Clinical Impairment Assessment Research Articles

An examination of the Clinical Impairment Assessment among women at high risk for eating disorder onset

Identifying measures that reliably and validly assess clinical impairment has important implications for eating disorder (ED) diagnosis and treatment. The current study examined the psychometric properties of the Clinical Impairment Assessment (CIA) in women at high risk for ED onset. Participants were 543 women (20.6 ± 2.0 years) who were classified into one of three ED categories: clinical ED, high risk for ED onset, and low risk control. Among high risk women, the CIA demonstrated high internal consistency (α = 0.93) and good convergent validity with disordered eating attitudes (rs = 0.27–0.68, ps < 0.001). Examination of the CIA's discriminant validity revealed that CIA global scores were highest among women with a clinical ED (17.7 ± 10.7) followed by high risk women (10.6 ± 8.5) and low risk controls (3.0 ± 3.3), respectively (p < 0.001). High risk women reporting behavioral indices of ED psychopathology (objective and/or subjective binge episodes, purging behaviors, driven exercise, and ED treatment history) had higher CIA global scores than those without such indices (ps < 0.05), suggesting good criterion validity. These data establish the first norms for the CIA in a United States sample. The CIA is psychometrically sound among high risk women, and heightened levels of impairment among these individuals as compared to low risk women verify the relevance of early intervention efforts.

P03-354 - Clinical assessment of cognitive impairment in schizophrenia through the schizophrenia cognition rating scale: A validation study in the italian population

Cognitive deficits are a core feature of schizophrenia and the need for a simple and reliable method for assessment of cognitive functions in schizophrenia is well recognized. The Schizophrenia Cognition Rating Scale (SCoRS) has proved to be a valid measure of neurocognitive performance and to correlate with the psychosocial functioning of schizophrenic patients. Aim of the present study was to investigate the correlations among global ratings of the Italian version of the SCoRS and measures of cognitive performance, symptoms severity and psychosocial functioning in schizophrenic subjects. We intended also to test the SCoRS sensitiviity to change over time, in relation also to changes of the above mentioned clinical, neurocognitive and outcome parameters. Forty-eight patients with schizophrenia (29 males, 19 female; mean age 39.1 years) were assessed at baseline and after three months of usual outpatient treatment according to the Italian community assertive treatment program, with the following instruments:1)SCoRS;2)comprehensive neuropsychological battery;3)the Positive And Negative Syndrome Scale and the Clinical Global Impression;4)the Global Assessment of Functioning, the Health of the Nation Outcome Scale, the Camberwell Assessment of Needs scale.At baseline, SCoRS global ratings significantly correlated with the composite scores of cognitive performance, with positive, negative and total PANSS scores and with all measures of psychosocial functioning. Conversely, SCoRS global ratings did not change significantly over the 3-month follow up and the changes from baseline did not significantly correlate with the changes of neurocognitive, clinical and functional assessments over the same time period.

Eating disorder examination questionnaire and clinical impairment assessment questionnaire: General population and clinical norms for young adult women in Sweden

Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18–30 years (N = 760) as well as from a clinical population aged 18–66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.

Evaluation of magnetic resonance imaging and radionuclide bone scan in early spondyloarthropathy

Introduction Spondyloarthropathy (SpA) comprises a small percentage of low backache (LBA) and presents with inflammatory pain. Sacroiliitis in SpAs forms the basis of diagnosis, and may take 7–8 years to become visible in plain radiographs. In order to achieve significant modification of the course of the disease it is imperative to make an early diagnosis, identify risk factors for aggressive disease and initiate the therapy right at outset. Magnetic resonance imaging (MRI) is a promising modality to pick up inflammation and structural damage early in the course of the disease. Objective To assess the role of MRI and radionuclide bone scan in patients with early SpA of less than 2 years. Methods Patients with inflammatory LBA, defined according to the Calin criteria and satisfying the European Spondyloarthropathy Study Group (ESSG) criteria for SpA of less than 2 years duration, were included. Controls had mechanical LBA. A detailed clinical assessment and assessment of disease activity and functional impairment was done with validated measures. Radiological assessment included conventional radiograph of the pelvis, radionuclide scan and MRI of sacroiliac joints (SI joints). The sensitivity, specificity and predictive value of each modality in contributing to the diagnosis of SpA were assessed. Results Assessment of 132 SI joints in 33 patients (Age 31 ± 6.14 years, M:F 24:9) and 33 controls (Age 31.8 ± 7.21 years, M:F 27:5) was done. The mean disease duration of cases was 10.7 (± 6.97) months. Conventional radiograph failed to pick up sacroiliitis in any of the cases. Positive bone scan was present in 27 patients (21 bilateral sacroiliitis, 6 unilateral sacroiliitis). Bone scan had a sensitivity of 81.8% and a specificity of 88%. MRI abnormality was present in 29 patients (50 joints, bilateral in 21 and unilateral in 8) and in none of the controls. This accounted for a sensitivity of 87.9% and a specificity of 100%. The MRI changes included bone marrow oedema (89%), synovial enhancement (55%), subchondral oedema (41%), erosions (51%) and sclerosis (28%). Both inflammatory and structural changes in MRI showed positive correlation with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ( P = 0.034, 0.02) and erythrocyte sedimentation rate (ESR) ( P = 0.02, 0.001). Conclusions In patients with early SpA of less than 2 years duration, conventional radiographs did not pick up sacroiliitis; however, both the radionuclide scan and MRI were useful.

