Reliability of an interview approach to the Functional Independence Measure

Daily steps, walking tests, and functioning in chronic stroke; comparing independent walkers to device-users

BACKGROUND AND PURPOSE

Community mobility post-stroke is important for gaining independence in daily activities. Walking devices can facilitate mobility, but it remains unclear whether individuals who use a walking device walk as many daily steps as those who do not require a device. It is also unclear whether these groups differ in their independence in daily living. This study aimed (1) to compare daily steps, walking tests, and independence in basic and instrumental activities of daily living (IADL) six months post-stroke between individuals who walk independently and individuals who use a walking device, (2) within each group to assess correlations between daily steps and walking tests, independence in basic and IADL.

METHODS

Thirty-seven community-dwelling individuals with chronic stroke; 22 participants used a walking-device and 15 participants walked independently. Daily steps were calculated as a 3-day mean by hip accelerometers. Clinical walking tests included the 10-m-walk-test, Timed Up & Go and 'Walking While Talking'. Daily living was assessed using the Functional-Independence Measure and the IADL questionnaire.

RESULTS

Daily steps of the device-users were significantly lower than the independent-walkers (195-8068 versus 147-14010 steps/day) but independence in daily living was not significantly different. Different walking tests correlated with daily steps for device-users and independent-walkers.

CONCLUSIONS

This preliminary investigation in chronic stroke revealed that device-users walk significantly fewer daily steps but are as independent in daily living as independent-walkers. Clinicians should differentiate between individuals with and without a walking device and the use of different clinical walking tests to explain daily steps should be considered. Further research is needed to assess the impact of a walking device post-stroke.

Does frequent use of an exoskeletal upper limb robot improve motor function in stroke patients?

PURPOSE

To determine how differences in frequency of the single-joint hybrid assistive limb (HAL-SJ) use affect the improvement of upper limb motor function and activities of daily living (ADL) in stroke patients.

MATERIALS AND METHODS

Subacute stroke patients were divided into the high or low frequency of HAL-SJ use groups. The two groups were matched by propensity score, and the degree of changes 30 days after initiating HAL-SJ use was compared. A logistic regression analysis was performed to examine whether frequent use would increase the number of subjects experiencing the efficacy of more than the minimal clinically important difference (MCID) of Fugl-Meyer assessment (FMA).

RESULTS

Twenty-five stroke patients were matched by propensity score, and nine pairs were matched. The high-frequency group showed a significantly superior increase to total FMA shoulder, elbow, forearm, and Barthel index compared with the low-frequency group. Logistic regression analysis revealed no significant associations between frequent use and MCID.

CONCLUSIONS

The frequency of HAL-SJ use may affect the improvement of motor function and ADL ability of the upper limb with exception of the fingers and wrist. However, the frequency of intervention was not effective enough to further increase the number of subjects with clinically meaningful changes in upper limb motor function.IMPLICATIONS FOR REHABILITATIONThe current study aimed to clarify how differences in the frequency of single-joint hybrid assistive limb (HAL-SJ) use can affect the improvement of upper-limb motor functions and ADL in subacute stroke patients.Our results implied that the frequency of HAL-SJ use may influence the recovery of upper limb function.However, even if HAL-SJ is used frequently, it does not mean that more patients will achieve clinically meaningful recovery.

Psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in stroke survivors

PURPOSE

This study aimed to evaluate the psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in adults with stroke.

METHODS

A secondary analysis of the Stroke Recovery in Underserved Populations Cohort Study. The CES-D was administrated to 828 stroke patients at discharge from inpatient rehabilitation facilities and at 3- and 12-month follow-ups. Data were analyzed using classical test theory (CTT) and Rasch measurement model.

RESULTS

Confirmatory factor analyses of the CES-D items showed excellent fit of a four-factor model (CFI = 0.98; TLI = 0.98; RMSEA = 0.05). CTT analyses revealed satisfactory reliability and validity. Rasch analyses also supported the unidimensionality of each factor (subscale). Wright maps indicated a floor effect and item gaps. A few items displayed differential item functioning: 3 items (1 depressed affect and 2 somatic symptoms) across gender, 1 item (depressed affect) across time of assessment and all # somatic symptom items across time of assessment.

CONCLUSION

The four-factor structure of the CES-D was confirmed and its psychometric properties were validated, supporting the use of four subscales to characterize depressive symptomatology in adults with stroke. Supplementary assessments are needed for evaluating and comparing somatic symptoms over time. A refinement of the CES-D was recommended to better differentiate stroke survivors with subtle depressive symptoms.

Does grip strength of the less-affected side of ischemic stroke survivors influences performance of self-care activities?

Background and aim

Adequate grip strength is needed to execute various self-care activities. This study was aimed to assess the influence of grip strength of the less-affected side of ischemic stroke survivors on performance of self-care activities, and also to determine the reference values of less-affected grip strength needed for independent performance of each of the self-care activities.

Methods

Seventy-three consenting patients with ischemic stroke participated in this cross-sectional study. Handheld dynamometer was used to measure grip strength of the less-affected hand, while functional independence measure was used to evaluate self-care activities (eating, grooming, bathing, dressing of upper body, dressing of lower body and toileting) as independent and dependent. Data was analyzed using inferential statistics of Pearson’s correlation, binomial logistic regression, and receiver operating characteristics. Alpha level was set at p < 0.05.

Results

The mean hand grip strength, functional independence measure and trunk control test scores were 23.8 kg, 29.9 kg, and 68.2 kg respectively. Grip strength was significantly associated with independence in all of the self-care activities (p < 0.05). Less-affected grip strength of 19.5 kg (sensitivity, 80.4%; specificity, 80.1%; area under curve, 0.85), 23.7 kg (sensitivity, 79%; specificity, 72.2%; area under curve, 0.79), 24.8 kg (sensitivity, 70.2%; specificity, 65.2%; area under curve, 0.75), 24.7 kg (sensitivity, 82.1%; specificity, 80.1%; area under curve, 0.84), 23.7 kg (sensitivity, 80.1%; specificity, 76.1%; area under curve, 0.84), and 19.9 kg (sensitivity, 76.9%; specificity, 76.2%; area under curve, 0.79) was needed for independent performance in eating, grooming, bathing, dressing of upper body, dressing of lower body, and toileting respectively.

Conclusion

The less-affected grip strength of patients with ischemic stroke influences their ability to independently perform self-care activities. The reference values of less-affected grip strength in association with other stroke-related characteristics may help clinicians to estimate independence in eating, grooming, bathing, dressing of upper body, dressing of lower body, and toileting among patients with ischemic stroke.

Food Literacy Evaluation Questionnaire (Chinese version, FLEQ-Ch): a validity and cross-cultural adaptation

OBJECTIVE

To conduct a Food Literacy Evaluation Questionnaire Chinese Version (FLEQ-Ch) through a cross-cultural validation of the original questionnaire.

