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Shi Y, Lenze EJ, Mohr DC, Lee JM, Hu L, Metts CL, Fong MWM, Wong AWK. Post-stroke Depressive Symptoms and Cognitive Performances: A Network Analysis. Arch Phys Med Rehabil 2024; 105:892-900. [PMID: 37884084 PMCID: PMC11039566 DOI: 10.1016/j.apmr.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To examine the relationships between post-stroke depression and cognition using network analysis. In particular, we identified central depressive symptoms, central cognitive performances, and bridge components that connect these 2 constructs. DESIGN An observational study. We applied network analysis to analyze baseline data to visualize and quantify the relationships between depression and cognition. SETTING Home and Community. PARTICIPANTS 202 participants with mild-to-moderate stroke (N=202; mean age: 59.7 years; 55% men; 55% Whites; 90% ischemic stroke). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Patient Health Questionnaire (PHQ-8) for depressive symptoms and the NIH Toolbox Cognitive Battery for cognitive performances. RESULTS Depressive symptoms were positively intercorrelated with the network, with symptoms from similar domains clustered together. Mood (expected influence=1.58), concentration (expected influence=0.67), and guilt (expected influence=0.63) were the top 3 central depressive symptoms. Cognitive performances also showed similar network patterns, with executive function (expected influence=0.89), expressive language (expected influence=0.68), and processing speed (expected influence=0.48) identified as the top 3 central cognitive performances. Psychomotor functioning (bridge expected influence=2.49) and attention (bridge expected influence=1.10) were the components connecting depression and cognition. CONCLUSIONS The central and bridge components identified in this study might serve as targets for interventions against these deficits. Future trials are needed to compare the effectiveness of interventions targeting the central and bridge components vs general interventions treating depression and cognitive impairment as a homogenous clinical syndrome.
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Affiliation(s)
- Yun Shi
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Mandy W M Fong
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Michigan Avenue Neuropsychologists, Chicago, IL
| | - Alex W K Wong
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Wong AWK, Tomazin R, Walker K, Heeb Desai R, Hollingsworth H, Newland PK, Morgan KA. Text messaging intervention for fatigue self-management in people with stroke, spinal cord injury, and multiple sclerosis: A pilot study. Disabil Health J 2024; 17:101549. [PMID: 38001005 DOI: 10.1016/j.dhjo.2023.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Fatigue negatively impacts the function and quality of life of people with disabilities (PwD). Mobile health (mHealth) platforms are recognized as effective and accessible approaches to delivering health interventions and may show higher satisfaction by tailoring the information toward personalized needs for PwD. OBJECTIVE To evaluate the acceptability, feasibility, and participant engagement with a Short Message Service (SMS) text messaging intervention for fatigue self-management and to explore the pre- and post-score health changes in PwD. METHODS A total of 27 PwD (multiple sclerosis = 9, spinal cord injury = 9, or stroke = 9) experiencing fatigue in their daily lives participated in a 12-week self-management text messaging intervention. Participants completed a demographic survey and health outcome measures, including patient activation, self-efficacy for managing symptoms, fatigue, sleep, and satisfaction with participation in social roles before and after the intervention. Participants also completed a client satisfaction questionnaire after the intervention. We also tracked the program retention and SMS response rates over the 12-week intervention period. RESULTS Twenty-five participants completed the entire intervention (93% retention rate), and the overall SMS response rate was 84.67%, indicating high acceptability and adherence to the intervention. The mean satisfaction score was 3.18, indicating high satisfaction with the intervention. Despite finding a negligible effect on patient activation, we found a small intervention effect on self-efficacy for managing symptoms (η2 = 0.04) and moderate effects on fatigue (η2 = 0.06-0.12), sleep (η2 = 0.11), and satisfaction with participation in social roles (η2 = 0.08). CONCLUSIONS This study provides initial feasibility and health outcome change evidence to support an SMS text messaging intervention to manage fatigue in PwD.
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Affiliation(s)
- Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Rachel Tomazin
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Kim Walker
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Rachel Heeb Desai
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA.
| | - Holly Hollingsworth
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Pamela K Newland
- Goldfarb School of Nursing at Barnes Jewish College, St. Louis, MO, USA.
| | - Kerri A Morgan
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
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Shi Y, Fong MWM, Metts CL, LaVela SL, Bombardier C, Hu L, Wong AWK. Dynamics of Perceived Social Isolation, Secondary Conditions, and Daily Activity Patterns Among Individuals With Stroke: A Network Analysis of Ecological Momentary Assessment Data. Arch Phys Med Rehabil 2024:S0003-9993(24)00847-5. [PMID: 38458373 DOI: 10.1016/j.apmr.2024.02.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To assess contemporaneous and temporal dynamics of perceived social isolation (PSI), secondary conditions, and daily activity patterns in individuals post-stroke. DESIGN Longitudinal observational study using ecological momentary assessment (EMA) as a real-time assessment of an individual's lived experiences. We conducted dynamic network analyses to examine longitudinal associations among EMA variables. SETTINGS Home and Community. PARTICIPANTS 202 individuals with mild-to-moderate chronic stroke (median age=60 years; 45% women; 44% black; 90% ischemic stroke; median NIHSS score=2; N=202). INTERVENTION Not applicable. MAIN OUTCOME MEASURES EMA questions measured PSI, secondary conditions (pain, tiredness, stress, anxiety, worthlessness, difficulty concentrating, and cheerfulness), and daily activity patterns (being at home, being alone, and participating in productive activities). RESULTS The median EMA response rate was 84%. The contemporaneous model showed that PSI was associated with being home, alone, and all symptoms except pain. The temporal model revealed a pathway indicating that feelings of worthlessness predicted PSI (regression coefficient=0.06, P=.019), followed by stress (regression coefficient=0.06, P=.024), and then by being not at home (regression coefficient=-0.04, P=.013). CONCLUSION Implementing dynamic network analyses on EMA data can uncover dynamic connections among PSI, secondary conditions, and daily activity patterns after stroke. This study found a significant temporal association between PSI and negative emotions. Feeling isolated was followed by feeling stressed, which was followed by a tendency to be out of home, indicating adaptive behaviors in individuals with stroke. These findings highlight the importance of engaging in out-of-home or outdoor activities to mitigate PSI and negative emotions.
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Affiliation(s)
- Yun Shi
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Mandy W M Fong
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Michigan Avenue Neuropsychologists, Chicago, IL
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Sherri L LaVela
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edwards Hines Jr VA Hospital, Hines, IL
| | - Charles Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Alex W K Wong
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Li Z, Lei Y, Bui Q, DePaul O, Nicol GE, Mohr DC, Lee SI, Fong MWM, Metts CL, Tomazin SE, Wong AWK. A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial. JMIR Rehabil Assist Technol 2024; 11:e50863. [PMID: 38373029 PMCID: PMC10912984 DOI: 10.2196/50863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. OBJECTIVE This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. METHODS A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System's Self-Efficacy for Managing Chronic Conditions. RESULTS The retention rate was 82% (9/11), and the engagement (SMS text message response) rate was 78% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). CONCLUSIONS Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. TRIAL REGISTRATION ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137&rank=1.
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Affiliation(s)
- Zhaoying Li
- Division of Occupational Science and Occupational Therapy, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Yating Lei
- Department of Occupational Therapy, New York University, New York, NY, United States
| | - Quoc Bui
- Institute for Informatics, Data Science & Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Olivia DePaul
- Memorial Hospital Belleville, Belleville, IL, United States
| | - Ginger E Nicol
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - David C Mohr
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sunghoon I Lee
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Mandy W M Fong
- Michigan Avenue Neuropsychologists, Chicago, IL, United States
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Stephanie E Tomazin
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Wirth M, Motl RW, Bombardier CH, Bartle B, Wong AWK, Aguina K, LaVela SL. Factors associated with perceived social isolation among veterans with spinal cord injury and disorders: Cross sectional survey. J Spinal Cord Med 2024:1-10. [PMID: 38315055 DOI: 10.1080/10790268.2023.2299500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
CONTEXT/OBJECTIVE Examine demographics, injury characteristics, objective measures of social isolation and health factors that are associated with perceived social isolation (PSI) among Veterans with spinal cord injury and disorders (SCI/D). DESIGN Cross-sectional survey. SETTING The Veterans Health Administrations (VHA) SCI/D system of care. PARTICIPANTS Veterans with SCI/D who have used the VHA health care system. INTERVENTION Not applicable. OUTCOMES MEASURES We assessed unadjusted associations of high PSI (above population mean) vs low (normative/below population mean), and multivariable logistic regression for independent associations with PSI. RESULTS Out of 1942 Veterans with SCI/D, 421 completed the survey (22% response rate). Over half (56%) had PSI mean scores higher than the general population. Among the objective measures, having a smaller social network size was associated with increased odds of high PSI (OR 3.59, P < .0001); additionally, for health factors, having depression (OR 3.98, P < 0.0001), anxiety (OR 2.29, P = 0.009), and post-traumatic stress (OR 2.56, P = 0.003) in the previous 6 months, and having 4 or more chronically occurring secondary conditions (OR 1.78, P = 0.045) was associated with increased odds of high PSI. The most commonly identified contributors to feelings of PSI included mobility concerns (63%), having a SCI/D (61%), and concerns about being a burden on others (57%). CONCLUSIONS Factors such as social network size may be used to identify individuals with SCI/D at risk for PSI. Additionally, by identifying mental health problems, presence of multiple chronically occurring secondary conditions, and Veteran-identified contributors of PSI, we can target these factors in a patient-centered interventions to identify and reduce PSI.
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Affiliation(s)
- Marissa Wirth
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Brian Bartle
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Alex W K Wong
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Keith Aguina
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Munsell EGS, Bui Q, Kaufman KJ, Tomazin SE, Regan BA, Lenze EJ, Lee JM, Mohr DC, Fong MWM, Metts CL, Pham V, Wong AWK. Intraindividual variability in post-stroke cognition and its relationship with activities of daily living and social functioning: an ecological momentary assessment approach. Top Stroke Rehabil 2024:1-12. [PMID: 38278142 DOI: 10.1080/10749357.2024.2307203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Ecological momentary assessment (EMA) is a methodological approach to studying intraindividual variation over time. This study aimed to use EMA to determine the variability of cognition in individuals with chronic stroke, identify the latent classes of cognitive variability, and examine any differences in daily activities, social functioning, and neuropsychological performance between these latent classes. METHODS Participants (N = 202) with mild-to-moderate stroke and over 3-month post-stroke completed a study protocol, including smartphone-based EMA and two lab visits. Participants responded to five EMA surveys daily for 14 days to assess cognition. They completed patient-reported measures and neuropsychological assessments during lab visits. Using latent class analysis, we derived four indicators to quantify cognitive variability and identified latent classes among participants. We used ANOVA and Chi-square to test differences between these latent classes in daily activities, social functioning, and neuropsychological performance. RESULTS The latent class analysis converged on a three-class model. The moderate and high variability classes demonstrated significantly greater problems in daily activities and social functioning than the low class. They had significantly higher proportions of participants with problems in daily activities and social functioning than the low class. Neuropsychological performance was not statistically different between the three classes, although a trend approaching statistically significant difference was observed in working memory and executive function domains. DISCUSSION EMA could capture intraindividual cognitive variability in stroke survivors. It offers a new approach to understanding the impact and mechanism of post-stroke cognitive problems in daily life and identifying individuals benefiting from self-regulation interventions.
