Godelieve Nuyens

Inter-rater reliability of the Ashworth scale in multiple sclerosis

A study of 30 patients with multiple sclerosis was undertaken to determine the inter-rater reliabilty of the Ashworth scale for the clinical assessment of spasticity in the lower limbs. Scores of two physiotherapists were compared. Kendalls tau correlation coefficients higher than 0.60 were found for M soleus, M gastrocnemius and for the M psoas. For the adductors and the internal rotators of the hip, the interrater reliability according to Kendalls tau was lower than 0.55. For the M quadriceps and the flexors of the knee, Kendalls tau correlations were higher on the left side than on the right side. No explanation could be found for this inconsistent finding. It was concluded that the Ashworth scale may be used as a reliable scale for some muscles but not for others. More research is needed to find out if differences in ratings could be explained by fluctuations or differences in the clinical assessment of the muscle tone.

Do posture and straining influence urinary-flow parameters in normal women?

The influence of posture of the pelvis and straining on urinary flow was investigated in 21 normal women, mainly physiotherapists, who were asked to urinate on an uro‐flow chair at their usual time and frequency. Subjects were at random instructed to urinate in five different test situations: anteversion, anteversion with straining, retroversion, retroversion with straining, and forward bending without straining. The urinary‐flow parameters investigated were volume, peak flow, time to peak, peak‐to‐end time, total time, and mean flow. The analysis was done by means of analysis of variance but only for micturition volumes >150 mL. The morphology of the urinary‐flow curves was examined for the presence of irregularities and increasing (after top) or decreasing (for top) curve tops and after‐dribbling. Results demonstrated no significant differences for peak flow, total time, and mean flow in the anteversion, retroversion, and the forward‐bending position. This holds for test situations and re‐test controls. However, straining increased the peak flow and mean flow rates in all positions and in all women, whereas it reduced the total voiding time. The voided volumes were lowest in anteversion. Irregularities were less frequent in the forward‐bending position. It can be concluded that the forward‐bending position is the most preferable urinating position to relax the pelvic floor muscles. Neurourol. Urodynam. 19:3–8, 2000.

Comparison of self‐administration and face‐to‐face interview for surveys of low back pain in adolescents

The aim of this study was to compare self‐administration with face‐to‐face interview in the investigation of low back pain in adolescents. Fifty‐seven adolescents with low back pain (mean age 17.3 y; range 16–18) first completed a questionnaire and were then invited to an interview. Analysis included item completion, percentages of agreement and weighted kappa. Item completion rates were high and comparable between self‐administration and interview. Information between both methods was analogous for severity and localization of problems, sleep behaviour, medical consultation and sports/leisure activities. Onset, progression, duration of low back pain and some items on the influence of movement/positions presented less comparable data.

Self-Report Assessment of Fatigue in Multiple Sclerosis: A Critical Evaluation

SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians usually assess fatigue by asking people to describe and rate their fatigue in a self-report instrument. This paper evaluates the clinical usefulness and the scientific properties of a selection of various self-report instruments for fatigue. To be selected, instruments had to assess fatigue or a related concept, have some published information on reliability and validity, be used in at least one clinical trial of fatigue with people with multiple sclerosis, and demonstrate validity in people with MS. Five fatigue specific scales and four subscales of quality of life instruments were selected and evaluated. In occupational therapy, the fatigue subscales or items of quality of life measurements give limited information about the quality of fatigue. The selection of an instrument may depend on the clinical setting or trial design.

Torque variations during repeated passive isokinetic movements of the knee in subjects with Parkinson's disease and healthy control subjects

The purpose of this study was to quantify response variations during isokinetic passive movements of the knee in subjects with Parkinsons disease. Parkinsonian patients demonstrated a greater decrease of resistive torque compared to healthy control subjects, particularly in tests at higher velocities and during knee flexion movements. Responses were influenced by electromyographic activity in stretched and shortened muscle groups and also by mechanical factors. The results indicate that repetition of movements needs to be taken into account when measuring hypertonia in parkinsonian subjects.

Reliability of torque measurements during passive isokinetic knee movements in healthy subjects.

