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PubMed2001

Predicting ambulatory function following lower extremity trauma using the functional capacity index.

This study evaluated the accuracy of experts' predictions of ambulatory function following lower extremity trauma using the Functional capacity index (FCI). Data from three orthopedic trauma studies designed to determine long-term function following specific types of lower extremity injuries were used to examine the extent of agreement between the reported and predicted ambulatory function of 921 subjects. Functional limitations reported by the cohort using a generalized health status measure and more detailed questions on lower extremity function were compared with those predicted by experts based on the injuries sustained. The overall agreement between predicted and self-reported FCI function for ambulation was relatively low (31%). In the majority of cases (80%), the disagreement differed by one functional level. Subjects were more likely to report worse function than predicted by the experts. Multivariate modeling identified different injuries, combinations of injuries, and patient characteristics that significantly influenced agreement. For example, subjects who sustained both a tibia and a femur fracture were three times more likely than subjects who did not sustain either fracture type to report poorer ambulatory function than predicted. Many challenges are faced in predicting long-term function following trauma. More empirical data are needed to inform the process. These data suggest that until the FCI can more accurately predict long-term ambulatory function following different lower extremity injuries, it should not be used for this purpose.

Activities of Daily Living↗

PubMedDate not supplied

[The role of exercise testing in evaluation of functional capacity at patients with ischemic ventricular dysfunction].

UNLABELLED: The assessment of functional capacity represents an important parameter in the prognostic stratification of patients with heart failure. The objective of the paper is the testing of exercise capacity at patients with ischemic ventricular dysfunction. METHODS: There have been selected 80 patients with coronary heart disease (old myocardial infarction, angina pectoris, ischemic cardiomiopathy) admitted in the Department of Internal Medicine, Rehabilitation Hospital, Iasi, during 1.01.1998-31.12.1999. They were divided into two groups: group A (46 patients) with proper ventricular function and ejection fraction (EF) above 50% and group B (34 patients) with EF under 50%. They underwent exercise testing at the ergometric bicycle. RESULTS: Patients of group B had higher values of resting heart rate (74 +/- 9 vs 70 +/- 11, p = 0.04). There were registered similar levels at the maximal exercise at both groups (time-tension index, watt, MET). The evolution of the group with ventricular dysfunction is distinguished by a lower length of time of exercise (8.6 +/- 4.4 vs 9.8 +/- 5.2 min, p = 0.05) and by a significantly greater value of the ST depression (1.6 +/- 1.4 vs 0.9 +/- 1.1 mm, p = 0.01). DISCUSSION AND CONCLUSIONS: The higher resting heart rate at patients with heart failure suggests the activation of neuroumoral mechanisms, especially the adrenergic activation. These patients reach maximal levels similar to those with good systolic function but in a shorter length of time, due to a physical deconditioning or to the same neuroumoral mechanisms. Ischemia is higher at these patients.

Adult↗

PubMed2026

Large-scale proteomics profiling of peripheral blood of DM1 patients identifies biomarkers for disease severity and functional capacity.

BackgroundMyotonic Dystrophy Type 1 (DM1), the most common genetic neuromuscular disorder in adults, poses significant challenges for drug development due to its multisystem nature and high clinical variability in symptoms and disease progression. With a growing number of therapies entering clinical trials, this study addresses the urgent need for biomarkers that can serve as surrogate endpoints.MethodsWe profiled 437 serum samples from adult DM1 patients collected at two timepoints of the OPTIMISTIC trial using bottom-up mass spectrometry with data-independent acquisition. Associations between protein expression, the disease-causing CTG-repeat and 25 clinical outcome measures were studied using linear mixed-effect models. All key study findings were validated in an independent cohort of 69 DM1 patients and 10 healthy controls.ResultsOf the 259 identified proteins, 161 showed significant associations with the CTG-repeat length (FDR < 5%). Hypogammaglobulinemia was confirmed and shown to be worse in severely affected patients. A strong proteomic signature was associated with clinical measures of functional capacity, with the 6-Minute Walk Test showing the strongest signal (70 associations, FDR < 5%). These novel associations reveal a compelling link between chronic inflammation and reduced functional capacity. A machine learning algorithm identified a minimal set of 13 proteins robustly reflecting both the underlying genetic defect and functional capacity.ConclusionsDM1 induces a broad disease fingerprint in the serum proteome, predominantly affecting proteins of the immune system. A carefully selected panel of proteins showed the greatest potential to meet the statistical criteria required for surrogate endpoints in clinical trials.