DESIGN

This was an observational, cross-sectional study undertaken in two phases: (1) translation and cross-culture adaptation, and (2) psychometric evaluation.

SAMPLE

A total of 509 residents in Yangzhou City, China were enrolled in this study.

METHODS

A translation and cross-cultural adaptation of the FLEQ in Chinese was developed. The psychometric characteristics of FLEQ-Ch were analyzed for internal consistency, content validity, construct validity and discriminant validity.

RESULTS

The KMO value of the questionnaire was 0.901 and the approximate chi-square value of Bartlett's sphericity test was 8132.538. The ranges of the Cronbach's α coefficient and the test-retest coefficient of the total questionnaire and three dimensions were 0.869-0.955 and 0.941-0.952, respectively. The value of content validity index of the total questionnaire was 0.945. Construct validity: (1) Aggregation coefficient was between 0.828 and 0.955; (2) Discrimination coefficient was between 0.004 and 0.227; (3) Correlation coefficient between each factor was between 0.046 and 0.188; the correlation coefficient between each factor and the total questionnaire ranged from 0.419 to 0.788. Discriminant validity: the standardized factor loadings of all items on the corresponding factors were 0.75-0.96. The results of the model-fit indices showed RMSEA was 0.08 and GFI was 0.91.

CONCLUSIONS

The FLEQ-Ch can effectively evaluate the food literacy of the general public in terms of foods planning and management, foods selection, and foods-making attitudes. It covers the four areas of food literacy, and shows good practicability and operability.

Health-related quality of life measured by EQ-5D-3L for the spouses of breast cancer patients

To explore factors influencing the health-related quality of life of spouses of breast cancer patients and the suitable questionnaires for this purpose. A cross-sectional study was conducted in the Third Affiliated Hospital of Kunming Medical University. The spouses of breast cancer patients were included and evaluated via face-to-face interviews. Self-designed demographic characteristics and disease-related questionnaires, the 12-item health survey questionnaire (SF-12), the three-level European five-dimensional health status scale (EQ-5D-3L), and the Social Support Rate Scale (SSRS) were used. The internal consistency reliability measure Cronbach’s coefficient, criterion-related validity, construct validity, and sensitivity were used to evaluate the applicability of the EQ-5D-3L. Univariate and multivariate analyses were performed to analyze the factors associated with the health-related quality of life of spouses of breast cancer patients. We investigated a total of 100 spouses of breast cancer patients. Cronbach’s α, the internal consistency reliability coefficient, was 0.502. The EQ-5D-3L health utility score was moderately correlated with PCS-12 (r=0.46, p=0.0001) and weakly correlated with MCS-12 (r=0.35, p=0.0001). The EQ-5D-3L health utility score for the spouses of breast cancer patients was 0.870, and the EQ-VAS was 78.3. In multivariate analysis, social support and cognition of the treatment effect were factors that influenced the EQ-5D-3L health utility score. The EQ-5D-3L has good reliability, validity, and sensitivity for measuring the physiological aspects of the health-related quality of life of spouses of BC patients. EQ-5D-3L was considered suitable for this study.

Community-Based Rehabilitation Promotes the Functional Recovery of Patients After Intracerebral Hemorrhage

BACKGROUND

Intracerebral hemorrhage (ICH), a severe disorder with the high death rate, high recurrence rate and high disability rate, affected the quality of human life. Community-based rehabilitation (CBR) helps disabled people at both community and family levels. However, the effect of CBR on the recovery of people after ICH remains unclear.

METHODS

Patients were treated with the CBR training program, subsequently, medication compliance test, clinical neural impairment measurements, functional comprehensive assessments, improved Barthel index score, and life qualities assessments were to performed at 3-month or 6-month intervention of CBR to evaluate the influence of CBR on the medication compliance, physical function and life quality of patients after ICH.

RESULTS

After the treatment of CBR, we observed that, the rate of medication compliance, motor function, functional comprehensive rating scale score, modified Barthel index score, and generic quality of life inventory-74 in the CBR-treated group were significantly higher than that in the control group; the neural impairment measure score in the CBR-treated group was significantly decreased in comparison to the control group.

CONCLUSION

CBR increased the medication compliance, promoted the recovery of the neurological function and improved the life qualities of ICH patients.

Racial Variation in the Association Between Domains of Depressive Symptomatology and Functional Recovery in Stroke Survivors

OBJECTIVE

The purpose of the study was to investigate the relationships between various domains of depressive symptomatology and functional recovery in Black and White stroke survivors.

METHODS

Black (n = 181) and White (n = 797) stroke survivors from the Stroke Recovery in Underserved Population database were included. Four domains of depressive symptomatology (depressed affect, positive affect, somatic symptoms, interpersonal difficulties) were measured by the Center for Epidemiologic Studies Depression Scale at discharge; functional recovery was measured by the Functional Independence Measure at discharge and 3-month follow-up. Multivariable linear regression analyses examined the relation between race and functional recovery, and the association between depressive symptomatology and functional recovery by race.

RESULTS

Three-month functional recovery was greater among White stroke survivors than Black survivors. Affective symptoms of depression predicted poorer functional recovery of White survivors; whereas somatic symptoms predicted poorer functional recovery of Black survivors.

CONCLUSIONS

Domains of depressive symptomatology were differentially associated with poorer functional recovery in Black and White stroke survivors. Psychosocial interventions aimed at alleviating depressive symptomatology have the potential to improve functional recovery in Black and White stroke survivors and should be addressed in planning rehabilitation post-stroke.

Depressive Symptomatology and Functional Status Among Stroke Survivors: A Network Analysis

OBJECTIVE

To (1) characterize poststroke depressive symptom network and identify the symptoms most central to depression, and (2) examine the symptoms that bridge depression and functional status.

DESIGN

Secondary data analysis of the Stroke Recovery in Underserved Population database. Networks were estimated using regularized partial correlation models. Topology, network stability and accuracy, node centrality and predictability, and bridge statistics were investigated.

SETTING

Eleven inpatient rehabilitation facilities across 9 states of the United States.

PARTICIPANTS

Stroke patients (N=1215) who received inpatient rehabilitation.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The Center for Epidemiologic Studies Depression Scale and Functional Independence Measure were administered at discharge from inpatient rehabilitation.

RESULTS

Depressive symptoms were positively intercorrelated within the network, with stronger connections between symptoms within the same domain. "Sadness" (expected influence=1.94), "blues" (expected influence=1.14), and "depressed" (expected influence=0.97) were the most central depressive symptoms, whereas "talked less than normal" (bridge expected influence=-1.66) emerged as the bridge symptom between depression and functional status. Appetite (R²=0.23) and sleep disturbance (R²=0.28) were among the least predictable symptoms, whose variance was less likely explained by other symptoms in the network.

