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Chen, Pin-Wei, Nathan A. Baune, Igor Zwir, Jiayu Wang, Victoria Swamidass, and Alex W. K. Wong. "Measuring Activities of Daily Living in Stroke Patients with Motion Machine Learning Algorithms: A Pilot Study." International Journal of Environmental Research and Public Health 18, no. 4 (February 9, 2021): 1634. http://dx.doi.org/10.3390/ijerph18041634.
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Measuring activities of daily living (ADLs) using wearable technologies may offer higher precision and granularity than the current clinical assessments for patients after stroke. This study aimed to develop and determine the accuracy of detecting different ADLs using machine-learning (ML) algorithms and wearable sensors. Eleven post-stroke patients participated in this pilot study at an ADL Simulation Lab across two study visits. We collected blocks of repeated activity (“atomic” activity) performance data to train our ML algorithms during one visit. We evaluated our ML algorithms using independent semi-naturalistic activity data collected at a separate session. We tested Decision Tree, Random Forest, Support Vector Machine (SVM), and eXtreme Gradient Boosting (XGBoost) for model development. XGBoost was the best classification model. We achieved 82% accuracy based on ten ADL tasks. With a model including seven tasks, accuracy improved to 90%. ADL tasks included chopping food, vacuuming, sweeping, spreading jam or butter, folding laundry, eating, brushing teeth, taking off/putting on a shirt, wiping a cupboard, and buttoning a shirt. Results provide preliminary evidence that ADL functioning can be predicted with adequate accuracy using wearable sensors and ML. The use of external validation (independent training and testing data sets) and semi-naturalistic testing data is a major strength of the study and a step closer to the long-term goal of ADL monitoring in real-world settings. Further investigation is needed to improve the ADL prediction accuracy, increase the number of tasks monitored, and test the model outside of a laboratory setting.
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Gobbens, Robbert J. "Associations of ADL and IADL disability with physical and mental dimensions of quality of life in people aged 75 years and older." PeerJ 6 (August 9, 2018): e5425. http://dx.doi.org/10.7717/peerj.5425.
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Background Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life. Methods A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension. Results All ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item “stand up from sitting in a chair”, and IADL items “do “heavy” household activities” and “do the shopping” were negatively associated with both quality of life dimensions after controlling for all the variables in the model. Discussion This study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.
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Monjazebi, Fateme, Asghar Dalvandi, Abbas Ebadi, Hamid Reza Khankeh, Mehdi Rahgozar, and Jörg Richter. "Functional Status Assessment of COPD Based on Ability to Perform Daily Living Activities: A Systematic Review of Paper and Pencil Instruments." Global Journal of Health Science 8, no. 3 (August 6, 2015): 210. http://dx.doi.org/10.5539/gjhs.v8n3p210.
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<p><strong>CONTEXT: </strong>Activity of daily living (ADL) is an important predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Increasing ADL is important in patients with COPD and assessment of ADL is one of the best ways to evaluate the status of COPD patients.</p> <p><strong>OBJECTIVES: </strong>The objective of this systematic review was to provide an overview of the psychometric properties of paper and pencil instruments measuring ADL in patients with COPD.</p> <p><strong>DATA SOURCES:</strong> English papers published from 1980 to 2014 regarding ADL in patients with COPD were searched in Web of Science, MEDLINE, Google Scholar, Cochrane, PubMed, ProQuest, and CINAHL databases using the following keywords: “COPD”, “ADL”, “activities of daily living”, “daily activities”, “instrument”, “questionnaire”, “paper-and-pencil instruments”, and “measure”. Following the Internet search, manual search was also done to find article references.</p> <p><strong>STUDY SELECTION:</strong> A total of 186 articles were found. Of those, 31 met the inclusion criteria. Full texts of articles meeting the inclusion criteria were studied. Consensus-based standards for the selection of health measurement instruments<strong>"</strong>(COSMIN) were used to assess the quality of the studies.</p> <p><strong>DATA EXTRACTION:</strong> Data extraction form based on research aims developed by researchers and<strong> </strong>psychometric experts, with 17 questions was used.</p> <p><strong>RESULTS: </strong>In these articles, 14 pen and paper instruments were identified for examining ADL in patients with COPD; of which, 4 dealt directly with ADL while 9 assessed other criteria i.e. dyspnea as ADL indicator. The majority of instruments only dealt with two main dimensions of ADL: Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL), and did not consider Advanced Activities of Daily Living (AADL), which is influenced by cultural and motivational factors.</p> <p><strong>CONCLUSION:</strong> Despite several ADL instruments identified, complete psychometric processes have only been done in a few of them. Selection of the appropriate instrument should focus on the aim of the study and the target construct.</p>
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Hsueh, I.-Ping, Jyun-Hong Chen, Chun-Hou Wang, Wen-Hsuan Hou, and Ching-Lin Hsieh. "Development of a Computerized Adaptive Test for Assessing Activities of Daily Living in Outpatients With Stroke." Physical Therapy 93, no. 5 (May 1, 2013): 681–93. http://dx.doi.org/10.2522/ptj.20120173.
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Background An efficient, reliable, and valid measure for assessing activities of daily living (ADL) function is useful to improve the efficiency of patient management and outcome measurement. Objective The purpose of this study was to construct a computerized adaptive testing (CAT) system for measuring ADL function in outpatients with stroke. Design Two cohort studies were conducted at 6 hospitals in Taiwan. Methods A candidate item bank (44 items) was developed, and 643 outpatients were interviewed. An item response theory model was fitted to the data and estimated the item parameters (eg, difficulty and discrimination) for developing the ADL CAT. Another sample of 51 outpatients was interviewed to examine the concurrent validity and efficiency of the CAT. The ADL CAT, as the outcome measure, and the Barthel index (BI) and Frenchay Activities index (FAI) were administered on the second group of participants. Results Ten items did not satisfy the model's expectations and were deleted. Thirty-four items were included in the final item bank. Two stopping rules (ie, reliability coefficient >.9 and maximum test length of 7 items) were set for the CAT. The participants' ADL scores had an average reliability of .93. The CAT scores were highly associated with those of the full 34 items (Pearson r=.98). The scores of the CAT were closely correlated with those of the combined BI and FAI (r=.82). The time required to complete the CAT was about one fifth of the time used to administer both the BI and FAI. Limitations The participants were outpatients living in the community. Further studies are needed to cross-validate the results. Conclusions The results demonstrated that the ADL CAT is quick to administer, reliable, and valid in outpatients with stroke.
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DE JONGHE, JOS F. M. "Everyday actions are activities of daily living." Journal of the International Neuropsychological Society 12, no. 5 (September 2006): 755. http://dx.doi.org/10.1017/s1355617706060917.
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Giovannetti and co-authors (Giovannetti et al., 2006) highlight the importance of measuring activities of daily living (ADL) and Instrumental activities of daily living (IADL) for the diagnosis of dementia. The method used, Naturalistic Action Test (NAT), is performance based. Study rationale was that “the relevance of diagnosis to everyday functioning has gone largely unexplored.” However, this statement seems to be invalid: cognitive impairment interfering with daily/social functioning is one of the DSM-IV dementia criteria. Secondly, many different ADL/IADL scales exist and are used in dementia research, including those that are performance based (Burns et al., 2004). Authors should have reviewed these scales more thoroughly and present a rationale for introducing a new one. NAT items model household chores and preparing a simple meal only. These activities are quite different from and perhaps easier to perform than using the telephone, handling finances, and similar instrumental activities. Simple activities or ADL may not be useful in differentiating dementia from normality, especially in the early stages of dementia.
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Sandhu, Sukhmeet K., Casey H. Halpern, Venus Vakhshori, Keyvan Mirsaeedi-Farahani, John T. Farrar, and John Y. K. Lee. "Brief Pain Inventory–Facial minimum clinically important difference." Journal of Neurosurgery 122, no. 1 (January 2015): 180–90. http://dx.doi.org/10.3171/2014.8.jns132547.
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OBJECT Neurosurgeons are frequently the primary physicians measuring pain relief in patients with trigeminal neuralgia (TN). Unfortunately, the measurement of pain can be complex. The Brief Pain Inventory–Facial (BPI-Facial) is a reliable and validated multidimensional tool that consists of 18 questions. It measures 3 domains of pain: 1) pain intensity (worst and average pain intensity), 2) interference with general activities of daily living (ADL), and 3) face-specific pain interference. The objective of this paper is to determine the patient-reported minimum clinically important difference (MCID) using the BPI-Facial. METHODS The authors conducted a retrospective study of 234 patients with TN seen in a single neurosurgeon's office. Patients completed baseline and 1-month follow-up BPI-Facial questionnaires. The MCID was calculated using an anchor-based approach in which the defined anchor was the 7-point patient global impression of change (PGIC). Two statistical methods were employed: mean change score and optimal cutoff point. RESULTS Using the mean change score method, the investigators calculated the MCID for the 3 domains of the BPIFacial: 44% and 30% improvement in pain intensity at its worst and average, respectively, 54% improvement in interference with general ADL, and 63% improvement in interference with facial ADL. Using the optimal cutoff point method, they also calculated the MCID for the 3 domains of the BPI-Facial: 57% and 28% improvement in pain intensity at its worst and average, respectively, 75% improvement in interference with general ADL, and 62% improvement in interference with facial ADL. CONCLUSIONS The BPI-Facial is a multidimensional pain scale that measures 3 domains of pain. Although 2 statistical methods were used to calculate the MCID, the optimal cutoff point method was the superior one because it used data from the majority of subjects included in this study. A 57% improvement in pain intensity at its worst and a 28% improvement in pain intensity at its average were the MCIDs for patients with facial pain. A greater improvement was needed to achieve the MCID for interference with general and facial ADL. A 75% improvement in interference with general ADL and a 62% improvement in interference with facial ADL were needed to achieve an MCID. While pain intensity is easier to measure, pain's interference with ADL may be more important for patient outcomes when designing or evaluating interventions in the field of TN. The BPI-Facial is a useful instrument to measure changes in multidimensional aspects of pain in patients with TN.
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Türnquist, Kristina. "New Scandinavian Doctorate:Verifying and Measuring the Ability to Perform Activities of Daily Living (ADL). A Critical Examination of ADL Instruments and the Practice of Occupational Therapy." Scandinavian Journal of Occupational Therapy 2, no. 2 (January 1995): 85. http://dx.doi.org/10.3109/11038129509106673.
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Sutton, Ryan M., Elizabeth L. McDonald, Rachel J. Shakked, Daniel Fuchs, and Steven M. Raikin. "Determination of Minimum Clinically Important Difference (MCID) in Visual Analog Scale (VAS) Pain and Foot and Ankle Ability Measure (FAAM) Scores After Hallux Valgus Surgery." Foot & Ankle International 40, no. 6 (March 6, 2019): 687–93. http://dx.doi.org/10.1177/1071100719834539.