Humans↗

PubMedDate not supplied

[Is the age a limiting factor of functional capacity and cardiac performance in patients with chronic myocardial infarction ?].

UNLABELLED: Actually the old age is not considered a contra-indication of cardiac rehabilitation, although it influences the prognosis of patients with chronic myocardial infarction. The objective of the paper is the study of age as a limiting factor of the cardiac performance and exercise capacity at patients with myocardial infarction at the admission in rehabilitation programmes. METHODS: Among the patients admitted in the Department of Internal Medicine of Rehabilitation Hospital of Iasi there were selected 132 with chronic myocardial infarction; they were divided into two groups: group A of 56 patients more than 55 years old and group B of 76 under 55. There were analysed the clinical features (risk factors, symptoms), the cardiac performance (by echographic study of the regional and global abnormalities of myocardial contractility) and the functional capacity (by exercise testing at the ergometric bicycle). RESULTS: Both groups were similar by the point of view of the prevalence of the risk factors and location of the infarction. The ejection fraction, although smaller at the group A (45% vs 50%), did not reach the statistical significance. The exercise testing revealed a lower capacity of the group A, marked by higher levels of the cardiac rate and time-tension index at similar levels of exercise. The metabolic equivalent (MET) and VO2max were significantly lower (p = 0.001 respectively 0.002). There can be concluded that the age diminishes the exercise capacity of the patients with myocardial infarction without a marked influence of the cardiac performance. The last one depends on the infarction size and the myocardial status while the lowering of the functional capacity is influenced by noncardiac factors as well.

Age Factors↗

PubMed2007

Functional capacity after traditional Chinese medicine (qi gong) training in patients with chronic atrial fibrillation: a randomized controlled trial.

Evidence indicates that low energy expenditure protocols derived from traditional Chinese medicine may benefit patients with cardiac impairment; therefore, the authors carried out a randomized controlled trial to test a 16-week medically assisted qi gong training program for the physical rehabilitation of patients with stable chronic atrial fibrillation and preserved left ventricular function. Functional capacity variation was evaluated using the 6-minute walk test, which was performed at baseline, at the end of the intervention, and after 16 weeks. Thirty men and 13 women (mean age, 68+/-8 years) were randomized to the intervention protocol or to a wait-list control group. Qi gong training was well tolerated and, compared with baseline, trained patients walked an average 114 meters more (27%) at the end of treatment (P<.001) and 57 meters more (13.7%) 16 weeks later (P=.008). Control subjects showed no variation in functional capacity. These results seem promising and deserve confirmation with further research.

Aged↗

PubMed2003

Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery.

