Assessing Activity Limitations Research Articles

Translation and internal content validation of the Swedish version of the Brachial Assessment Tool (BrAT).

To translate and culturally adapt the Brachial Assessment Tool (BrAT) into Swedish and evaluate the internal consistency, and internal content validity using Rasch analysis in patients with traumatic brachial plexus injuries (TBPI). The translation was made in accordance with international guidelines. TBPI patients were identified in clinical records. The BrAT-Swe was sent out to patients by post. Internal consistency was assessed using Cronbach alpha and content validity using Rasch analysis evaluating fit to the Rasch model, threshold response, local dependency, dimensionality, differential item functioning (DIF), and targeting. The translation of the BrAT was completed without major discrepancies. A total of 164 patients completed the BrAT-Swe. Internal consistency ranged from 0.90 to 0.98. Rasch analysis supported the content validity. All subscales demonstrated fit to the model with no local dependency, minimal disordered thresholds and no unidimensionality. Uniform DIF for item 6 by age, was identified. Minimal differences in hierarchical ordering were identified. This study presents a Swedish translation of the BrAT (BrAT-Swe) and has demonstrated that the translated BrAT-Swe is well adapted for Swedish circumstances. Analysis supports the internal content validity of the BrAT-Swe as a unidimensional targeted PROM designed to assess activity limitation after TBPI.

Danish translation, cultural adaptation and psychometric testing of the Brachial Assessment Tool (BrAT), designed to assess activity limitation in adults with traumatic brachial plexus injuries

Purpose To translate and cross-culturally adapt The Brachial Assessment Tool (BrAT) into Danish and assess its content validity and reproducibility in adults with traumatic brachial plexus injury (BPI). Material and methods Translation followed international guidelines. BrAT(DK) were cognitive tested with 19 adults with traumatic BPI to evaluate cross-cultural understanding, relevance, comprehensiveness and comprehensibility. Content validity and reproducibility were evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Participants were recruited from an outpatient hand clinic. Test-retest reliability was assessed using intra-class-correlation coefficient (ICC) and the smallest detectable change (SDC). Internal consistency was evaluated using Cronbach’s alpha. Results Minor cultural differences were observed in the content validity analysis of BrAT(DK). Cognitive testing revealing no significant issues. All participants found the items relevant and important. 63 participants with traumatic BPI were recruited; 49 completed the retest. ICC values for the sub-scales and the total score ranged from 0.91 to 0.95 (95% CI 0.85 to 0.97). Internal consistency ranged from 0.87 to 0.98. SDC ranged from 4.16 to 9.63 for subscales and 16.01 for the total score. Conclusion BrAT(DK) appeared to be content valid and reliabel as a measure of activity limitation in adults with traumatic BPI.

PCR20 Assessing Activity Limitations Caused by Rheumatoid Arthritis to Inform Appropriate Selection of Patient-Reported Outcomes Measures

PCR20 Assessing Activity Limitations Caused by Rheumatoid Arthritis to Inform Appropriate Selection of Patient-Reported Outcomes Measures

Reliability and construct validity of the ACTIVLIM-Hemo and Haemophilia Activities List (HAL) questionnaires in individuals with haemophilia.

