Changes In Functional Ability Research Articles

A prospective study of psychological predictors of lumbar surgery outcome.

Prospective design in which 102 patients were evaluated with a battery of psychological assessment tests 1-2 weeks before surgery, and outcome was assessed 6 months and 1 year after surgery. The study examined whether three aspects of psychological distress (depression, anxiety, and hostility) predict several surgical outcomes (employment status, subjective pain change ratings, and changes in functional abilities). Surgery for back pain has been shown to yield poor results in 15-45% of patients. Tools are needed to identify those "at risk" for poor outcome. Aspects of emotional distress, including anxiety, depression, and hostility, have been found to be relevant to various illness outcomes (e.g., cancer, heart disease), but their influence has not been prospectively evaluated for back pain surgical outcome. Study patients completed measures of distress before surgery, including the Spielberger Trait Anxiety Inventory, Zung Depression Scale, Modified Somatic Perception Questionnaire, and Cook-Medley Hostility Scale. At 1-year follow-up, patients completed pain change ratings, functional abilities measure (Dallas Pain Questionnaire), and questions about employment status. Multivariate regression analyses, controlling for significant demographic variables, found that failure to return to work was predicted by presurgical anxiety (P < 0.001) and depression (P < 0. 01); failure to report improvement in pain was predicted by presurgical somatic anxiety (P < 0.01) and depression (P < 0.058); and failure to report improved functional abilities was predicted by presurgical somatic anxiety (P < 0.01) and depression (P < 0.05). Hostility did not predict any outcome. Regression analyses found a strong predictor to be a combination of the Zung Depression Scale and Modified Somatic Perception Questionnaire, known as the Distress and Risk Assessment Method (DRAM). These results indicate that screening for presurgical distress is likely to identify those patients at risk for poor outcome. Studies to evaluate whether presurgical psychological treatment improves outcome are warranted.

Therapeutic options in dementia.

Dementia is the final common path of various pathogenetic mechanisms that may lead to a number of different clinical forms, with primary degenerative and vascular dementias accounting for more than 80% of cases. Dementia is a complex clinical condition that includes cognitive, personality, and behavioral changes. Therefore a therapeutic approach to dementia should be based from the beginning on a comprehensive intervention plan, both pharmacological and nonpharmacological. This should not be aimed at obtaining a complete (impossible) recover but at achieving the best day-to-day management of a chronic, progressive, disabling disease involving numerous domains and showing impairments with varying rates of progression. Deterioration in functional abilities of daily living has a major impact on the quality of life of those suffering from dementia, and this is a critical predictor for institutionalization. Increasingly necessary for optimizing intervention strategies are studies to: (a) measure changes in functional abilities over the course of dementia (namely Alzheimer's disease), (b) evaluate the relationship between functional abilities and cognition, and (c) quantify the effect of various therapeutic approaches on functional decline. Symptomatic drugs affecting cognitive abilities and psychoactive drugs for behavioral disturbances should be considered. For the cognitive domain positive results have been obtained with acetylcholinesterase inhibitors. Among the psychoactive drugs indicated for behavioral disorders, significant improvement in terms of both efficacy and tolerability can be expected from the use of new antipsychotic drugs.

The role of stress in functional disability among women with systemic lupus erythematosus: a prospective study.