OBJECTIVE: Improvement in survival and quality of life are the primary indications for coronary artery bypass graft (CABG) operations. Among elderly patients the main goal of surgery is not necessarily to prolong life, but to improve the health-related quality of life. Factors associated with mortality and morbidity following CABG surgery have been well defined, but the quality of life and functional capacity in elderly patients undergoing CABG are poorly documented. The aim here was to investigate changes in health-related quality of life, overall performance status and symptomatic status during 1 year after CABG surgery. METHODS: Comprehensive data on 508 CABG patients were prospectively collected, including preoperative risk factors and postoperative morbidity in a surgical center and in all eighteen secondary referral hospitals up to discharge. The RAND-36 Health Survey (RAND-36) was used as indicator of quality of life. The primary outcome was change in the physical component summary, mental component summary and General Health summary scores from the RAND-36. Karnofsky dependency category was used to assess overall performance status, and symptomatic status was estimated according to New York Heart Association (NYHA) class. All assessments were made preoperatively and repeated 12 months later. Analysis was based on three age groups: 64 years or less (282 patients), 65-74 years (175 patients), and 75 or more years (51 patients). RESULTS: Thirty-day and 1-year survival rates were 98.2 and 96.7%, respectively. A great majority (86.4%) of the patients recovered without major complication. In all, the present data showed significant improvement in all eight domains of QOL as well as in functional capacity and NYHA class during the 1st year after CABG. However, the mean change in RAND-36 Mental Component Summary scores among patients aged 75 years or more did not reach a statistically significant level (P=0.097) and they had significantly minor improvement as compared to younger patients (P<0.05). Moreover, their General Health score improvement was poorer and statistically insignificant (P=0.817). CONCLUSIONS: Elderly patients not only have higher mortality and morbidity but also derive less benefit from CABG regarding certain aspects of QOL.

Adult↗

PubMed1997

Mass and functional capacity of regenerating muscle is enhanced by myoblast transfer.

Morphology and functional capacity of homotopically transplanted extensor digitorum longus muscles (EDL) of adult SCID mice that received 1 x 10(6) myoblasts [stably transfected to express nuclear localizing beta-galactosidase under the control of the myosin light-chain 3F promoter/enhancer] 2 days posttransplantation were evaluated 9 weeks after transplantation, to determine whether the injection of exogenous myoblasts had an effect on muscle regeneration. Regenerated muscles that received exogenous myoblasts were compared to similarly transplanted muscles that received (a) no further treatment, or (b) sham injection of the vehicle (without myoblasts) and to unoperated EDL. Nine weeks after myoblast transfer, myofibers containing donor-derived nuclei could be identified after staining with X-gal solution. Judging from its size and poor functional performance compared to muscles subjected to transplantation only, sham injection provided a secondary trauma to the regenerating muscle from which it failed to fully recover. In comparison to the sham-injected muscle, the myoblast-injected muscles weighed 61% more and had 50% more myofibers and 82% more cross-sectional area occupied by myofibers at the muscles' widest girths. Their absolute twitch and tetanic tensions were threefold and twofold greater, respectively, and their specific twitch and tetanic tensions were 71% and 50% greater, respectively, than those of sham-injected muscles. In many parameters, the regenerating muscle subjected to myoblast transfer equaled or exceeded those of muscles that were transplanted only (received only one trauma). Absolute twitch and tetanic tensions were 73% and 65% greater, respectively, and specific twitch tensions of the muscles receiving myoblasts were 50% greater than forces generated by muscles subjected to whole-muscle transplantation only.

Animals↗

PubMed1994

Influence of beta-blockade with metoprolol on symptoms and functional capacity of patients with idiopathic dilated cardiomyopathy.

Long-term treatment with beta-adrenergic blocking drugs has been shown to induce clinical amelioration in patients with chronic heart failure. However, the efficacy of these agents has not been consistent, and the mechanisms of their beneficial effects remain to be established. The present study evaluated the influence of oral metoprolol on symptoms and exercise tolerance of patients with idiopathic dilated cardiomyopathy (3 women and 9 men, left ventricular ejection fraction < 0.45, NYHA functional class II or III). One patient did not tolerate metoprolol, whereas 11 patients terminated the study. After 6 months of beta-blocking therapy, detectable improvements of symptoms (NYHA class and questionnaire-derived symptom score) were observed in 6 patients. Six patients reported an increase in functional capacity [oxygen consumption at peak exercise (VO2p) during cardiopulmonary exercise test]. For the whole group, no significant changes in symptoms and exercise tolerance were detected. During exercise, oxygen pulse (VO2/heart rate) and VO2/RPP (VO2/heart rate/systolic pressure) were significantly increased after 6 months on metoprolol (+35, 9% and +27.1%, respectively; both p < 0.01 vs baseline). In conclusion, beta-blocking therapy was well tolerated by the majority of patients, some of which reported improvement of symptoms and functional capacity. The observed increase on oxygen pulse and Vo2/RPP suggests that beta-blockade may reduce myocardial oxygen requirements in proportion to cardiac work. An increase in the energy available to myocardial cells for synthetic and reparative processes may thus account, at least in part, for the beneficial influence of long-term beta-blockade in heart failure patients.

