Comparing the responsiveness of the assessment of motor and process skills and the functional independence measure

An immersive virtual reality shopping task detects declines in instrumental activities of daily living in individuals with Parkinson's disease

INTRODUCTION

Declines in instrumental activities of daily living (IADLs) have been proposed as a prodromal marker of Parkinson's disease (PD). The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform combines an omnidirectional treadmill with a virtual reality headset to create a virtual grocery store that a user physically walks through and completes a shopping task. The primary aim of this project was to determine the known-group validity of the CC-VRS platform in discriminating IADL performance and to characterize specific motor and cognitive declines responsible for PD-related IADL impairments.

METHODS

Sixteen individuals with PD and 15 healthy adults completed traditional motor, cognitive, and IADL assessments and the CC-VRS task. Group differences were evaluated using Welch's t-test.

RESULTS

There were no between-group differences in traditional performance measures of motor, cognitive, or IADL function. Regarding CC-VRS performance, participants in the PD group completed the task significantly slower than controls (690 vs. 523 sec, respectively). Participants with PD spent 25 % more time walking and turning and were stopped 46 % longer than controls. Average gait speed when viewing the shopping list, a measure of dual-task performance, was significantly slower in the PD group compared to controls (0.26 vs. 0.17 m/s, respectively).

CONCLUSION

Unlike traditional performance measures of motor, cognitive, and IADL function, the CC-VRS discriminated participants with PD from healthy older adults. For the PD group, motor and dual-task declines contributed to diminished CC-VRS performance. Identifying underlying contributors to IADL declines supports using ecological assessments, such as the CC-VRS, for the routine clinical evaluation of IADLs.

The predictors to self-reported and performance-based physical function in knee osteoarthritis patients: a cross-sectional study

Background

Osteoarthritis (OA) knee patients have limited ability in physical function, or difficulties with physical tasks and activities may develop disability. This study aimed to observe the predictors of self-reported and performance-based physical function in patients with knee OA by analyzing the impacts of demographic, pathological, and muscle impairment factors.

Methods

135 knee OA patients participated in this study to complete self-reported questionnaires using Knee Injury and Osteoarthritis Outcome Score (KOOS). When measuring performance-based physical function, a 6-meter gait speed (6MGS) test was measured to evaluate their mobility, and a 5-time Sit-to-Stand test (5STS) was assessed to evaluate their balance. Pain intensity, knee extensor and flexor muscle strength, age, body mass index (BMI), durations of symptoms, and radiographic severity were also collected. Spearman correlation and stepwise multiple linear regression were used to explore the association and predictors in self-reported and performance-based physical function.

Results

BMI and durations of symptoms did not indicate any significant correlation with either self-reported or performance-based physical function. Age is significantly negatively associated with 6MGS (r 2 = -0.383, p < 0.01), while knee extensor muscle strength has a moderate correlation with 5STS (r 2 = -0.528, p < 0.01). In the stepwise multiple linear regression models, pain intensity (β = 0.712, p < 0.001), knee flexor muscle strength (β = 0.112, p = 0.042) were significantly associated with self-reported physical function in daily activities and contributed to 55.0% of the variance in KOOS-PF score. Knee muscle strength, including knee extensor (5STS: β = -0.428, p < 0.001) and flexor muscle strength (6MGS: β = 0.367, p < 0.001), were the main predictors with performance-based physical function.

Conclusion

Pain intensity was the leading risk factor of self-reported physical function, and knee flexor muscle strength contributed as well. The severity of knee OA, durations of symptoms and BMI did not contribute to physical function. However, knee extensor and flexor muscle strength were the main predictors of performance-based performance. Our results show that strengthening of weak knee muscles in both quadriceps and hamstring muscle strength should be considered a priory consideration in knee OA no matter if people are in the early or end-stage of knee OA.

Predicting length of stay with assessment of motor and process skills in subjects with acquired brain injury

BACKGROUND

The Functional Independence Measure (FIM) is a well-established predictor of length of stay (LOS) for rehabilitation. The Assessment of Motor and Process Skills (AMPS) is a more in-depth construct for measuring activities of daily living (ADL) and may therefore be a valuable adjunct when predicting LOS. This paper aimed to investigate AMPS as a candidate predictor of LOS in a statistical model including FIM.

