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PubMed1999

The effects of metrifonate on the cognitive, behavioral, and functional performance of Alzheimer's disease patients. Metrifonate Study Group.

BACKGROUND: The objective of this study was to evaluate the efficacy and safety of metrifonate, a long-acting acetylcholinesterase inhibitor, in patients clinically diagnosed with probable Alzheimer's disease of mild-to-moderate severity. METHOD: This was a prospective, multicenter, 26-week, double-blind, parallel group study. The 264 randomized patients met diagnostic criteria of the National Institute of Neurological and Communicative Diseases and Stroke and the Alzheimer's Disease and Related Disorders Association for probable Alzheimer's disease. Patients had Mini-Mental State Examination (MMSE) scores of 10-26 and ischemic scores (Rosen modification) of <4. Metrifonate-treated patients received a single 50-mg dose once daily. The efficacy of metrifonate was investigated with respect to 3 symptom domains. Cognitive performance was analyzed using the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and the MMSE. Psychiatric and behavioral disturbances were analyzed using the Neuropsychiatric Inventory (NPI) and the ADAS-Noncognitive subscale (ADAS-Noncog). The ability to perform instrumental and basic activities of daily living was evaluated using the Disability Assessment for Dementia (DAD) scale. Additionally, global state was assessed using the Clinician Interview-Based Impression of Change with Caregiver Input (CIBIC-Plus) scale. RESULTS: After 26 weeks of metrifonate therapy, a statistically significant benefit of metrifonate was observed in the cognitive performance of Alzheimer's disease patients (ADAS-Cog, t = 2.55, df = 237, p = .012; MMSE, t = 4.60, df = 237, p = .0001). Metrifonate also significantly attenuated the deterioration in activities of daily living of the patients (DAD total score, t = -2.11, df = 233, p = .036) and relieved patients' psychiatric and behavioral disturbances (NPI total score, t = 2.51, df = 233, p = .013). In addition, metrifonate significantly improved the scores for the global state of the patients (CIBIC-Plus, t = 2.07, df = 232, p = .039). Metrifonate was well tolerated; adverse events were predominantly mild in intensity, and no hepatotoxicity was observed. CONCLUSION: In this study, metrifonate was safe and well tolerated. It benefited the cognitive decline, psychiatric and behavioral disturbances, impaired ability to perform instrumental and basic activities of daily living, and global state of patients diagnosed with mild-to-moderate Alzheimer's disease.

Activities of Daily Living↗
PubMed2000

Naturalistic assessment of functional performance in school settings: reliability and validity of the School AMPS scales.

The School Assessment of Motor and Process Skills (School AMPS) is an assessment tool designed to be used by occupational therapists to measure the effectiveness of a student's ability to perform school tasks in naturalistic classroom settings. Rater reliability, internal scale validity, and person response validity of the School AMPS was investigated by examining the goodness-of-fit of raters, motor and process skill items, and students to the many-faceted Rasch model used in the development of the School AMPS. Five of six raters demonstrated acceptable goodness-of-fit (MnSq < or = 1.4 and z < 2). All 36 motor and process skill items demonstrated acceptable goodness-of-fit. Of the 208 students in the study, 93.7% demonstrated acceptable goodness-of-fit on the School AMPS motor scale and 88.9% demonstrated acceptable goodness-of-fit on the School AMPS process scale. The results of this study support the rater reliability, scale validity, and person response validity for the School AMPS as a tool to be used to evaluate the effectiveness of student performance of school tasks in the classroom setting.

Activities of Daily Living↗
PubMed2002

The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis.

Osteoarthritis (OA) is a common chronic and progressive degenerative joint condition. A major consequence of knee OA is physical disability; especially difficulty with activities requiring ambulation and transfer, which are necessary to maintain independence and a good quality of life. The purposes of this study were to determine the efficacy of a muscle exercise program along with education about knee care, and investigate the clinical factors which influence its therapeutic efficacy. A prospective study was carried out among elderly Thai people aged 60 years and over, living in an urban community of the Bangkok metropolitan area around Siriraj Hospital, between October 1997 and September 1999. The number of elderly people with osteoarthritis of the knee was 392 (male:female=86:306) with a mean age of 67.7+/-6 years. They were interviewed for demographic data and information about their symptoms. The range of the knee movement, quadriceps strength and the six-minute walking distance and a knee X-ray were evaluated. Group exercise was arranged twice a week for 8 weeks for the intervention group only. The results of the study revealed that the quadriceps strength in the intervention group had a tendency to increase and the walking distance was significantly improved especially in the first two months but there was a tendency to decline by the sixth and twelfth month after enrollment. On the other hand, there was no statistically significant difference of both important outcomes for the control group when assessed in the second month. The findings at the sixth and twelfth month after enrollment were that the quadriceps strength was slightly increased but the walking distance was decreased when compared with the initial assessment. An exercise frequency of 12 sessions in two months was sufficient to improve muscle strength and walking distance. Group exercise produces a significant improvement in strength and walking ability, especially in the first two months. Deterioration over time could be due to multiple factors, such as lack of regular exercise, lack of motivation, lack of family support or poor economic status, so we should encourage the elderly to exercise regularly.

Aged↗
PubMed2001

Occupational-psychosocial perceptions influencing return to work and functional performance of injured workers.

Much has been done to identify psychosocial factors influencing risk of vocational injury and prolonged disability. The purpose of this paper is to enhance the ability of injured workers to return to their prior worker role through the identification of the influencing psychosocial perceptions. Psychosocial perceptions may assist in the identification of negative or counterproductive factors that hinder the rehabilitative process. Identifying perceptions are individual centered and focused on the views of injured workers as they proceed through the transition in life following injury. Occupational therapists play a key role in the rehabilitative process of injured workers through enhancing the person-job-environment fit [4].

Journal Article↗
PubMed1990

Rehabilitation of chronic stroke patients: changes in functional performance.

Forty stroke patients who were at least one year post-onset completed a one-month intensive rehabilitation program. The month before the program served as a control period. During the program, patients received individual sessions in occupational and physical therapy four days a week, and they participated in group activities on the fifth day. Therapy emphasized instruction in motor planning, balance and weight shift, and the use of adaptive equipment; these motor abilities were then practiced within real life situations. The patients demonstrated significant improvement in the outcome measures of weight shift, balance, and ADL scores after the one-month rehabilitation program (weight shift: F = 16.1, p = .0001; balance: F = 6.26, p = .0007; ADL: F = 13.8, p = .0001). They retained these new skills during a three-month follow-up period.

Activities of Daily Living↗
PubMed1990

[Ergometric assessment of functional performance deficit in psychosomatic patients].

Patients with marked loss of physical and psychological fitness and cardiovascular symptoms without objective findings often pose diagnostic problems. Fifteen patients hospitalized for general incapacity with normal cardiovascular findings were tested in the ECG laboratory on a conventional bicycle ergometer and in a more natural environment climbing stairs in a windowed staircase. Work capacity in the two tests was compared. Eight out of fifteen patients achieved only 40% of their age and weight adjusted nominal value on the bicycle ergometer, while they were fully efficient on the staircase (= discordant result). Four patients reached their expected nominal values in both tests. The performance of three patients was much lower than expected, more markedly so in the laboratory situation on the bicycle. All patients' performance was limited by central nervous incapacitating cardiovascular symptoms. Diagnosis of psychosomatic situational cardiovascular insufficiency in the absence of pathological findings can be substantiated by comparing exercise tests in a physiological and non-physiological environment. This is helpful to both patient and physician by facilitating a more precise diagnostic process and documentation of therapeutic improvement.

Adult↗