Adult↗

PubMed2006

Development and validation of a short-form functional capacity evaluation for use in claimants with low back disorders.

OBJECTIVES: Functional Capacity Evaluations (FCE) are used for making return-to-work decisions, yet FCE's modest predictive ability is currently outweighed by the administrative burden of testing. We attempted to develop a short-form FCE while maintaining comparable predictive ability. METHODS: Three databases previously created for evaluating FCE predictive validity were used. Subjects were compensation claimants with low back disorders. FCE measures included items in the Isernhagen Work Systems' FCE. Days until benefit suspension served as an indicator of return-to-work. Analysis included Cox regression. RESULTS: Three items, floor-to-waist lift, crouching, and standing, were maintained in the short-form FCE. The short-form FCE was found to predict comparably to the entire FCE protocol in two validation cohorts (R (2) difference<3%). Subjects meeting job demands on all three items consistently experienced faster benefit suspension. CONCLUSION: A short-form FCE for determining future work status in claimants with low back disorders was developed. A substantially abbreviated FCE may offer an efficient alternative.

Canada↗

PubMed2004

Practical aspects of functional capacity evaluations.

Physicians, employers, insurers, and benefits adjudicators often rely upon functional capacity evaluations (FCEs) to determine musculoskeletal capacity to perform physical work, often with legal or occupational consequences. Despite their widespread application for several decades, a number of scientific, legal, and practical concerns persist. FCEs are based upon a theoretical model of comparing job demands to worker capabilities. Validity of FCE results is optimal with accurate job simulation and detailed, intensive assessments of specific work activities. When test criteria are unrelated to job performance, or subjective evaluation criteria are employed, the validity of results is questionable. Reliability within a subject over time may be adequate to support the use of serial FCE data collection to measure progress in worker rehabilitation. Evaluation of sincerity of effort, ability to perform complex or variable jobs, and prediction of injury based upon FCE data is problematic. More research, especially studies linking FCE results to occupational outcomes, is needed to better define the appropriate role for these evaluations in clinical and administrative settings.

Humans↗

PubMed2004

Functional capacity evaluations as a post-offer employment: a case study.

Functional capacity evaluations in the post-offer phase of employment has the capacity to minimize work related injuries and promote wellness on the worksite. This paper includes a discussion of the value of post-offer evaluations and possible assessment options. To investigate the feasibility of administering post-offer evaluations, a case study was initiated. The Physical Work Performance Evaluation (PWPE) was administered to a new employee, VA, who was employed for the task of kneading dough, at a major food company. When compared to detailed work demands, there was no match between the job demands, and the client's capability in two sub-tests: lift from waist to eye level and trunk rotation. Based upon findings, recommendations for an initial graded work schedule, basic strengthening exercises, and modifications of the job site and task were made to the employer. The project was initiated with the hope of raising employee's and employer's awareness of workers health issues in the post-offer phase as it express itself in post-offer evaluation that aims to prevent musculoskeletal problems. This article aims to expand occupational therapists' awareness to the potential benefits of such a process.

Employment↗

PubMed2004

Effects of whole-body exercise training on body composition and functional capacity in normal-weight patients with COPD.

