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Poster 228 Men with Late Effects of Polio Decline More Than Women in Lower Limb Muscle Strength: A 4-year Longitudinal Study
S166
Abstracts / PM R 7 (2015) S83-S222
Objective: To evaluate the test-retest reliability of the rating scale Self-reported Impairments in Persons with late effects Polio (SIPP) and to define limits for the smallest change that indicates a real change, both for a group of individuals and a single individual. Design: Postal survey. Setting: University hospital outpatient program for people with late effects of polio. Participants: 51 persons (31 men and 20 women; mean age 72 years) with clinically and electromyographically verified late effects of polio. Interventions: Not applicable Main Outcome Measures: The rating scale Self-reported Impairments in Persons with late effects Polio (SIPP) consists of 13 items (impairments) typical of and directly related to late effects of polio, but also impairments that are commonly reported by the patients and indirectly related to their prior polio. The participants responded twice to the SIPP, two weeks apart. Response frequencies at test occasion 1 (T1) and test occasion 2 (T2) were calculated. Test-retest reliability was analyzed by the percentage agreement (PA) of each item, the intra-class correlation coefficient (ICC), the mean difference between the test sessions together with the 95% confidence intervals the mean difference, the standard error of measurement (SEM), the smallest real difference (SRD) and a Bland & Altman graph. Results or Clinical Course: The PA (same scoring at both test occasions) was > 70% for 10 of 13 items. The mean score (SD) was 27.9 (5.7) points at T1 and 28.2 (6.0) points at T2, with no systematic difference between test occasions. The ICC was 0.88, the SEM (the smallest change for a group of individuals) was 2.0 points and the SRD (the smallest change for a single individual) was 5.6 points, respectively. Conclusion: The Self-reported Impairments in Persons with late effects Polio (SIPP) has previously been Rasch analyzed and shown good construct validity and internal consistency. This additional analysis of the scale’s psychometric properties shows that the SIPP is a reliable rating scale in persons with late effects of polio. It can therefore be used to evaluate effects of rehabilitation interventions and changes of perceived impairments over time, both for a group of individuals and for a single individual.
Poster 228 Men with Late Effects of Polio Decline More Than Women in Lower Limb Muscle Strength: A 4-year Longitudinal Study Jan Lexell, MD, PhD (Lund University, Lund, Sweden), Christina Broga˚rdh, PhD, RPT, Ulla-Britt Flansbjer, PhD Disclosures: Research Grants - Various Swedish government and private research foundations; Non-remunerative Positions of Influence Swedish Paralympic Committee Objective: To assess changes in lower limb muscle strength annually over 4 years in persons with late effects of polio and to identify prognostic factors for changes in muscle strength. Design: Prospective, longitudinal study. Setting: University hospital outpatient program for people with late effects of polio. Participants: 52 ambulant persons (28 men and 24 women; mean age 64 years, SD 6) with clinically and electromyographically verified late effects of polio. Interventions: Not applicable Main Outcome Measures: Isokinetic concentric knee extension, knee flexion and ankle dorsiflexion muscle strength and isometric knee extension and ankle dorsiflexion muscle strength were measured with a BiodexÒ Multi-Joint System 3 PRO dynamometer. All participants were tested annually over four years (a total of five times) and as close as possible to one year between each test. Mixed Linear Models were
used to analyze changes in muscle strength and to identify determinants among the covariates gender, age, age at acute polio infection, time with late effects of polio, body mass index and estimated baseline muscle weakness. Results or Clinical Course: For the men there were significant linear effects of time for all knee muscle strength measurements (from -1.4% for less affected isokinetic knee flexion; P<.05 to -4.2% for more affected isokinetic knee extension per year; P<.001), and for two ankle dorsiflexor muscle strength measurements (-3.3% to 1.4% per year; P<.05). For the women there was a significant linear effect of time only for ankle dorsiflexor measurements (4.0% to 5.5% per year; P<.01). Gender was the strongest factor that predicted a change in muscle strength over time. Conclusion: Little is known about prognostic factors for changes in lower limb muscle strength in persons with late effects of polio. This prospective, longitudinal study of muscle strength revealed only small changes in muscle strength over the four year period. The strongest predictor of change in lower limb muscle strength was the participants’ gender. Men declined more in muscle strength than women, especially in the knee muscles, but the rate of the decline did not accelerate over time.
