Elizabeth A. Hill

Agreement between physiotherapists on quality of movement rated via videotape

Background: Although achieving quality of movement after stroke is an important aim of physiotherapy it is rarely measured objectively or described explicitly. Objective: To test whether physiotherapists agree on a composite measure of quality of movement. Setting: A movement analysis laboratory Subjects: Ten stroke patients and 10 healthy age-matched volunteers. Design: Prospective correlational. Procedure: All subjects were videofilmed performing three trials of six standardized functional tasks. Two videotapes were made, each with a different randomized order of appearance of the trials. Ten senior physiotherapists independently rated the videotapes twice using a 100-mm visual analogue scale. Analysis: Analysis of variance models were fitted to transformed data. Estimates of components of variance were calculated and presented as a percentage of the total variance for differences, within subjects (intra-subject), between raters (inter-rater) and within raters (intra-rater). An acceptable percentage was set at less than 10%. Results: The percentage of intra-subject variance ranged from 1% (pick up box and walking) to 9% (step on block). The percentage of inter-rater variance ranged from 18% (pick up pencil) to 38% (sit to stand). The percentage of intra-rater variance was less than 1% for all tasks. Conclusions: Although physiotherapists disagreed with each other on quality of movement they were more consistent in their own scoring.

The size, location, and clinical severity of corneal infiltrative events associated with contact lens wear.

Purpose. The purpose of this study is to determine the relationship between the size, location, and clinical severity of corneal infiltrative events (CIEs) associated with contact lens wear. Methods. We examined a series of contact lens wearers, presenting consecutively to a large hospital clinic, who had any form of CIE. The severity of the CIE was quantified using a clinical severity matrix based on scores attributed to each of 10 signs and symptoms. The infiltrate was accurately drawn on a schematic diagram of the ocular surface, and from this, we determined its size (i.e., largest dimension) and distance from the limbus. Cartograms were constructed to illustrate the size and location of the corneal infiltrates according to wearing modality and lens type. Results. Useable data pertaining to 111 patients were analyzed. A significant positive correlation was found between the distance of the infiltrate from the limbus versus clinical severity (p = 0.002), but not between the distance of the infiltrate from the limbus versus infiltrate size (p = 0.97). The cartograms revealed a tendency for infiltrates to occur in the superior cornea of patients wearing extended wear silicone hydrogel lenses (p = 0.0002) in the central cornea of patients wearing daily wear hydrogel daily disposable lenses (p = 0.007) and in the peripheral cornea of patients wearing daily wear hydrogel (excluding daily disposable) lenses (p = 0.0006). Conclusions. These data statistically validate the previously held anecdotal notion that CIEs which occur in the peripheral cornea are less clinically severe than those which occur in the central cornea. Consideration of the distribution of CIEs may facilitate a better understanding of the etiology of these events and can serve to alert practitioners as to their likely clinical presentation.

An exploration of the effects of weighted garments on balance and gait of stroke patients with residual disability

Objective: To explore the effects of weighted garments on the balance and gait of stroke patients. Design: A pilot randomized controlled study with blinded measurement. Setting: Weighted garments were worn by patients living in the community and measurement was made in a hospital-based gait laboratory. Subjects: Twenty-four adults who were at least six months post stroke and were able to walk 10 metres with or without assistance or a walking aid. Intervention: The six-week treatment-phase subjects were given a set of weighted garments which they were shown how to apply and instructed to wear on their paretic side. Subjects randomly allocated to the six-week control phase were not given any weighted garments. Main outcome measures: Balance was measured with the Berg Balance Scale. Gait was measured using GaitMat II, an instrumented walkway. Gait parameters of interest were velocity and symmetry of: step length; single support time; double support time; and support base width. Measures were made at baseline before randomization (baseline) and at the end of the six weeks of intervention (outcome). Results: No statistically significant differences were found between the treatment and control groups at outcome for balance (Mann–Whitney U-test; p = 0.74), gait velocity (p = 0.68) or symmetry of gait parameters (p = 0.33 to p = 0.75). Conclusions: We found no evidence to support the clinical use of these weighted garments for stroke survivors.

