Effects of Motor Rehabilitation on Balance and Functional Activities in Elderly Patients with Peripheral Neuropathy and Recurrent Falls.

To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM (p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH (p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.

Determinants of improvement in functional abilities in peripheral neuropathy patients undergoing rehabilitation: the role of Berg Balance Scale items.

PURPOSE: This prospective observational cohort study aimed to verify whether single Berg Balance Scale (BBS) items were important determinants of improvement in functional abilities in patients with peripheral neuropathy (PN). METHODS: Data were collected in 75 older patients with PN performing a standard motor rehabilitation program. Backward stepwise multiple regression analyses were performed to identify determinants of outcome measures. Gain in total and motor Functional Independence Measure (FIM) and gain in motor-FIM areas were the outcome measures. RESULTS: Among BBS items, at the end of rehabilitation, the score was higher in "sitting unsupported" (3.94 ± 0.22) and lower in "standing on one foot" (1.18 ± 1.06). The gain was higher in "standing to sitting" (1.02 ± 0.67) and "standing unsupported" (1.00 ± 1.00), and lower in "sitting unsupported" (0.22 ± 0.60) and "standing on one foot" (0.65 ± 0.77). "Standing unsupported" was the only determinant of gain in motor-FIM (beta - 0.36, p = 0.002) and gain in self-care (beta - 0.37, p = 0.002). The R2 value of the models was 0.13 and 0.14, respectively. No independent variable was a determinant of gain in total-FIM. CONCLUSIONS: The study shows that "unsupported standing" is an important determinant of results of ADL rehabilitation in PN patients and indicates that ability to stand without support for a fairly long time is an essential requirement to achieve with rehabilitation higher gain levels in functional abilities in PN patients.

Functional ability before and after rehabilitation in elderly patients with shortening and/or rotational deformity of the lower limb after hip fracture.

BACKGROUND: Shortening and rotational deformity of the lower limb (SRD) is a major complication of hip fracture surgery. It causes not only hip joint dysfunction but also functional impairments due to abnormal gait parameters, decreased gait velocity, and poor balance. Despite a number of previous studies, the effect of SRD on the postsurgical recovery of these patients is still not clear. OBJECTIVE: To compare the functional abilities and balance before and after rehabilitation for people with and without SRD after hip fracture surgery and to assess whether SRD affects rehabilitation. DESIGN: Prospective observational study. SETTING: Inpatients of a rehabilitation unit. PARTICIPANTS: A total of 102 people with hip fracture (62 without SRD and 40 with SRD at the time of admission to the unit). MAIN OUTCOME MEASURES: Berg Balance Scale (BBS) and Functional Independence Measure (FIM) motor score, administered before and after rehabilitation. INTERVENTIONS: Motor rehabilitation. RESULTS: Before rehabilitation, patients with SRD had lower motor-FIM (p = .002) and BBS (p = .001) scores than those without SRD. After rehabilitation, both groups showed similar improvements in motor-FIM, BBS, range of motion, muscle strength, and pain scores (p < .001, for all), but patients with SRD still had lower motor-FIM and BBS scores (p = .014 and .003, respectively) and lower effectiveness in motor-FIM and BBS (p = .039 and p = .034, respectively) than those without SRD. CONCLUSIONS: SRD is associated with lower levels of balance and functional abilities before and after rehabilitation and it adversely affects rehabilitation for patients with hip fractures.

Predictive factors of functional abilities in older patients with peripheral neuropathy.

BACKGROUND AND AIMS: Little is known about the outcome predictors in peripheral neuropathy (PN). This prospective observational study aimed to identify possible factors predicting the functional abilities in older patients with PN undergoing motor rehabilitation. METHODS: Data were collected in 80 PN patients, aged over 65 years, performing a standard inpatient motor rehabilitation program. The total Functional Independence Measure (FIM) score after rehabilitation, as well as efficiency and effectiveness in total-FIM, were the outcome measures. Backward multiple regression analyses identified the predictors of functional status. RESULTS: At the end of rehabilitation, total-FIM score was 102.66 ± 10.75, efficiency in total-FIM 0.64 ± 0.29 and effectiveness in total-FIM 48.81 ± 15.35%. Katz index at admission was a predictor of the final total-FIM score (beta 0.46, p < 0.001) and efficiency in total-FIM (beta - 0.38, p = 0.001). Conversely, age was a predictor of the final total-FIM score (beta - 0.31, p = 0.002) and effectiveness in total-FIM (beta - 0.49, p < 0.001). The R2 values of the models were, respectively, 0.39, 0.15, and 0.24. DISCUSSION: In PN patients, functional impairment at admission and age are important predictors of functional abilities at the end of rehabilitation. CONCLUSIONS: These findings suggest the need for more intensive rehabilitation in older, more disabled PN patients because they risk achieving lower functional levels with standard rehabilitation programs.

