The perceived family burden scale: measurement and validation.

Findings in family burden research suggest that, in families with a mentally ill relative, patterns of family interaction develop in response to the onset of major mental illness and result from the burden experienced by family members in coping with illness. The present study focused on instrument development and validation of the Perceived Family Burden Scale (PFBS), a measure of those patient behaviors associated with schizophrenia and the impact of these behaviors on relatives. The PFBS was found to be a valid and reliable instrument which demonstrated greater predictive power for early symptomatic relapse in schizophrenia than another measure of family interaction, expressed emotion.

The lennie test for measuring scapular position in healthy young adult females: a reliability and validity study.

Normal scapular rest position is neither adequately described nor agreed upon by authorities. The purpose of this study was to devise and describe a reliable and valid test (the Lennie Test) to measure scapular position, including normal scapular rest position. Fifteen healthy females (age 19-21 years) participated in the study. Horizontal and vertical scapular position in the frontal plane was quantified by three different investigators using a scoliometer and caliper. Same-day radiographs were used to validate scapular position surface measurements. The medial borders of the scapulae were found to be parallel to the thoracic midline. The scapulae were on average 17.19 +/- 1.85 cm apart (at the level of the root of the scapulae) with the dominant arm scapula being on average 0.49 +/- 0.74 cm lower than the nondominant scapula. This difference in height between scapulae was not statistically significant (p > .01). Correlation coefficients between skin surface and radiograph measurements of scapular position ranged from .43 to .82. Intertester intraclass correlation coefficients for surface measurements of scapular position ranged from .64 to .86. The Lennie Test was found to have moderate to high intertester reliability and to provide an accurate measurement of the anatomical location of the scapulae based on X-ray verification. Surface landmark measurements for scapular position were on average within 0.56 cm and within 1.7 degrees of the measurements made from X-rays for linear and angular position, respectively. We propose the use of the Lennie Test in populations, healthy or otherwise, where scapular position needs to be objectively measured.

Electrocardiographic changes in pericardial effusion.

OBJECTIVE: To investigate the association between ECG changes and the presence of pericardial effusion. BACKGROUND: The ECG changes associated with pericardial effusion described in textbooks are based only on small series of human cases and data from animals. These changes include low QRS voltage, electrical alternans, P wave changes, and T wave inversion. METHODS: All patients who had undergone 2 temporally separate echocardiographic and ECG examinations, with 1 echocardiographic examination indicating the presence and the other indicating the absence of pericardial effusion were identified (n = 46). These patients were age- and sex-matched to 46 patients without effusion (control subjects). Pericardial effusion was classified echocardiographically as small (n = 28), moderate (n = 13), and large (n = 5). The ECG variables were independently measured by two investigators blinded to effusion status. RESULTS: When 2 temporally separate ECGs for 46 patients were obtained in a repeated-measures fashion (1 obtained during the absence and the other during the presence of effusion; median time interval, 1.24 months), only the mean heart rate in patients with sinus rhythm (98 beats per minute increasing to 106 beats per minute) and the percentage of patients with QRS voltage of less than 0.5 mV (10 percent increasing to 22 percent) were associated with the development of effusion. A weak correlation (r = 0.296) was noted between QRS voltage and effusion size. Electrical alternans occurred only in one of the five patients with a large effusion but in no others. In addition, when the ECGs indicating effusion from the 46 patients were compared with the ECGs from their age- and sex-matched control subjects, differences in heart rate (106 beats per minute vs 80 beats per minute, respectively) and small changes in QRS voltage were associated with effusion status. No ECG variable was sensitive for the detection of pericardial effusion. CONCLUSIONS: In both repeated-measures and case-control comparisons, ECG findings are two few, subtle, insensitive, and nonspecific to be useful as indicators of the presence of pericardial effusion.

A comparison of the characteristics of preferred low-back motion of normal subjects and low-back-pain patients.

The purpose of this study was to compare the preferred low-back motion of normal subjects and low-back-pain patients. Each subject performed a maximum isometric flexion trial followed by repeated flexion and extension against a relative resistance set at 50% of the recorded maximum flexion isometric torque. The subjects were instructed to move at their own pace through their preferred movement range until either exhaustion or for 120s. The results showed that the groups differed significantly in their preferred motion characteristics, although the performances were equally consistent.

Reliability of reciprocal isokinetic testing of the knee extensors and flexors.

