Gender differences in the performance of activities of daily living11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

The Purdue Pegboard Test: Normative Data From 1,355 Healthy People From Austria

IMPORTANCE

The Purdue Pegboard Test (PPT) is widely used as a measure of manual dexterity. Declining manual dexterity may predict cognitive decline among elderly people, but normative data for this population are scarce.

OBJECTIVE

To identify demographic and clinical predictors of PPT results in normal middle-aged and elderly Austrian people and to provide norms stratified by significant determinants.

DESIGN

A prospective, community-based cohort study using baseline data of participants from two study panels (1991-1994 and 1999-2003).

SETTING

Monocentric study Participants: 1,355 healthy, randomly selected, community-dwelling people ages 40 to 79 yr.

METHOD

Extensive clinical examination, including completion of the PPT.

OUTCOMES AND MEASURES

The number of pegs placed within a 30-s time limit on four subtests: using the right hand, left hand, both hands, and assembly (within 60 s), respectively. Demographic outcomes were the highest grade achieved.

RESULTS

For all four subtests, increasing age (βs = -0.400 to -0.118, SEs = 0.006 to 0.019, p < .001) and male sex (βs = -1.440 to -0.807, SEs = 0.107 to 0.325, p < .001) was related to worse test results. Among vascular risk factors, diabetes (βs = -1.577 to -0.419, SEs = 0.165 to 0.503, p < .001) was related to worse test results but explained only a small portion (0.7%-1.1%) of the variability in PPT performance.

CONCLUSIONS AND RELEVANCE

We provide age- and sex-specific norms of the PPT for a middle-aged and elderly population. The data represent useful reference values when assessing manual dexterity in older age groups. What This Article Adds: Advancing age and male sex relate to worse performance on the PPT in a community-dwelling cohort without signs and symptoms of neurological disease. Vascular risk factors explain only very little of the variance of test results in our population. Our study adds to the limited age- and sex-specific norms of the PPT among middle-aged and older people.

Agreement between self-reported and observed functioning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia, and the influence of pain and fatigue: a cross-sectional study

Objective: To evaluate the relationship between self-reported and performance-based measures of functioning in rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and the influence of pain and fatigue.Method: Self-reported functioning was assessed by the Stanford Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Knee injury and Osteoarthritis Outcome Score. Performance-based measures of task-related physical activity included grip strength and Six-Minute Walk Test (6MWT). Assessment of Motor and Process Skills (AMPS) was used to obtain performance-based measures of activities of daily living (ADL) ability. Pain and fatigue were assessed by 100 mm visual analogue scales. Spearman's rho correlation and regression modelling were applied.Results: Correlations between self-reported functioning and performance-based measures of ADL ability were weak to moderate, and strongest in OA (r = 0.57, p = 0.002), and AMPS ADL ability measures did not enter regression models as explanatory factors for self-reported functioning. Correlations between AMPS ADL ability measures and measures of task-related physical activity were weak, except for a strong correlation between AMPS ADL motor ability and 6MWT in OA (r = 0.63, p = 0.000). The 6MWT was the only performance-based test explaining variance in AMPS motor ability (OA = 42%; FM = 11%). Pain explained variance in self-reported ability and contributed to variance in AMPS ADL motor ability measures in OA.Conclusion: Self-reported and observed measures of functioning assess partly different aspects of functioning, and both approaches may therefore be relevant in a structured assessment of patients with musculoskeletal disorders.

Male-Female Differences In The Effects Of Age On Performance Measures Recorded For 23 Hours In Mice

Functional independence is an important aspect of successful aging and differs with age and by sex in humans. Physical performance often declines earlier than other age-associated functional impairments. Rodent models are used to study pharmacological/toxicological effects of human therapies. However, physical outcomes in mice are usually assessed for short periods, with limited information on the influence of age and sex. Here, we investigated how age and sex affected murine physical performance over 23 hours of continuous observation. Young (3 months) and old (22 months) C57BL/6JArc male and female mice were assessed using the Laboratory Animal Behavior Observation, Registration, and Analysis System. Mice were individually housed for recording of distance travelled, mean gait speed, and durations of different physical activities. Compared to young mice of the same sex, old mice travelled significantly shorter distances with slower gait speeds, shorter durations of locomotion, rearing, climbing and immobility. Older mice groomed significantly more than young mice. Old females reared more during the light cycle than old males. Young females climbed substantially more than young males. Significant age*sex interactions were detected for rearing and climbing, whereby an age-related decline was greater in males than females. Our results suggest that old age reduces exploratory activities and increases grooming in mice. Age-related declines vary between sexes and tend to be greater in males. This non-invasive assessment can be applied to investigate how different interventions affect rodents of different ages and sexes, through the day-night cycle.