Predictors of balance in older hip fracture patients undergoing standard motor rehabilitation.

PURPOSE: Little is known about the factors predicting balance in hip fracture patients. The aim of this retrospective observational study was to assess balance before and after inpatient rehabilitation and, secondarily, to identify factors predicting the balance levels in older hip fracture patients after motor rehabilitation. METHODS: Data were collected in 124 hip fracture patients over a 2-year period. All patients underwent a standard motor rehabilitation program. A modified version of Berg Balance Scale (BBS) score after rehabilitation, daily gain and percentage of improvement in BBS were the outcome measures. Multivariate regression analysis was performed to identify the predictors of balance. RESULTS: The mean BBS score was 8.33 ± 7.23 at admission and 21.79 ± 12.15 at the end of rehabilitation (p < 0.001). The daily gain in BBS score was 0.39 ± 0.31 and the percent improvement was 32.28 ± 23.04%. Standing with one foot in front and standing on one foot were the BBS items with the lowest score at discharge and the lowest daily gain and percent improvement. The Cognitive-Functional Independence Measure (cognitive-FIM), hip muscles strength, and Katz index at discharge had moderate-to-strong relationships with final score, daily gain and percentage of improvement in BBS. Cognitive-FIM was a predictor of final BBS score (beta 0.49, p < 0.001), daily gain in BBS (beta 0.34, p < 0.001) and percent improvement in BBS (beta 0.44, p < 0.001). Conversely, hip muscles strength was a predictor of final BBS score (beta 0.32, p = 0.001), and Cumulative Illness Rating Scale severity, a predictor of daily gain in BBS (beta -0.29, p = 0.001). The R2 value of the models were, respectively, 0.39, 0.23, and 0.19. CONCLUSIONS: Cognitive function, comorbidities and hip muscles strength are important predictors of balance in hip fracture patients. Knowledge of these specific factors can be useful for physicians to identify patients needing specific rehabilitation programs for balance.

Use of inhaled devices during a hospital exacerbation of COPD: a summary of an interdisciplinary audit held at ICS Maugeri Pavia, Italy (March-June 2019).

To date treatment protocols in Respiratory and or Internal departments across Italy for treatment of chronic obstructive pulmonary disease (COPD) patients at hospital admission with relapse due to exacerbation do not find adequate support in current guidelines. Here we describe the results of a recent clinical audit, including a systematic review of practices reported in literature and an open discussion comparing these to current real-life procedures. The process was dived into two 8-hour-audits 3 months apart in order to allow work on the field in between meeting and involved 13 participants (3 nurses, 1 physiotherapist, 2 internists and 7 pulmonologists). This document reports the opinions of the experts and their consensus, leading to a bundle of multidisciplinary statements on the use of inhaled drugs for hospitalized COPD patients. Recommendations and topics addressed include: i) monitoring and diagnosis during the first 24 h after admission; ii) treatment algorithm and options (i.e., short and long acting bronchodilators); iii) bronchodilator dosages when switching device or using spacer; iv) flow measurement systems for shifting to LABA+LAMA within 48 h; v) when nebulizers are recommended; vi) use of SMI to deliver LABA+LAMA when patient needs SABA <3 times/day independently from flow limitation; vii) use of DPI and pre-dosed MDI to deliver LABA+LAMA or TRIPLE when patient needs SABA <3 times/day, with inspiratory flow > 30 litres/min; viii) contraindication to use DPI; ix) continuation of LABA-LAMA when patient is already on therapy; x) possible LABA-LAMA dosage increase; xi) use of SABA and/or SAMA in addition to LABA+LABA; xii) use of SABA+SAMA restricted to real need; xiii) reconciliation of drugs in presence of comorbidities; xiv) check of knowledge and skills on inhalation therapy; xv) discharge bundle; xvi) use of MDI and SMI in tracheostomized patients in spontaneous and ventilated breathing.

Functional recovery in hip fracture patients: the role of pharmacotherapy.