In the literature, few data are available about the reliability of torque measured during passive isokinetic knee movements. This study investigated the consistency of torque measurements during passive knee movements at 60, 180 and 300 degrees/second in 30 healthy subjects. Intraclass correlation values ranged between 0.78 and 0.92 when the results of two consecutive tests were compared. When retests were performed after repositioning the subjects, intraclass correlation values ranged between 0.43 and 0.87. These findings indicate the necessity for meticulous standardization of the test situation. Series of 10 consecutive movements, specifically repetitions of knee flexion at 180 and 300 degrees/second, indicated that torque measurements during the first two movements were less stable than those following. A concurrent change in electromyographic activity in the rectus femoris muscle suggested that these torque variations resulted from habituation of the stretch reflex.

TORQUE VARIATIONS DURING REPEATED PASSIVE ISOKINETIC KNEE MOVEMENTS IN PERSONS WITH MULTIPLE SCLEROSIS

The purposes of this study were to investigate the effect of movement repetitions on resistive torque during passive isokinetic dynamometry of the knee and to determine the role of electromyographic activity in the stretched muscles on the torque measurements. Ten persons with multiple sclerosis and hypertonia of the knee muscles were compared with 10 healthy age- and gender-matched control subjects. During series of 10 flexion and extension movements of the knee at 60, 180 and 300 degrees/s, torque and electromyographic activity in the stretched muscles were registered. The persons with hypertonia presented a significantly larger torque reduction (p < 0.05) than the control subjects in all test conditions except for repeated knee flexion at 300 degrees/s. Electromyographic activity in the stretched muscles was not identified as the only explanatory mechanism for the reduction in hypertonia during the movement repetitions, suggesting that other factors were also involved.

Predictive Value of SF–36 for MS–Specific Scales of the MS Quality of Life Inventory

Background: The MS Quality of Life Index (MSQLI) is a modular health-related quality of life instrument consisting of the Health Status Questionnaire (SF-36) and nine MS-specific measures. The purpose of this study is to assess whether adding all the proposed MS-specific measures to the SF-36 is necessary to obtain a more comprehensive measurement of quality of life in MS. Method: Eighty-eight persons with multiple sclerosis, 42 men and 46 women, with an average age of 52.5 ± 11 years, completed the MSQLI questionnaires. The predictive value of SF-36 items to MS-specific scales was low to moderate, with r2-values ranging between 0.02 and 0.57. The accuracy of the predictive models was not sufficient enough to replace the MS-specific scales with the SF-36 items. Conclusion: Adding scales to the SF-36 may be valuable to obtain a more comprehensive view on the quality of life of people with MS. (Int J MS Care. 2003; 5: 8–14)

Time use of stroke patients in an intensive rehabilitation unit: a comparison between a Belgian and a Swiss setting

PURPOSE Functional improvement after stroke has been related to the intensity of treatment. The present study was set up to observe how stroke patients spend their time in a rehabilitation unit. METHOD Behavioural mapping was performed throughout a full working day in a Belgian and Swiss stroke unit. RESULTS Patients were most frequently involved in therapeutic activities, 28% of the day in Belgium and 45% in Switzerland. Physiotherapy accounted for the majority of the therapy time. The Belgian patients spent 27% of the day in their own room and Swiss patients 49% of the day. The most striking finding was that the Swiss patients spent nearly 1.5 hours per day more in therapy. CONCLUSIONS Differences between the two settings could only partially be explained by more favourable patient-staff ratios in the Swiss setting. Autonomous practice, group therapy sessions and family involvement have to also be considered.

Fluctuations of spasticity in the lower limbs in patients with multiple sclerosis

A study of 25 patients with multiple sclerosis was performed to observe fluctuations of spasticity in the lower limbs during the day. Six muscle groups were tested on the left and right side, including the extensors, the adductors and the internal rotators of the hip, the flexors and extensors of the knee and the plantar flexors of the ankle. Spasticity was evaluated in supine position with the Ashworth scale four times during one day between 7.30 a.m. and 8.00 p.m. The data were analysed with the Friedman test. No statistically significant fluctuations in muscle tone were disclosed (α = 0.05) except for the knee extensors on the right side. An additional analysis with statistics of concordance based on the comparison of consecutive scores confirmed the finding that no major changes of spasticity were registered with the Ashworth scale for the 25 patients during the period of testing. The general opinion of clinicians, that spasticity is a variable phenomenon, was not supported statistically by the results of the present study, possibly because of the standardization of the test situation. The fact that standardization of the test situation might be enough to obtain steady scores on the Ashworth scale could be interesting in studies of the effects of treatments on spasticity.