Activities of daily living in Parkinson's disease: Time/gender perspective

OBJECTIVE

The objectives of this study were to explore the changes in the activities of daily living (ADL) in persons with Parkinson's disease (pwPD) over time and to investigate possible differences in ADL performance between men and women with PD.

MATERIALS & METHODS

One hundred twenty-nine persons (76 men) with a clinically established PD self-assessed their ADL performance from the time of diagnosis up to 8 years follow-up using the ADL taxonomy. Other demographic and clinical data (motor state, cognition, depression) were also collected and subjected to further analysis.

RESULTS

Nine of 12 domains in the ADL taxonomy showed a change over time (Eating and Drinking [P = .009], Mobility [P < .001], Toilet activities [P = .031], Dressing [P < .001], Personal hygiene [P < .001], Communication [P < .001], Cooking [P = .001], Shopping [P < .001] and Cleaning [P < .001]). In addition to time, two domains, (Shopping [P = .007] and Cleaning [P = .027]) also showed an effect of gender with worse scores in women. The nine ADL domains showing effect of time, showed temporary improvement at 12 months follow-up, most probably due to dopaminergic medication. All nine domains deteriorated at later follow-up.

CONCLUSIONS

As expected, there was deterioration in self-assessed performance in the majority od ADL domains over time. Women assessed their ADLs worse in two domains (Shopping and Cleaning) probably reflecting a general gender-related activity pattern rather than being a PD-specific finding.

Manual dexterity in young and healthy older adults. 1. Age- and gender-related differences in unimanual and bimanual performance

This study aimed to better characterize age-related differences in dexterity by using an integrative approach where movement times and kinematics were measured for both hands. Forty-five young (age 19-31) and 55 healthy older adults (age 60-88) were evaluated during unimanual and bimanual performance of the Purdue Pegboard Test. Gender effects were also assessed. From video-recorded data, movement times and kinematics were obtained for reaching, grasping, transport, and inserting. Results showed that older adults had longer movement times for grasping and inserting with the right hand, and across all movements with the left hand. Kinematic differences were found in path length, linear, and angular velocity. The patterns of slowing were similar in unimanual and bimanual tasks. Gender effects showed more slowing in older males than older females. Age differences in dexterity not only comprise slowing of movements but also kinematic alterations. The importance of gender in hand function was demonstrated.

Influences of patient informed cognitive complaints on activities of daily living in patients with bipolar disorder. An exploratory cross-sectional study

Many patients with bipolar disorder (BD) experience debilitating cognitive deficits, with risk of impaired occupational and psychosocial functioning. However, knowledge of how these deficits impact the patients' ability to perform Activities of Daily Living (ADL), tasks related to self-care and domestic life is limited. We explored the relation between impaired cognitive function and the ability to perform ADL in patients with BD. A total of 42 outpatients (mean age 36 years (range 19.0-58.0 years), 69% women) with BD in remission and with subjective cognitive complaints (≥ 13 on the Cognitive Complaints in Bipolar Disorder Rating Assessment questionnaire (COBRA)) were included. Objective neurocognitive function was evaluated with a short comprehensive cognitive test battery and ADL ability was evaluated with the performance-based Assessment of Motor and Process Skills (AMPS) in the homes of the patients. Our findings indicate that low processing speed correlated with decreased ADL ability, and processing speed as measured by the cognitive test battery thus seems to be significantly related to patients' ability to live independently in the community. Overall, adding a performance based test to assess ADL ability in patients with BD home-surroundings seems to provide new insights regarding the effect of cognitive impairment in patients with BD.