Impairment-Based 3-D Robotic Intervention Improves Upper Extremity Work Area in Chronic Stroke: Targeting Abnormal Joint Torque Coupling With Progressive Shoulder Abduction Loading

The implementation of a robotic system (ACT(3D)) that allowed for a quantitative measurement of abnormal joint torque coupling in chronic stroke survivors and, most importantly, a quantitative means of initiating and progressing an impairment-based intervention, is described. Individuals with chronic moderate to severe stroke (n = 8) participated in this single-group pretest-posttest design study. Subjects were trained over eight weeks by progressively increasing the level of shoulder abduction loading experienced by the participant during reaching repetitions as performance improved. Reaching work area was evaluated pre- and postintervention for ten different shoulder abduction loading levels along with isometric single-joint strength and a qualitative clinical assessment of impairment. There was a significant effect of session (pre versus post) with an increase in reaching work area, despite no change in single-joint strength. This data suggests that specifically targeting the abnormal joint torque coupling impairment through progressive shoulder abduction loading is an effective strategy for improving reaching work area following hemiparetic stroke. Application of robotics, namely, the ACT(3D), allowed for quantitative control of the exercise parameters needed to directly target the synergistic coupling impairment. The targeted reduction of abnormal joint torque coupling is likely the key factor explaining the improvements in reaching range of motion achieved with this intervention.

Adaptation and evaluation of the Clinical Impairment Assessment to assess disordered eating related distress in an adolescent female ethnic Fijian population

Objective:Measurement of disease-related impairment and distress is central to diagnostic, therapeutic, and health policy considerations for eating disorders across diverse populations. This study evaluates psychometric properties of a translated and adapted version of the Clinical Impairment Assessment (CIA) in an ethnic Fijian population.Method:The adapted CIA was administered to ethnic Fijian adolescent schoolgirls (N = 215). We calculated Cronbach's α to assess the internal consistency, examined the association between indicators of eating disorder symptom severity and the CIA to assess construct and criterion validity, and compared the strength of relation between the CIA and measures of disordered eating versus with measures of generalized distress.Results:The Fijian version of the CIA is feasible to administer as an investigator-based interview. It has excellent internal consistency (α = 0.93). Both construct and criterion validity were supported by the data, and regression models indicated that the CIA predicts eating disorder severity, even when controlling for generalized distress and psychopathology.Discussion:The adapted CIA has excellent psychometric properties in this Fijian study population. Findings suggest that the CIA can be successfully adapted for use in a non-Western study population and that at least some associated distress and impairment transcends cultural differences. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord, 2010

Psychometric properties of the clinical impairment assessment: Norms for young adult women

This study aimed to investigate the initial psychometric properties and to establish norms for the Clinical Impairment Assessment (CIA v. 3.0) among a nonclinical sample of young adult women. The CIA is a brief, 16-item self-report measure designed to assess psychosocial impairment due to eating disorder features over the past 28 days. We administered the CIA and the Eating Disorder Examination-Questionnaire (EDE-Q v. 6.0) to 438 university women (mean age = 25 years). Participants' mean global CIA score was 6.4 (SD = 7.5; range 0-40). Acceptable levels of internal consistency (Cronbach's alpha = 0.94) and 1-week test-retest reliability were observed. Significant correlations were found between the CIA and the EDE-Q total and subscale scores (Spearman rhos = 0.58-0.79), indicating that greater levels of impairment were associated with higher levels of eating disorder psychopathology. Results demonstrated satisfactory psychometric properties of the CIA among a sample of young adult women, suggesting the utility of the CIA to measure impairment due to eating disorder features in nonclinical samples.

