Dallas E. Johnson

The Stroke Impact Scale Version 2.0 Evaluation of Reliability, Validity, and Sensitivity to Change

BACKGROUND AND PURPOSE To be useful for clinical research, an outcome measure must be feasible to administer and have sound psychometric attributes, including reliability, validity, and sensitivity to change. This study characterizes the psychometric properties of the Stroke Impact Scale (SIS) Version 2.0. METHODS Version 2.0 of the SIS is a self-report measure that includes 64 items and assesses 8 domains (strength, hand function, ADL/IADL, mobility, communication, emotion, memory and thinking, and participation). Subjects with mild and moderate strokes completed the SIS at 1 month (n=91), at 3 months (n=80), and at 6 months after stroke (n=69). Twenty-five subjects had a replicate administration of the SIS 1 week after the 3-month or 6-month test. We evaluated internal consistency and test-retest reliability. The validity of the SIS domains was examined by comparing the SIS to existing stroke measures and by comparing differences in SIS scores across Rankin scale levels. The mixed model procedure was used to evaluate responsiveness of the SIS domain scores to change. RESULTS Each of the 8 domains met or approached the standard of 0.9 alpha-coefficient for comparing the same patients across time. The intraclass correlation coefficients for test-retest reliability of SIS domains ranged from 0.70 to 0.92, except for the emotion domain (0.57). When the domains were compared with established outcome measures, the correlations were moderate to strong (0.44 to 0.84). The participation domain was most strongly associated with SF-36 social role function. SIS domain scores discriminated across 4 Rankin levels. SIS domains are responsive to change due to ongoing recovery. Responsiveness to change is affected by stroke severity and time since stroke. CONCLUSIONS This new, stroke-specific outcome measure is reliable, valid, and sensitive to change. We are optimistic about the utility of measure. More studies are required to evaluate the SIS in larger and more heterogeneous populations and to evaluate the feasibility and validity of proxy responses for the most severely impaired patients.

Randomized Clinical Trial of Therapeutic Exercise in Subacute Stroke

BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration. The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear. The objective of this study was to determine whether a structured, progressive, physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care. METHODS This randomized, controlled, single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions. We included persons with stroke who were living in the community. One hundred patients (mean age, 70 years; mean Orpington score, 3.4) consented and were randomized from a screened sample of 582. Ninety-two subjects completed the trial. Intervention was a structured, progressive, physiologically based, therapist-supervised, in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility, strength, balance, endurance, and upper-extremity function. Main outcome measures were postintervention strength (ankle and knee isometric peak torque, grip strength), upper- and lower-extremity motor control (Fugl Meyer), balance (Berg and functional reach), endurance (peak aerobic capacity and exercise duration), upper-extremity function (Wolf Motor Function Test), and mobility (timed 10-m walk and 6-minute walk distance). RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect, the intervention produced greater gains than usual care (Wilks lambda=0.64, P=0.0056). Both intervention and usual care groups improved in strength, balance, upper- and lower-extremity motor control, upper-extremity function, and gait velocity. Gains for the intervention group exceeded those in the usual care group in balance, endurance, peak aerobic capacity, and mobility. Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function. CONCLUSIONS This structured, progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance, balance, and mobility beyond those attributable to spontaneous recovery and usual care.

Effects of calcium salts on beef longissimus quality.

