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Biomedical subjects

D T Wade

Publications and source records attributed to D T Wade.

At least 19 recordsLinked to original sources
PubMed2003

Neuroprotection during cardiac surgery: a randomised trial of a platelet activating factor antagonist.

OBJECTIVE: To assess platelet activating factor (PAF) antagonists, potent neuroprotective agents in experimental cerebral dysfunction, in clinical practice. DESIGN: Double blind, minimised, placebo controlled trial of low and high dose PAF antagonist (lexipafant). SETTING: Cardiac surgery unit. PATIENTS: 150 patients undergoing coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass. INTERVENTIONS: Randomisation to placebo, low dose (10 mg) or high dose (100 mg) lexipafant. MAIN OUTCOME MEASURES: Incidence of impairment on four established cognitive tests, undertaken before, five days, and three months after CABG, examined by three methods for defining impairment. RESULTS: The three groups were similar with respect to preoperative and intraoperative factors. Observed levels of cognitive impairment were less than had been predicted from previous studies. There was no difference in the groups in cognitive change scores at five days or three months. Group mean analysis showed significant time factors for all four tests but not for interactions or for the lexipafant group. A composite cognitive index, based on the aggregate of four normally distributed tests, showed a significant effect for timing of the test but not for the lexipafant group or interaction. Age, but not duration of bypass, was the most important determinant of postoperative cognitive impairment. CONCLUSIONS: The neuroprotective PAF antagonist lexipafant did not differentially reduce the level of cognitive impairment after CABG as determined by power estimates derived from published studies. The strongest predictors of cognitive impairment were age and timing of the test after operation.

Cognition Disorders↗
PubMed2003

Multidisciplinary rehabilitation for people with Parkinson's disease: a randomised controlled study.

OBJECTIVE: To determine whether a programme of multidisciplinary rehabilitation and group support achieves sustained benefit for people with Parkinson's disease or their carers. METHODS: The study was a randomised controlled crossover trial comparing patients and carers who had received rehabilitation four months before assessment with those who had not. Patients were recruited from a neurology clinic, attended a day hospital from home weekly for six weeks using private car or hospital transport, and received group educational activities and individual rehabilitation from a multidisciplinary team. Patients were assessed at entry and at six months using a 25 item self assessment Parkinson's disease disability questionnaire, Euroqol-5d, SF-36, PDQ-39, hospital anxiety and depression scale, and timed stand-walk-sit test. Carers were assessed using the carer strain index and Euroqol-5d. RESULTS: 144 people with Parkinson's disease without severe cognitive losses and able to travel to hospital were registered (seven were duplicate registrations); 94 had assessments at baseline and six months. Repeated measures analysis of variance comparing patients at the 24 week crossover point showed that those receiving rehabilitation had a trend towards better stand-walk-sit score (p = 0.093) and worse general and mental health (p = 0.002, p = 0.019). Carers of treated patients had a trend towards more strain (p = 0.086). Analysis comparing patients before and six months after treatment showed worsening in disability, quality of life, and carer strain. CONCLUSIONS: Patients with Parkinson's disease decline significantly over six months, but a short spell of multidisciplinary rehabilitation may improve mobility. Follow up treatments may be needed to maintain any benefit.

Activities of Daily Living↗
PubMed2003

The Adult Memory and Information Processing Battery (AMIPB) test of information-processing speed: a study of its reliability and feasibility in patients with multiple sclerosis.

OBJECTIVE: To investigate how useful the Adult Memory and Information Processing Battery Task A (AMIPB) is as a test of the speed of information processing in patients with multiple sclerosis (MS) by comparing various methods of presenting the test and assessing the reliability (test-retest and inter-rater) and utility of each version. DESIGN: Each patient was assessed twice verbally by the same assessor 1-2 weeks apart. Then 1-2 weeks later half were assessed by another observer, and half were assessed by the first observer using a written method. SETTING: A specialist young disabled unit. SUBJECTS: Thirty-three patients with MS. MEASURES: The AMIPB, the Short Memory-Orientation-Concentration Test (SOMC) and the Barthel ADL Index. RESULTS: The average (SD) number of correct responses after 4 min was 23.3 (18.6), median 21. The test-retest reliability (n = 24) of the 4-min AMIPB was high (r = 0.98) and the difference of the score ranged from -7 to 9: median 3, mean (SD) 1.88 (4.01) and interquartile range 0 to 3.25. The inter-observer reliability (n = 12) of the 4-min AMIPB was also high (r = 0.97) and the mean (SD) differences between scores were 4.3 (5.8), median 4, range +19 to -2. The score at 60 seconds and the score at 240 seconds were highly correlated (r = 0.98). The scores obtained verbally and by writing were closely correlated (r = 0.99). CONCLUSIONS: The AMIPB used over 120 seconds with verbal responses is a reliable and reasonable test for major information-processing deficits.

Adult↗
PubMed2002

A randomised placebo controlled exploratory study of vitamin B-12, lofepramine, and L-phenylalanine (the "Cari Loder regime") in the treatment of multiple sclerosis.

