Upper extremity disability after stroke. Psychometric properties of outcome measures and perceived ability to perform daily hand activities.

Disability of the upper extremity is common after stroke. To be able to evaluate recovery and effects of interventions there is a need for stable and precise outcome measures. In order to design and target efficient rehabilitation interventions it is important to know which factors that affect the ability to perform daily hand activities. At the time when the studies in this thesis were planned there was limited knowledge of the psychometric properties of outcome measures for persons with mild to moderate impairments of the upper extremity after stroke. There was also a lack of knowledge of which daily hand activities these persons perceive difficult to perform and which factors are associated with the performance.The overall aim of this thesis was to evaluate the psychometric properties of outcome measures for upper extremity after stroke, and to describe which daily hand activities persons with mild to moderate impairments in upper extremity after stroke perceive difficult to perform and identify associated factors with their performance.In paper I – IV, between 43 and 45 participants were included. Muscle strength in the upper extremity, somatosensation (active touch), dexterity and self-perceived ability to perform daily hand activities were assessed twice, one to two weeks apart. In paper V, 75 participants were included and the evaluated measures of the upper extremity were used together with other stroke specific outcomes to cover important aspects of functioning and disability according to the International Classification of Functioning, Disability and Health (ICF). Test-retest analyses for continuous data were made with the Intraclass Correlation Coefficient (ICC), the Change in Mean, the Standard Error of Measurement (SEM) and the Smallest Real Difference (SRD) (Paper I, III and IV). For ordinal data the Kappa coefficient and the Elisabeth Svensson rank-invariant method were used (Paper II and III). For analyses of convergent validity the Spearman’s correlation coefficient (rho) was calculated (Paper III). The ability to perform daily hand activities and the associations with potential factors were evaluated by univariate and multivariate linear regression models (Study V). The results showed that outcome measures for isometric and isokinetic muscle strength, active touch, dexterity and self-perceived daily hand activities have high test-retest agreements and can be recommended for persons with mild to moderate impairments in the upper extremity after stroke (Paper I to IV). Isometric strength measurements had lower measurement errors than isokinetic measurements and might be preferred (Paper I). The outcomes of dexterity showed learning effects (Paper III) and the ratings of perceived daily hand activities (Paper IV) had relatively high random measurement errors which must be taken into account when recovery and effects of interventions are evaluated. The three evaluated dexterity measures were partly related and can complement each other (Paper IV). Daily hand activities that require bimanual dexterity were perceived most difficult to perform, and dexterity and participation were the strongest contributing factors for performing daily hand activities after stroke (Paper V).In conclusion, this thesis has shown that outcome measures assessing functioning and disability of upper extremity after stroke are reliable and can be used in clinical settings and research. To increase the ability to perform daily hand activities, dexterity and perceived participation, in particular, should be considered in the assessments, goal-settings and rehabilitation after stroke

Measurement variability of quantitative sensory testing in persons with post-stroke shoulder pain.

OBJECTIVE: To evaluate the measurement variability of quantitative sensory testing (QST) in persons with post-stroke shoulder pain. DESIGN: A test-retest design. PARTICIPANTS: Twenty-three persons with post-stroke shoulder pain (median age 65 years).METHODS: Thermal detection thresholds (cold and warm), pain thresholds (cold and heat) and mechanical pain thresholds (pressure and pin prick) were assessed twice in both arms, 2–3 weeks apart. Measurement variability was analysed with the intraclass correlation coefficient (ICC2.1), the change in mean (đ) with 95% confidence interval (logarithmic scales), and the relative standard error of measurement (SEM%; re-transformed scales). RESULTS: The ICCs for thermal thresholds ranged from 0.48 to 0.89 in the affected (painful) arm and from 0.50 to 0.63 in the unaffected arm, and for mechanical pain thresholds from 0.66 to 0.90 in both arms. No systematic changes in the mean (đ) were found. The SEM% ranged from 4% to 10% for thermal detection and heat pain thresholds, and from 17% to 42% for cold pain and mechanical pain thresholds in both arms.CONCLUSION: QST measurements, especially cold pain thresholds and mechanical pain thresholds, vary in persons with post-stroke shoulder pain. Before QST can be used routinely to evaluate post-stroke shoulder pain, a test protocol with decreased variability needs to be develope

Test-retest reliability of the Shape/Texture Identification testTM in people with chronic stroke

To evaluate the test-retest reliability of the Shape/Texture Identification test (STI-test(TM)) in persons with chronic stroke

Epidermal Overexpression of Stratum Corneum Chymotryptic Enzyme in Mice: A Model for Chronic Itchy Dermatitis