The objective of this study is to assess the reliability and construct validity of ACTIVLIM-Hemo, a newly developed Rasch-built questionnaire designed to evaluate activity limitations in people with haemophilia (PwH), in comparison with the Haemophilia Activities List (HAL), which was developed using Classical Test Theory. A total of 130 participants with haemophilia A or B were included. They underwent various assessments, including joint health scoring (HJHS), functional tests (TUG and 2MWT) and completed questionnaires such as the BPI, IPAQ, HAL and ACTIVLIM-Hemo. Reliability indices and the minimum detectable change (MDC95) were determined for ACTIVLIM-Hemo and for HAL. Construct validity was evaluated through correlations and multiple linear regression, considering demographic and clinical factors. Both ACTIVLIM-Hemo (Person Separation Index=0.92) and HAL (Cronbach's α=0.98) demonstrated high reliability. The MDC95 for ACTIVLIM-Hemo represented 11.6% of its measurement range, while for HAL, it amounted to 18/100 score points. Activity limitations measured by both instruments were significantly correlated with demographic and clinical factors. Joint health (HJHS), pain severity (BPI) and walking performance (2MWT) emerged as the main predictors of activity limitations, explaining 75% of the variance in ACTIVLIM-Hemo and 60% in HAL. ACTIVLIM-Hemo stands as a reliable and valid instrument for assessing activity limitations in PwH. Both instruments exhibited significant correlations with demographic and clinical factors, but ACTIVLIM-Hemo displayed a more homogeneous construct. Given its linear scale and lower MDC95 and better targeting, ACTIVLIM-Hemo shows promise as a patient-centric instrument for assessing responsiveness to treatment during individual follow-up.

Myalgic Encephalomyelitis-Chronic Fatigue Syndrome Common Data Element item content analysis.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multisystem chronic disease estimated to affect 836,000-2.5 million individuals in the United States. Persons with ME/CFS have a substantial reduction in their ability to engage in pre-illness levels of activity. Multiple symptoms include profound fatigue, post-exertional malaise, unrefreshing sleep, cognitive impairment, orthostatic intolerance, pain, and other symptoms persisting for more than 6 months. Diagnosis is challenging due to fluctuating and complex symptoms. ME/CFS Common Data Elements (CDEs) were identified in the National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke (NINDS) Common Data Element Repository. This study reviewed ME/CFS CDEs item content. Inclusion criteria for CDEs (measures recommended for ME/CFS) analysis: 1) assesses symptoms; 2) developed for adults; 3) appropriate for patient reported outcome measure (PROM); 4) does not use visual or pictographic responses. Team members independently reviewed CDEs item content using the World Health Organization International Classification of Functioning, Disability and Health (ICF) framework to link meaningful concepts. 119 ME/CFS CDEs (measures) were reviewed and 38 met inclusion criteria, yielding 944 items linked to 1503 ICF meaningful concepts. Most concepts linked to ICF Body Functions component (b-codes; n = 1107, 73.65%) as follows: Fatiguability (n = 220, 14.64%), Energy Level (n = 166, 11.04%), Sleep Functions (n = 137, 9.12%), Emotional Functions (n = 131, 8.72%) and Pain (n = 120, 7.98%). Activities and Participation concepts (d codes) accounted for a smaller percentage of codes (n = 385, 25.62%). Most d codes were linked to the Mobility category (n = 69, 4.59%) and few items linked to Environmental Factors (e codes; n = 11, 0.73%). Relatively few items assess the impact of ME/CFS symptoms on Activities and Participation. Findings support development of ME/CFS-specific PROMs, including items that assess activity limitations and participation restrictions. Development of psychometrically-sound, symptom-based item banks administered as computerized adaptive tests can provide robust assessments to assist primary care providers in the diagnosis and care of patients with ME/CFS.

Comparison between two patient-reported outcome measures for patients with cervical radiculopathy: A think-aloud study

BackgroundThe Cervical Radiculopathy Impact Scale (CRIS) and Patient Specific Functional Scale 2.0 (PSFS 2.0) are patient-reported outcome measures (PROMs) used to assess activity limitations in patients with cervical radiculopathy (CR). This study a) compared the CRIS subscale 3 and the PSFS 2.0 in patients with CR with respect to completeness and patient preference, b) established the correlation between both PROMs in assessing the individual patient's level of functional limitations and c) assessed the frequency of reported functional limitations. MethodsParticipants with CR participated in semi-structured, individual, face-to-face interviews as part of a “think-aloud” process; verbalising their thoughts while completing both PROMs. Sessions were digitally recorded and transcribed verbatim for analysis. ResultsTwenty-two patients were recruited. The most frequently reported functional limitation on the CRIS was: ‘working at a computer’ (n = 17) and overhead activities' (n = 10) for the PSFS 2.0. There was significant moderate positive correlation between the scores on the PSFS 2.0 and the CRIS (Spearman's r = 0.55, n = 22 p = .008). Most patients (n = 18; 82%) preferred the ability to present their own individual functional limitations of the PSFS 2.0. Eleven participants (50%) preferred the 11-point scale of the PSFS 2.0 over the 5-point Likert scale scoring option of the CRIS. ConclusionBoth easy to complete PROMs capture functional limitations in patients with CR. Most patients prefer the PSFS 2.0 over the CRIS. The wording and layout of both PROMs need refinement to enhance user-friendliness and avoid misinterpretation.

