The Functional Status Questionnaire: reliability and validity when used in primary care

Content comparison of multidimensional functional outcome measures in rehabilitation and the ICF clinical functioning information tool: A scoping literature review

Background:

The ICF-based Clinical Functioning Information Tool (ClinFIT) was developed as a standardized tool to facilitate the assessment of functioning in clinical and, research settings.

Objective:

This review describes the contents of commonly used multidimensional outcome measures that describe functioning in rehabilitation settings and maps these measures to ICF categories covered by the ClinFIT to identify commonalities and discrepancies in the content.

Methods:

A scoping review included a systematic search of PubMed, Embase, Cochrane Library, and other resources. Twelve outcome measures were selected, and their meaningful concepts were linked to the ClinFIT by 2 authors using established ICF linking rules. Content density, bandwidth, and content diversity indices were calculated for each measure.

Results:

A total of 369 meaningful concepts from the 292 items from 12 measures were selected. Of these, 293 (79.4%) concepts were linked to the ClinFIT categories, with a majority (80.5%) linked to “activities and participation”; however, 76 (20.6%) meaningful concepts could not be linked to any ClinFIT categories. The extent of content coverage varied significantly between measures, reflecting the differences in the scope of each measure. The “activity and participation” categories had the highest bandwidth for all measures (range: 28.6%–71.4%), while the “body function” category was less represented (range: 0%–33.3%).

Conclusions:

ClinFIT can be the useful outcome measure for functional assessment in rehabilitation settings, as it covers wider concepts, considered important in rehabilitation settings, compared with other common functional outcome measures. It can establish comparability of a minimal data set on functional outcomes across various medical conditions and settings.

A causal model of health-related quality of life in colorectal cancer patients post-surgery

PURPOSE

this study aims to develop and test a model examining the causal relationship between self-efficacy, social support, fatigue, pain, functional status, and health-related quality of life (HRQL).

METHODS

A cross-sectional correlation study was conducted using a multi-stage sampling technique to recruit 256 individuals aged 20 to 59 with colorectal cancer (CRC) post-surgery from three hospitals in Northern Vietnam. The hypothesized model, based on Ferrans' HRQL conceptual model and literature review, was validated using structural equation modeling (SEM) and Mplus.

RESULTS

the model fit the data well, explaining 52% of the variance of HRQL. Self-efficacy emerged as the most influential factor directly impacting HRQL (β = .494, p < .05) and also had negative indirect effects on HRQL through fatigue and pain (β = -.271, p < .05). Social support had a positive direct (β = .406, p < .001) and negative indirect effects on HRQL via fatigue and pain (β = -.143, p < .05). Fatigue and pain had negative indirect effects on HRQL through functional status (β = -.336, p < .05 and β = -.219, p < .05, respectively). Functional status had a positive direct effect on HRQL (β = .418, p < .001).

CONCLUSIONS

The study's findings highlight the importance of improving self-efficacy, social support, and functional status, while reducing fatigue and pain to enhance HRQL among individuals with CRCpost-surgery. These insights can inform the development of targeted interventions to improve the well-being of this population.

Assessments scales for the evaluation of health-related quality of life in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy: a systematic review

Background

The concept of wellbeing is expansive and intricate, making it challenging to define precisely. Similarly, the instruments employed to assess wellbeing are complex and multifaceted. Therefore, it is more appropriate to refer to the notion of wellbeing as Health-Related Quality of Life (HRQoL), which is the central focus of many measures used to assess the feeling of wellbeing. This review aimed to identify the tools most commonly used to evaluate HRQoL in individuals with Parkinsonism-a group of movement disorders that negatively impact the quality of life due to the intricate interplay of symptoms, socio-demographic characteristics, and psychological factors. The main aim was to assess the psychometric properties of these measures in terms of validity and reliability.

Methods

A literature review was conducted, focusing on research related to the assessment of HRQoL in connection to symptoms of Parkinsonism. This review included all studies that examined HRQoL using evaluation scales, exams, or self-reported questionnaires. The literature review was conducted using the databases Scopus and Web of Science and the search engine PubMed to identify studies published between 1996 and 2023. Only records that assessed HRQoL in individuals with Parkinson's disease and Parkinsonism were selected for evaluation.

Results

A total of 393 records were examined, and eight tools were identified as the most frequently used in the evaluation of HRQoL.

Discussion

The results show a significant gap in knowledge regarding the latent structure and measurement invariance of HRQoL measurements, which may have a significant influence on the interpretation of test outcomes. Moreover, there is a lack of clear divergent validity between HRQoL assessments and other tests used as predictors of HRQoL. This could represent a significant limitation, affecting the construct and criterion validity of HRQoL measures.

Facets of physical function assessed by patient-reported outcome measures in oncology research

PURPOSE

The U.S. Food & Drug Administration has identified physical functioning (PF) as a core patient-reported outcome (PRO) in cancer clinical trials. The purpose of this study was to identify PF PRO measures (PROMs) in adult cancer populations and classify the PROMs by content covered (facets of PF) in each measure.

METHODS

As part of the Patient Reports of Physical Functioning Study (PROPS) research program, we conducted a targeted literature review to identify PROMs that could be used in clinical trials to evaluate PF from the patient perspective. Next, we convened an advisory panel to conduct a modified, reactive, Delphi study to reach consensus on which PF facets are assessed by PROMs identified in the review. The panel engaged in a "card sort" activity to classify PROM items by PF facets. Consensus was reached when 80% of panel members agreed that at least one facet was being measured by each PROM item.

RESULTS

The literature review identified 13 PROMs that met inclusion criteria. Eight facets of PF were identified for classification in the Delphi study: ability, completion, difficulty, limitation, quality, frequency, bother, and satisfaction. Through two rounds, the panel documented and classified conceptual approaches for each PRO item presented. The most prevalent PF facets were ability, difficulty, and limitation.

CONCLUSION

Classifying PF PROMs by PF facets will promote more consistent communication regarding the aspects of PF represented in each PROM, helping researchers prioritize measures for inclusion in cancer clinical trials.

What facets of physical function are most important to adults diagnosed with cancer?

PURPOSE

Successful patient-focused drug development involves selecting and measuring outcomes in clinical trials that are important to patients. The U.S. Food & Drug Administration's definition of clinical benefit includes how patients feel, function, or survive. Patients are considered the experts in describing how they feel and function. In cancer trials, patient-reported measures of physical function provide insight into how patients function at baseline, benefit from the interventions being studied, and the impact of treatment side effects. We conducted a qualitative study with adults diagnosed with cancer to describe facets of physical function from their perspective and to identify which facets are most important to this patient population.

METHODS

Using concept elicitation and cognitive interviewing techniques, we conducted semi-structured interviews with 72 adults ≥ 22 years of age with cancer who received treatment with an anticancer drug or biologic within six months of the interview. We selected participants using purposive sampling with the aim to elicit diverse experiences regarding how they may interpret and respond to questions related to physical function. Participants were presented with patient-reported outcome (PRO) items representative of PRO measures used in cancer and general populations.

RESULTS

Five facets of how physical function relates to activities were defined from the patient perspective: ability, difficulty, limitation, satisfaction, and completion. More than half of the participants indicated that ability was the most important facet of physical function. The next most important were satisfaction (18.3%), limitation (14.1%), difficulty (5.6%), and completion (2.8%).

CONCLUSION

This study demonstrates that we must be more specific about the facets of physical function that we set out to assess when we use PRO measures to describe the patient experience. These results have implications for the specificity of physical function facets when measured in cancer clinical trials.

Validation of the Indian (Hindi) version of the life-space assessment scale among community-dwelling older adults: a multicentric cross-sectional study

BACKGROUND

The Life-Space Assessment (LSA) is an instrument that measures mobility in older adults as they reach different areas, defined as life-spaces extending from home to beyond towns or regions. The purpose of the study was to develop the Hindi version of the LSA (LSA- H) and to investigate the validity and reliability of the Hindi version as well as its cultural adaptation.

