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PubMed1998

Clinical and functional outcomes of internal fixation of displaced pilon fractures.

The clinical and functional outcomes for patients treated with open reduction and plate fixation of displaced tibial pilon fractures were determined. A retrospective search of the authors' trauma database was conducted for AO and Orthopaedic Trauma Association Code 43 injuries (pilon fractures) in adults 18 years or older who were treated between December 1988 and December 1992. The group of 64 patients who required open reduction and internal fixation to treat their fractures make up the primary cohort for this analysis. Twenty of these cases required no fibular fixation; the remainder were mostly fixed with 1/3 tubular or 3.5-mm compression plates. Tibial fixation was done using most commonly 3.5-mm cloverleaf plates, 1/3 tubular plates, or both. Of the 64 patients treated with open reduction and internal replacement, four (5%) patients had deep infection develop. Two (7%) of 14 patients had open fractures, and two (4%) of 50 patients had closed fractures. Three of these four patients smoked tobacco products; one was also an intravenous drug abuser. Staphylococcus aureus was the organism in two cases; Enterobacter, in the other two. The infection was controlled with a free flap in two cases, with antibiotics and wound debridement in one and with an arthrodesis in one. Thirty of the 64 patients completed the Short Form-36; two of these patients had bilateral fractures. The study group had significant differences in general health perceptions, physical function, physical role function, emotional role function, social and mental function, and pain and energy levels when compared with age matched population data and patients with tibial plateau fractures. The effect of other injuries on these functional status results cannot be determined specifically.

Adolescent↗

PubMed1999

Short Form 36 (SF-36) Health Survey questionnaire: which normative data should be used? Comparisons between the norms provided by the Omnibus Survey in Britain, the Health Survey for England and the Oxford Healthy Life Survey.

BACKGROUND: Population norms for the attributes included in measurement scales are required to provide a standard with which scores from other study populations can be compared. This study aimed to obtain population norms for the Short Form 36 (SF-36) Health Survey Questionnaire, derived from a random sample of the population in Britain who were interviewed at home, and to make comparisons with other commonly used norms. METHODS: The method was a face-to-face interview survey of a random sample of 2056 adults living at home in Britain (response rate 78 per cent). Comparisons of the SF-36 scores derived from this sample were made with the Health Survey for England and the Oxford Healthy Life Survey. RESULTS: Controlling for age and sex, many of mean scores on the SF-36 dimensions differed between the three datasets. The British interview sample had better total means for Physical Functioning, Social Functioning, Mental Health, Energy/Vitality, and General Health Perceptions. The Health (interview) Survey for England had the lowest (worst) total mean scores for Physical Functioning, Social Functioning, Role Limitations (physical), Bodily Pain, and Health Perceptions. The postal sample in central England had the lowest (worst) total mean scores for Role Limitations (emotional), Mental Health and Energy/Vitality. CONCLUSION: Responses obtained from interview methods may suffer more from social desirability bias (resulting in inflated SF-36 scores) than postal surveys. Differences in SF-36 means between surveys are also likely to reflect question order and contextual effects of the questionnaires. This indicates the importance of providing mode-specific population norms for the various methods of questionnaire administration.

Adolescent↗

PubMed2006

Quality of life changes after inguinal hernia repair using anterior rectus sheath--a preliminary study.

Chronic pain is the most serious long-term complication after groin hernia repair. The aim of this preliminary research was to assess the quality of life before and after standard tension-free mesh repair and new method of tension-free inguinal hernia repair using anterior rectus sheath. Total of 62 patients were evaluated. Anterior rectus sheath method was performed in 29 patients and in 33 patients standard mesh repair was used (Lichtenstein repair). Quality of life was assessed before and after the surgery using short-form SF-36 questionnaire (QualityMetric Inc.), adjusted for Croatian language. There were statistically significant improvements in bodily pain and general health scores in both groups. Patients operated using mesh technique also demonstrated statistically significant improvements in social functioning and emotional role. Similarly, patients in whom inguinal hernia was repaired using anterior rectus sheath had significantly better postoperative scores for physical functioning and role physical scores. Quality of life assessment demonstrated good ability to differentiate between several independent aspects of quality of life. Anterior rectus sheath repair significantly improved quality of life and was shown to be similar to mesh repair in the aspect of physical functioning.