The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies.

Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS). We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing. NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%-13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%-7.2%] and MCBS 5.3% [95% CI 4.7%-5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability. In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

ACTIVLIM-Hemo: A new self-reported, unidimensional and linear measure of activity limitations in persons with haemophilia.

To assess activity limitations in people with haemophilia (PwH), the self-reported Haemophilia Activity List (HAL) is widely employed, despite several methodological limitations impacting the interpretation of categorical scores. Modern psychometric approaches avoid these limitations by using a probabilistic model, such as the Rasch model. The ACTIVLIM is a Rasch-built measurement of activity limitations previously validated in several clinical conditions like neuromuscular disorders. This study sought to develop the ACTIVLIM-Hemo, meaning an ACTIVLIM scale version specifically adapted to assess daily activity limitations in adult PwH. Daily activities were assessed as "impossible," "difficult" or "easy" by 114 PwH (median age of 44 years) with 63 of them reassessed after 12 days. The Rasch Rating Scale model was used to identify activities delineating a unidimensional and linear scale unbiased by demographic and clinical status. Concurrent validity was determined through correlation with the HAL sub-scores and sum score. The ACTIVLIM-Hemo included 22 pertinent activities, with difficulties independent of demographic and clinical conditions, allowing a reliable measure of activity limitations (PSI=.92) expressed on a linear and unidimensional scale in PwH (7%-100 % range, ceiling effect of 1/114) with excellent test-retest reliability (ICC=.978). Spearman rank correlations between ACTIVLIM-Hemo and HAL sub-scores ranged between .623 and .869. The ACTIVLIM-Hemo is an easy-to-administer, valid and reliable alternative to HAL in assessing activity limitations in PwH. Its invariant scale can be used across conditions and time to compare the functional status of PwH over a wide measurement range.

Development of a holistic communication score (HoCoS) in patients treated for oral or oropharyngeal cancer: Preliminary validation.