Association between daily activities, process skills, and motor skills in community-dwelling patients after left hemiparetic stroke

[Purpose] The purpose of this study was to evaluate the relationships between daily activities, information processing, and motor skills in individuals with hemineglect after having a left hemiparetic stroke. [Subjects and Methods] The instrumental activities of daily living of 35 patients (22 male and 13 female; age: 57.1 ± 16.9 years) with hemineglect after having a left hemiparetic stroke were assessed by using three clinical measurement tools, including activity card sorting, assessment of motor and process skills, and the modified Barthel Index. [Results] The results of the regression analysis indicated that the patients' processing skills in instrumental activities of daily living after having a left hemiparetic stroke were reduced. Participation in leisure and social activities was also affected as assessed by using the modified Barthel Index. [Conclusion] This study supports the clinical need for rehabilitation intervention after a left hemiparetic stroke to improve patients' processing skills and independence in performing activities of daily living.

Activities of Daily Living in Survivors of Childhood Brain Tumor

OBJECTIVE. This cross-sectional, descriptive study evaluated the performance in activities of daily living (ADLs) of youth and young adult survivors of childhood brain tumor (BT) and explored associations with health-related quality of life (HRQoL).

METHOD. Thirty-six participants were examined using the Assessment of Motor and Process Skills to evaluate their quality of ADL task performance and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF–12) to evaluate HRQoL.

RESULTS. Participants had significantly lower performance in ADLs compared with age norms (p &lt; .05), and their functional level was positively associated with the SF–12 Physical (r 2 = .5) and Mental (r 2 = .3) scales.

CONCLUSION. Participants had significant limitations in both motor and process skills, which affected their performance in ADLs. Study results emphasize the importance of long-term follow-up and rehabilitation services aimed at improving the functional level and HRQoL of BT survivors.

Cognitive Rehabilitation After Traumatic Brain Injury: A Reference for Occupational Therapists

Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.

Ability in daily activities after early supported discharge models of stroke rehabilitation

More knowledge is needed about how different rehabilitation models in the municipality influence stroke survivors' ability in activities of daily living (ADL).

OBJECTIVES

To compare three models of outpatient rehabilitation; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke.

METHODS

A group comparison study was designed within a randomized controlled trial. Included participants were tested with the Assessment of Motor and Process Skills (AMPS) at baseline and discharged directly home. Primary and secondary outcomes were the AMPS and the modified Rankin Scale (mRS).

RESULTS AND CONCLUSIONS

Included were 154 participants (57% men, median age 73 years), and 103 participants completed the study. There were no significant group differences in pre-post changed ADL ability measured by the AMPS. To find the best rehabilitation model to improve the quality of stroke survivors' motor and process skills needs further research. Patients participating in the ESD rehabilitation models were, compared with traditional treatment, significantly associated with improved ADL ability measured by the mRS when controlling for confounding factors, indicating that patients with social needs and physical impairment after stroke may benefit from ESD rehabilitation models.

Detecting differences in activities of daily living between children with and without mild disabilities

OBJECTIVE

We evaluated whether the Assessment of Motor and Process Skills (AMPS) measures are valid for detecting differences in activities of daily living (ADL) ability among children with and without mild disabilities.

METHOD

Retrospective data from the AMPS database were analyzed using many-facet Rasch analyses and forced regression analyses to evaluate for significant group differences.

RESULTS

Regression analyses of data for 10,998 children ages 4-15 who met the inclusion criteria revealed significant Age × Group interaction effects (B ≥ 0.23, T ≥ 6.20, p ≤ .001). Post hoc t tests revealed significant group differences in ADL ability at all ages beyond age 4. ADL process ability effect sizes were moderate to large at all ages, and ADL motor ability was mostly moderate to large at ages 6 or older.

CONCLUSION

These findings support the validity of the AMPS measures when used to identify ADL problems among children with mild disabilities.

Predicting clinically significant changes in motor and functional outcomes after robot-assisted stroke rehabilitation

OBJECTIVE

To investigate the predictors of minimal clinically important changes on outcome measures after robot-assisted therapy (RT).

DESIGN

Observational cohort study.

SETTING

Outpatient rehabilitation clinics.

PARTICIPANTS

A cohort of outpatients with stroke (N=55).

INTERVENTIONS

Patients with stroke received RT for 90 to 105min/d, 5d/wk, for 4 weeks.

