Objective: To develop and validate a statistical model to predict wheelchair skills at discharge (t₂) from personal and lesion characteristics and wheelchair skills at the start of spinal cord injury inpatient rehabilitation (t₁).

Design: Prospective cohort study

Setting: Eight Dutch rehabilitation centres.

Subjects: One hundred and forty-two patients with a spinal cord injury.

Main measures: Models were developed with the performance time and ability score at t₂ as dependent variables and t₁ scores of performance time and ability score, age, gender, body mass index, level and completeness of the lesion as independent variables. The statistical models were evaluated by comparing individual estimated scores with actual measured scores.

Results: The main independent variables to predict wheelchair skills at discharge were the t₁ performance time and ability score, age, gender and lesion level. The intraclass correlation coefficient between the estimated and actual ability score was 0.79 and for the performance time 0.86. However, the 95% limits of agreement and their confidence intervals were relatively wide for both ability score (-2.3 to 3.4, range 0–8) and performance time (-12.5 to 8.2, range 11–40 seconds).

Conclusion: The prognostic models developed in this study to predict future wheelchair skills might help planning the course of rehabilitation. The models should be used with caution in daily clinical practice, but may add useful information to clinical expertise and knowledge of the individual patient.

Objective: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture.

Design: An intertester reliability study.

Setting: An acute 20-bed orthopaedic hip fracture unit.

Subjects: Fifty consecutive patients with a median age of 83 (25–75% quartile, 68–86) years.

Interventions: The CAS, which describes the patient’s independency in three activities – (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability – was assessed by two independent physiotherapists at postoperative median day 3. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent of human assistance). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent ambulation.

Main measures: Reliability was evaluated using weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD).

Results: The kappa coefficient, the SEM and the SRD in the three activities and the total CAS were ≥0.92, ≤0.20 and ≤0.55 CAS points, respectively.

Conclusions: The intertester reliability of the CAS is very high, and a change of more than 0.20 and 0.55 CAS points for the total CAS indicates a real change in basic mobility, at group level and for an individual patient, respectively.

Aim: To develop a grounded theory of nursing’s contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation.

Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory.

Setting: Five inpatient rehabilitation units in Australia.

Participants: Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice.

Findings: The analysis revealed a situation whereby nurses made decisions about when to ‘opt in’ and when to ‘opt out’ of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about ‘opting in’ and ‘opting out’ were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, ‘opting out’ of addressing them. They did this not to make their working lives easier, but more manageable.

Conclusion: System-based problems impacted negatively on the nurses’ ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.

Objective: To investigate whether surface electrical stimulation can increase the effectiveness of task-related exercises for improving the walking capacity of patients with chronic stroke.

Design: Randomized, placebo-controlled clinical trial.

Setting: Home-based programme.

Subjects: One hundred and nine hemiparetic stroke survivors were assigned randomly to: (1) transcutaneous electrical nerve stimulation (TENS), (2) TENS + exercise, (3) placebo stimulation + exercise, or (4) control group.

Interventions: The TENS group received 60 minutes of electrical stimulation. Both the TENS + exercise group and placebo stimulation + exercise group did 60 minutes of exercises, followed respectively by 60 minutes of electrical and placebo stimulation. Treatment was given five days a week for four weeks. The control group had no active treatment.

Outcome measures: Comfortable gait speed was measured using a GAITRite II walkway system. Walking endurance and functional mobility were measured by the distance covered during a 6-minute walk test (6MWT) and by timed up and go test scores before treatment, after two weeks and after four weeks of treatment, and at follow-up four weeks after treatment ended.

Results: When compared with the other three groups, only the combined TENS + exercise group showed significantly greater absolute and percentage increases in gait velocity (by 37.1–57.5%, all P < 0.01) and reduction in timed up and go scores (by –14.9 to –23.3%, P < 0.01) from week 2 onwards. When compared with the control and TENS groups, only the combined TENS + exercise group covered significantly more distance in the 6MWT (by 22.2–34.7%, P < 0.01) from week 2 onwards.

Conclusion: TENS can improve the effectiveness of task-related exercise for increasing walking capacity in hemiparetic stroke survivors.

Objective: To investigate the effect of eating utensil weight on kinematic performance in people with Parkinson’s disease.

Design: A counterbalanced repeated-measures design.

Setting: A motor control laboratory in a university setting.

Subjects: Eighteen adults with Parkinson’s disease and 18 age-matched controls.

Experimental conditions: Each participant performed a food transfer task using spoons of three different weights: lightweight (35 g), control (85 g) and weighted (135 g). Kinematic variables of arm movement were derived and compared between conditions.

Main measures: Kinematic variables of arm movement, including movement time, peak velocity and number of movement units.