This study was conducted to assess the reliability of torque measurements across different trials and different test sessions. Each trial consisted of three maximal, reciprocal contractions of the knee extensors and flexors at test velocities of 60 and 180 degrees /sec. Three trials were conducted on each of three test sessions, with each session separated by 48 hours. Results indicate that reliability of reciprocal isokinetic testing of the knee can be improved by 1) testing in more than one occasion, 2) testing more than three trials during a single session if testing during more than one session is impossible, and 3) allowing the subject to become familiar with the isokinetic test procedure and to warm up adequately. Data obtained in this study indicated performance variability was predominantly associated with between subject differences and secondarily related to within subject changes over trials and days. Dynamometer calibration remained stable across all test sessions, indicating that the method was reliable for recording torque output during all testing procedures. J Orthop Sports Phys Ther 1991;14(3):121-127.

The characteristics of preferred low-back motion.

The purposes of this study were to identify the loading effects on preferred low-back motion and to determine the consistency of preferred low-back motion. Fifteen male and female volunteers served as subjects. Each subject performed four trials of repeated flexion and extension until either the subject became exhausted or for 120s. Each trial corresponded to a relative load of 0, 25, 50, and 75% of the subject's prerecorded maximum torque in isometric flexion. The subjects were instructed to perform the movements at their own pace and through their preferred movement range. The results showed that above the 25% resistance level, the increased loads were accompanied by decreased velocities, with the changes due to the cycle temporal characteristics. The increased loads also resulted in decreased cycle excursions, with these changes due to reductions in the extension endpoints. With increased resistances the descriptive parameters became more variable, with a trend of increased variability toward the latter portion of a trial.

Focal family therapy: theory and practice.

During the past 30 years, the prescription of neuroleptic medication has made a major impact on the treatment of symptoms in patients with schizophrenia. Nonetheless, for many patients, symptom remission and social functioning remain less than optimal. Consequently, clinicians have employed a combined approach of drugs, psychosocial therapies, and psychiatric rehabilitation to treat the range of deficits presented by individuals suffering with this illness. In this article, we describe Focal Family Therapy, a model of family therapy developed for working with families and patients who are struggling with schizophrenia. Using the example of a particular case, we illustrate the following: (a) the identification and formulation of the Focal Issue; (b) the targeting of behavior and attitudes that will constitute the Focal Change; and (c) the techniques of Focal Family Therapy.

Focal family therapy outcome study. I: Patient and family functioning.

This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.

Trends in isodynamic and isometric trunk testing on the Isostation B200.

A total of 200 men and 100 women with no prior history of low back pain were evaluated by a series of 6 different tests on the Isostation B200 (Isotechnologies, Hillsborough, NC, U.S.A.) to obtain normative data on the functional performance of the low back. The data collected in this descriptive study were analyzed for significant patterns and differences between an asymptomatic male and female population. In the range of motion test, male subjects demonstrated greater range of motion in all planes; however, values for women showed greater standard deviations. In the maximum isometric test, male torque values exceeded female values, but male values showed greater standard deviations. A rank order of parameter values was made from values recorded during repetitive tests for both men and women. Coupling patterns observed during single-plane repetitive tests allowed secondary and tertiary axes to be identified. Torque values generated over the set resistance were calculated for the repetitive tests conducted in three different planes. A positive curvilinear, concave downward relationship was observed when these values were plotted against the predetermined resistance settings. Future research will study the effect resistance settings on maximum torque output and the role of velocity as a key discriminator between normal and abnormal populations.

Abnormal patient data for the isostation b100.

The purpose of this study was to document the torque and range of motion parameters generated on the lsostation B100 by subacute low back pain patients 2-7 days postinjury. Abnormal values found in this study were compared to normal values found in a previous study. One hundred and forty-three males and 29 females were evaluated in a predetermined combination of three tests. These included: a) range of motion in each plane, b) repetitive flexion/extension, and c) a modified maximum lift. The results of the investigation indicate significant differences (p = 0.01) in parameters generated by the lsostation B100 between normals and abnormals in each test. Discrepancies between normals and abnormals were greater for females than males. Torque output was most significantly affected (p = 0.01) in the axis of flexion/extension for both males and females. Range of motion was most significantly affected (p = 0.01) in extension for both males and females. In test b (the flexion/extension repetitive test), the most significant (p = 0.01) percent reduction in torque and range of motion values occurred in the secondary axis of rotation and lateral flexion rather than flexion/extension. This reduced crossover activity, crosstalk, may be an indicator of guarded effort, poor effort or both. The lsostation B100 is a valuable tool as it provides objective information on torque output and range of motion for the low back.J Orthop Sports Phys Ther 1988;10(4):121-133.