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Affiliation(s)
- Elizabeth G S Munsell
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Quoc Bui
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine J Kaufman
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Stephanie E Tomazin
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Bridget A Regan
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Vy Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wong AWK, Fong MWM, Munsell EGS, Metts CL, Lee SI, Nicol GE, DePaul O, Tomazin SE, Kaufman KJ, Mohr DC. Using Intervention Mapping and Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study. JMIR Hum Factors 2023; 10:e45099. [PMID: 37486748 PMCID: PMC10407772 DOI: 10.2196/45099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/14/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Digital therapeutics, such as interventions provided via smartphones or the internet, have been proposed as promising solutions to support self-management in persons with chronic conditions. However, the evidence supporting self-management interventions through technology in stroke is scarce, and the intervention development processes are often not well described, creating challenges in explaining why and how the intervention would work. OBJECTIVE This study describes a specific use case of using intervention mapping (IM) and the taxonomy of behavior change techniques (BCTs) in designing a digital intervention to manage chronic symptoms and support daily life participation in people after stroke. IM is an implementation science framework used to bridge the gap between theories and practice to ensure that the intervention can be implemented in real-world settings. The taxonomy of BCTs consists of a set of active ingredients designed to change self-management behaviors. METHODS We used the first 4 steps of the IM process to develop a technology-supported self-management intervention, interactive Self-Management Augmented by Rehabilitation Technologies (iSMART), adapted from a face-to-face stroke-focused psychoeducation program. Planning group members were involved in adapting the intervention. They also completed 3 implementation measures to assess the acceptability, appropriateness, and feasibility of iSMART. RESULTS In step 1, we completed a needs assessment consisting of assembling a planning group to codevelop the intervention, conducting telephone surveys of people after stroke (n=125) to identify service needs, and performing a systematic review of randomized controlled trials to examine evidence of the effectiveness of digital self-management interventions to improve patient outcomes. We identified activity scheduling, symptom management, stroke prevention, access to care resources, and cognitive enhancement training as key service needs after a stroke. The review suggested that digital self-management interventions, especially those using cognitive behavioral theory, effectively reduce depression, anxiety, and fatigue and enhance self-efficacy in neurological disorders. Step 2 identified key determinants, objectives, and strategies for self-management in iSMART, including knowledge, behavioral regulation, skills, self-efficacy, motivation, negative and positive affect, and social and environmental support. In step 3, we generated the intervention components underpinned by appropriate BCTs. In step 4, we developed iSMART with the planning group members. Especially, iSMART simplified the original psychoeducation program and added 2 new components: SMS text messaging and behavioral coaching, intending to increase the uptake by people after stroke. iSMART was found to be acceptable (mean score 4.63, SD 0.38 out of 5), appropriate (mean score 4.63, SD 0.38 out of 5), and feasible (mean score 4.58, SD 0.34 out of 5). CONCLUSIONS We describe a detailed example of using IM and the taxonomy of BCTs for designing and developing a digital intervention to support people after stroke in managing chronic symptoms and maintaining active participation in daily life.
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Affiliation(s)
- Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Mandy W M Fong
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth G S Munsell
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Center for Education in Health Sciences, Feinberg School of Medicine, Chicago, IL, United States
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Sunghoon I Lee
- Manning College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Ginger E Nicol
- Department of Psychiatry, Washington Univesity School of Medicine, St. Louis, MO, United States
| | - Olivia DePaul
- Memorial Hospital Belleville, Barnes-Jewish/Christian HealthCare, Belleville, IL, United States
| | - Stephanie E Tomazin
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Katherine J Kaufman
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - David C Mohr
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Morgan KA, Wong AWK, Walker K, Desai RH, Knepper TM, Newland PK. A Mobile Phone Text Messaging Intervention to Manage Fatigue for People With Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing. JMIR Form Res 2022; 6:e40166. [PMID: 36542466 DOI: 10.2196/40166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person's natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. OBJECTIVE This study aimed to develop and test a mobile phone-based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. METHODS We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. RESULTS A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. CONCLUSIONS This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person's needs.
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Affiliation(s)
- Kerri A Morgan
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kim Walker
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Rachel Heeb Desai
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Tina M Knepper
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Pamela K Newland
- Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, United States
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9
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Lau SCL, Judycki S, Mix M, DePaul O, Tomazin R, Hardi A, Wong AWK, Baum C. Theory-Based Self-Management Interventions for Community-Dwelling Stroke Survivors: A Systematic Review and Meta-Analysis. Am J Occup Ther 2022; 76:23320. [PMID: 35772070 DOI: 10.5014/ajot.2022.049117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Self-management is a critical component of stroke rehabilitation. A better understanding of the use of theory and behavior change techniques (BCTs) informs the development of more effective stroke self-management interventions. OBJECTIVE To examine what theories and BCTs have been applied in stroke self-management interventions; investigate the extent to which these interventions encourage implementation of behavior changes; and appraise their effectiveness to enhance self-efficacy, quality of life, and functional independence. DATA SOURCES Ovid MEDLINE, Embase, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched from inception to May 26, 2020. STUDY SELECTION AND DATA COLLECTION Randomized controlled trials (RCTs) in six databases were reviewed for inclusion and analysis. We included trials that involved community-dwelling adult stroke survivors, assessed the effectiveness of self-management interventions, and explicitly mentioned the use of theory in the development of the intervention. We assessed use of theory and BCTs using the Theory Coding Scheme and BCT taxonomy v1, respectively. FINDINGS A total of 3,049 studies were screened, and 13 RCTs were included. The predominant theory and BCT categories were Social Cognitive Theory (7 studies) and goals and planning (12 studies), respectively. Significant and small effect sizes were found for self-efficacy (0.27) and functional independence (0.19). CONCLUSIONS AND RELEVANCE Theory-based self-management interventions have the potential to enhance stroke outcomes. Systematic reporting on the use of theory and BCTs is recommended to enhance clarity and facilitate evaluations of future interventions. What This Article Adds: This review supports and guides occupational therapy practitioners to use theory-based self-management intervention as a routine part of stroke rehabilitation to improve stroke survivors' experience in the community.
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Affiliation(s)
- Stephen C L Lau
- Stephen C. L. Lau, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Stephanie Judycki
- Stephanie Judycki, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Mikayla Mix
- Mikayla Mix, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Olivia DePaul
- Olivia DePaul, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Rachel Tomazin
- Rachel Tomazin, BS, is Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Angela Hardi
- Angela Hardi, MLIS, is Librarian, Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Alex W K Wong
- Alex W. K. Wong, PhD, DPhil, is Assistant Professor, Program in Occupational Therapy, Department of Neurology, and Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Carolyn Baum
- Carolyn Baum, PhD, is Professor, Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO;
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10
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Walsh RJ, McKay VR, Hansen PE, Barco PP, Jones K, Lee Y, Patel RD, Chen D, Heinemann AW, Lenze EJ, Wong AWK. Using Implementation Science to Guide the Process of Adapting a Patient Engagement Intervention for Inpatient Spinal Cord Injury/Disorder Rehabilitation. Arch Phys Med Rehabil 2022; 103:2180-2188. [PMID: 35588857 DOI: 10.1016/j.apmr.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES This study aimed to describe the process of adapting an evidence-based patient engagement intervention, Enhanced Medical Rehabilitation (E-MR), for inpatient spinal cord injury/disease (SCI/D) rehabilitation using an implementation science framework. DESIGN We applied the Collaborative Intervention Planning Framework (CIPF) and included a community advisory board (CAB) in an intervention mapping process. SETTING A rehabilitation hospital. PARTICIPANTS Stakeholders from inpatient SCI/D rehabilitation (N=7) serving as a CAB and working with the research team (N=7) to co-adapt E-MR. INTERVENTIONS E-MR MAIN OUTCOME MEASURES: Logic model and matrices of change used in CAB meetings to identify areas of intervention adaptation. RESULTS The CAB and research team implemented adaptations to E-MR, including (1) identifying factors influencing patient engagement in SCI/D rehabilitation (e.g., therapist training); (2) revising intervention materials to meet SCI/D rehabilitation needs (e.g., modified personal goals interview and therapy trackers to match SCI needs); (3) incorporating E-MR into the rehabilitation hospital's operations (e.g., research team coordinated with CAB to store therapy trackers in the hospital system); and (4) retaining fidelity to the original intervention while best meeting the needs of SCI/D rehabilitation (e.g., maintained core E-MR principles while adapting). CONCLUSIONS This study demonstrated that structured processes guided by an implementation science framework can help researchers and clinicians identify adaptation targets and modify the E-MR program for inpatient SCI/D rehabilitation.