In the last decade, the biopsychosocial approach has been applied to systemic lupus erythematosus (SLE) to understand the multiple factors involved in the disease course. This study examined the link between stress and changes in functional disability as assessed by the Stanford Health Assessment Questionnaire (HAQ) in women with SLE. Forty-two women with SLE were assessed at baseline and 8 months later. Major stress (Life Events), minor stressors (Hassles), depression (Beck Depression Inventory), disease activity (Systemic Lupus Activity Measure), and functional disability were collected at both time points, while demographic and disease damage variables (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) were collected once at baseline. Mean HAQ scores at baseline (0.52) and followup (0.46) indicated mild disability and remained fairly stable, although individual variation was observed (mean change -0.07; range -1.25-0.5). Demographic (age, education) and disease (duration, activity, damage) variables were not related to 8-month changes on the HAQ. Of the baseline stress measures, greater negative life events in the preceding 6 months was correlated with reduced functional ability (r = 0.42) 8 months later. Individual changes in depressed mood over the 8-month period were correlated (r = 0.33) with changes in functional ability. Hierarchical multiple regression revealed that after controlling for baseline HAQ scores and changes in depressed mood, baseline negative life events remained a significant predictor of changes in functional ability. We found that the major short-term determinants of functional disability were not demographic- or disease-related factors, but rather stress caused by negative life events. Comprehensive treatment of SLE requires management of life stress.

Functional motor abilities of children with cerebral palsy: a systematic literature review of assessment measures.

To provide an overview of functional assessment measures for children with cerebral palsy, supporting the selection of measures and the interpretation of results from measures. Instruments were selected on the basis of a literature search of the Medline, Sportdisk and PsychLIT databases. ISSUES REVIEWED: Instruments were reviewed with respect to target group, purpose, nature, type and psychometric properties. In the literature 17 instruments that are used in paediatric rehabilitation and paediatric physical therapy to assess the functional motor abilities of children with cerebral palsy were found. While there is an urgent need for measures that can evaluate change in functional abilities, it was found that most measures are developed and validated for discriminative purposes. Although instruments developed within the last decade meet psychometric criteria more adequately than those developed previously, it is concluded that only two evaluative assessment measures, the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI), fulfil the criteria of reliability and validity with respect to responsiveness to change.

Assessing Functional Ability in Patients with Unilateral Trans-tibial Amputation for Vascular Disease

In this study we describe and compare the functional ability of unilateral trans-tibial dysvascular amputees by two different methods: the Swedish version of the Katz Index of Activities of Daily Living (Katz Index of ADL) and the Functional Rating Scale for Amputees (FRSA-scale). Fifty patients newly amputated for vascular disease and living either in their own homes or in sheltered housing (24 women and 26 men; mean age 79 years, SD 7, range 61–92 years) were assessed at discharge from hospital and at six months after the amputation. The results revealed that the majority of the patients were dependent on another person on both occasions. In conclusion, to assess functional ability in patients newly amputated for vascular disease in the ward, the Katz Index of ADL appears to be an appropriate instrument. However, the FRSA-scale seems to be more appropriate for monitoring and documenting changes in functional ability with a prosthesis later on in the rehabilitation period. Further evaluation studies are required for the FRSA-scale before it can be recommended for wider use.

Activities of daily living: changes in functional ability in three samples of elderly and very elderly people.

to investigate changes in functional ability and physical health, psychiatric morbidity, life satisfaction, service use and social support. a structured interview survey of three samples of elderly people living at home at two points in time. The three samples comprised one census of people aged 85 and over [City (of London) and Hackney], and two random samples of people aged 65-84 (City and Hackney and Braintree). The follow-up interviews took place 2.5-3 years after the baseline interviews. City and Hackney (East London) and Braintree (Essex). Respondents were interviewed at home by one of 12 trained interviewers. 630 people aged 85+ at baseline (70% response rate) and 78% of survivors re-interviewed at follow-up; 464 people aged 65-84 in Hackney at baseline (67% response rate), and 83% of survivors re-interviewed; 276 people aged 65-84 in Braintree at baseline (82% response rate), and 78% of survivors re-interviewed. scores on scales of functional ability, psychiatric morbidity, life satisfaction and social support, and items measuring number and type of health symptoms and services used. decreasing levels of physical functioning were associated with poor mental health, trouble with feet and problems with muscles and joints. There were no associations with level of physical functioning and use of rehabilitative or general medical services, use of social worker or carer relief. Few respondents used preventive or rehabilitation services.

