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Lee YC, Chen SS, Koh CL, Hsueh IP, Yao KP, Hsieh CL. Development of two Barthel Index-based Supplementary Scales for patients with stroke. PLoS One 2014; 9:e110494. [PMID: 25329051 PMCID: PMC4203801 DOI: 10.1371/journal.pone.0110494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Barthel Index (BI) assesses actual performance of activities of daily living (ADL). However, comprehensive assessment of ADL functions should include two other constructs: self-perceived difficulty and ability. OBJECTIVE The aims of this study were to develop two BI-based Supplementary Scales (BI-SS), namely, the Self-perceived Difficulty Scale and the Ability Scale, and to examine the construct validity of the BI-SS in patients with stroke. METHOD The BI-SS was first developed by consultation with experts and then tested on patients to confirm the clarity and feasibility of administration. A total of 306 participants participated in the construct validity study. Construct validity was investigated using Mokken scale analysis and analyzing associations between scales. The agreement between each pair of the scales' scores was further examined. RESULTS The Self-perceived Difficulty Scale consisted of 10 items, and the Ability Scale included 8 items (excluding both bladder and bowel control items). Items in each individual scale were unidimensional (H ≥ 0.5). The scores of the Self-perceived Difficulty and Ability Scales were highly correlated with those of the BI (rho = 0.78 and 0.90, respectively). The scores of the two BI-SS scales and BI were significantly different from each other (p<.001). These results indicate that both BI-SS scales assessed unique constructs. CONCLUSIONS The BI-SS had overall good construct validity in patients with stroke. The BI-SS can be used as supplementary scales for the BI to comprehensively assess patients' ADL functions in order to identify patients' difficulties in performing ADL tasks, plan intervention strategies, and assess outcomes.
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Affiliation(s)
- Ya-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sheng-Shiung Chen
- Department of Physical Medicine and Rehabilitation, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chia-Lin Koh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Zhongzheng District, Taipei, Taiwan
- * E-mail:
| | - Kai-Ping Yao
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Zhongzheng District, Taipei, Taiwan
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Nilsen DM, Gillen G, DiRusso T, Gordon AM. Effect of imagery perspective on occupational performance after stroke: a randomized controlled trial. Am J Occup Ther 2013; 66:320-9. [PMID: 22549597 DOI: 10.5014/ajot.2012.003475] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This preliminary study sought to determine whether the imagery perspective used during mental practice (MP) differentially influenced performance outcomes after stroke. METHOD Nineteen participants with unilateral subacute stroke (9 men and 10 women, ages 28-77) were randomly allocated to one of three groups. All groups received 30-min occupational therapy sessions 2×/wk for 6 wk. Experimental groups received MP training in functional tasks using either an internal or an external perspective; the control group received relaxation imagery training. Participants were pre- and posttested using the Fugl-Meyer Motor Assessment (FMA), the Jebsen-Taylor Test of Hand Function (JTTHF), and the Canadian Occupational Performance Measure (COPM). RESULTS At posttest, the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF (p < .05). All groups improved on the COPM (p < .05). CONCLUSION MP combined with occupational therapy improves upper-extremity recovery after stroke. MP does not appear to enhance self-perception of performance. This preliminary study suggests that imagery perspective may not be an important variable in MP interventions.
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Affiliation(s)
- Dawn M Nilsen
- Programs in Occupational Therapy, Columbia University, 710 West 168th Street, 8th Floor, New York, NY 10032, USA.
