216
Physiotherapy Outcome Measures for
Rehabilitation of Elderly People
Responsiveness to change of the Rivermead
Mobility Index and Barthel Index
June Wright
Janet Cross
Sarah Lamb
Key Words
Physiotherapy outcome, rehabilitation, mobility function, respon-
siveness to change.
Summary
This study was part of an on-going exercise to identify and im-
plement outcome measures in physiotherapy practice on the
rehabilitation wards of the Department of Clinical Geratology at
the Radcliffe Infirmary, Oxford. The aim was to compare the
responsiveness to change and other measurement properties
(floor and ceiling effects) of the Rivermead Mobility Index (RMI)
and Barthel Index (BI).
The RMI and BI were scored at admission to the rehabilitation
ward, and on discharge, by therapy and nursing staff. Mobility
prior to the admission was assessed by self or proxy report from
the patients and carers.
Fifty-eight people were recruited into the study (mean age 83
years, range 63-99 years, 22 men and 36 women), and had a
range of orthopaedic, neurological, cardiorespiratory, and other
conditions for which physiotherapy was indicated. Eight people
died, and their data were excluded from the results. Overall, the
participants improved in their functional and mobility abilities as
scored by the RMI and BI.
Both the RMI and BI are responsive to changes in older people
having physiotherapy (effect sizes 1 and 0.87 respectively). The
RMI was more efficient in measuring outcome than the BI, but only
by a modest amount (parametric relative efficiency 1.42; non-
parametric relative efficiency 1.25). Floor and ceiling effects are
evident in the RMI and 81 respectively, and it is concluded that
this could limit their ufefulness for in-patients. The findings of this
study have implications for the use of outcome measures in
physiotherapy practice and research.
Introduction
Physiotherapists need to adopt outcome measures
which will document the efficacy of their inter-
ventions, and guide clinical decisions and
treatment planning. These measures need to be
clinically appropriate, functionally relevant, valid,
reliable and responsive t o change. In addition,
they need to be user friendly so as to minimise the
burden to therapists and patients. This study was
part of an on-going exercise to identify and imple-
ment outcome measures in physiotherapy practice
on the rehabilitation wards of the Department of
Clinical Geratology at the Radcliffe Infirmary,
Oxford.
The aim was to investigate the responsiveness to
Physiotherapy, May 1998, vol84, no 5
change, and floor and ceiling effects, in two
measures which have been recommended for
assessing functionally relevant outcomes in
rehabilitation. The measures were the Barthel
Index (BI) (Collin et al, 1988) and the Rivermead
Mobility Index (RMI)(Collen et al, 1991).
The BI is a ten-item test, which records the ability
to perform basic activities of daily living, conti-
nence and mobility (including transfers, walking
and climbing the stairs).It is scored by either self-
report or observation of the patient, and for each
item the patient is scored according to the amount
of help needed. The Royal College of Physicians
(1992) recommends its use as a n outcome
measure for multi-disciplinary rehabilitation
(including physiotherapy) of older patients, and
it is currently used for this purpose in our ward
setting.
The RMI is a 15-item test, which collects infor-
mation on a range of mobility tasks considered
essential to basic activities of daily living (Collen
et a l , 1991). These tasks range from the ability
to turn over in bed to running a short distance.
It is scored by self-report or direct observation on
all test items. The RMI has previously been vali-
dated in people who have neurological conditions
(Collen et al, 1991). For the majority of patients
undergoing rehabilitation in our ward setting, the
primary treatment aim is t o improve mobility;
scrutiny of the items of the RMI suggested that it
should be a valid and more responsive measure of
outcome than the BI for our patient group.
Responsiveness t o change is recognised as a n
important characteristic of measurement which is
distinct from validity and reliability in that it
measures the efficiency with which the measure
detects clinical change (Guyatt et al, 1987; Lachs,
1993). If significant clinical change occurs and a
measure is unable to detect this, it is redundant.
For measures to be responsive, the scores should
be distributed evenly around the middle score,
and there should be no floor o r ceiling effects
where patients can decline or improve beyond the
measurement range (Wade, 1992). To date, there
have been few studies which have examined the
responsiveness to change, and floor and ceiling
effects, in measures which have been recom-
mended for measuring physiotherapy outcome.