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Background: Minimum clinically important difference (MCID) defines a threshold when determining clinically significant treatment improvement. Visual analog scale (VAS) and Foot and Ankle Ability Measure activities of daily living (FAAM-ADL) are commonly used for measuring hallux valgus correction. This study aimed to determine MCID in VAS pain and FAAM-ADL scores for hallux valgus correction and additionally, to identify variables influencing achievement of the VAS pain MCID. Methods: Patients undergoing hallux valgus surgery were retrospectively included. VAS pain, FAAM-ADL, and pain satisfaction surveys were collected preoperatively and minimum 1-year postoperatively. Using a 6-point Likert-type pain satisfaction scale, patients reporting low postoperative satisfaction scores 1 through 3 were categorized as “dissatisfied,” and high satisfaction scores 4 through six as “satisfied.” One distribution-based method and 2 anchor-based methods were used to calculate MCID. Further, a logistic regression was calculated to determine if one group (defined by sex, pain satisfaction, preoperative VAS pain, concomitant lesser toe deformity correction, and specific hallux valgus correction procedure) had a greater likelihood of achieving the VAS pain MCID threshold. This study included 170 patients with postoperative follow-up averaging 23.6 months. Results: Calculated MCID scores ranged from 1.8 to 5.2 points for VAS pain and 11.1 to 22.7 points for FAAM-ADL. Moderate deformity correction with proximal first metatarsal osteotomy (Ludloff) (OR=2.236, P = .036) or severe deformity correction with first tarsometatarsal arthrodesis (Lapidus) (OR=3.145, P = .046); and higher preoperative pain scores (OR=1.045, P < .010) had significantly higher odds of meeting VAS pain MCID. Conclusion: This study demonstrated MCID values that may indicate significant pain and function improvement after hallux valgus correction. Higher preoperative pain, and utilization of proximal metatarsal osteotomy or first tarsometatarsal arthrodesis for moderate or severe deformity correction resulted in significantly greater likelihood of reaching the VAS pain MCID than utilizing distal metatarsal and/or proximal phalanx osteotomy for mild deformity treatment. Level of Evidence: Level IV, validating outcome measures.
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Souza, Renata Guzzo, Vanderci Borges, Sonia Maria Cesar de Azevedo Silva, and Henrique Ballalai Ferraz. "Quality of life scale in parkinson's disease PDQ-39 - (Brazilian Portuguese version) to assess patients with and without levodopa motor fluctuation." Arquivos de Neuro-Psiquiatria 65, no. 3b (September 2007): 787–91. http://dx.doi.org/10.1590/s0004-282x2007000500010.
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Quality of life (QoL) is an important treatment outcome indicator in Parkinson's disease (PD). The aim of this study is to assess the usefulness of the Parkinson's disease questionnaire - PDQ-39 (Brazilian Portuguese Version) in measuring QoL of PD patients with or without motor fluctuations. Fifty-six PD patients with mean disease duration of 7.4 years were assessed and 41 of them (73.3%) had motor fluctuations. The PDQ-39 has eight dimensions ranging from 0 to 100; being the higher the score, the worse the QoL. Comparing groups with and without motor fluctuations showed that the dimensions mobility, activities of daily living (ADL), communication and bodily discomfort scored higher in the fluctuating group. There was a tendency to see that the higher the Hoehn and Yahr (HY) scale stages, the higher the PDQ-39 scores. Patients suffering from the disease for more than five years had worse PDQ-39 scores only in the items ADL and communication, when compared with those with the disease for < 5 years. The PDQ-39 is an instrument that detects decrease in QoL of PD patients and the presence of motor fluctuations predicts QoL reduction.
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Castner, Jessica, and Susan Dean-Baar. "Measuring Nursing Error: Psychometrics of MISSCARE and Practice and Professional Issues Items." Journal of Nursing Measurement 22, no. 3 (2014): 421–37. http://dx.doi.org/10.1891/1061-3749.22.3.421.
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Background and Purpose: Health care error causes inpatient morbidity and mortality. This study pooled the items from preexisting nursing error questionnaires and tested the psychometric properties of modified subscales from these item combinations. Methods: Items from MISSCARE Part A, Part B, and the Practice and Professional Issues were collected from 556 registered nurses. Principal component analyses were completed for items measuring (a) nursing error and (b) antecedents to error. Results: Acceptable factor loadings and internal consistency reliability (.70–.89) were found for subscales Acute Care Missed Nursing Care, Errors of Commission, Workload, Supplies Problems, and Communication Problems. Conclusions: The findings support the use of 5 subscales to measure nursing error and antecedents to error in various inpatient unit types with acceptable validity and reliability. The Activities of Daily Living (ADL) Omissions subscale is not appropriate for all inpatient unit types.
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Wang, Dean, Brenda Chang, Francesca R. Coxe, Mollyann D. Pais, Thomas L. Wickiewicz, Russell F. Warren, Scott A. Rodeo, and Riley J. Williams. "Clinically Meaningful Improvement After Treatment of Cartilage Defects of the Knee With Osteochondral Grafts." American Journal of Sports Medicine 47, no. 1 (November 27, 2018): 71–81. http://dx.doi.org/10.1177/0363546518808030.
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Background: Mosaicplasty and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage–bone dowels into chondral lesions of the knee. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance include the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Purpose: To define the MCID and SCB after mosaicplasty or OCA for the International Knee Documentation Committee (IKDC) subjective form and Knee Outcome Survey–Activities of Daily Living (KOS-ADL) and to determine patient factors that are predictive of achieving the MCID and SCB after mosaicplasty or OCA. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: An institutional cartilage registry was reviewed to identify patients who underwent mosaicplasty or OCA. The decision to perform either mosaicplasty or OCA was generally based on chondral defect size. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. Patient responses to the outcome measures were aggregated, and the MCID and SCB of these outcome scores were calculated with anchor-based methods. Multivariate analysis adjusted for age and sex was performed to identify patient factors predictive of achieving the MCID and SCB. Results: Of the 372 eligible patients, 151 (41%) were lost to follow-up, 46 (12%) had incomplete preoperative outcome scores and 2 were treated with OCA of the tibia and therefore excluded. In total, 173 knees were analyzed (n = 173 patients; mean age, 33.0 years; 37% female). Seventy-five (43%) and 98 (57%) knees were treated with mosaicplasty and OCA, respectively. The mean ± SD MCIDs for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. The SCBs for the IKDC and KOS-ADL were 30 ± 6.9 and 17 ± 3.9, respectively. Univariate analysis demonstrated no association between procedure (mosaicplasty or OCA) and likelihood of achieving the MCID or SCB. In the multivariate analysis, lower preoperative IKDC and KOS-ADL scores, higher preoperative Marx Activity Rating Scale scores, lower preoperative 36-Item Short Form Health Survey pain scores, and a history of ≤1 prior ipsilateral knee surgical procedure were predictive of achieving the MCID and/or SCB. Conclusion: These values can be used to define a clinically meaningful improvement for future outcome studies. For surgeons considering mosaicplasty or OCA for their patients, these results can help guide clinical decision making and manage patient expectations before surgery.
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Apriani, Miftah, and Ria Wulandari. "The Effects of Occupational Modality Therapy on the Independence Level of the Elderly." Disease Prevention and Public Health Journal 15, no. 2 (August 21, 2021): 83. http://dx.doi.org/10.12928/dpphj.v15i2.3553.
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Background: Independence in elderlies is the ability to carry out daily activities. The Activity of Daily Living (ADL) is a form of measuring a person's ability to perform ADL independently so that information on elderly morbidity can be analyzed. Occupational therapy is the art and science of supporting interactions in everyday life through work (occupation) that enables people to do work that promotes health and well-being and enables a just and inclusive society, encouraging everyone to optimize their potential in the workplace from everyday life. This study aims to identify the independence level of elderlies before and after occupational modality therapy. Methods: The method employed in this study was a quasi-experimental technique design using a pretest-posttest control group design. Results: The results of the study showed a p-value of 0.00, indicating that occupational modality therapy affected the level of independence of the elderlies who were given treatment with a change of independence level from 13.50 to 16.95. Meanwhile, in the control group where the respondents were not given occupational modality therapy, there was no significant difference before and after the final observation. Conclusion: The elderlies who were given treatment became more independent in carrying out their daily activities compared to those who were not given treatment in the control group.
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MITOBE, Kazutaka, Mikihito KOJIMA, Yuhki TERATA, Makoto TAKAHASHI, and Noboru YOSHIMURA. "The Sensory-Motor Coordination Measuring System Using Pointing Movements for the Evaluation of the Activities of Daily Living (ADL)." International Journal of the Society of Materials Engineering for Resources 12, no. 1 (2004): 16–21. http://dx.doi.org/10.5188/ijsmer.12.16.
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Sommers, Juultje, Tom Vredeveld, Robert Lindeboom, Frans Nollet, Raoul H. H. Engelbert, and Marike van der Schaaf. "de Morton Mobility Index Is Feasible, Reliable, and Valid in Patients With Critical Illness." Physical Therapy 96, no. 10 (October 1, 2016): 1658–66. http://dx.doi.org/10.2522/ptj.20150339.
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Abstract Background Intensive care unit (ICU) stays often lead to reduced physical functioning. Change in physical functioning in patients in the ICU is inadequately assessed through available instruments. The de Morton Mobility Index (DEMMI), developed to assess mobility in elderly hospitalized patients, is promising for use in patients who are critically ill. Objective The aim of this study was to evaluate the clinimetric properties of the DEMMI for patients in the ICU. Design A prospective, observational reliability and validity study was conducted. Methods To evaluate interrater and intrarater reliability (intraclass correlation coefficients), patients admitted to the ICU were assessed with the DEMMI during and after ICU stay. Validity was evaluated by correlating the DEMMI with the Barthel Index (BI), the Katz Index of Independence in Activities of Daily Living (Katz ADL), and manual muscle testing (MMT). Feasibility was evaluated based on the percentage of participants in which the DEMMI could be assessed, the floor and ceiling effects, and the number of adverse events. Results One hundred fifteen participants were included (Acute Physiology and Chronic Health Evaluation II [APACHE II] mean score=15.2 and Sepsis-related Organ Failure Assessment [SOFA] mean score=7). Interrater reliability was .93 in the ICU and .97 on the wards, whereas intrarater reliability during the ICU stay was .68. Validity (Spearman rho coefficient) during the ICU stay was .56, −.45, and .57 for the BI, Katz ADL, and MMT, respectively. The DEMMI showed low floor and ceiling effects (2.6%) during and after ICU discharge. There were no major adverse events. Limitations Rapid changes in participants' health status may have led to underestimation of intrarater reliability. Conclusion The DEMMI was found to be clinically feasible, reliable, and valid for measuring mobility in an ICU population. Therefore, the DEMMI should be considered a preferred instrument for measuring mobility in patients during and after their ICU stay.
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Wang, Dean, Brenda Chang, Francesca R. Coxe, Mollyann D. Pais, Thomas L. Wickiewicz, Russell F. Warren, Scott A. Rodeo, and Riley J. Williams. "Preoperative Outcome Scores are Predictive of Achieving the Minimal Clinically Important Difference After Treatment of Focal Cartilage Defects of the Knee with Osteochondral Grafts." Orthopaedic Journal of Sports Medicine 6, no. 7_suppl4 (July 1, 2018): 2325967118S0013. http://dx.doi.org/10.1177/2325967118s00137.