METHODS

A cross-sectional study of two hundred forty-five older adults participated in the study from four different study practice areas. Following forward backwards translation, the LSA-H was developed, and the scores were correlated with those of the Activities-Specific Balance Confidence Scale Hindi (ABC- H), the Physical Health Subscale of the WHO-BREF Questionnaire and the Geriatric Depression Scale: Short Form Hindi (GDS-SFH) to test the criterion and concurrent validity.

RESULTS

The mean score and standard deviation of the LSA-H questionnaire were 56.53 ± 35.99, those of the Physical Health Subscale of the WHO-BREF instrument were 18.54 ± 7.87, those of the GDS-SFH questionnaire were 6.95 ± 4.21 and those of the ABC- H questionnaire were 54.40 ± 28.96. The Pearson correlation coefficient (r) between the LSA-H score and ABC-H score was 0.707 (p value < 0.0001), that between the LSA-H score and the Physical Health Subscale of the WHO-BREF was 0.766 (p value < 0.0001), and that between the LSA-H score and GDS-SFG score was - 0.674 (p value < 0.0001).

CONCLUSION

This study demonstrated that the Hindi version of the LSA is a valid and reliable instrument for assessing living space among older adults in the Hindi language in an Indian population. Furthermore, the LSA-H was significantly correlated with other health assessment tools in terms of functional mobility, general health status and mental well-being.

The effects of treatment with pimavanserin on activities of daily living in patients with Parkinson's disease psychosis: a 16-week, single-arm, open-label study

Background

More than half of patients with Parkinson's disease will experience psychosis symptoms in the form of hallucinations or delusions at some point over the course of their disease. These symptoms can significantly impact patients' health-related quality of life, cognitive abilities, and activities of daily living (ADLs) and function. Clinical assessment of how psychosis impacts these measures is crucial; however, few studies have assessed this sufficiently, in part due to a lack of appropriate scales for comprehensively assessing function.

Objective

The objective was to assess how symptoms of Parkinson's disease psychosis (PDP) impact ADLs and function, cognitive function, and health-related quality of life.

Design

To address this unmet need, we utilized a modified version of the Functional Status Questionnaire (mFSQ) to measure the impact of psychosis on ADLs and function in patients with PDP treated with pimavanserin, a US Food and Drug Administration-approved medication to treat hallucinations and delusions associated with PDP.

Methods

Eligible patients entered a 16-week, single-arm, open-label study of oral pimavanserin (34 mg) taken once daily. The primary endpoint was change from baseline to Week 16 on the mFSQ. Secondary endpoints included the Movement Disorders Society-modified Unified Parkinson's Disease Rating Scale (MDS-UPDRS) I and II; Schwab and England ADL; Clinical Global Impression-Severity of Illness (CGI-S), Clinical Global Impression-Improvement (CGI-I), and Patient Global Impression-Improvement (PGI-I), and were also measured as change from baseline to Week 16 using mixed-effects model for repeated measures (MMRM) and least-squares mean (LSM).

Results

Our results in a proof-of-concept, 16-week, open-label clinical study in 29 patients demonstrated that an improvement in psychosis symptoms following treatment with pimavanserin was associated with improvements in multiple measures of ADLs and function. Notably, a significant improvement was found on the primary endpoint, change from baseline to Week 16 in mFSQ score [LSM [SE] 14.0 [2.50], n = 17; 95% CI (8.8, 19.3); p < 0.0001].

Conclusion

These findings highlight the potential for improvement in function with improvement of psychosis symptoms in patients with PDP and suggest that the mFSQ may be a measurement tool to evaluate the level of improvement in function.

Trial registration

ClinicalTrials.gov Identifier: NCT04292223.

[Long covid and disability]

Long covid is a health problem that will entail a high hidden cost attributable to the pandemic years after it because it affects the work capacity of many workers. Given the millions of covid-19 cases worldwide and current research showing that one in 7covid-19 patients remain symptomatic at 12 weeks, the number of long covid patients is likely to be substantial. Long covid is characterized by heterogeneous sequelae that often affect multiple systems, organs with an impact on the functioning and capacity of the worker. Workers with long covid symptoms can return to their occupation but this involves a complex individualized approach to the impact of symptoms on work, adjustments and modifications to the workplace. Patients with long covid typically report prolonged multisystem involvement and signicant disability. The psychological cost to the worker must also be addressed. A survey by the Community of Madrid (CCOO, SATSE, CSIF, AMYTS) in 2022 reveals that 24.5% of those affected by long covid were sick for more than 12 months; 30% of those affected by persistent covid need and adaption to their workplace. In Spain, more than 10million people infected with SARS-CoV-2 have been reported since the pandemic began, so it is estimated that there could be one million people with persistent covid. In 2021 alone there were more than 2.6 million sick leave due to covid-19 in Spain, the average duration of which was 10 days. One hundred million people around the world suffer from persistent covid, but few countries officially count them, nor do they help those affected with employment. In advanced countries, like the United States, long covid is treated as a disability,and the number of people with disabilities working or looking for work increased by 1.36 million, an increase of 23%, between January 2021 and January 2022. In the United Kingdom, some 200,000 people are not working or are not looking for work due to long-term health problems attributable to long covid, since the pandemic began.

The California Cognitive Assessment Battery (CCAB)

Introduction

We are developing the California Cognitive Assessment Battery (CCAB) to provide neuropsychological assessments to patients who lack test access due to cost, capacity, mobility, and transportation barriers.

Methods

The CCAB consists of 15 non-verbal and 17 verbal subtests normed for telemedical assessment. The CCAB runs on calibrated tablet computers over cellular or Wi-Fi connections either in a laboratory or in participants' homes. Spoken instructions and verbal stimuli are delivered through headphones using naturalistic text-to-speech voices. Verbal responses are scored in real time and recorded and transcribed offline using consensus automatic speech recognition which combines the transcripts from seven commercial ASR engines to produce timestamped transcripts more accurate than those of any single ASR engine. The CCAB is designed for supervised self-administration using a web-browser application, the Examiner. The Examiner permits examiners to record observations, view subtest performance in real time, initiate video chats, and correct potential error conditions (e.g., training and performance failures, etc.,) for multiple participants concurrently.

Results

Here we describe (1) CCAB usability with older (ages 50 to 89) participants; (2) CCAB psychometric properties based on normative data from 415 older participants; (3) Comparisons of the results of at-home vs. in-lab CCAB testing; (4) We also present preliminary analyses of the effects of COVID-19 infection on performance. Mean z-scores averaged over CCAB subtests showed impaired performance of COVID+ compared to COVID- participants after factoring out the contributions of Age, Education, and Gender (AEG). However, inter-cohort differences were no longer significant when performance was analyzed with a comprehensive model that factored out the influences of additional pre-existing demographic factors that distinguished COVID+ and COVID- cohorts (e.g., vocabulary, depression, race, etc.,). In contrast, unlike AEG scores, comprehensive scores correlated significantly with the severity of COVID infection. (5) Finally, we found that scoring models influenced the classification of individual participants with Mild Cognitive Impairment (MCI, z-scores < -1.50) where the comprehensive model accounted for more than twice as much variance as the AEG model and reduced racial bias in MCI classification.

Discussion

The CCAB holds the promise of providing scalable laboratory-quality neurodiagnostic assessments to underserved urban, exurban, and rural populations.

The little intervention that could: creative aging implies healthy aging among Canadian seniors

OBJECTIVES

Through a process of 'creative ageing', there is increased interest in how active participation in the arts can help promote health and well-being among seniors. However, few studies have quantitatively examined the benefits of a foray into artistic expression, and even fewer employ rigorous identification strategies. Addressing this knowledge gap, we use a series of quantitative techniques (ordinary least squares and quantile regression) to analyze the impact of an arts-based intervention targeting the elderly.