In head and neck cancer, many tools exist to measure speech impairment, but few evaluate the impact on communication abilities. Some self-administered questionnaires are available to assess general activity limitations including communication. Others are not validated in oncology. These different tools result in scores that does not provide an accurate measure of the communication limitations perceived by the patients. To develop a holistic score measuring the functional impact of speech disorders on communication in patients treated for oral or oropharyngeal cancer, in two steps: its construction and its validation. Patients treated for oral/oropharyngeal cancer filled six self-questionnaires: two about communicative dynamics (ECVB and DIP), two assessing speech function (PHI and CHI) and two relating to quality of life (EORTC QLQ-C30 and EORTC QLQ-H&N35). A total of 174 items were initially collected. A dimensionality reduction methodology was then applied. Face validity analysis led to eliminate non-relevant items by surveying a panel of nine experts from communication-related disciplines (linguistics, medicine, speech pathology, computer science). Construct validity analysis led to eliminate redundant and insufficiently variable items. Finally, the holistic communication score was elaborated by principal component factor and validated using cross-validation and latent profile analysis. A total of 25 patients filled the questionnaires (median age = 67 years, EIQ = 12; 15 men, 10 women; oral cavity = 14, oropharynx = 10, two locations = 1). After face validity analysis, 44 items were retained (κ > 0.80). Four additional items were excluded because of a very high correlation (r > 0.90) with other items presenting a better dispersion. A total of 40 items were finally included in the factor analysis. A post-analysis score prediction was performed (mean = 100; SD = 10). A total of 24 items are finally retained for the construction of the holistic communication score (HoCoS): 19 items from questionnaires assessing communicative dynamics (13 from the ECVB and six from the DIP), four items from a perceived speech impairment questionnaire (PHI) and one from a quality-of-life questionnaire (EORTC QLQ-H&N35). The reliability is good (five-fold cross-validation: rs = 0.91) and the complementary latent profile analysis shows a good validity of the HoCoS, clustering subjects by level of communication performance. A global score allowing a measure of the impact of the speech disorder on communication was developed. It fills the lack of this type of score in head and neck oncology and allows the better understanding of the functional and psychosocial consequences of the pathology in the patients' follow-up. What is already known on the subject Because of their anatomical location, head and neck cancer degrades the speech abilities. Few tools currently allow the assessment of the impact of the speech disorder on communication abilities. In ENT oncology, self-administered questionnaires are available to assess activity limitations and participation restrictions (International Classification of Functioning (ICF)-WHO). Other tools from the field of neurology allow an evaluation of communication dynamics. But these different tools, constructed by items, give global additive or averaged scores. This implies an identical weighting of each item, resulting in global scores that are not very representative of the communication limitations really perceived by the patients. What this paper adds to existing knowledge A new global holistic score allowing a measurement of the impact of speech impairment on communication after treatment of oral or oropharyngeal cancer has been developed. The methodology of its construction allows a better reflection of the symptomatological, pragmatic and psychosocial elements leading to a degradation of communication abilities. What are the potential or actual clinical implications of this work? The developed HoCoS score fills the gap in the absence of this type of tool in head and neck oncology. It may allow a better understanding of the factors involved in the functional and psychosocial limitations of these patients, and better customize their follow-up.

Association between post-stroke psychological disorders, activity limitations and health-related quality of life in chronic stroke survivors in Benin

Purpose To evaluate the association between depression/anxiety and activity limitations and health-related quality of life (HRQoL) in chronic stroke survivors in Benin. Materials and methods One hundred and seventy-six chronic stroke survivors (113 males; mean age (±SD): 56.5 (±10.5) years old) were included. We used the Barthel index (BI) to assess activity limitations. Participants were screened for depression and anxiety symptoms using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). Euroqol-5 Dimensions-3 Levels (EQ-5D-3L) including a Visual Analog Scale (EQ-VAS) was used to assess HRQoL. Multivariate linear regressions were performed to determine the impact of psychological disorders on activity limitations and HRQoL. Results Depression (β=–0.54; p < 0.0001) and anxiety (β=–0.35; p < 0.0001) were negatively associated with activity limitations (R 2=0.60). Similar patterns of association were observed with HRQoL (β≤–0.28; p < 0.0001; R 2 ≥0.40). Inversely, occupational status showed positive association with EQ-5D-3L summary index scores (β = 0.21; p = 0.015). Conclusions Depression and anxiety had a negative impact on activity limitations and HRQoL in Beninese chronic stroke survivors. This call for action to integrate psychological interventions as part of rehabilitation programs in low and middle-income countries. Implications for rehabilitation Post-stroke depression and anxiety are quite common among stroke survivors in sub-Saharan Africa. Post-stroke depression and anxiety negatively impact activities and health-related quality of life in chronic stroke survivors in sub-Saharan Africa. Managing these post-stroke psychological disorders is necessary to promote the functional recovery and social reintegration of stroke survivors in their communities.

Assessment of Social Limitations in Children with Peanut Allergy Undergoing Peanut Oral Immunotherapy

We sought to describe responses to the Social Activities Limitations Inventory (SALI), a 20-item checklist to assess activity limitation due to food allergy, which has not previously been evaluated in children with food allergy pursuing oral immunotherapy (OIT).