Chronic Disease↗

PubMed2002

Does aspirin attenuate the effect of angiotensin-converting enzyme inhibitors on health outcomes of very old patients with heart failure?

OBJECTIVES: Concomitant ischemic heart disease (IHD) is common in older individuals with heart failure (HF). We estimated the effect of aspirin use on the rate of mortality, morbidity, and decline in physical functioning in nursing home residents with HF taking angiotensin-converting enzyme (ACE) inhibitors. DESIGN: We conducted a retrospective cohort study using a nursing home database linking resident information collected via the Minimum Data Set (MDS) with drug utilization data. SETTING: Nursing homes in four states (1992-1995). PARTICIPANTS: Of 49,779 residents with HF admitted to these homes, 12,703 residents were taking an ACE inhibitor; 2,046 of these took aspirin. MEASUREMENTS: Medicare enrollment files provided the date of death, and we used the Part A Medicare files to identify hospital admissions. The activity of daily living scale from repeat MDS assessments allowed us to evaluate decline in physical function. Cox proportional hazards models provided adjusted estimates of the aspirin effect, with nonusers as the reference group. RESULTS: The overall mortality rate, hospitalization rate,and rate of decline in physical function of aspirin users were not different from those of nonusers (e.g., hospitalization rate ratio = 0.99, 95% confidence interval = 0.92-1.07). This effect did not vary by presence of concomitant IHD or by dose or type of ACE inhibitor. CONCLUSION: In a cohort of older HF residents receiving ACE inhibitors in nursing homes, we found that treatment with aspirin did not appear to affect outcomes negatively.

Activities of Daily Living↗

PubMed1994

Psychological consequences of screening mammography.

OBJECTIVE: To examine the psychological consequences at a number of stages in the screening process for women attending a screening mammography programme. SETTING: A pilot mammographic screening programme in Melbourne, Australia. METHOD: The psychological consequences questionnaire (PCQ; a reliable and valid measure of the psychological consequences of screening mammography) was used to measure the emotional, social, and physical functioning of women in a mammographic screening programme and a control community sample. A screening group (in whom no abnormality was detected at initial screen; n = 142) had four measurements: at screening clinic; before results were received; one week after all-clear results were received; and eight months after initial visit. The recall group (who were recalled for further investigation which showed the detected abnormality to be benign; n = 58) had measurements at the same points as the screening group and an additional measurement while waiting at the recall assessment clinic. A randomly selected community control group (n = 52) had measurements one week, two weeks, three weeks, and eight months after consenting to participate. RESULTS: Emotional, social, and physical functioning of women in the screening group did not change over time and at no point differed significantly from that of community controls. The profiles of emotional and physical dysfunction of women in the recall group differed significantly from those of the screening and control groups. The level of emotional and physical dysfunction in the recall group was highest while waiting at recall assessment clinic, and scores were still significantly higher than scores obtained at comparable times from screening and control groups one week after obtaining notification that there was no sign of cancer (emotional P < 0.001; physical P < 0.05). This difference had disappeared eight months after the screening visit, when the level of emotional and physical functioning was similar to that of the screening and control groups. Social dysfunction scores did not change significantly over time and were similar for all three groups. CONCLUSIONS: Given that up to 10% of women are recalled for further investigations on first round screening, significant numbers of women may have psychological consequences. This speaks for the necessity for accurate reading of mammograms to minimise the false positive recall rate, and for counselling services to be available at recall assessment centres.

Attitude to Health↗

PubMedDate not supplied

Physical performance effects of low-intensity exercise among clinically defined high-risk elders.