OBJECTIVE: To determine whether combination therapy with lofepramine, L-phenylalanine, and intramuscular vitamin B-12 (the "Cari Loder regime") reduces disability in patients with multiple sclerosis. METHODS: A placebo controlled, double blind, randomised study carried out in five United Kingdom centres on outpatients with clinically definite multiple sclerosis, measurable disability on Guy's neurological disability scale (GNDS), no relapse in the preceding six months, and not on antidepressant drugs. Over 24 weeks all patients received vitamin B-12, 1 mg intramuscularly weekly, and either lofepramine 70 mg and L-phenylalanine 500 mg twice daily, or matching placebo tablets. Outcome was assessed using the GNDS, the Kurtzke expanded disability status scale; the Beck depression inventory, the Chalder fatigue scale, and the Gulick MS specific symptom scale. RESULTS: 138 patients were entered, and two were lost from each group. There was no statistically significant difference between the groups at entry or at follow up. Analysis of covariance suggested that treated patients had better outcomes on four of the five scales used. Both groups showed a reduction of 2 GNDS points within the first two weeks, and when data from all time points were considered, the treated group had a significant improvement of 0.6 GNDS points from two weeks onwards. CONCLUSIONS: Patients with multiple sclerosis improved by 2 GNDS points after starting vitamin B-12 injections. The addition of lofepramine and L-phenylalanine added a further 0.6 points benefit. More research is needed to confirm and explore the significance of this clinically small difference.

Adolescent↗
PubMed2002

Characteristics of patients with persistent severe disability and medically unexplained neurological symptoms: a pilot study.

This study audited 25 patients (21 female) from Oxfordshire who had been referred to either the liaison psychiatry or the neurological disability service between 1992 and 1998, reported a Barthel activities of daily living index score < 20 or a global assessment of functioning score of < or = 30, and had no pathology to explain their neurological disability. Levels of motor impairment, disability, mood, and cognitive status were assessed using standardised scales, and all patients were assigned a psychiatric diagnosis according to the International classification of diseases, 10th revision. Of the 25 patients, 13 had a motor conversion disorder, 8 had diverse somatoform disorders, and 3 had chronic fatigue syndrome. Nine had extensive previous contact with psychiatric services and 11 had experienced physical or sexual abuse. In 6 patients cessation of repeated self harm was closely associated with the onset of wheelchair use. Seven were receiving treatment for depression. The commonest putative diagnoses were multiple sclerosis (6) and epilepsy (5). Twelve were unable to walk and 20 owned a wheelchair but only 3 had formal care packages. The mean (SD) Barthel score was 14.1 (3.3) and the mean (SD) Frenchay activity index score was 12.9 (7.5). All were unemployed and receiving a disability living allowance, and some had benefits of up to pound 1815 a month. This small but significant group of disabled patients had a variety of psychiatric and neurological diagnoses and used considerable health care resources.

Activities of Daily Living↗
PubMed2001

Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment.

OBJECTIVE: To establish the reliability and validity of 4 mobility measures in neurologically impaired adults undergoing rehabilitation. DESIGN: Repeated assessment of same patients. SETTING: Two specialized neurologic centers in England. PATIENTS: Forty-six patients with neurologic disabilities selected from inpatient and outpatient rehabilitation centers who were able to stand and walk at least 10 meters, with some aid if needed. INTERVENTIONS: Patients were assessed twice, at an interval of 7 days, by the same person at the same location. Validity and reliability of each measure were compared by means of scatterplots, Bland-Altman method, and correlation coefficients. Validity was also established by comparing groups of patients expected to differ in mobility. MAIN OUTCOME MEASURES: The Rivermead Mobility Index (RMI) standard version and a version with 4 levels of answer, the 10-meter timed walk, and the 2-minute walk test. RESULTS: The measures showed significant intercorrelation, suggesting that all were valid mobility measures. Each was reasonably reliable, with no evidence of systematic bias. The revised RMI was less sensitive to differences. The distance covered in the 2-minute walk test was significantly decreased for patients using aids (p <.0005) and those with impaired leg sensation (p =.02). CONCLUSIONS: All 4 measures tested (2 RMI versions, 1-meter timed walk, 2-minute walk test) showed similar validity and reliability, and the 4-level RMI version failed to show an increased ability to detect differences. All measures showed more disability in patients using aids and those with sensory impairment.

Activities of Daily Living↗
PubMed2001

An initial investigation of the reliability of the Rivermead Extended ADL index in patients presenting with neurological impairment.

