Extended Activities Of Daily Living Scale Research Articles

Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke

Spasticity, a common impairment after stroke, has profound negative impact on outcomes in patients with stroke. Botulinum toxin type A (BoNT-A) injection combined with rehabilitation training is suggested for spasticity treatment. However, there is no recommendation about what kind of rehabilitation training is more appropriate than others following BoNT-A injection. The purpose of this study was to compare the effects of combining BoNT-A injection with bilateral robot-assisted (RT) or mirror (MT) or task-oriented (TT) therapy for upper extremity (UE) spasticity in patients with chronic stroke. Participants were randomly assigned to RT, or MT, or TT group after BoNT-A injection. The participants received 45 minutes of intervention per day, 3 days/week, for 8 weeks according the allocated results. In addition, all participants received 30 minutes of functional practice training. At pre-intervention, post-intervention and 3-month follow-up a blinded research assistant did outcome measures, including body function and structures by Fugl-Meyer Assessment (FMA), and Modified Ashworth Scale (MAS); activity and participation measures by Motor Activity Log (MAL), and Nottingham Extended Activities of Daily Living Scale (EADLS). Thirty-seven subjects met the inclusion criteria and underwent randomization, 13 were assigned to the RT; 12 to MT; and 12 to TT group. The 3 groups were well matched with regard to baseline characteristics and functional status. All groups had significant improvement in FMA, MAS and MAL post-intervention. There were no group differences in FMA, MAS, EADLs either post-intervention or at follow-up. There was a trend that TT group had higher quality of movement (QOM) in MAL post intervention than the other 2 groups ( P = 0.07), at follow-up TT group had significantly higher QOM in MAL than the other 2 groups ( P = 0.03). Combining BoNT-A injection with TT resulted in better quality of UE movement in patients with spastic stroke than with RT or MT.

Post-stroke depression and expressed emotion

Primary objectives: This study examined the role of expressed emotion (EE) in post-stroke depression (PSD) and the extent to which partner/spouse EE interacted with lesion laterality in PSD. The relationship between (i) lesion location and levels of PSD and (ii) levels of EE and levels of PSD were investigated. The role of perceived EE in PSD was also explored.Design: Cross-sectional, between-subjects design.Methods: Measures applied to stroke survivors included Extended Activities of Daily Living Scale (EADL), Post-Stroke Depression Rating Scale (PSDRS) and Level of Expressed Emotion Scale (LEE); spouses/partners completed the LEE.Results: The interaction between lesion laterality and levels of partner/spouse EE on PSD was not statistically significant (p = 0.63, F = 0.24, df = 1,56). However, a clear relationship was found between lesion laterality and PSD (p = 0.028). As levels of spouse/partner LEE scores increased, levels of PSD also increased (p = 0.039). Perceived EE scores illustrated a significant interaction between lesion laterality and levels of EE on PSD (p = 0.005, F = 8.591, df = 1,56).Conclusion: Whilst spouse/partner EE scores showed no interaction with lesion laterality to determine levels of PSD, a significant interaction was found when compared with stroke survivor perceived EE scores. Furthermore, left hemisphere (LHS) stroke survivors reported higher levels of depression than right hemisphere (RHS) stroke survivors. As levels of EE increased, PSD also increased, with LHS being greater than RHS.

Variation in Functional Independence among Stroke Survivors Having Fatigue and Depression