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Grano C, Aminoff D, Lucidi F, Violani C. Long-term disease-specific quality of life in adult anorectal malformation patients. J Pediatr Surg 2011; 46:691-698. [PMID: 21496539 DOI: 10.1016/j.jpedsurg.2010.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 10/11/2010] [Accepted: 10/17/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fecal and urinary incontinence may differently influence various aspects of quality of life (QOL). The main aim of the present study is to determine whether fecal and urinary incontinence measured at time 1 of the study will predict QOL at time 2 (after 4 years), above and beyond the prediction already explained by fecal and urinary incontinence at time 2. METHODS Thirty-six adult patients from the Italian Parents' and Patients' Association for Anorectal Malformations answered items about urinary and fecal incontinence at time 1 of the study and completed the Hirschsprung Disease/Anorectal Malformation Quality of Life questionnaire after 4 years from the first questionnaire. Two sets of hierarchical regression analyses were conducted with fecal and urinary incontinence serving as predictors of QOL and the different areas of QOL from the Hirschsprung Disease/Anorectal Malformation Quality of Life serving as outcome variables. RESULTS The principal findings indicated that fecal continence is a strong predictor of QOL in the areas of social functioning, emotional functioning, and body image and that urinary incontinence predicted sexual functioning. CONCLUSIONS It seems that one's past experience with fecal incontinence is extremely relevant to current QOL, especially for body image. Urinary incontinence contributed less in explaining QOL in our patients, but because it is very relevant for sexual functioning, it should not be disregarded.
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Affiliation(s)
- Caterina Grano
- Department of Psychology, University of Rome "La Sapienza," 00185 Rome, Italy.
| | - Dalia Aminoff
- Italian Parents and Patients Organization for Anorectal Malformation (AIMAR), 00199 Rome, Italy.
| | - Fabio Lucidi
- Department of Social and Development Psychology, University of Rome "La Sapienza," 00185 Rome, Italy.
| | - Cristiano Violani
- Department of Psychology, University of Rome "La Sapienza," 00185 Rome, Italy.
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Dean E. Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother Theory Pract 2010; 25:330-53. [PMID: 19842862 DOI: 10.1080/09593980802668027] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Part I of this two-part introduction to this Special Issue on the practice of physical therapy in the 21st century outlines the epidemiological basis and rationale for evidence-informed physical therapy practice for addressing contemporary health priorities. This evidence emanates from the definition of health by the World Health Organization (WHO) and the International Classification of Functioning (ICF), and WHO and other international databases on the prevalence of lifestyle conditions. Lifestyle conditions include ischemic heart disease, smoking-related conditions, hypertension and stroke, obesity, diabetes, and cancer. Epidemiological data combined with evidence supporting the effectiveness of noninvasive interventions related to physical therapy to address these priorities (e.g., health education and exercise) are highly consistent with the promotion of health and wellness and the ICF. Given their commitment to exploiting effective noninvasive interventions, physical therapists are in a preeminent position to focus on prevention of these disabling and lethal conditions in every client or patient, their cure in some cases, as well as their management. Thus, a compelling argument can be made that clinical competencies in 21st century physical therapy need to include assessment of smoking and smoking cessation (or at least its initiation), basic nutritional assessment and counseling, recommendations for physical activity and exercise, stress assessment and basic stress reduction recommendations, and sleep assessment and basic sleep hygiene recommendations. The physical therapist can then make an informed clinical judgment regarding whether a client or patient needs to be referred to another professional related to one or more of these specialty areas. The prominence of physical therapy as an established health care profession and its unique pattern of practice (prolonged visits over prolonged periods of time) attest further to the fact that physical therapists are uniquely qualified to lead in the assault on lifestyle conditions. Evidence-based physical therapy practiced within the context of epidemiological indicators (i.e., evidence-informed practice) maximally empowers clinicians to promote lifelong health in every person and in turn, the health of communities. This vision of physical therapy's leading role in health promotion and health care in the 21st century holds the promise of reducing the need for invasive health interventions (drugs and surgery). Part II of this introduction describes evidence-based physical therapy practice within this context of evidence-informed practice.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Röding J, Glader EL, Malm J, Eriksson M, Lindström B. Perceived impaired physical and cognitive functions after stroke in men and women between 18 and 55 years of age – a national survey. Disabil Rehabil 2009; 31:1092-9. [DOI: 10.1080/09638280802510965] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Caty GD, Theunissen E, Lejeune TM. Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke. Arch Phys Med Rehabil 2009; 90:1061-3. [PMID: 19480885 DOI: 10.1016/j.apmr.2008.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 12/11/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS Adult stroke patients (N=28; 59+/-13y). The time since stroke ranged from 3 to 253 weeks. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The ABILOCO questionnaire. RESULTS The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively). CONCLUSIONS The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research.
