Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis. Clinical interpretation of computerized adaptive test outcome measures in patients with foot/ankle impairments. Outcome measurement in functional somatic syndromes: SF-36 summary scores and some scales were not valid. Tailored psychotherapy for patients with functional neurological symptoms: a pilot study. Clinical Interpretation of a Lower-Extremity Functional Scale–Derived Computerized Adaptive Test Functional electrical stimulation therapy for severe hemiplegia: Randomized control trial revisited Impact of a person-centred community rehabilitation service on outcomes for individuals with a neurological condition Goal attainment scaling: does it provide added value as a person-centred measure for evaluation of outcome in neurorehabilitation following acquired brain injury? Design of treatment trials for functional gastrointestinal disorders. A feasibility study to investigate the clinical application of functional electrical stimulation (FES), for dropped foot, during the sub-acute phase of stroke – A randomized controlled trial The relation between impairments and functional outcomes poststroke. An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial. A randomized controlled trial of an education and counselling intervention for families after stroke A study on additional early physiotherapy after stroke and factors affecting functional recovery Functional outcomes and quality of life in patients with brain tumors: a preliminary report. Longitudinal imaging of Alzheimer pathology using [11C]PIB, [18F]FDDNP and [18F]FDG PET Clinical practice improvement approach in multiple sclerosis rehabilitation: a pilot study
BACKGROUND CONTEXT Objective measures including neurological findings , radiographic evaluation , and the Japanese Orthopaedic Association ( JOA ) score are commonly used for the evaluation of surgical outcomes . Because many surgeries are performed primarily to improve quality of life , a patient 's subjective evaluations are also important for accurately assessing surgical outcomes . Currently available instruments for assessing quality of life include the Short-Form 36 ( F-36 ) , the Oswestry disability index ( ODI ) , and the visual analog scale ( VAS ) clinical pain scale . PURPOSE The aims of this study were to measure surgical outcomes by using both objective measures and subjective measures including patient self- assessment s and psychological changes ; to assess the adequacy of the JOA alone for measuring outcome ; and to determine which measures , the SF-36v2 , ODI , VAS , or JOA correlate with the VAS pain scale score in lumbar canal stenosis . STUDY DESIGN We performed a prospect i ve study to measure surgical outcomes for lumbar canal stenosis using traditional objective measures such as neurological findings and subjective measures such as performance of ADLs , patient self- assessment s , and psychological changes . PATIENT SAMPLE Forty-two surgical patients with a mean age of 66.8+/-10.9 years at the time of surgery were included in the study . All cases were followed for more than 2 years . Surgical indications included no response to conservative treatment and neurological deterioration . Neurological symptoms were classified as nerve root type , cauda equine type , or combined type . We performed surgical decompression at the location of the dural or root indentation by myelography . The concomitant diagnosis causing the spinal stenosis was degenerative spondylolisthesis in 20 cases undergoing posterolateral fusion with pedicle screws . OUTCOME MEASURES Surgical outcomes were assessed by comparing preoperative and 24-month postoperative JOA scores for low back pain , SF-36v2 , ODI-v2 , and VAS scores . Statistical analysis was performed by using the analysis of variance . A p value<0.05 was considered statistically significant . METHODS Objective clinical measures , patient self- assessment s , and psychological changes were measured before and at 24 months postoperatively . We also examined which measurements correlated with the VAS scale for pain evaluation , thereby relating patient satisfaction to surgery outcome . RESULTS All JOA , SF-36v2 , ODI-v2 , and VAS scores significantly improved postoperatively . The physical component summary ( PCS ) of the SF-36 v2 showed significant improvement , although all scores remained less than the Japanese norm-based scores ( NBSs ) . The mental component summary ( MCS ) exhibited such a significant improvement that all postoperative subscales were higher than the Japanese NBS . JOA scores significantly correlated only with postoperative lower-extremity VAS score . All PCS and two MCS scores significantly correlated with the VAS score for low back pain . Parts of the PCS and MCS significantly correlated with the lower-extremity VAS . The ODI significantly correlated with both the preoperative and postoperative VAS scores for low back pain as well as with the postoperative lower-extremity VAS score . CONCLUSIONS The JOA , SF-36 , ODI , and VAS question naires are all useful instruments for measuring surgical outcomes . The VAS score is a better assessment of physical rather than mental health . The ODI is more reflective of patients ' subjective symptoms . Finally , the SF-36 is particularly informative because it includes questions addressing both psychological and physical status . Therefore , when combined , the SF-36v2 , VAS , and ODI scores are a valuable complement to the JOA scores in evaluating outcomes of surgery for lumbar canal stenosis STUDY DESIGN Prospect i ve cohort study of 10 287 patients with foot/ankle impairments receiving outpatient physical therapy .  