An Inventory to Assess Activities of Daily Living for Clinical Trials in Alzheimerʼs Disease

We developed a set of informant-based items describing performance of activities of daily living (ADL) by patients with Alzheimer's disease (AD) to identify which ADL are useful for assessment of patients in clinical trials. Evaluation of ADL is an important outcome measure in AD clinical trials. For clinical trial measurement, ADL should have broad applicability, good test-retest reliability, scaling to cover a range of performance, and sensitive to detect change in disease progression. A total of 45 ADL items developed from literature review and clinical experience were administered to informants of 242 AD patients and 64 elderly controls as part of the multicenter Alzheimer's Disease Cooperative Study Instrument protocol. Half of the subjects were re-evaluated at 1 and 2 months and all at 6 and 12 months. Controls performed virtually all ADL items optimally at baseline and at 12 months. Among subjects with AD, 27 of the 45 ADL were widely applicable, i.e., performed at baseline or premorbidly by >90% of subjects; showed good test-retest reliability between baseline and 1 and 2 months; correlated with MMSE scores of AD patients cross-sectionally; and showed a decline in performance from baseline to 12 months in at least 20% of AD patients. ADL could be identified that capture change in functional ability in patients across the entire range of the MMSE. The remaining 18 ADL included several that may be useful for trials that target specific populations, e.g., women with AD. Because change on specific items depends on baseline MMSE, ADL evaluation should include items relevant to the severity of dementia of patients enrolled in a clinical trial …

Inter-observer reliability of the Spondylitis Functional Index Instrument for assessing spondylarthropathies.

To study the Spondylitis Functional Index (SFI) by having two physical therapists observe patients with spondylitis perform various tasks listed on the instrument. The physical therapists' observations were compared with each other and with the self-reported abilities of the patients. Subjects (n = 30) were recruited from a cross-section of patients participating in a prospective randomized, multicenter, double-blind, parallel clinical trial of the efficacy of sulfasalazine on ankylosing spondylitis (n = 13), psoriatic arthritis (n = 13), and Reiter's syndrome (n = 4) conducted at the Veterans Affairs Medical Center in Salt Lake City. Percents of agreement and Cohen's kappa analysis were used to assess the reliability of the observations of the therapists and patients. The overall percent of agreement between the observers on the SFI was 93%. The overall percent of agreement between observer 1 and patients on the SFI was 66% and between observer 2 and patients was 67%. The overall inter-observer reliability measured by the Pearson coefficient was 0.91 and by Cohen's kappa was 0.86. Between observer 1 and the patients the Pearson was r = 0.53 and kappa = 0.39. For observer 2 the Pearson was r = 0.52 and kappa 0.39. We consider the agreement and reliability between observers to be high. The agreement and inter-observer reliability was poor between observers and patients. The SFI, as enhanced for use in this study to assess change in functional ability of patients with spondylitis, demonstrated high reliability when used by trained observers.

Changes in functional abilities of the microbial community during composting of manure

The objective of this study was (a) to detect changes of the functional abilities of the microflora during composting of manure as a result of windrow turning frequency and (b) to detect differences between distinct zones within the windrows. Biolog GN microtiter plates containing 95 different carbon sources were inoculated with diluted suspensions of compost material containing 15,000 microorganisms per well (120 μl). We found a dramatic shift in functional microbial community structure during the 8-week composting process. The shift was more rapid when the compost windrows were turned. The substrate use pattern in the outer, well-aerated zone of the unturned windrow was similar to that of the turned windrows. Microbial biomass and respiration decreased more rapidly in the turned than in the unturned windrows, indicating a different pace of compost maturation. The data suggest that the Biolog assay may be a suitable approach to determine compost maturity.

Self-Ratings of Health: Do they also Predict change in Functional Ability?

