The Stanford Health Assessment Questionnaire was modified for use amongst British patients by the substitution of colloquial expressions. Completion of the modified questionnaire was shown to be simplified compared with the original. Results correlated well with scores obtained at interview and were shown to be more sensitive to patients' functional changes than the Steinbrocker grading.
Of 1094 patients with a confirmed stroke admitted to Northwick Park, a district general hospital, 364 (33%) died while in hospital, 215 (20%) were fully recovered when discharged, and 329 (30%) were too frail or too ill from diseases other than stroke to be considered for active rehabilitation. Only 121 (11%) were suitable for intensive treatment. They and 12 patients referred direct to outpatients were allocated at random to one of three different courses of rehabilitation. Intensive was compared with conventional rehabilitation and with a third regimen which included no routine rehabilitation, but under which patients were encouraged to continue with exercises taught while in hospital and were regularly seen at home by a health visitor. Progress at three months and 12 months was measured by an index of activities of daily living. Improvement was greatest in those receiving intensive treatment, intermediate in those receiving conventional treatment, and least in those receiving no routine treatment. Decreasing intensity of treatment was associated with a significant increase in the proportions of patients who deteriorated and in the extent to which they deteriorated.Probably only a few stroke patients, mostly men, are suitable for intensive outpatient rehabilitation, but for those patients the treatment is effective and realistic. IntroductionRemedial therapists spend much of their time' rehabilitating patients disabled by strokes, though this has not been convincingly shown to improve chances of recovery. If rehabilitation is ineffective therapists' efforts are wasted and patients inconvenienced. If, on the other hand, rehabilitation is effective more investment in it might be justified.Three randomised controlled trials2-4 on the effectiveness of rehabilitation after stroke have been inconclusive, possibly because of their small numbers. Garraway et a15 have recently shown that patients admitted to a special stroke unit fared better than those admitted to medical units, but their trial was concerned largely with the effects of inpatient management, and the advantage was not sustained on longer follow-up.6 This paper compares the effectiveness of three intensities of outpatient rehabilitation. Patients and methodsAll 1094 patients with a recent confirmed stroke who were admitted to Northwick Park Hospital from October 1972 to September 1978 were considered for the trial. Of these, 364 (33%) died while in hospital and 215 patients (20%) made a full recovery while in hospital, in terms not only of day-to-day activities but also of limb function and speech. The remaining 515 patients were considered for the trial. The main criterion for entry was that the patient should BRITISH MEDICAL JOURNAL VOLUME 282 be able to manage the most intensive of the three regimens, even if they were eventually allocated to one of the other regimens. A further 329 patients (30%) were excluded by this criterion: most of these were elderly patients, predominantly women, who were either too old or too frail for intensive reh...
SUMMARY Thirty-eight of 58 patients with skeletal tuberculosis (TB) reviewed were immigrants and 20 were of British indigenous origin. Spinal involvement in 28 cases was less common than involvement of peripheral joints, bones, or tendon sheaths (30 cases). Predisposing factors, including previous TB, were present in 70% of British patients and 31 % of immigrants. Follow-up study of 23 cases showed that a complete clinical recovery of the skeletal disease was more likely in immigrants than indigenous cases and also in cases referred to hospital early. Immigrants presented usually within 5 years after arrival in Britain and at a younger age than indigenous cases; a quarter had additional sites of infection outside the skeletal system. Skeletal tuberculosis in the indigenous population remains very uncommon, and in half of these cases a history of previous TB was given. The need for continued awareness of skeletal TB is stressed, especially in immigrants, and also the importance of early diagnosis and institution of appropriate therapy.In the British Isles the incidence of tuberculosis (TB), both pulmonary and extrapulmonary, has been steadily declining, and in the past 20 years has fallen by 12 % per annum.1 However, the notification rate of TB in immigrants, particularly Asians, has been steadily increasing. In some centres in Britain TB is now more common in immigrants than in the indigenous population.2 3 Skeletal TB remains a rare site of extrapulmonary TB and now presents infrequently to most hospital departments. It is recognised that early diagnosis is important, as early treatment results in cure and avoids the high morbidity that occurred before antituberculous therapy came in. We have undertaken a retrospective and follow-up study to assess the experience gained by all departments of the London Hospital in
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SUMMARY Eight patients with rheumatoid arthritis received an intra-articular injection of either 50 mg or 100 mg of prednisolone acetate into the knee joint. After the injection plasma levels of prednisolone were measured by radioimmunoassay and plasma cortisol levels were estimated fluorimetrically. Peak prednisolone levels were reached at between 2 and 4 hours after the intra-articular injection at both dosage levels, though the peak was higher with the larger dose. The 50 mg dose did not have any effect on the plasma cortisol level at 24 or 48 hours, but there was some suppression of plasma cortisol levels for up to 48 hours after the 100 mg dose.The intra-articular use of steroids is now well established in the inflammatory arthropathies as an effective adjunct to other modes of treatment. The anti-inflammatory effect of the corticosteroid is believed to extend beyond the confines of the joint into which it has been injected, an effect which was noted early in the use of intra-articular steroid injection (Bywaters and Dixon, 1953). Systemic effects that have been observed include a fall in circulating eosinophils (Mason and Ward, 1953); suppression of plasma cortisol levels (Shuster and Williams, 1961); and suppression of the hypothalamic-pituitary axis (Koehler et al., 1974). These effects would all follow the absorption of corticosteroid from the synovial cavity, a phenomenon which has been shown directly with cortisol and indirectly with prednisolone derivatives (Bain et al., 1967).Sensitive radioimmunoassay and competitive protein binding techniques are now available for the estimation of synthetic corticosteroids. One such procedure (English et al., 1974) was used in the present study in an attempt to confirm the systemic absorption of prednisolone acetate injected into an inflamed joint and to gauge the blood levels achieved.
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