BACKGROUND AND AIM: The aim of this prospective observational cohort study was to verify the relationship between number of drugs used and functional outcome in hip fracture patients undergoing rehabilitation. METHODS: This study was conducted on 139 patients with hip fracture who underwent a rehabilitation program. Efficiency rate in the Functional Independence Measure (FIM) and Berg Balance Scale (BBS), and length of stay (LOS) were the outcome measures. RESULTS: At the end of rehabilitation, 66.1% of patients showed an increase in number of drugs used, while 33.9% used the same or lower number of drugs than at admission. At the end of rehabilitation patients with increased pharmacotherapy took a higher total number of drug classes (p = 0.001), had longer LOS (p = 0.009) and lower Berg efficiency (p = 0.048) than patients with the same or lower pharmacotherapy. The number of drugs used at discharge was an independent determinant of LOS (beta = 0.19, p = 0.022) and FIM efficiency (beta = - 0.20, p = 0.025). Age was a determinant of LOS (beta = 0.17, p = 0.044) and BBS efficiency (beta = - 0.23, p = 0.009), while CIRS severity was a determinant of BBS efficiency only (beta = - 0.22, p = 0.016). DISCUSSION: Findings of study indicate that in hip fracture patients, the number of drugs prescribed at discharge is an important indicator of LOS and rehabilitation efficiency. CONCLUSIONS: These findings can help the physician to better plan the rehabilitation of hip fracture patients who require polypharmacy.

Determinants of functional outcome in hip fracture: the role of comorbidity.

BACKGROUND AND AIMS: Executed studies did not clearly identify which index of comorbidity was an independent outcome determinant. The aim of this prospective observational cohort study was to address this issue. METHODS: We analyzed 200 consecutive patients with hip fracture. All patients underwent rehabilitation. At admission comorbidity was assessed through the cumulative severity, severity index, and comorbidity index of the Cumulative Illness Rating Scale. Discharge scores and effectiveness in the Functional Independence Measure motor subscale, and discharge destination were the outcome measures. Multivariate regression analyses were performed to identify determinants of outcome. RESULTS: Mini Mental State Examination and comorbidity index of the Cumulative Illness Rating Scale were important independent determinants of final (respectively, ß = 0.46 and -0.25) and effectiveness (respectively, ß = 0.47 and -0.25) in motor Functional Independence Measure scores, while hip strength and Rankin score were determinants of final motor Functional Independence Measure score (respectively, ß = 0.21 and -0.20). Comorbidity index of the Cumulative Illness Rating Scale (odds ratio 8.18 for ≥3 versus < 3 comorbidity score; 95% confidence interval, 1.03-64.7) and Geriatric Depression Scale (odds ratio 4.02 for ≥6 versus ≤5 depression scale score; 95% confidence interval, 1.52-10.63) were risk indicators for nursing home. CONCLUSIONS: Among the indices of the Cumulative Illness Rating Scale, comorbidity index is the sole independent determinant of both motor Functional Independence Measure scores and discharge destination in hip fracture patients. This suggests to specifically evaluate this index to identify the patients who may be admitted to a rehabilitation program.

Osteopathic Manual Treatment for Amyotrophic Lateral Sclerosis: A Feasibility Pilot Study.

BACKGROUND: Current interventions in amyotrophic lateral sclerosis (ALS) are focused on supporting quality of life (QoL) and easing pain with a multidisciplinary approach. OBJECTIVE: Primary aim of this pilot work assessed feasibility, safety, tolerability and satisfaction of osteopathic manual treatment (OMT) in 14 ALS outpatients. METHODS: Patients were randomized according to an initial single-blind design (12 weeks, T0-T1), in order to receive OMT (weekly for 4 weeks, and fortnightly for the following 8 weeks) versus usual-care (n=7 each group), followed by an OMT open period (T1-T2, once a week for 8 weeks, n=10). Secondary aims included blind osteopathic assessment of somatic dysfunctions (SD) for goal attainment scale (GAS) calculation, Brief Pain Inventory-short form and McGill QoL-16 items. RESULTS: OMT was demonstrated feasible and safe and patients displayed high satisfaction (T1-VAS=8.34 ± 0.46; T2-VAS=8.52 ± 0.60). Considering secondary aims no significant differences emerged. Finally, at study entry (T0), a cervico-dorsal SD was found in 78% of ALS patients versus 28% of healthy matched controls (p<0.01). CONCLUSION: OMT was found feasible, safe and satisfactory in ALS. The lack of secondary aim differences can be due to the limited sample size. OMT could be an interesting option to explore in ALS.