Objective. This study evaluated variation in functional independence in activities of daily living (ADL) and instrumental activities of daily living (IADL) among individuals with poststroke fatigue (PSF) and poststroke depression (PSD). Methods. A cross-sectional survey involved 65 consenting poststroke survivors who were purposively recruited from physiotherapy clinics of the University College Hospital, Ibadan, Adeoyo Maternity Teaching Hospital, Ibadan, and Federal Medical Center, Gusau. Participants were assessed for symptoms of PSD with short geriatric depression scale-15, PSF with fatigue severity scale, ADL with Barthel Index and IADL with Nottingham extended ADL scale. Data analysis was done using Chi-square and unpaired t-test with significance level being 0.05. Results. Participants' age ranged from 58 to 80 years. PSD alone (P = 0.002) and both PSF and PSD (P = 0.02) were significantly associated with ADL, while PSF alone was not (P = 0.233). PSD alone (P = 0.001) and both PSF and PSD (P = 0.001) significantly negatively affected IADL, while PSF alone had no significant effect (P = 0.2). Conclusions. Participants with PSD alone and those with both PSF and PSD had lower functional independence in ADL and IADL.

Responsiveness and validity of two outcome measures of instrumental activities of daily living in stroke survivors receiving rehabilitative therapies

Objective: To comprehensively investigate and compare the responsiveness and validity of two instrumental activities of daily living (ADL) measures: a modified version of the Nottingham Extended ADL Scale and the Frenchay Activities Index, after stroke rehabilitation. Setting: Rehabilitation clinics. Subjects: Seventy stroke patients received a three-week intervention (mean (SD) age, 55.5 (12.1) years; 46 (65.7%) men; mean (SD) time post stroke, 19.9 (12.5) months). Measures: Four outcome measures (modified Nottingham Extended ADL Scale, Frenchay Activities Index, Stroke Impact Scale and Motor Activity Log) were administered before and after treatment. We used the standardized response mean (SRM) to examine responsiveness and the Spearman correlation coefficient (ρ) to examine concurrent validity. Results: Responsiveness was significantly larger for the modified Nottingham Extended ADL Scale (SRM = 0.9) compared with the Frenchay Activities Index (SRM = 0.5). The correlations between the modified Nottingham Extended ADL Scale and Frenchay Activities Index were good to excellent before (ρ = 0.8) and after treatment (ρ = 0.8). The modified Nottingham Extended ADL Scale and Frenchay Activities Index showed fair correlations with the Stroke Impact Scale ADL/Instrumental ADL domain, Stroke Impact Scale total score and Motor Activity Log before treatment (ρ = 0.3—0.4). After treatment, the modified Nottingham Extended ADL Scale and Frenchay Activities Index demonstrated moderate to good correlations with the Stroke Impact Scale ADL/Instrumental ADL domain (ρ = 0.6) and fair correlations with the Stroke Impact Scale total score and Motor Activity Log (ρ = 0.2—0.5). Conclusions: The modified Nottingham Extended ADL Scale and Frenchay Activities Index are both valid outcome measures but the modified Nottingham Extended ADL Scale is more responsive than the Frenchay Activities Index. While simultaneously considering the properties of responsiveness and validity, the modified Nottingham Extended ADL Scale may be a relatively sound measure of instrumental ADL function in stroke patients receiving rehabilitation.

Depression, Anxiety, Activities of Daily Living, and Quality of Life Scores in Patients Undergoing Renal Replacement Therapies

The aim of this study was to investigate anxiety, depression, quality of life (QOL), and activities of daily living (ADL) among our hemodialysis and renal transplant subjects. Psychological disorders were prevalent among patients with end-stage renal disease (ESRD), adversely affecting QOL and ADL. All patients ≥18 years under renal replacement therapy were asked to participate in the study. Patients completed 4 questionnaires including the Symptom Checklist-90 subscales of depression and anxiety, the Nottingham Extended ADL scale, and the Duke Health Profile questionnaire. We examined a total of 100 transplant and 63 hemodialysis patients. Transplant patients were significantly younger, better educated, and with lower morbidity than the hemodialysis patients. Transplant patients also showed less depression and anxiety as well as better ADL and physical health. Of the variance in anxiety scores, 12.2% was explained by gender and the presence of cardiac disease ( P = .022). For depression, replacement therapy and gender explained 16.4% of the variance ( P = .004). Replacement therapy accounted for 35.3% of the variance of the ADL score ( P < .001), while together with the additional factors of age, gender, and education these 52.8% ( P = .007) was accounted for. For the general health score, gender, and cardiac disease explained 11.6% of the variance ( P < .001). This study demonstrated that depression and anxiety are more prevalent among hemodialysis patients compared with kidney transplant subjects; the method of treatment was a major contributor to the variance in ADL and depression scores among ESRD patients.