Cross-cultural validity of the Animated Activity Questionnaire for patients with hip and knee osteoarthritis: a comparison between the Netherlands and Brazil

BackgroundThe Animated Activity Questionnaire (AAQ) was developed in the Netherlands to assess activity limitations in individuals with hip/knee osteoarthritis (HKOA). The AAQ is easy to implement and minimizes the disadvantages of questionnaires and performance-based tests by closely mimicking real-life situations. The AAQ has already been cross-culturally validated in six other countries. ObjectiveTo assess the cross-cultural validity, the construct validity, the reliability of the AAQ in a Brazilian sample of individuals with HKOA, and the influence of formal education on the construct validity of the AAQ. MethodsThe Brazilian sample (N = 200), mean age 64.4 years, completed the AAQ and the Western Ontario and McMaster Universities Index (WOMAC). A subgroup of participants performed physical function tests and completed the AAQ twice with a one-week interval. The Dutch sample (N = 279) was included to examine Differential Item Functioning (DIF) between the scores obtained in the Netherlands and Brazil. For this purpose, ordinal regression analyses were used to evaluate whether individuals with the same level of activity limitations from the two countries (the Dutch as the reference group) scored similarly in each AAQ item. To evaluate the construct validity, correlation coefficients were calculated between the AAQ, the WOMAC domains, and the performance-based tests. To evaluate reliability, the Cronbach's alpha coefficient, the intraclass correlation coefficient, and the standard error of measurement (SEM) were calculated. ResultsThe AAQ showed significant correlations with all the WOMAC domains and performance-based tests (rho=0.46–0.77). The AAQ showed high internal consistency (Cronbach's alpha=0.94), excellent test-retest reliability (ICC2,1 = 0.98), and small SEM (2.25). Comparing to the scores from the Netherlands, the AAQ showed DIF in two items, however, they did not impact on the total AAQ score (rho=0.99). ConclusionOverall, the AAQ showed adequate cross-cultural validity, construct validity, and reliability, which enables its use in Brazil and international/multicenter studies.

Transcultural adaptation and validation of the Spanish-language version of ACTIVLIM in adults with inherited myopathies using the Rasch model

IntroductionACTIVLIM is an instrument for the measurement of activity limitations in patients with neuromuscular disorders. The aim of this study is to establish a transcultural adaptation and psychometric validation of the Spanish-language version of ACTIVLIM in a sample of Spanish patients with inherited myopathies. Patients and methodA Spanish-language version of ACTIVLIM was developed using the translation/back translation method. The questionnaire was administered to 135 patients with inherited myopathies. The psychometric properties of the questionnaire were assessed using the Rasch model. Floor and ceiling effects were estimated. Unidimensionality was evaluated with a principal component analysis of the residuals of the model, and using infit and outfit statistics. We estimated reliability with the person separation reliability index and invariance with differential item functioning. External construct validity was tested through correlation with the Brooke scale, the Vignos scale, the Functional Independence Measure scale, and floor-to-stand time. Test–retest reliability was evaluated with the intraclass correlation coefficient and differential item functioning. ResultsThe psychometric analysis of the Spanish-language version of ACTIVLIM demonstrated that floor effect was absent, although a modest ceiling effect was identified. The instrument displayed unidimensionality, good internal consistency, external construct validity, and good test–retest reliability. ConclusionThe Spanish-language version of ACTIVLIM is a valid and reliable measurement instrument for assessing activity limitations in patients with inherited myopathies.

Cross-Cultural Adaptation and Validation of the Simplified Chinese Version of the Lower Extremity Functional Scale.

Purpose The purpose of this study was to cross-culturally adapt and validate the Simplified Chinese version of the Lower Extremity Functional Scale (SC-LEFS). Methods The original English version of the Lower Extremity Functional Scale was translated and cross-culturally adapted into Simplified Chinese according to international guidelines. The SC-LEFS and 36-Item Short-Form Health Survey were administered to 213 patients with lower extremity musculoskeletal disorders. Psychometric properties including internal consistency, test-retest reliability, content validity, and construct validity were tested. Results There were no floor or ceiling effects for the SC-LEFS. The scale had high values for internal consistency (Cronbach α = 0.97) and test-retest reliability (intraclass correlation coefficient = 0.97). Corrected item-total correlations for every item ranged from 0.67 to 0.89. And the item-level content validity index (I-CVI) for each item ranged from 0.78 to 1.00. Principal component analysis revealed a one-factor structure. Nine of ten prior hypotheses were confirmed, which further supports good construct validity within the SC-LEFS. Conclusion The SC-LEFS has high internal consistency, good test-retest reliability and content validity, convergent construct validity, and a one-factor structure. Thus, it could be regarded as a reliable and valid tool to assess activity limitations in Chinese patients with lower extremity musculoskeletal disorders.