Self-ratings of health by individuals responding to surveys have shown themselves to be potent predictors of mortality in a growing number of studies; they appear to contribute significant additional independent information to health status indicators gathered through self-reported health histories or medical examinations. A key question raised by these studies is: What are the mediating processes involved in the association? Specifically, do poor self-ratings increase the risk of disability and morbidity, and are these outcomes intervening steps in the link to mortality? In this report we address the first question, of self-ratings predicting future levels of functional disability, our choice of an index of overall impact of morbidity. Data come from the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) site (N = 2,812). Results show that self-ratings of health in 1982, net of baseline functional ability, health and sociodemographic status, are associated with changes in functional ability over periods of one through six years. These findings extend our understanding of the meaning of excellent, good, fair, and poor ratings of health, and that they have implications not just for survival but for the loss or maintenance of functional ability in daily life.

Changes in functional ability from ages 70 to 75. A Danish longitudinal study.

The purpose of this article is (a) to describe changes in functional ability from the age of 70 to 75 years, (b) to examine whether a new functional ability measure is a good predictor of dependency, and (c) to examine whether sociodemographic factors are associated with transitions. The investigation is part of the longitudinal study of the 1914 population in Glostrup, Denmark, and comprised 576 men and women who were interviewed in their homes about functional ability, social situation, and so forth when they were 70 and 75 years old. Tiredness in mobility and daily activities measured by two functional ability scales at age 70 were independent predictors of need for help in mobility and daily activities at age 75. Among the sociodemographic variables, education among women and income among men were found to be independent predictors of dependency at age 75.

Associations with Changes in Level of Functional Ability. Results from a Follow-up Survey at Two and a Half Years of People Aged 85 Years and Over at Baseline Interview

ABSTRACTThis paper describes association with changes in functional ability among very elderly people who were interviewed first in 1987 when they were aged 85+, and followed-up in 1990. It focuses, in particular, on those with severe difficulties with ADL. It was notable that while those with chronic problems with disability used more health and social services, few received services specific to rehabilitation and social support (e.g. physiotherapy, occupational therapy and social work), and substantial numbers in this group (30–45%) did not receive any chiropody services; although the provision of instrumental aid with tasks of daily living was relatively high from home help services, and, in particular, from relatives.

Cerumen-impaction management for clients of all ages.

A cerumen plug in the external auditory canal can cause dizziness, pain, itching, ringing or decreased hearing. These symptoms are particularly distressing to elderly clients who may already have compromised hearing or be experiencing changes in functional ability. A cerumen plug that causes hearing impairments can retard children's educational and psychosocial development. This article focuses on the physiology of cerumen, the risk factors of cerumen plugs and the best way to remove cerumen in clients of all ages. The contraindications and complications of aural lavaging and instrument removal of cerumen are discussed. An ear-irrigation flow sheet is also included for ambulatory clinical use.

Pain and Analgesia: Considerations for the Elderly in Critical Care

A large percentage of patients in critical care are older than 65 years old. Pain is a problem common to the elderly receiving critical care. Effective management of pain is accomplished through collaboration between nursing and medicine. Understanding physiologic changes experienced with aging and anticipated changes in functional abilities is necessary to the development of a pain-management plan and to providing comprehensive nursing care. Pharmacologic analgesia will be a part of the pain-management plan, with consideration given to the effects on the elderly.

Measurement and Treatment in Cerebral Palsy: An Argument for a New Approach

This article describes the need for a shift in our therapeutic strategies for patients with cerebral palsy. Changes in functional abilities must be stressed in therapy. Coincident with this emphasis must be the development of functional assessments to be used when documenting intervention outcomes. Research on functional arm movement using kinematic analysis is described for this patient group.

Families U.S.A. (United for Senior Action) Foundation.

Families U.S.A. (United for Senior Action) Foundation.