Method
Men and women admitted to the rehabilitation
ward from an acute care ward were included in
the study, provided that they received physio-
therapy assessment and intervention while on the
ward. The age, sex, primary diagnosis responsible
for admission and length of stay were recorded.
The RMI was collected by physiotherapists
responsible for the treatment of the patients, by
direct observation of performance. The BI was
collected from the medical and nursing assess-
ments, and had been recorded by direct
observation of performance by the nursing staff.
Both assessments were recorded within 48 hours
of admission, and at 24 t o 48 hours prior t o
discharge. Data of pre-morbid abilities were
collected by report from patients or their carers.
To facilitate good inter-rater reliability with the
RMI, guidelines for use were clarified with all
raters, and the measure was piloted for one month
prior to the study.
Data Analysis
The BI and RMI are scored out of a total of 15 and
20 points, respectively. To allow accurate compar-
ison the scores on the BI and RMI were both
transformed t o give a score out of one hundred
using the formula:
Patient score oo
Total possible score
Then the frequency distribution of the trans-
formed scores, prior t o admission and at
admission and discharge, were graphed (including
the average summarised as the median, inter-
quartile range and range of values). These plots
were scrutinised for floor and ceiling effects.
Wilcoxon sign rank tests were used to test for
statistically significant differences between the BI
scores at admission and discharge, and for the
RM1 scores at admission and discharge. Associa-
tion between the scores on the BI and RMI prior to
admission, at admission and at discharge were
tested using the Spearmans rank correlation co-
efficient. Change in scores between admission and
discharge were computed as the percentage
change (Pocock, 1987) using the formula:
Discharge score
x 100 = %change
Admission score
They were expressed as the median anc’ .nter-
quartile range. A Wilcoxon sign rank test was
used to test if the change in RMI score was signif-
icantly different from the change in BI score.
Associations between the change in scores on the
BI and RMI were tested using a Spearmans rank
correlation coefficient.
Calculation of effect sizes and relative efficiency
217
are recognised methods of comparing the respon-
siveness to change of different measures (Liang,
1995; Kazis et al, 1989; Meenan et al, 1984; Liang
et al, 1985). An effect size is a standardised
measurement of change; it provides an estimate
of the ‘signal t o noise ratio’ of a measure; the
change in score is the ‘signal’ and standard devi-
ation of the baseline scores is used as an indicator
of the ‘noise’. Effect sizes were calculated sepa-
rately for the RMI and BI using the method of
Kazis et a1 ( 1989):
Effect size =
(Mean discharge score - Mean admission score)
Standard deviation of admission score
The larger the effect size, the more responsive the
measure is t o clinical change. Effect size scores
of less than 0.2 can be interpreted as small, 0.5 as
moderate and 0.8 o r greater as large (Cohen,
1977).
Disadvantages of using effect sizes to estimate the
responsiveness of ordinal scales like the RMI and
BI are that they assume that each successive
point on the score represents an equal amount of
change (which is not strictly the case for the BI
and RMI) and that the data are normally distrib-
uted (referred t o as parametric assumptions).
Also, effect sizes do not provide a direct method
of calculating the relative efficiency of two
measures.
Calculations described by Liang et a1 (1985) can
be used to estimate directly the relative efficiency
of two measures. In this approach a single ‘signal
t o noise’ estimate is derived for each measure
(using parametric assumptions and a t statistic).
T statistics are calculated for each measure using
a paired t-test of the admission and discharge
scores (Altman, 19921, and then compared by
dividing one by the other (Liang, 1995). Barr et
al (1994) have reported a method of calculating
relative efficiency which does not require para-
metric assumptions, but because this method is
used so infrequently, interpreting the clinical
meaning of the statistic is more difficult. To over-
come these difficulties both parametric and non-
parametric methods of calculation were used.
First, the relative efficiency of the RMI uersus the
BI was calculated using the parametric method of
Liang et a1 (1985):
Relative efficiency (RMI versus BI) = ($)
The non-parametric relative efficiency was calcu-
lated according t o Barr et a1 (1994) using the z
statistics derived from the Wilcoxon sign rank test
of admission and discharge scores:
Relative efficiency (RMl versus 81) = (T)
Physiotherapy, May 1998, vol84, no 5
218

Table 1 : Diagnosis at admission of 58 patients assessed for the study

~

Orthopaedic Neurological Cardiorespiratory Circulatory Nonspecific Medical

Trauma 15 CVA 11 COAD/CCF 6 Amputation 1 Falls 4 Cancer 1

Arthritis 2 Parkinson’s Chest infection 4 Ulcers 2 Confusion 1 Addison’s
Osteoporosis 2 disease 2 Femoral/popliteal Frailty 1 disease 1
Cervical bypass Drop attacks 1 Anaemia 1
discectomy 1
Meningitis 1
Total %* 33 26 17 7 12 5
*Patients in each diagnostic category expressed as a percentage of the total number of patients studied.
Of the 58 patients detailed in the table, eight died. The diagnosis at admission for patients who died were orthopaedic trauma (2);
CCF (2); frailty (2) and hemiplegia (2).