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Affiliation(s)
- Gilles D Caty
- Physical Medicine and Rehabilitation Department, Université catholique de Louvain, Brussels, Belgium
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Abstract
Despite a widespread myth of parental autonomy in decision-making for extremely preterm neonates, families in the United States are often not given access to accurate information about the consequences of preterm birth, resuscitation and treatment, or about their ethical options. Professional, philosophical, and financial incentives for hospitals and neonatologists to provide intensive treatment may trump parental wishes in delivery rooms and neonatal units. Parents may also be intimidated by the atmosphere of intensive care and by the behavior of committed staff. Prenatal advance directives allow parents to receive information on outcomes, treatments, and options, including palliative care, 'on their own turf' and as a part of routine prenatal counseling. The use of directives and other techniques for transparency in obstetric and neonatal care could improve the process of informed parental choice.
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Vandervelde L, Dispa D, Van den Bergh PY, Thonnard JL. A Comparison Between Self-Reported and Observed Activity Limitations in Adults With Neuromuscular Disorders. Arch Phys Med Rehabil 2008; 89:1720-3. [DOI: 10.1016/j.apmr.2008.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 01/15/2008] [Accepted: 01/15/2008] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE Interpretation of patient scores on functional tests is enhanced by an understanding of test performance in reference groups. The purpose of this study was to expand performance values, by age and gender, on balance tests [the Multi-Directional Reach (MDRT); Berg Balance (BBS); Sharpened Romberg, eyes open (SREO), eyes closed (SREC); Activities-Specific Balance Confidence (ABC)], and a general mobility test [Physical Performance Test, (PPT-7, PPT-9)]. The study also examined relationships between test performance and subject characteristics. DESIGN AND SUBJECTS Eighty-three community-dwelling adults over 50 participated in the study and completed the 5 functional tests during one test session. Means, standard deviations, and confidence intervals were calculated for each of the tests. Multiple linear regression analysis was used to examine relationships between test scores and age, gender, height, and weight. RESULTS Test performance is reported by gender,within 10-year age cohorts. Regression analysis showed that age contributed significantly to prediction of performance on all of the tests and gender contributed significantly to prediction of scores on the Berg, SREO, and SREC. CONCLUSIONS Test performance values, in a sample of community-dwelling adults, is provided by age and gender cohorts to provide additional reference data that can be used by clinicians for comparison with client data. The small sample size for subjects over 80 years limits the reference value of data for this age group. In regression analyses, age and gender help predict outcomes on the dependent variables used in the study.
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Affiliation(s)
- T M Steffen
- Concordia University Wisconsin, 12800 N Lake Shore Dr., Mequon, WI, USA.
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Shulman LM, Pretzer-Aboff I, Anderson KE, Stevenson R, Vaughan CG, Gruber-Baldini AL, Reich SG, Weiner WJ. Subjective report versus objective measurement of activities of daily living in Parkinson's disease. Mov Disord 2006; 21:794-9. [PMID: 16482533 DOI: 10.1002/mds.20803] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We compared subjective self-reports with objective performance ratings of activities of daily living (ADLs) and instrumental ADLs (IADLs) in patients with Parkinson's disease (PD) and identified variables associated with discordance of ratings between these two methods. Seventy-six PD patients completed a modified Older Americans Resources and Services scale, assessing ADLs and IADLs. These results were compared with structured performance tests of walking, eating, dressing, money, and medicine management administered in the clinic. Patient performance was rated on a five-point Likert-type scale, ranging from 1 = no difficulty to 5 = completely unable to perform task. Significant differences were found between patients and clinicians' ratings on all tasks except walking. On the other four tasks, paired group t tests showed that patients reported better function compared with the clinician rating of medication management (1.33 vs. 2.80), eating (1.53 vs. 1.76), dressing (1.64 vs. 1.86), and managing money (1.44 vs. 2.06). A discrepancy was found between patients subjective reporting of ADL and IADL function and objective ratings. Patients overestimated their function on four of five tasks. Further study is necessary to identify whether subjective or objective performance ratings are more reflective of actual daily function.