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Objectives: Osteochondral autograft transfer (OAT) and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage into focal chondral defects of the knee. Both techniques have demonstrated good results, as defined by statistically significant post-surgical improvements in patient-reported outcome measures. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance, such as the minimal clinically important difference (MCID) and substantial clinical benefit (SCB), have become the standard. Although a previous study defined a MCID in patients treated for articular cartilage defects in the knee (Greco et al, AJSM 2010), these patients were treated with various cartilage restoration procedures (e.g., debridement, microfracture, autologous chondrocyte implantation), and none were treated with OAT/OCA. Therefore, the purpose of this study was to define the MCID and SCB thresholds after OAT/OCA for the International Knee Documentation Committee subjective knee form (IKDC) and Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADL) and to determine clinical and demographic patient factors predictive for achieving the MCID and SCB after OAT/OCA. Methods: A prospective institutional cartilage registry was reviewed to identify patients who underwent OAT/OCA. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. The MCID and SCB of these outcome scores were calculated using anchor-based methods. Receiver operative characteristic (ROC) analysis was used to determine the SCB using an anchor question, with the area under the curve (AUC) used to evaluate predictive ability. Multivariate analysis was performed to identify patient factors associated with achieving the MCID and SCB. Results: In total, 173 knees in 173 patients (mean age, 33.0 ± 13.2 years; 37.0% female) were identified. Patient demographics and clinical variables are listed in Table 1. Using the anchor-based method, the MCID for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. Using the ROC method, the SCB for the IKDC and KOS-ADL were 32 (AUC 0.86) and 10 (AUC 0.76), respectively. Univariate analysis demonstrated no association between procedure (OAT or OCA) or lesion location and likelihood of achieving the MCID/SCB. In multivariate analysis, lower preoperative IKDC scores and higher preoperative Marx Activity Scale scores were predictive of achieving an MCID and SCB on the IKDC, and lower preoperative KOS-ADL scores, lower preoperative SF-36 pain subscale scores, and a history of 1 or less previous ipsilateral knee surgeries were predictive of achieving a MCID and SCB on the KOS-ADL (Table 2). Conclusion: In patients treated for focal cartilage defects of the knee with osteochondral grafts, these values can be used to define a clinically important change and substantial clinical benefit for future outcome studies. In this study population, higher preoperative activity levels and a history of 1 or less previous ipsilateral knee surgeries were predictive of achieving a clinically important change and substantial clinical benefit after OAT/OCA. These findings have implications for managing preoperative expectations of OAT/OCA surgery. [Table: see text][Table: see text]
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Haripriya S, Dhanesh Kumar K U, Sanjay Eapen Samuel, and Ajith S. "The effect of a multicomponent exercise program on cognitive function and functional ability in community dwelling older adults." International Journal of Research in Pharmaceutical Sciences 11, no. 1 (January 6, 2020): 109–14. http://dx.doi.org/10.26452/ijrps.v11i1.1793.
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Normal aging results in alterations in the structure and function of the brain, causing impairment in cognitive function and dependency in performing activities of daily living. A multicomponent physical activity program has been recommended to maintain physical and cognitive function in elderly individuals. The present study aimed at measuring the effect of such an exercise program on the cognitive function and activities of daily living(ADL) function in community dwelling elderly individuals. 52 elderly adults living in the community and ambulating independently were selected purposively and underwent a 10-week multi-component exercise program which included aerobic exercise, strength training, balance exercises and functional training. The participants were assessed using the Mini-Mental State Examination (MMSE) and Barthel Index(BI) at baseline and every two weeks up till 10 weeks. The data obtained was analysed usind descriptive statistics and t-test for finding the effect of the intervention program on the outcome measures. The results showed a significant difference in the pre- to post-intervention scores of both the outcome measures. A multicomponent exercise program was seen to be effective in improving the cognitive function and level of ADL activity in community dwelling elderly individuals. Such an exercise program should be recommended to all elderly adults in order to maintain their cognitive and overall functioning and to improve their productivity.
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Kierkegaard, Marie, Ulrika Einarsson, Kristina Gottberg, Lena von Koch, and Lotta Widén Holmqvist. "The relationship between walking, manual dexterity, cognition and activity/participation in persons with multiple sclerosis." Multiple Sclerosis Journal 18, no. 5 (October 7, 2011): 639–46. http://dx.doi.org/10.1177/1352458511426736.
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Background: Multiple sclerosis has a vast impact on health, but the relationship between walking, manual dexterity, cognition and activity/participation is unclear. Objective: The specific aims were to explore the discriminative ability of measures of walking, manual dexterity and cognition, and to identify cut-off values in these measures, for prediction of independence in personal and instrumental activities of daily living (ADL) and activity/participation in social and lifestyle activities. Methods: Data from 164 persons with multiple sclerosis were collected during home visits with the following measures: the 2 × 5 m walk test, the Nine-hole Peg Test, the Symbol Digit Modalities Test, the Katz Personal and Instrumental ADL Indexes, and the Frenchay Activities Index (measuring frequency in social and lifestyle activities). Results: The 2 × 5 m walk test and the Nine-hole Peg Test had high and better discriminative and predictive ability than the Symbol Digit Modalities Test. Cut-off values were identified. The accuracy of predictions was increased above all by combining the 2 × 5 m walk test and the Nine-hole Peg Test. Conclusion: The proposed cut-off values in the 2 × 5 m walk test and the Nine-hole Peg Test may be used as indicators of functioning and to identify persons risking activity limitations and participation restrictions. However, further studies are needed to confirm the usefulness in clinical practice.
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Li, Chih-Ying, Sergio Romero, Heather S. Bonilha, Kit N. Simpson, Annie N. Simpson, Ickpyo Hong, and Craig A. Velozo. "Linking Existing Instruments to Develop an Activity of Daily Living Item Bank." Evaluation & the Health Professions 41, no. 1 (November 16, 2016): 25–43. http://dx.doi.org/10.1177/0163278716676873.
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This study examined dimensionality and item-level psychometric properties of an item bank measuring activities of daily living (ADL) across inpatient rehabilitation facilities and community living centers. Common person equating method was used in the retrospective veterans data set. This study examined dimensionality, model fit, local independence, and monotonicity using factor analyses and fit statistics, principal component analysis (PCA), and differential item functioning (DIF) using Rasch analysis. Following the elimination of invalid data, 371 veterans who completed both the Functional Independence Measure (FIM) and minimum data set (MDS) within 6 days were retained. The FIM-MDS item bank demonstrated good internal consistency (Cronbach’s α = .98) and met three rating scale diagnostic criteria and three of the four model fit statistics (comparative fit index/Tucker–Lewis index = 0.98, root mean square error of approximation = 0.14, and standardized root mean residual = 0.07). PCA of Rasch residuals showed the item bank explained 94.2% variance. The item bank covered the range of θ from −1.50 to 1.26 (item), −3.57 to 4.21 (person) with person strata of 6.3. The findings indicated the ADL physical function item bank constructed from FIM and MDS measured a single latent trait with overall acceptable item-level psychometric properties, suggesting that it is an appropriate source for developing efficient test forms such as short forms and computerized adaptive tests.
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Hyun Moon, Seong, Rahul Soangra, Christopher F. Frames, and Thurmon E. Lockhart. "THREE DAYS MONITORING OF ACTIVITIES OF DAILY LIVING AMONG YOUNG HEALTHY ADULTS AND PARKINSON’S DISEASE PATIENTS." Biomedical Sciences Instrumentation 57, no. 2 (April 1, 2021): 177–83. http://dx.doi.org/10.34107/yhpn9422.04177.
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Parkinson’s Disease (PD) is a neurodegenerative disorder affecting the substantia nigra, which leads to more than half of PD patients are considered to be at high risk of falling. Recently, Inertial Measurement Unit (IMU) sensors have shown great promise in the classification of activities of daily living (ADL) such as walking, standing, sitting, and laying down, considered to be normal movement in daily life. Measuring physical activity level from longitudinal ADL monitoring among PD patients could provide insights into their fall mechanisms. In this study, six PD patients (mean age=74.3±6.5 years) and six young healthy subjects (mean age=19.7±2.7 years) were recruited. All the subjects were asked to wear the single accelerometer, DynaPort MM+ (Motion Monitor+, McRoberts BV, The Hague, Netherlands), with a sampling frequency of 100 Hz located at the L5-S1 spinal area for 3 days. Subjects maintained a log of activities they performed and only removed the sensor while showering or performing other aquatic activities. The resultant acceleration was filtered using high and low pass Butterworth filters to determine dynamic and stationary activities. As a result, it was found that healthy young subjects performed significantly more dynamic activities (13.2%) when compared to PD subjects (7%), in contrast, PD subjects (92.9%) had significantly more stationary activities than young healthy subjects (86.8%).
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Papastavrou, Evridiki, Panayiota Andreou, Nicos Middleton, Savvas Papacostas, and Irini Kyriacou Georgiou. "Factors associated with quality of life among family members of patients with dementia in Cyprus." International Psychogeriatrics 26, no. 3 (December 5, 2013): 443–52. http://dx.doi.org/10.1017/s104161021300224x.
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ABSTRACTBackground:Numerous studies have reported that caring for a person with dementia is a stressful experience. Nevertheless, quality of life (QoL) measures have commonly focused on patients, while factors that influence caregivers’ QoL have not been clearly identified. In order to contribute to the understanding of caregivers’ QoL, we explored how QoL among caregivers is related to their perceived level of burden, their reported number of depressive symptoms, and the level of care recipients’ dependency.Methods:Seventy-six caregivers referred by the two main referral centers of patients with dementia in Cyprus participated in a cross-sectional survey with a descriptive correlational design. Caregivers completed four instruments, measuring burden (ZBI), depression (CES-D), quality of life-Alzheimer's disease (QoL-AD), and activities of daily living (ADL) of the care recipients and provided socio-demographic information.Results:The majority of the participants scored high levels of burden (M = 43.32/SD = 15.23) and depression (59.2% scored over the cut-off point of 16). QoL was only moderate (M = 30.89/SD = 8.21) and negatively correlated with burden (r = −32, p = 0.01) and depression (r = −0.296, p < 0.05). Only a weak correlation was observed between QoL and ADL (r = 0.167, p = 0.15). Hierarchical multiple regression analyses revealed that overall burden scores and income were associated with QoL, explaining 20% of the overall variance of the caregiver's QoL.Conclusion:Further research is necessary to investigate which additional domains determine QoL and further our understanding of the factors that may reduce the burden imposed on dementia caregivers.
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Tanaka, Tomoko, Toyohiro Hamaguchi, Makoto Suzuki, Daigo Sakamoto, Junpei Shikano, Naoki Nakaya, and Masahiro Abo. "Estimation of Motor Impairment and Usage of Upper Extremities during Daily Living Activities in Poststroke Hemiparesis Patients by Observation of Time Required to Accomplish Hand Dexterity Tasks." BioMed Research International 2019 (November 7, 2019): 1–8. http://dx.doi.org/10.1155/2019/9471921.