OBJECTIVES To describe meaningful interpretations of functional status ( FS ) outcomes measures , estimated using a body-part-specific computerized adaptive test ( CAT ) . BACKGROUND Increased use of CATs to generate outcome measures in rehabilitation has stimulated questions concerning score interpretation . Identifying meaningful intra-individual change and reporting clinical interpretation of those generated outcomes are essential to advance the quality of rehabilitation practice . METHODS We performed 4 approaches to clinical ly interpret outcomes data . First , we used the st and ard error of the estimate to construct a 90 % confidence interval for each CAT estimated score . Second , we presented the percentile rank of FS scores . Third , we used 2 threshold approaches to define individual-patient-level change : statistically reliable change and clinical ly important change . Last , we illustrated a functional staging method . RESULTS Precision of a single score was estimated by an FS score of + /-4 . Based on score distribution , percentile ranks at 25th , 50th , and 75th percentiles corresponded to intake FS scores of 38 , 47 , and 57 , and discharge FS scores of 52 , 64 , and 77 , respectively . Minimal detectable change supported 7 or more FS change units out of 100 represented statistically reliable change , and ROC analyses supported 8 or more FS change units represented minimal clinical ly important improvement . Using a functional staging system , we established 5 hierarchical functional status levels . CONCLUSION CAT-generated outcome measures can be interpreted to improve clinical interpretation and to assist clinicians in using patient-reported outcomes during therapy practice OBJECTIVE This study aim ed to test the validity of the 36-item Short-Form Health Survey ( SF-36 ) scales and summaries in patients with severe functional somatic syndromes ( FSS ) , such as fibromyalgia and irritable bowel syndrome . STUDY DESIGN AND SETTING One hundred twenty patients with severe FSS enrolled in a r and omized controlled trial filled in the SF-36 question naire .  We tested for data quality , central scaling assumptions , and agreement with the conceptual model . RESULTS Most SF-36 scales were found to be valid ; however , three scales ( role physical , role emotional , and general health ) did not satisfy predefined criteria for construct validity , internal consistency , or targeting to the sample . The correlations between SF-36 scales differed considerably from those reported in the general population . As a consequence , the SF-36 summaries , physical component summary ( PCS ) and mental component summary ( MCS ) , did not accurately reflect their underlying scales and were negatively correlated ( r=-0.46 , 95 % CI [ -0.60 to -0.31 ] ) . CONCLUSION Although the SF-36 is a valuable instrument to assess perceived health in patients with severe FSS , there are problems with some of the scales and with the scoring procedure of the summaries . The SF-36 PCS may , therefore , not accurately measure the physical health status of these patients . Alternative summary measures are needed OBJECTIVE The objective of this study was to assess whether individually tailored psychotherapy for patients with functional neurological symptoms is associated with improvements in patient-centered measures of emotional well-being , quality of life , as well as somatic symptoms and whether this treatment modality is likely to be cost-effective . METHODS We conducted an uncontrolled prospect i ve pilot study of consecutive patients with functional symptoms referred from neurology outpatient clinics to a single psychotherapist using vali date d question naires [ Clinical Outcomes in Routine Evaluation Outcome Measure ( CORE-OM ) , Short Function (SF)-36 Health Survey , and  Patient Health Question naire  (PHQ)-15 ] . Patients had a median of 6 treatment sessions ( range=1 - 24 ) . Ninety-one patients completed question naires at referral , 63 did at the end of treatment , and 34 did at follow-up after 6 months . Significant improvements were seen on all measures and were maintained at follow-up ( CORE-OM , P=.003 ; SF-36 , P<.001 ; PHQ-15 , P=.001 ) . Significance was not lost in an intention-to-treat analysis . Of all the patients , 49.2 % improved by at least 1 S.D. in at least one of the measures . The number of patients needed to be treated to see an improvement of at least 1 S.D. in one of the three outcome measures was 2 ; that in two measures , 3.9 ; and that in all measures , 7 . The mean cost of the intervention was pound231 ; the cost per quality -adjusted life year was estimated as pound5,328 . RESULTS Psychotherapy was associated with