CONCLUSION

Findings illustrate the potential of network analysis for discerning the complexity of poststroke depressive symptomology and its interplay with functional status, uncovering priority treatment targets and promoting more precise clinical practice. This study contributes to the need for expansion in the understanding of post-stroke psychopathology and challenges clinicians to use targeted intervention strategies to address depression in stroke rehabilitation.

Intermittent Fasting: A User-Friendly Method for Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is an alarmingly rising disorder characterized mainly by insulin resistance and hyperglycemia. Due to the impairment of glucose homeostasis, most subjects present with elevated serum glucose levels, which can lead to several complications, including hospitalizations and even death. Diet quality and quantity are at the heart of its pathogenesis; hence, for the management of this condition, a technique known as intermittent fasting (IF) has been an area of interest for researchers. Different fasting regimens, including alternate-day fasting, religious fasting, and time-restricted fasting, have proven to be of strategic importance for glycemic control due to their physiologic effects. According to case studies and randomized trials, therapeutic fasting has been shown to reverse insulin resistance, resulting in the discontinuance of insulin therapy while maintaining blood sugar levels.

Studies on IF have demonstrated their efficacy in glycemic control and other metabolic parameters, including reducing visceral fat and controlling inflammatory mediators and markers such as C-reactive protein (CRP) and interleukin-6 (IL-6), but control in obesity is its most significant effect as it acts as a risk factor for T2DM. Several case studies have shown a reduction in elevated hemoglobin A1c (HbA1c) levels in subjects after fasting, which some believe is due to sirtuin-6 (SIRT6) proteins. SIRT6 proteins are believed to be responsible for blood glucose homeostasis and insulin resistance reversal by increasing its sensitivity. This family of proteins is increased after fasting; hence, further research in this area will help researchers better understand its mechanism of action and potential therapeutic effects on T2DM. With an alarming increase in the incidence of T2DM around the world, a cost-effective strategy is required to control the disease with easy patient compliance, and IF might prove to be the solution.

Functional recovery following hospitalisation of patients diagnosed with COVID-19: a protocol for a longitudinal cohort study

INTRODUCTION

COVID-19 is an international public health crisis with more than 132 million infections worldwide. Beyond acute infection, emerging data indicate patients diagnosed with COVID-19 may experience persistent sequelae similar to survivors of sepsis or acute respiratory syndromes, including mobility limitations and fatigue. However, there is limited evidence on the trajectory of functional recovery in those hospitalised with COVID-19. The primary aim of the Coronavirus Registry Functional Recovery (COREG-FR) study is to understand the trajectory of functional recovery among individuals hospitalised for COVID-19 over the medium (up to 6 months) and longer term (6-12 months) that will guide clinical care and optimal management of serious COVID-19 illness and recovery.

METHODS AND ANALYSIS

COREG-FR is a multicentre longitudinal cohort study. We will enrol a minimum of 211 adults age 18 years and older with COVID-19 from five hospitals. Participants will be followed from admission to hospital as an inpatient, to hospital discharge, and at 3-month, 6-month, 9-month and up to 12-month post-hospital discharge. We will conduct telephone interviews at ward admission and discharge, and telephone interviews plus in-person assessments of physical function and lung function at all remaining follow-ups. Our primary outcome is the Activity Measure for Post-Acute Care mobility scale measured at all time points. We will conduct linear mixed effects regression analyses to explore determinants of functional outcomes after COVID-19 illness. Subgroup analyses based on age (≤65 vs >65 years), frailty status (Clinical Frailty Scale score ≤4 vs >5) and variants of concern will be conducted.

ETHICS AND DISSEMINATION

COREG-FR has been approved by Research Ethics Boards at participating sites. We will disseminate this work through peer-reviewed manuscripts, presentations at national and international meetings and through the established COREG website (www.coregontario.ca). COREG-FR is designed as a data platform for future studies evaluating COVID-19 recovery.

TRIAL REGISTRATION NUMBER

NCT04602260; Pre-results.

The effect of dietary fiber (oat bran) supplement on blood pressure in patients with essential hypertension: A randomized controlled trial

BACKGROUND AND AIMS

Insufficient dietary fiber (DF) intake is associated with increased blood pressure (BP) and the mode of action is unclear. The intake of DF supplements by participants in previous interventional studies was still far below the amount recommended by the World Health Organization. Therefore, this study aims to explore the effect of supplementing relatively sufficient DF on BP and gut microbiota in patients with essential hypertension (HTN).

METHODS AND RESULTS

Fifty participants who met the inclusion criteria were randomly divided into the DF group (n = 25) and control group (n = 25). All the participants received education on regular dietary guidance for HTN. In addition to dietary guidance, one bag of oat bran (30 g/d) supplement (containing DF 8.9 g) was delivered to the DF group. The office BP (oBP), 24 h ambulatory blood pressure, and gut microbiota were measured at baseline and third month. After intervention, the office systolic blood pressure (oSBP; P < 0.001) and office diastolic blood pressure (oDBP; P < 0.028) in the DF group were lower than those in the control group. Similarly, the changes in 24hmaxSBP (P = 0.002), 24hmaxDBP (P = 0.001), 24haveSBP (P < 0.007), and 24haveDBP (P = 0.008) were greater in the DF group than in the control group. The use of antihypertensive drugs in the DF group was significantly reduced (P = 0.021). The β diversity, including Jaccard (P = 0.008) and Bray-Curtis distance (P = 0.004), showed significant differences (P < 0.05) between two groups by the third month. The changes of Bifidobacterium (P = 0.019) and Spirillum (P = 0.006) in the DF group were significant.

CONCLUSIONS

Increased DF (oat bran) supplement improved BP, reduced the amount of antihypertensive drugs, and modulated the gut microbiota.

TRIAL REGISTRATION NUMBER

ChiCTR1900024055.

Remedial Training of the Less-Impaired Arm in Chronic Stroke Survivors With Moderate to Severe Upper-Extremity Paresis Improves Functional Independence: A Pilot Study

The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.

The determinants of motorized mobility scooter driving ability after a stroke

Purpose: To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke.Method: The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure.Results: The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = -.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R² = .76).Conclusions: The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.

Effect of an intensive functional rehabilitation program on the recovery of activities of daily living after total knee arthroplasty: A multicenter, randomized, controlled trial

BACKGROUND

Postoperative exercise is effective for improving activities of daily living (ADL) in patients undergoing total knee arthroplasty (TKA), and exercise has been included in standard care after surgery provided in Japan. However, it is unknown whether standard care has room to develop for improving ADL. The goal of this study was to investigate the effect of an intensive functional rehabilitation (IFR) program in addition to standard care on the recovery of ADL following surgery.