METHODS

A cohort study of 647 patients with acquired brain injuries admitted for rehabilitation. LOS was analyzed in a multiple regression model with the motor and process/cognitive domains of AMPS and FIM.

RESULTS

Independence in ADL process ability and FIM cognition were associated with 31% (p < 0.001) and 38% (p < 0.001) shorter LOS, respectively, relative to patients needing total assistance. Independence in ADL motor ability was associated with a 26% (p = 0.002) shorter LOS, whereas FIM motor was not a predictor.

CONCLUSIONS

The AMPS predicts LOS for rehabilitation at a level that is at least as good as that of FIM. Conducting the AMPS early in the course of inpatient rehabilitation provides clinicians and managers with valuable information for planning LOS.

Effect of Action Observation Therapy in the Rehabilitation of Neurologic and Musculoskeletal Conditions: A Systematic Review

OBJECTIVE

To investigate the effect of action observation therapy (AOT) in the rehabilitation of neurologic and musculoskeletal conditions.

DATA SOURCES

Searches were completed until July 2020 from the electronic databases Allied and Complementary Medicine Database (via OVID SP), Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, MEDLINE, and the Physiotherapy Evidence Database.

STUDY SELECTION

Randomized controlled trials comparing AOT with standard care were assessed. Musculoskeletal (amputee, orthopedic) and neurologic (dementia, cerebral palsy, multiple sclerosis, Parkinson disease, stroke) conditions were included. There were no age limitations. Articles had to be available in English.

DATA EXTRACTION

Two reviewers independently screened titles, abstracts and full extracts of studies for eligibility and assessed the risk of bias of each study using the Cochrane Risk of Bias Tool. Data extraction included participant characteristics and intervention duration, frequency, and type.

RESULTS

The effect of AOT in different outcome measures (OMs) was referenced in terms of body structures and functions, activities and participation, and environmental factors as outlined by the International Classification of Functioning, Disability, and Health (ICF). Of the 3448 articles identified, 36 articles with 1405 patients met the inclusion criteria. Seven of the 11 meta-analyses revealed a significant effect of intervention, with results presented using the mean difference and 95% CI. A best evidence synthesis was used across all OMs. Strong evidence supports the use of AOT in the rehabilitation of individuals with stroke and Parkinson disease; moderate evidence supports AOT in the rehabilitation of populations with orthopedic and multiple sclerosis diagnoses. However, moderate evidence is provided for and against the effect of AOT in persons with Parkinson disease and cerebral palsy.

CONCLUSIONS

This review suggests that AOT is advantageous in the rehabilitation of certain conditions in improving ICF domains. No conclusions can be drawn regarding treatment parameters because of the heterogeneity of the intervention. AOT has been considerably less explored in musculoskeletal conditions.

Comparing Component-Based and Occupation-Based Interventions of a Person with Visual Deficits' Performance

This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention (Vision Coach), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.

Patients from residential aged care with hip fractures-Does discharge destination from acute care affect outcomes?

OBJECTIVE

The aim of this study was to describe the demographics of patients from residential aged care facilities (RACFs) who underwent fixation of hip fracture and to compare 12-month functional and mortality outcomes for those returning to their RACF with those admitted to a subacute facility (SAF) following their acute hospital stay.

METHODS

A retrospective review was undertaken of all patients from a RACF with high-level care needs admitted to Alfred Hospital, Melbourne, for fixation of hip fracture in 2014-2015. Data including demographic and hospital event details, length of stay (LOS), discharge destination and 12-month functional outcomes measured by the Glasgow Outcome Scale-Extended (GOS-E), were collected. Factors related to discharge destination and outcomes were analysed.

RESULTS

Ninety patients from a RACF were included in this study, with 68 patients (76%) returning to their RACF and 22 (24%) admitted to a SAF after acute hospital stay. Those discharged to a SAF had an average LOS at this facility of 20.79 days (SD 8.02). The SAF group also had a longer acute LOS (7 days IQR 5-10, compared to 6 days IQR 4-7.5) but there was no difference between groups at 12 months in terms of mortality or function, with 50% of all patients deceased at this time point (n = 40) and the remaining 40 patients (50%) reporting a poor functional outcome.