The measurement of impairment due to eating disorder psychopathology

Eating disorders have a profound and highly specific impact on psychosocial functioning. The aim of this research was to develop a measure of such secondary impairment. A 16-item, self-report instrument was developed, the Clinical Impairment Assessment (CIA), which was designed to measure such impairment overall and in three specific domains (personal, cognitive, social). The psychometric properties of the instrument were evaluated using data collected in the context of a transdiagnostic treatment trial. The findings consistently supported the utility of the instrument with the CIA being shown to have high levels of internal consistency, construct and discriminant validity, test–retest reliability, and sensitivity to change. The CIA should be of value to clinicians when assessing patients with eating disorders and their response to treatment. It should also help inform epidemiological research.

Foot control in incomplete SCI: distinction between paresis and dexterity

Objective: To complement the clinical assessment of motor impairment after incomplete spinal cord injury (iSCI) by introducing a test that reliably distinguishes between muscle weakness (paresis) and impairment of dexterity in a simple foot motor task.Methods: Auditory-paced ankle dorsi- and plantarflexion, in a supine position, was studied in 30 controls (to establish control values and to test reliability) and in 16 iSCI patients (test validation). The subjects were instructed to initiate dorsi- and plantarflexion as accurately in timing and with the largest range of motion (ROM) possible. For each frequency, accuracy of timing, ROM, peak velocity of dorsi- and plantarflexion and a time quotient for changing from dorsi- to plantarflexion and vice versa were determined. In iSCI subjects, these parameters were related to clinical measures of paresis, spasticity and proprioception.Results: The test parameters showed good to very good reliability. The iSCI subjects were able to follow the target frequency with high accuracy, while ROM and peak velocity for dorsi- and plantarflexion were significantly reduced. Furthermore, there was a strong correlation between ROM/peak velocities and motor scores within the iSCI patients.Discussion: Repetitive foot dorsi- and plantarflexion enables a distinction to be made between muscle weakness and reduced dexterity as the underlying cause of affected foot control. This distinction between and quantification of these two movement components complements the existing clinical examination, and in follow-up works, the recovery of these components may provide further insight into the mechanisms underlying motor function improvement after iSCI.

Changes in quality of life in people with Parkinson’s disease left untreated at diagnosis

Background:The issue of whether to adopt a “wait and watch” strategy or to initiate drug therapy soon after diagnosis in Parkinson’s disease (PD) has been the subject of some debate....

Sensorimotor Impairments and Reaching Performance in Subjects With Poststroke Hemiparesis During the First Few Months of Recovery

Little is known about the relationship between upper-extremity (UE) sensorimotor impairment and reaching performance during the first few months after stroke. The purpose of this study was to examine: (1) how measures of UE sensorimotor impairment are related to the speed, accuracy, and efficiency of reaching in subjects with hemiparesis during the subacute phase after stroke and (2) how impairments measured during the acute phase after stroke may predict the variance in reaching performance a few months later. Upper-extremity sensorimotor impairments and reaching performance were evaluated in 39 subjects with hemiparesis at 2 time points: during the acute phase (8.7+/-3.6 [X+/-SD] days) and the subacute phase (108.7+/-16.5 days) after stroke. Ten subjects who were healthy (control subjects) were evaluated once. Regression analyses were used to determine which impairments were the best predictors of variance in reaching performance in the subacute phase after stroke. Only a small amount of variance (<30%) in reaching performance was explained at the subacute time point, using either acute or subacute impairments as predictor variables. Of the impairments measured, UE strength deficits were the strongest, most consistent predictors of the variance in reaching performance during the first 3 months after stroke. Surprisingly, the detailed clinical assessment of UE sensorimotor impairment, measured at the acute or subacute phase after stroke, did not explain much of the variance in reaching performance during the subacute phase after stroke. The findings that UE strength deficits (ie, decreased active range of motion and isometric force production) were the most common predictors of the variance in reaching performance during the first 3 months after stroke are consistent with the current viewpoint that impaired volitional muscle activation, clinically apparent as UE weakness, is a prominent contributing factor to UE dysfunction after stroke.

