[Pain disorders in traumatized individuals - neurophysiology and clinical presentation]

This overview portrays the salient physiological mechanisms being involved in the clinical manifestation of chronic pain in traumatized patients. A «hypermnesia-hyperarousal-model» is purported to support the neurophysiologic plausibility of the trauma-pain-relationship. We discuss seven characteristic clinical pain entities which alone or in combination can be found in patients with a previous psychological trauma.

[Test-retest reliability of a German language multidimensional assessment instrument in elderly probands]

Most geriatric assessment instruments have been developed in the English language. Translated versions might differ in their psychometric properties. We analyzed the test-retest reliability and internal consistency of a German instrument for multidimensional geriatric assessment that was based on a newly developed English version. A group of 100 over 75-year-old community-dwelling persons (mean age 83.0 years, 81% women) in Hamburg (n = 26) and Ulm (n = 51), Germany, and Berne (n = 23), Switzerland was interviewed twice by the same trained interviewers with a one week interval. We administered questions on general health, chronic disorders, basic and instrumental activities of daily living, urinary incontinence, nutrition, falls, pain, the social support/network and preventive care measures. In addition, the Functional Status Questionnaire, the Physical Activity Scale for the Elderly, the Geriatric Oral Health Assessment Index, the Visual Function Questionnaire, the Hearing Handicap Inventory for the Elderly and the Geriatric Depression Scale were administered. Cohen's kappa was good to excellent (0.64 < or = kappa < or = 0.89) with only three exceptions (pain questions, kappa = 0.53; questions on preventive care services, kappa = 0.51; and one of the questions on recent falls, kappa = 0.44). Cronbach alpha (internal consistency) was good to excellent for all domains (0.76 < or = alpha < or = 0.95). The study results confirm good test-retest reliability of the German version of this multidimensional geriatric assessment instrument. Adapted versions of this instrument can be used for different purposes, e.g., preventive home visits, outpatient geriatric assessments or epidemiological studies in older persons.

[A multidimensional questionnaire as a component of preventive geriatric assessment: comparison of self-assessment version with the interview version]

In an earlier study we have shown good internal consistency and test-retest-reliability of a newly developed German-language instrument in the interviewer-administered version. The aim of this study was to test the reliability of a self-administered version compared to the original interviewer-administered version of our newly developed German-language instrument. We recruited a group of 50 over 75-year-old community-dwelling persons in Hamburg, Germany (N = 25) and Berne, Switzerland (N = 25). The questionnaire contains items on: self-perceived health, chronic conditions, basic and instrumental activities of daily living, urinary incontinence, nutrition, recent falls, pain, the social support/network and preventive-care measures. In addition, the Functional Status Questionnaire, the Physical Activity Scale for the Elderly, the Geriatric Oral Health Assessment Index, the Visual Function Questionnaire, the Hearing Handicap Inventory for the Elderly and the Geriatric Depression Scale were administered. Cohen's Kappa (self-administered version compared to the interviewer-administered version) was good to excellent (0.69-1.0) with only three exceptions (physical activity kappa = 0.49, basic activities kappa = 0.54 and oral health kappa = 0.54). For the domains activities of daily living, oral health, visual function and depression the self-administered version detected significantly more problems than the interview. In the future the self-administered version of this assessment instrument can be used for various purposes, e.g. (annual) preventive geriatric assessment for outpatients and other community-dwelling persons and epidemiological studies in older persons.