Poster 229 Soft Tissue Sarcoma Affecting the Right Shoulder of a Man with Paraplegia from a Remote Traumatic Spinal Cord Injury: A Case Report Colin K. Franz, MD, PhD (Rehabilitation Institute of Chicago, Chicago, IL, United States), Gayle R. Spill, MD Disclosures: C. K. Franz: I Have No Relevant Financial Relationships To Disclose. Case Description: A 50-year-old man with history of complete paraplegia from a remote traumatic T6 spinal cord injury presented with a painful right shoulder mass. MRI revealed a heterogeneously enhancing mass that involved the right deltoid and pectoralis major muscles. Core biopsy demonstrated a spindle cell sarcoma. Physiatry and Surgical Oncology were consulted. Setting: Tertiary hospital. Results or Clinical Course: Prior to admission the patient lived alone in an accessible apartment. He had diffuse weakness throughout the right arm, which was at least partly related to pain guarding. He had decreased pin prick sensation and paresthesias in digits 3-5. He was not able to perform transfers to or from his manual wheelchair. Oncology recommended treatment for his tumor with a course of outpatient radiation therapy followed by gross total resection. Despite the possibility of losing his previous level of independence he ultimately opted to proceed with aggressive oncology treatment. He began intensive inpatient rehabilitation after he was given clearance to weight bear through his arm. Currently he is able to perform some simple transfers and manual wheelchair self-propulsion at a supervision level. Further developments will be discussed. Discussion: Soft tissue sarcomas of the extremity are uncommon. To our knowledge there are no published cases of them occurring in a patient with a traumatic spinal cord injury. The Physiatry pre-operative consult focused heavily on functional prognostication as the potentially curative Oncology treatment plan put him at risk for severe functional detriment. We happily report that the patient is progressing towards his goal of returning back to his apartment with modified independence. Conclusion: As patients with chronic spinal cord injury live longer, they are at risk for developing cancers and the functional impairment that can be caused by cancer and its treatment. This case illustrates the crucial role a Physiatrist specializing in Cancer Rehabilitation can play in both the functional prognostication and restoration of function
Abstracts / PM R 7 (2015) S83-S222
Objective: To evaluate the test-retest reliability of the rating scale Self-reported Impairments in Persons with late effects Polio (SIPP) and to define limits for the smallest change that indicates a real change, both for a group of individuals and a single individual. Design: Postal survey. Setting: University hospital outpatient program for people with late effects of polio. Participants: 51 persons (31 men and 20 women; mean age 72 years) with clinically and electromyographically verified late effects of polio. Interventions: Not applicable Main Outcome Measures: The rating scale Self-reported Impairments in Persons with late effects Polio (SIPP) consists of 13 items (impairments) typical of and directly related to late effects of polio, but also impairments that are commonly reported by the patients and indirectly related to their prior polio. The participants responded twice to the SIPP, two weeks apart. Response frequencies at test occasion 1 (T1) and test occasion 2 (T2) were calculated. Test-retest reliability was analyzed by the percentage agreement (PA) of each item, the intra-class correlation coefficient (ICC), the mean difference between the test sessions together with the 95% confidence intervals the mean difference, the standard error of measurement (SEM), the smallest real difference (SRD) and a Bland & Altman graph. Results or Clinical Course: The PA (same scoring at both test occasions) was > 70% for 10 of 13 items. The mean score (SD) was 27.9 (5.7) points at T1 and 28.2 (6.0) points at T2, with no systematic difference between test occasions. The ICC was 0.88, the SEM (the smallest change for a group of individuals) was 2.0 points and the SRD (the smallest change for a single individual) was 5.6 points, respectively. Conclusion: The Self-reported Impairments in Persons with late effects Polio (SIPP) has previously been Rasch analyzed and shown good construct validity and internal consistency. This additional analysis of the scale’s psychometric properties shows that the SIPP is a reliable rating scale in persons with late effects of polio. It can therefore be used to evaluate effects of rehabilitation interventions and changes of perceived impairments over time, both for a group of individuals and for a single individual.
