Study design: An international cross-sectional study. Objective: To examine the quality of life (QoL) of people with spinal cord injury (SCI) across six countries worldwide, controlling for socio-demographic and lesion-related sample characteristics and using a cross-culturally valid assessment. Methods: Data from 243 persons with SCI from Australia, Brazil, Canada, Israel, South Africa and the United States were analyzed. QoL was measured using five satisfaction items from the World Health Organization Quality of Life Assessment. Cross-culturally valid, Rasch-transformed scores were used for comparison. Results: Analysis of variance showed a significant difference in QoL between countries (F=3.938; df=5; P =0.002). Shorter time since injury, no paid employment and living in Brazil were significant predictors of lower QoL, explaining 13% of variance in linear regression. Using multilevel regression with country as higher-order variable, time since injury and paid employment remained significant predictors and explained 18% of variance in QoL. The intraclass correlation coefficient (0.05) indicates that 5% of the variability can be accounted for by country. Conclusion: This study showed QoL differences between countries that could not be explained by differences in demographic and lesion-related characteristics. Results point to the relevance of reintegration of people with SCI into the workforce. Further international comparative research using larger samples is recommended.

Study design: Qualitative, multi-center study. Objectives: To examine the lived experiences of persons with spinal cord injury (SCI) in both the early post-acute and the long-term context using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Setting: International study sites representing the six World Health Organization world regions. Methods: A qualitative study using focus groups methodology was conducted. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. The resulting meaningful concepts were linked to ICF categories according to established linking rules. Results: Forty-nine focus groups with 230 participants were performed. Saturation was reached in four out of the six world regions. A total of 3122 and 4423 relevant concepts were identified in the focus groups for the early post-acute and the long-term context, respectively, and linked to a total of 171 and 188 second-level categories. All chapters of the ICF components Body functions , Activities and participation and Environmental factors were represented by the linked ICF categories. In all, 36 and 113 concepts, respectively, are not classified by the ICF and 306 and 444, respectively, could be assigned to the ICF component Personal Factors , which is not yet classified. Conclusion: A broad range of the individual experiences of persons with SCI is covered by the ICF. A large number of experiences were related to Personal Factors .

Study design: A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. Objectives: The objective of the study was to report on the results of the consensus process to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set, and a Brief ICF Core Set for individuals with spinal cord injury (SCI) in the long-term context. Setting: The consensus conference took place in Switzerland. Preparatory studies were performed worldwide. Methods: Preparatory studies included an expert survey, a systematic literature review, a qualitative study and empirical data collection involving people with SCI. Relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. Results: The preparatory studies identified a set of 595 ICF categories at the second, third or fourth level. A total of 34 experts from 31 countries attended the consensus conference (12 physicians, 6 physical therapists, 5 occupational therapists, 6 nurses, 3 psychologists and 2 social workers). Altogether, 168 second-, third- or fourth-level categories were included in the Comprehensive ICF Core with 44 categories from body functions, 19 from body structures, 64 from activities and participation and 41 from environmental factors. The Brief Core Set included a total of 33 second-level categories with 9 on body functions, 4 on body structures, 11 on activities and participation and 9 on environmental factors. Conclusion: A formal consensus process integrating evidence and expert opinion based on the ICF led to the definition of the ICF Core Sets for individuals with SCI in the long-term context. Further validation of this first version is needed.

Study design: A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. Objectives: The aim of this study was to report on the results of the consensus process to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set and a Brief ICF Core Set for individuals with spinal cord injury (SCI) in the early post-acute context. Setting: The consensus conference took place in Switzerland. Preparatory studies were performed worldwide. Methods: Preparatory studies included an expert survey, a systematic literature review, a qualitative study and empirical data collection involving people with SCI. ICF categories were identified in a formal consensus process by international experts from different backgrounds. Results: The preparatory studies identified a set of 531 ICF categories at the second, third and fourth levels. From 30 countries, 33 SCI experts attended the consensus conference (11 physicians, 6 physical therapists, 5 occupational therapists, 6 nurses, 3 psychologists and 2 social workers). Altogether 162 second-, third- or fourth-level categories were included in the Comprehensive ICF Core Sets with 63 categories from the component Body Functions , 14 from Body Structures , 53 from Activities and Participation and 32 from Environmental Factors . The Brief Core Set included a total of 25 second-level categories with 8 on Body Functions , 3 on Body Structures , 9 on Activities and Participation , and 5 on Environmental Factors . Conclusion: A formal consensus process-integrating evidence and expert opinion based on the ICF led to the ICF Core Sets for individuals with SCI in the early post-acute context. Further validation of this first version is needed.