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Aim. This study evaluated whether specific actual performance could accurately predict body function levels and upper limb use in the real-life functioning of poststroke hemiparesis patients to aid in choosing the most appropriate rehabilitation exercises. Methods. We measured the time taken for poststroke patients to move small objects with the paralyzed hand and investigated how the measurement could estimate upper extremity motor impairment and hand usage during activities of daily living (ADL). We examined 86 stroke patients (age 66 ± 16 years) whose upper extremity motor paralysis was measured using the Fugl-Meyer assessment (FMA) and Southampton Hand Assessment Procedure (SHAP), and patient-reported ADL was investigated using the Jikei Assessment Scale for Motor Impairment in Daily Living (JASMID). To identify the time required to perform each SHAP item, we employed a linear regression analysis. The prediction formula was used in the linear regression analysis, and the coefficient of determination (R2) was applied to compare each component item score that was obtained with the predicted values derived from the linear regression analysis. Results. The most easily accomplished task was Heavy Power in the SHAP. The R2 between the SHAP Heavy Power item score and the FMA scores was moderate (R2 = 0.344, P<0.0001), whereas the R2 with the JASMID score was low (R2 = 0.126, P<0.001). Conclusions. By measuring the time it takes for poststroke hemiparesis patients to hold and move an object, we developed a prediction formula for upper extremity motor function and hand dexterity.
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Perez-Jara, J., D. Walker, P. Heslop, and S. Robinson. "Measuring fear of falling and its effect on quality of life and activity." Reviews in Clinical Gerontology 20, no. 4 (July 27, 2010): 277–87. http://dx.doi.org/10.1017/s0959259810000237.
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SummaryIn this review, we analyse original research articles in English and Spanish in which fear of falling (FoF) as a long-term syndrome defines the participants, or is the main outcome, or in cases where FoF is a secondary outcome, falls or activity are the main outcomes.FoF is difficult to measure. Attempts are made to do so by use of single questions or scales. Restriction in activity due to FoF is a secondary outcome and can be an important influence on a person's quality of life. There are also various methods of measuring it by use of single questions or scales, and general questions in basic or instrumental activities of daily living (ADL) indices are frequently used. Other scales or questionnaires about quality of life (such as the SF-36) or activity (such as the Survey of Activity and Fear of Falling Scales (SAFE), or the Groningen Activity Restriction Scale (GARS)) are also used. The varying objectives of the analysed articles explain some of the variations in measures used. Further work is required to reach a consensus on definition and standardized measurement of FoF and its effect on quality of life and activity.
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Selian, Ariwan, Bahagia Loebis, Mustafa M. Amin, and Nazli Mahdinasari. "Factors Related to the Depression Score in the Elderly at the Social Service of the Dharma Asri Binjai Nursing Home." Open Access Macedonian Journal of Medical Sciences 9, T3 (May 14, 2021): 9–12. http://dx.doi.org/10.3889/oamjms.2021.6279.
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BACKGROUND: Depression is the most common psychiatric problem in the elderly. Suicidal thoughts or recurring thoughts of death are common in people suffering from depression. Depression in the elderly has a very poor prognosis compared to people in other age groups because they have a relatively higher risk of suicide and death. Elderly people in nursing homes is a condition that significantly affects the quality of life and survival and harms the psychology of the elderly, cause stress is due to elderly people in nursing homes associated with medical and psychosocial problems such as divorce/widows, poverty, and social isolation. AIM: We aimed to find out the factors that affect the Geriatric Depression Scale (GDS 15) score in elderly people at the Social Service of the Dharma Asri Binjai Nursing Home. METHODS: This study used a cross-sectional approach to 91 subjects at the Dharma Asri Binjai Nursing Home Social Service starting from June to July 2020 utilizing sampling, namely, simple random sampling. The tests conducted in this study consisted of a bivariate test and a multivariate linear regression test to determine which factors are associated with depression. The measuring instrument used was the GDS 15. RESULTS: After the multivariate test was carried out, the variables that were statistically significant to the total score of depression in the elderly at the Binjai Dharma Asri nursing home were Gender (p < 0.001) and activity of daily living (ADL) Score (p < 0.001). CONCLUSION: The factors associated with the GDS score of 15 and the occurrence of depression in the elderly were found in the gender variable and the ADL score variable.
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Törnquist, Kristina. "Verifying and measuring the ability to perform activities of daily living (ADL) - a critical examination ofADL instruments and the practice of occupational therapy." Scandinavian Journal of Social Welfare 5, no. 3 (July 1996): 202. http://dx.doi.org/10.1111/j.1468-2397.1996.tb00142.x.
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HT, Herni Ali, and Ali Rama. "Indeks Kinerja Perbankan Syariah di Asia Tenggara Berdasarkan Konsep Maqâshid al-Syarî`ah." MADANIA: JURNAL KAJIAN KEISLAMAN 22, no. 1 (July 3, 2018): 33. http://dx.doi.org/10.29300/madania.v22i1.782.
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Abstract: Sharia Banking Performance Index in Southeast Asia Based on the Concept of Maqâshid al-Syarî`ah. Islamic banks as a banking system that carries out Islamic vision in the field of finance and economics should develop a method of measuring performance in accordance with its vision. The vision of Islamic banks can be derived from the vision that chills reversed from the laws of sharia which is called maqâshid al-syarî`ah. Therefore, this study intends to develop methods of measuring the performance of Islamic banking based on the skill maqâshid al-syarî`ah. The maqâshid al-syarî`ah index is an index based on the three main visions of sharia banks, namely individual education (ta’dîb al-fard), justice enforcement (iqâmah al`adl) and welfare encouragement (jalb al-maslâhah). From the vision (dimension) is derived into indicators that are relevant and measurable. This research uses indexing method in calculating maqâshid al-syarî`ah index with case studies of sharia banking that has been operating in Southeast Asia covering Indonesia, Malaysia, Brunei Darussalam, Singapore, Thailand and Philippines. This tudy found that the majority of sharia banks in Southeast Asia have a low-performance maqâshid al-syarî`ah index. This shows that sharia banking is generally still run based on conventional vision even though it has operated in accordance with sharia principles or sharia compliance.
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Oort, Q., L. Dirven, F. Boele, R. Grant, H. Sato, A. Talacchi, T. Young, J. C. Reijneveld, and M. J. B. Taphoorn. "OS3.3 Development of an EORTC questionnaire measuring instrumental activities of daily living (IADL) in patients with brain tumours: phase I-III." Neuro-Oncology 21, Supplement_3 (August 2019): iii9. http://dx.doi.org/10.1093/neuonc/noz126.027.
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Abstract BACKGROUND In brain tumour patients, impairments in every day functioning can impact quality of life, and are therefore an important outcome in both clinical trials and practice. One way to measure every day functioning is with an activities of daily living (ADL) questionnaire. Instrumental ADL (IADL) are the cognitively more complex activities, that are essential to function autonomously within society. Cognitive decline may therefore negatively impact IADL, making these activities particularly relevant to brain tumour patients. The aim of this study is to develop a reliable and valid questionnaire to measure IADL in primary malignant and metastatic brain tumour patients. MATERIAL AND METHODS The questionnaire development study followed the standard European Organisation for Research and Treatment of Cancer (EORTC) four phase methodology: (I) generation of activities list, (II) construction of item list, (III) pre-testing, and (IV) field testing. This report covers phases I-III. To ensure cross-cultural validity, participants were recruited from different countries (The Netherlands, United Kingdom, Italy, Austria and Japan). In phase I, potential activities were identified based on a literature review and in-depth interviews with patients, proxies and healthcare professionals. In phase II, activities were turned into items, and translated into all required languages by the EORTC Translation Unit. In phase III, the item list was pre-tested in patient-proxy dyads. In accordance with predetermined decision rules to reduce items, final items were selected, and preliminary psychometric properties (i.e. factor structure, validity, reliability) were assessed. RESULTS Phase I (N=44 dyads) resulted in 59 IADL activities which were converted into 59 items in phase II. In phase III, N=85 dyads completed and reviewed this item list. The item list was subsequently reduced to 32 items. An exploratory factor analysis indicated several items measuring similar underlying constructs (e.g. domestic life and using computer/smartphone) showing acceptable to good (α≥0.7) internal consistency (range α=0.69–0.89). Seven items were less related to these underlying constructs (e.g. work or managing your own medication), and therefore single items. Construct validity, measured with known-group comparisons analyses between cognitively impaired and unimpaired patients, showed significant differences in scores between the two groups on some scales and several single items. CONCLUSION The currently developed EORTC IADL-BN32 questionnaire can be a valuable asset in assessing IADL functioning in brain tumour patients, but further validation in phase IV is required and is planned.
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Scott, Elizabeth, Natalie Glass, Brian R. Wolf, Carolyn M. Hettrich, and Matthew Bollier. "Performance of PROMIS Physical Function Compared with KOOS, SF-36, Eq5d And Marx Activity Scale in Patients Who Undergo ACL Reconstruction." Orthopaedic Journal of Sports Medicine 6, no. 3_suppl (March 1, 2018): 2325967118S0000. http://dx.doi.org/10.1177/2325967118s00003.
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Objectives: Anterior cruciate ligament reconstruction is a commonly performed orthopaedic procedure. PROMIS (Patient-Reported Outcome Measurement Information System) was developed by the National Institutes of Health in an effort to advance patient-reported outcome (PRO) instruments by developing question banks for major health domains. Our goal was to compare the responsiveness and construct validity of the PROMIS physical function (PF) computer adaptive test (CAT) with current PRO instruments utilized in patients who undergo anterior cruciate ligament reconstruction. Methods: A total of 174 patients ages 14-53 scheduled to undergo anterior cruciate ligament reconstruction were asked to complete PROMIS PF-CAT, Short Form-36 Health Survey (SF36-PF and -GH), Marx activity rating scale (Marx), Knee Injury and Osteoarthritis Score (KOOS-ADL, -Sport, -QOL), and the EuroQol five dimensions questionnaire (EQ5D) at their preoperative visit. These surveys were repeated at six weeks and six months after surgery. Correlations between PRO instruments was defined as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), and poor (0.2-0.3) using Spearman Correlation Coefficients. The effect size (Cohen d) and standardized response mean (SRM) were used to describe the responsiveness of each PRO at the 6 week and 6 month follow-up visits and were defined as small (0.2), medium (0.5) and large (0.8). Ceiling and floor effects were defined as present if ≥15% of participants scored the highest or lowest score on a PRO, respectively. Subgroup analyses were performed comparing change in PRO scores at follow-up between participants with and without additional arthroscopic procedures (meniscal debridement and/or repair, microfracture, or OATS vs ACL reconstruction only) using linear mixed models. Results: There were excellent and excellent-good correlations between the PROMIS PF-CAT and physical function PROs including the SF36-PF (r=0.75-0.80, p<.01), KOOS-ADL (r=0.62-0.70, p<.01) and KOOS-Sport (r=0.32-0.69, p<0.01) at most time points, respectively. There was also excellent-good correlation with the EQ5D (r=0.60-0.71, p<.01) and good correlation with the KOOS-QOL (r=0.52-0.58, p<0.01). As expected, there was no (p>0.05) to poor correlation with Marx activity (r=0.24, p<0.01) and the SF36-GH (r=0.32-0.34, p<0.01). No ceiling or floor effects were noted for the PROMIS PF-CAT; there was a ceiling effect noted for KOOS-ADL at the 6 month visit (38.1%). Effect size estimates for physical function PROs increased from small to large changes from the 6 week to 6 month visits and were largest in the PROMIS PF-CAT (1.34) followed by KOOS-ADL (1.19) and SF36-PF (1.06). Patients answered on average 4 questions utilizing the PROMIS. Baseline subgroup analyses showed no significant differences in physical function PRO scores, and at follow-up, both groups showed significant improvement in physical function PRO scores that was not statistically different. Conclusion: Our results support the construct validity of the PROMIS PF-CAT in patients who undergo ACL reconstruction. Responsiveness to change was highest by 6 months postop and greater for the PROMIS PF-CAT than for other measures of physical function with no ceiling or floor effects and a low time-burden. Taken together, these findings suggest that the PROMIS PF-CAT is a beneficial alternative to measuring and tracking changes in physical function in adults undergoing ACL reconstruction.
