Outcome measures for physical fatigue in individuals with multiple sclerosis: a systematic review

INTRODUCTION

Physical fatigue can be a common reason for early retirement or sick leave since it appears in the earliest stages of multiple sclerosis (MS). Therefore, a prompt and accurate diagnosis is essential. This systematic review aims to identify and describe the instruments used to assess physical fatigue in MS patients with consideration for the languages used to validate the instruments and their methodological qualities.

AREA COVERED

This study has been carried out through 'Medline,' 'Scopus,' 'Cinhal,' and 'Web of Science' databases for all the papers published before 24 January 2020. Three independent authors have chosen the eligible studies based upon pre-set criteria of inclusion. Data collection, data items, and assessment of the risk of bias: the data extraction approach was chosen based on the Cochrane Methods. For data collection, the authors followed the recommendations from the COSMIN initiative. Study quality and risk of bias were assessed using the COSMIN Check List.

EXPERT OPINION

119 publications have been reviewed. The 45 assessment scales can be divided into specific scales for physical fatigue and specific scales for MS. The most popular tools are the Fatigue Severity Scale and the Modified Fatigue Impact Scale.

Predictive Validity of a New Instrumental Activities of Daily Living Scale for Detecting the Incidence of Functional Disability among Community-Dwelling Older Japanese Adults: A Prospective Cohort Study

We examined the predictive validity of a newly developed scale-the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL)-to measure instrumental activities of daily living (IADL) ability. We tested the scale for detecting new incidences of functional disability among community-dwelling older Japanese adults. Participants were 2708 older adults (mean age = 79.0 years, 51.6% women) living in the community who had no functional decline at baseline. We assessed IADL ability using the NCGG-ADL scale, comprising 13 self-report questions. Next, we assessed their functional disability monthly for 24 months, based on the national long-term care insurance (LTCI) system. Among all participants, 430 (15.9%) had an IADL limitation at baseline, and 289 (10.7%) were newly certified as functionally disabled. Participants scoring ≤ 12 of 13 points in the NCGG-ADL showed a significantly higher risk of functional disability than did those scoring 13 points, even after adjusting for covariates (hazard ratio [95% confidence interval] = 1.58 [1.19-2.09]). We thus validated the NCGG-ADL as a screening tool for assessing the risk of functional disability among community-dwelling older Japanese adults. We conclude that IADL limitations, as measured by the NCGG-ADL, could be useful predictors of functional disability.

Effective Measurement of the Functional Progress of Stroke Clients

There is a need for occupational therapists to establish a range of outcome measures that can measure change effectively. The aim of this study was to identify effective methods of measuring the functional performance of individuals who had experienced a stroke and had been discharged from a rehabilitation ward. Measures with recorded validity and reliability and in clinical use were selected. The measures were the Barthel Index (Shah version), Nottingham Extended Activities of Daily Living scale, Motricity Index (Upper and Lower Limb), Rivermead Mobility Index and Nine-Hole Peg Test. Assessments were carried out at the point of discharge from hospital and 6 months later.

Responsiveness was analysed using effect size and relative efficiency statistics. The practicality (feasibility) was established by comparing completion rates. The Nottingham Extended Activities of Daily Living scale and the Rivermead Mobility Index were found to be more responsive than the Barthel Index and Lower Limb Motricity Index respectively and to be practical after discharge from hospital. The Nine-Hole Peg Test was found to be more responsive than the Upper Limb Motricity Index but less practical. The analysis suggested that some measures are more suitable than others for tracking change in function after discharge from hospital for a wide case mix of people who have experienced a stroke.

Evaluating Health Interventions for Older People

In recent years there has been a growing emphasis on evidencebased medicine and measuring outcomes of health care. The evaluation of health interventions for older people has increasingly relied upon the use of standardized assessment instruments, which are seen as providing detailed, holistic and patient-centred information. This article argues that such an approach has several drawbacks which may have serious implications for the evaluation and provision of health care. Standardized assessment instruments ignore the social dimensions of interviewing, decontextualize scores and contain an implicitly individualistic biomedical ideology of health. These factors undermine the effective evaluation of interventions. This is particularly significant when health care is purchased on the basis of delivering demonstrable gains. Provision for older people may be under threat if methods of evaluating its efficacy are inadequate.

Programme evaluation of a geriatric rehabilitation day hospital

Objective: To evaluate the rehabilitation programme in a geriatric day hospital.

Design: An observational study.

Setting: An urban geriatric rehabilitation day hospital.

Subjects: Three hundred and fifty-three older patients admitted to a rehabilitation day hospital during 2000: 163 post stroke, 113 with deconditioning and 77 post orthopaedic surgery (hip fracture and joint replacement).

Main outcome measures: Functional Independence Measure (FIM), Nottingham Extended ADL Index, timed ‘get up and go’ test.

Results: The mean discharge scores of all FIM items were significantly higher than the mean admission scores. Mean score change, however, for each item was less than one point. Most of the patients (70%) improved by less than 5 points, regardless of main admission diagnoses. Patients with a lower admission FIM score improved more than those with a higher admission score. The majority of the enrolled patients (92%) showed an improvement in their Nottingham Extended ADL Index score. The mean (SD) score on admission was 21 (11.9) and at discharge 31 (14.6). In all but three items (self-feeding, using a telephone and driving a car), mean scores at discharge were significantly higher than admission scores ( p < 0.001). A significant improvement in timed ‘get up and go’ score was found for all patients regardless of main diagnosis. Performance time decreased by 33% and discharge scores for all patient groups were approximately 20 seconds.