BACKGROUND: Falls are among the leading causes of injuries and deaths. Results from a number of studies have suggested that a community-based exercise program may be effective in improving lower body strength, although some have shown only limited improvements. However, the impact of these programs on gait and balance are equivocal. Further, studies that have specifically targeted deconditioned elderly individuals, rather than individuals drawn from the general community, either showed limited or no improvements in gait and balance. OBJECTIVE: This study examined the effectiveness of a community-based, short-term, low-intensity exercise intervention strategy on measures of mobility skills, gait and balance, and muscle strength for a clinically targeted group of elderly individuals at high risk of falls. METHODS: 245 men and women aged 60 years or older were randomized into either an intervention or control group and received a baseline (T1) assessment. Subjects in the intervention group received up to 24 sessions (45 min long) of low-intensity standard exercise modalities tailored to the individual patient over an 8- to 10-week period. At the conclusion of the program, the participants in the intervention group were instructed to continue performing the exercises at home until 1 year after T1. Measures of physical function and performance were collected for all subjects at three different points of study enrollment. RESULTS: Of the subjects assessed at baseline, 138 (56%) also had a postintervention assessment (T2), 128 (52%) had a 6-month follow-up assessment (T3), and 105 subjects had assessments at all time points. Primary analyses were based on the 105 subjects who had assessments at all time points. Intervention and control subjects did not differ in any of the physical function or performance measures at baseline. Between T1 and T2, the intervention subjects showed significantly greater improvement than the control subjects on all outcomes, with improvements plateauing for most measures between T2 and T3. Gait and balance scores continued to improve throughout the study period for both groups of subjects. CONCLUSIONS: This easily implemented, low-intensity exercise program may lead to improvements in physical functioning that are retained over the long term and effectively targets a clinically defined population of deconditioned elders at high risk of falling and sustaining serious injury.

Accidental Falls↗

PubMed2006

A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children.

OBJECTIVE: Wrist buckle fractures are a frequent reason for emergency department visits. Although textbooks recommend 2 to 4 weeks of immobilization in a short arm cast, management varies. Treatment with both casts and splints is common, and length of immobilization varies. The objective was to determine if children with distal radius and/or ulna buckle fractures treated with a removable splint have better physical functioning than those treated with a short arm cast for 3 weeks. METHODS: This was a randomized, controlled trial in the emergency department of an academic, tertiary care children's hospital. Participants were children 6 to 15 years of age with distal radius and/or ulna buckle fractures who were randomly assigned to treatment with a short arm cast for 3 weeks or a removable splint. Cast removal was at 3 weeks. A validated self-reported outcome tool, the Activities Scales for Kids performance version (ASKp), was used to measure physical functioning over a 4-week period. The main outcome was the ASKp score at 14 days postinjury. RESULTS: We randomly assigned 113 patients, and 87 were included in the final analysis: 42 in the splint group and 45 in the cast group. Study groups were similar in age, gender, bone fractured, and dominant hand injured. There were significant differences in ASKp score at day 14 and change in ASKp from baseline at days 14 and 20, indicating better functioning in the splint group. Splinted children had less difficulty with bathing throughout the entire study. There were no significant differences in pain between groups as measured by visual analog scale. There were no refractures. CONCLUSIONS: Children treated with removable splinting have better physical functioning and less difficulty with activities than those treated with a cast.

Adolescent↗

PubMed2003

Prospective psychosocial monitoring of living kidney donors using the SF-36 health survey.