In both cases, a result greater than 1 would indi-
cate the RMI t o be more responsive than the BI,
a score of less than 1would indicate the RMI to be
less responsive, and a score of 1 would indicate
responsiveness t o be the same. Data were
analysed using Microsoft Excel and SPSS for
Windows statistical software packages. Statistical
significance was claimed at the p < 0.05 level.
Results
A total of 58 people were recruited into the study
(mean age 83 years, range 63-99 years, 22 men, 36
women). Orthopaedic problems were the most
common diagnoses responsible for admission.
Eight subjects died before discharge, and the
average length of stay for survivors was 34 days
(range 6-124 days). Participants who died had
lower scores on the BI and the RMI on admission.
They were excluded from the analysis (table 1).
100
Plots of BI and RMI scores prior t o admission, at
admission and on discharge are shown in the
figure. Before admission, the average BI score was
95 out of 100. All scored above the middle point
of the scale and 21 people (44%) scored the
maximum possible, ie there was a ceiling effect-in
the BI for scores before admission. In comparison,
the average score on the RMI was much nearer
to the mid-point of the scale, and only 15 people
(31%)scored the maximum possible score.
At admission, the scores on the BI were evenly
distributed around the mid-point of the scale;
there was no evidence of a floor or ceiling effect.
The average score of the RMI was below the mid-
point of the scale, and three participants (6%)
scored the minimum value; thus a floor effect was
demonstrated.
At discharge, the average score on the BI was
above the mid-point of the measurement scale,

80

20

0
Before admission Admission Discharge Before admission Admission Discharge
Barthel Index Rivermead Mobility Index
Barthel Index and Rivermead Mobility Index scores prior to admission, at admission and
on discharge from the unit for the 50 patients described. For each assessment the median (solid line),
inter-quartile range (open box) and range from smallest to largest values are given

Physiotherapy, May 1998, vol84, no 5

 219

Table 2: Rivermead Mobility and Barthel scores (raw and transformed) prior to
admission, within 48 hours of admission, and at discharge for 50 patients
admitted to the rehabilitation wards
Pre-admission Admission Discharge % change

RMV15 10 (7.3, 14.0) 3 (1.3, 5.8) 6 (3.4, 8)

RMV100 67 (48.5, 100) 24 (8.5, 38.3) 40 (21.7, 53) 41 (11,72)*
BV20 18 (15.6, 20) 9 (6.3, 12) 13 (9.3, 17)
BI/IOO 95 (85, 100) 45 (31.3, 60) 65 (46.3, 85) 48 (17, 116)t
~ ~ ~ ~ ~~ ~

Values are the average (summarised as the median) and inter-quartile range. Also shown
are the median and inter-quartile range of the change in scores between admission and
discharge.
*Denotes p < 0.001 for Wilcoxon signed rank test of differences between admission and
discharge scores on the RMI. The z statistic was 5.21.
+Denotes p < 0.001 for Wilcoxon signed rank test of differences between admission and
sicharge scores on the BI. The z statistic was 4.65.
The raw scores were not tested for statistically significant differences.