Study design: Cross-sectional, multicenter study. Objectives: To identify the most common problems of individuals with spinal cord injury (SCI) in the early post-acute and the long-term context, respectively, using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Setting: International. Methods: The functional problems of individuals with SCI were recorded using the 264 ICF categories on the second level of the classification. Prevalence of impairment was reported along with their 95% confidence intervals. Data were stratified by context. Results: Sixteen study centers in 14 countries collected data of 489 individuals with SCI in the early post-acute context and 559 in the long-term context, respectively. Impairments in thirteen ICF categories assigned to Body functions and Body structures were more frequently reported in the long-term context, whereas limitations/restrictions in 34 ICF categories assigned to Activities and Participation were more frequently found in the early post-acute context. Eleven ICF categories from the component Environmental Factors were more frequently regarded as barriers, facilitators or both by individuals with SCI in the early post-acute context as compared with individuals with SCI in the long-term context. Only two environmental factors were more relevant for people with SCI in the long-term context than in the early post-acute context. Conclusion: The study identified a large variety of functional problems reflecting the complexity of SCI and indicated differences between the two contexts. The ICF has potential to provide a comprehensive framework for the description of functional health in individuals with SCI worldwide.

This article aims to assist inpatient rehabilitation clinicians to choose appropriate measures. Emphasis is given to measurement processes and interpretation. The authors provide examples of measures commonly reported for five rehabilitation diagnostic groups: stroke, traumatic brain injury, spinal cord injury, multiple sclerosis and cardio-respiratory rehabilitation.

A 22.5m long marine shelf sequence in northern Denmark covers the climatic shifts from glacial environments, through interglacial and into early glacial conditions. The interglacial was interrupted by two cool intervals. Also the early glacial succession experienced oscillations of the climate, and a period with ameliorated temperature conditions has been separated as an interstadial. These results are based on a multidisciplinary high-resolution study of lithology, foraminifera, ostracods, macrofauna, diatoms and stable isotopes in a silty clay sequence from a borehole at Nørre Lyngby (70.5–48.0m depth). The lithostratigraphy and the variations in depositional environment in the area is supported by a reflection seismic profile across the core site. The chronostratigraphy is discussed on the basis of biostratigraphical correlation and seismostratigraphy as well as Optically Stimulated Luminescence (OSL) dating and amino acid measurements. The biostratigraphy and the OSL dates suggest an Eemian age for the interglacial, while amino acid results point to an older age. If the interglacial is confirmed as Eemian, we believe that the succeeding interstadial period is likely to be correlated with the Brørup Interstadial. The climatic changes in this eastern part of the North Sea region are closely linked with changes in the North Atlantic circulation pattern, and the environmental fluctuations at Nørre Lyngby are therefore believed to reflect fluctuations in the past regional climatic and oceanic system.

Seventeen female agoraphobic patients were treated in three groups by in vivo exposure over 10 sessions. Dependent measures comprised an assessment using a behavioural hierarchy and an assessment of subjective anxiety. Pre-treatment assessment of the number of problems and fears, interpersonal variables and personality as measured by the E.P.P.S. were also carried out. Correlational evidence was sought of relationships between pre-treatment assessment variables and treatment outcome. It was found that low scores for “Aggression” on the E.P.P.S. and the rated ability of designated significant others to manage the agoraphobics' behaviour successfully were predictive of good outcome. Possible reasons for and implications of these findings are discussed.

The advantages of selecting agoraphobic patients for treatment by group exposure according to their residential geographic neighbourhood were evaluated in terms of facilitation of ‘homework’ practice and increased social contact. Both ‘zoned’ and ‘unzoned’ groups showed gains in ability to perform hierarchy items after 11 sessions of exposure, relative to a no-treatment control group. However only zoned subjects showed significant reductions in experienced anxiety when executing such items. Self-ratings of overall phobic severity also suggested a zoned group was superior to unzoned while assessors' ratings indicated both groups as equally improved. Only zoned subjects showed a significant increase in social range. Improvements were maintained at 3-months follow-up. No effect of treatment was found on either the Zung measure of anxious mood or on social integration.

Examined previous notions about the nature of agoraphobia. A contrast of emphasis was found between those who regarded it primarily as a situational fear and others who saw it essentially as a product of some underlying anxiety. A more precise situational analysis was attempted that focused on six variables: Unaccompanied vs. with someone, distance from home, familiarity of location, crowdedness, type of location, and time spent. One hundred and twenty-eight situation descriptions were generated by factorially combining the different levels of each variable. The items thus produced were assembled randomly into a questionnaire that was completed by 30 agoraphobic patients. The importance of the contribution of each variable to the rated fear-provoking potential of the situation description was analyzed. Results were discussed in terms of the agoraphobic as typically dependent upon a significant other, and treatment implications were examined.

Various investigations into the relative effectiveness of different treatment procedures with agoraphobic patients (e.g. Emmelkamp, 1974; Emmelkamp and Wessels, 1975) have shown that in-vivo exposure is a common factor in successful aproaches. Emmelkamp (1974) has suggested that in-vivo exposure is the essential element of treatment which may eventually result in habituation. He has also demonstrated (Emmelkamp and Emmelkamp-Benner 1975) that group treatment can be just as effective as the same approach used individually, which has obvious implications for cost-efficiency.