Aphasia and activities of daily living in stroke patients.

BACKGROUND: Few studies have investigated the relationships between aphasia and activities of daily living (ADLs) in stroke patients. AIM: This study was aimed firstly to determine which task within the ADLs has poorer functional recovery in stroke patients with aphasia after rehabilitation, second to identify which specific task is related to aphasia. DESIGN: This is a prospective and observational study. SETTING: Inpatients of our Rehabilitation Unit. POPULATION: The study was carried out in 219 patients with primary diagnosis of stroke with (104) and without aphasia (115). METHODS: All patients underwent usual rehabilitation. Aachen Aphasia Test and Functional Independence Measure scale were used to assess severity of aphasia and ADLs, respectively. Gain in ADLs was the main outcome measure. RESULTS: At the end of rehabilitation patients with aphasia had lower gain in bathing, dressing upper body, dressing lower body, toileting, stair climbing, and higher gain in social interaction, problem solving, and memory with respect to patients without aphasia. However, when data were adjusted for side of hemiplegia, Fugl-Meyer score and trunk control test, patients with aphasia showed lower gain in dressing upper body (P=0.027), dressing lower body (P=0.009), lower toileting (P=0.027), and higher gain in social interaction (P<0.001). In the multivariate regression analysis, aphasia was an important determinant of gain in bathing (ß=0.26), dressing upper body (ß=0.24), dressing lower body (ß=0.22), lower toileting (ß=0.22), and social interaction (ß=-0.29). CONCLUSIONS: The current study points out that, after usual rehabilitation, the patients with aphasia show a poor gain in personal care activities and higher gain in social interaction. CLINICAL REHABILITATION IMPACT: Knowledge of these findings: 1) can guide the rehabilitation team in selecting specific and appropriate therapies aimed to give patient with aphasia the highest possible functional independence in ADLs; 2) is useful to family members and social rehabilitation services for domiciliary management of patients with aphasia.

Biodex Fall Risk Assessment in the Elderly With Ataxia: A New Age-Dependent Derived Index in Rehabilitation: An Observational Study.

The aim of this study was to evaluate if the Biodex Fall Risk Assessment could provide an age-adjusted index useful for classifying patients at "risk of fall."This was a cohort study conducted on 61 chronic patients, in stable conditions, having a history of ataxia, difficulty in walking or loss of balance, and aged >64 years. These patients were coming from home to our Institute undergoing a period of in-hospital standard rehabilitation. Assessment of clinical parameters was performed at entry. Functional scales (Functional Independence Measure [FIM] for motor and cognitive function, Barthel G, Tinetti POMA), and the Biodex Fall Risk Index (FRI) were performed at entry and discharge. The Normalized FRI, obtained adjusting FRI to the reported maximum predictive FRI for the relevant age, identified 2 types of patients: those with a greater risk of fall than expected for that age, labeled Case 1 (Normalized FRI>1); and those with an equal or even lesser risk of fall than expected for that age, labeled Case 0 (Normalized FRI≤1).FRI, Normalized FRI as well as independent variables as age, sex, pathology group, FIM, BarthelG, were considered in a multiple regression analysis to predict the functional improvement (i.e., delta Tinetti Total score) after rehabilitation.Normalized FRI is useful in assessing patients at risk of falls both before and after rehabilitation. At admission, the Normalized FRI evidenced high fall risk in 46% of patients (Case 1) which decreased to 12% after rehabilitation, being greater than age-predicted in 7 patients (Case 1-1) despite the functional improvement observed after the rehabilitation treatment. Normalized FRI evidenced Case 1-1 patients as neurological, "very old" (86% in age-group 75-84 years), and with serious events at 18 to 24 months' follow-up. Normalized FRI, but not FRI, at admission was a predictor of improvement in Tinetti Total scores.The normalized FRI effectively indicated patients at higher risk of fall, in whom health deterioration, falls, or cognitive decline was later documented at follow-up. The normalized FRI could be a standardized measure for identifying frailer patients becoming a further criterium of discharge home and marker of fall risk at home.

Determinants of functional outcome in hip fracture patients: the role of specific neuropsychiatric symptoms.