Factors relating to depression after stroke

Depression is common after stroke and can impede rehabilitation. The aim of this study was to determine which factors predicted the severity of depression at the time of recruitment to a treatment study and depression 6 months later. A questionnaire-based longitudinal study. A total of 123 depressed stroke patients who were between 1 and 6 months post-stroke and had mild to moderate disabilities were recruited to a randomized controlled trial of cognitive behavioural psychotherapy (CBT) to treat depression (Lincoln & Flannaghan, 2003). At recruitment and at 6 months follow-up, patients (N=112) were assessed on the Beck Depression Inventory (BDI), General Health Questionnaire-28 (GHQ-28), Wakefield Depression Inventory (WDI), Barthel index, Extended activities of daily living scale (EADL), Sheffield Screening Test for Acquired Language Disorders (SST) and Recovery locus of control scale (RLOC). Logistic regression showed that greater communication impairment on the SST at recruitment was predictive of severe depression on the BDI at recruitment (OR=0.72, p=.01). Patients with greater communication impairment (OR=0.69, p<.05) and a more external locus of control (OR=0.89, p<.05) at recruitment were more likely to remain depressed at follow-up. Patients who remained depressed at follow-up were more severely depressed at recruitment (p=.001). Locus of control and communication impairment were related to depression. Communication impairment was the strongest predictor of depression severity and prognosis. Mild depression was more likely to resolve. The regression models only accounted for a small proportion of the variance in depression scores. Therefore, further studies of psychosocial factors in a more representative sample are required.

Causes of elimination of hemodialysis patients from renal transplantation list in Iran

The aim of this study was to investigate anxiety, depression, quality of life (QOL), and activities of daily living (ADL) among our hemodialysis and renal transplant subjects. Psychological disorders were prevalent among patients with end-stage renal disease (ESRD), adversely affecting QOL and ADL. All patients ≥18 years under renal replacement therapy were asked to participate in the study. Patients completed 4 questionnaires including the Symptom Checklist-90 subscales of depression and anxiety, the Nottingham Extended ADL scale, and the Duke Health Profile questionnaire. We examined a total of 100 transplant and 63 hemodialysis patients. Transplant patients were significantly younger, better educated, and with lower morbidity than the hemodialysis patients. Transplant patients also showed less depression and anxiety as well as better ADL and physical health. Of the variance in anxiety scores, 12.2% was explained by gender and the presence of cardiac disease (P = .022). For depression, replacement therapy and gender explained 16.4% of the variance (P = .004). Replacement therapy accounted for 35.3% of the variance of the ADL score (P < .001), while together with the additional factors of age, gender, and education these 52.8% (P = .007) was accounted for. For the general health score, gender, and cardiac disease explained 11.6% of the variance (P < .001). This study demonstrated that depression and anxiety are more prevalent among hemodialysis patients compared with kidney transplant subjects; the method of treatment was a major contributor to the variance in ADL and depression scores among ESRD patients.

Caregiver strain in spouses of stroke patients.

To test the ability of a previously generated logistic regression model to predict caregiver strain from carer mood, negative affectivity and perceived patient functional ability. Postal prospective survey. Spouses of community-residing patients identified from hospital stroke registers. Spouses were assessed at three and six months after stroke. A previously derived equation was used to make predictions at three months of their level of strain at six months, which were compared with observed outcomes. Spouses were asked to complete the Caregiver Strain Index (CSI), the General Health Questionnaire (GHQ-12), the Positive and Negative Affectivity Schedule (PANAS) and to assess patients' independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Of 409 stroke patients, 276 had an identifiable co-resident spouse and 116 (42%) completed the measures. At three months after stroke, 39 carers (34%) were under significant strain with 40 (35%) under strain at six months. The predictive model using the GHQ-12, PANAS and EADL at three months was 78% accurate in predicting levels of caregiver strain at six months. Carers at risk of later strain could be identified for further follow-up. Services to provide emotional support to carers might be effective in the reduction of carer strain.