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Affiliation(s)
- Ryan J Walsh
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108.
| | - Virginia R McKay
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, and Dissemination and Implementation Research Core, Washington University Institute of Clinical and Translational Sciences, St. Louis, MO 63110.
| | - Piper E Hansen
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL 0661.
| | - Peggy P Barco
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108.
| | - Kayla Jones
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611.
| | - Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108.
| | - Riddhi D Patel
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611.
| | - David Chen
- Spinal Cord Injury Section, Shirley Ryan AbilityLab, Chicago, IL 60611, and Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA, and Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA, and Departments of Physical Medicine & Rehabilitation and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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11
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Heary KO, Wong AWK, Lau SCL, Dengler J, Thompson MR, Crock LW, Novak CB, Philip BA, Mackinnon SE. Quality of Life and Psychosocial Factors as Predictors of Pain Relief Following Nerve Surgery. Hand (N Y) 2022; 17:193-199. [PMID: 32188297 PMCID: PMC8984711 DOI: 10.1177/1558944720911213] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Peripheral nerve injuries may result in pain, disability, and decreased quality of life (QoL). Pain is an incompletely understood experience and is associated with emotional and behavioral qualities. We hypothesized that pain following peripheral nerve surgery could be predicted by changes in emotions or QoL postoperatively. Methods: Using prospectively collected data, a retrospective study design was used to evaluate the relationships among pain, QoL, and psychosocial factors in patients who underwent peripheral nerve surgery. Patients completed questionnaires rating pain; impact of pain on QoL, sadness, depression, frustration, anger, and hopefulness before surgery; and each postoperative follow-up visit. Multilevel modeling was used to assess the concurrent and lagged relationships between pain and psychosocial factors. Results: Increased pain was concurrently associated with decreased hopefulness (P = .001) and increased the impact on QoL, sadness, depression, and anger (P < .001). In lagged analyses, the impact on QoL and anger prospectively predicted pain (P < .001 and P = .02, respectively). Pain predicted subsequent scores of QoL, sadness, depression, anger, and hopefulness (P < .01). Having an upper limb nerve injury and self-report of "no comment for childhood trauma" were predictors of postsurgical pain. Conclusion: Psychosocial measures and pain are reciprocally related among patients who underwent surgery for peripheral nerve injuries or compression. Our study provides evidence of the important relationships among psychosocial factors, pain, and outcome and identifies treatment targets following nerve surgery.
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Affiliation(s)
| | - Alex W. K. Wong
- Washington University School of
Medicine, St. Louis, MO, USA
| | | | | | | | - Lara W. Crock
- Washington University School of
Medicine, St. Louis, MO, USA
| | | | | | - Susan E. Mackinnon
- Washington University School of
Medicine, St. Louis, MO, USA,Susan E. Mackinnon, Division of Plastic and
Reconstructive Surgery, Department of Surgery, Washington University School of
Medicine, 660 S. Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, USA.
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12
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Lee Y, Walsh RJ, Fong MWM, Sykora M, Doering MM, Wong AWK. Heart rate variability as a biomarker of functional outcomes in persons with acquired brain injury: Systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:737-754. [PMID: 34626686 PMCID: PMC9006352 DOI: 10.1016/j.neubiorev.2021.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 01/09/2023]
Abstract
This review aimed to quantify correlations between heart rate variability (HRV) and functional outcomes after acquired brain injury (ABI). We conducted a literature search from inception to January 2020 via electronic databases, using search terms with HRV, ABI, and functional outcomes. Meta-analyses included 16 studies with 906 persons with ABI. Results demonstrated significant associations: Low frequency (LF) (r = -0.28) and SDNN (r = -0.33) with neurological function; LF (r = -0.33), High frequency (HF) (r = -0.22), SDNN (r = -0.22), and RMSSD (r = -0.23) with emotional function; and LF (r = 0.34), HF (r = 0.41 to 0.43), SDNN (r = 0.43 to 0.51), and RMSSD (r = 0.46) with behavioral function. Results indicate that higher HRV is related to better neurological, emotional, and behavioral functions after ABI. In addition, persons with stroke showed lower HF (SMD = -0.50) and SDNN (SMD = -0.75) than healthy controls. The findings support the use of HRV as a biomarker to facilitate precise monitoring of post-ABI functions.
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Affiliation(s)
- Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Ryan J Walsh
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Mandy W M Fong
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63108, USA.
| | - Marek Sykora
- Department of Neurology, St. John's Hospital, Vienna, Austria; Medical Faculty, Sigmund Freud University, Vienna, Austria; Department of Neurology, Comenius University in Bratislava, Bratislava, Slovakia.
| | - Michelle M Doering
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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13
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Hoyt CR, Chuck AC, Varughese TE, Fisher LC, Manis HE, O'Connor KE, Shen E, Wong AWK, Abel RA, King AA. Psychometric Properties of the Infant Toddler Activity Card Sort. OTJR (Thorofare N J) 2021; 41:259-267. [PMID: 33955289 DOI: 10.1177/15394492211012657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Infant Toddler Activity Card Sort (ITACS) is a new measure that engages caregivers in goal development by measuring participation in early childhood. Initial evaluation of the ITACS is required to assess its psychometric properties. To evaluate test-retest reliability, concurrent validity, and between-group differences of the ITACS. Caregivers (N = 208) of children 0-3 years, who were typically developing (TD) or had a developmental delay (DD), completed the ITACS and Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) with repeat assessment after 2 weeks later (n = 117). The ITACS demonstrated moderate concurrent validity with the PEDI-CAT. Children with DD had significantly more activity concerns on the ITACS than TD. Adequate test-retest reliability was not achieved. The ITACS is a useful tool for identifying caregiver concerns in activity engagement; interventions can be tailored to address concerns and increase participation in childhood routines.
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Affiliation(s)
| | - Ashley C Chuck
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Laura C Fisher
- Washington University School of Medicine, St. Louis, MO, USA
| | - Hannah E Manis
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Evelyn Shen
- Washington University School of Medicine, St. Louis, MO, USA
| | - Alex W K Wong
- Washington University School of Medicine, St. Louis, MO, USA
| | - Regina A Abel
- Washington University School of Medicine, St. Louis, MO, USA
| | - Allison A King
- Washington University School of Medicine, St. Louis, MO, USA
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14
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Lenze EJ, Nicol GE, Barbour DL, Kannampallil T, Wong AWK, Piccirillo J, Drysdale AT, Sylvester CM, Haddad R, Miller JP, Low CA, Lenze SN, Freedland KE, Rodebaugh TL. Precision clinical trials: a framework for getting to precision medicine for neurobehavioural disorders. J Psychiatry Neurosci 2021; 46:E97-E110. [PMID: 33206039 PMCID: PMC7955843 DOI: 10.1503/jpn.200042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The goal of precision medicine (individually tailored treatments) is not being achieved for neurobehavioural conditions such as psychiatric disorders. Traditional randomized clinical trial methods are insufficient for advancing precision medicine because of the dynamic complexity of these conditions. We present a pragmatic solution: the precision clinical trial framework, encompassing methods for individually tailored treatments. This framework includes the following: (1) treatment-targeted enrichment, which involves measuring patients' response after a brief bout of an intervention, and then randomizing patients to a full course of treatment, using the acute response to predict long-term outcomes; (2) adaptive treatments, which involve adjusting treatment parameters during the trial to individually optimize the treatment; and (3) precise measurement, which involves measuring predictor and outcome variables with high accuracy and reliability using techniques such as ecological momentary assessment. This review summarizes precision clinical trials and provides a research agenda, including new biomarkers such as precision neuroimaging, transcranial magnetic stimulation-electroencephalogram digital phenotyping and advances in statistical and machine-learning models. Validation of these approaches - and then widespread incorporation of the precision clinical trial framework - could help achieve the vision of precision medicine for neurobehavioural conditions.
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Affiliation(s)
- Eric J Lenze
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Ginger E Nicol
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Dennis L Barbour
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Thomas Kannampallil
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Alex W K Wong
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Jay Piccirillo
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Andrew T Drysdale
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Chad M Sylvester
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Rita Haddad
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - J Philip Miller
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Carissa A Low
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Shannon N Lenze
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Kenneth E Freedland
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
| | - Thomas L Rodebaugh
- From the Washington University School of Medicine, St. Louis, Missouri (Lenze, Nicol, Kannampallil Wong, Piccirillo, Drysdale, Sylvester, Haddad, Miller, Lenze, Freedland); the Washington University McKelvey School of Engineering, St. Louis, MO (Barbour); the University of Pittsburgh, Pittsburgh, PA (Low); and the Washington University School of Arts & Sciences, St. Louis, MO (Rodebaugh)
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15
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Wong CHY, Liu J, Lee TMC, Tao J, Wong AWK, Chau BKH, Chen L, Chan CCH. Fronto-cerebellar connectivity mediating cognitive processing speed. Neuroimage 2020; 226:117556. [PMID: 33189930 DOI: 10.1016/j.neuroimage.2020.117556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022] Open
Abstract
Processing speed is an important construct in understanding cognition. This study was aimed to control task specificity for understanding the neural mechanisms underlying cognitive processing speed. Forty young adult subjects performed attention tasks of two modalities (auditory and visual) and two levels of task rules (compatible and incompatible). Block-design fMRI captured BOLD signals during the tasks. Thirteen regions of interest were defined with reference to publicly available activation maps for processing speed tasks. Cognitive speed was derived from task reaction times, which yielded six sets of connectivity measures. Mixed-effect LASSO regression revealed six significant paths suggestive of a cerebello-frontal network predicting the cognitive speed. Among them, three are long range (two fronto-cerebellar, one cerebello-frontal), and three are short range (fronto-frontal, cerebello-cerebellar, and cerebello-thalamic). The long-range connections are likely to relate to cognitive control, and the short-range connections relate to rule-based stimulus-response processes. The revealed neural network suggests that automaticity, acting on the task rules and interplaying with effortful top-down attentional control, accounts for cognitive speed.
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Affiliation(s)
- Clive H Y Wong
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; Laboratory of Neuropsychology and Human Neuroscience, Department of Psychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
| | - Jiao Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, Fujian 350122, China; National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, United States; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of Traditional Chinese Medicine), Ministry of Education.
| | - Tatia M C Lee
- Laboratory of Neuropsychology and Human Neuroscience, Department of Psychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, China.
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, Fujian 350122, China; National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of Traditional Chinese Medicine), Ministry of Education.
| | - Alex W K Wong
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, United States; Department of Neurology, Washington University School of Medicine, St. Louis, United States.
| | - Bolton K H Chau
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Hong Kong.
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, Fujian 350122, China; National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of Traditional Chinese Medicine), Ministry of Education.
| | - Chetwyn C H Chan
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Hong Kong.