BACKGROUND: Psychosocial assessment and monitoring of living kidney donors is not yet standard practice, despite calls for it in the literature. METHODS: Psychosocial assessment of living kidney donors was performed preoperatively and 4 months postoperatively, using the SF-36 Health Survey, the Patient Health Questionnaire psychiatric assessment, and semistructured interview. RESULTS: Assessment was acceptable to the majority of donors; 92% (44) of 48 consecutive donors completed both assessments. Preoperatively, both physical function (SF-36 Physical Component Score [PCS]) and psychosocial function (SF-36 Mental Component Score [MCS]) were significantly higher than community (state of Victoria) norms. Postoperatively, PCS and MCS fell significantly, but not below the Victorian norm. Seven donors (16%) developed adjustment disorder or anxiety disorder; their MCS were significantly lower than those without psychiatric disorder. CONCLUSIONS: It is concluded that routine psychosocial assessment performed by a psychiatrist, including the use of questionnaires, is acceptable to donors and identifies those impaired. Potential donors need to be well prepared for such assessment and well educated about the extent of physical and psychosocial impairment that might occur in the postoperative period.

Adult↗

PubMed1999

Health status and satisfaction of asymptomatic HIV-positive haemophiliacs in Kyushu, Japan.

The purpose of this study was to elucidate the effects of human immunodeficiency virus (HIV) on haemophiliacs with physical functional disabilities induced by haemophilia in Kyushu, Japan. The subjects were 38 adult haemophiliacs who were selected from 129 patients registered with the North Kyushu Haemophilia Centre. They were divided into 21 asymptomatic HIV-positive and 17 HIV-negative adult haemophiliacs. Coagulation factor levels, modified DePalma classification, Arthritis Impact Measurement Scale 2 (AIMS 2), and a satisfaction in daily life (SDL) questionnaire were used to investigate the clinical severity of their haemophilia and arthropathy, physical functional disabilities, and satisfaction. Although there were no significant differences in the objective assessments of health status between the HIV-positive and -negative haemophiliacs, the HIV-positive haemophiliacs were significantly more dissatisfied with their social activities and mood, according to AIMS 2, and with social intercourse, job, self-development, and social security and pension according to SDL assessment. These dissatisfactions were due to the effects of HIV, in addition to the physical functional disabilities that were caused by haemophilia. Dissatisfaction with social security and pension may be a specific feature in HIV-positive haemophiliacs in Japan resulting from the origin of HIV infection.

Adult↗

PubMed1999

The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the reliability, construct validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS). SUBJECTS AND METHODS: The LEFS was administered to 107 patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics. METHODS: The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks. The SF-36 (acute version) was administered during the initial assessment and at weekly intervals. A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability. Pearson correlations and one-way analyses of variance were used to examine construct validity. Spearman rank-order correlation coefficients were used to examine the relationship between an independent prognostic rating of change for each patient and change in the LEFS and SF-36 scores. RESULTS: Test-retest reliability of the LEFS scores was excellent (R = .94 [95% lower limit confidence interval (CI) = .89]). Correlations between the LEFS and the SF-36 physical function subscale and physical component score were r=.80 (95% lower limit CI = .73) and r = .64 (95% lower limit CI = .54), respectively. There was a higher correlation between the prognostic rating of change and the LEFS than between the prognostic rating of change and the SF-36 physical function score. The potential error associated with a score on the LEFS at a given point in time is +/-5.3 scale points (90% CI), the minimal detectable change is 9 scale points (90% CI), and the minimal clinically important difference is 9 scale points (90% CI). CONCLUSION AND DISCUSSION: The LEFS is reliable, and construct validity was supported by comparison with the SF-36. The sensitivity to change of the LEFS was superior to that of the SF-36 in this population. The LEFS is efficient to administer and score and is applicable for research purposes and clinical decision making for individual patients.

Activities of Daily Living↗

PubMed2001

The role of knee alignment in disease progression and functional decline in knee osteoarthritis.