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Croy, Theodore, Susan Saliba, Ethan Saliba, Mark W. Anderson, and Jay Hertel. "Talofibular Interval Changes After Acute Ankle Sprain: A Stress Ultrasonography Study of Ankle Laxity." Journal of Sport Rehabilitation 22, no. 4 (November 2013): 257–63. http://dx.doi.org/10.1123/jsr.22.4.257.
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Introduction:Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown.Methods:Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM).Results:The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2.35 mm; limb × position F1,26 = 4.9, P = .035) at baseline. Inversion stress also resulted in greater interval changes (23.41 ± 2.81 mm) than in the uninvolved ankles (21.13 ± 2.08 mm). A main effect for time was observed for inversion (F2,52 = 4.3, P = .019, 21.93 ± 2.24 mm) but not for anterior drawer (F2,52 = 3.1, P = .055, 21.18 ± 2.34 mm). A significant reduction in the talofibular interval took place between baseline and week 3 inversion measurements only (F1,26 = 5.6, P = .026). FAAM-ADL and sports results increased significantly from baseline to wk 3 (21.9 ± 16.2, P < .0001 and 23.8 ± 16.9, P < .0001) and from wk 3 to wk 6 (2.5 ± 4.4, P = .009 and 10.5 ± 13.2, P = .001).Conclusions:Stress US methods identified increased talofibular interval changes suggestive of talocrural laxity and ATFL injury using anterior drawer and inversion stress that, despite significant improvements in self-reported function, only marginally improved during the 6 wk after ankle sprain. Stress US provides a safe, repeatable, and quantifiable method of measuring the talofibular interval and may augment manual stress examinations in acute ankle injuries.
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Mümken, Sandra Angelika, Paul Gellert, Malte Stollwerck, Julie Lorraine O'Sullivan, and Joern Kiselev. "Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults." BMJ Open 11, no. 7 (July 2021): e049926. http://dx.doi.org/10.1136/bmjopen-2021-049926.
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ObjectivesTo develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults.DesignCross-sectional validation study.SettingTwo study centres in urban and rural German outpatient hospital settings.ParticipantsIn total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men).Primary and secondary outcome measuresThe final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure.ResultsIn the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=−0.26; 95% CI=−0.42 to −0.08), Timed Up and Go Test (β=−0.37; 95% CI=−0.68 to −0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=−0.22; 95% CI=−0.41 to −0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=−0.19; 95% CI=−0.42 to 0.03) and male gender (β=0.15; 95% CI=−0.04 to 0.35) were not significant.ConclusionThe LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings.Trial registration numberDRKS00019023.
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Carender, Christopher N., Matthew J. Bollier, Brian R. Wolf, Kyle R. Duchman, Qiang An, and Robert W. Westermann. "Preoperative Performance of PROMIS in Patients With Patellofemoral Malalignment and Chondral Disease." Orthopaedic Journal of Sports Medicine 7, no. 7 (July 2019): 232596711985500. http://dx.doi.org/10.1177/2325967119855001.
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Background: Use of the Patient-Reported Outcomes Measurement Information System (PROMIS) instrument has not yet been validated in patients undergoing operative treatment for patellofemoral malalignment and chondral disease. Purpose: To evaluate the PROMIS Physical Function Computer Adaptive Testing (PF CAT) instrument in a population of patients with patellofemoral malalignment and chondral disease relative to established patient-reported outcome (PRO) instruments. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Eligible patients were prospectively enrolled at the time of indication for surgery and completed 5 PRO instruments preoperatively: 36-Item Short Form Health Survey (SF-36); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); Marx activity rating scale (Marx); EuroQol 5-dimension, 5-level instrument (EQ-5D-5L); and PROMIS PF CAT. Convergent and discriminant validity was assessed by measuring correlations between PROMIS PF CAT and other PRO instruments, including the Knee injury and Osteoarthritis Outcome Score (KOOS). Strength of correlation was measured by use of Spearman correlation coefficients. Results: In total, 37 patients (40 knees) were enrolled in the study. All knees underwent Fulkerson osteotomy and concomitant cartilage procedure (29 chondroplasty, 6 allograft, 5 microfracture). Mean patient age was 33.4 years, and 73% of knees were in female patients. Correlations ( r) between PROMIS PF CAT and knee PRO instruments were as follows: SF-36 PF ( r = 0.80; P < .01); KOOS Pain ( r = 0.74; P < .01); KOOS Symptoms ( r = 0.47; P < .01); KOOS Quality of Life ( r = 0.68; P < .01); KOOS Sports and Recreation ( r = 0.72; P < .01); KOOS Activities of Daily Living (ADL) ( r = 0.80; P < .01); WOMAC Function ( r = 0.80; P < .01); WOMAC Pain ( r = 0.72; P < .01); WOMAC Stiffness ( r = 0.38; P = .02); Marx ( r = 0.22; P = .31); and EQ-5D-5L ( r = 0.72; P < .01). Neither floor nor ceiling effects were observed in PROMIS PF CAT or KOOS ADL. Mean (±SD) question burden with PROMIS PF CAT was 5.6 ± 0.6 questions. Conclusion: In patients with patellofemoral malalignment and chondral disease, PROMIS PF CAT is an efficient and reliable PRO instrument to preoperatively assess patients across a spectrum of knee function without floor or ceiling effects.
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Racic, Maja, Srebrenka Kusmuk, and Vesna Krstovic-Spremo. "Effectiveness of the Home-based Habilitation Programme for Children with Cerebral Palsy." Indian Journal of Physical Medicine and Rehabilitation 25, no. 1 (2014): 6–12. http://dx.doi.org/10.5005/ijopmr-25-1-6.
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Abstract Objective This study was undertaken with the aim to compare the effects of home-based habilitation programmes with the effects of hospital-based habilitation programme for children with cerebral palsy (CP) on motor performance and daily functioning. Patients and methods The study was conducted on a sample of 60 children with cerebral palsy. First group included 30 children, 5 to 12 years old, who had a continued physical home treatment and education in public/special school. The second group consisted of 30 children, from Banja Luka region, who continued inpatient habilitation programme and training. Habilitation outcomes were analysed by measuring muscle tone (using original Tardieu Scale), muscle strength, range of motion (ROM), gross motor functions (gross motor function measure-88) and the Barthel Index of activities of daily living (ADL). Results The proportion of clinically significant change in gross motor functions, ADLs, ROM and muscle strength didn't show major differences between the two groups. Conclusion There were no significant differences in effectiveness between home-based and hospital-based habilitation programmes according to the treatment outcomes. The effectiveness of home-based programme increases when supplemented by frequent consultations with the rehabilitation team members and occasional out-patient physical therapy treatment, education as well as counselling and support for parents.
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Salama, Heba, Marc Loesche, Antje Herrmann, Friedhelm Taube, and Martin Gierus. "A simplified maturity index to quantify the development stage of perennial ryegrass (Lolium perenne L.) and its relationship with yield and nutritive value." Die Bodenkultur: Journal of Land Management, Food and Environment 68, no. 2 (June 30, 2017): 89–101. http://dx.doi.org/10.1515/boku-2017-0009.
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SummaryPlant maturity substantially influences the yield and quality performance of grasses. Grass phenology is often not considered objectively to evaluate the new genotypes prior to registration. Measuring the mean stage by count (MSC) is time consuming, and simplified approaches are, therefore, required. Twenty diploid, intermediate heading Lolium perenne L. genotypes were evaluated in a 2-year field study in Northern Germany for yield and the content of Neutral Detergent Fiber (NDF), Acid Detergent Fiber (ADF), Acid Detergent Lignin (ADL), and digestible organic matter (DOM). Data from the first and second cut, each comprising three sampling dates, were included in this study. A simplified maturity index (SMI8), expressing the percentage of tillers at or beyond the boot stage, from MSC was derived. This index resulted in similar correlations with yield and quality parameters compared to MSC but is easier to use and less laborious. The SMI8 reduced the variations among genotypes, as for the first cut NDF and ADF content, where the genotype effect disappeared after considering SMI8 as the covariable. Moreover, the ranking of the genotypes was slightly modified for most studied traits, indicating that a large part of the variations in the studied parameters was caused by variations in maturity.
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Iwaasa, A. D., K. A. Beauchemin, S. N. Acharya, and J. G. Buchanan-Smith. "Shearing force of alfalfa stems: effects of cultivar and shearing site." Canadian Journal of Plant Science 79, no. 1 (January 1, 1999): 49–55. http://dx.doi.org/10.4141/p97-017.
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A 3-yr study was conducted to investigate the effect of shearing position on shearing force characteristics in alfalfa (Medicago sativa L.) stems and to evaluate the relationship between cell wall (CW) chemical constituents and stem shearing force. Stems from plots of 24 alfalfa cultivars were harvested from the second, third and fourth production years. Each stem was divided into three 16-cm segments: top, middle and bottom, and the force required to shear each segment was measured using a modified Ottawa Texture Measuring System. Cultivar by stem segment interactions were significant (P < 0.05) for stem diameter, weight and shearing force. The middle and bottom stem segments were the best sampling site to detect cultivar differences for shearing force. Stem diameter and weight were generally the variables most associated with shearing force for all three stem segments. However, shearing force characteristics for certain cultivars could not be entirely explained by stem diameter or weight and may be affected by CW chemical constituents and/or structural tissues. The ADL concentrations were not consistently correlated to shearing force at the top and bottom segments over the 3 yr. For the bottom stem segment a negative relationship (r = −0.42, P < 0.001) resulted between shearing force and hemicellulose, while a positive relationship (r = 0.40, P < 0.001) resulted between shearing force and cellulose. Key words: Cultivar, environment, shearing force, cell wall chemical constituents
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Jayaram, Mayank, Chang Wang, Lu Wang, and Kevin C. Chung. "Validating the Michigan Hand Outcomes Questionnaire in patients with rheumatoid arthritis using Rasch analysis." PLOS ONE 16, no. 7 (July 22, 2021): e0254984. http://dx.doi.org/10.1371/journal.pone.0254984.