BACKGROUND: Skeletal muscle wasting is related to muscle dysfunction, exercise intolerance, and increased mortality risk in patients with COPD. STUDY OBJECTIVES: The aims of this study were to investigate the effects of whole-body exercise training on body composition in normal-weight patients with COPD, and to study the relationship between changes in body composition and functional capacity. SETTING AND PARTICIPANTS: Fifty patients with COPD (FEV(1), 39% of predicted [SD, 16]) admitted to the pulmonary rehabilitation center at Hornerheide, and 36 healthy age-matched control subjects (for baseline comparison) were included. INTERVENTIONS: Patients participated in a standardized inpatient exercise training program consisting of daily submaximal cycle ergometry, treadmill walking, weight training, and gymnastics during 8 weeks. MEASUREMENTS: Fat-free mass (FFM) was measured by bioelectrical impedance analysis. None of the patients met the criteria for nutritional supplementation (body mass index </= 21, or FFM index </= 15 kg/m(2) in women and </= 16 kg/m(2) in men). Exercise capacity was measured using incremental cycle ergometry. Isokinetic quadriceps strength was measured with a Biodex dynamometer (Biodex Medical Corporation; Shirley, NY). RESULTS: At baseline, patients were characterized by a significantly lower FFM than the control subjects. Age and FFM were independent predictors of skeletal muscle function and exercise capacity in patients. After rehabilitation, weight (72.4 +/- 9.8 to 73.0 +/- 9.4 kg, p < 0.05) significantly increased, as a result of increased FFM (52.4 +/- 7.3 to 53.4 +/- 7.7 kg, p < 0.05), while fat mass (20.0 +/- 6.1 to 19.6 +/- 5.7 kg) tended to decrease. Peak work rate (63 +/- 29 to 84 +/- 42 W, p < 0.001), maximal oxygen consumption (O(2)max) [1,028 +/- 307 to 1,229 +/- 421 mL/min, p < 0.001], and isokinetic quadriceps strength (82.5 +/- 36.4 to 90.3 +/- 34.9 Newton-meters, p < 0.05) all improved. Changes in FFM were proportionally smaller than functional improvements, and were related to changes in O(2)max (r = 0.361, p < 0.05), but not to other changes in functional capacity. CONCLUSIONS: Intensive exercise training per se is able to induce an anabolic response in normal-weight patients with COPD classified into Global Initiative for Chronic Obstructive Lung Disease stages III-IV. Improvements in exercise performance and muscle function are proportionally larger than increases in FFM.

Aged↗

PubMed1979

Surface properties and in vitro functional capacities of human T lymphocyte subsets separated by linear density gradients.

Human lymphocytes derived from various central and peripheral sources were separated on linear density gradients (LDG). Cells from individual density fractions were tested in parallel for: the capacity to form nonimmune rosettes with neuraminidase-treated SRBC, the number of surface-associated HTLA, and in vitro proliferative responses to mitogenic lectins and alloantigens. Heterogeneous density distribution profiles were obtained for all sources of human T cells and revealed an organ specificity. The various T cell density classes obtained from identical organs as well as the identical density classes of different sources revealed to some extent differences in their surface marker patterns and/or their in vitro reactivities. On the basis of the combined techniques at least two major subsets among thymocytes were identified that differed in both surface properties and functional capacities. Density classes of T cells from all peripheral sources were distinguished from thymocytes by a homogeneous lowered HTLA expression. Whereas clear-cut differences in the in vitro functional capacity were observed between the two thymocyte subsets, less striking but still significant differences were found to exist among the various density classes of peripheral T cells.

Animals↗

PubMed2006

Does functional capacity evaluation predict recovery in workers' compensation claimants with upper extremity disorders?