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16
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Wong AWK, Garcia SF, Hahn EA, Semik P, Lai JS, Magasi S, Hammel J, Nitsch KP, Miskovic A, Heinemann AW. Rasch Analysis of Social Attitude Barriers and Facilitators to Participation for Individuals with Disabilities. Arch Phys Med Rehabil 2020; 102:675-686. [PMID: 33223007 DOI: 10.1016/j.apmr.2020.09.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To develop item banks of social attitude barriers and facilitators to participation and validate them with established instruments. DESIGN We used the Rasch model to identify misfitting items and rating scale problems, calibrate items, and develop KeyForms and short forms. Correlations between the Social Attitude Barriers and Facilitators item banks with the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Health domain and National Institutes of Health Toolbox Emotional Battery Social Relationships domain were computed to evaluate convergent and divergent validity. SETTING Community-dwelling individuals traveled to 3 academic medical centers for testing. PARTICIPANTS Participants (N=558) who had a primary impairment of stroke, spinal cord injury, or traumatic brain injury (mean age, 47.0±16.0y) completed 31 social attitude facilitator and 51 barrier items using a 5-point rating scale. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Item banks to measure social attitude barriers and facilitators for individuals with disabilities. RESULTS After combining the "never" and "rarely" rating scale categories, 30 Facilitator items fit the Rasch model and demonstrated person reliability of 0.93. After collapsing the "never" and "rarely" rating scale categories, 45 Barrier items fit the Rasch model and demonstrated person reliability of 0.95. Ceiling and floor effects were negligible for both item banks. Facilitators and Barriers item banks were negatively correlated, and these banks were moderately correlated with PROMIS and Toolbox measures, providing evidence of convergent and divergent validity. CONCLUSIONS Findings support the reliability and validity of the Social Attitude Facilitators and Barriers item banks. These item banks allow investigators and clinicians to measure perceptions of social attitudes, providing information that can guide individual interventions to reduce barriers and promote facilitators. Moderate correlations between the Social Attitude banks and PROMIS and Toolbox variables provide support for the measurement and theory of environmental influences on social health and participation.
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Affiliation(s)
- Alex W K Wong
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL.
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago
| | - Patrick Semik
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL
| | - Kristian P Nitsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
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17
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Neff AJ, Lee Y, Metts CL, Wong AWK. Ecological Momentary Assessment of Social Interactions: Associations With Depression, Anxiety, Pain, and Fatigue in Individuals With Mild Stroke. Arch Phys Med Rehabil 2020; 102:395-405. [PMID: 32918909 DOI: 10.1016/j.apmr.2020.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine real-time relationships between social interactions and poststroke mood and somatic symptoms in participants' daily environments. DESIGN Prospective observational study using smartphone-based ecological momentary assessment (EMA) surveys 5 times a day for 2 weeks. Multilevel models were used to analyze data for concurrent and lagged associations. SETTING Community. PARTICIPANTS Adults (N=48) with mild stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES EMA measures of self-appraisal of social interactions (confidence, satisfaction, and success), as well as mood (depression and anxiety) and somatic (pain and fatigue) symptoms. RESULTS In concurrent associations, increased depressed mood was associated with reduced ratings of all aspects of social interactions. Fatigue was associated with reduced ratings of social satisfaction and success. In lagged associations, increased anxious mood preceded increased subsequent social confidence. Higher average social satisfaction, confidence, and success were related to lower momentary fatigue, anxious mood, and depressed mood at the next time point. Regarding clinicodemographic factors, being employed was concurrently related to increased social interactions. An increased number of comorbidities predicted higher somatic, but not mood, symptoms at the next time point. CONCLUSIONS This study provides preliminary evidence of dynamic relationships between social interactions and somatic and mood symptoms in individuals with mild stroke. Interventions to not only address the sequelae of symptoms, but also to promote participation in social activities in poststroke life should be explored.
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Affiliation(s)
- Anna J Neff
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Alex W K Wong
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.
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18
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Lee Y, Chen B, Fong MWM, Lee JM, Nicol GE, Lenze EJ, Connor LT, Baum C, Wong AWK. Effectiveness of non-pharmacological interventions for treating post-stroke depressive symptoms: Systematic review and meta-analysis of randomized controlled trials. Top Stroke Rehabil 2020; 28:289-320. [PMID: 32783504 DOI: 10.1080/10749357.2020.1803583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the effectiveness of non-pharmacological interventions on depressive symptoms in people after stroke. DATA SOURCES A literature search was performed through databases from January 2000 to August 2018: MEDLINE; CINAHL Plus; Scopus; Academic Search Complete; Cochrane Central Register of Controlled Trials; Scopus; and Library, Information Science and Technology Abstracts. Search terms included depression, stroke, non-pharmacologic, and intervention. STUDY SELECTION We included randomized controlled trials comparing non-pharmacological interventions to controls for depressive symptoms in people after stroke. Of 1703 identified articles, 22 trials were included in narrative synthesis, of which 13 were eligible for meta-analysis. DATA EXTRACTION Two reviewers extracted characteristics of participants, interventions, and results from all included trials. DATA SYNTHESIS Thirteen interventions were categorized into four types: complementary and alternative therapy (five trials, n=228), exercise (four trials, n=263), psychosocial therapy (two trials, n=216), and multifactorial therapy (two trials, n=358). Overall beneficial effects of non-pharmacological interventions on depressive symptoms were found both post-intervention (effect size [ES] = -0.24, 95% confidence Interval [CI]: -0.37 to -0.11, p < 0.05) and at follow-up (ES = -0.22, CI: -0.36 to -0.07, p< 0.05). We found individual beneficial effects for complementary and alternative therapy (ES = -0.29, CI: -0.55 to -0.02, p < 0.05) and psychosocial therapy (ES = - 0.33, CI: -0.60 to -0.06, p < 0.05) post-intervention. CONCLUSIONS Complementary and alternative therapy and psychosocial therapy appear to be promising strategies for improving post-stroke depression. Future studies target a personalized approach for people with specific conditions such as cognitive impairment.
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Affiliation(s)
- Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian Chen
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Mandy W M Fong
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ginger E Nicol
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa T Connor
- Program in Occupational Therapy & Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn Baum
- Program in Occupational Therapy & Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex W K Wong
- Program in Occupational Therapy, Department of Neurology & Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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19
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Li L, Huang J, Wu J, Jiang C, Chen S, Xie G, Ren J, Tao J, Chan CCH, Chen L, Wong AWK. A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17219. [PMID: 32401221 PMCID: PMC7254286 DOI: 10.2196/17219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/08/2020] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. OBJECTIVE This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone-based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. METHODS A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. RESULTS Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95% and 82% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95% and 80% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (X21=1.6, P=.21 for 2-week follow-up; X21=1.9, P=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (X23=6.7, P=.04 for 2-week follow-up; X23=8.0, P=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (X23=13.9; P=.03). CONCLUSIONS The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. TRIAL REGISTRATION chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831&htm=4.
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Affiliation(s)
- Li Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou, China
| | - Jingsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Cai Jiang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shanjia Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Guanli Xie
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jinxin Ren
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, HongKong, Hong Kong
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, China
| | - Alex W K Wong
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States.,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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20
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Yu Q, Chau BKH, Lam BYH, Wong AWK, Peng J, Chan CCH. Neural Processes of Proactive and Reactive Controls Modulated by Motor-Skill Experiences. Front Hum Neurosci 2019; 13:404. [PMID: 31798435 PMCID: PMC6868094 DOI: 10.3389/fnhum.2019.00404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
This study investigated the experience of open and closed motor skills on modulating proactive and reactive control processes in task switching. Fifty-four participants who were open-skilled (n = 18) or closed-skilled athletes (n = 18) or non-athletic adults (n = 18) completed a cued task-switching paradigm task. This task tapped into proactive or reactive controls of executive functions under different validity conditions. Electroencephalograms of the participants were captured during the task. In the 100% validity condition, the open-skilled participants showed significantly lower switch cost of response time than the closed-skilled and control participants. Results showed that the open-skilled participants had less positive-going parietal cue-locked P3 in the switch than repeat trials. Participants in the control group showed more positive-going cue-locked P3 in the switch than repeat trials, whereas the closed-skilled participants had no significant differences between the two types of trials. In the 50% validity condition, the open- and closed-skilled participants had less switch cost of response time than the control participants. Participants in the open- and closed-skilled groups showed less positive-going parietal stimulus-locked P3 in the switch than repeat trials, which was not the case for those in the control group. Our findings confirm the dissociation between proactive and reactive controls in relation to their modulations by the different motor-skill experiences. Both proactive and reactive controls of executive functions could be strengthened by exposing individuals to anticipatory or non-anticipatory enriched environments, suggesting proactive and reactive controls involved in motor-skill development seem to be transferable to domain-general executive functions.
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Affiliation(s)
- Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bolton K H Chau
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bess Y H Lam
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Alex W K Wong
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jiaxin Peng
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Department of Education, Shaoguan University, Shaoguan, China
| | - Chetwyn C H Chan
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Hong Kong, China
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21
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Ng SHX, Wong AWK, Chen CH, Tan CS, Müller-Riemenschneider F, Chan BPL, Baum MC, Lee JM, Venketasubramanian N, Koh GCH. Stroke Factors Associated with Thrombolysis Use in Hospitals in Singapore and US: A Cross-Registry Comparative Study. Cerebrovasc Dis 2019; 47:291-298. [PMID: 31434100 DOI: 10.1159/000502278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This paper aims to describe and compare the characteristics of 2 stroke populations in Singapore and in St. Louis, USA, and to document thrombolysis rates and contrast factors associated with its uptake in both populations. METHODS The stroke populations described were from the Singapore Stroke Registry (SSR) in -Singapore and the Cognitive Rehabilitation Research Group Stroke Registry (CRRGSR) in St. Louis, MO, USA. The registries were compared in terms of demographics and stroke risk factor history. Logistic regression was used to determine factors associated with thrombolysis uptake. RESULTS A total of 39,323 and 8,106 episodes were recorded in SSR and CRRGSR, respectively, from 2005 to 2012. Compared to CRRGSR, patients in SSR were older, male, and from the ethnic majority. Thrombolysis rates in SSR and CRRGSR were 2.5 and 8.2%, respectively, for the study period. History of ischemic heart disease or atrial fibrillation was associated with increased uptake in both populations, while history of stroke was associated with lower uptake. For SSR, younger age and males were associated with increased uptake, while having a history of smoking or diabetes was associated with decreased uptake. For CRRGSR, ethnic minority status was associated with decreased uptake. CONCLUSIONS The comparison of stroke populations in Singapore and St Louis revealed distinct differences in clinicodemographics of the 2 groups. Thrombolysis uptake was driven by nonethnicity demographics in Singapore. Ethnicity was the only demographic driver of uptake in the CRRGSR population, highlighting the need to target ethnic minorities in increasing access to thrombolysis.