CONCLUSIONS

Mobility status during acute and subacute stay, and 12-month functional and mortality outcomes were similar in both groups irrespective of discharge destination, with the influence of cognition and concomitant medical issues currently unknown. Further research is required to evaluate the efficacy of current hip fracture models of care, the factors that influence clinician discharge planning decision-making and to interrogate new models of care that support rehabilitation and complex medical management in RACFs.

Identifying elderly patients at risk of readmission after discharge from a short-stay unit in the emergency department using performance-based tests of daily activities

Background

Readmission is a serious and adverse event for elderly patients. Despite efforts, predicting the risk of readmission remains imprecise. The objective of this study is to examine if performance-based tests of daily activities can identify elderly patients at risk of readmission within 26 weeks after discharge from a short-stay unit in the emergency department.

Methods

The current study is an observational study based on data from 144 elderly patients included in a previous non-randomised controlled trial. Before discharge, patients were assessed for limitations in performing daily activities using three performance-based tests with predetermined cut-off values: the Assessment of Motor and Process Skills, Timed Up and Go and the 30s-Chair Stand Test. Outcome was risk of readmission within 26 weeks after discharge.

Results

Limitations in performing daily activities were associated with risk of readmission as measured by the Assessment of Motor and Process Skills motor scale (Crude OR = 4.38 [1.36; 14.12]), (Adjusted OR = 4.17 [1.18; 14.75]) and the 30s-Chair Stand Test (Adjusted OR = 3.36 [1.42; 7.93]). No significant associations were found in regards to other measures.

Conclusion

The Assessment of Motor and Process Skills motor scale and the age, gender and comorbidity adjusted 30s-Chair Stand Test can identify elderly patients at increased risk of readmission after discharge from the emergency department. The results were limited by one-third of the patients did not perform the Assessment of Motor and Process Skills and the association between 30s-Chair Stand Test and risk of readmission were only positive when adjusted for age, gender and comorbidity.

Psychometric properties of the Assessment of Motor and Process Skills in patients undergoing rehabilitation following hand-related disorders

Introduction

Assessment of Motor and Process Skills (AMPS) has been proven to be a suitable measurement tool for assessing performance-based ADL ability; however, its reliability and validity have not been tested on patients with hand-related disorders.

Methods

Patients referred for outpatient hand rehabilitation were assessed with AMPS, The Canadian Occupational Performance Measure (COPM), dynamometer and goniometer at baseline and after eight weeks of hand therapy. Construct validity and responsiveness of AMPS were assessed by hypothesis testing. Construct validity was assessed by correlating the baseline score of AMPS with the baseline score of the other measurement tools. Responsiveness was assessed by correlating the change scores of each measurement tool with a Global Rating Scale.

Results

Fifty-one patients were recruited. The construct validity of AMPS indicated that the various measurement tools captured different aspects to functioning from the AMPS, as the correlations between AMPS and the other measurement tools were generally weak to low (r < 0.25 to 0.49). AMPS was less responsive than COPM when correlated with the GRS. The correlation between COPM and GRS was r = 0.62 compared with the AMPS motor, r = 0.45 and AMPS process, r = 0.33. Relative responsiveness of AMPS is similar to that of the dynamometer (r = 0.39) and goniometer (r = –0.34).

Discussion

In a sample of 51 patients, this study found that the construct validity of AMPS seemed to be moderate, while the responsiveness of AMPS seemed to be poor. However, due to the small sample size no conclusions can be made, and should be further assessed in larger studies.

Influence of different rehabilitative aerobic exercise programs on (anti-) inflammatory immune signalling, cognitive and functional capacity in persons with MS - study protocol of a randomized controlled trial

BACKGROUND

Studies have shown positive effects of therapeutic exercise on motor- and cognitive function as well as on psychosocial outcomes in persons with multiple sclerosis (MS). A reduction of inflammatory stress through physical exercise has been suspected as one key mechanism, mediating the positive effects of exercise in the context of MS. The primary objective of this trial is to investigate the acute and chronic effects of different exercise modalities on (anti-)inflammatory immune signalling as well as on cognitive and functional capacity in persons with MS.