METHODS

A total of 104 inpatients with knee osteoarthritis undergoing TKA were randomly assigned to either the experimental or the control group. The experimental group (n = 57) were given standard care and participated in the IFR program immediately after surgery (e.g., stand up and sit down, strengthen the knee extensor muscle, climbing onto a platform, and walking laterally). The control group (n = 47) were given standard care only. Primary outcomes were the score of Functional Independence Measure (FIM) and the Barthel Index (BI) at 2 weeks postoperatively. Matching using the propensity score was performed to control the influence of the patient characteristic on the outcome.

RESULTS

As a result of matching, 42 patients were extracted. The averages (standard deviation) of the FIM motor score were 79.0 (10.8) for the experimental group and 80.5 (9.4) for the control group. The BI scores were 88.1 (13.3) for the experimental group and 91.0 (10.1) for the control group. The experimental and control groups did not show significant intergroup differences in either score.

CONCLUSIONS

Our study shows that as compared to standard care, IFR program for 2 weeks in addition to standard care after surgery did not significantly improve ADL in patients undergoing TKA.

Feasibility of, Adherence to, and Satisfaction With Video Game Versus Traditional Self-Training of the Upper Extremity in People With Chronic Stroke: A Pilot Randomized Controlled Trial

OBJECTIVE

We compared the feasibility of, adherence to, and satisfaction with a newly developed upper extremity (UE) self-training protocol using commercial video games with a traditional self-training program for people with chronic stroke.

METHOD

Twenty-four participants with mild to moderate UE weakness were randomized to a video game (n = 13) or traditional (n = 11) self-training program. Participants were requested to train 60 min/day, 6×/wk. During the 5-wk self-training program and 4-wk follow-up, participants documented their self-training time and rated their perceived enjoyment and exertion.

RESULTS

Eleven participants completed video game training; 9 completed traditional self-training. During the follow-up period, 8 participants (72.7%) continued the video game training, and 4 (44.4%) continued traditional training. Perceived enjoyment, satisfaction, and benefit for UE improvement were relatively high.

CONCLUSIONS

Participants demonstrated high adherence to and satisfaction with both self-training programs. More participants continued to play video games after the intervention, indicating its potential to maintain ongoing activity.

Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction?

This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months' post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = -4.21, p < .001) and instrumental activity limitation (Z = -4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = -4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors' predictions, clinicians' predictions were more closely aligned with actual stroke survivor functioning at three months' post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.

Occupational therapy and activity pacing with hospital-associated deconditioned older adults: a randomised controlled trial

Purpose: To examine the efficacy of an occupational therapy activity pacing intervention with deconditioned older adults in rehabilitation.Method: Randomised, single-blind controlled trial of deconditioned older adults admitted for rehabilitation following treatment of an acute medical condition, allocated to intervention [n = 51, males = 14, mean age = 80(8)] or control [n = 49, males = 12, mean age = 81(7)] group. The intervention group received individual and group activity pacing education with practice and application of techniques to daily activities and the home environment, while the control group received a typical occupational therapy program, which included brief activity pacing education. Outcomes included participation in daily living skills, health status (including pain and fatigue symptoms), self-efficacy in daily activities and activity pacing techniques using the Australian Therapy Outcome Measures-Occupational Therapy (AusTOMs-OT), Short Form-36 Health Survey (SF-36), Self-Efficacy Gauge and Activity Pacing Assessment.Results: No differences in groups at admission. Comparison at discharge and three months post discharge using 2 × 2 mixed ANOVA demonstrated small differences in only one scale of the activity limitation domain of the AusTOMs-OT. No significant differences were found in other scales or domains of the AusTOMs-OT, nor secondary outcome measures.Conclusion: Activity pacing in addition to typical occupational therapy during inpatient rehabilitation did not demonstrate benefits to participants in the management of their daily activities on returning home post hospitalisation.Implications for rehabilitationActivity pacing has been identified as one of the commonly used occupational therapy interventions utilised with deconditioned older adults in rehabilitation.An activity pacing intervention in conjunction with typical occupational therapy demonstrated no benefits for deconditioned older adults over typical occupational therapy which included basic education on this topic.Continuation of the activity pacing intervention into the outpatient setting may be of benefit to older adults and requires further investigation.

Kettle test efficacy in predicting cognitive and functional outcomes in geriatric rehabilitation

BACKGROUND/AIM

Limited research has been available to support the use of the Kettle Test in a subacute rehabilitation setting with patients diagnosed with a variety of medical conditions. The Kettle Test is an occupation based performance measure designed to detect cognitive processes and function. The aim of this research was to measure the correlation between three cognitive tests, the Mini-Mental State Examination (MMSE), Cognitive Functional Independence Measure (Cognitive FIM) and the Kettle Test. Secondly, to assess the efficacy of these tests in predicting functional outcomes via the motor subscale of the Functional Independence Measure (mFIM).

METHODS

A prospective single-centre cohort study in a subacute rehabilitation setting of 97 patients.

RESULTS

Correlation coefficients between the tests were statistically significant and moderately strong, with values ranging from 0.593 to -0.589. Significant positive correlations were seen between admission MMSE, Cognitive FIM and the mFIM and significant negative correlations between Kettle Test scores and the mFIM. The Kettle Test score had a stronger relationship with mFIM (r = -0.40; P < 0.01) compared to the Cognitive FIM (r = 0.33; P < 0.01) and MMSE (r = 0.26; P < 0.05). The Kettle Test variance is significantly associated with the MMSE and Cognitive FIM at admission and discharge measures. Modelling identified that age and gender significantly contribute to this relationship. When adjusted for age and gender the MMSE and Cognitive FIM both explained the 47% of the variance at discharge.

CONCLUSION

There were statistically significant inter-test correlations between the MMSE, Cognitive FIM and Kettle Test. The Kettle Test had the strongest relationship to patient functional outcomes.

The Effect of Low-Carbohydrate Diet on Glycemic Control in Patients with Type 2 Diabetes Mellitus

Objective: In China, a low-fat diet (LFD) is mainly recommended to help improve blood glucose levels in patients with type 2 diabetes mellitus (T2DM). However, a low-carbohydrate diet (LCD) has been shown to be effective in improving blood glucose levels in America and England. A few studies, primarily randomized controlled trials, have been reported in China as well. Method: Firstly, we designed two ‘six-point formula’ methods, which met the requirements of LCD and LFD, respectively. Fifty-six T2DM patients were recruited and randomly allocated to the LCD group (n = 28) and the LFD group (n = 28). The LCD group received education about LCD’s six-point formula, while the LFD group received education about LFD’s six-point formula. The follow-up time was three months. The indicators for glycemic control and other metabolic parameters were collected and compared between the two groups. Results: Forty-nine patients completed the study. The proportions of calories from three macronutrients the patients consumed met the requirements of LCD and LFD. Compared to the LFD group, there was a greater decrease in HbA1c level in the LCD group (−0.63% vs. −0.31%, p < 0.05). The dosages of insulin and fasting blood glucoses (FBG) in the third month were lower than those at baseline in both groups. Compared with baseline values, body mass index (BMI) and total cholesterol (TC) in the LCD group were significantly reduced in the third month (p < 0.05); however, there were no statistically significant differences in the LFD group. Conclusions: LCD can improve blood glucose more than LFD in Chinese patients with T2DM. It can also regulate blood lipid, reduce BMI, and decrease insulin dose in patients with T2DM. In addition, the six-point formula is feasible, easily operable, and a practical educational diet for Chinese patients with T2DM.