MAIN OUTCOME MEASURES

Outcome measures, including the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), were measured before and after the intervention. Potential predictors include age, sex, side of lesion, time since stroke onset, finger extension, Box and Block Test (BBT) score, and FMA distal score.

RESULTS

Statistical analysis showed that the BBT score (odds ratio[OR]=1.06; P=.04) was a significant predictor of clinically important changes in the FMA. Being a woman (OR=3.9; P=.05) and BBT score (OR=1.07; P=.02) were the 2 significant predictors of clinically significant changes in the MAL amount of use subscale. The BBT score was the significant predictor of an increased probability of achieving clinically important changes in the MAL quality of movement subscale (OR=1.07; P=.02). The R(2) values for the 3 logistic regression models were low (.114-.272).

CONCLUSIONS

The results revealed that patients with stroke who had greater manual dexterity measured by the BBT appear to have a higher probability of achieving clinically significant motor and functional outcomes after RT. Further studies are needed to evaluate other potential predictors to improve the models and validate the findings.

Validity of using the Assessment of Motor and Process Skills to determine the need for assistance

OBJECTIVE

This study evaluated the validity of using Assessment of Motor and Process Skills (AMPS) measures as evidence of the need for assistance in the community.

METHOD

In a retrospective analysis of existing data (N = 64,466), receiver operating characteristic (ROC) curves were generated, and a split-sample method was used to validate the predictions.

RESULTS

When identifying people who need assistance versus those who do not need assistance in the community, activity of daily living (ADL) motor and ADL process measures have fair and good discriminating value, respectively (areas under the ROC curves were .78 and .84). Evidence supports placing ADL motor and ADL process independence cutoff measures at 1.50 logits (sensitivity = .67, specificity = .72) and 1.00 logit (sensitivity = .81, specificity = .70), respectively. Accuracy was highest when matched motor and process decisions occurred (sensitivity = .85, specificity = .83).

CONCLUSION

Evidence supports using ADL ability measures from the AMPS to provide evidence of a client's need for assistance in the community.

Occupational performance and awareness of disability in mild cognitive impairment or dementia

Limited awareness of disabilities is common in mild cognitive impairment and dementia. In order to get a broader base in planning interventions, it is important to consider a person's awareness of his/her disability encountered in performance. The aim of this study was to examine the relationship between occupational performance and awareness of disability in older adults with mild cognitive impairment or dementia. Thirty-five older adults were evaluated with the AMPS (Assessment of Motor and Process Skills) and with the AAD (Assessment of Awareness of Disability). Many-faceted Rasch models generated individual measures of ADL performance and awareness of disability. Non-parametric correlation statistics were used to analyse the relationships. The findings showed that there was an overall positive relationship between occupational performance and awareness of disability. However, individual variations in the sample implied that limitations in performance were not equivalent to a limited awareness of disability. In conclusion, awareness of disability should be individually evaluated when planning interventions together with clients and their families.

Group Constraint-Induced Movement Therapy: Motor and Functional Outcomes in Individuals with Stroke

Background

Strokes frequently cause limitations of the upper extremity and in performance of activities of daily living (ADL). Constraint-induced movement therapy (CIMT) is designed to enhance the use of the hemiplegic arm.

Purpose

To assess the effects of group CIMT on upper-extremity motor function and performance level of motor and process skills for instrumental activities in daily living (IADL) in community-dwelling individuals whose stroke occurred at least six months earlier.

Methods

Eight adults with stroke participated in this study. Group-based CIMT was administered for two weeks, five times per week, with two-hour intensive daily training.

Findings

The Fugl-Meyer Assessment (FMA) score and the Assessment of Motor and Process Skills (AMPS) scores improved after intervention.

Implications

The results of this study suggest that relatively brief group-based CIMT may be an effective intervention for improving motor function of the affected upper-limb and the level of IADL in individuals who have had stroke.

Differences in activities of daily living performance between long-term pediatric sarcoma survivors and a matched comparison group on standardized testing

BACKGROUND

In a cross-sectional study examining late effects of pediatric sarcoma therapy, long-term survivors were evaluated on their activities of daily living (ADL) performance.