Results: Utensil weights significantly affected the movement kinematics of all participants. Both groups had fewer movement units in the lightweight condition (Parkinson’s disease group: 22.18, controls: 19.89) than in the weighted condition (Parkinson’s disease group: 22.68, controls: 21.36), suggesting smoother movement in the former condition. In addition, both groups had higher peak velocity in the lightweight than in the weighted condition.

Conclusions: Our findings suggest that a lightweight utensil may facilitate smoother and higher-velocity arm movement than a weighted one in people with Parkinson’s disease.

Objective: To examine the risk and frequency of falls, prevalence of fear of falling and activity avoidance, the magnitude of fall-related self-efficacy, and anxiety and depression in patients with chronic obstructive pulmonary disease.

Design and settings: A cross-sectional study in patients with a diagnosis of chronic obstructive pulmonary disease who visited a lung clinic at a university hospital in Sweden.

Subjects: Successive inclusion from autumn 2005 to spring 2006 of 80 patients with a mean age of 65 years.

Intervention: Nil.

Main measures: A questionnaire about fall history and consequences of fall, The Falls Efficacy Scale, Swedish version, and the Hospital Anxiety and Depression Scale were used.

Results: Twenty patients (25%) reported at least one fall in the last year and 29% displayed fear of falling. Odds ratio for falling was 4–5 times higher in patients with severe chronic obstructive pulmonary disease. Older patients, women and patients with previous falls had a higher rate of fear of falling, and those with fear of falling had lower fall-related self-efficacy, increased level of anxiety and depression, more activity avoidance and use of assistive device.

Conclusion: The increased risk of falls in patients with chronic obstructive pulmonary disease warrants attention in order to reduce serious and adverse health consequences of falls.

Objective: To confirm previous findings that hip abductor activity measured by electromyography (EMG) on the side contralateral to cane use is reduced during walking in stroke patients. To assess whether an orthosis (TheraTogs) or hip abductor taping increase hemiplegic hip abductor activity compared with activity during cane walking or while walking without aids. To investigate the effect of each condition on temporo-spatial gait parameters.

Design: Randomized, within-participant experimental study.

Setting: Gait laboratory.

Subjects: Thirteen patients following first unilateral stroke.

Intervention: Data collection over six gait cycles as subjects walked at self-selected speed during: baseline (without aids) and in randomized order with (1) hip abductor taping, (2) TheraTogs, (3) cane in non-hemiplegic hand.

Main measures: Peak EMG of gluteus medius and tensor fascia lata and temporo-spatial gait parameters.

Results: Cane use reduced EMG activity in gluteus medius from baseline by 21.86%. TheraTogs increased it by 16.47% (change cane use–TheraTogs P = 0.001, effect size = -0.5) and tape by 5.8% (change cane use–tape P = 0.001, effect size = -0.46). In tensor fascia lata cane use reduced EMG activity from baseline by 19.14%. TheraTogs also reduced EMG activity from baseline by 1.10% (change cane use–TheraTogs P = 0.009, effect size -0.37) and tape by 3% (not significant). Gait speed (m/s) at: baseline 0.44, cane use 0.45, tape 0.48, TheraTogs 0.49.

Conclusion: Hip abductor taping and TheraTogs increase hemiplegic hip abductor activity and gait speed during walking compared with baseline and cane use.

Objective: To determine if treatment of longstanding complex regional pain syndrome type 1, focusing on functional improvement only while neglecting pain, results in clinical improvement of this syndrome.

Design: Prospective description of a case series of 106 patients.

Setting: Outpatient clinic for rehabilitation.

Interventions: Physical therapy of the affected limb directed at a functional improvement only while neglecting the pain, was performed following an extensive explanation. Normal use of the limb between the treatments was encouraged despite pain. A maximum of five of these sessions were performed in three months.

Measures: Radboud Skills Test was used to monitor functional improvement of the arms. Speed and walking distance was used as the measure of outcome for the legs.

Results: The function of the affected arm or leg improved in 95 patients. Full functional recovery was experienced in 49 (46%) of them. A reduction in pain presented in 75 patients. In 23 patients functional recovery was reached despite an increase in pain. Four patients stopped early due to pain increase.

Conclusions: Our results suggest that ‘pain exposure physical therapy’ is effective and safe for patients who are unresponsive to accepted standard therapies. Avoiding the use of a limb due to pain will result in loss of function. Forced usage of limbs restores the function, reverses these adaptive processes and leads to regain of control by practice with a reduction of pain in most cases.

Objectives: To investigate the clinimetric properties and clinical utility of the AsTex®, a new clinical tool for evaluation of hand sensation following stroke.

Design: The AsTex® was administered on two occasions separated by a week to appraise test–retest reliability, and by three assessors on single occasion to establish inter-rater reliability. Pilot normative values were collected in an age-stratified sample. Clinical utility was evaluated based on ease of administration, ceiling and floor effects, and responsiveness to sensory recovery.