METHODS

A two armed single-blind randomized controlled design will investigate 72 persons with relapsing remitting or secondary progressive MS (EDSS 3.0-6.0), during 3 weeks of inpatient rehabilitation. Participants will be randomized into either a high-intensity interval training (HIIT) or a moderate continuous training group; the latter represents the local standard therapy (ST). Both groups will exercise 3x per week. The HIIT group will perform 5 × 1.5-min high-intensive exercise bouts at 95-100% of their maximum heart rate (HRmax) followed by active breaks of unloaded pedalling (60% HRmax) for 2 min. In contrast, the ST group will exercise for 24 min continuously at 65% of HRmax. The proportion of circulating regulatory T-cells will be measured as primary outcome. Secondary outcomes comprise numbers and proportions of further immune cells including Th17-cells, soluble factors ((anti-) inflammatory cytokines, tryptophan metabolites), endurance capacity, cognitive performance, processing skills for activities of daily living, fatigue, depression and healthcare-related quality of life. Outcomes will be assessed before (T0) and after (T3) the 3-week exercise intervention program. Blood samples of T0 will be taken immediately before the first exercise session. Additionally, blood samples for the soluble factors will be collected immediately after (T1) and three hours (T2) after the first exercise session of each group.

DISCUSSION

This study will be the first to investigate both acute and chronic effects of aerobic exercise on immune function and disease associated biomarkers in persons with MS. Combining biological analyses with cognitive and functional capacity assessments may contribute to a better understanding of responses to rehabilitative training, needed to improve exercise recommendations for persons with MS.

TRIAL REGISTRATION

This trial was prospectively registered at ClinicalTrials.gov ( NCT03652519 ; 29 August 2018).

Converting Functional Autonomy Measurement System Scores of Patients Post-Stroke to FIM Scores

Purpose: The Functional Independence Measure (FIM) is widely used to assess persons post-stroke. The Quebec government has selected the Functional Autonomy Measurement System (SMAF) for use in all care settings. In this article, we propose simple equations to convert SMAF scores to FIM scores for persons undergoing post-stroke rehabilitation. Method: Persons post-stroke (n=143) from three rehabilitation centres were assessed at admission and discharge using the FIM and SMAF. The sample was randomly split into derivation and validation data sets. Regression analysis was performed on the first data set to derive a conversion equation at each time point. The validity of the equations was measured using correlation coefficients, and differences between the observed and predicted FIM scores were computed from the second data set. Results: The relationship between the SMAF and FIM scores was linear at admission but quadratic at discharge. The proposed equations are, at admission, FIM=139-1.5×SMAF and, at discharge, FIM=118-0.018×SMAF². The observed and predicted FIM scores were highly correlated in the validation data set (rs=0.92 and 0.93 at admission and discharge, respectively). Furthermore, the equations performed well in classifying stroke severity compared with a classification based on the observed FIM scores. Conclusions: SMAF scores can be reliably converted to FIM scores using the proposed equations, thus facilitating international trials in stroke rehabilitation.

The association between effectiveness of clinical supervision of allied health professionals and improvement in patient function in an inpatient rehabilitation setting

Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective clinical supervision of allied health professionals improves patients' outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence. Methods: A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure.Results: Physiotherapists (n = 27) and occupational therapists (n = 26) in inpatient rehabilitation were recruited and the medical records of their patients (n = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence.Conclusions: Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients' mobility or personal care, respectively.Implications for rehabilitationEffective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients.Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision.Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice.Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.

Comparison of self-reported and performance-based measures of functional ability in elderly patients in an emergency department: implications for selection of clinical outcome measures

Background

Assessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED).

Methods

Participants were 61 patients aged 65 years and above admitted to an ED. The self-reported measure used was the Barthel-20; the performance-based measures were Timed Up and Go (TUG); 30s-Chair Stand Test (30s-CST) and Assessment of Motor and Process Skills (AMPS) with the two scales; motor and process. Correlation analyses were conducted to examine the relationships between the self-reported and performance-based measures of functional ability.

Results

The correlation between the Barthel-20 and the TUG was moderate (r = −0.64). The correlation between the Barthel-20 and the AMPS motor was also moderate (r = 0.53). The correlation between the Barthel-20 and the 30s-CST was fair (r = 0.45). The correlation between Barthel-20 and the AMPS process was non-significant. The results were affected by high ceiling effect (Barthel-20).