METHODS

Recruited from Saint John, New Brunswick (a city of about 125,000 people in Eastern Canada), 130 seniors were randomly assigned to the programme, with the remaining 122 serving as the control. This intervention consisted of weekly 2-h art sessions (i.e. drawing, painting, collage, clay-work, performance, sculpting, and mixed media), taking place from January 2020 until April 2021.

RESULTS

Relative to the control group, the intervention tended to reduce participant loneliness and depression, and improve their mental health. Outcomes were more evident toward the latter part of the programme, were increasing in attendance, and most efficacious among those with initially low levels of well-being.

CONCLUSION

These findings imply that creative ageing promotes healthy ageing, which is especially noteworthy given COVID-19 likely attenuated our results.

Health-related quality of life assessment instruments for extracorporeal membrane oxygenation survivors: A scoping review

BACKGROUND AND OBJECTIVE

Extracorporeal membrane oxygenation (ECMO) has been successfully and widely used in adult patients for the past 5 years. About 50% of these patients can survive and are discharged from hospitals. Health-related quality of life (HRQOL) is crucial for evaluating survived ECMO patients. This scoping review aims to identify instruments commonly used to measure HRQOL of ECMO survivors and give pertinent instrument characteristics.

METHODS

A systematic search was conducted in PubMed, Web of Science, EMBASE (OVID), MEDLINE (OVID), CINAHL (EBSCO), Cochrane Library, and three Chinese databases from January 2012 to December 2021. Two reviewers independently reviewed publication selection and data extraction.

RESULTS

Twenty-nine studies met the inclusion criteria. Most studies (93%) were cross-sectional, and the median (or average) follow-up time ranged from 3 months to 9 years. Two prospective studies (7%) followed patients longitudinally until 1 year after discharge. ECMO survivors had poorer long-term HRQOL than the general population. However, it is comparable to or better than patients with other critical or chronic illnesses. Identified HRQOL assessment instruments show four generic HRQOL instruments, one disease-specific HRQOL instrument, and nineteen single-dimensional instruments. Seven instruments were used in more than three articles. SF-36 (86.2%), IES/IES-R (41.4%), and HADS (37.9%) were the most frequently used instruments.

CONCLUSION

The timing, frequency, and tools for HRQOL assessment of ECMO survivors are variable. No ECMO-specific HRQOL instrument was developed and validated. Further studies on assessment instruments are warranted. Research is also needed to identify interventions that may enhance HRQOL in ECMO survivors.

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.

The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature

BACKGROUND

Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity.

OBJECTIVE

To review the relationship between mental health and lost productivity and undertake a critical review of the published literature.

METHODS

A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken.

RESULTS

Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality.

CONCLUSION

Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.

Designing Mobile Health Applications to Support Walking for Older Adults

Physical activity is extremely important at an older age and has major benefits. There is a range of applications that help maintain physical activity. However, their adoption among older adults is still limited. The purpose of the study is to explore the key aspects of the design of mobile applications that support walking for older adults. We conducted a field study with older adults, aged 69-79 years, using a technology probe (a mobile application developed as an early prototype) with the purpose of eliciting requirements for mobile health applications. We interviewed the participants during and after the study period, asking them about their motivation for walking, usage of the application, and overall preferences when using such technologies. The findings suggest that mobile applications that support walking should address a range of walking variables, support a long-term learning process, and enable the user to take control and responsibility for the walk. In addition, we provide design guidelines concerning the motivation for walking and the data visualization that would make technology adoption easier. The findings from this study can be used to inform the design of more usable products for older users.

Stigma, self-compassion, and psychological distress among people with Parkinson's

PURPOSE

People with Parkinson's disease (hereafter Parkinson's) can experience stigma through the attitudes and actions of others (enacted stigma) and through anticipation of enacted stigma and internalisation of negative stereotypes (felt stigma). Self-compassion may protect against the impact of stigma. This study aimed to investigate the relationships between self-compassion, stigma, and psychological distress among people with Parkinson's.

METHODS

A total of 130 people with Parkinson's completed questionnaires measuring self-compassion, enacted and felt stigma, and depression, anxiety, and stress. Correlation, mediation, and moderation models were used to investigate relationships between variables.

RESULTS

All variables correlated significantly in the expected directions. Felt stigma mediated the relationship between self-compassion and the three outcome variables - depression, anxiety, and stress. Self-compassion did not moderate the relationship between enacted stigma and distress and suggested enacted stigma was associated with distress, regardless of levels of self-compassion.

CONCLUSIONS

Self-compassion and both enacted and felt stigma are important predictors of distress for people with Parkinson's. Part of the relationship between lower self-compassion and psychological distress appears to occur via the internalisation of stigma. These findings may be relevant to the development of individualised and societal interventions with the aim of improving the psychological wellbeing of people with Parkinson's.Implications for rehabilitationSelf-compassion was associated with lower levels of psychological distress (i.e., depression, anxiety, and stress) and self-stigma partially mediated this relationship.Self-compassion did not moderate the relationship between enacted stigma and psychological distress, suggesting enacted stigma increases distress, regardless of self-compassion.The development and assessment of the effectiveness of compassion-focused interventions tailored for people with Parkinson's may be important as well as systemic stigma focused interventions.

Health-Related Quality of Life (HRQOL) Instruments and Mobility: A Systematic Review

Physical function is one of the most important constructs assessed in health-related quality of life (HRQOL), and it could be very useful to assess movement ability from the perspective of the patient. The objective of this study was to compare the content of the domains related to mobility covered by the HRQOL questionnaires based on the International Classification of Functioning, Disability and Health (ICF) and to evaluate their quality according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. For this, a systematic review was carried out in the databases Scopus, Web of Science and Science Direct. The inclusion criteria were development and/or validation studies about generic HRQOL measures, and the instruments had to include items related to mobility and studies written in English or Spanish. The comparison of content was performed using the ICF coding system. A total of 3614 articles were found, 20 generic HRQOL instruments were identified and 120 (22.4%) mobility-related items were found. Walking was the most represented category. Low-quality evidence on some measurement properties of the generic HRQOL instruments was revealed. The CAT-Health is a useful questionnaire to be used in rehabilitation due to its psychometric properties and its content.

COVID-19: dealing with ventilator shortage

PURPOSE OF REVIEW

To describe different strategies adopted during coronavirus disease 2019 pandemic to cope with the shortage of mechanical ventilators.

RECENT FINDINGS

Short-term interventions aimed to increase ventilator supply and decrease demand. They included: redistributing and centralizing patients, repurposing operating rooms into intensive care units (ICUs) and boosting ventilator production and using stocks and back-ups; support by the critical care outreach team to optimize treatment of patients in the ward and permit early discharge from the ICU, ethical allocation of mechanical ventilators to patients who could benefit more from intensive treatment and short term ICU trials for selected patients with uncertain prognosis, respectively. Long-term strategies included education and training of non-ICU physicians and nurses to the care of critically-ill patients and measures to decrease viral spread among the population and the progression from mild to severe disease.

SUMMARY

The experience and evidence gained during the current pandemic is of paramount importance for physicians and law-makers to plan in advance an appropriate response to any future similar crisis. Intensive care unit, hospital, national and international policies can all be improved to build systems capable of treating an unexpectedly large number of patients, while keeping a high standard of safety.

Predicting future cognitive decline from non-brain and multimodal brain imaging data in healthy and pathological aging

Previous literature has focused on predicting a diagnostic label from structural brain imaging. Since subtle changes in the brain precede a cognitive decline in healthy and pathological aging, our study predicts future decline as a continuous trajectory instead. Here, we tested whether baseline multimodal neuroimaging data improve the prediction of future cognitive decline in healthy and pathological aging. Nonbrain data (demographics, clinical, and neuropsychological scores), structural MRI, and functional connectivity data from OASIS-3 (N = 662; age = 46-96 years) were entered into cross-validated multitarget random forest models to predict future cognitive decline (measured by CDR and MMSE), on average 5.8 years into the future. The analysis was preregistered, and all analysis code is publicly available. Combining non-brain with structural data improved the continuous prediction of future cognitive decline (best test-set performance: R2 = 0.42). Cognitive performance, daily functioning, and subcortical volume drove the performance of our model. Including functional connectivity did not improve predictive accuracy. In the future, the prognosis of age-related cognitive decline may enable earlier and more effective individualized cognitive, pharmacological, and behavioral interventions.

