A prospective natural history study of inclusion body myositis: implications for clinical trials.

Eleven patients with untreated inclusion body myositis (IBM) were prospectively studied during a 6-month period that included muscle strength, lean body mass, and muscle mass measurements. There was an overall quantifiable mean decline in percent of predicted normal muscle strength of 4% from baseline in a 6-month period, but one third of patients showed no change or slight improvements in strength. Short-term treatment trials in IBM will require large numbers of patients to detect slowing, arrest, or even slight improvement in muscle strength.

Use of gold weights to correct lagophthalmos in neuromuscular disease.

Upper eyelid gold-weight implants are widely used in the correction of lagophthalmos in many neuromuscular conditions, most commonly facial palsy. The paralytic lagophthalmos that occurs in facioscapulohumeral muscular dystrophy (FSHD) is common and can cause severe ocular complications. It is not usually considered for surgical correction. Upper lid loading with 24K gold implants and reconstructive lower lid surgery in a 64-year-old woman with FSHD corrected eyelid deformity and exposure keratitis. Surgical treatment also markedly improved facial appearance. This treatment may merit wider use in FSHD.

Inpatient rehabilitation: physiatric and nurse practitioner admission assessment of stroke patients and their rehabilitation outcomes.

The purpose of this study was to compare outcomes in stroke patients with two different methods of admission to an inpatient unit. Patients' outcomes were studied for 3 years. Admission screening was performed either by a physiatrist (group I, n = 93) or by a nurse practitioner (group II, n = 100). All admission decisions were made solely by the physiatrist. The outcome measures used were appropriateness of admission, discharge to home versus nursing home and functional gains measured on the Functional Independence Measure. The average length of stay was 28 days for group 1 patients and 29 days for group II. Ninety-seven per cent of group I and 94% of group II patients were considered appropriate for admission. The difference is not statistically significant (Z = 1.02). Ninety-six per cent of patients in each group were discharged home. Ninety-six per cent of group I and 89% of group II patients met the functional goals. Group I fared better than group II, and the difference between the groups (Z = 1.85) is statistically significant at p < 0.04.

Predicting discharge functional status and rehabilitation efficiency from preadmission functional assessments.

Various indicators have been used to predict functional change and outcome in stroke rehabilitation. One previous study indicated that functional assessments performed prior to rehabilitation admission correlated well with functional status at discharge and also were indicative of rehabilitation efficiency scores. The present study attempted to replicate these findings in a study of 14 additional stroke patients admitted to an inpatient unit; data collection on additional patients is ongoing. Patients' weekly Functional Independence Measure (FIM) scores were assessed, together with their preadmission FIM score (PFM) and other clinical data. As in the previous study, PFM scores correlated well with functional ratings made by the team following admission (r = 0.78), and with discharge FIM scores (r = 0.68). Patients with PFM scores of 30 or less had much lower rehabilitation efficiency ratios (0.62) than those with PFM scores greater than 30 (0.97). Finally, in a multiple regression equation with discharge functional status as the dependent variable, PFM scores accounted for almost as much of the variance (47%) as FIM scores obtained during the first week of admission (63%). Overall, the results obtained were remarkably consistent with the previous study cited. The current results imply that the use of preadmission functional ratings may be a valid and useful way to predict functional change and efficiency of inpatient rehabilitation admission.