Reliability of a measure of post-stroke shoulder pain in patients with and without aphasia and/or unilateral spatial neglect

Objective: To determine the inter/intra-rater reliability of expert physiotherapists (PTs) measuring post-stroke shoulder pain with 100 mm vertical visual analogue scales (VAS; intensity, frequency and affective response) and a categorical site-of-pain scale. Design: Three PTs independently rated subjects (normal clinical procedure but with a standardized starting position) on three days, at the same time of day, during one week in a randomized order determined by a nested latin square. Reliability for VAS scores was determined with the intraclass correlation coefficient (ICC) and for site-of-pain with the kappa statistic (. Acceptable reliability was set at 0.75. The limits of agreement were also calculated. Setting: Community. Subjects: Thirty-three patients, mean time post stroke 42 months (range 7–360). Results: Mean inter-rater reliability was 0.79 for intensity, 0.75 for frequency and 0.62 for affective response (ICC). The limits of agreement were wide and rater bias was significant for 6/27 ratings. Mean intra-rater reliability was 0.70 for intensity, 0.77 for frequency and 0.69 for affective response (ICC). For site-of-pain inter-rater reliability ranged from 0.156 (to 0.385 (and intrarater reliability ranged from 0.300 (to 0.559 (. Conclusions: Although inter-rater reliability was acceptable for intensity and frequency there was a consistently large systematic bias between pairs of raters. Agreement might be improved if a standardized assessment procedure was used and/or if training in pain behaviour interpretation was provided.

Inefficacy of Aspheric Soft Contact Lenses for the Correction of Low Levels of Astigmatism

Purpose. The purpose of this article is to compare the visual performance of a toric soft (TS) contact lens (SofLens 66 Toric; Bausch &Lomb, Rochester, NY), an aspheric soft (AS) contact lens (Frequency Aspheric; CooperVision, Fairport, NY) and a spectacle correction (SC) in subjects with low levels of astigmatism. Methods. One eye of 30 subjects with refractive astigmatism of –0.75 DC or –1.00 DC was tested. After pupil dilation, each subject was fitted with all three forms of correction in random order. Subjects were masked from the contact lens type. High-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA) were recorded for each correction using 2-mm, 4-mm, and 6-mm artificial pupils. Results. With a 2-mm pupil, HCVA was similar for the TS lens and the SC (p = 0.13); better HCVA was demonstrated with the TS lens than with the AS lens (p = 0.001). With 4-mm and 6-mm pupils, HCVA was poorer with the AS lens than with the SC (p < 0.002) and TS lenses (p < 0.0001). The difference in HCVA between the TS and AS lenses was two letters, three letters, and one line with pupil sizes of 2 mm, 4 mm, and 6 mm, respectively. LCVA was similar for the three refractive conditions with the 2-mm pupil size. With 4-mm and 6-mm pupils, LCVA was similar for the TS lens and SC, but better than the AS lens by approximately one line in each case (all p < 0.0001). Conclusions. For small pupil sizes, there is little difference in HCVA and LCVA between various refractive corrections. However, for larger pupils, HCVA and LCVA are superior with TS contact lenses and SC versus AS contact lenses by approximately a half-line or more, which is considered to be clinically significant. Superior vision can be achieved for low astigmatic contact lens wearers using TS rather than AS contact lenses.

Heterogeneity of O(6)-alkylguanine-DNA alkyltransferase activity in colorectal cancer: implications for treatment.

Objectives: MGMT (O6-alkylguanine-DNA alkyltransferase) reverses the carcinogenic, mutagenic and cytotoxic effects of alkylating agents. Measurement of MGMT activity in tumours might thus be of use in selecting those patients with colorectal cancer who may be sensitive to adjuvant alkylating agent therapy. The aim of this study was to assess whether measurement of MGMT activity in a single tumour biopsy is representative of the whole tumour. Methods: Multiple symmetrically spaced biopsies were taken from colorectal cancers obtained from 9 patients. MGMT activity was then measured in cell-free extracts by quantifying the transfer of [3H]methyl group from calf thymus DNA methylated in vitro with N-nitroso-N-[3H]-methylurea to the MGMT protein. Results: MGMT activity was detected in all tumour samples with the activity ranging between 3.6 and 36.2 fmol/µg DNA and 202–1,986 fmol/mg protein. Heterogeneity in MGMT activity (ratio of maximum/minimum MGMT levels per tumour) varied between 1.3 and 5.4. Conclusions: Measurement of MGMT activity in a single biopsy is not necessarily indicative of the level throughout the tumour. The response of colorectal cancers to alkylating agent treatment is likely to be non-uniform both within the tumour and between patients.

Longitudinal variation in O(6)-alkylguanine DNA-alkyltransferase activity in the human colon and rectum.

In a systematic study of O6-alkylguanine DNA-alkyltransferase activity in the human colon and rectum, tumours were found to occur in regions of low activity. These results are consistent with the hypothesis that O6-alkylguanine DNA-alkyltransferase levels and alkylating agent exposure may be important determinants of large bowel tumorigenesis.