The reliability and validity of the Nottingham Extended Activities of Daily Living Scale in patients with multiple sclerosis.

To investigate whether the Nottingham Extended Activities of Daily Living Scale (EADL) is reliable and valid for the assessment of disability in patients with multiple sclerosis (MS). Questionnaire measures were administered on two occasions four months apart. A total of 240 patients recruited through a randomized controlled trial of cognitive assessment and treatment in MS. The Nottingham EADL, Guys Neurological Disability Scale (GNDS) and SF-36 quality of life scale. The EADL items did not form a Guttman Scale (CR 0.8, CS 0.3). The EADL and its four subscales all had high internal consistency (alpha 0.72-0.94). Test-retest reliability was satisfactory (r(s) 0.81-0.90) with a mean difference in scores on the two occasions of 0.29. Factor analysis generally supported the subscale structure. There were significant but weak correlations with quality of life measures. The EADL shows promise for the assessment of disability in MS, but the range of items needs to be extended. Further evaluation of the scale seems warranted.

Assessment of emotional problems in people with multiple sclerosis.

To investigate the occurrence of emotional problems in multiple sclerosis (MS) patients. The utility of rating scales used to measure such problems was studied to make recommendations for clinical practice. Questionnaires were both sent by post and completed with an assistant psychologist at a home visit. Ninety-six MS patients in contact with a rehabilitation consultant. Patients were assessed using the Guy's Neurological Disability Scale (GNDS), Extended Activities of Daily Living Scale (EADL), Hospital Anxiety and Depression Scale (HAD), Beck Anxiety and Depression Scales (BAI, BDI), Clinical Outcomes in Routine Evaluation Measure (CORE) and the Brief Symptom Inventory (BSI). Rates of anxiety and depression ranged from 16% to 48% according to the measures used. All mood scales were highly significantly correlated with each other. Disability as measured by the GNDS, but not the EADL, was significantly correlated with all mood measures. Kappa values showed poor correspondence in the classification of cases. Receiver operating characteristic curves indicated an optimum cut-off point of 7/8 on the HAD and 2/3 on the General Health Questionnaire (GHQ-12). Rates of emotional problems were low given the highly disabled population studied. The HAD was relatively insensitive in comparison with the BAI and BDI. The GHQ-12 was sensitive and therefore recommended as a short screening measure. An alternative short screen, 'Emotional GNDS', was proposed.

Factors associated with strain in co-resident spouses of patients following stroke.

To identify the factors associated with carer strain following stroke. Co-resident spouses of stroke patients were sent questionnaire measures of their perceptions of strain, stress, mood, handicap, adjustment, social support, life satisfaction and personality, and patient's mood and independence in activities of daily living. Stroke spouses were identified from the stroke register at City Hospital, Nottingham. In a sample of 222 carers, 37% had significant strain. Strain was highly correlated with negative affectivity on the Positive and Negative Affectivity Scale, carer mood on the General Health Questionnaire-12 (GHQ-12) and carer's perceptions of patient's independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Logistic regression analysis of 96 of these carers supported the correlations and showed three factors, carer GHQ-12, patient EADL and negative affectivity, were independently associated with carer strain. The relationship between these factors and strain needs to be tested prospectively. Early identification of carers who may be at risk of strain later on will enable services to be targeted at prevention rather than cure.