CONTEXT: Knee osteoarthritis (OA) is a leading cause of disability in older persons. Few risk factors for disease progression or functional decline have been identified. Hip-knee-ankle alignment influences load distribution at the knee; varus and valgus alignment increase medial and lateral load, respectively. OBJECTIVE: To test the hypotheses that (1) varus alignment increases risk of medial knee OA progression during the subsequent 18 months, (2) valgus alignment increases risk of subsequent lateral knee OA progression, (3) greater severity of malalignment is associated with greater subsequent loss of joint space, and (4) greater burden of malalignment is associated with greater subsequent decline in physical function. DESIGN AND SETTING: Prospective longitudinal cohort study conducted March 1997 to March 2000 at an academic medical center in Chicago, Ill. PARTICIPANTS: A total of 237 persons recruited from the community with primary knee OA, defined by presence of definite tibiofemoral osteophytes and at least some difficulty with knee-requiring activity; 230 (97%) completed the study. MAIN OUTCOME MEASURES: Progression of OA, defined as a 1-grade increase in severity of joint space narrowing on semiflexed, fluoroscopically confirmed knee radiographs; change in narrowest joint space width; and change in physical function between baseline and 18 months, compared by knee alignment at baseline. RESULTS: Varus alignment at baseline was associated with a 4-fold increase in the odds of medial progression, adjusting for age, sex, and body mass index (adjusted odds ratio [OR], 4.09; 95% confidence interval [CI], 2.20-7.62). Valgus alignment at baseline was associated with a nearly 5-fold increase in the odds of lateral progression (adjusted OR, 4.89; 95% CI, 2.13-11.20). Severity of varus correlated with greater medial joint space loss during the subsequent 18 months (R = 0.52; 95% CI, 0.40-0.62 in dominant knees), and severity of valgus correlated with greater subsequent lateral joint space loss (R = 0.35; 95% CI, 0.21-0.47 in dominant knees). Having alignment of more than 5 degrees (in either direction) in both knees at baseline was associated with significantly greater functional deterioration during the 18 months than having alignment of 5 degrees or less in both knees, after adjusting for age, sex, body mass index, and pain. CONCLUSION: This is, to our knowledge, the first demonstration that in primary knee OA varus alignment increases risk of medial OA progression, that valgus alignment increases risk of lateral OA progression, that burden of malalignment predicts decline in physical function, and that these effects can be detected after as little as 18 months of observation.

Aged↗

PubMed1999

Spinal-flexibility-plus-aerobic versus aerobic-only training: effect of a randomized clinical trial on function in at-risk older adults.

BACKGROUND: As exercise is associated with favorable health outcomes, impaired older adults may benefit from specialized exercise interventions to achieve gains in function. The purpose of this study was to determine the added benefit of a spinal flexibility-plus-aerobic exercise intervention versus aerobic-only exercise on function among community-dwelling elders. METHODS: We employed a randomized clinical trial consisting of 3 months of supervised exercise followed by 6 months of home-based exercise with telephone follow-up. A total of 210 impaired males and females over age 64 enrolled in this study. Of these, 134 were randomly assigned to either spinal flexibility-plus-aerobic exercise or aerobic-only exercise, with 116 individuals completing the study. Primary outcomes obtained at baseline, after 3 months of supervised exercise, and after 6 months of home-based exercise included: axial rotation, maximal oxygen uptake (VO2max); functional reach, timed-bed-mobility; and the Physical Function Scale (PhysFunction) of the Medical Outcomes Study SF-36. RESULTS: Differences between the two interventions were minimal. Overall change scores for both groups combined indicated significant improvement for: axial rotation (p=.001), VO2max (p=.0001), and PhysFunction (p=.0016). Secondary improvements were noted for overall health (p=.0025) and reduced symptoms (p=.0008). Differences between groups were significant only for VO2max (p=.0014) at 3 months with the aerobic-only group improving twice as much in aerobic capacity as the spinal flexibility-plus-aerobic group. Repeated measures indicated both groups improved during the supervised portion of the intervention but tended to return toward baseline following the home-based portion of the trial. CONCLUSIONS: Gains in physical functioning and perceived overall health are obtained with moderate aerobic exercise. No differential improvements were noted for the spinal flexibility-plus-aerobic intervention.