Poster 228 Men with Late Effects of Polio Decline More Than Women in Lower Limb Muscle Strength: A 4-year Longitudinal Study Jan Lexell, MD, PhD (Lund University, Lund, Sweden), Christina Broga˚rdh, PhD, RPT, Ulla-Britt Flansbjer, PhD Disclosures: Research Grants - Various Swedish government and private research foundations; Non-remunerative Positions of Influence Swedish Paralympic Committee Objective: To assess changes in lower limb muscle strength annually over 4 years in persons with late effects of polio and to identify prognostic factors for changes in muscle strength. Design: Prospective, longitudinal study. Setting: University hospital outpatient program for people with late effects of polio. Participants: 52 ambulant persons (28 men and 24 women; mean age 64 years, SD 6) with clinically and electromyographically verified late effects of polio. Interventions: Not applicable Main Outcome Measures: Isokinetic concentric knee extension, knee flexion and ankle dorsiflexion muscle strength and isometric knee extension and ankle dorsiflexion muscle strength were measured with a BiodexÒ Multi-Joint System 3 PRO dynamometer. All participants were tested annually over four years (a total of five times) and as close as possible to one year between each test. Mixed Linear Models were
used to analyze changes in muscle strength and to identify determinants among the covariates gender, age, age at acute polio infection, time with late effects of polio, body mass index and estimated baseline muscle weakness. Results or Clinical Course: For the men there were significant linear effects of time for all knee muscle strength measurements (from -1.4% for less affected isokinetic knee flexion; P<.05 to -4.2% for more affected isokinetic knee extension per year; P<.001), and for two ankle dorsiflexor muscle strength measurements (-3.3% to 1.4% per year; P<.05). For the women there was a significant linear effect of time only for ankle dorsiflexor measurements (4.0% to 5.5% per year; P<.01). Gender was the strongest factor that predicted a change in muscle strength over time. Conclusion: Little is known about prognostic factors for changes in lower limb muscle strength in persons with late effects of polio. This prospective, longitudinal study of muscle strength revealed only small changes in muscle strength over the four year period. The strongest predictor of change in lower limb muscle strength was the participants’ gender. Men declined more in muscle strength than women, especially in the knee muscles, but the rate of the decline did not accelerate over time.
Poster 229 Soft Tissue Sarcoma Affecting the Right Shoulder of a Man with Paraplegia from a Remote Traumatic Spinal Cord Injury: A Case Report Colin K. Franz, MD, PhD (Rehabilitation Institute of Chicago, Chicago, IL, United States), Gayle R. Spill, MD Disclosures: C. K. Franz: I Have No Relevant Financial Relationships To Disclose. Case Description: A 50-year-old man with history of complete paraplegia from a remote traumatic T6 spinal cord injury presented with a painful right shoulder mass. MRI revealed a heterogeneously enhancing mass that involved the right deltoid and pectoralis major muscles. Core biopsy demonstrated a spindle cell sarcoma. Physiatry and Surgical Oncology were consulted. Setting: Tertiary hospital. Results or Clinical Course: Prior to admission the patient lived alone in an accessible apartment. He had diffuse weakness throughout the right arm, which was at least partly related to pain guarding. He had decreased pin prick sensation and paresthesias in digits 3-5. He was not able to perform transfers to or from his manual wheelchair. Oncology recommended treatment for his tumor with a course of outpatient radiation therapy followed by gross total resection. Despite the possibility of losing his previous level of independence he ultimately opted to proceed with aggressive oncology treatment. He began intensive inpatient rehabilitation after he was given clearance to weight bear through his arm. Currently he is able to perform some simple transfers and manual wheelchair self-propulsion at a supervision level. Further developments will be discussed. Discussion: Soft tissue sarcomas of the extremity are uncommon. To our knowledge there are no published cases of them occurring in a patient with a traumatic spinal cord injury. The Physiatry pre-operative consult focused heavily on functional prognostication as the potentially curative Oncology treatment plan put him at risk for severe functional detriment. We happily report that the patient is progressing towards his goal of returning back to his apartment with modified independence. Conclusion: As patients with chronic spinal cord injury live longer, they are at risk for developing cancers and the functional impairment that can be caused by cancer and its treatment. This case illustrates the crucial role a Physiatrist specializing in Cancer Rehabilitation can play in both the functional prognostication and restoration of function