Conclusion

Self-reported and performance-based measures seem to assess different aspects of functional ability. Thus, the two methods provide different information, and this highlight the importance of supplementing self-reported measures with performance-based measures when assessing functional ability in elderly patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0376-1) contains supplementary material, which is available to authorized users.

Functional Assessments Used by Occupational Therapists with Older Adults at Risk of Activity and Participation Limitations: A Systematic Review

Introduction

The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults.

Methods

A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria.

Results

Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population.

Conclusions

The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary.

Declines in mobility and changes in performance in the instrumental activities of daily living among mildly disabled community-dwelling older adults

BACKGROUND

Gait speed is as an important predictor of mortality, volume of medical care, hospitalization, onset of activities of daily living (ADL) disability, and nursing home placement. We examined associations between change in gait speed and change in observed performance in the instrumental ADL (IADL) in a sample of mild-to-moderately disabled older adults.

METHODS

Participants in the Sources of Independence in the Elderly project (n = 375) were approached to complete a 4-m gait assessment and a performance test of IADL competency at three points over 2 years. IADL competency was assessed by occupational therapists, who rated participants using the Assessment of Motor and Process Skills (AMPS) and who also made a global rating of need for help or supervision. Linear mixed models were developed to assess change in motor AMPS score relative to baseline status and change in gait speed and AMPS process scores.

RESULTS

Baseline gait and change in gait were significant correlates of change in the AMPS motor ability measures in models that adjusted for cognitive status and AMPS process ability. Even respondents with gait speeds of 1 m/s at baseline were at risk of declining AMPS motor ability and an occupational therapist rating of IADL disability if gait speed declined.

CONCLUSIONS

Slowing in gait speed is an important risk factor for IADL disability in mild to moderately disabled older adults.

Does consumption of polyunsaturated fatty acids influence on neurorehabilitation in traumatic spinal cord-injured individuals? A double-blinded clinical trial

STUDY DESIGN

A double-blinded randomized clinical trial.

OBJECTIVES

The anti-inflammatory and neuroprotective effect of omega-3 fatty acids have been shown so far, but still its influence on clinical measures in spinal cord-injured human models were not known. We tried to investigate changes in disability and dependency scores in chronic traumatic spinal cord-injured patients after 14 months of ω-3 fatty-acid consumption.

METHODS

Main inclusion criteria were: traumatic spinal cord injury (SCI) and post injury duration longer than 1 year. Disability and dependency was assessed using U.K Functional Independence Measure and Functional Assessment Measure (FIM+FAM) scale. MorDHA capsules (435 mg of docosahexaenoic acid and 65 mg of eicosapentaenoic acid) were administered in treatment group, whereas control group received placebo capsules for 14 months. U.K. FIM+FAM scale were estimated before intervention and at the end of the trial.

RESULTS

Fifty-four patients in treatment group and 50 patients in placebo group completed the trial. Highest scores were detected in cognitive domain in both groups before and after intervention. Most dependency was observed in locomotion subscale and secondly in sphincter control. Scores of none of these components were changed by ω-3 fatty-acid consumption.

CONCLUSION

Although omega-3 fatty acids have been shown to have neuroprotective effect in acute phase of SCI, it seems that they have no significant influence in chronic inflammatory state of SCI. The positive effect of ω-3 fatty acid in chronic neurorecovery process, if exists, is weaker to exert any significant improvement in UK FIM+FAM scores in spinal cord-injured individuals.

The validity of occupational performance assessments: a validity generalization meta-analysis

The purpose of this meta-analysis was to determine sample weighted mean validity effect sizes for occupational performance assessments, and their generalizability from research to clinical settings. The bare-bones Validity Generalization (VG) guidelines developed by Hunter and Schmidt ( 2004 ) augmented by Maximum Likelihood (ML) procedures were used to complete the meta-analysis. The sample consisted of 27 studies in which convergent, divergent, and predictive validity estimates of occupational performance assessments were investigated. The mean coefficients of assessments validated in the studies constituting the sample for this meta-analysis ranged from medium to large. Further meta-analysis with complete dis-attenuation of observed mean validity coefficients is indicated.