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Introduction The Michigan Hand Outcomes Questionnaire (MHQ) is a patient-reported outcome measure previously validated in patients with rheumatoid arthritis (RA) using classical test theory. Rasch analysis is a more rigorous method of questionnaire validation that has not been used to test the psychometric properties of the MHQ in patients with RA. The objective of this study is to evaluate the validity and reliability of the MHQ for measuring outcomes in patients with RA with metacarpophalangeal joint deformities. Methods We performed a Rasch analysis using baseline data from the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) prospective cohort study. All domains were tested for threshold ordering, item fit, targeting, differential-item functioning, unidimensionality, and internal consistency. Results The Function and Work domains showed excellent fit to the Rasch model. After making adjustments, the Pain, Activities of Daily Living (ADL) and Satisfaction domains also fulfilled all Rasch model criteria. The Aesthetics domain met the majority of Rasch criteria, but could not be tested for unidimensionality. Conclusions After collapsing disordered thresholds and removing misfitting items, the MHQ demonstrated reliability and validity for assessing outcomes in patients with RA with metacarpophalangeal joint deformities. These results suggest that interpreting individual domain scores may provide more insight into a patient’s condition rather than analyzing an overall MHQ summary score. However, more Rasch analyses are needed in other RA populations before making adjustments to the MHQ.
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Wenborn, Jennifer, Aidan G. O’Keeffe, Gail Mountain, Esme Moniz-Cook, Michael King, Rumana Z. Omar, Jacqueline Mundy, et al. "Community Occupational Therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID]) study: A single-blind, randomised controlled trial." PLOS Medicine 18, no. 1 (January 4, 2021): e1003433. http://dx.doi.org/10.1371/journal.pmed.1003433.
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Background We aimed to estimate the clinical effectiveness of Community Occupational Therapy for people with dementia and family carers–UK version (Community Occupational Therapy in Dementia–UK version [COTiD-UK]) relative to treatment as usual (TAU). We hypothesised that COTiD-UK would improve the ability of people with dementia to perform activities of daily living (ADL), and family carers’ sense of competence, compared with TAU. Methods and findings The study design was a multicentre, 2-arm, parallel-group, assessor-masked, individually randomised controlled trial (RCT) with internal pilot. It was conducted in 15 sites across England from September 2014 to January 2018. People with a diagnosis of mild to moderate dementia living in their own home were recruited in pairs with a family carer who provided domestic or personal support for at least 4 hours per week. Pairs were randomised to either receive COTiD-UK, which comprised 10 hours of occupational therapy delivered over 10 weeks in the person with dementia’s home or TAU, which comprised the usual local service provision that may or may not include standard occupational therapy. The primary outcome was the Bristol Activities of Daily Living Scale (BADLS) score at 26 weeks. Secondary outcomes for the person with dementia included the following: the BADLS scores at 52 and 78 weeks, cognition, quality of life, and mood; and for the family carer: sense of competence and mood; plus the number of social contacts and leisure activities for both partners. Participants were analysed by treatment allocated. A total of 468 pairs were recruited: people with dementia ranged from 55 to 97 years with a mean age of 78.6 and family carers ranged from 29 to 94 with a mean of 69.1 years. Of the people with dementia, 74.8% were married and 19.2% lived alone. Of the family carers, 72.6% were spouses, and 22.2% were adult children. On randomisation, 249 pairs were assigned to COTiD-UK (62% people with dementia and 23% carers were male) and 219 to TAU (52% people with dementia and 32% carers were male). At the 26 weeks follow-up, data were available for 364 pairs (77.8%). The BADLS score at 26 weeks did not differ significantly between groups (adjusted mean difference estimate 0.35, 95% CI −0.81 to 1.51; p = 0.55). Secondary outcomes did not differ between the groups. In total, 91% of the activity-based goals set by the pairs taking part in the COTiD-UK intervention were fully or partially achieved by the final COTiD-UK session. Study limitations include the following: Intervention fidelity was moderate but varied across and within sites, and the reliance on primarily proxy data focused on measuring the level of functional or cognitive impairment which may not truly reflect the actual performance and views of the person living with dementia. Conclusions Providing community occupational therapy as delivered in this study did not improve ADL performance, cognition, quality of life, or mood in people with dementia nor sense of competence or mood in family carers. Future research should consider measuring person-centred outcomes that are more meaningful and closely aligned to participants’ priorities, such as goal achievement or the quantity and quality of activity engagement and participation. Trial Registration Current Controlled Trials ISRCTN10748953.
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Said, Salmah, A. Syathir Sofyan, and Andi Muhammad Ali Amiruddin. "Mashlaha in Financing Risk Measurement in Sharia Financing Institutions." IQTISHADIA 12, no. 2 (October 23, 2019): 240. http://dx.doi.org/10.21043/iqtishadia.v12i2.4992.
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<p><em>The crisis of confidence in the credit rating agency forced Islamic financing institutions to apply risk measurement methods independently and renewed the study of credit risk measurement. Moreover, this research also discusses mashlaha (public interest) in measuring financing risk. This research </em><em>use</em><em>s a mixed method</em><em> approach, </em><em>combining quantitative methods to measure risk by utilizing CreditRisk+</em><em>,</em><em> and qualitative </em><em>methods</em><em> in analyzing mashlaha </em><em>i</em><em>n these measurements. This study revealed that CreditRisk+</em> <em>is able to measure financing risk accurately.</em><em> This study also found that there is mashlaha as part of </em><em>maqashid al-sharia</em><em> in risk measur</em><em>e</em><em>ment</em><em>, namely 1) Tahdzib al-Fard, that mak</em><em>es</em><em> a financial institution capable of independently measuring the risk of its own financing; 2) Iqamah al-Adl, independent measurement will create information justice by comparing measurement results both internally and externally. 3) Mashlaha itself, with internal risk measurement</em><em>,</em><em> will reduce systemic risk. </em><em>The i</em><em>mplications of this study is </em><em>the use of mashlaha in analyzing financing risk provides more stringent prudential in the measurement of financing risk</em><em>.</em></p>
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Ames, David. "A useful development in measuring activities of daily living." International Psychogeriatrics 27, no. 9 (July 30, 2015): 1417. http://dx.doi.org/10.1017/s1041610215000964.
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Standard activities of daily living (ADL) scales developed in the 1960s and 1970s do not capture the subtle impairments seen in individuals with progressive mild cognitive impairment (MCI), which in many cases is due to prodromal Alzheimer's disease (AD). Given the promise of treatments now in development to modify the underlying AD process, early detection of MCI may become very important in future. De Vriendt and colleagues, whose paper has been chosen by the editorial team of International Psychogeriatrics, to be paper of the month in this issue, are to be congratulated for developing and validating the advanced ADL tool with the aim of providing a useful ADL measure to distinguish normal from pathological cognitive aging. They have assessed a large sample (150 people with AD, MCI and healthy controls) and report acceptable parameters for discrimination of these three groups using the instrument they have developed. The next step will be to try it out in a variety of clinical populations, settings, and cultures and perhaps to see how well it stacks up against other methods of detecting preclinical and prodromal AD (e.g. amyloid PET scans or lumbar punctures). The publication of this very good paper will allow other teams around the world to start using this user-friendly instrument and I await the outcome of further work on it with great interest.
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Shin, Youngsul, Yu Jin Park, and Soon Ju Kang. "Data-Driven Knowledge-Based System for Self-Measuring Activities of Daily Living in IoT-Based Test." Applied Sciences 10, no. 14 (July 19, 2020): 4972. http://dx.doi.org/10.3390/app10144972.
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This paper proposes a data-driven knowledge-based system with which aged people can measure the degree of activities of daily living (ADL) by themselves. The proposed system, called E-coach for ADL Test (EAT), provides participants with self-measurement procedures, using e-coaching, which is a guidance mechanism to lead the participants from an initial stage to a target goal. The EAT traces the behavior of the participants to gather ADL data that tell how well they perform the given e-coaching. Driven by the Internet of Things data, the knowledge-based inference of the EAT carries out the e-coaching mechanism that figures out what state the self-measurement procedures stay on and what guidance is necessary for the next state. The EAT ensures that all the procedures for ADL measurement are executed automatically without any help from medical professionals. The experiment described in this paper demonstrates that the EAT distinguishes between dementia patients and normal people. The measurement report assists medical doctors in the diagnosis of certain medical conditions that these people may have.
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Frochen, Stephen, and Shahla Mehdizadeh. "Functional Status and Adaptation: Measuring Activities of Daily Living and Device Use in the National Health and Aging Trends Study." Journal of Aging and Health 30, no. 7 (May 4, 2017): 1136–55. http://dx.doi.org/10.1177/0898264317707299.
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Objective: The objective of this study is to evaluate the functional status and adaptation of older Americans and discover the factors that contribute to device use. Method: Using the community participants’ portion of the first round of National Health and Aging Trends Study (NHATS), we demonstrate the prevalence of device use and reduction in activities, creating a multilevel measure of activities of daily living (ADL) functionality as compared with Katz’s dichotomous measure. In determining whether adaptation is universal irrespective of age, sex, race, living arrangement, and income, or dependent on these variables, we create a measure of device use, performing a path analysis of the device use measure and sociodemographic variables, with disability score as an intervening measure. Results: ADL functionality becomes more nuanced between the Katz-ADL and NHATS-ADL. Age, sex, and living arrangement were predictors of device use; income was indirectly, whereas race was not. Discussion: When assessors design service plans, consideration should be given to older adults’ ability, capacity, and resources to adapt.
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Weinberg, Jeffrey, Mary Frances McAleer, Hussein Tawbi, and Frederick Lang. "55. A RANDOMIZED, MULTICENTER PHASE III TRIAL OF SURGERY PLUS STEREOTACTIC RADIOSURGERY (SRS) COMPARED WITH SURGERY PLUS PERMANENTLY IMPLANTED COLLAGEN TILE BRACHYTHERAPY (CTBT) FOR RESECTABLE METASTATIC BRAIN TUMORS-PROTOCOL IN PROGRESS." Neuro-Oncology Advances 2, Supplement_2 (August 2020): ii11. http://dx.doi.org/10.1093/noajnl/vdaa073.043.