Evaluation of stroke patients with the extended activities of daily living scale in Taiwan

Purpose : This study examined the construct validity of the Nottingham Extended Activities of Daily Living scale (EADL) in stroke patients in Taiwan. Methods : The EADL and the Barthel Index were administered via telephone interview. Minor revisions were made for the EADL to reflect cultural differences and the recommendations of two previous studies on the use of EADL. One hundred and fifty three stroke patients from the community participated in the study. Results : Two items, 'make hot snack' and 'write letters', were deleted from the EADL because they appeared to be of little discriminative value. The results suggest that a changed hierarchical order was present among the domestic and leisure subscales. All of the subscales, then, fulfilled the Guttman scaling criteria (coefficient of reproducibility < 0.9, coefficient of scalability < 0.6). The scores of the revised EADL were significantly related to age and the Barthel Index scores (Spearman correlation coefficients 0.41 and 0.69, respectively, p < 0.001). There was no significant difference between the overall scores of men and women (median = 10, 10, respectively, Mann-Whitney U test, p < 0.67). Conclusion : These data support the validity of the EADL with minor modifications in the evaluation of the functional performance in stroke patients in Taiwan and confirm it to be a useful outcome measure in stroke research.

Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial

Patients who have a stroke are not always admitted to hospital, and 22-60% remain in the community, frequently without coordinated rehabilitation. We aimed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital. In this single-blind randomised controlled trial, consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated randomly to up to 5 months of occupational therapy at home or to no intervention (control group) 1 month after their stroke. The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living. Patients were assessed on outcome measures at baseline (before randomisation) and at 6 months. The primary outcome measure was the score on the extended activities of daily living (EADL) scale at 6 months. Other outcome measures included the Barthel index, the general health questionnaire 28, the carer strain index, and the London handicap scale. All assessments were done by an independent assessor who was unaware of treatment allocation. The analysis included only data from completed questionnaires. 185 patients were included: 94 in the occupational therapy group and 91 in the control group. 22 patients were not assessed at 6 months. At follow-up, patients who had occupational therapy had significantly higher median scores than the controls on: the EADL scale (16 vs 12, p<0.01, estimated difference 3 [95% CI 1 to 4]); the Barthel index (20 vs 18, p<0.01, difference 1, [0-1]); the carer strain index (1 vs 3, p<0.05, difference 1 [0 to 2]); and the London handicap scale (76 vs 65, p<0.05, difference 7, [0.3 to 13.5]). There were no significant differences on the general health questionnaire between the patient or carer. Occupational therapy significantly reduced disability and handicap in patients with stroke who were not admitted to hospital.

A comparison of the Barthel index and Nottingham extended activities of daily living scale in the assessment of disability in chronic airflow limitation in old age

there is no disease-specific instrument for measuring activities of daily living (ADLs) in elderly patients with chronic airflow limitation (CAL). We assessed sensitivity, specificity and positive and negative predictive values of two ADL scales: the Barthel index and the Nottingham extended ADL scale in elderly people with and without CAL. the Breathing Problems Questionnaire was used as a measure of quality of life (a low score indicates good quality of life) in 96 outpatients (56 men) with CAL aged 70–93 (mean 78) years and 55 community-dwelling controls (23 men) aged 71–90 (mean 78) years with normal lung function drawn from a recent community survey. CAL subjects had been clinically stable for >6 weeks. All subjects were cognitively intact. mean best 1 s forced expiratory volume/forced vital capacity was 45.5% (SE 1.4) in CAL subjects and 71.4% (SE 1.3) in controls. All CAL subjects considered themselves disabled and had higher breathing questionnaire scores [geometric mean scores: 395 (range 13–112) vs 4.8 (range 0.6–40) for controls; t= 13.4, P<0.0001]. However, the Nottingham extended ADL index (threshold >18) discriminated better than the Barthel index (threshold >17) in terms of sensitivity (76% vs 19%; x2=60.9, P< 0.0001) and negative predictive value (75% vs 40%; x2=20.2, P<0.0001). Altering the Barthel threshold did not improve its performance. Multiple regression analysis showed that variability in physiological and psychological variables related to CAL predicted variability in Nottingham extended ADL score (R2=0.71) but not in Barthel score. the Barthel index underestimates disability in CAL in old age. The Nottingham extended ADL discriminates better between normal old people and those with CAL.