The objective of this research was to evaluate the effects of injection marination with calcium salts on beef longissimus quality traits. Strip loins were injected (11% by weight) with distilled water or a 0.1, 0.2, or 0.3 M solution of calcium ascorbate, calcium chloride, or calcium lactate. Non-injected loins served as controls. Visual and instrumental color evaluations indicated that calcium ascorbate accelerated myoglobin oxidation, and increasing molar concentration of any calcium salt caused faster (P<0.05) discoloration. Aerobic microbial plate counts were lower (P<0.05) for treatments containing calcium lactate than those with calcium chloride or calcium ascorbate. Calcium ascorbate inhibited lipid oxidation whereas calcium lactate and calcium chloride appeared to be pro-oxidants of lipid oxidation. No differences for Warner-Bratzler shear force or sensory panel tenderness were found among the calcium salts; however, 0.3 M treatments had lower shear values and were judged more tender than 0.1 M treatments. Calcium ascorbate and calcium chloride treatments resulted in less (P<0.05) beef flavor and more (P<0.05) off-flavors than calcium lactate treatments. In addition, 0.1 M treatments had higher (P<0.05) beef flavor scores while 0.3 M treatments had higher (P<0.05) off-flavor scores. Considering the effects on color life, microbial inhibition, shear force, and sensory traits, we recommend injecting beef longissimus with a 0.1 M solution of calcium lactate to enhance both uncooked and cooked quality.

Effects of enhancing beef longissimus with phosphate plus salt, or calcium lactate plus non-phosphate water binders plus rosemary extract.

Beef strip loins (n=36) were enhanced with a sodium phosphate plus salt solution (PS); or with a calcium lactate solution (Ca) plus 1% or 2% beef broth (Br) plus natural flavoring (N) containing rosemary extract; or with 1% or 2% kappa carrageenan (Cr) plus N to determine effects of ingredients on color life, water-binding ability, and palatability traits. Enhancement with PS resulted in higher pH, higher pumped yields, greater water-binding ability, and higher tenderness and juiciness scores than enhancement with Ca (all p<0.05). Enhancement with Ca resulted in less color deterioration, less metmyoglobin discoloration, higher L (∗), a (∗), and b (∗) values, higher beef flavor intensity scores and lower off-flavor scores than enhancement with PS (all p<0.05). Warner-Bratzler shear values did not differ among treatments. Steaks enhanced with Br had less color deterioration, less metmyoglobin discoloration, and higher L (∗) values than those enhanced with Cr (all p<0.05). Pumped yields were not different between loins enhanced with Br or Cr. The N flavoring containing rosemary extract decreased (p<0.05) discoloration. Enhancing beef longissimus with PS increased water-binding capacity and sensory tenderness traits, but reduced color stability and increased off-flavors, whereas Ca preserved color stability and enhanced flavor at the expense of pumped yields. The use of Br or Cr had no influence on tenderness or palatability traits.

Conceptualization of a New Stroke-Specific Outcome Measure: The Stroke Impact Scale

Abstract Current stroke outcome measures are unable to detect some consequences of stroke that affect patients, families, and providers. The objective of this study was to ensure the content validity of a new stroke outcome measure. This was a qualitative study using individual interviews with patients and focus group interviews with patients, caregivers, and health care professionals. Participants included 30 individuals with mild and moderate stroke, 23 caregivers, and 9 stroke experts. Qualitative analysis of the individual and focus group interviews generated a list of potential items. Consensus panels reviewed the potential items, established domains for the measure, developed item scales, and decided on mechanisms for administration and scoring. Although the participants with stroke appeared highly recovered based on scores from conventional stroke assessments (Barthel Index and NIH Stroke Scale), stroke survivors and their caregivers identified numerous persisting impairments, disabilities, and handicaps. In general, stroke survivors described themselves as only about 50% recovered and reported that they had difficulty in activities in which they were not independent. To fully assess the impact of stroke on patients, we used the results of this qualitative study to develop a new stroke-specific outcome, the Stroke Impact Scale.