and two (4%)of participants scored the maximum Discussion

value, demonstrating a mild ceiling effect. The
In this study we demonstrated that the RMI is
average RMI score was closer to the mid point of
more efficient than the BI in detecting changes
the scale; none of the participants scored maxi-
in patients receiving rehabilitation for mobility
mally but three (6%) scored the minimum score,
limitation. I t is important t o note t h a t the
showing a minor floor effect. The participants who
improvements in mobility cannot be attributed
scored the minimum scores on the RMI at admis-
to physiotherapy alone as patients were receiving
sion were not those who scored a minimum score
other medical, nursing and rehabilitation inter-
at discharge. Those who scored zero at discharge ventions during their in-patient stay. The BI was
had all declined in the RMI and BI scores from
chosen for the comparison as it is accepted as
admission. There was no record of a score below
the gold standard for meisuring rehabilitation
2 in any of the assessments using the BI. Subjects
outcomes (Wade and Collin, 1988; Johnston et al,
who did not improve on the RMI did not improve
1992; Shah and Cooper, 1993). It is also currently
on the BI.
used t o measure rehabilitation outcomes in our
Table 2 gives the raw and transformed scores on ward setting.
the BI and RMI prior t o admission, at admission
There are several differences between the scales
and on discharge. Scores on the BI and RMI
which might account for our being able to report
were highly correlated prior to admission, and at
the difference in responsiveness. First, the BI
admission and discharge (Spearmans rank 0.74,
measures global function but the RMI is specific
0.78, 0.87 respectively p < 0.001 for all compar- t o mobility, relating t o lower limb function
isons). Overall the participants demonstrated
and ability to walk. Only ten out of a total
statistically significant improvements in their
score of 20 points on the BI measure mobility-
functional and mobility abilities measured by the
related tasks. The high correlation between the
BI and RMI (Wilcoxon sign rank tests p < 0.001).
RMI and BI suggests that they are measuring
The average percentage change betyeen admis-
similar constructs and indicates the importance
sion and discharge was 41% for the BI and 48% for
of mobility to functioning in everyday life in
the RMI; this difference was statistically signifi-
this group of patients. Secondly, the nursing
cant (Wilcoxon sign rank test p < 0.001). The
staff recorded the BI whereas physiotherapists
amount of change in the BI and RMI was corre-
recorded the RMI. Ideally, an independent rater
lated (Spearmans rank correlation coefficient 0.65
should have recorded both the RMI and BI, but
p < 0.001). The effect size calculated for the RMI
this was not possible. The bias introduced is likely
was 1, and 0.87 for the BI. Parametric calcula-
to be small as the incentive t o record improve-
tion of the relative efficiency of the RMI uersus the
ments in patients’ function was similar in each
BI was 1.42; non-parametric methods gave a
group, and the nurses and physiotherapists were
result of 1.25 for the same comparison.
unaware of the RMI and BI score respectively. The
time that elapsed between recording the measure-
ments was never greater than two days, although
on admission the BI was most often recorded
before the RMI. Given that the average length of
stay was long, these differences are not likely t o