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Abstract BACKGROUND Resection (R) followed by single or multi-fraction stereotactic radiosurgery (SRS) lowers resection bed recurrence compared to R alone. Nevertheless for larger brain metastasis (>2.5 cm) 12-month recurrence rates after R+SRS can exceed 20–30%. Aiming to improve outcomes, a permanently implanted collagen tile brachytherapy (CTBT) device (GammaTile, GT Medical Technologies, Tempe AZ) utilizing Cs-131 was developed, hypothesizing that immediate adjuvant radiotherapy (RT) and/or RT dose intensification could improve outcomes. The device received FDA clearance for this indication, based on a single-arm pre-commercial study and in early commercial use due to the excellent safety and local control of R+CTBT. It is hypothesized that R+CTBT will increase the time to post-resection-recurrence, while prolonging survival and reducing the impact on functional and neurocognitive status compared to R+SRS. STUDY DESIGN Multicenter, randomized, comparison trial. Patients with resectable, previously untreated “index” brain metastases measuring >2.5–5 cm and 0–3 other tumors will be preoperatively randomized 1:1 to undergo either R+ SRS or R+CTBT to the index lesion; unresected tumors in both groups will receive SRS. Planned sample size is 160 from ~5 sites; accrual to start in Q3-2020. Primary endpoint is surgical bed-recurrence free survival. Secondary endpoints include overall survival, quality of life (Functional Assessment of Cancer Therapy-Brain, Linear Analog Self-Assessment), neurocognition (Hopkins Verbal Learning Test, Trail Making Tests, Mini-Mental Status Exam, Controlled Oral Word Association), functional decline (Karnofsky Performance Scale, Barthel-ADL), and adverse events. Follow-up will be at 1,3,6,9, and 12 months, then q 6 months through 5 years. CONCLUSIONS This will be the first randomized trial comparing R+SRS versus R+CTBT delivered by Cs-131 sources in permanently implanted resorbable collagen tile carriers. Primary and secondary outcome measures will be captured to elucidate the potential risks and benefits of these two differing approaches for patients with metastatic brain tumors.
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Weinberg, Jeffrey, Mary Frances McAleer, Jason Michael Johnson, Rajat Kudchadker, Jeffrey Scott Wefel, Ying Yuan, and Heather Y. Lin. "A phase III multicenter randomized controlled trial of postsurgical stereotactic radiotherapy versus surgically targeted radiation therapy (STaRT) for the treatment of large (>2.5cm) newly diagnosed brain metastases: Trial in progress." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): TPS2067. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.tps2067.
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TPS2067 Background: Resection (R) followed by single or multi-fraction stereotactic radiosurgery (SRT) of brain metastases lowers resection bed recurrence compared to R alone. Nevertheless, for larger (>2.5cm) brain metastasis, 12-month recurrence rates after R+SRT can exceed 20–30%. Aiming to improve outcomes, a permanently implanted collagen tile brachytherapy device (GammaTile or GT, GT Medical Technologies, Tempe, AZ) utilizing Cs-131 seeds embedded within a bioresorbable collagen tile was developed and is described as Surgically Targeted Radiation Therapy (STaRT) to distinguish it from external beam radiation therapy. It is hypothesized that immediate adjuvant radiotherapy (RT) and/or RT dose intensification could improve outcomes. The device is FDA-cleared for this indication and early commercial use is demonstrating favorable safety and efficacy outcomes. STaRT allows rapid dose delivery of radiation therapy directly to the tumor bed with predictable dosimetry immediately at the time of resection, and an intense but localized radiation treatment, which may confer a reduced risk for radiation necrosis compared to other therapies. The device is easily placed with minimal additional operative time and limited staff radiation exposure. It is hypothesized that R+ STaRT will increase the surgical bed recurrence-free survival, while reducing the impact on functional and neurocognitive status compared to R+SRT. Methods: Multicenter, randomized, comparison trial of patients with resectable, previously untreated “index” brain metastases measuring ≥2.5–5 cm, and 0–3 other tumors, will be preoperatively randomized 1:1 to undergo either R+ SRT or R+STaRT to the index lesion; unresected tumors in both groups will receive SRT. Planned sample size is 180 from 13 sites. Enrollment will open in Q1. Primary endpoint is surgical bed-recurrence free survival. Secondary endpoints include overall survival, quality of life (Functional Assessment of Cancer Therapy-Brain, Linear Analog Self-Assessment), neurocognition (Hopkins Verbal Learning Test, Trail Making Tests, Controlled Oral Word Association), functional status (Karnofsky Performance Scale, Barthel-ADL), and adverse events. Follow-up will be at 1,3,6,9, and 12 months, then every 6 months through 24 months. This will be the first randomized trial comparing R+SRT versus R+STaRT delivered by Cs-131 sources in permanently implanted resorbable collagen tile carriers. Primary and secondary outcome measures will be captured to elucidate the potential risks and benefits of these two differing post-operative RT delivery methods in the setting of newly diagnosed metastatic brain tumors. Clinical trial information: NCT04365374.
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Drager, Justin, Alexander Newhouse, Jorge Chahla, Shane Nho, and Jonathan Rasio. "Patients with a Hypoplastic Labrum Achieve Similar Outcomes After Primary Labral Repair in the Treatment of Femoracetablular Impingement Syndrome Compared to Patients with a Normal Labrum." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0043. http://dx.doi.org/10.1177/2325967120s00436.
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Objectives: A preoperative or intraoperative finding of an acetabular labrum width of <4mm is often cited as an indication for performing primary labral reconstruction over repair in the surgical correction of Femoracetablular Impingement Syndrome (FAIS). The purpose of this study is to compare patient reported clinical outcomes and rates of reaching Minimum Clinical Important Differences (MCID) and Patient Acceptable Symptomatic State (PASS) between patients with a hypoplastic labrum compared to those with a normal labrum width at a minimum 1 year from arthroscopic treatment of FAIS. Methods: Data from consecutive patients who underwent primary hip arthroscopy between November 2015 and July 2018 for the treatment of FAIS were analyzed. Baseline demographic data, preoperative, and minimum 1 year post-operative clinical outcomes including Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool 12 questions (iHOT-12), and visual analog scale (VAS) for pain and satisfaction were recorded. The labrum size was documented by the senior surgeon for all patients using the tip of an arthroscopic probe measuring 4mm. Labrum hypoplasia was defined as a labrum width at the 12 o’clock position of <4mm and normal labrum was defined as labrum width between 4 and 7mm. Patients with hypoplastic labrum were matched 1:1 by age and BMI to patients with normal labrum width. All patients underwent arthroscopic labral repair in addition to impingement resection and capsular repair. The groups were further compared after separating by acetabular coverage, in which a Lateral Center Edge Angle of 18-24.9 was considered borderline dysplastic and 25-40 was considered normal. Rates of achieving MCID calculated using a distribution-based method and PASS calculated using an anchor-based method. Results: A total of 360 patients were included in the study with 180 in each of the normal and hypoplastic groups. There was no significant differences seen in 1-year post operative outcome scores or score improvement between the two groups. When examining only borderline dysplastic patients there were no significant differences in outcomes between normal and hypoplastic labrum patients. In the subset with a normal LCEA only post-operative VAS satisfaction (85.5 ± 19.3 vs 78.2 ± 27.4; p=0.050) was significantly higher in the normal labrum patients compared to hypoplastic labrum. Patients with hypoplastic labrum achieved MCID and PASS at the same rate as patients with normal labrum across all outcome measures. Conclusions: Patients with an intraoperative finding of labral hypoplasia achieve 1-year meaningful clinical outcome at the same rate as those with normal labral width following arthroscopic labral repair. These results bring into question the need for primary labral reconstruction in patients with labral hypoplasia with a normal or borderline dysplastic acetabulum.
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Kim, Dae Hyun, Elisabetta Patorno, Ajinkya Pawar, Hemin Lee, Sebastian Schneeweiss, and Robert J. Glynn. "Measuring Frailty in Administrative Claims Data: Comparative Performance of Four Claims-Based Frailty Measures in the U.S. Medicare Data." Journals of Gerontology: Series A 75, no. 6 (September 30, 2019): 1120–25. http://dx.doi.org/10.1093/gerona/glz224.
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Abstract Background There has been increasing effort to measure frailty in the U.S. Medicare data. The performance of claims-based frailty measures has not been compared. Methods This cross-sectional study included 3,097 community-dwelling fee-for-service Medicare beneficiaries (mean age 75.6 years) who participated in the 2008 Health and Retirement Study examination. Four claims-based frailty measures developed by Davidoff, Faurot, Segal, and Kim were compared against frailty phenotype, a deficit-accumulation frailty index (FI), and activities of daily living (ADL) dependence using Spearman correlation coefficients and C-statistics. Results Claims-based frailty measures were positively associated with frailty phenotype (prevalence in ≤10th vs >90th percentile: 8.0% vs 41.3% for Davidoff; 5.9% vs 53.1% for Faurot; 3.3% vs 48.0% for Segal; 2.9% vs 51.0% for Kim) and FI (mean in ≤10th vs >90th percentile: 0.17 vs 0.33 for Davidoff; 0.13 vs 0.37 for Faurot; 0.12 vs 0.31 for Segal; 0.10 vs 0.37 for Kim). The age and sex-adjusted C-statistics for frailty phenotype for Davidoff, Faurot, Segal, and Kim indices were 0.73, 0.74, 0.73, and 0.78, respectively, and partial correlation coefficients with FI were 0.18, 0.32, 0.26, and 0.55, respectively. The results for ADL dependence were similar (prevalence in ≤10th vs >90th percentile: 3.7% vs 50.5% for Davidoff; 2.3% vs 55.0% for Faurot; 3.0% vs 38.3% for Segal; 2.3% vs 50.8% for Kim). The age and sex-adjusted C-statistics for the indices were 0.79, 0.80, 0.74, and 0.81, respectively. Conclusions The choice of a claims-based frailty measure can influence the identification of older adults with frailty and disability in Medicare data.
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Janssen, Leah, and Kate de Medeiros. "Are We Missing the Target When Measuring Quality of Life?" Innovation in Aging 4, Supplement_1 (December 1, 2020): 373. http://dx.doi.org/10.1093/geroni/igaa057.1201.
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Abstract Over the last several decades, many instruments have been created to measure quality of life (QoL) in older adults, particularly for intervention research on individuals living with dementia. However, since definitions of QoL lack standardization across the research literature, the question of how to holistically capture an elusive and expansive concept such as QoL remain. This research uses qualitative content analysis to explore definitions and domains of QoL with an eye toward overlap and gaps. Definitions of QoL were extracted from gerontology encyclopedia entries and other peer-reviewed supplemental resources and analyzed for themes using Dedoose qualitative software. Results revealed three over-arching themes: no standardized or universal definition of QoL, use of subjective and objective factors for measurement, and varying domains of QoL. Additionally, we further distilled theme three to identify eight unique QoL domains: 1) economic/financial, 2) environment, 3) ADL/IADL function, 4) participation in activities, 5) personal resources, 6) physical health, 7) psychological well-being, and 8) social/relational, the total of which were only found in one of 15 definitions of QoL. Overall, findings led to an overarching definition of QoL that cuts across multiple dimensions and factors. We argue that by having all eight domains our understanding and measurement of QoL is enhanced, thereby improving our assessment of existing definitions of QoL, as well as the instruments used to measure QoL.
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Oort, Q., L. Dirven, S. Sikkes, N. Aaronson, F. Boele, C. Brannan, J. Egeter, et al. "OS05.4.A Do neurocognitive deficits explain the differences between brain tumour patients and their proxies assessing the patient’s I-ADL?" Neuro-Oncology 23, Supplement_2 (September 1, 2021): ii7. http://dx.doi.org/10.1093/neuonc/noab180.021.