significant improvements in patient-centered measures , which seemed to be achieved at a comparatively low cost . CONCLUSIONS The results indicate that psychotherapy may be a cost-effective intervention for patients presenting with functional neurological symptoms . The findings warrant further assessment of this treatment with a r and omized and controlled trial Background : The increasing use of computerized adaptive tests ( CATs ) to generate outcome measures during rehabilitation has prompted questions concerning score interpretation . Objective : The purpose of this study was to describe meaningful interpretations of functional status ( FS ) outcome measures estimated with a body part – specific CAT developed from the Lower-Extremity Functional Scale ( LEFS ) . Design : This investigation was a prospect i ve cohort study of 8,714 people who had hip impairments and were receiving physical therapy in 257 outpatient clinics in 31 states ( United States ) between January 2005 and June 2007 . Methods : Four approaches were used to clinical ly interpret outcome data . First , the st and ard error of the estimate was used to construct the 90 % confidence interval for each CAT-generated score estimate . Second , percentile ranks were applied to FS scores . Third , 2 threshold approaches were used to define individual subject – level change : statistically reliable change and clinical ly important change . The fourth approach was a functional staging method . Results : The precision of a single score was estimated from the FS score ±4 . On the basis of the score distribution , 25th , 50th , and 75th percentile ranks corresponded to intake FS scores of 40 , 48 , and 59 and discharge FS scores of 50 , 61 , and 75 , respectively . The reliable change index supported the conclusion that changes in FS scores of 7 or more units represented statistically reliable change , and receiver operating characteristic analyses supported the conclusion that changes in FS scores of 6 or more units represented minimal clinical ly important improvement . Participants were classified into 5 hierarchical levels of FS using a functional staging method . Limitations : Because this study was a secondary analysis of prospect ively collected data via a proprietary data base management company , generalizability of results may be limited to participating clinics . Conclusions : The results demonstrated how outcome measures generated from the hip LEFS CAT can be interpreted to improve clinical meaning . This finding might facilitate the use of patient-reported outcomes by clinicians during rehabilitation services Background . Stroke is the leading cause of long-term disability . Stroke survivors seldom improve their upper-limb function when their deficit is severe , despite recently developed therapies . Purpose . This study aims to assess the efficacy of functional electrical stimulation therapy in improving voluntary reaching and grasping after severe hemiplegia . Method . A post hoc analysis of a previously completed r and omized control trial ( clinical trials.gov , No. NCT00221078 ) was carried out involving 21 participants with severe upper-limb hemiplegia ( i.e. , Fugl-Meyer Assessment –Upper Extremity [ FMA-UE ] ≤ 15 ) result ing from stroke .  Findings . Functional Independence Measure Self-Care subscores increased 22.8 ( ±6.7 ) points in the intervention group and 9 ( ±6.5 ) in the control group , following 40 hr of equal-intensity therapy . FMA-UE score changes were 27.2 ( ±13.5 ) and 5.3 ( ±11.0 ) for the intervention and control groups , respectively . Implication s. The results may represent the largest upper-limb function improvements in any stroke population to date , especially in those with severe upper-limb deficit Abstract Purpose : To evaluate the impact of a person-centred , community rehabilitation service on outcomes for people with a neurological condition , in the first year of service . Method : A prospect i ve , observational , pre-post study was conducted with 206 people who had a neurological condition and attended the rehabilitation service  to restore function ( e.g. , Stroke ) ; maximize recovery in an ongoing situation ( e.g. , Spina Bifida ) ; or maximize function and independence while preparing for inevitable decline ( e.g. , Parkinson ’s Disease ) . Outcomes were measured via self-report question naires , prior to , and following three months of rehabilitation . The primary outcome was achievement of self-identified goals , measured by the Patient-Specific Functional scale . Secondary outcomes included the Lawton Instrumental Activities of Daily Living ( IADL ) scale , EQ-5D-5L European Quality of Life scale , and ICECAP-O – Index of Capability for Older Adults and health and medical re source use . Results : Participants demonstrated significant goal achievement and a significant reduction in health and medical re source use . There were small positive changes in the Lawton IADL , EQ-5D-5L , and ICECAP-O however these changes were not significant . Conclusions : In the first year of operation , the community rehabilitation service made a significant impact on outcomes for individuals with a neurological condition . Further research is required to identify appropriate measures of activities of daily living and quality of life that reflect person-centred rehabilitation outcomes for restoring function , maximizing function , or preparing for functional decline . Implication s for Rehabilitation Self-identified goals are an important guide for achievement of meaningful outcomes for individuals with a neurological condition . Person-centred outcome measures are required to evaluate the benefits of a person-centred community rehabilitation service for individuals with a neurological condition OBJECTIVE To compare  goal attainment scaling ( GAS ) and st and ardized measures in evaluation of person-centred outcomes in neurorehabilitation . DESIGN A prospect i ve cohort analysis from a tertiary inpatient neuro-rehabilitation service for younger adults with complex neurological disability . SUBJECTS/ PATIENTS Consecutive patients ( n = 164 ) admitted for rehabilitation following acquired brain injury ( any cause ) over 3 years . Mean age 44.8 ( st and ard deviation 14.4 ) years . DIAGNOSIS 66 % strokes , 18 % trauma , 16 % other . Male : female ratio 102:62 . METHODS GAS-rated achievement of 1 - 6 patient-selected goals was compared with the Functional Assessment Measure ( UK FIM+FAM ) , and Barthel Index ( BI ) , rated on admission and discharge . Personal goals were mapped retrospectively to the FIM+FAM and International Classification of Functioning , Disability and Health ( ICF ) . RESULTS Median ( interquartile range ; IQR ) GAS T-scores were 50.0 ( 44.2 - 51.8 ) and moderately correlated with changes in FIM+FAM and BI ( both rho 0.38 ( p < 0.001 ) ) . St and ardized response means were 2.2 , 1.6 and 1.4 for GAS , FIM+FAM and BI , respectively . Of 667 personal goals set , 495 ( 74 % ) were fully achieved . Although 413 ( 62 % ) goals were reflected by changes in FIM+FAM , over one-third of goals were set in other areas . CONCLUSION GAS appeared to be more responsive , and captured gains beyond the FIM+FAM , thus providing added value as an adjunct to outcome measurement in patients with complex disability Until recently many clinical trials of functional gastrointestinal disorders ( FGIDs ) suffered from important weaknesses in trial design , study execution , and data analysis . This makes it difficult to determine whether truly efficacious therapies exist for these disorders . One of the important method ologic problems is the absence of vali date d outcome measures and lack of consensus among stakeholders on how to measure outcome . Currently much of the effort is being put into the development of vali date d outcome measures for several of the FGIDs . The r and omized , controlled trial with parallel groups is the design of choice . In this report , guidelines are given for the basic architecture of intervention studies of FGIDs . Further studies on design issues are required to ensure the recommendations will become evidence based in the future Purpose Functional electrical stimulation ( FES ) , for dropped foot , has been shown to have positive benefits in chronic stroke . It has been suggested that similar benefits may be seen earlier after stroke . The aim of this feasibility study was to evaluate the trial methodology of undertaking a r and omized controlled trial ( RCT ) of FES in sub-acute stroke . Method : This was a r and omized feasibility study with non-blinded outcomes at 6 and 12 weeks . Sixteen sub-acute stroke in- patients with dropped foot were r and omized into two groups ( control , n = 7 ; intervention , n = 9 ) . Both groups received routine gait re-education and an orthotic device , the control group used an ankle foot orthosis and the intervention group used FES . Outcome measures included gait velocity and cadence , Functional Ambulation Classification , Visual Analogue Scale of perception of walking , and the Stroke Impact Scale . Results : Eligibility criteria developed for inclusion of participants in the trial were appropriate . Set-up of FES during sub-acute stroke was feasible but more challenging than with chronic patients . Outcome measures were suitable and have informed the choice of measures for future work . Conclusions : It is feasible to undertake a trial evaluating FES during the sub-acute phase of recovery after stroke . A larger RCT is required OBJECTIVE To assess the influence of initial stroke impairments on the severity of basic and higher level functional deficits over time and to determine the cumulative impact on functional deficits beyond severity of motor deficits alone . DESIGN Observational study . SETTING Twelve participating hospitals in the Greater Kansas City area , as part of the Kansas City Stroke Study ( October 1995-March 1998 ) . PARTICIPANTS Individuals ( n = 459 ) who sustained an eligible stroke were evaluated prospect ively using st and ardized assessment s at enrollment ( within 14 days of stroke onset , 8.8 + /- 3.5 days ) . MAIN OUTCOME MEASURES Mobility and activities of daily living ( ADLs ) were assessed at 1 , 3 , and 6 months poststroke using the Functional Independence Measure , Barthel index , Lawton Instrumental Activities of Daily Living ( IADL ) , and