Participants: Test–retest (n = 31) and inter-rater (n = 31) reliability and normative values (n = 95) for the AsTex® were established in neurologically normal participants aged 18–85 years. Test–retest reliability was investigated in 22 individuals a mean of 46 months (range 12–125) post stroke and clinical utility was evaluated in an additional 24 subacute stroke participants a mean of 29.4 days (range 12–41) post stroke.

Main measure: The AsTex®.

Results: The AsTex® demonstrated excellent test–retest (intraclass correlation coefficient (ICC) = 0.98, 95% confidence interval (95% CI) = 0.97–0.99) and inter-rater reliability (ICC = 0.81, 95% CI = 0.73–0.87) in neurologically normal participants. Test–retest reliability of the AsTex® in individuals following stroke was excellent (ICC = 0.86, 95% CI = 0.68–0.94). The AsTex® was simple to administer, demonstrated small standard error of measurement (0.14 mm), minimal floor and ceiling effects (12.5% and 8.3%) and excellent responsiveness (standardized response mean = 0.57) in subacute stroke participants.

Conclusion: The AsTex® is a reliable, clinically useful and responsive tool for evaluating hand sensation following stroke.

Objective: To compare outcomes from hip arthroplasty between a surgical unit with a rapid discharge policy and two comparison units to test the hypothesis that the centre with rapid discharge has outcomes that are not inferior to the comparison sites.

Design: Prospective cohort study.

Subjects: Consecutive consenting patients receiving primary hip arthroplasty during 12 months beginning July 2006 in three UK National Health Service surgical units. One has shortened postoperative stay to median three days; one was a new treatment centre with median stay of five days; the third was a traditional unit with median stay of six days (N = 316, 119, 87, respectively).

Methods: Patients were assessed preoperatively and six weeks postoperatively. The primary indicator of function was the Oxford Hip Score. Additional secondary measures included further self-report indicators of function and quality of life and health service costs.

Results: Patient outcome in the unit with rapid discharge was not impaired by comparison with the other sites on any measure: Oxford Hip Score decreased from 49 to 27 in the short-stay unit, from 40 to 30 in the treatment centre and from 43 to 32 in the traditional unit. Cost of arthroplasty was least in the short-stay unit, although there was potential for cost savings in each.

Conclusion: Short postoperative stay after hip arthroplasty can be achieved without intensive patient preparation or post-discharge care and without compromising short-term patient outcome or increasing health care costs. Longer term follow-up is needed.

Objective: To describe the time use of stroke patients on rehabilitation units of a nursing home focusing on the time spent on therapeutic activities, non-therapeutic activities, interactions and the location wherein these took place.

Design: A descriptive study.

Setting: Rehabilitation units of a nursing home.

Subjects: Seventeen chronic stroke patients, including 9 men, 8 women, with a mean age of 77 years (SD ± 7.6 years).

Main measures: Daily activities of patients were measured using Behavioural Mapping, including therapeutic activities, non-therapeutic activities, interactions and their location. Functional status was measured with the Barthel Index.

Results. Of the patients 15 (88%) were partly/fully paralysed, with a mean Barthel Index score of 9.4 (SD ± 4.3). The patients spent 20% of the day on therapeutic activities, whereas 80% of the day was spent on non-therapeutic activities; 9% on therapeutic activities with the nurse. For 60% of the day patients were alone and not interacting with others.

Conclusions. Stroke patients spend only short periods of time during the day on therapeutic activities. For the largest part of the day, the patient is alone and passive. A challenge for nurses is how to activate patients and engage them in purposeful task-oriented training in daily activities.

Objective: To evaluate a self-administration of auditory cueing on gait difficulties in people with Parkinson’s disease over a one-week period.

Design: Single group pre and post test.

Setting: Research lab, community.

Participants: Twenty-one individuals with Parkinson’s disease.

Interventions: Self-application of an auditory pacer set at a rate 25% faster than preferred cadence.

Main outcome measures: Self-selected gait speed, cadence, stride length, and double support time with and without the pacer at the initial visit and after one week of pacer use.

Results: During the initial visit, the auditory pacer improved gait speed (79.57 (18.13) cm/s vs. 94.02 (22.61) cm/s, P < 0.0005), cadence (102.88 (11.34) step/min vs. 109.22 (10.23) steps/min, P = 0.036) and stride length (94.33 (21.31) cm vs. 103.5 (22.65) cm, P = 0.012). After one week, preferred gait speed was faster than the initial preferred speed (79.57 (18.13) vs. 95.20 (22.23) cm/s, P < 0.0005). Stride length was significantly increased (94.33 (21.31) vs. 107.67 (20.01) cm, P = 0.001). Double support time was decreased from 21.73 (5.23) to 18.94 (3.59)% gait cycle, P = 0.016.

Conclusion: Gait performance in people with Parkinson’s disease improved significantly after walking with the auditory pacer for one week.