Identification of tissue-specific mechanisms involved in the pathophysiology of inflammatory skin diseases could offer new possibilities to develop effective therapies with fewer systemic effects. The serine protease stratum corneum chymotryptic enzyme is preferentially expressed in cornifying epithelia. We have previously reported on increased expression of the stratum corneum chymotryptic enzyme in psoriasis. Here is reported an increased epidermal expression of stratum corneum chymotryptic enzyme also found in chronic lesions of atopic dermatitis. Transgenic mice expressing human stratum corneum chymotryptic enzyme in suprabasal epidermal keratinocytes were found to develop pathologic skin changes with increased epidermal thickness, hyperkeratosis, dermal inflammation, and severe pruritus. The results suggest that stratum corneum chymotryptic enzyme may be involved in the pathogenesis of inflammatory skin diseases, and that stratum corneum chymotryptic enzyme and related enzymes should be evaluated as potential targets for new therapies

Test-retest reliability of the ABILHAND Questionnaire in persons with chronic stroke.

To be able to evaluate recovery, effects of rehabilitation interventions and changes over time, reliable and valid outcome measures are needed. The ABILHAND Questionnaire is a measure of self-reported ability to perform complex daily hand activities. It is commonly used in stroke rehabilitation, but data about the measurement variability are missing

Seasonality of ventricular fibrillation at first myocardial infarction and association with viral exposure

AIMS:To investigate seasonality and association of increased enterovirus and influenza activity in the community with ventricular fibrillation (VF) risk during first ST-elevation myocardial infarction (STEMI). METHODS:This study comprised all consecutive patients with first STEMI (n = 4,659; aged 18-80 years) admitted to the invasive catheterization laboratory between 2010-2016, at Copenhagen University Hospital, Rigshospitalet, covering eastern Denmark (2.6 million inhabitants, 45% of the Danish population). Hospital admission, prescription, and vital status data were assessed using Danish nationwide registries. We utilized monthly/weekly surveillance data for enterovirus and influenza from the Danish National Microbiology Database (2010-2016) that receives copies of laboratory tests from all Danish departments of clinical microbiology. RESULTS:Of the 4,659 consecutively enrolled STEMI patients, 581 (12%) had VF before primary percutaneous coronary intervention. In a subset (n = 807), we found that VF patients experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with the patients without VF (OR 3.39, 95% CI 1.76-6.54). During the study period, 2,704 individuals were diagnosed with enterovirus and 19,742 with influenza. No significant association between enterovirus and VF (OR 1.00, 95% CI 0.99-1.02), influenza and VF (OR 1.00, 95% CI 1.00-1.00), or week number and VF (p-value 0.94 for enterovirus and 0.89 for influenza) was found. CONCLUSION:We found no clear seasonality of VF during first STEMI. Even though VF patients had experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with patients without VF, no relationship was found between enterovirus or influenza exposure and occurrence of VF

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Life satisfaction after stroke and the association with upper extremity disability, sociodemographics, and participation

Introduction: Remaining disability after stroke can reduce a person's life satisfaction. Because previous studies of life satisfaction show inconsistent results, there is a need for more knowledge regarding perceived life satisfaction after stroke and associated factors. Objective: To assess perceived life satisfaction after stroke in relation to Swedish reference values; and the association with upper extremity disability, sociodemographics, and participation. Design: Cross-sectional study. Setting: University hospital. Participants: Seventy-five persons (72% male) with mild to moderate disability in a stable phase after stroke. Interventions: Not applicable. Main Outcome Measure: Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11), which includes one global item Life as a whole and 10 domain-specific items. Global life satisfaction and explanatory factors were evaluated in two multivariate logistic regression models. Results: Fifty-three percent of the participants were satisfied with Life as a whole. Highest satisfaction was found for Family life (78%) and Partner relationship (77%) and lowest satisfaction for Vocational situation (32%), Sexual life (25%), and Physical health (23%). Life as a whole and most domain-specific items showed a significantly lower proportion of satisfied persons compared to Swedish reference values. In the first regression model with factors of upper extremity disability, manual ability was the strongest explanatory variable for Life as a whole (p value =.032, Nagelkerke R Square 0.117). In the second regression model, participation, social, and working status were the final explanatory variables (p value =.006, Nagelkerke R Square = 0.207). Conclusion: Our findings indicate that persons with mild to moderate disability after stroke perceive overall less satisfaction with Life as a whole and domain-specific items than the general Swedish population. To increase a person's life satisfaction after stroke, rehabilitation interventions should target a variety of aspects including enhancing functioning of upper extremity, reducing participation restrictions, and providing support regarding social and vocational situation