Developing the content of a locomotor disability scale for adults in Bangladesh: a qualitative study

Background

Bangladesh has an estimated 17 million adults with disabilities. A significant proportion of them are believed to have locomotor disabilities. There are over 300 non-governmental organizations providing different types of rehabilitation services to them. However, there is no locally developed and validated locomotor disability measurement scale in Bangladesh. The purpose of this study was to develop a locomotor disability scale with disability indicators suitable for adults in Bangladesh.

Methods

Semi-structured interviews were conducted with 25 purposively selected adults with locomotor disabilities to generate scale items. At the second stage, cognitive interviews were conducted with 12 purposively selected adults with locomotor disabilities in order to refine the measurement questions and response categories. Data were analysed using the framework technique- identifying, abstracting, charting and matching themes across the interviews.

Results

For a locomotor disability scale, 70 activities (disability indicators) were identified: 37 mobility activities, 9 activities of daily living, 17 work/productivity activities and 7 leisure activities. Cognitive interviews revealed that when asking the respondents to rate their difficulty in performing the activities, instead of just mentioning the activity name, such as taking a bath or shower, a detailed description of the activity and response options were necessary to ensure consistent interpretation of the disability indicators and response options across all respondents.

Conclusions

Identifying suitable disability indicators was the first step in developing a locomotor disability scale for adults in Bangladesh. Interviewing adults with locomotor disabilities in Bangladesh ensured that the locomotor disability scale is of relevance to them and consequently it has excellent content validity. Further research is needed to evaluate the psychometric properties of this scale.

Electromyographic analysis of constraint-induced movement therapy effects in patients after stroke in chronic course

[Purpose] The purpose is to analyze the effects of Constraint-induced Movement Therapy in post stroke patients in chronic course. [Subjects and Methods] This is a Quasi-experiment study and the adopted protocol consisted of a three-hour therapy for ten consecutive working days applied to a constraint intact upper limb. Surface Electromyography, Motor Activity Log, Wolf Motor Function Test and Functional Independence Measure were used for evaluating the experiment. [Results] The individuals showed reduction in the degree of spasticity, confirmed by Surface Electromyography. In relation to Motor Activity Log this study showed an increase in amount and in quality of the paretic upper limb movement. The Wolf Motor Function Test showed reduction in the average time to perform the tasks and a functional improvement was identified through the Functional Independence Measure. [Conclusion] Constraint Induced Movement Therapy proved to be a relevant method to improve motor function in chronic hemiparesis post stroke reducing the spasticity, maximizing and improving the use of committed upper limb.

The synergistic effect of dual use of amphetamine-type stimulants and ketamine on drug-induced psychotic symptoms in Chinese synthetic drug users

The use of amphetamine-type stimulants (ATS) and ketamine is of particular clinical concern because of its associated psychotic symptoms. In Chinese clinical practice, ATS and ketamine are commonly used simultaneously, but very few studies have reported the symptom profile of users who use both drugs. This study determined whether the combined use of ATS and ketamine is associated with more psychotic symptoms than either ATS or ketamine alone. According to drug use characteristics, 375 Chinese synthetic drug users were categorized into 2 pairs of comparison groups: ATS-only (n=125) vs. ATS-mainly (ATS most of the time and ketamine sometimes, n=150) and ketamine-only (n=38) vs. ketamine-mainly (ketamine most of the time and ATS sometimes, n=62). We used the Chinese Brief Psychiatric Rating Scale (BPRS) to assess these patients’ psychotic symptoms. ATS-mainly group had more anxiety/depression and anergia symptoms than ATS-only group (p<0.001), and ketamine-mainly group had more thinking-disorder, activity and hostility-suspicion symptoms than ketamine-only group (p≤0.001). These findings indicate that ATS may exacerbate the thinking-disorders, activity and hostility-suspicion symptoms of ketamine users, and ketamine may exacerbate anxiety/depression and anergia symptoms of ATS users.

Self-training to improve UE function at the chronic stage post-stroke: a pilot randomized controlled trial

BACKGROUND AND PURPOSE

On-going practice and use of the weaker upper extremity (UE) are important for maintaining and improving function in individuals with chronic stroke. The effectiveness of two self-training programs for UE function and daily-use was compared.

METHODS

In this pilot, single-blinded clinical trial, individuals with chronic stroke were randomized to video-games or traditional self-training (1-hour/day, 6-times/week, 5 weeks). Assessments were performed pre-intervention (an average of two assessments), post-intervention, and at 4-week follow-up. The primary outcome was the functional ability of the upper extremity [The Action Research Arm Test (ARAT)]. Secondary measures were the daily use of the upper extremity [Motor Activity Log (MAL)] and manual dexterity (Box and Block Test). Repeated measures ANOVA was used to test the effectiveness and estimate effect sizes.

RESULTS

Twenty-four of the 142 participants screened by phone were randomized to video-games [N = 13, mean (SD) age - 59.1 (10.5)] or traditional [N = 11, mean (SD) age - 64.9 (6.9)] self-training. Significant between-group differences were not detected. ARAT significantly improved by 13.9% and 9.6% following the video-games and traditional self-training programs (respectively), with a large effect size. MAL (quantity) also improved significantly between pre- intervention to follow-up with medium-large effect size.

CONCLUSIONS

UE functional improvement can be achieved by self-training at the chronic stage and, therefore, should be encouraged by clinicians. Implications for rehabilitation Video-games or traditional self-training programs can be used to practice repetitive UE movements without the supervision of a clinician Self-training of the UE is beneficial at the chronic stage post-stroke and, therefore, should be encouraged The type of self-training (video-games or traditional) should be suited to the client's abilities and preferences. The compliance of self-training using video-games during the follow-up period was higher than the traditional self-training. This is important since self-training programs for chronic stroke need to be long-term and sustainable.