Physiotherapy, May 1998, vol84, no 5

220
have affected the results of the study. If they had,
the study would have under estimated the respon-
siveness of the RMI.
The RMI was originally designed and validated for
stroke patients (Collen et al, 1991). The partici-
pants of this study had a much wider range of
conditions and included people with limited exer-
cise tolerance due t o long-standing medical
problems and those requiring long-term care. The
results suggest that the RMI is a useful measure
in groups of patients who have disability associ-
ated with impairments other than stroke. Future
studies need to examine the intra- and inter-
tester reliability of the RMI in the diagnostic
groups that we studied. However, our results indi-
cate that in frail older people the RMI it is not
maximally responsive to change during hospital-
isation. A measure which includes more basic
mobility items, such as the Hierarchical Ass-
essment of Balance and Mobility (HABAM)
(MacKnight and Rockwood, 1995) o r Elderly
Mobility Scale (EMS) (Smith, 1994) may be more
responsive and this hypothesis should be subject
t o further investigation. MacKnight and Rock-
wood (1995) reported the relative efficiency of
the BI and HABAM in a similar group of patients.
The comparative efficiency of the HABAM was
in excess of 3 (calculated using a parametric
method). In comparison, the gains in efficiency
that we report using the RMI are modest. Unlike
the BI, the RMI provided a much more compre-
hensive assessment of pre-admission ability, and
community physiotherapists continued to use the
RMI to monitor change in the higher levels of func-
tional mobility after discharge. The BI is limited
in its usefulness as a n outcome measure after
discharge from hospital because of the marked
ceiling effect. The responsiveness of the BI could
be improved by expanding the number of cate-
gories used to record change in each activity of
daily living (Shah et al, 1989). The results of the
analysis of relative efficiency were similar when
the more conservative non-parametric methods
were used.
Smith (1993) suggests that the BI should not be
used to measure physiotherapy outcome because
it lacks responsiveness t o clinical change. Our
results demonstrate that although the BI is less
sensitive than the RMI, it still provides valuable
information on the recovery of patients who
receive physiotherapy as a part of their rehabili-
tation. Unlike the RMI it provides additional
information concerning the amount of help that
people require to complete activities of daily living
which is important in care planning.
I n summary, physiotherapists need t o use
outcome measures to document the efficacy of
their interventions, to guide clinical decision
Physiotherapy, May 1998, vol84, no 5
making and planning, and to assist in research.
The RMI is an appropriate and functionally rele-
vant measure in this patient group, especially for
those who have a predicted outcome of indepen-
dence and higher levels of mobility. It is more
responsive to change than the BI. However,
further improvements for this patient population
could be made if the scale was supplemented or
expanded t o contain more information at the
lower levels of mobility - for example, t o include
change in mobility in those whose level of de-
pendency on physical help has changed during
hospitalisation.
Acknowledgments
To all the staff and patients who participated in the study.
Sarah Lamb was supported by the PPP Research Fellowship in
Health Care of the Elderly.
Authors
June Wright MCSP is a senior physiotherapist in geratology at the
Radcliffe Infirmary and Janet Cross MCSP is a senior physio-
therapist at the Oxford Community Hospital in Churchill Hospital,
Oxford. They were responsible for data collection and contributed
to writing the report.
Sarah Lamb DPhil MSc MCSP is a research Fellow in clinical
geratology, University of Oxford, and co-director of the physio-
therapy research unit at the Nuffield Orthopaedic Centre. She
analysed the data and contributed to writing the report.
This article was received on August 27, 1997, and accepted on
February 11, 1998.
Address for Correspondence
Miss S Lamb, Co-director of Physiotherapy Research Unit,
Nuffield Orthopaedic Centre NHS Trust, Oxford OX3 7LD.
References
Altman, D G (1 992). Practical Statistics for Medical Research,
Chapman and Hall, London.
Barr, S, Bellamy, N, Buchanan, W W, Chalmers, A, Ford, P M,
Kean, W F, Kraag, R R , Gerecz-Simon, E and Campbell, J
(1994). ‘A comparative study of signal versus aggregate methods
of outcome measurement based on the WOMAC Osteo-arthritis
Index’, Journal of Rheurnatology,21,2106-12.
Cohen, J (1997). Statistical Power Analysis for the Behavioural
Sciences, Academic Press, New York.
Collen, F M, Wade, D T, Robb, G F and Bradshaw, C M (1991).
‘The Rivermead Mobility Index: A further development of the
Rivermead Motor Assessment’, international Disability Studies,
13, 50-54.
Collin, C, Wade, D T, Davies, S and Horne, V (1998). ‘The Barthel
Index: A reliability study’, lnternational Disability Studies, 10,
61-63.
Guyatt, G, Walter, S and Normal, G (1987). ‘Measuring change
over time: Assessing the usefulness of evaluative instruments’,
Journal of Chronic Disease, 40, 171-1 78.
Johnston, M V, Keith, R A and Hinderer, S R (1992). ‘Measure-
ment standards for interdisciplinary medical rehabilitation’,
Archives of Physical Medicine and Rehabilitation,73, 125.
Kazis, L E, Anderson, J J and Meenan, M D (1989). ‘Effect sizes
for interpreting changes in health status’, Medical Care, 27, 3 ,
178-1 79.
Lachs, M S (1993). ‘The more things change’, Journal of Clin-
ical Epidemiology,46, 1091-92.
 221

Additional references Society (1 992). Standardised Assessment Scales for Elderly

Liang, M H (1995). ‘Evaluating measurement responsiveness’,
Journal of Rheumatology, 6, 1191-92.
Liang, M H, Larson, M G, Cullen, K E and Schwartz, J A (1985).
‘Comparative measurement efficiency and sensitivity of five
health status instruments for arthritis research’, Arthritis and
Rheumatism, 2 8 , 5 5 4 2 4 4 7 .
MacKnight, C and Rockwood, K A (1995). ‘Hierarchical assess-
ment of balance and mobility’, Age and Ageing, 24, 126-1 30.
Mahoney, F I and Barthel, D W (1965). ‘Functional evaluation:
The Barthel Index’, Mavland State MedicalJournal, 14, 61-65.
Meenan, R F, Anderson, J J, Kazis, L E, Eeler, M J, Altz-Smith,
M, Samuelson, C 0, Willkens, R F, Solsky, M A, Hayes, S P,
Blocka, K L, Weinstein, A, Guttadauria, M, Kaplan, S B and
Klippel, J (1 984). ‘Outcome assessment in clinical trials’, Arthritis
and Rheumatism, 27,12,1344-52.
Pocock, S J (1 987). Clinical Trials: A practical approach, John
Wiley and Sons, Chichester, chapter 12, page 190.
Royal College of Physicians of London and British Geriatric
People, RCP and BGS, London.
Shah, S (1994). ‘In praise of the biometric and psychometric qual-
ities of the Barthel Index’, Physiotherapy, 80, 1 1 , 769-771.
Shah, S and Cooper, B (1993). ‘Commentary on a critical evalu-
ation of the Barthel Index’, British Journal of Occupational
Therapy, 56, 2, 70-72.
Shah, S, Vanclay, F and Cooper, B (1989). ‘Improving the sensi-
tivity of the Barthel Index for stroke rehabilitation’, Journal of
Clinical Epidemiology, 42, 8, 703-709.
Smith, R (1993). ‘Beware of the Barthel’, Physiotherapy, 79, 12,
843-844.
Smith, R (1994). ‘Validation and reliability of the Elderly Mobility
Scale’, Physiotherapy, 80, 1 1, 744-747.
Wade, D T (1992). Measurement in Neurological Rehabilitation,
Oxford University Press, chapter 8, pages 70-71, 77.
Wade, D T and Collin, C (1988). ‘The Barthel ADL Index. A stan-
dard measure of physical disability?’ lnternational Disability
Studies, 10, 64-65.

