Task independence, safety, and adequacy among nondisabled and osteoarthritis-disabled older women

Task-Specific Training for Adults With Chronic Knee Pain: A Case Series

Study Design Case series. Background Recent evidence suggests that traditional impairment-based rehabilitation approaches for patients with knee pain may not result in improved function or reduced disability. This case series describes a novel task-specific training approach to exercise therapy for patients with chronic knee pain and reports changes in measures of clinical outcome (pain and physical function) following participation in the training program. Case Description Seven patients with chronic knee pain aged 40 years or older were included. Each reported at least "moderate" difficulty with sit-to-stand transfers, floor transfers, and/or stair negotiation at baseline. Experienced physical therapists provided between 8 and 16 treatment sessions focusing on improving performance of difficult or painful tasks. Outcomes A majority of patients demonstrated clinically important improvements in both patient-rated outcomes (Knee injury and Osteoarthritis Outcome Score, numeric pain-rating scale, modified Arthritis Self-Efficacy Scale) and performance-based outcomes (30-second chair-rise test, timed stair-climb test, floor transfer test, Performance Assessment of Self-Care Skills). Discussion A task-specific training approach for patients with chronic knee pain was described and yielded considerable improvement in pain and function for most of the individuals in this case series. Larger studies are needed to determine how task-specific training compares with more traditional impairment-based exercise approaches for chronic knee pain. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(8):548-556. doi:10.2519/jospt.2017.7349.

Dynamic interactions between impairment and activity after stroke: examining the utility of decision analysis methods

Objective: To examine the utility of decision analysis methods for examining the dynamic nature of impairment-activity interactions following stroke.

Design: Decision analyses (Chi-squared Automatic Interaction Detector) of a prospective cohort study.

Setting: Community and institutional settings based on the location of participants three months after stroke.

Participants: Individuals were recruited from consecutive admissions to a regional academic health center and were assessed three months after stroke (N=67).

Main outcome measures: Neurological impairment was measured with the National Institutes of Health Stroke Scale (NIHSS). Mobility, self-care and instrumental activities of daily living (instrumental ADL) performance were assessed with a performance observation measure, the Performance Assessment of Self-care Skills (PASS). Decision analysis methods were used to examine interactions between neurological impairments and activity outcomes.

Results: Unique neurological impairments were associated with each activity outcome (bowel and bladder urgency interacted with mobility; hand function interacted with self-care; mental functions interacted with instrumental ADL), and these findings are supported by previous studies. The predictive validity of mobility and self-care analyses was stronger than the instrumental ADL analyses.

Conclusions: Decision analysis methods show promise for understanding dynamic impairment-activity interactions. This understanding may enhance methods for informing rehabilitation decisions.

Performance-Based Impairment Measures as Predictors of Early-Stage Activity Limitations in Community-Dwelling Older Adults

OBJECTIVE

The objective of the current investigation was to explore performance-based predictors of decline in the performance quality of everyday tasks as a first step for early identification, screening, and referral to minimize disability in community-dwelling older adults.

METHOD

This was a secondary analysis of data from 256 community-based older women. Mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) were measured using the Performance Assessment of Self-Care Skills (PASS). Logistic regression models explored cognitive and motor predictors of performance quality while controlling for demographics and diagnoses.

RESULTS

Functional reach ( p = .049) and cognition ( p = .012) were predictive of mobility quality, whereas balance ( p = .007) and the Keitel Function ( p = .005) were predictive of ADL quality. Manipulation and cognitive measures were predictive of cognitive and physical IADL quality.

DISCUSSION

Cognitive and physical screens are both important to identify older adults at risk for disability.

Instrumental activities of daily living performance and role satisfaction in people with and without mild cognitive impairment: a pilot project

OBJECTIVE

We investigated differences in observed performance of instrumental activities of daily living (IADLs) and self-reported satisfaction with social role performance between people with amnestic mild cognitive impairment (a-MCI) and age- and gender-matched control participants.

METHOD

We measured observed performance of 14 IADLs using the Independence, Safety, and Adequacy domains of the Performance Assessment of Self-Care Skills (PASS) and the Patient-Reported Outcomes Measurement Information Systems (PROMIS) to examine satisfaction with social role performance.

RESULTS

Total PASS scores were significantly lower in participants with a-MCI (median=40.6) than in control participants (median=44.2; p=.006). Adequacy scores were also significantly lower. No significant differences were found between groups on the PROMIS measures.