The Effect of Training Older Adults with Stroke to Use Home-Based Assistive Devices

This study evaluated whether an additional home training program on bathing devices would improve the rate of use, personal independence, and service satisfaction of older adults who had experienced strokes. A prospective pretest and posttest randomized control trial design was adopted. Fifty-three older adults who had experienced strokes were randomly assigned to either the intervention group or the control group. The prescription of and training in the use of devices was conducted with both groups while they were in the hospital. The intervention group received additional home-based intervention in the use of devices immediately after discharge, but the control group did not. All of the subjects were assessed before discharge and 3 months after discharge using the Functional Independence Measure and the Quebec User Evaluation of Satisfaction with Assistive Technology. The results showed that the intervention group improved significantly in functioning ( t = 3.89; df = 51; P = .01) and satisfaction ( t = 69.8; df = 29; P = .01) after intervention. The rate of use of bathing devices was relatively higher in the intervention group (96.7%) than in the control group (56.5%). Further studies with extended follow-up services are needed to evaluate the long-term effects of training in the use of assistive devices.

Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia

OBJECTIVES

To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living (ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types.

DESIGN

Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study.

SETTING

Residential care facilities, Umeå, Sweden.

PARTICIPANTS

Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N=186).

INTERVENTION

Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.

MEASUREMENTS

Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months.

RESULTS

Linear mixed models showed no between-group effect on ADL independence at 4 (FIM=1.3, 95% confidence interval (CI)=-1.6-4.3; BI=0.6, 95% CI=-0.2-1.4) or 7 (FIM=0.8, 95% CI=-2.2-3.8; BI=0.6, 95% CI=-0.3-1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8-6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months.

CONCLUSION

In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia.

Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke

PURPOSE

To translate and cross-culturally adapt the Functional Independence Measure (FIM) into the Persian language and to test the reliability and validity of the Persian FIM (PFIM) in patients with stroke.

METHOD

In this cross-sectional study carried out in an outpatient stroke rehabilitation center, 40 patients with stroke (mean age 60 years) were participated. A standard forward-backward translation method and expert panel validation was followed to develop the PFIM. Two experienced occupational therapists (OTs) assessed the patients independently in all items of the PFIM in a single session for inter-rater reliability. One of the OTs reassessed the patients after 1 week for intra-rater reliability.

RESULTS

There were no floor or ceiling effects for the PFIM. Excellent inter-rater and intra-rater reliability was noted for the PFIM total score, motor and cognitive subscales (ICC(agreement)0.88-0.98). According to the Bland-Altman agreement analysis, there was no systematic bias between raters and within raters. The internal consistency of the PFIM was with Cronbach's alpha from 0.70 to 0.96. The principal component analysis with varimax rotation indicated a three-factor structure: (1) self-care and mobility; (2) sphincter control and (3) cognitive that jointly accounted for 74.8% of the total variance. Construct validity was supported by a significant Pearson correlation between the PFIM and the Persian Barthel Index (r = 0.95; p < 0.001).

CONCLUSIONS

The PFIM is a highly reliable and valid instrument for measuring functional status of Persian patients with stroke.

IMPLICATIONS FOR REHABILITATION

The Functional Independence Measure (FIM) is an outcome measure for disability based on the International Classification of Functioning, Disability and Health (ICF). The FIM was cross-culturally adapted and validated into Persian language. The Persian version of the FIM (PFIM) is reliable and valid for assessing functional status of patients with stroke. The PFIM can be used in Persian speaking countries to assess the limitations in activities of daily living of patients with stroke.

Video-games used in a group setting is feasible and effective to improve indicators of physical activity in individuals with chronic stroke: a randomized controlled trial

OBJECTIVES

To investigate the feasibility of using video-games in a group setting and to compare the effectiveness of video-games as a group intervention to a traditional group intervention for improving physical activity in individuals with chronic stroke.

DESIGN

A single-blind randomized controlled trial with evaluations pre and post a 3-month intervention, and at 3-month follow-up. Compliance (session attendance), satisfaction and adverse effects were feasibility measures. Grip strength and gait speed were measures of physical activity. Hip accelerometers quantified steps/day and the Action Research Arm Test assessed the functional ability of the upper extremity.

RESULTS

Forty-seven community-dwelling individuals with chronic stroke (29-78 years) were randomly allocated to receive video-game (N=24) or traditional therapy (N=23) in a group setting. There was high treatment compliance for both interventions (video-games-78%, traditional therapy-66%), but satisfaction was rated higher for the video-game (93%) than the traditional therapy (71%) (χ(2)=4.98, P=0.026). Adverse effects were not reported in either group. Significant improvements were demonstrated in both groups for gait speed (F=3.9, P=0.02), grip strength of the weaker (F=6.67, P=0.002) and stronger hands (F=7.5, P=0.001). Daily steps and functional ability of the weaker hand did not increase in either group.

CONCLUSIONS

Using video-games in a small group setting is feasible, safe and satisfying. Video-games improve indicators of physical activity of individuals with chronic stroke.

Development and Testing of Self-Management Scale for PD Patients

OBJECTIVES

To develop and evaluate the self-management scale for peritoneal dialysis (PD) patients.

METHODS

The item pool was formulated based on literature reviews and in-depth interviews. An initial scale containing five factors and 44 items was constructed through two rounds of Delphi expert consultation and a preliminary test. A total of 313 PD patients from the Jiangsu-Zhejiang-Shanghai area were surveyed to test the reliability and validity of the scale.

RESULTS

Five factors, namely solution bag replacement, troubleshooting during operation, diet management, complication monitoring, emotion management and return to social life, were extracted by exploratory factor analysis: the 28 items could explain 64.567% of the total variance; the content validity index was 0.963; the Cronbach's α coefficient and split-half coefficient were 0.926 and 0.960 respectively; and test-retest reliability was 0.937.

CONCLUSION

The scale has been proved to be a reliable and valid tool which allows PD nurses to evaluate the self-management ability of PD patients. The evaluation outcomes can serve as a basis for individualized nursing plans and interventions so as to provide highly effective nursing care.

Eliciting Upper Extremity Purposeful Movements Using Video Games

Background. Video games have become popular in stroke rehabilitation; however, the nature of this intervention is not fully understood. Objectives. To compare the number of ( a) purposeful and nonpurposeful repetitions of the weaker upper extremity (UE) and ( b) movement accelerations as assessed by accelerometer activity counts of the weaker and stronger UEs of individuals with chronic stroke while playing video games or participating in traditional therapy. Methods. Twenty-nine individuals (mean age 59 years, 1-7 years poststroke) took part in a group intervention of video -games (n = 15) or traditional therapy (n = 14) as part of a randomized controlled trial. During 1 - 2 sessions, participants were video-taped while wearing wrist accelerometers. Assessors counted the number of repetitions and classified movements as purposeful or nonpurposeful using videotapes. The weaker UE motor impairments were correlated to movement accelerations, to determine if participants were using their potential during the sessions. Results. Participants in the video game group performed a median of 271 purposeful movements and 37 970 activity counts compared to 48 purposeful movements and 14 872 activity counts in the traditional group ( z = −3.0, P = .001 and z = −1.9, P = .05, respectively). Participants in the traditional group performed a median of 26 nonpurposeful (exercises) compared with 0 in the video game group ( z = −4.2, P = .000). Strong significant correlations were found between the motor ability of the weak UE to repetitions of participants in both groups ( r = .86, P < .01). Participants with higher motor ability performed more repetitions. Conclusions. Video games elicited more UE purposeful repetitions and higher acceleration of movement compared with traditional therapy in individuals with chronic stroke.