the Medical Outcomes Study Short-Form Health Survey instruments . RESULTS The cumulative probability of achieving independence with walking , a Barthel index of 60 or greater or 90 or greater , and independence in 3 or more IADL was significantly different for the following 4 impairment groups in descending order : motor ; motor and somatosensory ; motor and hemianopia ; and motor , sensory , and hemianopia . Although motor severity was a strong predictor of outcome ( p < .0001 ) , the additional somatosensory and hemianopia deficits significantly ( p < .05 ) affected time and likelihood of achieving these levels of function . CONCLUSION Cumulative deficits poststroke affect patients ' functional outcome in the first 6 months poststroke beyond the effect of motor severity alone OBJECTIVE To investigate the feasibility of a motor imagery program integrated into physiotherapy and occupational therapy . DESIGN A parallel-group , phase II , assessor-blind r and omized controlled trial comparing motor imagery embedded in usual therapy with usual therapy only . SETTING A neurologic rehabilitation center ( Oxford , United Kingdom ) . PARTICIPANTS In patients and out patients diagnosed with stroke , brain injury , or multiple sclerosis , participating in a rehabilitation program with sufficient language skills to undertake the intervention were recruited ( N=30 ) and assessed at baseline , after 6 weeks ( postintervention ) , and after 12 weeks ( follow-up ) . INTERVENTIONS A motor imagery strategy was developed that could be integrated into usual therapy , tailored to individual goals , and used for any activity . The control group received st and ard care . MAIN OUTCOME MEASURES Goal attainment scaling was used as the primary outcome measure . Other measures included the Barthel activities of daily living index and the Rivermead Mobility Index . RESULTS Compliance with advised treatment was poor in 85 % of the therapists and in 72 % of the patients . Goal attainment scaling scores significantly improved at postintervention and follow-up ( F(2,27)=45.159 ; P<.001 ) , but no significant difference was observed between the groups over time ( F(1,28)=.039 ; P=.845 ) . CONCLUSIONS Therapist and patient compliance with performing the intervention was low , restricting the conclusions regarding the effectiveness of the integrated motor imagery program . Future studies will need to explore barriers and facilitators to uptake of this intervention in clinical practice . Trial recruitment and retention were good . The study demonstrated that imagery could be successfully integrated into usual therapy and tailored for a wide range of functional activities Objectives : To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses , and better functional and social outcomes for patients . Design : Two-group r and omized controlled trial . Data were collected on admission to and discharge from rehabilitation , and again six months later . Setting : Rehabilitation units at Repatriation General Hospital and Griffith Hospital , in Adelaide , South Australia . Participants : Sixty-two stroke patients and their spouses , 32 in the intervention group and 30 in the control group . Intervention : Stroke information package and three visits from a social worker trained in family counselling . Outcome measures : Family functioning : McMaster Family Assessment Device ( FAD ) ; functional status : Barthel Index ( BI ) ; social recovery : Adelaide Activities Profile ( AAP ) ; depression : Geriatric Depression Scale ( GDS ) ; anxiety : Hospital Anxiety and Depression Scale ( HADS ) ; mastery : Mastery Scale ( MS ) ; health status : SF-36 . Results : At six months the intervention group had better family functioning for both patients ( mean FAD difference 0.19 ) and spouses ( mean difference 0.09 ) . A modest benefit in functional status for intervention patients ( mean BI difference 1.3 ) was related to improved family functioning . Intervention patients reported better social recovery ( mean AAP differences : domestic chores 5.7 , household maintenance 4.6 , social activities 11.5 ) , but there were no significant effects on depression , anxiety , mastery or health status . Conclusions : An education and counselling intervention maintained family functioning , and in turn led to improved functional and social patient outcomes . This approach helps patients and their spouses to make the optimal adjustment to living with stroke Objective : To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients . Design : A prospect i ve , r and omized , controlled study . Setting : One stroke ward and an acute stroke unit in a large teaching hospital , southern China . Subjects : Patients with first-onset stroke consecutively admitted to the stroke centre . Interventions : One group ( n = 78 ) received additional early physiotherapy ( AEP ) for 45 minutes , five days a week for four weeks starting within the first week since stroke onset ; the routine therapy ( RT ) group ( n = 78 ) received no professional rehabilitation therapy . Main outcome measures : Glasgow Coma Scale , Mini-Mental State Examination , Fugl-Meyer Assessment of Motor Recovery , Clinical