Reliability assessment of measuring active wrist pronation and supination range of motion with a smartphone.

This study aimed to improve clinical examination techniques by determining the reliability of different methods to evaluate forearm movements. Two methods using the iPhone™ 5 and its gyroscope application (alone [I5] or attached to a selfie stick [ISS]) were compared with two conventional measurement devices (a plastic goniometer with a hand-held pencil [HHP] and a bubble goniometer [BG]) to evaluate the active range of movement (AROM) of the wrist during pronation and supination. Two independent groups of subjects took part in this prospective single-center diagnostic study: 20 healthy subjects and 20 patients. The four evaluation methods had high intra-observer consistency after three measurements (intra-class correlation coefficient [ICC] [3, 1] of 0.916 for the HHP; 0.944 for ISS; 0.925 for BG; 0.933 for I5) and excellent inter-observer reliability (ICC [2, k] of 0.926 for HHP; 0.934 for ISS; 0.899 for BG; 0.894 for I5), with an agreement of plus or minus 2°. When these devices are used with rigorous methodology, they are reliable for the goniometric evaluation of AROM of wrist pronation and supination.

Social deprivation and stroke severity on admission: a French cohort study in Burgundy and the West Indies - Guyana region.

BACKGROUND AND PURPOSE: Although there is growing and convincing evidence that socially deprived patients are at higher risk of stroke and worse outcomes, it remains controversial whether or not they suffer more severe stroke. This study aimed to evaluate the influence of social deprivation on initial clinical severity in patients with stroke. METHODS: A total of 1536 consecutive patients with an acute first-ever stroke (both ischaemic stroke and intracerebral hemorrhage) were prospectively enrolled from six French study centers. Stroke severity on admission was measured by the National Institutes of Health Stroke Scale score. Social deprivation was assessed at the individual level by the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examen de Santé (EPICES) score, a validated multidimensional questionnaire, and several additional single socioeconomic indicators. Polytomous logistic regression analyses were performed to evaluate the association between social deprivation and stroke severity. RESULTS: In univariate analysis, the EPICES score (P = 0.039) and level of education (P = 0.018) were the only two socioeconomic variables associated with stroke severity. Multivariate analysis of the association between EPICES and National Institutes of Health Stroke Scale scores showed that more deprived patients presented a significantly higher risk of both mild and moderate/severe stroke (odds ratio for mild versus minor stroke, 1.39; 95% confidence interval, 1.06-1.84; odds ratio for moderate/severe versus minor stroke, 1.44; 95% confidence interval, 1.09-1.92). A non-significant trend towards a higher risk of both mild and moderate/severe stroke in less educated patients was observed. CONCLUSIONS: Social deprivation was associated with a more severe clinical presentation in patients with stroke. These findings may contribute to the worse outcome after stroke in deprived patients, and underline the need for strategies to reduce social inequalities for stroke.