Conclusions: The notable improvement in mobility and instrumental activities of daily living on the one hand, and the minor improvements achieved in basic activities of daily living on the other, suggests a need to revise treatment goals of day hospitals.

Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial

Aims

Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment.

Methods

A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index.

Results

No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033).

Conclusion

Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium.

Post-stroke depression and expressed emotion

PRIMARY OBJECTIVES

This study examined the role of expressed emotion (EE) in post-stroke depression (PSD) and the extent to which partner/spouse EE interacted with lesion laterality in PSD. The relationship between (i) lesion location and levels of PSD and (ii) levels of EE and levels of PSD were investigated. The role of perceived EE in PSD was also explored.

DESIGN

Cross-sectional, between-subjects design.

METHODS

Measures applied to stroke survivors included Extended Activities of Daily Living Scale (EADL), Post-Stroke Depression Rating Scale (PSDRS) and Level of Expressed Emotion Scale (LEE); spouses/partners completed the LEE.

RESULTS

The interaction between lesion laterality and levels of partner/spouse EE on PSD was not statistically significant (p = 0.63, F = 0.24, df = 1,56). However, a clear relationship was found between lesion laterality and PSD (p = 0.028). As levels of spouse/partner LEE scores increased, levels of PSD also increased (p = 0.039). Perceived EE scores illustrated a significant interaction between lesion laterality and levels of EE on PSD (p = 0.005, F = 8.591, df = 1,56).

CONCLUSION

Whilst spouse/partner EE scores showed no interaction with lesion laterality to determine levels of PSD, a significant interaction was found when compared with stroke survivor perceived EE scores. Furthermore, left hemisphere (LHS) stroke survivors reported higher levels of depression than right hemisphere (RHS) stroke survivors. As levels of EE increased, PSD also increased, with LHS being greater than RHS.

A Review of Measures to Evaluate Participation Outcomes Post-Stroke

Background:

Stroke is one of the most common disabling conditions of adulthood. Participation problems are extremely common post-stroke. Occupational therapists, by virtue of their commitment to enabling occupation, are in a strong position to help stroke survivors improve their participation. To demonstrate effectiveness, occupational therapists must be able to provide evidence of post-treatment changes in participation.

Objective:

The objective of this paper was to identify participation measures that have been developed for, or tested with, individuals who have experienced a stroke and to review them for use as occupational therapy outcome measures.

Method:

A literature review was carried out to locate relevant tools. These tools were then rated for psychometric and clinical properties that are critical for clinical outcome measurement. In addition, the theoretical fit of each evaluation with occupational therapy's commitment to client-centredness was considered.

Results:

Ten evaluations were identified and rated. These ratings were designed to assist occupational therapists to choose a participation measure for their practice.

Conclusion:

Selection and use of such a measure will help occupational therapists to document its effectiveness in improving participation among stroke survivors.

Limitations in physical functioning among older people as a predictor of subsequent disability in instrumental activities of daily living

BACKGROUND

physical functioning describes the underlying abilities that make activities necessary for independent living in the community possible.

OBJECTIVE

to test self-reported and objective measures of physical functioning in predicting subsequent disability in cooking, shopping and housework.

DESIGN

we used data from the first and second waves of the Survey of Health, Ageing and Retirement in Europe. The respondents were asked about physical functioning (climbing, pulling/pushing, stooping/crouching/kneeling, lifting/carrying and reaching/extending were comparable) and they had their grip strength and walking speed measured.

PARTICIPANTS

men and women aged 65 years or over who reported no disability in cooking, shopping and housework at baseline were included in the analysis. There were 6,841 individuals for whom data on disability status at follow-up were available.

METHODS

Poisson regression was used to calculate relative risks for the associations between self-reported and objective measures of physical functioning with disability at 2 years, adjusting for age, gender, educational level, cognitive function and chronic conditions.

RESULTS

those with limitations in physical functioning at baseline more frequently reported subsequent disability. Walking ability was most strongly associated with disability; climbing, pulling/pushing, lifting/carrying and reaching/extending were comparable (picking was non-significant). Similar results were obtained with grip strength and walking speed.

CONCLUSIONS

both self-reports and objective measures capture information on the functional ability of older people that can be used to predict disability onset. Objective measures offer little to the development of intervention strategies, whereas self-reports provide some insight into the demands of the environment, being more amenable to interventions.

Reliability and validity of the Turkish version of the Nottingham Extended Activities of Daily Living Scale

BACKGROUND AND AIMS

The aim of this study was to develop a Turkish version of the Nottingham Extended Activities of Daily Living Scale (NEADLS) and to assess its reliability and validity.

METHODS

Sixty healthy volunteers over 67 years old were included in the study. After translation, the Turkish version of the scale was filled in by each participant over a period of 2 weeks. Reliability was assessed by internal consistency, test-retest intraclass correlation coefficient (ICC) and Spearman's correlation. Converging validity was determined correlating the scale with the Modified Barthel Index (MBI).

RESULTS

The mean age of participants was 77+/-5.67 years. In the reliability studies, internal consistency within the subsections and items of the NEADLS was good and very good, with Cronbach's alpha values ranging between 0.84-0.93 and 0.74-0.97 respectively. The Cronbach's alpha for the total NEADLS score was also determined as 0.97. Test-retest intraclass correlation coefficients, determined as 0.97 in total score, ranged from 0.84-0.97 between items. The converging validity study for the NEADLS total score was correlated with the MBI and the r value was found statistically significant (r=0.84, p<0.0001).

CONCLUSIONS

The Turkish version of the NEADLS is a reliable and valid scale and can be used in activities of daily living assessment of Turkish elderly persons.