On Analyzing Two-Way AoV Data with Interaction

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Staged injection marination with calcium lactate, phosphate and salt may improve beef water-binding ability and palatability traits §

Semitendinosus and longissimus muscles from USDA Select carcasses were used to investigate the effects of staged injection of calcium lactate followed by phosphate and salt (PS) on water-binding ability and palatability traits. Calcium lactate (0.2 M) and PS (8.4% and 4.2%, respectively) were sequentially injected (5.5% by weight) into muscles with 0, 1, 3, or 5 h holding time between injections. Treatments also included a double pump of 0.1 M calcium lactate with 0 h holding time between injections and a non-marinated control. Injection of calcium lactate and PS increased (P<0.05) pumped yield and decreased (P<0.05) expressible moisture values compared to calcium lactate injection only. No differences in peak force, total energy, or myofibrillar fragmentation index were observed among marination treatments for either muscle; however, longissimus tenderness was unusually high. Trained-panel evaluation of sensory traits did not differ for the semitendinosus muscle. Staged injection of calcium lactate and PS improved (P<0.05) myofibrillar and overall sensory tenderness scores of longissimus muscle over those of the non-marinated control. However, beef flavor intensity scores were lowered (P<0.05) by addition of PS. Holding time between injections did not appear to consistently influence water-binding ability or palatability traits. These data suggest that separate solutions of calcium lactate and PS may be injected into longissimus muscle to improve water-binding ability and palatability traits.

Efficacy of lactic acid salts and sodium acetate on ground beef colour stability and metmyoglobin-reducing activity.

This study examined two concentrations (0.6 and 1.0mol) of three lactic acid salts (calcium lactate, CaL; potassium lactate, KL; and sodium lactate, NaL), with and without 0.01mol sodium acetate (n=3 replications), for effects on ground beef colour stability and metmyoglobin-reducing activity (MRA). Ground beef with CaL was least colour stable (P<0.05). Increasing CaL and NaL concentration decreased (P<0.05) colour stability. Ground beef with acetate only was most colour stable (P<0.05), but it did not result in more MRA (P>0.05) than control ground beef. Including both lactate and acetate was not as effective (P>0.05) in increasing colour stability as acetate alone. In general, both KL levels were equal (P>0.05) to the lower NaL concentration, and all three were superior in colour stability (P<0.05) to CaL and the higher NaL concentration. More MRA was generated by including lactates (P<0.05); KL and NaL had more MRA than CaL (P<0.05). However, these increases in MRA did not result in improved colour stability. Overall, adding KL to ground beef would not increase ground beef colour stability over adding nothing, but CaL and high levels of NaL would decrease colour stability. Using 0.01mol sodium acetate maximized ground beef colour stability.

Dry aging of beef in a bag highly permeable to water vapour.

The objective of this experiment was to compare traditional dry aging of beef with a novel technique of dry aging in a highly moisture-permeable bag. Four equal-sized sections from paired beef strip loins were dry aged traditionally, unpackaged, or packaged in the experimental bag for 14 or 21d at 3°C. No differences (P>0.05) were noted for pH, moisture, fat, total plate counts, cook loss, shear force, or any measured sensory attribute between the two aging treatments after either aging period. After 21d, however, dry aging in the bag (versus traditional dry aging) decreased (P<0.05) weight loss during aging, trim loss after aging, and yeast counts on lean tissue and increased lactic acid bacteria counts (P<0.05) on adipose and lean tissue. Dry aging in a highly moisture-permeable bag is feasible, will positively impact yields and reduce microbial spoilage, and will have no negative impact on product quality.

Effects of dry aging of bone-in and boneless strip loins using two aging processes for two aging times

This experiment investigated the combined effects of two dry-aging methods (unpackaged and in a bag), two loin-cut styles (bone-in shell loins and boneless strip loins), and two aging times (21 and 28days) on the physical, chemical, sensory, and microbial properties of dry-aged beef. Sections from shell and strip loin were assigned randomly to be aged unpackaged or aged packaged in a bag with high moisture permeability. Weight losses increased with aging time. Shell loins lost more (P<0.05) weight during aging compared with strip loins; dry aging in a bag had less (P<0.05) weight loss than unpackaged aging. There were no differences (P>0.05) in any of the sensory traits between shell and strip loins or dry aging using a traditional method or in a bag. Dry aging in a bag creates positive effects on yields, no negative effects on product quality, and adds flexibility and control of the aging environment.