An Observational Tool to Assess Activity Limitation in Ambulatory People with Cerebral Palsy When Performing Motor Skills.

Ratios of physical activity and sports participation in people with cerebral palsy (CP) are still low compared with people without a disability. For an adequate and useful practice, physical activity professionals should understand how different types of CP profiles constrain the performance of motor skills that are required during sports practice. This study aims to develop an observation-based assessment tool to evaluate activity limitations in individuals with a moderate level of CP when performing skills requiring jumping, sprinting, change of direction, coordination, and balance. Nineteen observers with different backgrounds from five world regions were recruited for this study, with accredited experience classifying/observing para-athletes with CP. All observers watched videos of 20 international para-athletes with different CP profiles (bilateral spasticity, athetosis/ataxia, unilateral spasticity; all Gross Motor Function Classification System level I) performing 16 motor tasks, and their observations were recorded throughout an ad-hoc data collection instrument. A total of 6080 units of qualitative information were recorded for data analysis. An observation-based tool with qualitative descriptors is derived from data analyses, describing how coordination and balance affected mainly in those with dyskinesia/ataxia, range of movement in those with diplegia, and asymmetries in those with hemiplegia. This tool would help sports practitioners and physical educators to better understand how different CP profiles constrain the performance of motor skills.

Turkish Adaptation of ACTIVLIM Questionnaire in Neuromuscular Diseases by Rasch Analysiz

Amaç: Bu çalışmanın amacı, Türkçe konuşan nöromüsküler hastalığı (NMH) olan bireylerde ACTIVLIM Ölçeği’nin Rasch analizi ile güvenirlik ve geçerliğini değerlendirmektir.Yöntem: Çalışmaya 169 NMH hastası dahil edildi. Günlük yaşam aktiviteleri ile ilgili bağımsızlık düzeyi Fonksiyonel Bağımsızlık Ölçeği, aktivite kısıtlaması ACTIVLIM Ölçeği kulanılarak değerlendirildi. Değerlendirmeler, çalışmanın başında ve 15 gün sonra olmak üzere iki kez yapıldı. İstatistiksel analiz Rasch yöntemi kullanılarak yapıldı.Sonuçlar: Çalışmaya, ortanca yaşı 10 olan 95 çocuk ve ortanca yaşı 34,5 olan 74 yetişkin dahil edildi. Yetmiş hasta (% 41,7) ikinci kez değerlendirildi. 22 maddeden ile başlanmış olup, bir maddeye (ACTIVLIM 5- Tuvalette oturma) ilişkin eşik değerleri, ölçek kategorileri ile uyumsuzluk gösterecek şekilde sıra takip etmedi. Test / tekrar test güvenirliğine göre, maddelerden hiçbiri madde işlev farklılığı göstermedi. Ölçeğin iç tutarlılığı yeterlidir (Cronbach’ın alfa 0,94). Ölçek, dış yapı geçerliliğini oluşturan FBÖ puanları ile beklenen korelasyonu göstermiştir (Pearson 0,95). Tartışma: ACTIVLIM, Türk NMH popülasyonunda aktivite kısıtlılıklarını değerlendirmek için kullanılabilecek güvenilir ve geçerli bir anket olarak bulunmuştur.