BACKGROUND: The correlation between single neuropsychiatric symptoms and functional outcome in hip fracture patients is little investigated in the literature, and it is not yet established which neuropsychiatric symptoms are the most important determinants of functional outcome. AIM: To determine which neuropsychiatric symptoms are the most important determinants of functional outcome. METHODS: This prospective study was carried out in 204 consecutive patients with primary diagnosis of hip fracture admitted to our Rehabilitation Unit for a course of rehabilitation. Neuropsychiatric symptoms were assessed at admission with the Neuropsychiatric Inventory (NPI). Outcome measures of rehabilitation were: final score, efficiency and effectiveness in motor-Functional Independence Measure (motor-FIM), and discharge destination. Pearson's correlation coefficients were used to assess the relationship between NPI variables and the outcome measures, while backward stepwise regression was used to identify determinants of the outcome measures. RESULTS: Pearson's correlation showed that night-time behavior disturbances were related to all outcome measures, while agitation, depression, elation, apathy, disinhibition and irritability were significantly related to motor-FIM outcomes. At multivariate regression analysis agitation was the only determinant of final motor-FIM score, while irritability was the only determinant of efficiency and effectiveness in motor-FIM score. No neuropsychiatric symptom was a determinant of discharge destination. CONCLUSIONS: This study highlights that in hip fracture patients there are relationships between specific neuropsychiatric symptoms and functional outcome. Among the neuropsychiatric symptoms, irritability and agitation are the most important. They are associated to poor functional outcome and are the only determinants of motor-FIM outcome measures. IMPLICATIONS FOR REHABILITATION: Relationships between specific neuropsychiatric symptoms and functional outcome have not been clearly described in hip fracture patients. Irritability and agitation have been shown to have the strongest relationship with poor functional outcomes. Appropriate identification, assessment and treatment of neuropsychiatric symptoms may be useful to physicians for the management of hip fracture patients.

Neuropsychiatric symptoms and rehabilitation outcomes in patients with hip fracture.

OBJECTIVE: The aim of this study was to determine the association between functional recovery and neuropsychiatric symptoms in hip fracture patients undergoing in-hospital rehabilitation. Very few studies have extensively evaluated neuropsychiatric symptoms in hip fracture patients, and the relationship between these symptoms and rehabilitation outcome is not yet clearly defined. DESIGN: This study was conducted on 200 patients with hip fracture who underwent a rehabilitation program. The Neuropsychiatric Inventory was used to identify neuropsychiatric symptoms. Efficiency and effectiveness in terms of the motor-Functional Independence Measure and length of stay were considered as outcome measures. RESULTS: At admission, 74% of the patients had neuropsychiatric symptoms. At the end of rehabilitation, the patients with neuropsychiatric symptoms had a lower motor-Functional Independence Measure effectiveness (P = 0.015) and efficiency (P = 0.002) and a longer length of stay (P = 0.008) than those without neuropsychiatric symptoms. However, after adjustment for the Mini-Mental State Examination, the patients with neuropsychiatric symptoms differed from those without symptoms only in terms of longer length of stay (P = 0.006) and lower motor-Functional Independence Measure efficiency (P = 0.008). CONCLUSIONS: Neuropsychiatric symptoms make the rehabilitation process slower and less efficient in hip fracture patients. Understanding the relationship between neuropsychiatric symptoms and outcome may be useful to physicians for the management of hip fracture patients.

[Rehabilitative and economic effectiveness of an outpatient rehabilition practice]. / Efficienza economica e riabilitativa di un ambulatorio di medicina riabilitativa.

UNLABELLED: Up to date studies have assessed costs and outcomes of rehabilitation in outpatients. Aim of the current prospective study was to evaluate the rehabilitative and economical effectiveness of an outpatient rehabilitative practice. METHODS: The study was performed in 349 patients admitted for rehabilitation due to sequelae of orthopaedic surgery (repair of rotator cuff tear, anterior cruciate ligament reconstruction), limbs fracture (should, wrist, foot), whiplash neck pain, and chronic spinal pain (low back pain and neck pain). All patients were submitted to rehabilitation. Before and after rehabilitation, range of motion of joint or pain were assessed. Economical effectiveness and rehabilitative effectiveness in range of motion and pain were considered as outcome measures. RESULTS: Rehabilitative effectiveness was 71.9%+/-30%. Length of rehabilitation (beta=0.29) and initial joint status (beta=0.36) had the strongest relationship with rehabilitative effectiveness. Rehabilitative effectiveness was higher in patients with sequelae of anterior cruciate ligament reconstruction. Economical effectiveness was 48.0%+01 and was related to length of rehabilitation (beta=0.11) only. Economical effectiveness was higher in low back pain carried out in group (136%+/-0.0). CONCLUSIONS: The study gives evidence that in outpatient rehabilitation the rehabilitative effectiveness is higher than economical one. In addition, the study shows that rehabilitative treatments carried out in group only have higher economical effectiveness. These data must be considered useful in planning the ambulatory rehabilitation.