Clinical Assessment of Hearing Impairment

Clinical Assessment of Hearing Impairment

Clinical Assessment of Hearing Impairment—Reply

Clinical Assessment of Hearing Impairment—Reply

Clinical Assessment of Hearing Impairment

Clinical Assessment of Hearing Impairment

Clinical assessment of pragmatic language impairment: A generalisability study of older people with Alzheimer's disease

Background: The Profile of Pragmatic Impairment in Communication (PPIC) is a clinical rating scale designed for the assessment of multiple facets of pragmatic language impairment in neuropsychiatric disorders. The PPIC has its origin in Grice's analysis of implicature and the Gricean principle of co‐operation and conversational maxims.Aims: We sought to evaluate the psychometric properties of the PPIC and to generate a profile of pragmatic language impairment associated with Alzheimer's disease (AD).Methods & Procedures: Speech samples were solicited from patients with AD (n = 13) and age‐matched healthy volunteers (n = 13) using several structured/semi‐structured tasks. Three trained raters made blind ratings on the PPIC on two occasions. Other raters evaluated mental status, aphasia, and communicative effectiveness. A generalisability analysis was conducted.Outcomes & Results: Good to excellent generalisability coefficients (0.86–0.94) were observed on most PPIC scales. PPIC ratings were strongly related to mental status and communicative effectiveness but not associated with aphasia. Diagnosis of AD made no substantive contribution to the prediction of PPIC ratings independently of mental status impairment.Conclusions: Results demonstrate evidence of good to excellent reliability, convergent validity, and discriminant validity of most PPIC scales. The observed associations are consistent with the view that pragmatic language impairment in AD is primarily a function of cognitive decline.

Oestrogen plus progestin doubles the risk of dementia in post-menopausal women

Shumaker S, Legault C, Rapp S et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the women’s health initiative memory study: a...

Assessing People with a Disability for Sport: The Profile System

Summary: The British Sports Association for the Disabled (BSAD) has used a multidisabled system of classification for 20 years. The number of sports in which disabled people take part has increased, so it has become necessary to use a system of classification which is sport-specific. This paper describes and illustrates the functional profile for each competitor which is estimated by a clinical assessment of impairment performed by a doctor or a physiotherapist. The illustrated and defined profiles are then grouped in a sport-specific standard way in consultation with the governing body of each sport. Research methods are used to evaluate the accuracy of the profiles, and to evaluate the competitors' interpretation of the compatibility of their opponents' functional ability. Collection of data from over 400 assessment cards has provided a baseline score for each profile, and comparability between assessors has been tested. Finally, evaluation of the teaching methods with questionnaires and interviews will assist in the production of a teaching module. Biography: Chris Meaden trained at Cardiff Royal Infirmary. She was assistant superintendent physiotherapist at The Prince of Wales Orthopaedic Hospital, Rhydlafar (1967–70). After a break in service for her family she has worked since 1976 part-time at St Mark's Hospital, Maidenhead, and part-time in private practice. Her interest in sport for people with disabilities started in 1968 when she was involved in sport for spinal injury patients at The Prince of Wales Hospital. In 1974 she was a founder member of Windsor and Maidenhead District Sports Association for the Disabled. She acted as team manager at regional and national multidisabled (BSAD) championships. She had been a member of the national medical/technical committee of BSAD since 1980 and was selected to act as team physiotherapist to the British Disabled Team at the 1984 International Games for the Disabled in New York. She is presently studying full-time for a Master or Doctor of Philosophy at the University of Surrey, sponsored by BSAD.

Clinical and electrophysiological assessment of neurological impairment in recently diagnosed lepromatous leprosy

Clinical and electrophysiological assessment of neurological impairment in recently diagnosed lepromatous leprosy

Clinical Assessment of Lumbar Impairment

Assessment of severity in low back injuries may be based on diagnosis, pain, disability, physical impairment, and capacity for work. It is important to distinguish between impairment and disability. Physical impairment is objective structural limitation; disability is the resulting loss of function. Disability can be assessed by the patient's report of restriction in activities of daily living: bending and lifting, sitting, standing, walking, traveling, socializing, sleep, sex, and putting on or taking off footwear. Detailed statistical analysis of 480 patients identified the most important elements of lumbar impairment as the anatomic and time patterns of pain, lumbar flexion, straight leg raising, neurologic signs, previous surgery, and spinal fractures. Methods of examination need to be improved. An anatomic chart is provided to calculate impairment in the individual patient. The patient's report of pain, disability, and capacity for work should then be compared with the physician's objective assessment of the injury, diagnosis, and lumbar impairment.

Clinical Assessment of Drug-Induced Impairment of Sexual Function in Men

Although there is an increasing awareness of the impor tance of induced sexual dysfunction in understanding noncompliance in hypertensive men, the fundamental nature of the dysfunctions produced, the ability to predict outcome before therapy, the selection of drugs, and the basal level of sexual function have not been thoroughly assessed in relation to psychosocial, neurologic, vascular, and endocrine parameters, particularly in men as they age. Treatment of hypertension with drugs into advanced age will be associated with a substantial incidence of impotence.