IMPACT OF MORNING STIFFNESS, EDUCATION, AND AGE ON THE FUNCTIONAL STATUS OF PATIENTS WITH RHEUMATOID ARTHRITIS.

The purpose of this study was to explore the relationship between disability status and duration of morning stiffness in hands with regard to age, level of education, and gender in patients with rheumatoid arthritis (RA). Also, the authors wanted to investigate this relationship with regard to the presence of rheumatoid factor, i.e., the serological status. A retrospective study was conducted in 250 patients with the classic form of RA (186 females, s64 males, mean age Xb = 49.96 y ears, range 25-60 years, disease duration 1-27 years, Xb = 6.41) previously diagnosed with RA according to the ACR (American College of Rheumatology 1987 criteria). All patients were in Steinbrocker functional classes II and III. The probability level was expressed by p < 0.01 and p < 0.05. The relationship between the variables was measured by point-biserial correlation. The correlation between duration of morning stiffness and functional class was positive but low [(r = 0.10, y = 0.00x + 2.37, p > 0.05) seronegative, (r = 0.12, y = 0.00x + 2.30, p > 0.05) seropositive]. High positive values were obtained for the linear correlation coefficient between duration of the disease and functional class (p < 0.01). Also, high values were obtained regarding the coefficient of correlation between age and functional class [(r = 0.29, p < 0.01) seronegative, (r = 0.47, p < 0.01) seropositive]. Uneducated patients were significantly more represented in functional class III [ 23 (50%) seronegative, 19 (42.2%) seropositive] than in functional class II [16 (20.3%) seronegative, 22 (27.5%) seropositive]. In conclusion, in this study of patients with rheumatoid arthritis, increased duration of morning stiffness was associated with functional disability. Functional disability increased with the duration of the disease, depended on age and educational level, and was more pronounced in older age, regardless of RA serological status. With regard to serological status and sex, the differences were non-significant.

Rehabilitation outcome following war-related transtibial amputation in Kosovo.

BACKGROUND: Previous literature has suggested that age, level of amputation, residual limb length, comorbidities, mental disorders, and cause of amputation can affect the ability to successfully ambulate with prosthesis. OBJECTIVES: The objective of this study was to analyze the predictors that affect the rehabilitation outcome of war-related transtibial amputees and the relationship of these factors with ambulation ability after prosthetic fitting. STUDY DESIGN: Retrospective observational study. METHODS: We reviewed the records of 69 war-related transtibial amputees. The rehabilitation outcome was analyzed according to the grade of rehabilitation summarized in three grades. Multiple logistic regression analysis was used to determine the odds of achieving the first rehabilitation grade. RESULTS: The majority of patients with transtibial amputations achieved the first grade of rehabilitation (59.4%). The factors that significantly influenced the achievement of the first grade of rehabilitation were age and absence of posttraumatic stress disorder. For every 1-year increase in patient age, the odds of achieving first grade of rehabilitation decreased by a factor of 0.9. Patients without posttraumatic stress disorder had 12.9 greater odds of achieving the first rehabilitation grade compared to patients with posttraumatic stress disorder. CONCLUSION: Achievement of the first grade of rehabilitation among war-related transtibial amputees is dependent on patient age and the absence of posttraumatic stress disorder. CLINICAL RELEVANCE: Understanding the factors that may affect the rehabilitation outcome of war-related amputees could lead to a more specific organization of the rehabilitation, especially in a country that has recently been involved in war. This is the first study to focus on determinants of prosthetic rehabilitation in these patients.

Rehabilitation of patients with war-related lower limb amputations.

AIM: To investigate the influence of factors: the amputation type and the time lag between last surgery and prosthetic rehabilitation, on the rehabilitation duration and outcome, in patients with war-related lower limb amputations. METHODS AND SUBJECTS: We reviewed the records of 101 war-related lower limb amputees who had inpatient rehabilitation at the National Ortho-Prosthetic Centre (NOPC) of Kosovo in Pristina, from July 1999 to June 2001, a retrospective observational study. Assessment of rehabilitation outcome-ambulation grade with prosthesis, is made on a 3-point scale. RESULTS: The amputation type was shown as an important predictor for the rehabilitation duration and outcome. The analysis by comparative groups has confirmed the amputation type to be of biggest importance. Earlier prosthetic rehabilitation, was shown as a factor of influence on the rehabilitation duration in all cases (r=0.22, P=0.027). This predictor was not relevant for the rehabilitation outcome. The most frequent type of prosthesis manufactured for the amputees, was the patellar tendon bearing below-knee prosthesis with suspension band (36.9%). CONCLUSION: Amputation of the limb should be performed as low as possible. If there are possibilities for prosthetic rehabilitation, any delays must be avoided, particularly in war-related lower limb amputees.