The effects of a stroke unit on activities of daily living

Objective: To determine whether specific daily activities are improved more by treatment in a specialized stroke unit for patients seen after stroke. Design: Randomized controlled study allocating patients to management in a stroke unit or on conventional hospital wards. Setting: District general hospital medical or geriatric wards, or a hospital stroke unit. Subjects: Patients who within five weeks of acute stroke were considered suitable for intensive stroke unit rehabilitation (if so randomized). Interventions: Standard rehabilitation as delivered in the medical/geriatric wards or as delivered in the stroke unit. Outcome measures: All individual items from the Barthel activities of daily living (ADL) scale, all items from the Rivermead ADL scales (self-care and household sections) and all items from the Nottingham Extended ADL scale were analysed. Results: One hundred and seventy-six patients were seen in the stroke unit and 139 on the conventional wards. At entry the stroke unit had more women and stroke unit patients had less good arm function; otherwise the groups were comparable. The main differences were in the areas of feeding, dressing and household activities. Conclusions: Stroke unit rehabilitation seems to improve feeding, dressing and household activities more than occurs on conventional wards; mobility was improved equally in both settings.

The Effect of a Stroke Rehabilitation Unit on Functional and Psychological Outcome: A Randomised Controlled Trial

The outcome of patients receiving rehabilitation on a stroke unit (SU) was compared with that of patients on general medical and health care of the elderly wards (conventional wards; CWs) in a randomised control trial. Of the 315 stroke patients admitted to hospital, 176 were randomly allocated to the SU and 139 to CWs. Outcome was assessed on the Barthel Index, Rivermead Activities of Daily Living Scale (ADL), Nottingham Extended ADL scale, General Health Questionnaire, Mood Ratings and Adjustment scales at 3, 6, and 12 months after stroke by an assessor who was ''blind'' to their group allocation. SU patients spent significantly longer in hospital. There was a significant difference in personal ADL at 3 and 6 but not 12 months after randomisation. On measures of extended ADL, SU patients were significantly more independent at 6 and 12 months but not at 3 months after randomisation. There were no significant differences between the groups in mood at 3 and 6 months, but SU patients showed better mood 12 months after randomisation. There was a significant difference in adjustment 6 months after randomisation. Patients who received rehabilitation on SUs were more independent in activities of daily living compared with those who received rehabilitation on CWs. By 6 months they were also psychologically more able to cope.

Validity of the extended activities of daily living scale

Scales that measure independence in the basic self-care activities of daily living (ADLs) suffer from ceiling effects when applied to an outpatient population. The instrumental activities of daily living (IADL) measures, which assess the performance of tasks required for independence at home are more appropriate. However, validity evaluation of IADL measures seldom goes beyond content validity and little is known about their sensitivity to change. The aim of this study was to evaluate the construct validity of the extended ADL scale (EADL) and to test its sensitivity to change. Three hundred and sixty-one consecutive acute stroke admissions were recruited and surveyed at one, six and 12 months after stroke, using the EADL. There were the expected correlations with the Barthel Index, Nottingham Health Profile, Geriatric Depression Score and the London Stroke Satisfaction Score. Logistic regression analysis showed that, although men were more mobile, they were less likely to carry out domestic and kitchen tasks. Also, nonwhites were more disabled, owner-occupiers had higher leisure scores and those living alone had higher kitchen scores. Analysis of effect sizes showed that the EADL is sensitive to the changes that occur after stroke and would be sensitive to the effect of an intervention that produced a change in independence of two or more ADLs. The EADL is a valid measure of the performance of instrumental ADLs and is sensitive to clinically important changes.