Examining the Delivery of a Tailored Chinese Mind-Body Exercise to Low-Income Community-Dwelling Older Latino Individuals for Healthy Aging: Feasibility and Acceptability Study

Background

Older Latino individuals are disproportionally affected by various chronic conditions including impairments in physical and cognitive functions, which are essential for healthy aging and independent living.

Objective

This study aimed to evaluate the feasibility and acceptability of FITxOlder, a 12-week mind-body exercise program, in community-dwelling low-income, predominantly older Latino individuals, and assess its preliminary effects on health parameters relevant to healthy aging and independent living.

Methods

This 12-week, single-arm, stage 1B feasibility study had a pre- and poststudy design. A total of 13 older adults (mean age 76.4, SD 7.9 years; 11/13, 85% Latino) of a congregate meal program in a senior center were enrolled. FITxOlder was a tailored Chinese mind-body exercise program using Five Animal Frolics led by a bilingual community health worker (CHW) participating twice a week at the senior center and facilitated by mobile health technology for practice at home, with incrementally increasing goals moving from once a week to at least 3 times a week. The feasibility and acceptability of the study were examined using both quantitative and qualitative data. Healthy aging–related outcomes (eg, physical and cognitive function) were assessed using paired 2-tailed t tests. Qualitative interview data were analyzed using thematic analysis.

Results

The attendance rate for the 24 exercise sessions was high (22.7/24, 95%), ranging from 93% (1.8/2) to 97% (1.9/2) over the 12 weeks. Participants were compliant with the incremental weekly exercise goals, with 69.2% (9/13) and 75.0% (9/12) meeting the home and program goals in the last 4 weeks, respectively. Approximately 83% (10/12) to 92% (11/12) of the participants provided favorable feedback on survey questions regarding the study and program implementation, such as program content and support, delivery by the CHW, enjoyment and appeal of the Five Animal Frolics, study burden and incentives, and safety concerns. The qualitative interview data revealed that FITxOlder was well accepted; participants reported enjoyment and health benefits and the desire to continue to practice and share it with others. The 5-time sit-to-stand test (mean change at posttest assessment=−1.62; P<.001; Cohen d=0.97) and 12-Item Short Form Health Survey physical component scores (mean change at post intervention=5.71; P=.01; Cohen d=0.88) exhibited changes with large effect sizes from baseline to 12 weeks; the other parameters showed small or medium effect sizes.

Conclusions

The research findings indicated that the CHW-led and mobile health–facilitated Chinese qigong exercise program is feasible and acceptable among low-income Latino older adults. The trending health benefits of the 12-week FITxOlder program suggest it is promising to promote physical activity engagement in underserved older populations to improve health outcomes for healthy aging and independent living. Future research with larger samples and longer interventions is warranted to assess the health benefits and suitability of FITxOlder.

What Do We Know Today about Long COVID? Nursing Care for a New Clinical Syndrome

Persistent COVID, long COVID, long-effects, long-term effects or chronic COVID are all names of a new syndrome caused by a set of multi-organ symptoms that appear after having been infected with SARS-CoV-2 [...].

Palliative Care, Patient-Reported Measures, and Outcomes in Hospitalized Patients With Cirrhosis

CONTEXT

Studies of palliative care (PC) in hospitalized patients with cirrhosis have been retrospective, with limited evaluation of patient-reported measures and outcomes.

OBJECTIVES

To examine the relationship between PC, patient-reported measures (quality of life and functional status), and outcomes.

METHODS

We performed a prospective cohort study of patients with cirrhosis hospitalized from 2014 to 2019. We recorded PC consultation details, quality of life (chronic liver disease questionnaire), and functional status (functional status questionnaire). Patients were followed for 90 days to assess readmissions, costs, and mortality.

RESULTS

Seventy-four of 679 patients saw PC, often later in the hospitalization (median hospital day 8; IQR 4-16). Those who saw PC had greater Charlson comorbidity index (mean 6.8 vs. 5.9), MELD (mean 25 vs. 20), and prior 30-day admission (47% vs. 35%). Compared to those who did not see PC, PC patients had greater impairments in intermediate activities of daily living (83% vs. 72%), social activity (72% vs. 59%), quality of interactions (49% vs. 36%), abdominal symptoms (mean score 3.1 vs. 3.6), activity (mean 3.3 vs. 3.6), and overall quality of life (mean 3.6 vs. 3.8). PC was associated with fewer transfusions and upper endoscopies and with greater completion of advanced directives. After multivariable adjustment, PC was not associated with intensive care, 30-day readmissions, 90-day costs, or mortality.

CONCLUSION

PC occurs infrequently and late in those with more severe liver disease and functional impairment. PC may be associated with reduction in utilization and greater completion of advanced directives. Randomized trials are needed to evaluate PC for this population.

Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis

BACKGROUND & AIMS

Patients with cirrhosis have high rates of hospital readmission, but prediction models are suboptimal and have not included important patient-reported outcome measures (PROMs). In a large prospective cohort, we examined the impact of PROMs on prediction of 30-day readmissions.

METHODS

We performed a prospective cohort study of adults with cirrhosis admitted to a tertiary center between June 2014 and March 2020. We collected clinical information, socioeconomic status, and PROMs addressing functional status and quality of life. We used hierarchical competing risk time-to-event analysis to examine the impact of PROMs on readmission prediction.

RESULTS

A total of 654 patients were discharged alive, and 247 (38%) were readmitted within 30 days. Readmission was independently associated with cerebrovascular disease, ascites, prior hospital admission, admission via the emergency department, lower albumin, higher Model for End-Stage Liver Disease, discharge with public transportation, and impaired basic activities of daily living and quality-of-life activity domain. Reduced readmission was associated with cancer, admission for infection, children at home, and impaired emotional function. Compared with a model including only clinical variables, addition of functional status and quality-of-life variables improved the area under the receiver-operating characteristic curve from 0.72 to 0.73 and 0.75, with net reclassification indices of 0.22 and 0.18, respectively. Socioeconomic variables did not significantly improve prediction compared with clinical variables alone. Compared with a model using electronically available variables only, no models improved prediction when examined with integrated discrimination improvement.

CONCLUSIONS

PROMs may marginally add to the prediction of 30-day readmissions for patients with cirrhosis. Poor social support and disability are associated with readmissions and may be high-yield targets for future interventions.

Reliability and Validity of the Function Impairment Screening Tool in Chinese Older Adults

Background: Physical function gradually decreases with age in older adults, affecting their independence and quality of life and leaving them prone to adverse outcomes. Despite the importance of assessing function for older adults, most studies have focused on disability and paid less attention to functional impairment. Thus, given the lack of valid and practical methods for evaluating functional impairment for older adults, we developed the function impairment screening tool (FIST) using the Delphi method.

Objective: This study aimed to evaluate the reliability and validity of the FIST in Chinese older adults.

Methods: A total of 489 participants aged 60 years or older, and who had completed the FIST were included. A subgroup of 50 participants completed the FIST a second time, 1 week after the first round, and the test–retest reliability was evaluated using the intraclass correlation coefficient (ICC). Reliability was tested using Cronbach's alpha. Validity was examined using exploratory factor analysis. Criterion-related validity was assessed using correlations between the FIST and the Barthel Index activities of daily living (ADL), Lawton, and Brody instrumental activities of daily living (LB-IADL).

