PubMed · 7478341
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P Friedman. 1995-10-13. Stroke rehabilitation.. https://pubmed.ncbi.nlm.nih.gov/7478341/
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To confirm concurrent validity of the final revision of the self-rating Barthel index (SB) and its test-retest reliability, we investigated 171 stroke outpatients without severe aphasia or dementia who were seen by a doctor on predetermined days at eight different hospitals. For 41 patients, the differences in scores among the original Barthel index (BI) and Granger's BI and SB were examined by the Friedman two-way analysis of variance and Wilcoxon matched-pairs signed-ranks test, and the difference in scores between Functional Independence Measure motor score (FIM-MS) and three-level scale FIM-MS was determined by the Wilcoxon's matched-pairs signed-ranks test. Concurrent validity of the SB was confirmed by Spearman's correlation coefficients with the original BI and FIM-MS, and internal consistency of the five measuring instruments was examined. For all 171 patients test-retest reliability of the SB was examined with the Spearman's correlation coefficient for total scores and kappa coefficients for each ADL item. Regression analysis was performed to determine what factors were related with test-retest reliability. Total scores of the SB and Granger's BI and the three-level scale FIM-MS were significantly higher than those of the original BI and FIM-MS, respectively. Correlation coefficients of the SB with the original BI and FIM-MS were 0.994 and 0.904, respectively, and its alpha-coefficient was 0.842. Test-retest reliability of the total score was 0.835 by the correlation coefficient, and kappa coefficients of 1 and 12 ADL items were fair and good, respectively. Regression analysis revealed that self-rating by a patient with a high SB total score is more accurate. Therefore, the SB has good concurrent validity and is well-related with the original BI and FIM, and its test-retest reliability is sufficiently high for practical use.
BACKGROUND: Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies. METHODS: We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery. RESULTS: Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P=0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P=0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients. CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.
OBJECTIVE: To determine the relative risk of myocardial ischemia triggered by specific emotions during daily life. DESIGN AND SETTING: Relative risk was calculated by the recently developed case-crossover method, in which the frequency of a presumed trigger during nonischemic, or control, hours is compared with the trigger's frequency during ischemic, or case, hours. Outpatients at Duke University Medical Center, Durham, NC, underwent 48 hours of ambulatory electrocardiographic (ECG) monitoring with concurrent self-report measures of activities and emotions. Occurrences of negative emotions in the hour before the onset of myocardial ischemia were compared with their usual frequency based on all hours in which ischemia did not occur. SUBJECTS: From a sample of 132 patients with coronary artery disease and recent evidence of exercise-induced ischemia who underwent 48 hours of ambulatory ECG monitoring, 58 patients exhibited ambulatory ischemia and were included in the analysis. OUTCOME MEASURES: Myocardial ischemia during 48-hour ECG monitoring was defined as horizontal or downsloping ST-segment depression of 1 mm (0.1 mV) or more for 1 minute or longer compared with resting baseline. The ECG data were cross-tabulated with subjects' concurrent diary ratings of 3 negative emotions-tension, sadness, and frustration-and 2 positive emotions-happiness and feeling in contro-on a 5-point scale of intensity. RESULTS: The unadjusted relative risk of occurrence of myocardial ischemia in the hour following high levels of negative emotions was 3.0 (95% confidence interval [CI], 1.5-5.9; P<.01) for tension, 2.9 (95% CI, 1.0-8.0; P<.05) for sadness, and 2.6 (95% CI, 1.3-5.1; P<.01) for frustration. The corresponding risk ratios adjusted for physical activity and time of day were 2.2 (95% CI, 1.1 -4.5; P<.05) for tension, 2.2 (95% CI, 0.7-6.4; P=.16) for sadness, and 2.2 (95% CI, 1.1-4.3; P<.05) for frustration. CONCLUSIONS: Mental stress during daily life, including reported feelings of tension, frustration, and sadness, can more than double the risk of myocardial ischemia in the subsequent hour. The clinical significance of mental stress-induced ischemia during daily life needs to be further evaluated.