A case of very rapid progressive ataxia in rehabilitation setting.

AIM: To describe the unusual course of a patient with cerebellar ataxia who underwent rehabilitation. METHOD: At admission, the patient underwent motor rehabilitation and assessment by Tinetti Assessment, Klockgether Score, National Institute of Health Stroke Scale, Trunk Control Test, Fugl-Meyer Scale, Barthel Index, and Mini Mental State Examination. RESULTS: The patient showed very rapid and severe decline of motor and functional tests during the first month of hospitalization and complete dependence in <2 months, despite rehabilitation. He died 10 months after onset, with a neuro-pathological diagnosis of sporadic Creutzfeldt-Jakob disease (CJD). CONCLUSION: Our case report suggests that sporadic CJD must be hypothesized when ataxia worsens rapidly and severely despite rehabilitation.

Effects of corticosteroids injection in rotator cuff tears.

OBJECTIVE: The aim of this study was to evaluate the effect of intraarticular injections of corticosteroids (triamcinolone) in patients with symptomatic rotator cuff tears (RCT). DESIGN: Randomized controlled study. SETTING: Rehabilitation unit. PATIENTS: Sixty patients with full-thickness RCT were enrolled in the study. Patients were randomly divided into three equal groups of 20 patients. The first group received single intraarticular injection of 40 mg triamcinolone, the second group received two injections of 40 mg triamcinolone at 21-day interval, and the third group received no treatment (control group). All patients underwent rehabilitation sessions. Outcome measures were pain, evaluated using a visual analog scale, and shoulder functional status, evaluated by Constant-Murley score. MEASURES: Outcome measures were pain, evaluated using a visual analog scale, and shoulder functional status, evaluated by Constant-Murley score. RESULTS: Pain at night score of both groups who received triamcinolone was lower than that of Control Group at 1 month (P < 0.05 and P < 0.01 in first and second groups, respectively) and at 3 months (P < 0.05 and P < 0.01 in the first and second groups, respectively). Similarly, activity pain score of groups treated with triamcinolone was lower than that of the control group at 1 month (P < 0.001 in both groups) and at 3 months (P < 0.001 in both groups). There was no statistically significant difference in pain at night between the first and second groups at 1 and at 3 months. There was no statistically significant difference among groups at 3 and 6 months in Constant-Murley scores. CONCLUSIONS: Our study indicates that intraarticular injection of triamcinolone improves pain relief for 3 months in RCT and its action is not prolonged or potentiated by two injections of the drug done at 21-day intervals.

Predicting outcome after stroke: the role of aphasia.

OBJECTIVE: Very few studies have investigated the predictive value of functional outcome, social outcome and discharge destination in patients with cerebrovascular accident (CVA) with aphasia. The aim of this study was to verify whether aphasia is predictor for outcome in patients with stroke with aphasia. METHODS: The study was carried out in 262 patients with primary diagnosis of CVA and aphasia, included over a 6-year period (2001-2007): 131 with and 131 without aphasia. Statistically significant variables at the univariate regression analysis were submitted to the multivariate analysis. Backward stepwise regression analysis was applied to predict final motor-Functional Independence Measure (FIM), effectiveness in motor-FIM, final cognitive-FIM score and effectiveness in cognitive-FIM and discharge destination. Independent variables were age, gender, aphasia, stroke type, stroke lesion size, comorbidity, bladder catheter, motor function, trunk control test, initial motor-FIM and committed caregiver identified on admission to rehabilitation. RESULTS: Patients with aphasia had lower motor-FIM and cognitive-FIM scores both at admission and at discharge, if compared with those without aphasia. Effectiveness in motor-FIM and cognitive-FIM scores was also poorer in patients with aphasia. Seventy-seven per cent of patients with aphasia and 91.6% of patients without aphasia returned at home. In the multivariate regression analysis, aphasia was predictor of final motor-FIM (ß = 0.15), final cognitive FIM (ß = 0.72), effectiveness in motor-FIM (ß = 0.17) and discharge destination (ß = 0.20). CONCLUSIONS: Aphasia is a predicting factor of outcome and it is the most important predictor of social outcome in patients with stroke with aphasia.