CONCLUSION

IADL differences between groups were related more to errors in adequacy than to safety and independence. Occupational therapy practitioners can play a key role in the diagnosis and treatment of subtle IADL deficits in people with MCI.

Performance measures rather than self-report measures of functional status predict home care use in community-dwelling older adults

BACKGROUND

Occupational therapists frequently assess functional status (FS) to determine the home care (HC) service requirements of older adults. However, it is unclear which type of FS measure is most effective for this purpose.

PURPOSE

This study investigated the predictive ability of three measures of FS (a self-report measure of usual behaviour, a self-report measure of capacity, and an observational performance measure-the Performance Assessment of Self-Care Skills [PASS]) on formal HC utilization.

METHOD

A secondary analysis of 2001 Aging in Manitoba Longitudinal Study (AIM) data was conducted.

FINDINGS

The odds of receiving HC within the 30-month follow-up period were 1.32 times (or 30%) higher for each increase in the number of dependent tasks based upon a standardized performance measure. The self-report measures did not predict HC utilization.

IMPLICATIONS

This study suggests that standardized performance measures-in particular, the PASS-are more predictive of formal HC use in community-dwelling older adults than self-report measures.

Maximizing ADL performance to facilitate aging in place for people with dementia

The purpose of this article is to review the effect of dementia on activities of daily living and consequently on the ability to age in place. Types of evaluation and information conferred from different types of assessment are discussed. Evidence-based interventions for preventing and minimizing activities-of-daily-living disability are outlined.

Evaluating capacity to live independently and safely in the community: Performance Assessment of Self-care Skills

To determine clients' capacity for community living, occupational therapists must use measures that capture the person-task-environment transaction and compare clients' task performance to a performance standard. The Performance Assessment of Self-care Skills, a performance-based, criterion-referenced, observational tool, fulfills this purpose. In this practice analysis, using data from this tool from multiple clinical studies (N = 941), the authors describe tasks that clients from various diagnostic populations could and could not perform independently and safely. For clinicians, the Performance Assessment of Self-care Skills can be used to identify which daily tasks are compromised and the point of task breakdown, as well as to provide guidance about potential interventions.

Enhancing our collective research acumen by using an epidemiological perspective

Nearly 50 million Americans report some level of disability in activities of daily living or instrumental activities of daily living. Public health officials advocate for a fresh perspective on disability by considering disability through an epidemiological approach. Should occupational therapists perform this research, and what are the benefits for our profession if we do? This article advocates for enhancing our research knowledge base by including an epidemiological perspective in our research design. The benefits to occupational therapy of this research include (1) increased understanding of the extent and nature of occupational performance disability, (2) advancement of the scope and depth of research for prevention and intervention programs, and (3) improved visibility of the profession as informants for public health policy. Suggestions for preparing researchers to perform these studies and students and practitioners to interpret the studies are provided.

Integrating a Performance-Based Observation Measure of Functional Status into a Population-Based Longitudinal Study of Aging

Over the past 15 to 20 years there has been discussion and debate in the gerontological literature about the relative merits of self-report versus performance-based observational (PBO) measures of functional status. In 2001 the Aging in Manitoba Longitudinal Study had the opportunity to add a PBO measure of functional status and use it together with two self-report measures on a sub-sample of 138 participants. The PBO measure that was used was the Performance Assessment of Self-Care Skills, Version 3.1 (Home). Using ranks of the proportion of participants who were independent in nine different tasks, no significant correlations were found between the performance measure scores and either of the self-report measures. This finding suggests that using self-report data rather than performance data could lead program developers and policy makers to different conclusions about the extent of need for assistance among older adults.

Influence of the environment on activity performance in older women with heart failure

PURPOSE

To examine the influence of the environment on activity performance in older women with heart failure living in the community.

METHOD

The cross-sectional study included 55 older women with heart failure. Differences in activity performance collected through performance observation in the clinic and home were analysed with repeated measures ANOVAs and paired samples t-tests.

RESULTS

Overall, the influence of the environment in the clinic was neutral for activity independence, and disabling for activity safety and activity adequacy at the global level. At the domain level, functional mobility and personal care were more independent but equally safe and adequate in the clinic compared to the home, cognitively-oriented instrumental activities were less independent, safe and adequate in the clinic compared to the home, and physically-oriented instrumental activities were equally independent, but less safe and adequate in the clinic compared to the home. At the activity level, 6 activities were positively influenced by the environment in the clinic and 13 activities were negatively influenced.

CONCLUSIONS

Findings suggest that the influence of the environment can be neutral, enabling, or disabling depending on the global scores or level of analysis being considered.