Results: The Cronbach's alpha coefficient for the FIST was 0.930 (P < 0.001). The test–retest reliability was good, with an ICC of 0.928 (95% confidence interval [0.874, 0.960]). Exploratory factor analyses revealed one factor accounting for 60.14% of the scale's variance and the load values of every item were >0.4 (0.489–0.872). The correlation coefficient was 0.572 (P < 0.001) between the FIST score and ADL, and was 0.793 (P < 0.001) between the FIST score and IADL. The FIST score was positively correlated with walking speed (r = 0.475, P < 0.001) and grip strength (r = 0.307, P < 0.001), and negatively correlated with age (r = −0.588, P < 0.001) and Fried frailty phenotype (r = −0.594, P < 0.001).

Conclusion: The FIST is a reliable and valid instrument for assessing physical function impairment in older adults.

Adapting Chinese Qigong Mind-Body Exercise for Healthy Aging in Older Community-Dwelling Low-income Latino Adults: Pilot Feasibility Study

BACKGROUND

Research translating the evidence for the benefit of mind-body exercise in older Latinos with limited access to community-based healthy aging programs is sparse.

OBJECTIVE

This study aimed to evaluate the feasibility of Function Improvement Exercises for Older Sedentary Community-Dwelling Latino Residents (FITxOlder), a Community Health Worker (CHW)-led, mobile technology-facilitated Chinese Qigong mind-body exercise program for healthy aging and to explore its impact on physical and cognitive function and quality of life (QoL) in older community-dwelling low-income Latino adults.

METHODS

This study was designed as a Stage 1 feasibility study to develop and pilot-test FITxOlder. In Phase 1 (Stage 1A), a working group of seniors, CHWs, and senior center staff guided the adaptation of Chinese Qigong into a healthy aging program. In Phase 2 (Stage 1B), 49 older Latino adults participated in a 3-arm controlled study to test the feasibility and preliminary effect of CHW-led FITxOlder on physical and cognitive function and QoL measures over 16 weeks.

RESULTS

Although the COVID-19 pandemic disrupted the implementation of the study protocol, we found favorable results regarding participant recruitment, retention, and fidelity of implementation. Notable findings included an 89.3% participant retention, 79.4% of the participants completed at least 70% of the weekly exercise goal, and no report of adverse events. The effects on intervention outcome measures were modest.

CONCLUSIONS

FITxOlder is feasible for promoting healthy aging in older Latino adults; future research needs to compare its feasibility with other low-impact exercise programs for healthy aging using a randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04284137; https://clinicaltrials.gov/ct2/show/NCT04284137.

Association between serum zinc levels and basic physical functioning: secondary data analysis of NHANES 2011-14

Background

Serum zinc (Zn) levels have been shown to be associated with functional status; however, it is not clear whether this association differs by other sociodemographic characteristics. We examined the association between serum Zn levels and physical functioning difficulty in a representative sample of older adults in the US.

Design and methods

A cross-sectional study was conducted on participants 50 years and older from the 2011–12 and 2013–14 National Health and Nutrition Examination Surveys (n = 1136). Serum Zn levels were analyzed as tertiles. The main outcome of interest was physical functioning difficulty, defined as self-reported difficulty of basic physical functioning that included walking, transferring, dressing, and feeding.

Results

Mean Zn levels (SE) were 0.67(0.1), 0.81(0.1), and 0.98(0.1) μg/mL in the low, middle, and high Zn groups, respectively. Approximately 24.9% participants reported physical functioning difficulty. In the multivariable model, we found a significant multiplicative interaction between sex and serum Zn (P for interaction =0.028) and between education and serum Zn (P for interaction = 0.001) on basic physical functioning difficulty. The stratified analysis revealed that among men, compared to those with low serum Zn, the odds of having physical functioning difficulty were lower in men who had high serum Zn [aOR 0.43 (95% CI: 0.25–0.76)]. For women, compared to those with low serum Zn the odds of having physical functioning difficulty were higher in women who had middle serum Zn [aOR 2.67 (1.58–4.50)]. Among individuals with less than high school education, the odds of having physical functioning difficulty were lower in those who had middle serum Zn compared to those who had low serum Zn [aOR 0.48 (0.26–0.89)]. However, the odds of having physical functioning difficulty were higher in those who had middle serum Zn compared to those who had low serum Zn for individuals with high school [aOR 5.72 (1.92–17.00)] and beyond high school education [aOR 1.77 (1.05–2.97)], respectively.

Conclusion

Sex and educational attainment interact with serum Zn levels to influence basic physical functioning difficulty in older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00461-z.

Impact of whey protein supplementation in a weight-loss intervention in rural dwelling adults: A feasibility study

BACKGROUND & AIMS

Weight loss in older adults enhances physical function, but may lead to sarcopenia and osteoporosis. Whey protein is a low cost rich source of essential amino acids, may improve physical function. We evaluated the feasibility and acceptability of consuming whey protein in the context of a weight-loss intervention in older adults with obesity.

METHODS

A 12-week pilot feasibility, non-randomized weight loss study of 28 older adults was conducted, consisting of individualized, weekly dietitian visits with twice weekly physical therapist-led group strengthening classes. Half consumed whey protein, three times weekly, following exercise. Preliminary efficacy measures of body composition, sit-to-stand, 6-min walk and grip strength and subjective measures of self-reported health and function were also evaluated.

RESULTS

Of the 37 enrolled, 28 completed the study (50 % in the protein group). Attendance rates for protein vs. non-protein groups were 89.9 ± 11.1 % vs. 95.6 ± 3.4 % (p = 0.08). Protein consumption was high in those attending classes (90.3 %) as was compliance at home (82.6 %). Whey was pleasant (67.3 ± 22.1, range 30-100, above average), had little aftertaste, and was neither salty or sticky. All were compliant (0.64 ± 0.84, range 0-5, low = higher compliance). Both groups lost significant weight (protein vs. no protein, -3.45 ± 2.86 vs. -5.79 ± 3.08, p = 0.47); Sit-to-stand, 6-min walk, and gait speed were no different, grip strength was improved in the protein compared to the non-protein group (-2.63 kg vs. 4.29 kg; p < 0.001).

CONCLUSIONS

Our results suggest that whey protein is a low-cost and readily available nutritional supplement that can be integrated into a weight loss intervention.

A causal model of functional status among persons with liver cirrhosis from four public hospitals in Thailand

Purpose

The purpose of this study is to develop and test the causal relationships between alcohol consumption, social support, illness perception, fatigue and functional status among persons with liver cirrhosis. The hypothesized model was developed based on the theory of unpleasant symptoms.

Design/methodology/approach

A cross-sectional study was conducted among 400 persons with liver cirrhosis by stratified random sampling. Data were collected at outpatient departments from four public hospitals across three regions in Thailand. Six self-report questionnaires were utilized to collect data from March to August 2020. The developed model was verified via a structural equation modeling analysis.

Findings

The proposed model fit with the empirical data considering from χ2/df = 2.397 (p = 0.061), root mean square error of approximation (RMSEA) = 0.056, comparative fit index (CFI) = 0.985, Tucker–Lewis index (TLI) = 0.981, and standardized root mean square residual (SRMR) = 0.048. The model explained 71.30% of the total variance in functional status. Social support was the most influential factor affecting functional status both directly and indirectly through illness perception. Illness perception had a negative direct effect on functional status and a positive indirect effect on functional status through fatigue. Fatigue had a negative direct effect on functional status. Alcohol consumption was found as the lowest influential factor affecting functional status.

Originality/value

This is the first study that explores the characteristics of functional status among persons with liver cirrhosis comprehensively. A causal relationship among various variables found in this study would shed light as important fundamental data for developing interventions to enhance functional status among this population.

Relationship between social support, physical symptoms, and depression in women with breast cancer and pain

PURPOSE

Fatigue and pain are common among women with breast cancer, and often related to depressive symptoms. Social support may influence levels of fatigue, pain interference, and depressive symptoms. We tested a theory-based, structural model examining the relationship between social support (i.e., emotional and instrumental) and depressive symptoms via fatigue and pain interference in women with breast cancer.