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Affiliation(s)
- Sheryl Hui-Xian Ng
- Saw Swee Hock School of Public Health, National University Health System, Singapore, Singapore
| | - Alex W K Wong
- Department of Neurology, Program in Occupational Therapy, Washington University in St Louis, St. Louis, Missouri, USA
| | - Cynthia Huijun Chen
- Saw Swee Hock School of Public Health, National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University Health System, Singapore, Singapore.,Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany
| | - Bernard P L Chan
- Division of Neurology, National University Hospital, National University Health System, Singapore, Singapore
| | - M Carolyn Baum
- Department of Neurology, Program in Occupational Therapy, Washington University in St Louis, St. Louis, Missouri, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University in St Louis, St. Louis, Missouri, USA
| | | | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University Health System, Singapore, Singapore,
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22
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Wong AWK, Chen C, Baum MC, Heaton RK, Goodman B, Heinemann AW. Cognitive, Emotional, and Physical Functioning as Predictors of Paid Employment in People With Stroke, Traumatic Brain Injury, and Spinal Cord Injury. Am J Occup Ther 2019; 73:7302205010p1-7302205010p15. [PMID: 30915962 DOI: 10.5014/ajot.2019.031203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our objective was to examine demographic, cognitive, emotional, and physical factors that predict return to paid employment for people after neurological injury. METHOD Four hundred eighty adults with stroke (n = 149), traumatic brain injury (n = 155), and spinal cord injury (n = 176) completed an occupational outcome questionnaire and physical, emotional, and cognitive assessments at three rehabilitation facilities. RESULTS Odds of employment were predicted by being married or partnered, having more education, requiring fewer prompts for task sequencing, and having higher inhibitory control (but were not predicted by specific type of injury). Participants who returned to work within 3 mo were more likely to work with the same employer and to take a full-time position than those who returned later. CONCLUSION Executive functioning, in particular sequencing and inhibitory control, strongly predicts employment and highlights the importance of cognitive strategy training during occupational therapy with people who have sustained neurological injuries.
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Affiliation(s)
- Alex W K Wong
- Alex W. K. Wong, PhD, DPhil, is Assistant Professor, Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO;
| | - Cynthia Chen
- Cynthia Chen, PhD, is Assistant Professor, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - M Carolyn Baum
- M. Carolyn Baum, PhD, OTR/L, FAOTA, is Professor and Elias Michael Executive Director, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Robert K Heaton
- Robert K. Heaton, PhD, is Professor, Department of Psychiatry, University of California, San Diego
| | - Berrit Goodman
- Berrit Goodman, BA, is Master of Science in Occupational Therapy Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Allen W Heinemann
- Allen W. Heinemann, PhD, ABPP-RP, FACRM, is Professor, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, and Director, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago
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23
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Sinha P, Wong AWK, Kallogjeri D, Piccirillo JF. Baseline Cognition Assessment Among Patients With Oropharyngeal Cancer Using PROMIS and NIH Toolbox. JAMA Otolaryngol Head Neck Surg 2018; 144:978-987. [PMID: 29710116 PMCID: PMC6248179 DOI: 10.1001/jamaoto.2018.0283] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/15/2018] [Indexed: 12/20/2022]
Abstract
Importance Cognitive dysfunction (CD) is recognized by the American Cancer Society as a treatment effect in head and neck cancer, but the extent of this problem at baseline in oropharyngeal cancer (OPC), the most common subsite in current practice, to our knowledge has never been studied. Objective To assess the baseline cognition of patients with OPC using National Institutes of Health (NIH)-sponsored instruments of Patient-Reported Outcomes Measurement Information System (PROMIS) and NIH Toolbox Cognitive Battery (NIHTB-CB). Design, Setting, and Participants This was a prospective cohort study conducted at a tertiary academic center. Of 83 consecutive patients, newly diagnosed as having OPC from September 2016 to May 2017, 16 were ineligible, 8 refused to participate, and 3 were lost to follow-up after screening, resulting in 56 study participants. Main Outcomes and Measures Self-perceived and objective cognition with PROMIS and NIHTB-CB standardized T scores, respectively, were main outcomes. Impairment was defined as (1) T scores less than 0.5 SD for PROMIS; (2) T score less than 1.5 SD in at least 1 cognitive domain or less than 1 SD in 2 or more domains for NIHTB-CB total cognition; and (3) T score per previously published criteria for NIHTB-CB intelligence-stratified cognition. Results Of the 56 study participants (52 men, 4 women; median age, 59 years [range, 42-77 years]), 19 (34%) had a college degree, and 20 (36%) had a professional or technical occupation. Thirty (about 53%) were never-smokers, 26 (46%) were never-drinkers, 29 (52%) were obese, 13 (23%) had a moderate to severe comorbidity, 3 (5%) used antidepressants, and 25 (52%) had hearing loss. Impaired self-reported, NIHTB-CB total, and intelligence-stratified cognition scores were observed in 6 (11%), 18 (32%), and 12 (21%), respectively. Among all variables, objective impairment was more common in men (23% vs 0%) and those with p16-negative OPC (33% vs 20%), moderate to severe comorbidity (31% vs 18%), and hearing loss (31% vs 12%). Conclusions and Relevance Impaired objective cognition was more common at baseline than self-reported, and was more frequent in men, participants with p16-negative OPC, moderate to severe comorbidity, and hearing loss. NIHTB-CB allowed immediate scoring of demographically adjusted cognitive function. In clinical practice, these scores can be used to identify patients with impaired cognition at baseline who may be susceptible to developing further impairment after treatment. Identification of impairment at baseline will help to institute early cognitive interventions, which may lead to an improved posttreatment quality of life.
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Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Alex W. K. Wong
- Program in Occupational Therapy & Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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24
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Xie G, Chen L, Yang S, Tao J, Chan CCH, Heinemann AW, Cella D, Lai JS, Correia H, Wong AWK. Simplified Chinese translation of 13 adult item banks from the Quality of Life in Neurological Disorders (Neuro-QoL). BMC Health Serv Res 2018; 18:825. [PMID: 30376828 PMCID: PMC6208024 DOI: 10.1186/s12913-018-3631-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Quality of Life in Neurological Disorders (Neuro-QoL) item banks evaluate and monitor the physical, mental, and social health of individuals with neurological conditions. Neuro-QoL items can be administered via short form or computerized adaptive testing. This paper describes the English-to-Simplified Chinese translation of 299 items from 13 adult item banks, which are publicly available. METHODS Items were translated according to the Functional Assessment of Chronic Illness Therapy (FACIT) method, including forward and backward translation, reconciliation, expert reviews, and cognitive debriefing with both general and clinical populations in China. RESULTS Most of the 299 Simplified Chinese items were well understood by the respondents. Revisions were made on a small number of items after cognitive debriefing. Although some difficulties were encountered in the translation process, all 13 item banks were linguistically validated with acceptable translations. CONCLUSION All Chinese adult Neuro-QoL measures are linguistically equivalent to their English sources. Future work includes psychometric validation of these measures in order to create a final version of the item banks. The translation methodology used in this study can serve as a blueprint for researchers in other countries interested in translating the Neuro-QoL.
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Affiliation(s)
- Guanli Xie
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
- Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine of the P.R.C., Fuzhou, Fujian China
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
- Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine of the P.R.C., Fuzhou, Fujian China
| | - Shanli Yang
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian China
- Rehabilitation Medical Technology Joint National Local Engineering Research Center, Fuzhou, Fujian China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, Fujian China
| | - Chetwyn C. H. Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine & Center for Rehabilitation Outcomes Research, Shirley Ryan Ability Lab (formerly Rehabilitation Institute of Chicago), Chicago, IL USA
| | - David Cella
- Department of Medical Social Science & Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Jin-Shei Lai
- Departments of Medical Social Science & Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Helena Correia
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alex W. K. Wong
- Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO 63108 USA
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25
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Carlozzi NE, Tulsky DS, Wolf TJ, Goodnight S, Heaton RK, Casaletto KB, Wong AWK, Baum CM, Gershon RC, Heinemann AW. Construct validity of the NIH Toolbox Cognition Battery in individuals with stroke. Rehabil Psychol 2018; 62:443-454. [PMID: 29265865 DOI: 10.1037/rep0000195] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The National Institutes of Health (NIH) Toolbox (NIHTB) for the Assessment of Behavior and Neurological Function Cognition Battery (NIHTB-CB) provides a brief assessment (approximately 30 min) of key components of cognition. This article examines construct validity to support the clinical utility of the NIHTB-CB in individuals with stroke. RESEARCH METHOD A total of 131 individuals with stroke (n = 71 mild stroke; n = 60 moderate/severe stroke) completed the NIHTB-CB. Univariate analyses were conducted to examine the cognitive profiles of the two different stroke groups (mild vs. moderate/severe stroke) on NIHTB-CB measures and composite scores. Pearson correlations were conducted between NIHTB-CB and established measures to examine convergent and discriminant validity. Effect sizes and clinical impairment rates for the different NIHTB-CB measures and composite scores were also examined. RESULTS Participants experiencing moderate to severe stroke had poorer performance than did individuals with mild stroke on several of the NIHTB cognition measures. Evidence of convergent validity was provided by moderate to strong correlations between the NIHTB measures and the corresponding standard neuropsychological test (Pearson rs ranged from 0.31 to 0.88; median = .60). Evidence of discriminant validity was provided by smaller correlations between different cognitive domains than correlations of measures within the same domain. Effect sizes for composite and subtest scores regarding stroke severity were generally moderate-to-large. In addition, 42% of the sample were exhibiting mild cognitive impairment (i.e., ≥2 low scores on fluid tests). CONCLUSIONS Findings provide support for the construct validity of the NIHTB-CB in individuals with stroke. (PsycINFO Database Record
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware
| | - Timothy J Wolf
- Occupational Therapy and Department of Neurology, Washington University
| | - Siera Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego
| | | | - Alex W K Wong
- Occupational Therapy and Department of Neurology, Washington University
| | - Carolyn M Baum
- Occupational Therapy and Department of Neurology, Washington University
| | | | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab
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Tulsky DS, Holdnack JA, Cohen ML, Heaton RK, Carlozzi NE, Wong AWK, Boulton AJ, Heinemann AW. Factor structure of the NIH Toolbox Cognition Battery in individuals with acquired brain injury. Rehabil Psychol 2018; 62:435-442. [PMID: 29265864 DOI: 10.1037/rep0000183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) measures reading, vocabulary, episodic memory, working memory, executive functioning, and processing speed. While previous research has validated the factor structure in healthy adults, the factor structure has not been examined in adults with neurological impairments. Thus, this study evaluated the NIHTB-CB factor structure in individuals with acquired brain injury. METHOD A sample of 392 individuals (ages 18-84) with acquired brain injury (n = 182 TBI, n = 210 stroke) completed the NIHTB-CB along with neuropsychological tests as part of a larger, multisite research project. RESULTS Confirmatory factor analyses supported a 5-factor solution that included reading, vocabulary, episodic memory, working memory, and processing speed/executive functioning. This structure generally held in TBI and stroke subsamples as well as in subsamples of those with severe TBI and stroke injuries. CONCLUSIONS The factor structure of the NIHTB-CB is similar in adults with acquired brain injury to adults from the general population. We discuss the implications of these findings for clinical practice and clinical research. (PsycINFO Database Record
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Affiliation(s)
- David S Tulsky
- Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware
| | - James A Holdnack
- The Center on Health Assessment Research and Translation, University of Delaware
| | - Matthew L Cohen
- The Center on Health Assessment Research and Translation, University of Delaware
| | - Robert K Heaton
- Department of Psychiatry, University of California-San Diego School of Medicine
| | - Noelle E Carlozzi
- Center for Clinical Outcomes Development and Application, University of Michigan Medical Center
| | - Alex W K Wong
- Department of Occupational Therapy and Neurology, Washington University School of Medicine
| | - Aaron J Boulton
- The Center for Health Assessment Research and Translation, University of Delaware
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
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Xu Y, Lin S, Jiang C, Ye X, Tao J, Wilfried S, Wong AWK, Chen L, Yang S. Synergistic effect of acupuncture and mirror therapy on post-stroke upper limb dysfunction: a study protocol for a randomized controlled trial. Trials 2018; 19:303. [PMID: 29855360 PMCID: PMC5984408 DOI: 10.1186/s13063-018-2585-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/07/2018] [Indexed: 12/01/2022] Open
Abstract
Background Upper limb dysfunction is common after stroke, posing an important challenge for post-stroke rehabilitation. The clinical efficacy of acupuncture for the recovery of post-stroke upper limb function has been previously demonstrated. Mirror therapy (MT) has also been found to be effective. However, the effects of acupuncture and MT have not been systematically compared. This trial aims to elucidate the synergistic effects of acupuncture and MT on upper limb dysfunction after stroke. Methods A 2 × 2 factorial randomized controlled trial will be conducted at the rehabilitation hospitals affiliated with Fujian University of Traditional Chinese Medicine. A total of 136 eligible subjects will be randomly divided into acupuncture treatment (AT), MT, combined treatment, and control groups in a 1:1:1:1 ratio. All subjects will receive conventional treatment. The interventions will be performed 5 days per week for 4 weeks. AT, MT, and combined treatment will be performed for 30 min per day (combined treatment: AT 15 min + MT 15 min). The primary outcomes in this study will be the mean change in scores on both the FMA and WMFT from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The secondary outcomes are the mean change in the scores on the Visual Analogue Scale, Stroke Impact Scale, and modified Barthel index. Medical abstraction of adverse events will be assessed at each visit. Discussion The results of this trial will demonstrate the synergistic effect of acupuncture and MT on upper limb motor dysfunction after stroke. In addition, whether AT and MT, either combined or alone, are more effective than the conventional treatment in the management of post-stroke upper limb dysfunction will also be determined. Trial registration Chinese Clinical Trial Registry: ChiCTR-IOR-17011118. Registered on April 11, 2017. Version number: 01.2016.09.1. Electronic supplementary material The online version of this article (10.1186/s13063-018-2585-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Xu
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Shufang Lin
- Rehabilitation Hospital Affiliated to Fujian University of TCM, Fuzhou, 350003, China
| | - Cai Jiang
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Xiaoqian Ye
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Jing Tao
- Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Schupp Wilfried
- M&i-Fachklinik Herzogenaurach, 91074, Herzogenaurach, Germany
| | - Alex W K Wong
- Program in Occupational Therapy & Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Lidian Chen
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Shanli Yang
- Rehabilitation Hospital Affiliated to Fujian University of TCM, Fuzhou, 350003, China.
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Wong AWK, Lau SCL, Fong MWM, Cella D, Lai JS, Heinemann AW. Conceptual Underpinnings of the Quality of Life in Neurological Disorders (Neuro-QoL): Comparisons of Core Sets for Stroke, Multiple Sclerosis, Spinal Cord Injury, and Traumatic Brain Injury. Arch Phys Med Rehabil 2018; 99:1763-1775. [PMID: 29625094 DOI: 10.1016/j.apmr.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/07/2018] [Accepted: 03/03/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the extent to which the content of the Quality of Life in Neurological Disorders (Neuro-QoL) covers the International Classification of Functioning, Disability and Health (ICF) Core Sets for multiple sclerosis (MS), stroke, spinal cord injury (SCI), and traumatic brain injury (TBI) using summary linkage indicators. DESIGN Content analysis by linking content of the Neuro-QoL to corresponding ICF codes of each Core Set for MS, stroke, SCI, and TBI. SETTING Three academic centers. PARTICIPANTS None. INTERVENTIONS None. MAIN OUTCOME MEASURES Four summary linkage indicators proposed by MacDermid et al were estimated to compare the content coverage between Neuro-QoL and the ICF codes of Core Sets for MS, stroke, MS, and TBI. RESULTS Neuro-QoL represented 20% to 30% Core Set codes for different conditions in which more codes in Core Sets for MS (29%), stroke (28%), and TBI (28%) were covered than those for SCI in the long-term (20%) and early postacute (19%) contexts. Neuro-QoL represented nearly half of the unique Activity and Participation codes (43%-49%) and less than one third of the unique Body Function codes (12%-32%). It represented fewer Environmental Factors codes (2%-6%) and no Body Structures codes. Absolute linkage indicators found that at least 60% of Neuro-QoL items were linked to Core Set codes (63%-95%), but many items covered the same codes as revealed by unique linkage indicators (7%-13%), suggesting high concept redundancy among items. CONCLUSIONS The Neuro-QoL links more closely to ICF Core Sets for stroke, MS, and TBI than to those for SCI, and primarily covers activity and participation ICF domains. Other instruments are needed to address concepts not measured by the Neuro-QoL when a comprehensive health assessment is needed.
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Affiliation(s)
- Alex W K Wong
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO; Department of Neurology, Washington University School of Medicine, St Louis, MO.
| | - Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO
| | - Mandy W M Fong
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - David Cella
- Department of Medical Social Science and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin-Shei Lai
- Departments of Medical Social Science and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine and Center for Rehabilitation Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL
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Shahpar S, Wong AWK, Keeshin S, Eickmeyer SM, Semik P, Kocherginsky M, McCarty S. Functional Outcomes of an Interdisciplinary Outpatient Rehabilitation Program for Patients with Malignant Brain Tumors. PM R 2018; 10:926-933. [PMID: 29550410 DOI: 10.1016/j.pmrj.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Malignant brain tumors cause significant impairments in function because of the nature of the disease. Nevertheless, patients with malignant brain tumors can make functional gains equivalent to those with stroke and traumatic brain injury in the inpatient rehabilitation setting. However, the efficacy of outpatient rehabilitation in this population has received little study. OBJECTIVE To determine if an interdisciplinary outpatient rehabilitation program will improve functional outcomes in patients with malignant brain tumors. DESIGN Nonrandomized prospective longitudinal study. SETTING Six affiliated outpatient sites of one institution. PATIENTS Forty-nine adults with malignant brain tumors were enrolled. METHODS Patients received interdisciplinary therapy services, with duration determined by the therapist evaluations. The therapists scored the Day Rehabilitation Outcome Scale (DayROS) and Disability Rating Scale (DRS) on admission and discharge. The caregivers filled out the DRS at discharge, 1 month, and 3 months after discharge. MAIN OUTCOME MEASUREMENTS The primary study outcome measure was the DayROS, which is a functional measure similar to the Functional Independence Measure. DRS was another functional outcome measure assessing basic self-care, dependence on others, and psychosocial adaptability. RESULTS Forty-six of 49 enrolled patients (94%) completed the day rehabilitation program. The average length of stay was 76.9 days. There was a significant improvement in total DayROS (P < .001), mobility (P < .001), Activities of Daily Living ( P < .001), and communication (P < .001) DayROS subscores from admission to discharge. There were no significant changes over time in the DRS scores. Women had higher DayROS gains (P = .003) and better therapist DRS scores from admission to discharge than men (P = .010). CONCLUSIONS Patients with malignant brain tumors can make functional gains in an interdisciplinary outpatient rehabilitation program. This level of care should be considered in this patient population. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Samman Shahpar
- Northwestern University Feinberg School of Medicine, Chicago, IL; and Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL 60611(∗).
| | - Alex W K Wong
- Washington University School of Medicine, St Louis, MO(†)
| | - Susan Keeshin
- Northwestern University Feinberg School of Medicine, Chicago, IL; and Shirley Ryan AbilityLab, Chicago, IL(‡)
| | - Sarah M Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas School of Medicine, Kansas City, KS(§)
| | - Patrick Semik
- Center of Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL(¶)
| | - Masha Kocherginsky
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL(#)
| | - Stacy McCarty
- Northwestern University Feinberg School of Medicine, Chicago, IL; and Shirley Ryan AbilityLab, Chicago, IL(∗∗)
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Kang EY, Jee SJ, Kim CS, Suh KS, Wong AWK, Moon JY. The feasibility study of Computer Cognitive Senior Assessment System-Screen (CoSAS-S) in critically ill patients with sepsis. J Crit Care 2017; 44:128-133. [PMID: 29096231 DOI: 10.1016/j.jcrc.2017.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/06/2017] [Accepted: 10/09/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Early cognitive assessment in the intensive care unit (ICU) is essential to monitor cognitive dysfunction after critical illness. We have implemented a Computer Cognitive Senior Assessment System-Screen (CoSAS-S) which is a brief, objective, and tablet-based cognitive screening test as a mobile platform to detect any cognitive problems in ICUs. This study aimed to evaluate the feasibility and initial validation of a tablet-based CoSAS-S in critically ill patients with sepsis. MATERIALS AND METHODS Thirty-six eligible patients completed CoSAS-S, Mini-Mental State Examination-Korean Version (MMSE-K) and Korean Version of Montreal Cognitive Assessment (K-MoCA) for validity testing at the ICU. RESULTS Eighty-eight percent of programmed assessments were completed by the sample. Spearman correlations of the CoSAS-S with MMSE-K (rho=0.613-0.874, p<0.00) and K-MoCA scores (rho=0.666-0.897, p<0.001) were moderate to high. Intra-class correlation coefficient (ICC) of total CoSAS-S score between two raters was 0.93 (p<0.001; 95% CI=0.82-0.97), suggesting the inter-rater reliability of CoSAS-S was excellent. CONCLUSIONS Support was found for the feasibility and validity of CoSAS-S. The application of CoSAS-S could identify the cognitive functioning of the patients. Utility of CoSAS-S in other clinical populations should be tested.