OBJECTIVES: Functional capacity evaluations (FCEs) are commonly used to determine return-to-work readiness and guide decision making following work related injury, yet little is known of their validity. The authors examined performance on the Isernhagen Work Systems' FCE as a predictor of timely and sustained recovery in workers' compensation claimants with upper extremity disorders. A secondary objective was to determine whether FCE is more predictive in claimants with specific injuries (that is, fracture) as compared to less specific, pain mediated disorders (that is, myofascial pain). METHODS: The authors performed a longitudinal study of 336 claimants with upper extremity disorders undergoing FCE. FCE indicators were maximum performance during handgrip and lift testing, and the number of tasks where performance was rated below required job demands. Outcomes investigated were days receiving time-loss benefits (a surrogate of return to work or work readiness) in the year following FCE, days until claim closure, and future recurrence defined as whether benefits restarted, the claim reopened, or a new upper extremity claim was filed. Cox and logistic regression were used to determine the prognostic effect of FCE crudely and after controlling for potential confounders. Analysis was performed separately on claimants with specific and pain mediated disorders. RESULTS: Most subjects (95%) experienced time-loss benefit suspension within one year following FCE. The one year recurrence rate was 39%. Higher lifting performance was associated with faster benefit suspension and claim closure, but explained little variation in these outcomes (r2 = 1.2-11%). No FCE indicators were associated with future recurrence after controlling for confounders. Results were similar between specific injury and less specific groups. CONCLUSIONS: Better FCE performance was a weak predictor of faster benefit suspension, and was unrelated to sustained recovery. FCE was no more predictive in claimants with specific pathology and injury than in those with more ambiguous, pain mediated conditions.

Accidents, Occupational↗

PubMed2002

Variable product purity and functional capacity after CD34 selection: a direct comparison of the CliniMACS (v2.1) and Isolex 300i (v2.5) clinical scale devices.

The two clinical scale devices currently available for CD34+ cell selection from peripheral blood stem cells (PBSC) apheresis products, the CliniMACS and the Isolex 300i, were compared directly by pooling and splitting two PBSC harvests collected on sequential days from 10 patients and processing half of each pooled harvest on each device. The CliniMACS product had significantly higher median CD34+ purity (90%vs 78%; P = 0.004) and lower median T-cell content (0.06%vs 0.44%; P = 0.003) compared with the Isolex 300i product. The median CD34+ yields were similar (64% and 60% respectively). However, when the functional capacities of the products were compared, the median recovery of colony-forming units was significantly greater from the Isolex 300i product (48%vs 38%; P = 0.035), as was expansion of cells in either erythroid or granulocytic lineage-specific liquid culture (2.1-fold more erythroid and 1.5-fold more granulocytic lineage progenitors on d 9 (P = 0.03 and 0.03 respectively). This was due to a higher proportion of apoptotic cells in the CliniMACS product (28%vs 18%; P = 0.007, annexin V binding). Hence, although the CliniMACS device yielded a higher purity product with fewer T cells, the Isolex 300i product contained fewer apoptotic cells and consequently had greater functional capacity in culture.

Antigens, CD34↗

PubMed1976

Assessments of the functional capacity of the gonadotrophs in men: effects of estrogen and clomiphene.

Serum LH and FSH responses to serial injections of LRF with small (10 mug x 5), large (150 mug x 5), decremental (300 to 10 mug), and incremental (10 to 300 mug) doses at 2-hour intervals were assessed in eugonadal men. At constant doses, pulses of LRF induced pulsatile LH release which was qualitatively similar but quantitatively greater for the large than for the small dose of LRF. There were no periods of refractoriness or augmentation of subsequent responses from prior exposure to LRF when administered at 2-hour intervals. LH responses to incremental and decremental doses of LRF resulted in corresponding measurable changes in the magnitude of pituitary LH release. The FSH responses to pulses of LRF at all doses tested were uniformly small. These data suggest that analyses of the initial and integrated release (10 h experiment) to pulses of LRF may disclose the functional capacity of the gonadotrophs and that small variations in the endogenous LRF delivered may represent a significant factor in the control of LH release. The small dose (10 mug x 5) of pulses of LRF was utilized in the assessment of estrogen and clomiphene treatments on the functional capacity of the gonadotrophs in normal men. Compared with the pretreatment results, both constant doses of ethinyl estradiol (50 mug/day x 7 days) and incremental doses of estradiol benzoate (100 to 400 mug, twice daily injections x 4 d) induced an attenuation of the initial release as well as of the integrated response 10 h) to pulses of LRF. Clomiphene treatment (100 mg/day x 5 d), likewise, resulted in a reduction of gonadotropin release to all pulses of LRF. These data suggest that circulating estrogen in intact men may have both a negative and a positive feedback effect on the gonadotrophs and that the testicular estrogen secretion as well as the extraglandular sources of estrogen, may play a critical role in the regulations of gonadotropin secretion in man.