METHODS

Women (N = 327) with stages I-III breast cancer were enrolled in a randomized trial investigating a behavioral pain intervention. Measures of social support, fatigue, pain interference, and depressive symptoms were completed at enrollment. Data were analyzed using structural equation modeling to test direct and indirect pathways relating social support, fatigue, pain interference, and depressive symptoms.

RESULTS

Our model evidenced good fit. Significant direct effects emerged linking higher levels of emotional support with lower levels of fatigue (β = -.30), pain interference (β = -.32), and depressive symptoms (β = -.31). More instrumental support was significantly associated with more depressive symptoms (β = .11), but not fatigue or pain interference. Higher levels of fatigue (β = .30) and pain interference (β = .34) were significantly related to higher levels of depressive symptoms. More emotional support related to less depressive symptoms via lower levels of fatigue (β = -.09) and pain interference (β = -.11).

CONCLUSION

Women reporting higher levels of emotional support endorsed fewer depressive symptoms, and that relationship was driven by lower levels of fatigue and pain interference. Our results highlight novel pathways that healthcare professionals can leverage to optimize social support topics in psychosocial interventions targeting breast cancer symptoms. This model should be replicated using longitudinal data.

Behavioral cancer pain intervention using videoconferencing and a mobile application for medically underserved patients: Rationale, design, and methods of a prospective multisite randomized controlled trial

BACKGROUND

Women with breast cancer in medically underserved areas are particularly vulnerable to persistent pain and disability. Behavioral pain interventions reduce pain and improve outcomes. Cancer patients in medically underserved areas receive limited adjunctive cancer care, as many lack access to pain therapists trained in behavioral interventions, face travel barriers to regional medical centers, and may have low literacy and limited resources. mHealth technologies have the potential to decrease barriers but must be carefully adapted for, and efficacy-tested with, medically underserved patients. We developed an mHealth behavioral pain coping skills training intervention (mPCST-Community). We now utilize a multisite randomized controlled trial to: 1) test the extent mPCST-Community reduces breast cancer patients' pain severity (primary outcome), pain interference, fatigue, physical disability, and psychological distress; 2) examine potential mediators of intervention effects; and 3) evaluate the intervention's cost and cost-effectiveness.

METHODS/DESIGN

Breast cancer patients (N = 180) will be randomized to mPCST-Community or an attention control. mPCST-Community's four-session protocol will be delivered via videoconferencing at an underserved community clinic by a remote pain therapist at a major medical center. Videoconference sessions will be supplemented with a mobile application. Participants will complete self-report measures at baseline, post-intervention, and 3- and 6-month follow-ups.

CONCLUSIONS

mPCST-Community has the potential to reduce pain and disability, and decrease barriers for cancer patients in medically underserved areas. This is one of the first trials to test an mHealth behavioral cancer pain intervention developed specifically for medically underserved communities. If successful, it could lead to widespread implementation and decreased health disparities.

A community-based study of prevalence and functional status of major depressive disorder in an industrial area

BACKGROUND

Depression is a significant public health issue that needs to be taken care of, as it poses a great economic burden on the society at large. Early identification and treatment of the patients will reduce mental morbidity and disability.

AIM

The aim is to study the prevalence and functional status of subjects with major depressive disorder in the community.

MATERIALS AND METHODS

After identification of the sample population, the sociodemographic details were recorded. Subsequently, assessment was carried out by General Health Questionnaire (GHQ), Patient Health Questionnaire-9 (PHQ-9), Functional Status Questionnaire (FSQ), and Mini Mental State examination (MMSE).

RESULTS

A total of 2000 subjects were screened using the GHQ and PHQ and 544 subjects were selected. These 544 subjects were further assessed with FSQ and MMSE. Out of the 544 subjects, 65.1% had a GHQ score of <14, 22.1% had a score between 15 and 19, and 12.9% had a score of >20. The PHQ-9 score was found to be <5 in 28.9% subjects, 5-14 in 64.3% subjects, and >14 in 6.8% subjects. Majority of the sample population was in the warning zone according to the FSQ. The MMSE scores were ≥23 in 86% and ≤22 in 14% of the patients. Over 65% of the subjects were relatively mentally healthy. Out of the remaining 35%, 22% of the subjects required screening for psychiatric disorders and 13% of them did require active psychiatric intervention.

CONCLUSIONS

It would be beneficial to the community if a database is created regarding the psychiatric disorders such as depression prevalent in the community and their functional status so that the effective measures can be implemented to minimize the suffering by providing effective psychiatric care at the earliest and follow them up in the long run.

Intensive nutrition counseling as part of a multi-component weight loss intervention improves diet quality and anthropometrics in older adults with obesity

BACKGROUND AND AIMS

Obesity significantly impacts older adults. Intensive nutrition counseling can aid in weight reduction and improve diet quality, but data are sparse in this population. The objective of this intervention is to determine how intensive nutrition counseling affects diet quality and anthropometric measures during a multi-component weight loss intervention in rural older adults with obesity.

METHODS

A series of 12-week, single-arm feasibility pilots were conducted in fall 2017 and winter/spring 2018 in a community aging center in rural Northern New England. Adults were eligible if ≥ 65 years old with a Body Mass Index (BMI) ≥30 kg/m². Exclusion criteria included dementia/cognitive impairment, uncontrolled psychiatric illness, weight-loss surgery, weight loss >5% in previous 6-months, life-threatening illness, palliative/hospice services, current participation in another weight-loss study/program, obesogenic medications, or presence of major chronic conditions. Participants received once-weekly nutrition counseling by a registered dietitian nutritionist (RDN), and twice-weekly exercise sessions by a physical therapist (PT). Primary outcomes were diet quality changes measured by total Rapid Eating and Activity Assessment for Patients-Short Version (REAP-S) and Automated Self-Administered 24-h dietary recall (ASA-24). Secondary outcome measures were changes in weight (kilograms) and waist circumference (centimeters). McNemar test was conducted for all paired categorical data while paired t-tests were conducted for all paired continuous data. All analyses were conducted in R; p-value<0.05 was significant.

RESULTS

Total n = 23. Mean age was 72.2 (5.8) years (73.9% female); mean BMI was 35.9 ± 5.0 kg/m². At 12 weeks, diet quality significantly improved. REAP-S scores increased by 3.53 ± 3.13 points (p < 0.001). Kilocalories, grams fat, grams saturated fat, milligrams sodium, grams added sugar, and grams alcohol via ASA-24 significantly decreased (all p < 0.05). Significant reductions in weight (-5.22 ± 3.13 kg) and waist circumference (-6.88 ± 5.67 cm) were observed (both p < 0.001).

CONCLUSION

Intensive nutrition counseling significantly enhances diet quality and reduces weight and waist circumference in rural older adults with obesity.

Continence: Bowel and Bladder and Physical Function Decline in Women

Purpose of review

The purpose of this article is to review the various forms of incontinence, highlight their impact on older women, and to explore current literature regarding the link between physical activity, physical function, and incontinence.

Recent findings

Both urinary and fecal incontinence become more prevalent with age, and are associated with significant morbidity. In parallel, there is a well-established decline in physical function that occurs with age. Furthermore, incontinence has a bidirectional relationship with physical function decline. Given the known link between increasing physical activity and preserved physical function, there is an emerging body of literature seeking to determine whether increases in physical activity may also improve incontinence outcomes. We review some recent data on this topic.

Summary

Continence and physical function are two closely linked entities. Further research is needed to determine whether interventions that increase physical activity might result in improved continence outcomes.