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Affiliation(s)
- Eun-Young Kang
- Rehabilitation and Participation Science, Program in Occupational Therapy, Washing University School of Medicine in St. Louis, MO, USA.
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, Republic of Korea.
| | - Cuk-Seong Kim
- Department of Physiology, School of Medicine, Chungnam National University, Deajeon, Republic of Korea.
| | - Kwang-Sun Suh
- Department of Pathology, Chungnam National University Hospital, Chungnam National University School of Medicine, Deajeon, Republic of Korea.
| | - Alex W K Wong
- Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine in St. Louis, MO, USA.
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 2017; 23:640-652. [PMID: 28660849 PMCID: PMC5703208 DOI: 10.1017/s1355617717000480] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
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Affiliation(s)
- Neco X Johnson
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Maria J Marquine
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Ilse Flores
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Anya Umlauf
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Carolyn M Baum
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alex W K Wong
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alexis C Young
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | | | - Allen W Heinemann
- 5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois
| | - Susan Magasi
- 6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois
| | - Robert K Heaton
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
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Wong AWK, Lau SCL, Cella D, Lai JS, Xie G, Chen L, Chan CCH, Heinemann AW. Linking of the quality of life in neurological disorders (Neuro-QoL) to the international classification of functioning, disability and health. Qual Life Res 2017; 26:2435-2448. [PMID: 28477085 DOI: 10.1007/s11136-017-1590-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The quality of life in neurological disorders (Neuro-QoL) is a U.S. National Institutes of Health initiative that produced a set of self-report measures of physical, mental, and social health experienced by adults or children who have a neurological condition or disorder. OBJECTIVE To describe the content of the Neuro-QoL at the item level using the World Health Organization's international classification of functioning, disability and health (ICF). METHODS We assessed the Neuro-QoL for its content coverage of functioning and disability relative to each of the four ICF domains (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify items into categories within each ICF domain and computed the percentage of categories within each ICF domain that were represented in the Neuro-QoL items. RESULTS All items of Neuro-QoL could be mapped to the ICF categories at the second-level classification codes. The activities and participation domain and the mental functions category of the body functions domain were the areas most often represented by Neuro-QoL. Neuro-QoL provides limited coverage of the environmental factors and body structure domains. CONCLUSIONS Neuro-QoL measures map well to the ICF. The Neuro-QoL-ICF-mapped items provide a blueprint for users to select appropriate measures in ICF-based measurement applications.
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Affiliation(s)
- Alex W K Wong
- Program in Occupational Therapy & Department of Neurology, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO, 63108, USA.
| | - Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - David Cella
- Department of Medical Social Science & Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jin-Shei Lai
- Departments of Medical Social Science & Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Guanli Xie
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine & Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
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Wong AWK, Ng S, Dashner J, Baum MC, Hammel J, Magasi S, Lai JS, Carlozzi NE, Tulsky DS, Miskovic A, Goldsmith A, Heinemann AW. Relationships between environmental factors and participation in adults with traumatic brain injury, stroke, and spinal cord injury: a cross-sectional multi-center study. Qual Life Res 2017; 26:2633-2645. [DOI: 10.1007/s11136-017-1586-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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Wong AWK, Chang TT, Christopher K, Lau SCL, Beaupin LK, Love B, Lipsey KL, Feuerstein M. Patterns of unmet needs in adolescent and young adult (AYA) cancer survivors: in their own words. J Cancer Surviv 2017; 11:751-764. [DOI: 10.1007/s11764-017-0613-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/09/2017] [Indexed: 12/13/2022]
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Wong AWK, O’Sullivan D, Strauser DR. Confirmatory Factor Analytical Study of the Revised Developmental Work Personality Scale. Measurement and Evaluation in Counseling and Development 2017. [DOI: 10.1177/0748175612449628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alex W. K. Wong
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Reid Yates JA, Wong AWK, Strauser DR, Heft Sears SJ. The Impact of Type D Personality Traits on the Career Readiness of College Students With and Without Disabilities. Rehabilitation Counseling Bulletin 2016. [DOI: 10.1177/0034355215610082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The primary purpose of the study was to investigate the relationship of Type D personality and perceived career readiness in a group of college students with and without disabilities. The findings of the study revealed no significant differences in levels of career readiness and Type D personality across disability groups. Results also revealed that Type D traits did have a significant relationship with career readiness variables, and that this relationship is particularly significant for college students with disabilities. Results also indicated that for individuals with disabilities, both Type D traits (negative affect and social inhibition) have an effect on different dimensions of career readiness. Implications of the results are discussed within the context of rehabilitation counselors and professionals. Future directions for research are also offered.
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Affiliation(s)
| | - Alex W. K. Wong
- Washington University School of Medicine, St. Louis, MO, USA
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Baum CM, Wolf TJ, Wong AWK, Chen CH, Walker K, Young AC, Carlozzi NE, Tulsky DS, Heaton RK, Heinemann AW. Validation and clinical utility of the executive function performance test in persons with traumatic brain injury. Neuropsychol Rehabil 2016; 27:603-617. [PMID: 27150506 DOI: 10.1080/09602011.2016.1176934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the relationships between the Executive Function Performance Test (EFPT), the NIH Toolbox Cognitive Function tests, and neuropsychological executive function measures in 182 persons with traumatic brain injury (TBI) and 46 controls to evaluate construct, discriminant, and predictive validity. Construct validity: There were moderate correlations between the EFPT and the NIH Toolbox Crystallized (r = -.479), Fluid Tests (r = -.420), and Total Composite Scores (r = -.496). Discriminant validity: Significant differences were found in the EFPT total and sequence scores across control, complicated mild/moderate, and severe TBI groups. We found differences in the organisation score between control and severe, and between mild and severe TBI groups. Both TBI groups had significantly lower scores in safety and judgement than controls. Compared to the controls, the severe TBI group demonstrated significantly lower performance on all instrumental activities of daily living (IADL) tasks. Compared to the mild TBI group, the controls performed better on the medication task, the severe TBI group performed worse in the cooking and telephone tasks. Predictive validity: The EFPT predicted the self-perception of independence measured by the TBI-QOL (beta = -0.49, p < .001) for the severe TBI group. Overall, these data support the validity of the EFPT for use in individuals with TBI.
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Affiliation(s)
- C M Baum
- a Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - T J Wolf
- a Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - A W K Wong
- a Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - C H Chen
- b Saw Swee Hock School of Public Health, National University of Singapore , Singapore
| | - K Walker
- a Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - A C Young
- a Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - N E Carlozzi
- c Department of Physical Medicine & Rehabilitation , University of Michigan , Ann Arbor , MI , USA
| | - D S Tulsky
- d Department of Physical Therapy , University of Delaware, College of Health Sciences , Newark , DE , USA
| | - R K Heaton
- e Department of Psychiatry , UC San Diego , La Jolla , CA , USA
| | - A W Heinemann
- f Department of Physical Medicine & Rehabilitation , Northwestern University , Chicago , IL , USA
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Connor LT, Wong AWK, Baum CM. Measuring Values in Everyday Life and Their Correlation to Activity Participation. Am J Occup Ther 2015. [DOI: 10.5014/ajot.2015.69s1-rp205b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/17/2015
In this study, we develop a measure that characterizes the relationship between values and participation in everyday life. The SPVLS will provide occupational therapists with information that will help to set person-centered goals to enable activity participation.
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Wong AWK, Lai JS, Correia H, Cella D. Validity of the Neurology Quality of Life Measurement System (Neuro-QoL) Spanish Social Health Items. Am J Occup Ther 2015. [DOI: 10.5014/ajot.2015.69s1-rp302d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/18/2015
In this study, we advance the understanding of the Neurology Quality of Life Measurement System (Neuro-QoL) and the importance for measuring the social health of persons with neurological conditions. This tool will aid occupational therapists to better evaluate and understand social health and to develop targets for future research and practice.
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Strauser D, Klosky JL, Brinkman TM, Wong AWK, Chan F, Lanctot J, Ojha RP, Robison LL, Hudson MM, Ness KK. Career readiness in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study. J Cancer Surviv 2014; 9:20-9. [PMID: 25047713 DOI: 10.1007/s11764-014-0380-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Adult survivors of childhood cancer experience difficulties in obtaining and maintaining employment. Employment-related challenges are associated with treatment-related health conditions and may also be related to vocational factors such as career readiness, skill acquisition, and work experience. Unfortunately, little is known about how treatment-, health-, and vocational-related factors interact to impact career development among childhood cancer survivors. METHODS Three hundred eighty-five adult survivors of childhood cancer (42.1% male, median age 38 years (21-62)), participating in the St. Jude Lifetime Cohort Study, completed a work experiences survey that included measures of career readiness and vocational identity. Logistic regression was used to compare characteristics of survivors in the low career readiness category to those in the medium or high career readiness category, and structural equation modeling (SEM) was utilized to evaluate associations between career readiness, vocational identity, treatment intensity, and physical/emotional health. RESULTS Low career readiness was prevalent in 17.4% of survivors. Univariate analysis did not identify any significant associations between cancer treatment-related factors and career readiness. Unemployed survivors (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2-4.5), those who were not college graduates (OR 3.0, 95% CI 1.6-5.6), and those who had no personal income (OR 5.9, 95% CI 1.7-30.9) were at increased risk of low career readiness. SEM indicated that associations between treatment intensity, physical health, age at diagnosis, and career readiness were mediated by emotional health and vocational identity. Sixty-three, 35, and 10% of the variance in career readiness, vocational identity, and emotional health, respectively, were explained by this theoretical model. CONCLUSIONS The results of this study indicate that individuals who reported low levels of career readiness were more likely to be unemployed and earn less than US$40,000 per year and were less likely to graduate from high school. The final structural model indicates that vocational identity and emotional health accounted for the indirect effect of treatment intensity, age at diagnosis, and physical health on career readiness. IMPLICATIONS FOR CANCER SURVIVORS Addressing career readiness may be important to improve employment outcomes for adult survivors of childhood cancer.