@information
These publications are distributed by the Medical Devices Agency to Regional general
managers, chief executives of District health authorities and health commissions, chief exec-
utives of NHS trusts, general managers of directly managed units, directors of social services,
managers of independent health care units and rehabilitation service managers. They should
be available for consultation by employees.
Summaries of relevant notices are given here. The full versions include action notes, back-
ground information and contact names.

Disability A25: January 1998

Equipment
Assessments
A23: September 1997
Handling equipment for moving
dependent people in bed
Several examples are taken of four main
types of equipment: sliding sheets, short
and long low friction rollers, and handling
devices.
Sixty carers tried out products a
minimum of five times in one week with
121 disabled people. The determinining
factors were ease of positioning and
efficacy in use.
Overall, the short low friction rollers
were favourites, the handling devices
being poorly rated.
The report also contains four pages
of advice on using handling equipment.
A24: January 1998
Enuresis alarms
This is not a comparative evaluation as
it was considered inappropriate to ask
children to evaluate more than one
type of device. Four alarms considered
representative of those available on
the UK market in 1994 were tested.
In general, the alarms were found to be
uncomfortable and too quiet, though the
latter characteristic may have been an
advantage in sensors which needed to be
dried before they could be turned off!
Seating for young children with
disabilities
Ten chairs were selected from about 60
similar products in three main types: four
floor sitters, four basic chairs and two
bolster seats.
Different chairs had different advan-
tages, but for usefulness in the home the
Jenx corner seat came out as the best
floor sitter, the Tripp Trapp in the basic
chairs, and the Jenx Mouse in the bolster
seats.
Evaluation
PS5: January 1998
Armchairs with special features to
reduce interface pressure, alternating
pressure cushions (main powered),
and supplementary cushions
This is the last in a series of special issues
relevant to the topic of pressure relief and
pressure sore prevention. Four armchairs
including one conventional model, four
mains powered dynamic cushions, and
examples of feather and fibre pillows were
evaluated in regard to their pressure redis-
tributing qualities. Pillows were included
because they areoften used to pad chairs
in hospitals and their effect on interface
pressure is not known. The products were
tested by elderly able-bodied subjects.
As well as individual assessments the
booklet includes a discussion and some
guidelines on using chairs and supple-
mentary cushions.
Prosthetics and
Orthotics
PO1: October 1997
Wrist splints for people with rheuma-
tological disease
A comparative evaluation of 12 wrist
splints representative of those on the
market for rheumatological conditions, this
report assesses their comfort, support,
pain reduction, facilitation of activities and
ease of putting on and off.
The report aims to provide prescribers
and fitters of wrist splints with a compre-
hensive guide on what to consider when
selecting a suitable splint, and instructions
on fitting the splints correctly. The recom-
mendations may be used when designing
stock wrist splints.
Bulletins
DB 9801: January 1998
Medical device and equipment man-
agement for hospital and community-
based organisations
A large ring-bound volume with indexed
separating sheets, this bulletin offers guid-
ance on selecting, buying, taking delivery,
commissioning, and maintaining new
equipment. There are also sections on
community issues, training, lending
systems, and documentation (which warns
against the hazards of computer based
records).

Physiotherapy, May 1998, vol84, no 5