PROCEDURE

Thirty-two persons with Ewing sarcoma family of tumors, rhabdomyosarcoma, and non-rhabdomysarcoma-soft tissue sarcoma enrolled an average of 17 years after treatment. Participants were evaluated using the Assessment of Motor and Process Skills (AMPS) 1, a standardized observational evaluation of ADL task performance. Means and 95% confidence intervals for ADL motor and ADL process ability measures were calculated for four groups: (1) sarcoma survivors, (2) "well" adults matched for age and gender, (3) "well" adults matched for gender that were 10 years older, and (4) "well" adults matched for gender that were 20 years older.

RESULTS

ADL motor ability was significantly lower for sarcoma survivors than for the age- and gender-matched comparison group (P < 0.05). There was no significant difference between ADL motor ability of sarcoma survivors and the comparison group 10 years older, but sarcoma survivors had significantly better ADL motor ability (P < 0.05) than the oldest comparison group (20 years older). Sarcoma survivors had significantly worse ADL process ability than the age-matched group (P < 0.05). There was no difference in ADL process ability between the sarcoma survivors and comparison groups that were 10 and 20 years older.

CONCLUSIONS

This first report of a clinical evaluation of ADL limitation in pediatric sarcoma survivors treated with intensive multimodal cancer therapy suggests that influences on performance of daily life activities are more common than previously reported.

Using the assessment of motor and process skills to measure functional change in adults with severe traumatic brain injury: A pilot study

AIM

To measure functional change in 10 adults following severe traumatic brain injury using the Assessment of Motor and Process Skills (AMPS).

METHODS

This clinical pilot study used a standardised occupational therapy tool, the AMPS, to measure motor and process scores during activities of daily living, for over 3 weeks of inpatient rehabilitation.

RESULTS

Wilcoxon signed ranks tests indicate significant improvement in motor and process scores from initial assessment to repeat evaluation (z = -2.70, p = 0.01; z = -2.81, P = 0.01, respectively).

CONCLUSIONS

The AMPS measured statistically and clinically significant change in motor and process abilities over 3 weeks of neurosurgical rehabilitation. Findings suggest that the AMPS is a sensitive measure of functional change for the study sample and timeframe.

Impact of general health status on validity of visual impairment measurement

PURPOSE

To examine the effects of bias and distortion from general health status on Rasch model-based measurements of visual function, and establish measurement equivalence across different health status groups in low vision patients.

METHODS

Self-reported data were obtained from 1746 low vision patients who completed the Activity Inventory (AI) and an intake health-related questionnaire prior to their first visit to the low vision rehabilitation service. Differential Item Functioning (DIF) analysis by health status and separate Rasch analyses adjusted by health status were performed on the responses to both a DIF-free scale and the full scale of the AI.

RESULTS

Of 48 Goal-level items, only 15 items showed significant DIF (P < 0.001). Comparing the vision-related estimates from the original full set of items with those from the DIF free scale; we found that only 25% of the person measure estimates differed by 0.5 logits or more and there was a strong intraclass correlation between the two scales in measuring the patients' vision-related functional ability (IC = 0.75). Patients' health status influenced the Rasch model based estimation of visual function by the AI (ANOVA, p = 0.005), but this effect was within accepted range of MISFIT statistics.

CONCLUSION

Taken together, our results indicate that despite confounding effects of general health status on vision-related ability, we can still regard visual ability to be a single theoretically constructed variable for the low vision population. It appears that self-perceived comorbidities add to vision-related disability, but do not distort its measurement.

Classification of traumatic brain injury for targeted therapies

The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.

Effectiveness of occupational therapy with frail community living older adults

This study examined the effectiveness of short-term, home-based occupational therapy guided by the Occupational Therapy Intervention Process Model for improving activities of daily living [ADL] with eight frail, older adults living in assistive living. A multi-method research approach was utilized to collect both quantitative and descriptive, qualitative data in the form of a retrospective examination of the participants' clinical records. The quantitative component was a within-subjects, repeated-measures analysis of participants' Assessment of Motor and Process Skills [AMPS] ADL motor and ADL process ability measures that revealed statistically significant improvement in ADL motor, but not ADL process abilities. The qualitative component was a content analysis of the clinical records. ADL baselines, goals, interventions and outcomes documented were analyzed. Improvement was noted in 77% of the written ADL goals. Results are discussed and recommendations were given for future research and documentation to improve the profession's ability to support evidence-based practice.