Influence of Gender on Tourette Syndrome Beyond Adolescence

Although boys are disproportionately affected by tics in Tourette syndrome (TS), this gender bias is attenuated in adulthood and a recent study has suggested that women may experience greater functional interference from tics than men. The authors assessed the gender distribution of adults in a tertiary University-based TS clinic population and the relative influence of gender and other variables on adult tic severity (YGTSS score) and psychosocial functioning (GAF score). We also determined retrospectively the influence of gender on change in global tic severity and overall TS impairment (YGTSS) since adolescence. Females were over-represented in relation to previously published epidemiologic surveys of both TS children and adults. Female gender was associated with a greater likelihood of tic worsening as opposed to tic improvement in adulthood; a greater likelihood of expansion as opposed to contraction of motor tic distribution; and with increased current motor tic severity and tic-related impairment. However, gender explained only a small percentage of the variance of the YGTSS global severity score and none of the variance of the GAF scale score. Psychosocial functioning was influenced most strongly by tic severity but also by a variety of comorbid neuropsychiatric disorders.

A Scoping Review of Nonpharmacological Interventions to Reduce Disability in Older Adults

BACKGROUND AND OBJECTIVES

Minimizing disability is critical to reduce the costly health care associated with disability and maintain quality of life into old age. We examined the effect sizes of nonpharmacological intervention studies in reducing disability and explored the active ingredients of interventions.

RESEARCH DESIGN AND METHODS

A scoping review was conducted via PubMed, PsycINFO, and CINAHL databases. Thirty-one randomized controlled trials were included. Eight active ingredients were identified by three experts (exercise, problem-solving, cognitive behavioral therapy, environmental modification, education, goal setting, comprehensive geriatric assessment, and cognitive training).

RESULTS

The range of Cohen's d was -0.85 to 1.76 across 31 studies (included 33 interventions); 67% studies (n = 22) obtained small-to-negative effect sizes (d = -0.85 to 0.18), accounting for 83% participants across studies. Interventions that incorporated exercise, problem-solving, cognitive behavior therapy, and environmental modification were associated with stronger effect sizes. Interventions that incorporated comprehensive geriatric assessment obtained small effect sizes.

DISCUSSION AND IMPLICATIONS

Majority of intervention studies found little or no effect in reducing disability for older adults. To optimize the effects of nonpharmacological interventions, we recommend researchers to (i) develop a screening tool for "risk of disability" to inform those who are early on the disability progression, yet not experience any difficulties in activities of daily living and instrumental activities of daily living; (ii) specify the active ingredients embedded in complex interventions to facilitate change in disability; and (iii) select sensitive tools to capture the progression of disability in late life.

Efficacy of a computer-tailored web-based physical activity intervention using Fitbits for older adults: a randomised controlled trial protocol

INTRODUCTION

Physical activity is an integral part of healthy ageing, yet the majority of older adults 65+ years are not sufficiently active. Web-based physical activity interventions hold much promise to reach older adults. Preliminary evidence suggests that web-based interventions with tailored advice and Fitbits may be well suited for older adults.

METHODS AND ANALYSIS

This study aims to test the effectiveness of 'Active for Life', a 12-week computer-tailored web-based physical activity intervention using Fitbits for older adults. We will recruit 300 participants who will be randomly assigned to one of three trial arms: (1) web-based physical activity intervention with tailored advice only, (2) web-based physical activity intervention with tailored advice and Fitbit or (3) a wait-list control. The primary outcome, objective moderate to vigorous physical activity (MVPA) and secondary outcomes of objective sedentary behaviour, objective sleep, quality of life, social support, physical function and satisfaction with life will be assessed at baseline and week 12. The secondary outcomes of self-reported physical activity, sitting time and sleep will be assessed at baseline, week 6, 12 and 24. Website usability and participant satisfaction will be assessed at week 12 and website usage and intervention fidelity will be assessed from week 1 to 24. Intention-to-treat linear mixed model analyses will be used to test for group (tailoring only, tailoring +Fitbit, control) differences on changes in the main outcome, MVPA and secondary outcomes. Generalised linear models will be used to compare intervention groups (tailoring only, tailoring +Fitbit) on website usability, participant satisfaction, website usage and intervention fidelity.

ETHICS AND DISSEMINATION

The study has received ethics approval from the Central Queensland University Human Research Ethics Committee (H16/12-321). Study outcomes will be disseminated through peer-reviewed publications and academic conferences and used to inform improvements and dissemination of a tailored, web-based physical activity intervention for adults 65+ years.

TRIAL REGISTRATION NUMBER

Australian and New Zealand Clinical Trials Registry Number: ACTRN12618000646246.

Development of an extensive assessment list for knee osteoarthritis based on the International Classification of Functioning, Disability and Health: a Delphi study

The objective of this study was to develop an extensive assessment list for individuals with knee osteoarthritis based on the International Classification of Functioning, Disability and Health (ICF) osteoarthritis comprehensive Core Set. Ten experienced physical therapists including five lecturers and five clinicians were purposively nominated to form an expert panel. Consensus among the experts was obtained through a four-iteration Delphi technique. A list of ICF categories and their third- and fourth-level categories were selected and matched with outcome measures associated with knee osteoarthritis. The expert panel agreed that 26 out of 38 second-level categories of the comprehensive ICF core set for osteoarthritis were relevant to identify problems related to knee osteoarthritis. The information relevant to the specific categories for knee osteoarthritis was obtained from self-reported, subjective observation and physical examination. The extensive assessment list for knee osteoarthritis based on the comprehensive ICF core set for osteoarthritis was assembled. This assessment tool can be used to expansively identify the multidimensional disabilities of impairment, activity limitation and participation restriction in individuals with knee osteoarthritis.

Understanding quality of life within occupational therapy intervention research: A scoping review

INTRODUCTION

There is little consensus regarding the meaning of quality of life (QOL) within occupational therapy literature. Measurement of QOL has varied in both research and practice. This scoping review explored the definitions and measures used within occupational therapy quantitative intervention research to evaluate QOL as an outcome.

METHODS

The review was completed by searching six databases using occupational therapy-related and QOL-related terms. Data were extracted from each article and authors performed descriptive statistics to establish trends for both definitions and measures.

RESULTS

Eighteen publications met the inclusion criteria. Seven articles included a definition of QOL. Most authors defined QOL as a multidimensional construct, comprised of varying domains. Fourteen different standardised measures and two non-standardised measures were utilised.

CONCLUSIONS

A clear conceptualisation of QOL that incorporates occupational therapy values such as client-centredness and holism is needed to advocate for the profession's role in health care and to encourage the development of suitable outcome measures.

Team functioning as a predictor of patient outcomes in early medical home implementation

BACKGROUND

New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes.

PURPOSE

The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality.

METHODOLOGY/APPROACH

Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia).

RESULTS

In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup.

CONCLUSION

These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes.

PRACTICE IMPLICATIONS

A focus on team functioning is important especially in the early implementation of team-based primary care models.

A Prospective Study on Cognitive Impairment in Middle-aged Adults With Newly Diagnosed Celiac Disease

AIMS

Our objectives were to: (1) determine whether celiac disease (CD) patients have cognitive impairment at diagnosis; and (2) compare their cognitive performance with nonceliac subjects who have similar chronic symptoms and healthy controls.

MATERIALS AND METHODS

Fifty adults (age range: 18 to 50 y) with symptoms and signs compatible with CD were enrolled in a prospective cohort irrespective of the final diagnosis. At baseline, all individuals underwent cognitive functional and psychological evaluation. CD patients were compared with subjects in whom CD was ruled out and with healthy controls matched by sex, age, and years of schooling.

RESULTS

Thirty-three subjects (66%) were diagnosed with CD. Compared with the healthy controls (n=26), CD cases and disease controls (n=17; mostly irritable bowel syndrome) had impaired cognitive performance (P=0.02 and P=0.04, respectively), functional impairment (P<0.01), and higher depression (P<0.01). CD patients had similar cognitive performance and anxiety, but nonsignificant lower depression scores compared with disease controls.

CONCLUSIONS

Abnormal cognitive functions detected in newly diagnosed CD adult patients seem not to be disease specific. Our results suggest that cognitive dysfunction could be related to the presence of prolonged symptoms due to a chronic disease.

