcome as assessed on the Barthel Index, Extended ADL scale and Rivermead Motor Assessment at 12 months after stroke.

Activities of Daily Living↗
PubMed1996

SORT: a validation study with stroke patients. Salford Objective Recognition Test.

The Salford Objective Recognition Test (SORT) was developed as a measure of recognition memory suitable for use with elderly people as it requires a shorter administration time than Warrington's Recognition Memory Test. Normative data for the SORT were collected from 50 normal elderly people living in the community. Fifty stroke patients were assessed on the SORT and other tests of psychological functioning. The words and faces subtests were found to correlate well with other measures of memory. The SORT was found to be uninfluenced by the effects of sex and time since onset of stroke, but was affected by language difficulties and perception problems. The split-half reliability of the test was found to be good as alternative versions of the subtests correlated well with each other.

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PubMed1996

Comparison of rehabilitation practice on hospital wards for stroke patients.

BACKGROUND AND PURPOSE: The aim of the study was to observe patients on a stroke unit and to compare their activity with that of patients on conventional hospital wards to identify aspects of rehabilitation practice that might account for differences in outcome. METHODS: Stroke patients admitted to the hospital were observed on three 8-hour shifts over 3 consecutive days. An observer recorded, at 10-minute intervals, where patients were, what they were doing, and whether their positioning was as recommended by rehabilitation therapists. Patients on a stroke unit were compared with those on conventional wards. RESULTS: Stroke unit patients spent less time by their beds and more time in other locations on the ward (P < .001). There were significant differences in the frequency of behaviors observed in the two types of ward (P < .001). Stroke unit patients had significantly more interaction with nurses and therapists (P < .001). They were also more often in the recommended position (P < .001). CONCLUSIONS: The proportion of time in therapeutic activity was low in all locations, with patients spending many hours sitting and doing nothing. Despite this, stroke unit patients had more therapeutic contact with staff and were more often in the recommended position. These two features may account for some of the differences in outcome.

Activities of Daily Living↗
PubMed1996

Effect of long-term glycemic control on cognitive function.

OBJECTIVE: To investigate the relationship between recurrent hypoglycemia and cognitive impairment in insulin-dependent diabetic patients. RESEARCH DESIGN AND METHODS: Seventy patients who were diagnosed as diabetic at age 18 years or older, were under 55 years old, and had no condition likely to affect cognitive abilities were recruited from a diabetic register. Patients were interviewed to obtain information on the frequency of major and minor hypoglycemia. Their cognitive abilities were assessed on tests of premorbid intelligence, current intelligence, reaction time, concentration, memory, and information processing. RESULTS: There was a significant correlation between the apparent decline in intelligence, expressed as the discrepancy between the estimated premorbid and the actual performance intelligence quotient, and the frequency of major hypoglycemic attacks (rs = -0.30; P < 0.01). Comparison of patients with and without recurrent hypoglycemia showed few significant differences in cognitive ability. CONCLUSIONS: Results support previous work that suggests that major hypoglycemic attacks have a significant effect on some aspects of cognitive function, but the clinical importance of this finding remains to be determined.

Adult↗
PubMed1994

Follow-up of a controlled trial of domiciliary stroke rehabilitation (DOMINO Study).

The DOMINO study compared domiciliary and hospital-based rehabilitation services for stroke patients after discharge from hospital, stratified by the hospital ward at discharge. No difference between the services had been found at 6 months, but home therapy was better than outpatient department therapy at improving household ability and leisure activity in the patients discharged from the Stroke Unit (SU), and attendance at a day hospital may have been better than a domiciliary service at preventing death or institutionalization for patients discharged from Health Care of the Elderly (HCE) wards. We report the follow-up of the patients between 6 months and 1 year after discharge, during which time few patients received further treatment and little change in health or function occurred. Over this period the benefits of domiciliary rehabilitation in the SU group were lost, largely because the patients who had been treated in outpatient departments continued to improve. Between 6 months and 1 year the numbers of HCE patients in the two treatment groups who died or were institutionalized were similar, but the advantage of day hospital attendance was still evident at 1 year.

Activities of Daily Living↗
PubMed1993

Use of the extended ADL scale with stroke patients.

The Extended ADL scale is a postal measure of Instrumental ADL ability, comprising sub-scales for mobility, household ability and leisure activity. Its validity was examined in 303 stroke patients who had participated in a rehabilitation study. Adequate Guttman scales were found in the mobility scale, an adjusted household scale and, in women, the leisure scale. Extended ADL scores at 6 months after discharge from hospital were independently predicted by the Barthel ADL score at discharge from hospital, the age of the patient, previous mobility, time spent in hospital for the stroke, the abbreviated mental test score at discharge and whether the patient was living alone or not. Extended ADL scores discriminated between patients in institutions and at home. In patients at home, the Extended ADL scores were lower in those who received social and nursing services than in those who did not. Death or institutionalization over the 6 months was uncommon in patients with high Extended ADL scores. These data support the validity of the Extended ADL scale and confirm it to be a useful measure of outcome in stroke research.

Activities of Daily Living↗
PubMed1993

A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital.

This study compared the functional ability and perceived health status of stroke patients treated by a domiciliary rehabilitation team or by routine hospital-based services after discharge from hospital. Patients discharged from two acute and three rehabilitation hospitals in Nottingham were randomly allocated in three strata (Health Care of the Elderly, General Medical and Stroke Unit) to receive domiciliary or hospital-based care after discharge. Functional recovery was assessed by the Extended Activities of Daily Living (ADL) scale three and six months after discharge and perceived health at six months was measured by the Nottingham Health Profile. A total of 327 eligible patients of 1119 on a register of acute stroke admissions were recruited over 16 months. Overall there were no differences between the groups in their Extended ADL scores at three or six months, or their Nottingham Health Profile scores at six months. In the Stroke Unit stratum, patients treated by the domiciliary team had higher household (p = 0.02) and leisure activity (p = 0.04) scores at six months than those receiving routine care. In the Health Care of the Elderly stratum, death or a move into long-term institutional care at six months occurred less frequently in patients allocated to the routine service, about half of whom attended a geriatric day hospital. Overall there was no difference in the effectiveness of the domiciliary and hospital-based services, although younger stroke unit patients appeared to do better with home therapy while some frail elderly patients might have benefited from day hospital attendance.

Activities of Daily Living↗
PubMed1992

Stroke rehabilitation.

Stroke produces impairments, disabilities and handicap. At each level attention may be directed at methods of assessment, monitoring or predicting outcome, and evaluating effects of treatment. There has been a change in emphasis from impairment to disability and handicap. The most informative research has been directed at evaluating rehabilitation effectiveness.

Activities of Daily Living↗
PubMed1991

Use of the Indented Paragraph test with right hemisphere-damaged stroke patients.

The Indented Paragraph reading test has been presented as a useful screening test for identifying hemispatial neglect, as it has been reported to be more sensitive to mild neglect than text with a predictable format (Caplan, 1987). The number of errors made by 42 right hemisphere-damaged stroke subjects on this test was compared with their performance on text with straight margins and unpredictable text, where both right and left margins were irregularly indented. The inter-rater reliability of the paragraphs was checked for 23 subjects. The scores from the three paragraphs were significantly correlated, and all were able to detect mild neglect. Inter-rater reliability was higher when identifying moderate and severe levels of neglect than mild neglect. Performance on the Indented Paragraph was also compared with that on the Star Cancellation and Article Reading subtests of the Behavioural Inattention Test in a separate group of 56 right hemisphere stroke subjects and found to classify patients differently.

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