Aged↗

PubMed2002

Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review.

OBJECTIVE: To determine whether land based therapeutic exercise is beneficial for people with osteoarthritis (OA) of the hip or knee in terms of reduced joint pain, improved physical function, and/or the patient's global assessment of therapeutic effectiveness. METHODS: Five databases were searched for randomized clinical trials. Standardized mean differences (SMD) with their 95% confidence intervals (CI) were calculated for each study and then combined using a fixed effects model. RESULTS: Only 2 studies, totaling about 100 participants, could potentially provide data on people with hip OA. Fourteen studies provided data on 1633 participants with knee OA. Nine of these studies were considered of high methodological quality. For pain, combining the results revealed a mean moderate beneficial effect (SMD 0.46, 95% Cl 0.35, 0.57), while for self-reported physical function a mean small beneficial effect (SMD 0.33, 95% CI 0.23, 0.43) was found. These results appeared to be sensitive to blinding of outcome assessor and choice of control group. CONCLUSION: Land based therapeutic exercise was shown to reduce pain and improve physical function for people with OA of the knee.

Databases, Bibliographic↗

PubMedDate not supplied

Factors associated with suboptimal analgesic use in community-dwelling elderly.

OBJECTIVE: To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly. DESIGN: Cross-sectional survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older. MAIN OUTCOME MEASURES: Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug). RESULTS: Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred in 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction. CONCLUSIONS: Suboptimal analgesic use is common in community-dwelling elderly, and its risk in consistently increased in those who are depressed or have impaired physical functional status.

Aged↗

PubMed1995

Development of a hierarchical activities of daily living scale for Chinese stroke patients in geriatric day hospitals.

A culture-specific 4-point hierarchical scale covering self-care, household activity and mobility was developed by modifying the Rivermead ADL scale to assess the physical function of Chinese stroke patients. Self-care ability (13 items scored 0/1/2/3 with a maximum of 39) and mobility (8 items scored 0/1/2/3 with a maximum of 24) were routinely assessed by occupational therapists and physiotherapists in stroke patients on admission to and at discharge from two geriatric day hospitals (GDHs). Household activity (6 items scored 0/1/2/3 with a maximum of 18) was assessed by occupational therapists in non-institutionalized patients with self-care scores within 15% of the maximum. The scale was acceptable to patients and staff. Graphical representation in profile format facilitates the identification of items requiring special attention. Internal reliability was high; the Cronbach's alpha for the self-care, household and mobility domains was 0.9732, 0.9530, and 0.9787, respectively. The scale was used to assess the change in physical function of 436 stroke patients discharged from two GDHs in Hong Kong over 18 months. Patients' mean age was 73 years (SD +/- 8.4), and the female/male ratio 1:3. On average, 38 visits (+/- 32) were made over a mean enrollment period of 220 days (+/- 289). Both the self-care and mobility scores showed statistically significant improvements at discharge, and changes in function exceeded 1/4 of the standard deviation of the initial scores. A substudy of 28 stroke patients, in whom household scores were assessed, revealed that for those with better initial physical function, a ceiling effect was apparent with the self-care score but not with the household or mobility scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed2004