Rehabilitation length of stay in patients suffering from aphasia after stroke.

BACKGROUND AND PURPOSE: Few studies have assessed the relationship between aphasia and rehabilitation length of stay (LOS). The aim of the current prospective study was to evaluate LOS in patients with aphasia and its relation to functional improvement. METHODS: The study was performed in 252 patients admitted for rehabilitation follow-up of their first stroke (126 patients with aphasia and hemiparesis [aphasia group] and 126 patients with hemiparesis but without aphasia [control group]). All patients were submitted to clinical, neurological, and neuropsychological examinations. The following tests were performed: Aachen Aphasia Test, Albert's test, anosognosia scale, Cumulative Illness Rating Scale (CIRS), Fugl-Meyer Scale, and FIM. RESULTS: LOS was 50.7 and 46.7 days in the aphasia and control groups, respectively. There was no statistically significant difference in the LOS between aphasia and control groups (p = .056). A longer LOS was correlated with low admission aphasia score (r = -0.19). The increase in motor FIM per day obtained by therapy (LOS-Eff) was 0.54 +/- 0.3 in the aphasia group and 0.75 +/- 0.5 in the control group. The LOS-Eff was significantly poorer in the aphasia group (p = .000). A high LOS-Eff was correlated with high aphasia score (r = 0.31). In multivariate regression analyses, aphasia was an important predictor of LOS-Eff (beta = 0.18). CONCLUSIONS: In patients with aphasia, LOS is few days longer and LOS-Eff is significantly poorer compared to patients without aphasia. Aphasia is a significant independent predictor of LOS-Eff at discharge.

Increased prevalence of silent myocardial ischaemia and severe ventricular arrhythmias in untreated patients with Alzheimer's disease and mild cognitive impairment without overt coronary artery disease.

OBJECTIVE: To assess the prevalence and the characteristics of silent myocardial ischaemia (SMI) and ventricular arrhythmias (VA) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and their relationships with QT interval dispersion (QTD). METHODS: Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy control subjects matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled. Each subject underwent clinical and cognitive examination, a structural brain imaging study, electrocardiogram (ECG), 24-h ECG recording, 24-h blood pressure monitoring, and echocardiogram. Detection and characterization of QT dispersion, SMI and VA were performed. RESULTS: The three groups were comparable regarding demographic and basal cardiovascular characteristics: notwithstanding this, SMI episodes were observed only in AD and MCI patients (19 and 14, respectively). A significantly greater prevalence of repetitive ventricular premature beats was observed in AD (mean 8.56+/-13.1) and in MCI (1.8+/-7.2) vs. control (0.7+/-1.7). The QTD, the ischaemic burden and the number of repetitive ventricular beats revealed to be significantly related. CONCLUSIONS: Increased prevalence of SMI and potentially ominous VA were found in AD and, to a lesser extent, in MCI. SMI and repetitive VA were significantly related with QTD. These findings could be related to an increased risk of sudden cardiac death in AD and MCI patients.

QT dispersion and left ventricular hypertrophy in elderly hypertensive and normotensive patients.

Inhomogeneity of ventricular repolarization as detected by QT dispersion may be a potential leading mechanism of sudden death in hypertensive and normotensive (age related) left ventricular hypertrophy. Aim of this study was to investigate QT dispersion, ventricular arrhythmias, and left ventricular mass index in elderly hypertensive and normotensive patients. Study population consisted of 60 consecutive patients (sex: 34 men/26 women; age: 63 +/- 11 years) with essential arterial hypertension and 48 age and sex-matched control subjects (24 men/24 women; 64 +/- 16 years). Measurements included QTc dispersion, ventricular arrhythmias, and left ventricular hypertrophy. Hypertensive patients had greater left ventricular mass index (P = .006) and higher QTc dispersion (P = .004) than controls. Left ventricular hypertrophy was diagnosed in 57 (31 men/26 women) of all subjects. These patients had higher blood pressure (P < .05), Lown's score (P < .001), and QTc dispersion (P < .001). QTc dispersion and Lown's score were independent predictors of left ventricular mass index (P < .001). Conclusively, QTc dispersion is a strong indicator of left ventricular mass index and might be used in risk stratification of hypertensive and normotensive elderly patients.