Patterns of mild cognitive impairment after treatment of depression in the elderly

OBJECTIVES

Late-life depression (LLD) is associated with persistent cognitive impairment in a subset of individuals. The purpose of this study was to 1) examine the frequency and characteristics of cognitive diagnoses (Mild Cognitive Impairment [MCI], dementia) among remitted elderly depressed subjects and 2) to compare the prevalence rate and correlates of cognitive diagnoses with those of comparison subjects.

DESIGN

Crosssectional.

SETTING

Outpatient geriatric mental health clinic.

PARTICIPANTS

The authors examined cognitive diagnoses among 109 subjects age 65 and older, after depression treatment response and 65 never-depressed, age- and education-equated comparison subjects.

MEASUREMENTS

Cognitive diagnoses were independently established by the University of Pittsburgh's Alzheimer's Disease Research Center. Bivariate and multivariate analyses were conducted to examine the role of specific risk factors for cognitive diagnosis among depressed subjects.

RESULTS

Relative to comparison subjects, nearly twice as many depressed subjects were diagnosed with MCI or dementia (48% versus 28%). Of the 109 depressed subjects, 38% were diagnosed with MCI (63% amnestic, 37% nonamnestic). The majority of amnestic MCI subjects (85%) had the multiple domain subtype. Age, but not age of onset or lifetime depression duration, predicted cognitive diagnosis.

CONCLUSIONS

Despite adequate depression treatment response, 48% of remitted depressed subjects had a cognitive diagnosis. Of the 38% diagnosed with MCI, there was high representation among both the amnestic and the nonamnestic subtypes, suggesting heterogeneity in cognitive course and outcomes in LLD.

Developing empirical models to enhance stroke rehabilitation

PURPOSE

Models identifying functional indicators most strongly associated with favourable and unfavourable outcomes may bolster evidence to improve stroke rehabilitation assessment and intervention. This study examined the feasibility of decision analysis methods for developing data-driven models that examined associations between specific functional indicators and global disability.

METHOD

Data were derived from functional assessment of 67 participants 3 months following stroke. Decision analysis methods were used to examine specific activity and body function indicators associated with global disability, and the degree of limitation or impairment that contributed to favourable and unfavourable outcomes, in 2 models. The feasibility of decision analysis methods was evaluated.

RESULTS

Of the 26 activity indicators, dressing was most strongly associated with global disability, followed by bill mailing, shopping and sweeping. Of 15 body function indicators, facial weakness and mental functions were most strongly associated with global disability. The misclassification risk estimates were fair for the two models.

CONCLUSIONS

Findings suggest that decision analysis methods show promise for developing models examining associations between specific functional indicators and disability. Further study with these methods may identify specific priorities for functional assessment and intervention in stroke rehabilitation.

Concordance of four methods of disability assessment using performance in the home as the criterion method

OBJECTIVE

To determine the concordance of 4 methods of disability assessment with the criterion method. Performance testing in the home was selected as the criterion.

METHODS

The task performance of 57 community-dwelling older women (>/=70 years) with knee osteoarthritis was examined through self report, proxy report, clinical judgment based on impairment measures, performance testing in an occupational therapy clinic, and performance testing in participants' homes. The 26 tasks represented 4 domains of daily living activities: 5 functional mobility, 3 personal care, 14 cognitively oriented instrumental activities of daily living (IADL), and 4 physically oriented IADL.

RESULTS

In general, self reports and proxy reports had the highest concordance with in-home performance test results. Nonetheless, even for these methods, depending on task domain, the rate of discordance ranged from 31% to 54%, being least in personal care and greatest in the physically oriented IADL.

CONCLUSION

Disability estimates based on self reports, proxy reports, clinical judgments, and hospital performance-based assessments are not interchangeable with in-home task performance.

Impact of osteoarthritis on individuals and society: how much disability? Social consequences and health economic implications

Osteoarthritis is a major cause of disability in both the developed and developing world. With the population aging, the prevalence of osteoarthritis is increasing and its consequences are impacting significantly on society. This is one of the reasons why osteoarthritis has been adopted as a major focus (along with osteoporosis, rheumatoid arthritis, back pain, and musculoskeletal trauma) by the global initiative--the Decade of Bone and Joint Disease. Adequate studies on the costs of osteoarthritis are urgently required so that cogent arguments can be made to governments to appropriately fund prevention and treatment programs for this condition. Its recognition as a major cause of disability, particularly in the aging population, should increase community focus on this important condition.