Does trunk, arm, or leg control correlate best with overall function in stroke subjects?

BACKGROUND

Attainment of functional independence is the ultimate goal of a sound stroke rehabilitation program. Good trunk stability is essential for balance and extremity use. Stroke patients may have upper extremity impairments that may affect functional activity and lower extremity impairments that may hinder mobility. Hence, quantifying the specific levels of impairment in the trunk, upper extremity, and lower extremity is helpful to determine the extent to which each might influence the ability to perform activities of daily living.

OBJECTIVE

To assess the impairment of the trunk and the upper and lower extremity of stroke patients and correlate it with overall function.

METHODS

A cross-sectional repeated correlation study. Twenty-three subjects with a first-time stroke, between 50 and 75 years of age, of both genders, admitted in hospital within 5 weeks of stroke onset were included using purposive sampling technique. On the eighth day of the stroke, trunk impairment was assessed using the Trunk Impairment Scale, upper and lower limb impairment was assessed using the Simplified Stroke Rehabilitation Assessment of Movement (upper and lower limb subscale, respectively), and overall function was measured by FIM.

RESULTS

Trunk activity showed highly significant correlation (r = 0.598, P = .003) with overall function compared with upper limb activity (r = 0.501, P = .015). Lower limb impairment showed no correlation with overall function (r = 0.208, P = .342).

CONCLUSIONS

The overall functional independence in acute stroke patients is most closely correlated with the levels of impairments of trunk function, followed by upper limb impairments.

Self-management: a systematic review of outcome measures adopted in self-management interventions for stroke

Purpose

To systematically review the psychometric properties of outcome measures used in stroke self-management interventions (SMIs) to (1) inform researchers, clinicians and commissioners about the properties of the measures in use and (2) make recommendations for the future development of self-management measurement in stroke.

Methods

Electronic databases, government websites, generic internet search engines and hand searches of reference lists. Abstracts were selected against inclusion criteria and retrieved for appraisal and systematically scored, using the COSMIN checklist.

Results

Thirteen studies of stroke self-management originating from six countries were identified. Forty-three different measures (mean 5.08/study, SD 2.19) were adopted to evaluate self-SMIs. No studies measured self-management as a discreet concept. Six (46%) studies included untested measures. Eleven (85%) studies included at least one measure without reported reliability and validity in stroke populations.

Conclusions

The use of outcome measures which are related, indirect or proxy indicators of self-management and that have questionable reliability and validity, contributes to an inability to sensitively evaluate the effectiveness of stroke self-SMIs. Further enquiry into how the concept of self-management in stroke operates, would help to clarify the nature and range of specific self-management activities to be targeted and aid the selection of existing appropriate measures or the development of new measures.

Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III)

STUDY DESIGN

Cross-sectional validation study.

OBJECTIVES

To develop and validate a self-report version of the Spinal Cord Independence Measure (SCIM III).

SETTING

Two SCI rehabilitation facilities in Switzerland.

METHODS

SCIM III comprises 19 questions on daily tasks with a total score between 0 and 100 and subscales for 'self-care', 'respiration & sphincter management' and 'mobility'. A self-report version (SCIM-SR) was developed by expert discussions and pretests in individuals with spinal cord injury (SCI) using a German translation. A convenience sample of 99 inpatients with SCI was recruited. SCIM-SR data were analyzed together with SCIM III data obtained from attending health professionals.

RESULTS

High correlations between SCIM III and SCIM-SR were observed. Pearson's r for the total score was 0.87 (95% confidence interval (CI) 0.82-0.91), for the subscales self-care 0.87 (0.81-0.91); respiration & sphincter management 0.81 (0.73-0.87); and mobility 0.87 (0.82-0.91). Intraclass correlations were: total score 0.90 (95% CI 0.85-0.93); self-care 0.86 (0.79-0.90); respiration & sphincter management 0.80 (0.71-0.86); and mobility 0.83 (0.76-0.89). Bland-Altman plots showed that patients rated their functioning higher than professionals, in particular for mobility. The mean difference between SCIM-SR and SCIM III for the total score was 5.14 (point estimate 95% CI 2.95-7.34), self-care 0.89 (0.19-1.59), respiration & sphincter management 1.05 (0.18-2.28 ) and mobility 3.49 (2.44-4.54). Particularly patients readmitted because of pressure sores rated their independence higher than attending professionals.

CONCLUSION

Our results support the criterion validity of SCIM-SR. The self-report version may facilitate long-term evaluations of independence in persons with SCI in their home situation.

Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study

OBJECTIVES

To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RMR) and body composition in the frail elderly.

DESIGN

Open, randomised, controlled pilot treatment study.

SETTING

Community-based research centre.

PARTICIPANTS

Ninety-six community-dwelling frail elderly people aged 75 and older, 40% men.

INTERVENTION

Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group.

MEASUREMENTS

The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months' intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals).

RESULTS

The training group showed a significantly increased RMR at 3 months. Otherwise, there were no observed differences within or between the four groups. There was no correlation over time between energy intake, RMR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study ('responders') had a statistically significantly lower BMI (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the 'non-responders'. The 'non-responders' showed a small but statistically significant decrease in body fat percentage at F1, and in body weight, BMI and FFM at 9 months (F3).

CONCLUSION

Individual nutrition counselling and physical exercise had no effect on energy intake, RMR or fat free mass in community-dwelling frail elderly people aged 75 and older. Interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

Effects of a physical training and nutritional intervention program in frail elderly people regarding habitual physical activity level and activities of daily living--a randomized controlled pilot study

The aim of this randomized controlled pilot study is to describe the effects of a physical training and nutritional intervention program on the physical activity level and activities of daily living (ADL) in frail elderly people. Ninety-six community-dwelling frail elderly people (58 women) above the age of 75 were included in the study. The 12-week physical and/or nutritional intervention program was followed by six months of home-based exercises for the training groups, followed up with training diaries. At baseline the subjects were screened for physical activity level, walking habits, and ADL. These measurements were repeated immediately after the intervention at 3 months, and at 2nd follow-up at 9 months. ADL data were also collected 24 months after baseline at 3rd follow-up. The intention-to-treat analyses showed an increase of the habitual physical activity level and walking duration at 1st follow-up for the two training groups compared to the other groups. These increases remained at 2nd follow-up. The nutrition intervention did not show any significant results. No significant effects on ADL were shown however, there were moderate correlations between increases in physical activity level and ADL as well as between the amounts of home-based exercises and ADL for the two training groups.

Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature

BACKGROUND

The rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems.

METHODS

English language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements.

RESULTS

In total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS.

CONCLUSION

Additional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.

Concurrent validity of administering the functional independence measure (FIM) instrument by interview

In this study, we measure the concurrent validity of administering the Functional Independence Measure instrument by interview. Data from 28 community-dwelling, cognitively intact, elderly patients with hip fracture were collected in 5 postacute rehabilitation facilities. Within 72 hrs of admission to (and at discharge from) the postacute facilities, both a Functional Independence Measure-certified interviewer and a multidisciplinary team administered the Functional Independence Measure instrument to each participant concurrently. At admission, the mean Functional Independence Measure ratings assigned by the interviewer and by the team were 84.3 and 80.5, respectively (P < 0.001). At discharge, the mean Functional Independence Measure ratings were 104.4 and 103.4 (P > 0.50), reflecting the participants' functional recovery during postacute rehabilitation. The intraclass correlation between the Functional Independence Measure ratings assigned by the interviewer and by the team was 0.74 (95% confidence interval = 0.58-0.91) at admission and 0.76 (95% confidence interval = 0.60-0.92) at discharge. Functional Independence Measure ratings assigned by Functional Independence Measure-certified interviewers are valid indicators of the functional status of groups of older people recovering from hip fracture and feasible for longitudinal study.

Everyday physical activity and community participation of adults with hemiplegic Cerebral Palsy

PURPOSE

To assess the level and potential determinants of everyday physical activity and participation in various life areas of adults with hemiplegic cerebral palsy (CP) in comparison with healthy subjects.

METHOD

In a cross-sectional study everyday physical activity was measured (Activity Monitor) in 16 adults with CP, aged 28 (3) years, and 16 age/gender matched healthy volunteers, aged 29 (3) years. Participation was assessed by means of validated questionnaires. Age, gender, body fat (skinfold thickness), muscle tone (Ashworth Scale), functional level and participation were assessed as potential determinants of everyday physical activity.

RESULTS

In adults with CP mean (SD) duration of dynamic activities during a day (10.6 [3.5]%) was comparable to healthy subjects (11.2 4%) (p = 0.66). In most life areas the level of participation was comparable for both groups, although adults with CP spent more time on non-intensive leisure activities. Participation in sports appeared to be a determinant of everyday physical activity in both groups.

CONCLUSIONS

The results indicate that the levels of everyday physical activity and community participation in adults with hemiplegic CP are comparable to levels in healthy comparison subjects.

Evaluation of a 5-level Functional Independence Measure in a longitudinal study of elderly stroke survivors

PURPOSE

The aim of the present study was to evaluate a modified 5-level Functional Independence Measure (FIM), by using the assessments from a longitudinal study of elderly stroke survivors.

METHOD

One hundred and seventy-three patients were followed longitudinally. Firstly, the 7-level FIM was used at 0-3 days, 3 weeks, and 3 months and then after 1 year following acute stroke. The data, in total 8996 assessments, were presented on the item level. Secondly, the data were recoded with the help of a modified 5-level FIM according to the cut-off levels suggested in a previous study of the same target group. Two registered occupational therapists did the assessments in the patients' natural environment, i.e., in their own homes or in different kinds of assisted living. The data were obtained both by interviews and with the help observations, when the occupational therapist asked the patients to perform specific activities.

RESULTS

The assessments on all four occasions were found to polarise when using the 7-level FIM, and the intermediate levels of assistance were more seldom used. After the assessment data were recoded with the modified 5-level FIM, it was shown that it was easier to follow the process of activity by using an instrument with fewer levels. A modified 5-level FIM had enough levels to ensure sensitivity and was easier to handle when evaluating performance of daily activities in a large population study.

CONCLUSIONS

A modified 5-level FIM can be useful in large population studies and most likely increase reliability without losing in sensitivity.

Issues for selection of outcome measures in stroke rehabilitation: ICF activity

PURPOSE

To evaluate the psychometric and administrative properties of outcome measures in the WHO International Classification of Functioning, Disability and Health (ICF) Activity category used in stroke rehabilitation research and reported in the published literature.

METHOD

Critical review and synthesis of measurement properties for nine commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature.

RESULTS

The reporting of specific measurement qualities for outcome instruments was relatively consistent across measures located within the same general ICF category. There was evidence to suggest that the measures were responsive to change as well as being valid and reliable tools. The best available instruments were associated with the assessment of activities of daily living, balance (static and dynamic), functional independence, and functional mobility.

CONCLUSIONS

Given the diversity that exists among available measures, the reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved functional activity in stroke rehabilitation. However, there appears to be good consensus regarding the most important indicators of successful rehabilitation outcome, especially in the case of functional mobility.

Agreement in activities of daily living performance after stroke in a postal questionnaire and interview of community-living persons

OBJECTIVE

To compare assessments of activities of daily living (ADL) made in a postal questionnaire and an interview.

DESIGN

Comparative study of a convenience sample.

SUBJECTS

Results in 36 persons with stroke >10 years previously.

METHODS

Data on ADL were gathered in a self-administered postal questionnaire followed by a semi-structured interview (within 1-2 weeks) using items in the Functional Independence Measure, combined with instrumental items, Instrumental Activity Measure or the ADL taxonomy (personal and instrumental items).

RESULTS

There was generally moderate to good agreement between the postal questionnaire and the interview. Other dependence identified was reported during the interviews. Although the operational descriptions of the items varied between the ADL indices, they primarily identified ADL independence in the same persons.

CONCLUSION

The use of a self administrated postal ADL questionnaire was feasible for studying ADL performance. However, in some persons, interviews may be needed to complement the results.

Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions

Background

To examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). To identify variables predictive of appropriateness and explore management alternatives.

Methods

Adults admitted as acute patients to Derby Hospitals NHS Foundation Trust (England). Data were collected prospectively and examined by a multi-disciplinary expert panel to determine the appropriateness of admission and length of stay (LoS). Management alternatives were discussed.

Results

A total of 119 participants were recruited. 32 admissions were inappropriate and 83 were for an inappropriate duration. Whether a participant lived in their own home was predictive of an inappropriate admission. The number of LTNCs, number of presenting complaints and whether the participant lived alone in their own home were predictive of an inappropriate LoS. For admissions judged to be inappropriate, the panel suggested management alternatives.

Conclusion

Patients with LTNCs are being admitted to hospital when other services, e.g. ambulatory care, are available which could meet their needs. Inefficiencies in hospital procedures, such as discharge planning and patient transfers, continue to exist. Recognition of the need to plan for discharge at admission and to ensure in-patient services are provided in a timely manner may contribute towards improved efficiency.