The objective of this study was to establish the reliability and sensitivity of both postal and interviewer-administrated versions of the Rivermead Extended Activities of Daily Living (READL) index, which assesses six domestic activities and six community activities. Sixty patients with stable neurological impairment were recruited. In one group (n = 40), every patient was assessed face-to-face using the READL, the Barthel index (BI) and the short orientation memory and concentration test (SOMC). One week later, the READL was repeated by the same person, in the same place. In the second group (n = 20), all the patients were first sent a postal form of the READL and were then seen face-to-face for assessment as in group 1. To be included patients had to score at least 18/28 points on the SOMC. Scores were compared using scatterplots, Bland and Altman plots and correlation coefficients, and difference scores were calculated. Sensitivity was established comparing groups of patients expected to differ in their activities. Repeated assessment score, both face-to-face and by post, showed significant correlation (Pearson coefficient = 0.97 and 0.88, respectively). Most scores were within four points of each other, with no systematic bias, although patients tended to rate themselves more independent. Both methods were able to detect differences in the level of activities as predicted between more and less dependent groups (t-test: p < 0.00001 and p = 0.00087). The READL index appears to be a reliable and sensitive measure, with some evidence for validity, but further research is needed.

Activities of Daily Living↗
PubMed2001

Research into the black box of rehabilitation: the risks of a Type III error.

Type I and Type II errors in the interpretation of data from clinical trials concern statistical matters, and the probability of drawing erroneous conclusions from inadequate data. However in rehabilitation research a third possible error may arise. Successful rehabilitation depends upon the co-ordinated work of an expert multidisciplinary team, and can be considered as a network involving a whole system. Demonstrating that one part of that system looked at in isolation does not have the expected effect does not prove that the specific part is not necessary to the success of the whole system. The isolated intervention may still have an important effect when interacting with other variables or interventions. Failure to consider the interactive effects of an intervention might constitute a Type III interpretation error.

Humans↗
PubMed2001

Social context as a focus for rehabilitation.

In some illnesses activity limitation is determined as much (or even more) by cultural factors as it is by the specific disease pathology or impairments experienced. There is now some evidence that cultural attitudes and expectations can be changed to reduce the burden of disability. This empirical evidence supports the WHO ICIDH-2 model of illness and the importance of contexts as intervening variables in the development and maintenance of disability.

Attitude to Health↗
PubMed2001

Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke. Royal College of Physicians Intercollegiate Stroke Working Party.

STUDY OBJECTIVE: To identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke. DESIGN: Retrospective audit of case notes and service organization. SETTING: Two hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland. PATIENTS: The 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stroke Audit. RESULTS: There are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay. CONCLUSIONS: There were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.

Aged↗
PubMed2001

Community rehabilitation.

Classifying rehabilitation services is not easy, and there is no agreed nomenclature. One way of classifying services to use the WHO ICIDH-2 model of illness. Services could specialize in one or more domains. Those services currently referred to as community rehabilitation services would be classified as services that specialized in intervening at the level of participation, and in the local aspects of physical and social context. They are an important part of a network of specialized services.

Australia↗
PubMed2001

Community rehabilitation in the United Kingdom.

OBJECTIVE: To investigate the extent and nature of community rehabilitation services within the United Kingdom. DESIGN: A postal survey starting with the Community Rehabilitation Network and extending to any other teams identified or making contact. SETTING: The National Health Service within the UK. SUBJECTS: Any team who identified themselves as a community rehabilitation service that worked 'primarily with adults with physical disability' within the UK. INTERVENTION: A questionnaire was sent to each team identified with follow-up telephone contact to clarify answers and/or to encourage replies. RESULTS: One hundred and fifty-two organizations were sent questionnaires and 145 replied, but 47 were excluded for various reasons leaving 98 valid replies. Four types of team were identified: community rehabilitation teams, young disabled community teams, community teams for older adults, and specific client group teams. There were huge variations in management arrangements, team composition, goals of the services and likely lifespan of the service. CONCLUSIONS: Community rehabilitation in the UK is currently characterized by small, often short-term teams with poor identity and the term has no clear or consistent meaning.

Adolescent↗
PubMed2000

Family support for stroke: a randomised controlled trial.

BACKGROUND: Attention is currently focused on family care of stroke survivors, but the effectiveness of support services is unclear. We did a single-blind, randomised, controlled trial to assess the impact of family support on stroke patients and their carers. METHODS: Patients with acute stroke admitted to hospitals in Oxford, UK, were assigned family support or normal care within 6 weeks of stroke. After 6 months, we assessed, for carers, knowledge about stroke, Frenchay activities index, general health questionnaire-28 scores, caregiver strain index, Dartmouth co-op charts, short form 36 (SF-36), and satisfaction scores, and, for patients, knowledge about stroke and use of services, Barthel index, Rivermead mobility index, Frenchay activities index, London handicap scale, hospital anxiety and depression scales, Dartmouth co-op charts, and satisfaction. FINDINGS: 323 patients and 267 carers were followed up. Carers in the intervention group had significantly better Frenchay activities indices (p=0.03), SF-36 scores (energy p=0.02, mental health p=0.004, pain p=0.03, physical function p=0.025, and general health perception p=0.02), quality of life on the Dartmouth co-op chart (p=0.01), and satisfaction with understanding of stroke (82 vs 71%, p=0.04) than those in the control group. Patients' knowledge about stroke, disability, handicap, quality of life, and satisfaction with services and understanding of stroke did not differ between groups. Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge (44 vs 56%, p=0.04), but use of other services was similar. INTERPRETATION: Family support significantly increased social activities and improved quality of life for carers, with no significant effects on patients.

Aged↗