Neurological Deficit Scale and Modified Barthel Index ( MBI ) . Results : Patients from the AEP group had a high drop-out rate ( n = 28 ) , but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI . Multiple linear regression analysis revealed that cognitive disturbance , aphasia , double incontinence , site of lesion and sensory impairment might affect functional recovery after stroke . Conclusions : Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study . Cognitive disturbance , aphasia , double incontinence , site of lesion as well as sensory impairment might affect functional outcome after stroke OBJECTIVES To determine the relationship between functional outcome and quality of life ( QOL ) in patients with brain tumors receiving inpatient rehabilitation , and to assess the sensitivity of 4 assessment tools in measuring changes in that population . DESIGN Prospect i ve study using longitudinal data collected from consecutively admitted patients . SETTING Acute inpatient rehabilitation unit . PARTICIPANTS Ten patients with primary brain tumors admitted to an acute inpatient rehabilitation unit . INTERVENTIONS Patients participated in an inpatient interdisciplinary rehabilitation program that used the following disciplines : occupational therapy , rehabilitation therapy , recreational therapy , speech therapy , physical therapy , rehabilitation nursing and case management . MAIN OUTCOME MEASURES The FIM instrument , Disability Rating Scale ( DRS ) , Karnofsky Performance Status Scale ( KPS ) , Functional Assessment of Cancer Therapy-Brain ( FACT-BR ) . RESULTS Improvement in total functional outcome was indicated by all 3 functional measures ( FIM : F = 46.84 , p < .05 ; DRS : F = 19.25 , p < .05 ; KPS : F = 10.11 , p < .05 ) . Significant improvements were found between admission and discharge scores for the FIM and DRS . The KPS revealed significant improvement between admission and 3-month follow-up scores . All admission and discharge functional scales ( FIM , DRS , KPS ) correlated significantly with each other . No significant change was noted in the FACT-BR between admission and discharge scores , but FACT-BR scores did improve at 1- and 3-months postdischarge relative to admission . The FIM , KPS , and DRS did not show significant correlation with the FACT-BR . Ninety percent of patients were initially discharged to a home environment . CONCLUSION Although patients make functional gains during and after inpatient rehabilitation , gains in QOL are not significant until 1 month postdischarge . QOL does not appear to correlate well with functional outcomes . Further , the KPS is less sensitive than the FIM and DRS in detecting change in functional status Purpose [11C]PIB and [18F]FDDNP are PET tracers for in vivo detection of the neuropathology underlying Alzheimer ’s disease ( AD ) . [18F]FDG is a glucose analogue and its uptake reflects metabolic activity . The purpose of this study was to examine longitudinal changes in these tracers in patients with AD or mild cognitive impairment ( MCI ) and in healthy controls . Methods Longitudinal , paired , dynamic [11C]PIB and [18F]FDDNP ( 90 min each ) and static [18F]FDG ( 15 min ) PET scans were obtained in 11 controls , 12 MCI patients and 8 AD patients . The mean interval between baseline and follow-up was 2.5 years ( range 2.0–4.0 years ) . Parametric [11C]PIB and [18F]FDDNP images of binding potential ( BPND ) and [18F]FDG st and ardized uptake value ratio ( SUVr ) images were generated . Results A significant increase in global cortical [11C]PIB BPND was found in MCI patients , but no changes were observed in AD patients or controls . Subsequent regional analysis revealed that this increase in [11C]PIB BPND in MCI patients was most prominent in the lateral temporal lobe ( p < 0.05 ) . For [18F]FDDNP , no changes in global BPND were found . [18F]FDG uptake was reduced at follow-up in the AD group only , especially in frontal , parietal and lateral temporal lobes ( all p < 0.01 ) . Changes in global [11C]PIB binding ( ρ = −0.42 , p < 0.05 ) and posterior cingulate [18F]FDG uptake ( ρ = 0.54 , p < 0.01 ) were correlated with changes in Mini-Mental-State Examination score over time across groups , whilst changes in [18F]FDDNP binding ( ρ = −0.18 , p = 0.35 ) were not . Conclusion [11C]PIB and [18F]FDG track molecular changes in different stages of AD . We found increased amyloid load in MCI patients and progressive metabolic impairment in AD patients . [18F]FDDNP seems to be less useful for examining disease progression The objective of this study was to explore methods examining patient complexity and therapy interventions in relation to functional outcomes from an inpatient multiple sclerosis ( MS ) rehabilitation program . Retrospective and prospect i ve data for 24 consecutive in patients at a tertiary rehabilitation facility assessed ( i ) impairment/disability – Exp and ed Disability Status Scale , Neurological Impairment Set , ( ii ) complexity of intervention – Rehabilitation Complexity Scale , Northwick Park Therapy Dependency Assessment ( NPTDA ) , the type and duration of therapy , ( iii ) Function – Barthel Index ( BI ) , functional independence measure ( FIM ) , ( iv ) hospital length of stay , discharge destination . The mean length of stay was 20 days ( SD=15.7 ) ; male : female ratio was 10 : 14 ; 11 ( 46 % ) had Exp and ed Disability Status Scale scores more than 6.5 , and all discharged to community . Over one-half had ‘ moderate – severe ’ scores for fatigue , and deficits in motor function and mood that result ed in significant functional limitation . Rehabilitation Complexity Scale scores showed substantial complexity with two-thirds requiring specialized nursing . The NPTDA score ( median 22 interquartile range 20–23 ) showed moderate dependency on admission in the following domains : physical , cognitive and psychosocial programs and preparing for discharge . The mean physiotherapy and occupational therapy  received was 45.76 and 24.04 min/day , respectively . Functional gains from admission to discharge for FIM and BI were significant ( P<0.001 ) . There were strong correlations between the total NPTDA and FIM motor scores ( Spearman 's ρ −0.80 ) and BI ( ρ −0.83 ) , but only weak correlations with the FIM cognitive score ( ρ −0.33 ) . In conclusion , this pilot study provided information about the complex interplay of patient and process factors , and their interrelationships that impact functional outcomes in MS rehabilitation . A prospect i ve study is now planned using appropriate tools to underst and the ‘ black box ’ of rehabilitation . Gegenst and der vorliegenden Studie waren die Method en der Untersuchung der Patientenkomplexität und der Therapieinterventionen in Bezug auf die funktionellen Beh and lungsergebnisse bei einem Reha-Programm für stationär beh and elte Patienten mit multipler Sklerose ( MS ) . Die retrospektiven und prospektiven Date n für 24 nachein and er stationär beh and elte Patienten in einer tertiären Reha-Einrichtung dienten der Beurteilung der ( i ) Schädigung/Behinderung – EDSS-Leistungsskala ( Exp and ed Disability Status Scale ) , Neurological Impairment Set , ( ii ) Komplexität der Intervention – Rehabilitation Complexity Scale  , Northwick Park Therapy Dependency Assessment ( NPTDA ) , Art und Dauer der Therapie , ( iii ) Funktion – Barthel-Index ( BI ) , funktionaler Selbständigkeitsindex ( Functional Independence Measure , FIM ) , ( iv ) Dauer des Krankenhausaufenthalts , Adresse nach der Entlassung . Die mittlere Aufenthaltsdauer betrug 20 Tage ( SD = 15,7 ) ; das Verhältnis Männer : Frauen betrug 10 : 14 ; 11 ( 46 ) wiesen Exp and ed Disability Status Scale-Scores von mehr als 6,5 auf , und alle wurden zurück in die Gemeinschaft entlassen . Mehr als die Hälfte der Patienten wiesen die Scores ‘ mittelschwer – schwer ’ für Ermüdung und Mängel i m Bereich der Motorik und Gemütsverfassung auf , die zu signifikanten Funktionseinschränkungen führten . Die Rehabilitation Complexity Scale-Scores erwiesen sich als äußerst komplex , und zwei Drittel der Patienten mussten speziell gepflegt werden . Der NPTDA-Score ( medianer Bereich : 22 , Interquartilbereich : 20–23 ) wies bei der Aufnahme in folgenden Domänen eine mäßige Abhängigkeit auf : physische , kognitive und psychosoziale Programme und Vorbereitung auf die Entlassung . I m Durchschnitt erhielten die Patienten 45.76 Min/Tag Physiotherapie bzw . 24.04 Min/Tag Ergotherapie . Die Funktionsgewinne von der Krankenhauseinweisung bis zur Entlassung waren beim FIM und BI signifikant ( P<0.001 ) . Es zeigten sich starke Korrelationen zwischen den NPTDA- und FIM-Motor-Scores insgesamt ( Spearman ρ −0.80 ) und BI ( ρ −0.83 ) , aber nur schwache Korrelationen beim FIM kognitiven Score ( ρ −0.33 ) . Zusammenfassend lässt sich sagen , dass diese Pilotstudie Informationen über das komplexe Wechselspiel zwischen Patient und Prozessfaktoren und ihre Zusammenhänge lieferte , die sich auf die funktionellen Beh and lungsergebnisse bei der MS-Rehabilitation auswirken . Jetzt ist eine Prospektivstudie unter Zuhilfenahme geeigneter Tools geplant , um so die ‘ Grauzone ’ der Rehabilitation verstehen zu können . El objetivo de este estudio fue explorar posibles métodos para valorar el tipo de tratamiento y la complejidad de éste en cada paciente , con relación a los result ados de las capacidades funcionales en el tratamiento de rehabilitación hospitalaria de pacientes con esclerosis múltiple ( EM ) . Se recolectaron datos retrospectivos y prospect ivos de 24 pacientes consecutivos hospitalizados en un centro de atención terciaria de rehabilitación , con el objetivo de valorar : 1 ) la deficiencia / discapacidad — mediante la Escala Exp and ida para la Valoración del Grado de Discapacidad , las Pruebas de Valoración del Grado de Deficiencia Neurológica— ; 2 ) el grado de complejidad del tratamiento — mediante la Escala de Complejidad del Tratamiento de Rehabilitación , la Valoración de Northwick Park de la Dependencia al Tratamiento ( NPTDA , por sus siglas en inglés ) , el tipo de tratamiento y la duración de éste ; 3 ) el funcionamiento — mediante el Índice de Barthel [ IB ) y la medida de la independencia funcional ( MIF ) ; 4 ] duración de la estancia hospitalaria y el lugar de destino del paciente después del alta . El valor medio de la duración del estancia hospitalaria fue de 20 días ( DE=15,7 ) ; la proporción varones : mujeres fue de 10 : 14 ; en 11 ( 46 % ) de estos pacientes los valores de la Escala Exp and ida para la Valoración del Grado de Discapacidad fue mayor que 6,5 , y después del alta todos regresaron a su hogar . En más de la mitad de los pacientes el grado de astenia fue de entre moderado e intenso , y presentaron alteraciones de las funciones motoras y del estado de ánimo que causaron importantes limitaciones funcionales . Los puntajes de la Escala de Complejidad del Tratamiento de Rehabilitación mostraron que el grado de complejidad suele ser alto , pues dos tercios de los pacientes necesitan atención especializada de enfermería . Los puntajes la NPTDA ( la mediana del intervalo entre cuartilas , de entre 20 y 23 ) mostró un grado de dependencia moderado al ingreso en los siguientes dominios : físico , cognitivo , y psicológico , y durante la preparación para el alta . La media de la duración del tratamiento de fisioterapia y de terapia ocupacional fueron de 45.76 y 24.04 min/día , respectivamente . Se logró una gran mejoría en la esfera funcional desde el momento del ingreso hasta el alta , según los puntajes de la MIF y del IB ( P<0.001 ) . Se hallaron importantes correlaciones entre los puntajes totales de la NPTDA y de la MIF de la esfera motora ( coeficiente de correlación de Spearman , ρ −0.80 ) y el IB ( ρ −0.83 ) , pero las correlaciones entre la NPTDA y de la MIF de la esfera cognitiva ( ρ −0.33 ) . En conclusión , este estudio preliminar aportó información importante sobre la compleja interacción entre los pacientes y los factores del proceso a rehabilitación , y las interrelaciones entre estos que influyen en los result ados funcionales de la rehabilitación de pacientes con EM . Se realizará un estudio prospect ivo utiliz and o las herramientas adecuadas para lograr descifrar la « caja negra » de la rehabilitación . Cette étude avait pour objet d'explorer des méthodes qui examinent la complexité des patients et les interventions de thérapie par rapport aux résultats fonctionnels d'un programme de rééducation de patients hospitalisés souffrant de sclérose en plaques . Les données rétrospectives et prospect ives pour 24 patients consécutifs hospitalisés dans un établissement de rééducation tertiaire évaluaient ( i ) la déficience ou l'invalidité - échelle de statut d'incapacité augmenté , jeu d'affections neurologiques , ( ii ) la complexité de l'intervention – échelle de complexité de la rééducation , évaluation NPTDA ( Northwick Park Therapy Dependency Assessment ) , le type et la durée du traitement , ( iii ) les fonctions - indice de Barthel  ( BI ) , la mesure d'indépendance fonctionnelle ( FIM ) , ( iv ) la durée du séjour hospitalier , la destination à la sortie de l'hôpital . La durée moyenne du séjour était de 20 jours ( écart type = 15.7 ) ; le ratio homme : femmes était de 10 : 14 ; 11 sujets ( 46 ) présentaient des scores supérieurs à 6.5 , sur l'échelle de statut d'incapacité augmenté et tous ont été replacés dans la collectivité à la sortie de l'hôpital . Plus de la moitié présentaient des scores modérés à sévères pour la fatigue , et des déficits de la fonction motrice et de l'humeur qui provoquaient de significatives limitations fonctionnelles . Les scores sur l'échelle de complexité de la rééducation indiquaient une complexité considérable , les deux tiers nécessitant des soins spécialisés . Le score NPTDA ( médiane de 22 , écart interquartile 20–23 ) faisaient apparaître une dépendance modérée à l'admission dans les domaines suivantsprogrammes physiques , cognitifs et psychosociaux et préparation au départ de l'hôpital . La moyenne reçue par la physiothérapie et l'ergothérapie était de 45.76 et 24.04 min/jour , respectivement . Les gains fonctionnels de l'admission au départ pour le FIM et le BI étaient significatifs ( P<0.001 ) . On a constaté de fortes corrélations entre les scores moteurs NPTDA et FIM totaux ( ρ de Spearman 0.80 ) et BI ( ρ −0.83 ) , mais seulement des corrélations faibles avec le score cognitif FIM ( ρ −0.33 ) . En conclusion , cette étude pilote a apporté des informations sur l'interaction complexe des patients et des facteurs du processus et leurs interrelations qui influent sur les résultats de la rééducation fonctionnelle de la sclérose en plaques . Une étude prospect i ve est maintenant planifiée en utilisant les outils appropriés pour comprendre la « boîte noire »
No single measure was identified for use across the range of FND symptoms in adults .
Across r and omised controlled trials ( k=40 ) and observational treatment studies ( k=40 ) , outcome measures most often assessed core FND symptom change .
Other domains measured commonly were additional physical and psychological symptoms , life impact ( ie , quality of life , disability and general functioning ) and health economics/cost-utility ( eg , healthcare re source use and quality -adjusted life years ) .
CONCLUSIONS There are few well-vali date d FND-specific outcome measures .
OBJECTIVES We aim ed to identify existing outcome measures for functional neurological disorder ( FND ) , to inform the development of recommendations and to guide future research on FND outcomes .