Sensitivity and predictive value of occupational and physical therapy assessments in the functional evaluation of patients with suspected normal pressure hydrocephalus.

Abstract

OBJECTIVE:

To examine effectiveness of standardized occupational therapy and physical therapy assessments in detecting functional changes and predicting clinical improvement in patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage.

DESIGN:

Cohort study.

PATIENTS:

Eighty-seven patients admitted to an inpatient neurology unit for elective cerebrospinal fluid drainage for suspected normal pressure hydrocephalus.

METHODS:

Before and after a protocol of continuous cerebrospinal fluid drainage via spinal catheter, patients were administered the Functional Independence Measure (FIMTM), Timed Up and Go (TUG), Tinetti Assessment Tool of Gait and Balance, 9-hole peg test, and Cognitive Assessment of Minnesota (CAM). Following cerebrospinal fluid drainage, changes in functional performance were compared for responders to cerebrospinal fluid drainage and non-responders to cerebrospinal fluid drainage.

RESULTS:

At baseline, CAM was more sensitive than the Mini Mental State Exam in predicting responders. Post-drainage: responders improved on 52% of tests while non-responders improved on only 11%. Assessments that differentiated magnitude of improvement in responders vs non-responders were: TUG (p<0.05), Tinetti total (p<0.001), Tinetti balance (p<0.001), Tinetti gait (p<0.001), FIM toilet transfer (p<0.001), and FIM lower body dressing (p<0.001).

CONCLUSION:

Specific occupational therapy and physical therapy assessments demonstrate sensitivity to change and predictive value with patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage.

• Authors: David Feick, Jennifer Sickmond, Li Liu, Philippe Metellus, Michael Williams, Daniele Rigamonti, Felicia Hill-Briggs
• Journal: Journal of rehabilitation medicine (J Rehabil Med) Vol. 40 Issue 9 Pg. 715-20 (Oct 2008) ISSN: 1651-2081 [Electronic] Sweden
• PMID: 18843422 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Activities of Daily Living
• Adult
• Aged
• Cerebrospinal Fluid Shunts
• Cognition
• Cohort Studies
• Female
• Humans
• Hydrocephalus, Normal Pressure (diagnosis, physiopathology, rehabilitation)
• Intracranial Pressure
• Male
• Mental Status Schedule
• Middle Aged
• Occupational Therapy
• Outcome Assessment, Health Care (methods)
• Physical Therapy Modalities
• Predictive Value of Tests
• Sensitivity and Specificity