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Abstract BACKGROUND Neurocognitive deficits are common among brain tumour patients, and may impact on patient awareness of deficits in instrumental activities in daily life (IADL). This study aimed to examine differences between patient-reported and proxy-reported assessments of the patient’s performance of IADL, and whether the level of (dis)agreement is associated with neurocognitive deficits. MATERIAL AND METHODS A phase III EORTC questionnaire measuring IADL in brain tumour patients (EORTC IADL-BN32) and six neurocognitive test measures were administered as part of a larger multicentre international study designed to develop a brain tumour specific IADL questionnaire. Bland-Altman plots and Mann-Whitney U tests were used to evaluated patient- and proxy-reported IADL on a group level. Subsequently, Mann-Whitney U tests were performed to compare patient-proxy difference scores (patient IADL score - their proxy IADL score) between patients who were considered clearly neurocognitively impaired (≥2 neurocognitive test measures; ≤2.0 SD below healthy controls) and patients who were not. Furthermore, multinomial logistic regression analyses were performed to examined which sociodemgraphic, clinical, and particularly neurocognitive variables were independently associated with patients and proxies differing in their evaluation of patient’s IADL. RESULTS Patients (N=81) and proxies (N=81), on group level, did not significantly differ on either the IADL individual item or scale scores. However, significant differences were found on patient-proxy difference scores between patients who were (N=37) and were not (N=44) considered clearly neurocognitively impaired for 10/32 individual items and one of the scales (i.e. Scale 4: Administrative tasks), all showing that the proxies of clearly neurocognitively impaired patients reported more problems relative to the patients themselves, compared to proxies of patients not clearly neurocognitively impaired. Furthermore, for each scale, a neurocognitive variable, either impaired information processing speed, cognitive flexibility, verbal fluency or the number of neurocognitive test measures impaired, was found to be independently associated with proxies reporting more problems. For 4/5 scales, a clinical variable was additionally independently associated with proxies reporting more problems. Only one variable was independently associated with patient reporting more problems, namely being in active treatment was found to be associated with patients reporting more problems on Scale 4: Administrative tasks. CONCLUSION Results imply a consistent trend of clearly neurocognitively impaired patients underreporting problems with IADL compared to their proxies. It would therefore be advised to administer both the patient- and proxy-version of the EORTC IADL-BN32, particularly if neurocognitive deficits are presumed.
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Cmelak, Anthony, Yael Flamand, Shuli Li, Shanthi Marur, Barbara A. Murphy, David Cella, Arlene A. Forastiere, and Barbara Burtness. "Assessment of established patient reported outcomes (PROs) instruments measuring toxicities and quality of life (QOL) for patients (pts) with head and neck cancer (HNC) treated on ECOG 1308 and 2399 studies." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 6074. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.6074.
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6074 Background: HPV HNC pts are younger and have a higher cure rate than smoking-related pts, and therefore carry treatment toxicities longer. Dose deintensification and conformal RT may result in decreased toxicity. We report the impact of these techniques on patient outcomes in E2399 and E1308 as measured through PROs. Methods: Longitudinal data on acute and late toxicities were recorded prospectively at baseline, post-treatment, and at 6, 12, 24 and 30 months in HPV+ pts on E1308 and HIV+/- pts on E2399 using the following measures: E1308: FACT-HN, KATZ Index of Independence (ADL), Brief Fatigue Index (BFI), Instrumental Activities of Daily Living (IADL), and the Vanderbilt Head and Neck Symptom Survey Version 2 (VHNSS V2); on E2399: FACT-HN. We correlated acute and late toxicities with de-escalation of RT dose (69.3Gy to 54Gy) on E1308, and with IMRT (E1308) vs. conformal RT (E2399). Results: 38 pts on E1308 completed 12 mo VHNSS V2; 32 received low dose IMRT and 6 standard dose, and 56 E2399 pts completed 12 mo FACT-HN. Items from the VHNSS V2 showed that difficulty eating solids (40% vs. 89%, p = 0.011) and improved nutrition (10% vs 44%, p = 0.025) were statistically improved at 12 months by lowering IMRT dose from 69.3Gy to 54Gy. The FACT-HN showed an improvement in eating solids at 12 mo when comparing low dose IMRT vs. 3DRT (65% vs. 33% had no or minimal solid food problems, p = 0.057). No other statistically significant reductions in toxicity were noted on any of the other PRO instruments. Conclusions: Both FACT-HN and VHNSS V2 demonstrated an improvement in eating solids by reducing IMRT dose. FACT-HN demonstrated that IMRT is associated with an improvement in eating solids when compared to 3DRT. Analyses are exploratory and need to be validated using randomized data.Future studies should stress accurate and complete PRO data. The KATZ, BFI, and IADL were not sensitive to detecting differences in toxicities from IMRT dose reduction on E1308. The VHNSS V2 and FACT-HN instruments corroborated specific toxicities both by RT technique as well as IMRT dose, and will therefore be utilized in future ECOG-ACRIN HNC studies. Clinical trial information: NCT01084083.
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Lunt, Eleanor, Terence Ong, Adam L. Gordon, Paul L. Greenhaff, and John R. F. Gladman. "The clinical usefulness of muscle mass and strength measures in older people: a systematic review." Age and Ageing, July 22, 2020. http://dx.doi.org/10.1093/ageing/afaa123.
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Abstract Background sarcopenia is the loss of muscle mass and quality and is diagnosed using measures of muscle strength, size and mass. We evaluated the literature on whether sarcopenia measures are predictive of motor outcomes in older people in clinical settings. Methods electronic databases (MEDLINE Ovid, EMBASE, CINAHL and Web of Science) were searched for articles on measures of muscle mass, volume, thickness or strength, in older people in clinical settings, which reported cross-sectional or longitudinal associations with motor outcomes. Clinical cohorts included geriatric medical inpatients and outpatients, patients with hip fracture, geriatric rehabilitation and care home residents. Motor outcomes were mobility, falls, balance and activities of daily living (ADL). Due to high study heterogeneity, standardised mean differences were used to compare strength of associations. Results in total, 83 articles were identified. The most frequently studied measures were grip strength (47 studies), knee extension strength (21 studies) and bioelectrical impedance analysis (18 studies). Handgrip strength (HGS) had evidence for cross-sectional associations with mobility (14 of 16 studies, 2,088 participants), balance (6 of 6 studies, 1,177 participants) and ADL independence (10 of 11 studies, 3,228 participants), and evidence of longitudinal associations with mobility (3 of 3 studies, 883 participants) and ADL independence (7 of 10 studies, 1,511 participants). There was no conclusive evidence for association with falls. Conclusions HS was the most studied measure and was associated with mobility, balance and ADL outcomes. There was a paucity of studies, particularly with longitudinal follow-up, measuring muscle mass, volume or thickness using gold-standard approaches.
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Hartsgrove, Caitlin, Jenieve Guevarra-Fernandez, Jamila Kendall, Gabrielle Delauter, and Steven Kirshblum. "MEASURING DISCHARGE OUTCOMES, LENGTH OF STAY, AND FUNCTIONAL ADL SCORE DURING COVID-19 IN INPATIENT REHABILITATION HOSPITALS." Archives of Physical Medicine and Rehabilitation, July 2021. http://dx.doi.org/10.1016/j.apmr.2021.07.003.
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Maple-Grødem, Jodi, Ingvild Dalen, Ole-Bjørn Tysnes, Angus Donald Macleod, Lars Forsgren, Carl Edward Counsell, and Guido Alves. "Association of GBA Genotype with Motor and Functional Decline in Newly Diagnosed Patients with Parkinsons Disease." Neurology, December 21, 2020, 10.1212/WNL.0000000000011411. http://dx.doi.org/10.1212/wnl.0000000000011411.
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Objectives:To establish the significance of GBA-carrier status on motor impairment in a large cohort of patients with incident Parkinson’s disease (PD).Methods:Three European population-based studies followed 528 patients with PD from diagnosis. 440 with genomic DNA from baseline were assessed for GBA variants. We evaluated motor and functional impairment annually using the Unified PD Rating Scale (UPDRS) motor and Activity of Daily Living (ADL) sections. Differential effects of classes of GBA variants on disease progression were evaluated using mixed random and fixed effects models.Results:387 idiopathic patients (age at baseline 70.3±9.5 years; 60.2% male) and 53 GBA-carriers (age at baseline 66.8±10.1 years; 64.2% male) were included. The motor profile of the groups was clinically indistinguishable at diagnosis. GBA-carriers showed faster annual increase in UPDRS scores measuring ADL (1.5 points per year, 95% CI 1.1 to 2.0) and motor symptoms (2.2 points per year, 95% CI 1.3 to 3.1) compared to non-carriers (ADL, 1.0 points per year, 95% CI 0.9 to 1.1, P = 0.003; motor, 1.3 points per year, 95% CI 1.1 to 1.6, P = 0.007). Simulations of clinical trial designs showed that recruiting only GBA-carriers can reduce trial size by up to 65% compared to a trial recruiting all patients with PD.Conclusion:GBA variants are linked to a more aggressive motor disease course over seven years from diagnosis in patients with PD. A better understanding of PD progression in genetic subpopulations may improve disease management and has direct implications for improving the design of clinical trials.
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Wang, Shengshu, Wangping Jia, Shanshan Yang, Ke Han, Wenzhe Cao, Xueling Ren, Jing Li, et al. "The Role of BMI and Blood Pressure in the Relationship Between Total Cholesterol and Disability in Chinese Centenarians: A Cross-Sectional Study." Frontiers in Medicine 8 (February 16, 2021). http://dx.doi.org/10.3389/fmed.2021.608941.
Full textAbstract:
Background: Lower serum lipid metabolism might be associated with the decline of activity of daily living in the extreme longevity group. However, studies on models and possible paths of this correlation between total cholesterol (TC) and disability in centenarians are scarce. The aim of this study was to verify this correlation and explore the mediating effect of BMI and blood pressure on this relationship in Hainan centenarians.Methods: We conducted a cross-sectional analysis of 1002 centenarians from the China Hainan Centenarians Cohort Study (CHCCS). Data on demographics, anthropometry data, lifestyle, and TC levels were collected through interviews, physical examinations, and laboratory tests. The Barthel index and Lawton index, measuring the disability status, were used to estimate the activity of daily living (ADL) and instrumental activity of daily living (IADL). A multivariable logistic regression model was used to explore the correlation between disability and TC levels. Mediation analyses were used to explore the both direct and indirect effects of TC level on disability.Results: After adjusting for covariates, with 1 mmol/L increment in TC, the adjusted odds ratios (ORs) of ADL severe disability and ADL moderate & severe disability were 0.789(95%CI: 0.650–0.959) and 0.822(95%CI: 0. 0.699–0.966), respectively. There was a significant declining trend in the prevalence of different types of disability with increment in TC. The correlation was more pronounced among Hainan female centenarians. In the analysis of mediating effect among the female population, BMI significantly mediated the effect of TC levels on different types of disability. BMI and SBP, as chain mediators, multiply and chain mediated the effect of TC levels on IADL.Conclusion: Low TC levels might be correlated with a higher frequency of disability in female centenarians, and this correlation might be mediated by BMI and blood pressure.