Functional status measures for the COPD patient: A practical categorization

The objective of this study is to review available functional status measures (FSMs) validated for use in the chronic obstructive pulmonary disease (COPD) population and categorizing the measures by their commonalities to formulate a framework that supports clinicians in the selection and application of FSMs. A literature review identifying valid and reliable measures of functional status for people with COPD was undertaken. Measures were thematically analyzed and categorized to develop a framework for clinical application. A variety of measures of activity levels exist, with 35 included in this review. Thematic categorization identified five categories of measures: daily activity, impact, surrogate, performance-based, and disability-based measures. The vast variety of FSMs available for clinicians to apply with people who have COPD may be overwhelming, and selection must be thoughtfully based on the nature of the population being studied/evaluated, and aims of evaluation being conducted, not simply as a standard measure used at the institution. Psychometric testing is a critical feature to a strong instrument and issues of reliability, validity, and responsiveness need to be understood prior to measurement use. Contextual nature of measures such as language used and activities measured is also important. A categorical framework to support clinicians in the selection and application of FSMs has been presented in this article.

Dual sensory impairment: The association between glaucomatous vision loss and hearing impairment and function

Background

Hearing impairment, vision impairment, and dual impairment (both hearing and vision impairment), have been independently associated with functional and cognitive decline. In prior studies of dual impairment, vision impairment is generally not defined or defined by visual acuity alone. Glaucoma is a leading cause of blindness and does not affect visual acuity until late in the disease; instead, visual field loss is used to measure vision impairment from glaucoma.

Objective

To examine the effect of glaucomatous visual field loss and hearing impairment on function.

Design

Cross-sectional.

Setting

Hospital-based clinic in Baltimore, Maryland.

Subjects

220 adults, ≥55 years presenting to the glaucoma clinic.

Methods

Vision impairment was defined as mean deviation on visual field testing worse than -5 decibels in the better eye, and hearing impairment was defined as pure tone average worse than 25 decibels on threshold audiometry testing in the better ear. Standardized questionnaires were used to assess functional status.

Results

Five participants were excluded for incomplete testing, leaving 32 with vision impairment only, 63 with hearing impairment only, 42 with dual impairment, and 78 controls with no hearing impairment or vision impairment. Participants with dual impairment were more likely to be older and non-White. Dual impairment was associated with significantly more severe driving limitation and more difficulty with communication compared to those without sensory impairment when adjusted for age, race, gender and number of comorbidities.

Conclusion

Older individuals with glaucoma and hearing loss seem to have generally poorer functioning than those with single sensory loss. Health professionals should consider visual field loss as a type of vision impairment when managing patients with dual impairment.

Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study

Background

Extracorporeal life support (ECLS) provides emergency pulmonary and cardiac assistance for patients in respiratory or cardiac failure. Most studies evaluate the success of ECLS based on patients’ survival rate. However, the trajectory of health status and quality of life (QOL) should also be important considerations. The study’s aim was to explore changes in health status and QOL in adult patients weaned from ECLS who survived to hospital discharge over a one-year period.

Study design

A prospective longitudinal study was conducted from April 2012 to September 2014. A convenience sample of patients who had undergone ECLS was followed for one-year after hospital discharge. Heath status was measured with a physical activity scale, the Centre for Epidemiologic Studies Depression scale, and a social support scale; we assessed quality of life with the physical and mental component summary scales of the Short-Form 36 Health Survey. Changes in depression, social support, physical activity and QOL were analysed with generalized estimating equations at 3-month intervals; participants’ QOL at 12 months after discharge was compared with the general population.

Results

A total of 231 patients received ECLS during the study period. Sixty-five patients survived to hospital discharge (28% survival rate); 32 participants completed the study. Data showed scores for physical activity increased significantly over time (p < .001), while depression and social support significantly decreased (p < .05 and p < .001, respectively). Participants with veno-venous ECLS had higher scores for depression than participants with veno-arterial ECLS (p < .05). PCS scores significantly increased at 9, and 12 months after discharge (p < .05 and p < .001, respectively). There was no significant change in MCS scores.

Conclusions

This was a preliminary study of patients with ECLS following hospital discharge over a one-year period. One year following hospital discharge survivors of ECLS continued to experience physical complications and some continued to have depressive symptoms; the level of social support was significantly lower after hospital discharge. Healthcare professionals should understand the trajectory of health status and QOL after discharge, which can help developing evidence-based interventions and improve QOL for survivors of ECLS.

Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review

INTRODUCTION

Work-related disability and productivity loss in Major Depressive Disorder (MDD) are critical determinants of patient quality of life and contribute significantly to the human and economic costs of MDD. Notwithstanding the return to work and pre-morbid levels of functioning as a critical therapeutic objective among individuals with MDD, it is unclear whether antidepressant treatment significantly and reliably improves measures of workplace functioning. Herein, we investigate to what extent antidepressant treatment improves workplace functioning among adults with MDD.

METHODS

We conducted a systematic review of randomized, double-blind, placebo-controlled or active comparator clinical trials primarily or secondarily investigating the efficacy of antidepressant agents on subjective ratings of workplace functioning and/or measures of work absence.

RESULTS

Thirteen placebo-controlled and four active comparator clinical trials reported on the efficacy of agomelatine, bupropion, desvenlafaxine, duloxetine, fluoxetine, levomilnacipran, paroxetine, sertraline, venlafaxine, or vortioxetine on subjective measures of workplace impairment. Overall, antidepressant treatment improved standardized measures of workplace functioning (e.g., Sheehan Disability Scale-work item). One placebo-controlled trial of agomelatine and one clinical trial comparing the efficacy of vortioxetine to that of venlafaxine had mixed results on measures of work absence.

LIMITATIONS

Included interventional trials evaluated work-related disability as a secondary outcome using subjective rating scales.

CONCLUSION

Extant data suggest that antidepressant treatment improves workplace outcomes in MDD. The capability of antidepressants in improving measures of workplace functioning should be considered in cost-benefit analyses to better inform cost-modelling studies pertaining to antidepressant therapy.

Big Five personality and health in adults with and without cancer

Personality is associated with health, but examinations in patients with illnesses are lacking. We aimed to determine whether personality-physical health associations differed between community and cancer samples. This cross-sectional study involved 168 participants without cancer, 212 men with prostate cancer, and 55 women with breast cancer. We examined whether the Big Five personality dimensions were associated with health behaviors and multiple health indicators. Higher conscientiousness and lower neuroticism were associated with better health behaviors and health (r_max = .31), with few differences between community and cancer samples. Findings call for research on the implications of personality in patients with serious illnesses.

Individuals with mild MS with poor sleep quality have impaired visuospatial memory and lower perceived functional abilities

BACKGROUND

Sleep disturbances are common in individuals with Multiple Sclerosis (MS), but the impact of poor sleep quality on cognitive and physical function in individuals with MS is less clear.

OBJECTIVE/HYPOTHESIS

The purpose of this study was to examine the relationship between sleep quality and cognitive and physical function in individuals with mild MS.

METHODS

Forty individuals with relapsing-remitting or secondary-progressive MS (50.3 ± 11.6 years of age) participated. The Pittsburgh Sleep Quality Index (PSQI) was used to index sleep quality. A PSQI of ≤5 was considered good sleep quality and >5 was considered poor sleep quality. Cognitive function was assessed using a battery of cognitive tests, and physical function was assessed using 2 objective measures and a self-report measure.

RESULTS

Thirteen individuals (32.5%) indicated good sleep quality and 27 (67.5%) of the participants reported poor sleep quality. Those with good sleep quality performed significantly better on a visuospatial memory test (p = 0.025) and reported higher functional abilities (p < 0.001) compared to those with poor sleep quality. There was no difference in performance on the cognitive tests of verbal memory, information processing, or executive function, or the objective function measures. Individuals with poor sleep quality had higher levels of fatigue, depression, and anxiety, and lower quality of life.

CONCLUSIONS

Visuospatial memory appears to be the memory domain particularly associated with poor sleep quality in people with mild MS. Also, individuals with mild MS with poor sleep quality may underestimate their functional abilities.