Adult↗

PubMed1977

The functional capacity of guinea pig megakaryocytes. II. The uptake of particles and macromolecules and the effect of rabbit antiguinea pig platelet antiserum.

The capacity of megakaryocytes to take up particles and macromolecules was tested by exposing them to homologous erythrocytes, latex particles, Micrococcus lysodeikticus, and horseradish peroxidase. Uptake of particles 1.1 to 7 mum. in size was extensive under the experimental conditions employed. After uptake of each of the three particles the addition of tannic acid and calcium to the fixative produced electron-dense deposits within the vacuole surrounding the particle; therefore, the vacuole was not closed off. This finding indicates that many of the particles could be actually trapped within the preformed elements of the demarcating membrane system. Horseradish peroxidase was concentrated within cytoplasmic vacuoles after 2 hours of exposure to 0.1 mg. per ml. The presence of surface membrane receptors was determined by the sheep cell rosette method. The presence of the C3b receptor for complement was determined by the sheep cell rosette method. The presence of the C3b receptor for complement produced rosette formation. The functional capacity of megakaryocytes to react like platelets was also tested by observing cell lytic changes and determining that there was approximately 40% release of 3H-serotonin produced by specific rabbit antiguinea pig platelet antiserum in the presence of complement. These studies demonstrate several functional capacities of megakaryocytes: the uptake of particles, pinocytosis, and the cell lytic response to specific antibody.

Acid Phosphatase↗

PubMed1988

Evaluation of functional capacity after stroke with special emphasis on motor function and activities of daily living.

In a multidisciplinary study comprising 280 patients with acute cerebrovascular disease (median age 76, range 30-96 years), instruments for functional assessment in stroke care were developed. The improvements of motor function and activities of daily living were investigated during a period of up to one year after a stroke. A new chart for motor capacity assessment, which includes both the paretic and the non-paretic side, modified after that of Fugl-Meyer et al, was tested for its reliability and validity. At the same time the Activity Index of Hamrin & Wohlin was further tested. The internal consistency reliability measured with the standardized item alpha method confirmed that the two instruments have high homogeneity. Construct validity was investigated by factor analysis and showed a logical structure. The predictive validity of the scores on admission was significant and the two tools had a satisfactory predictive capacity for survival and later functional outcome. The improvements in different motor functions were followed up for up to one year after the stroke among the 183 one-year survivors. In patients with minor impairment, the improvement occurred mostly during the first week. Patients with moderate or moderately severe impairment improved more continuously for up to three months, while the few surviving patients with very severe impairment continued to recover to some extent even after three months. Older patients with severe functional loss seemed to improve more slowly and not as well as younger patients with equivalent impairment. The patterns of instrumental activities of daily living (I-ADL), such as household work, locomotion, psychosocial functions and intellectual activities, were investigated in the 207 three-month survivors and the 183 one-year survivors. At both the three-month and the one-year follow-ups the scores had decreased considerably, compared with before the stroke, for all activities except locomotion, and many patients were dependent on somebody else for help. The same group of patients was also examined by a Standardized Practical Equipment (SPE) test constructed by Tömquist three months and one year after the stroke. The construct validity of the SPE test was estimated through factor analysis. Three factors emerged, one concerning mainly cognitive factors and co-ordination, one concerning hand function and one concerning mainly mobility and balance. The instruments developed in the course of this study have proved to be reliable and valid, and useful in assessing functional losses and following progress. The tools are well suited for any clinical settings and for home care examinations as well as research.

Activities of Daily Living↗