EFFICIENCY MEASURE OF FUNCTIONAL GAIN: WILL IT DISADVANTAGE SUBGROUPS OF STROKE PATIENTS?
Derrick K. S. Au (Department of Rehabilitation, Kowloon Hospital, Hong Kong)
Abstract: The ratio FIM gain / LOS (Gain in Functional Independence Measure / Length of Stay) is one of the outcome measures used in the USA to evaluate efficiency of rehabilitation programs. We retrospectively analysed the gain in Barthel Scores (an equivalent measure to FIM) of 283 stroke patients to see whether clinical subgroups may have slower rate of functional gain. The rapid recoverers with B.I. Gain / LOS > 0.75 (n=107) were compared with the slow recoverers with B.I. Gain / LOS <0.34 (n=87).
Results: There were no statistically significant differences in mean age (65.1 vs. 65.2), percentage of haemorrhagic strokes (33.6% vs. 33.3%), percentage of recurrent strokes (12.1% vs. 13.8%) between the two groups. Significant difference is seen for percentage of post-neurosurgical cases (5.6% vs. 12.6%; p <0.01), and for percentage of subcortical strokes (45.8% vs. 37.9%; p<0.05).
Conclusion: A program with emphasis on maximizing efficiency may discriminate against post-neurosurgical patients and cortical stroke.
The Effects of Muscle Strength, Physical Activity and Calcium Intake on Bone Mass
Kenji Kagechika, Katsuhiko Tachino, Fujiko Someya, Tetsutaro Yahata (Kanazawa University, Kanazawa, Japan)
For the prevention of the osteoporosis an increase in bone mass during adolescence and reduced-loss after the menopause stage are recommended. Increased physical activity and calcium intake promote these goals. The effects of physical exercise on bone mass have been already demonstrated by many investigators. Especially, adequate physical exercise in the period of acquisition of peak bone mass was suggested to protect middle-aged women from osteoporosis. For the elderly, however, either maintaining or enhancing muscle strength through moderate exercise is recommended for osteoporosis prevention. The relationship between bone mass and calcium intake has not yet been defined by epidemiological studies. Nevertheless, our findings show that we need more investigations focusing on this issue; the calcium intake may exert greater effects on bone mass in premenopausal women rather than in postmenopausal women, and be associated with an increase in bone mass during childhood prior to the acquisition of peak bone mass.