Functional Assessment Questionnaire Research Articles

Assessing the Swallowing Function in Children with Spinal Muscular Atrophy: An Easily Accessible and Objective Multidimensional Approach.

Spinal muscular atrophy (SMA), a genetic neuromuscular disease caused by lack of survival of motor neuron (SMN) protein, is characterized by muscular atrophy and respiratory and bulbar dysfunction. While swallowing disorders are common, they remain poorly studied. Our study aimed to explore 1) intraoral pressure measurements with the Iowa Oral Performance Instrument system and the reliability of a Swallowing Function Assessment Questionnaire (SFAQ) in healthy controls, and 2) evaluate their use as swallowing function biomarkers and the evolution of swallowing function over time in children with SMA. We recruited 53 healthy children and 27 SMA patients all treated with SMN gene modulator therapy. Participants completed the SFAQ and underwent at least one measurement of maximal oral pressures (lingual, labial, and masseter). Mean oral normalized pressure index were lower (all sites p < 0.001) and mean SFAQ scores were higher (p < 0.001) in patients compared with healthy controls. Pressure evolution over 1 year in SMA patients for all three oral sites did not show significant differences. SFAQ scores correlated negatively with oral pressures at all three sites in patients. Both tools provided new insights on the oral and pharyngeal phase of swallowing in SMA patients. In SMA patients, muscle strength in certain crucial anatomical regions during swallowing is weaker than in healthy children.

Are tactile function and body awareness of the foot related to motor outcomes in children with upper motor neuron lesions?

Somatosensory function can be reduced in children with Upper Motor Neuron (UMN) lesions. Therefore, we investigated relationships between somatosensory functions of the foot and motor outcomes in children with UMN lesions. In this cross-sectional study, we assessed the Tactile Threshold (TT) with monofilaments and body awareness with Tactile Localisation Tasks for spatial-related action (TLTaction) and structural-related perception (TLTperception) body representation at the foot sole. Furthermore, we assessed four motor outcomes: the Selective Control Assessment of the Lower Extremity (SCALE), the modified Timed Up and Go test (mTUG), the Gillette Functional Assessment Questionnaire (FAQ), and the Functional Mobility Scale (FMS). Spearman's correlations (ρ) were applied to assess relationships between the somatosensory function of the foot sole and the applied motor outcomes. Thirty-five children with UMN lesions, on average 11.7 ± 3.4 years old, participated. TLTperception correlated significantly with all lower limb motor outcomes (|ρ|=0.36-0.57; p < 0.05), but TLTaction (|ρ|=0.00-0.27; p = 0.15-0.97, and TT did not (|ρ|=0.01-0.83; p = 0.73-0.94). TLTperception correlated strongly with the Gross Motor Function Classification System (|ρ|=0.62; p = 0.001) in children with cerebral palsy (n = 24). Assessing structural body representation of the foot sole should be considered when addressing lower limb motor impairments, including gait, in children with upper motor neuron lesions. Our results suggest that the assessment of tactile function and spatial body representation may be less related to lower limb motor function.

Longitudinal trajectory effects of different MCI subtypes on general cognitive and daily functions in a population-based cohort of older adults

ObjectivesTo identify different mild cognitive impairment (MCI) phenotypes based on substantial relative impairment in specific cognitive domains and then characterize the complex process of general cognitive and daily functions over time in older adults with these MCI subtypes. MethodsA total of 1020 participants with MCI at baseline from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were recruited. MCI subtypes were obtained based on neuropsychological tests in five cognitive domains: memory (M), visuospatial function (V), language (L), processing speed (P), and executive function (E). General cognitive function and daily function were measured by the Mini-Mental State Examination (MMSE) and the Functional Assessment Questionnaire (FAQ), respectively. Linear mixed models were fitted to curve their trajectories across different MCI subtypes. ResultsConsidering visuospatial function, subtypes were MO (memory impaired only), M&V (memory and visuospatial function impaired) and M&nV (memory impaired and visuospatial function non-impaired). Similar subtypes and naming rules were obtained based on language, executive function, and processing speed. Further, depending on the number of relative impaired cognitive domains M&S and M&M were obtained. Participants with MO had the highest prevalence in the sample (53.4 %), followed by M&nV (31.1 %). Participants with M&V had the highest mean age (74.69 years) at baseline and the greatest dementia conversion rate (53.2 %). The MMSE and FAQ score trajectories changed most slowly in participants with MO while fastest in those with M&V. Obvious different trajectories of both MMSE and FAQ scores were observed across different subtypes based on visuospatial function and executive function. ConclusionCompared to MO, individuals with multi-dimensional cognitive impairment have worse general cognitive and daily functions, especially for those with M&V.

Apathy in Lewy body disease and its effects on functional impairment over time.