Detecting changes in functional ability in women with premenstrual syndrome

There has been a lack of objective assessment of the disruptive effect that the symptomatology of premenstrual syndrome has on the functional performance of affected women. This study assessed the functional performance of women with premenstrual syndrome at four phases of the menstrual cycle. Twelve women with premenstrual syndrome and nine asymptomatic women were tested on four functional instruments at the menstrual, early follicular, early luteal, and late luteal phases. Two tests of a paper-and-pencil type measured perceptual parameters, and two tests involving manipulation of objects measured manual dexterity. Mean performance on the Crawford Small Parts Dexterity Test—Part II, which tests fine motor function, was better at the late luteal testing, compared to the early follicular testing, in asymptomatic women but was worse in the women with premenstrual syndrome. This difference was statistically significant (p = 0.015). No significant differences between groups in performance changes were observed for the other functional tests. The Crawford Small Parts Dexterity Test—Part II is an objective measure that is potentially valuable in therapeutic trials involving patients with premenstrual syndrome.

Clinical judgment in rheumatoid arthritis. III. British rheumatologists' judgments of 'change in response to therapy'.

A realistic analysis of the criteria used by rheumatologists in evaluating the progress of patients suffering from rheumatoid arthritis must be based on actual clinical judgments rather than on expressed opinions. A randomly selected 15% sample of British rheumatologists (48) recorded judgements on the progress of 50 'paper' patients, based on data taken from actual patients participating in clinical trials. The rheumatologists differed markedly in their assessments of the progress of disease, with serious disagreements even when only 'clinically important' changes were considered. Some clinicians showed little consistency in their judgments of duplicate cases. Multiple regression analysis of the patient data in relation to the disease assessments provided a model of each clinician's judgment policy. These judgment policy models showed that the differences in clinical assessment were greater than could be explained by the inconsistent application of similar assessment policies, and were a consequence also of differences in the underlying judgment policies themselves. Judgments related more closely to changes in ESR and other process measures than to changes in functional ability.

Who Benefits from Adult Day Care: Changes in Functional Ability and Mental Functioning during Attendance

ABSTRACTThis paper examines changes in functional ability and mental functioning among participants (aged 50 and over) of Adult Day Care programs in Manitoba, Canada. It compares those who improve, remain stable, and deteriorate on each of these two dimensions in terms of their condition at time 1, a host of demographic factors, subjective and social factors, characteristics of their participation in the program, and diseases as coded from their medical claims records. In doing so it explores whether or not it is possible to identify who will benefit while in the program. The results provide only a potential answer to the question, but do suggest that the ADC program is performing an important social function which is related to improved functional ability, especially among those living alone and with fewer relatives. For mental health, the findings suggest the program works in conjunction with the existing marital relationship, benefiting most those still married. Research efforts are ongoing.

Defective immunoregulation in multiple sclerosis.

Imbalances in T cell subpopulations have been reported in multiple sclerosis (MS). In the present study of 31 MS patients, the percentage of T cells with Fc receptors for IgG (Tg) was found to be increased in patients with chronic progressive disease, and another T cell subset binding to the Raji B lymphoid cell line was decreased. An inverse correlation (r = -0.675; < 95% confidence limit) was found between these two subsets, suggesting that they vary inversely in MS. The mitogenic responses of MS mononuclear cells, isolated T cells, and recombinet T and non-T cells to the lectins phytohemagglutinin and pokeweek mitogen (PWM) did not differ from those of normal cells. However, more immunoglobulin (Ig)-producing cells were generated in a PWM-driven system with cells from MS patients than with cells from age-matched controls (p < 0.05). Autologous recombination of separated T and non-T cells did not significantly modify these results. T cells from MS patients added to B cells from normal controls exerted an effect that was related to their percentage of Tg cells; that is, values above 15% were associated with a suppression of Ig production, whereas for Tg values below 12%, a helper effect or no modification was observed. These results suggest that changes in T cell subsets in MS are related to changes in functional ability to modulate Ig production by normal B cells. However, MS B cells partly escape regulation by their own T cells, suggesting an associated B cell hyperactivity.