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Affiliation(s)
- Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Abstract
BACKGROUND AND PURPOSE Evidence for ethnic disparities in stroke incidence, severity, and mortality has continued to mount in recent years. However, the picture for disparities in acute management and rehabilitation remains more ambiguous. The objective of this report is to summarize current evidence from stroke epidemiology and studies focusing on disparities in stroke care and disability, suggesting courses for action. METHODS A comprehensive search of current literature on ethnic/racial variation in stroke incidence, mortality, and severity, as well as acute and postacute patient care was performed. RESULTS Recent evidence unambiguously reaffirms a greater burden of disease in stroke, greater mortality, and greater severity of strokes for blacks. Evidence for disparities in acute and postacute care is less conclusive, as is the evidence for disparities among other ethnic groups. Evidence for health disparities in stroke care across settings, regions, and the continuum of care varies considerably. CONCLUSIONS Minority ethnic groups have higher rates or more severe stroke, but variations in prognosis for clinical outcomes other than mortality remain less certain. There is considerable need for more studies that take into account regional ethnic variations in treatment and outcomes, and for better documentation of stroke outcomes among groups in addition to blacks. Dealing with ethnic disparities in stroke will be served by sustained attention to quality improvement in high-impact areas in stroke care, complemented by initiatives that promote cultural competence.
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Affiliation(s)
- James P Stansbury
- Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, Fla, USA.
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Knight EL, Ofsthun N, Teng M, Lazarus JM, Curhan GC. The association between mental health, physical function, and hemodialysis mortality. Kidney Int 2003; 63:1843-51. [PMID: 12675862 DOI: 10.1046/j.1523-1755.2003.00931.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mortality rates for individuals on chronic hemodialysis remain very high; therefore, strategies are needed to identify individuals at greatest risk for mortality so preventive strategies can be implemented. One such approach is to stratify individuals by self-reported mental health and physical function. Examining these parameters at baseline, and over time, may help identify individuals at greater risk for mortality. METHODS We enrolled 14,815 individuals with end-stage renal disease (ESRD) and followed these individuals for up to 2 years. The mean age was 61.0 +/- 15.4 years (range, 20 to 96 years) and 31% were African Americans. The SF-36 Health Survey was administered 1 to 3 months after hemodialysis initiation and 6 months later. We examined the associations between the initial SF-36 Health Survey mental component summary (MCS) and physical component summary (PCS) scores and mortality during the follow-up period, and examined the associations between 6-month decline in PCS and MCS scores and subsequent mortality. We also examined the interactions between age and MCS and PCS scores. The general population-based mean of each of these scores was 50 with a standard deviation of 10. The main outcome measurement was death. RESULTS Self-reported baseline mental health (MCS score) and physical function (PCS score) were both independently associated with increased mortality, and 6-month decline in these parameters was also associated with increased mortality. The multivariate hazard ratios for 1-year mortality for MCS scores of less than 30, 30 to 39, and 40 to 49 were 1.48 (95% CI, 1.32 to 1.64), 1.23 (95% CI, 1.14 to 1.32) and 1.18 (95% CI, 1.10 to 1.26) compared with a MCS score of 50 or more. The hazard ratios for PCS scores of less than 20, 20 to 29, and 30 to 39 were 1.97 (95% CI, 1.64 to 2.36), 1.62 (95% CI, 1.36 to 1.92), and 1.32 (95% CI, 1.11 to 1.57) compared with a PCS score of 50 or more. Six-month decline in self-reported mental health (hazard ratio, 1.07; 95% CI, 1.02 to 1.12, per 10-point decline in MCS score) and physical function (hazard ratio, 1.25; 95% CI, 1.18 to 1.33, per 10-point decline in PCS score) were also both significantly associated with an additional increase in mortality beyond baseline risk. We also found a significant interaction between age and physical function (P = 0.02). Specifically, there was a graded response between the PCS score category and mortality in most age strata, but this relationship was not observed in the oldest age (85 years old or older). CONCLUSION In individuals newly initiated on chronic hemodialysis, self-reported baseline mental health and physical function are important, independent predictors of mortality, and there is a graded relationship between these parameters and mortality risk. Following these parameters over time provides additional information on mortality risk. One must also consider age when interpreting the relationship between physical function and mortality.
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Affiliation(s)
- Eric L Knight
- Renal Unit, General Medicine Unit, Harvard Medical School, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02115, USA.
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