Physiotherapy interventions for ankylosing spondylitis.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Due to the consequences of the disease, physiotherapy is considered to be an important part of the overall management of AS. OBJECTIVES: The objective of this review was to summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and PEDro up to February 2004 for all relevant publications, without any language restrictions. The reference lists of relevant articles were checked and the authors of included articles were contacted. SELECTION CRITERIA: We included randomised and quasi-randomised studies with patients classified by the AS New York criteria and where at least one of the comparison groups received some kind of physiotherapy. The main outcomes of interest were pain, stiffness, spinal mobility, physical function and patient global assessment. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information. MAIN RESULTS: Six trials with a total of 561 participants were included in this updated review as compared to three trials and 241 patients in the previous version. Two trials compared individualised home exercise programs with no intervention and reported low quality evidence for effects in spinal mobility (relative percentage differences (RPD) 37%) and physical function, in favour of the home exercise program. Three trials compared supervised group physiotherapy with an individualised home-exercise program and reported moderate quality evidence for small differences in spinal mobility (RPD 18%) and patient global assessment in favour of supervised group exercises. Finally, in one study a three week inpatient spa-exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (without spa) was compared with weekly outpatient group physiotherapy alone; there was moderate quality evidence for effects in pain (RPD 18%), physical function (RPD 24%) and patient global assessment (RPD 29%), in favour of the combined spa-exercise therapy. REVIEWERS' CONCLUSIONS: The results of this review suggest that a home exercise program is better than no intervention, supervised group physiotherapy is better than home exercises, and that combined inpatient spa-exercise therapy followed by supervised outpatient weekly group physiotherapy is better than weekly group physiotherapy alone. The tendency toward positive effects of physiotherapy in the management of AS calls for further research in this field. New trials should also address other physiotherapy interventions commonly used in clinical practice.

Ambulatory Care↗

PubMed2003

Performance indicators for hospital services for older people.

BACKGROUND: standardised assessment is recommended in geriatric practice to improve patient care and generate quality data for audit and research. High level indicators used to measure performance of rehabilitation units suggested that more patients were discharged to long-term residential care from one of two hospitals in a Health Authority in South East England. OBJECTIVES: to test whether the information provided by standardised assessment could inform performance indicators used to compare outcomes between hospitals. DESIGN: prospective observational study. SUBJECTS: consecutive patients admitted for rehabilitation to two general geriatric rehabilitation wards in each of two nearby district general hospitals. METHODS: patients were assessed using standard tools (Barthel and Abbreviated Mental Test score) and various scales of the interRAI MDS assessment system (mental and physical functioning, pressure ulcers, continence, falls, mood), within a week of admission and up to one week before discharge. Place of residence prior to admission and discharge destination were determined. RESULTS: on bivariate analysis there was a significant difference in discharge to residential and nursing homes between hospitals. Results from multivariate logistic regression analysis showed an increased risk for institutionalisation at discharge for women [odds ratio 2.42 (95% CI 1.41-4.14)] and patients with impaired cognitive function [odds ratio 1.53 (95% CI 1.28-1.82) for each point increase in MDS cognitive performance scale] and physical function [odds ratio 1.15 (95% CI 1.08-1.22) for each point increase in MDS short ADL scale]. Barthel and Abbreviated Mental Test showed similar odds ratios. Hospital did not remain a significant predictor of discharge destination following adjustment for patients' physical and cognitive function. CONCLUSIONS: comparisons of outcomes between hospitals could be misleading unless informed by standardised data on physical and mental functioning of rehabilitation patients.

Activities of Daily Living↗

PubMed2004

Milk powders ageing: effect on physical and functional properties.

Milk powders are now considered as food ingredients, mainly because of the functional properties of milk proteins. During the storage of milk powders, many physicochemical damages, mainly dependent on lactose glass transition occur. They have important consequences on physical (flowability) and functional properties (solubility, emulsifying, and foaming properties) of milk powders. First, lactose crystallization modifies the microstructure and chemical composition of the surface of powder particles. Thus, milk powders flowability is decreased. Since the structure of milk proteins is destabilized, its solubility is damaged. Moreover, particle collapse and caking occur and mainly decrease the physical properties of milk powders (density and flowability). The mechanical stresses involved may also enhance proteins unfolding, which is detrimental to solubility. Finally, molecular mobility is favored upon ageing, and both chemical (Maillard reaction) and enzymatic reactions occur. Maillard reaction and oxidation enhance protein interactions and aggregations, which mainly lessen milk powders solubility. Maillard reaction also decreases emulsifying and foaming properties. Storage temperature and relative humidity have been considered as the predominant factors involved, but time, milk components, and their physical state also have been implied.

Animals↗