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

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

Cardiovascular disease is associated with activity limitations in osteoarthritis patients

Background: To investigate the associations between Cardiovascular Disease (CVD) and Cardiovascular (CV) risk factors with activity limitations in patients with knee or hip Osteoarthritis (OA). Methods and Findings: Consecutive patients were included from the Amsterdam Osteoarthritis cohort. A questionnaire assessed CVD and its risk factors and subsequently were confirmed by medical file review. The WOMAC-physical functioning subscale (PF), stair-climb tests and the Get Up and Go (GUG) were used to assess activity limitations. The associations of CVD and CV risk factors with activity limitations, adjusted for sex, age and disease severity were calculated using regression analyses. CVD was reported by 64 out of 447 patients (14%); 32 out of 148 men (22%) and 32 out of 299 women (11%). CV risk factors were reported in 9% (smoking) to 82 % (overweight) of the patients. CVD and the CV risk factors hypertension, hypercholesterolemia, diabetes mellitus and obesity were associated with a worse performance score on the GUG and stair-climb test. Women with CVD took 51% longer on the Get up and Go test (16.0 vs. 10.6 seconds). Both men and women with CVD performed significantly worse on the stair climb descent test (6.8 vs. 5.3 for men, and 11.3 vs. 7.1 for women). Conclusions: Patients with knee or hip OA show more activity limitations in association with CVD or CV risk factors. An intervention approach to improve daily functioning in the subgroup of patients with knee or hip osteoarthritis tailored to these patients’ CVD and CV risk factors is warranted.

Looking at hospitalized persons throughout the prism of the handicap

To describe the disability status of non-selected hospitalized persons. We conducted a cross-sectional survey to assess activity limitations of every persons older than 18 years old hospitalized in a regional university hospital covering all medical fields. Evaluators rated on a scale from 0 to 4, 22 selected items of the International Classification of Functioning, covering the 6 following domains: learning and applying knowledge, general tasks and demands, communication, mobility, self-care, interpersonal interactions and relationships. Univariate and multivariate analyses were performed to analyze the prevalence, severity and profile of the handicap in terms of sociodemographic characteristics and care pathways. Among 1572 eligible persons, 1267 (81%) were surveyed (mean age 62.7 ± 20.4 years; 655 male [51.7%]). Overall, 82% showed at least one activity limitation. For 52%, disability was severe or total for at least one ICF item. Prevalence of disabilities was higher for mobility (75%) and self-care domains (63%). Disability was strongly related to age: age older than 80 years versus 18 to 44 years (OR = 12.8; P < 0.01). Disability was associated with hospitalization in rehabilitation units (96%; OR = 4.3; P < 0.01). Severe disability was associated with hospitalization in critical care units (OR = 6.7; P < 0.001) and psychiatry units (OR = 5.3; P < 0.001). Handicap was common in hospitalized persons, involving all 6 tested ICF activity domains, particularly mobility and self-care. This study alerts care givers, hospital administrators, and in general people influencing health policies about the need to plan actions to reduce activity limitations of hospitalized persons, whatever the cause of the hospitalization.

Вплив ерготерапії на рівень самообслуговування дітей з церебральним паралічем

Purpose: form a block of ergotherapy for children with cerebral palsy, supplement it with a program of physical rehabilitation and determine its utility in increasing the level of self-service. Material & Methods: analysis and generalization of foreign and domestic special scientific and methodological literature; pediatric assessment of activity limitations (PEDI). The contingent of subjects – 106 children 4–6 years old, 54 of them with spastic hemiplegia and 52 with spastic diplegia. Methods of physical therapy were included in the exercises with control groups. The main groups received a part of the modified standard procedures, and the key difference was the use in the main groups of ergotherapy, namely targeted therapy . Results: purpose of ergotherapeutic interventions was to achieve the maximum possible activity of the child. Purposeful therapy required a priority analysis of the task, the environment of performance and the capabilities of the child. Procedures for targeted therapy were built from occupations that included a specific task algorithm. According to the final results, the main groups had significantly better results in a number of items in the self-service section of PEDI . Conclusions: use of targeted therapy in conjunction with physical therapy has advantages in improving self-service level, compared with the standard protocol of physical therapy.