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Affiliation(s)
- David Strauser
- University of Illinois Urbana-Champaign, Champaign, IL, USA,
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Wong AWK, Heinemann AW, Miskovic A, Semik P, Snyder TM. Feasibility of computerized adaptive testing for collection of patient-reported outcomes after inpatient rehabilitation. Arch Phys Med Rehabil 2014; 95:882-91. [PMID: 24440363 DOI: 10.1016/j.apmr.2013.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/23/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the feasibility of computer adaptive testing (CAT) using an Internet or telephone interface to collect patient-reported outcomes after inpatient rehabilitation and to examine patient characteristics associated with completion of the CAT-administered measure and mode of administration. DESIGN Prospective cohort study of patients contacted approximately 4 weeks after discharge from inpatient rehabilitation. Patients selected an Internet or telephone interface. SETTING Rehabilitation hospital. PARTICIPANTS Patients (N=674) with diagnoses of neurologic, orthopedic, or medically complex conditions. INTERVENTIONS None. MAIN OUTCOME MEASURE CAT version of the Community Participation Indicators (CAT-CPI). RESULTS From an eligible pool of 3221 patients, 674 (21%) agreed to complete the CAT-CPI. Patients who agreed to complete the CAT-CPI were younger and reported slightly higher satisfaction with overall care than those who did not participate. Among these patients, 231 (34%) actually completed the CAT-CPI; 141 (61%) selected telephone administration, and 90 (39%) selected Internet administration. Decreased odds of completing the CAT-CPI were associated with black and other race; stroke, brain injury, or orthopedic and other impairments; and being a Medicaid beneficiary, whereas increased odds of completing the CAT-CPI were associated with longer length of stay and higher discharge FIM cognition measure. Decreased odds of choosing Internet administration were associated with younger age, retirement status, and being a woman, whereas increased odds of choosing Internet administration were associated with higher discharge FIM motor measure. CONCLUSIONS CAT administration by Internet and telephone has limited feasibility for collecting postrehabilitation outcomes for most rehabilitation patients, but it is feasible for a subset of patients. Providing alternative ways of answering questions helps assure that a larger proportion of patients will respond.
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Affiliation(s)
- Alex W K Wong
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Patrick Semik
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Thomas M Snyder
- Department of Outcome Measurement Systems and Analysis, Rehabilitation Institute of Chicago, Chicago, IL
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Strauser DR, Wagner S, Chan F, Wong AWK. Perceptions of Young Adult Central Nervous System Cancer Survivors and Their Parents Regarding Career Development and Employment. Rehabilitation Research Policy and Education 2014. [DOI: 10.1891/2168-6653.28.3.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: Identify barriers to career development and employment from both the survivor and parent perspective.Method: Young adult survivors (N = 43) and their parents participated in focus groups to elicit information regarding perceptions regarding career development and employment.Results: Perceptions of both the young adults and parents indicate that there is a significant need for comprehensive career and employment services targeted for young adult central nervous system cancer survivors.Conclusions: Findings provide initial evidence and support for the need to incorporate career and vocational services into psychosocial treatment programs. More research is needed in this area to gain an understanding of the specific career and vocational needs and to further explore how the interaction between the young adults and their parents impact vocational outcomes.
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Rice IM, Wong AWK, Salentine BA, Rice LA. Differences in participation based on self-esteem in power and manual wheelchair users on a university campus: a pilot study. Disabil Rehabil Assist Technol 2013; 10:102-7. [DOI: 10.3109/17483107.2013.840864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Strauser D, Wagner S, Wong AWK, O’Sullivan D. Career readiness, developmental work personality and age of onset in young adult central nervous system survivors. Disabil Rehabil 2012; 35:543-50. [DOI: 10.3109/09638288.2012.703754] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Strauser DR, O'Sullivan D, Wong AWK. Work Personality, Work Engagement, and Academic Effort in a Group of College Students. Journal of Employment Counseling 2012. [DOI: 10.1002/j.2161-1920.2012.00006.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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O'Sullivan D, Strauser DR, Wong AWK. Examining differences in developmental work personality across disability category: Implications for individuals with psychiatric disabilities. Work 2012; 42:259-267. [PMID: 22699193 DOI: 10.3233/wor-2012-1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The purpose of this exploratory study was to examine the differences in levels of work personality for persons with psychiatric disabilities compared to persons with other types of disabilities. PARTICIPANTS Seventy one adults eligible to receive Vocational Rehabilitation services participated; 30 reported a physical disability, 26 reported a psychiatric disability, and 15 reported a learning disability. METHODS Eligible participants were recruited through VR offices and volunteered to participate. RESULTS Results indicate that persons with psychiatric disabilities scored significantly lower on the Work Task and Social Skills subscales of the Developmental Work Personality Scale (DWPS) when compared to individuals with physical disabilities, but scored higher than individuals with physical and learning disabilities on the Role Model subscale. CONCLUSIONS The results of this study provide some initial clarity regarding developmental work personality differences among three broad categories of disability. Recommendations for future research are provided.
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Affiliation(s)
- Deirdre O'Sullivan
- Counseling Psychology and Rehabilitation Services, 312 CEDAR Bldg, The Pennsylvania State University, University Park, PA 16802, USA.
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Chan CCH, Wong AWK, Ting KH, Whitfield-Gabrieli S, He J, Lee TMC. Cross auditory-spatial learning in early-blind individuals. Hum Brain Mapp 2011; 33:2714-27. [PMID: 21932260 DOI: 10.1002/hbm.21395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 05/29/2011] [Accepted: 05/31/2011] [Indexed: 11/10/2022] Open
Abstract
Cross-modal processing enables the utilization of information received via different sensory organs to facilitate more complicated human actions. We used functional MRI on early-blind individuals to study the neural processes associated with cross auditory-spatial learning. The auditory signals, converted from echoes of ultrasonic signals emitted from a navigation device, were novel to the participants. The subjects were trained repeatedly for 4 weeks in associating the auditory signals with different distances. Subjects' blood-oxygenation-level-dependent responses were captured at baseline and after training using a sound-to-distance judgment task. Whole-brain analyses indicated that the task used in the study involved auditory discrimination as well as spatial localization. The learning process was shown to be mediated by the inferior parietal cortex and the hippocampus, suggesting the integration and binding of auditory features to distances. The right cuneus was found to possibly serve a general rather than a specific role, forming an occipital-enhanced network for cross auditory-spatial learning. This functional network is likely to be unique to those with early blindness, since the normal-vision counterparts shared activities only in the parietal cortex.
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Affiliation(s)
- Chetwyn C H Chan
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Strauser DR, O'Sullivan D, Wong AWK. The relationship between contextual work behaviours self-efficacy and work personality: an exploratory analysis. Disabil Rehabil 2010; 32:1999-2008. [PMID: 20450457 DOI: 10.3109/09638281003797380] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Work personality and contextual work behaviours have been identified as constructs that play critical roles in developing the foundation for effective vocational and career behaviour for persons with disabilities. METHOD For this study, we used a sample of 84 individuals with disabilities who were eligible to receive vocational rehabilitation services. Demographic variables and questions concerning work personality, contextual work behaviours self-efficacy, employment status and longest time employed were obtained and analysed to determine the relationship between contextual work behaviours self-efficacy, work personality and employment outcomes. RESULTS The results indicate that work personality explained 24% (F = 2.73; p = 0.013) of the variance of contextual work behaviours self-efficacy with the subscale of Personal Presentation (β = 0.466) making a significant and unique contribution to CWB total score. Results of a correlation between the work personality profile scale and the contextual work behaviours self-efficacy scale revealed a significant and positive relationship. Levels of work personality and contextual work behaviours self-efficacy were unable to discriminate between employed and unemployed individuals. However, a post-hoc regression analysis did find that work personality and contextual work behaviours self-efficacy accounted for approximately 24% of the variance of longest time employed. CONCLUSIONS The results of this study provide initial support for the relationship between work personality and contextual work behaviours self-efficacy. Overall, work personality appears to be an important construct related to individual's confidence to meet the contextual demand of the work environment and length of employment tenure.
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Affiliation(s)
- David R Strauser
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, 213 A Huff Hall, MC-588, Champaign, IL 61820, USA.
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Chan CCH, Wong AWK, Lee TMC, Chi I. Modified automatic teller machine prototype for older adults: a case study of participative approach to inclusive design. Appl Ergon 2009; 40:151-160. [PMID: 18455146 DOI: 10.1016/j.apergo.2008.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 02/13/2008] [Accepted: 02/28/2008] [Indexed: 05/26/2023]
Abstract
The goal of this study was to enhance an existing automated teller machine (ATM) human-machine interface in order to accommodate the needs of older adults. Older adults were involved in the design and field test of the modified ATM prototype. The design of the user interface and functionality took the cognitive and physical abilities of older adults into account. The modified ATM system included only "cash withdrawal" and "transfer" functions based on the task demands and needs for services of older adults. One hundred and forty-one older adults (aged 60 or above) participated in the field test by operating modified or existing ATM systems. Those who operated the modified system were found to have significantly higher success rates than those who operated the existing system. The enhancement was most significant among older adults who had lower ATM-related abilities, a lower level of education, and no prior experience of using ATMs. This study demonstrates the usefulness of using a universal design and participatory approach to modify the existing ATM system for use by older adults. However, it also leads to a reduction in functionality of the enhanced system. Future studies should explore ways to develop a universal design ATM system which can satisfy the abilities and needs of all users in the entire population.
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Affiliation(s)
- Chetwyn C H Chan
- Ergonomics and Human Performance Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Wong AWK, Chan CCH, Li-Tsang CWP, Lam CS. Competence of people with intellectual disabilities on using human-computer interface. Res Dev Disabil 2009; 30:107-123. [PMID: 18302980 DOI: 10.1016/j.ridd.2008.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 01/15/2008] [Indexed: 05/26/2023]
Abstract
We investigated the task processes which hinder people with intellectual disabilities (ID) when using the human-computer interface. This involved testing performance on specific computer tasks and conducting detailed analyses of the task demands imposed on the participants. The interface used by Internet Explorer (IE) was standardized into 16 tasks (161 subtasks). A total of 57 people with ID completed all the tasks. The task demands of each subtask were analyzed and rated by an expert panel review. Results indicated that the 16 identified tasks to have varied levels of difficulty. Participants' performances were differentiated by two tasks: general motor functions and use customized bookmark. The majority of the tasks required visual acuity, vigilance, orientation, and basic sensori-motor abilities. The more difficult tasks were associated with higher levels of working memory and recognition of Chinese words. The model of identification, response, and execution was useful for analyzing the IE tasks. Successful IE performances appeared to be determined by the match between the participants' abilities and the task demands. The findings shed light on the use of task-specific screening tests and on the design of ability-specific training programs that enhance the computer competency of people with ID.
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Affiliation(s)
- Alex W K Wong
- Applied Cognitive Neurosciences Laboratory, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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