Outcome of comprehensive medical rehabilitation: Measurement by PULSES Profile and the Barthel Index
ABSTRACT In view of current emphasis on evaluation of benefits derived from rehabilitation programs, it is important that there be easily replicated measures for demonstrating the efficiency and effectiveness of services provided, as well as for transmitting information on patient functional status when transferring service responsibilities from one agency or facility to another. The authors used the PULSES profile and the Barthel index to measure severity of disability and to monitor rehabilitation progress in a heterogeneous sample of 307 severely disabled persons in 10 comprehensive medical rehabilitation centers, geographically selected. Gains in functional independence were registered for up to 2 years after admission. Cutting points of PULSES score totals or Barthel score totals distinguished the degree of severity of disability. The 2 scoring modalities appear valid, reliable, and sensitive for describing functional abilities and change over a period of time. They can be applied both to medical records and direct observations, and staff of medical facilities can readily be trained in their use.
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- "Activities of daily living were assessed using the Barthel Index (BI: ). The measure is widely used in stroke research, and Granger and Albrecht et al.  report good test–retest reliability (r = 0.89). The modified 0–20 scoring system was used, with a higher score indicating better functioning. "
ABSTRACT: To investigate the association between the illness representations of recently diagnosed stroke patients and their carers and distress in the months after stroke. Forty-two stroke survivors and their carers were assessed at 3 months and 32 couples returned data at 6 months after stroke. Patients and carers completed the Illness Perceptions Questionnaire-Revised, Barthel Index, Significant Others Scale and General Health Questionnaire. Analyses were conducted using the Actor-Partner Interdependence Model. Carers were more pessimistic than patients about the symptoms, timeline and consequences of the stroke. Patient distress was associated with both patient and carer illness representations at Time 1, and their own illness representations and discrepancy in the illness representations of patients and carers at Time 2. Carer distress was associated with their own illness representations at Time 1, but not the patient's illness representations. Discrepant illness representations were associated with higher carer distress at Time 1 but not Time 2. Illness representations of stroke patients and carers have implications for adjustment for both partners. It is important to understand couples' views of stroke, as discrepancy was as strongly associated with patient and carer distress as was physical disability.Journal of psychosomatic research 03/2012; 72(3):220-5. DOI:10.1016/j.jpsychores.2011.12.004 · 2.84 Impact Factor
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- "According to predetermined protocols, a comprehensive geriatric assessment was made within 72 h of admission (Stuck et al., 1993; Miralles et al., 2003) The principal domains assessed were functional status, cognitive function, depression and comorbidity, which were evaluated by standardized instruments. Functional status was evaluated by ability in activities of daily living (ADL) (expressed as BI, ranging 0–100) (Granger et al., 1979) and instrumental activities of daily living (IADL) (expressed as LI, ranging 0–8) (Lawton and Brody, 1969). BI was registered prior to admission, at admission and at discharge, and LI prior to admission. "
ABSTRACT: Authors wanted to assess the predictive value of the trunk control test (TCT) on recovering ambulation in elderly patients who have developed walking disability. The study design was a prospective study performed in a hospital-based intermediate-care unit. Twenty-one patients (mean age 78.5+/-6.7 years) were investigated, who had developed walking disability after prolonged bed rest for an acute condition. A comprehensive geriatric assessment with functional status evaluation, based on the activities of daily living (ADL) (expressed as Barthel index=BI), and instrumental activities of daily living (IADL) (expressed as Lawton index=LI), cognitive function (Mini-Mental State Examination-Folstein=MMSE), depression (Geriatric Depression Scale=GDS) and comorbidity (Charlson comorbidity index=CCI) was performed within 72h after admission. A specialist in physical medicine and rehabilitation designed a rehabilitation program. TCT was performed in all patients before they started the program. The mean TCT score of the 21 patients was 52.7+/-22.9 (range: 0-100), while this score was 47.3+/-16.9 in the 15 patients who recovered ambulation, and 66.2+/-31.4 in the rest who did not (p=0.08). No statistically significant differences were observed either in subtotal scores of the TCT between groups. Furthermore, none of the TCT cutoff point was significantly associated with recovery. Cognitive function assessed by the MMSE was significantly better in patients who recovered, than in those who did not (23.4+/-3.9 vs. 17.8+/-5.2; p<0.02). Our conclusion is that TCT has not proved to be a predictor of recovering ambulation in elderly patients. In the present study, cognitive function was significantly associated with recovery after prolonged bed rest.Archives of gerontology and geriatrics 02/2009; 49(3):409-12. DOI:10.1016/j.archger.2008.12.008 · 1.53 Impact Factor
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- "Delirium was scored by the CAM. Cognitive impairment was based on the medical history and functional impairment on the 10-item Barthel questionnaire below 13 points [Granger et al., 1979]. DNA was available for 100 patients, but genotyping of 5 patients was unsuccessful for all SNPs. "
ABSTRACT: Delirium is the most common neuropsychiatric syndrome in elderly ill patients. Previously, associations between delirium and the dopamine transporter gene (solute carrier family 6, member 3 (SLC6A3)) and dopamine receptor 2 gene (DRD2) were found. The aim of this study was to validate whether markers of the SLC6A3 and DRD2 genes are were associated with delirium in independent populations. Six European populations collected DNA of older delirious patients. Associations were determined per population and results were combined in a meta-analysis. In total 820 medical inpatients, 185 cardiac surgery patients, 134 non-cardiac surgery patients and 502 population-based elderly subjects were included. Mean age was 82 years (SD 7.5 years), 598 (36%) were male, 665 (41%) had pre-existing cognitive impairment, and 558 (34%) experienced delirium. The SLC6A3 rs393795 homozygous AA genotype was more frequent in patients without delirium in all populations. The meta-analysis showed an Odds Ratio (OR) for delirium of 0.4 (95% confidence interval (C.I.) 0.2-0.6, P = 0.0003) for subjects with AA genotype compared to the AG and GG genotypes. SLC6A3 marker rs1042098 showed no association with delirium. In meta-analysis the DRD2 rs6276 homozygous GG genotype showed an OR of 0.8 for delirium (95% C.I. 0.6-1.1, P = 0.24). When subjects were stratified for cognitive status the rs6276 GG genotype showed ORs of 0.6 (95% C.I. 0.4-1.0, P = 0.06) and 0.8 (95% C.I. 0.5-1.5, P = 0.51) for delirium in patients with and without cognitive impairment, respectively. In independent cohorts, a variation in the SLC6A3 gene and possibly the DRD2 gene were found to protect for delirium.American Journal of Medical Genetics Part B Neuropsychiatric Genetics 01/2009; 153B(2):648-55. DOI:10.1002/ajmg.b.31034 · 3.27 Impact Factor