Apathy strongly affects function in Alzheimer's disease and frontotemporal dementia, however its effect on function in Lewy Body Disease (LBD) has not been well-described. This study aims to (1) examine the prevalence and persistence of apathy in a large, national cohort of well-characterized patients with LBD, and (2) estimate the effect of apathy on function over time. Study included 676 participants with mild cognitive impairment (MCI) or dementia in the National Alzheimer's Coordinating Center Uniform Data Set. Participants were followed for an average of 3.4 ± 1.7 years and consistently had a primary diagnosis of LBD. Apathy was defined by clinician judgment, categorized into four mutually exclusive profiles: (1) never apathetic across all visits, (2) at least one but <50% of visits with apathy (intermittent apathy), (3) ≥50% but not all visits with apathy (persistent apathy), and (4) always apathy across all visits. Dementia severity was measured by baseline Clinical Dementia Rating score. Parkinsonism was defined by the presence of bradykinesia, resting tremor, rigidity, gait, and postural instability. Functional impairment was assessed using the Functional Assessment Questionnaire (FAQ). Baseline characteristics of the sample were: average age = 72.9 ± 6.9, years of education = 15.6 ± 3.4, Mini Mental State Exam (MMSE) = 24.4 ± 5.4, Geriatric Depression Scale (GDS) = 3.8 ± 3.2, FAQ = 12.0 ± 9.1. 78.8% were male and 89% were non-Hispanic white. Prevalence of apathy increased from 54.4% at baseline to 65.5% in year 4. 77% of participants had apathy at some point during follow-up. Independent of cognitive status and parkinsonian features, FAQ was significantly higher in participants with intermittent/persistent and always apathetic than never apathetic. Annual rate of decline in FAQ was faster in participants who were always apathetic than never apathy. In this large national longitudinal cohort of LBD patients with cognitive impairment, apathy was strongly associated with greater functional impairment at baseline and faster rate of decline over time. The magnitude of these effects were clinically important and were observed beyond the effects on function from participants' cognitive status and parkinsonism, highlighting the importance of specifically assessing for apathy in LBD.

Adaptive functioning and neurodevelopment in patients with Dravet syndrome: 12-month interim analysis of the BUTTERFLY observational study

ObjectiveThe BUTTERFLY observational study aims to elucidate the natural trajectory of Dravet syndrome (DS) and associated comorbidities in order to establish a baseline for clinical therapies. We present the 12-month interim analysis of the study. Materials and methodsPatients with a genetically confirmed diagnosis of DS were enrolled in the study. Adaptive functioning and neurodevelopmental status were measured using the Vineland Adaptive Behavior Scale, Third Edition (Vineland-III), Bayley Scales of Infant Development, Third Edition (BSID-III), and Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Executive function, ambulatory function and locomotor activities, and overall clinical status were measured using the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P) scale, Gillette Functional Assessment Questionnaire (Gillette FAQ), and Clinician or Caregiver Global Impression of Change scales (CGI-C or CaGI-C) respectively. ResultsOverall, 36 patients were enrolled across three age groups, with 35 patients completing at least part or all of one post-baseline visit through Month 12. Significant improvements in receptive communication, as assessed by Vineland-III and BSID-III raw scores, and in verbal comprehension subtests, as assessed by WPPSI-IV raw scores, were observed in BUTTERFLY patients for the all-patient group. Many patients performed on the impaired end of the BRIEF-P Global Executive Composite scale at baseline suggesting difficulties in executive function, and no significant change was observed in BRIEF-P scores for the all-patient group. Most patients performed in the dynamic range of the Gillette FAQ at baseline, and no significant change was observed in Gillette FAQ scores for the all-patient group. Lastly, there was significant improvement observed in the CaGI-C scores for the all-patient group. SignificanceThis BUTTERFLY interim analysis shows small improvements in communication skills along with stability in other developmental abilities across patients with DS enrolled in the study from baseline to Month 12.

Associations of musculoskeletal dysfunction, time to brake, and patient reported outcomes following lower extremity trauma

IntroductionInability to drive a motor vehicle due to lower extremity injury is a major inconvenience. Timing of safe return to driving has not been much studied. Objective measurements such as time to brake (TTB) have been proposed; however, utility and concordance of functional outcome measurements have not been previously evaluated. The purpose of this project is to measure these parameters and to assess for associations with ability to safely return to driving, improving the ability of clinicians to assess for measurements of driving readiness without specifically measuring TTB. MethodsA prospective, cohort study of 232 patients with complex lower extremity injuries to the pelvis, acetabulum, hip, femur, knee, tibia, ankle, and foot was performed. Time to brake (TTB) was measured once weightbearing was allowed. Function was assessed by the Musculoskeletal Function Assessment (MFA) questionnaire, and pain, mobility, and physical functions, via patient reported outcome measurement information system (PROMIS) surveys. ResultsPatients with longer TTB had significantly elevated MFA scores indicating increased musculoskeletal dysfunction post-injury. As the MFA score increased by 1 point, TTB increased by 0.013 s (p<0.001). PROMIS metrics were also significantly associated with patients experiencing more pain and worse mobility as TTB increased. DiscussionMany patients continue to exhibit musculoskeletal dysfunction several months post-treatment for complex lower extremity injuries. Patients with better PROMIS metrics and MFA scores, and shorter TTB are more appropriate to return to driving. Surgeons may be better informed about safe driving ability by considering these measurements. Level of EvidenceII

Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial

ObjectiveThis study aims to evaluate the effect of functional versus resistance exercise training on the functional capacity and quality of life of psoriatic arthritis patients.MethodsForty-one psoriatic arthritis patients (18 to 65 years old) were randomized into two groups: functional training group and resistance exercise group. The functional training group underwent functional exercises with elastic band and the functional training group underwent machine resistance exercise twice a week for 12 weeks. Outcome measures were: The Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S) for functional capacity and functional status, one-repetition maximum test for muscle strength, the Short Form 36 health survey questionnaire (SF-36) for quality of life, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Disease Activity Score 28 (DAS-28) for disease activity. Analyzes were performed by a blinded evaluator at baseline (T0), six (T6) and twelve (T12) weeks after the beginning of the exercise.ResultsAt baseline, the groups were homogeneous in the clinical and demographic characteristics. There was a statistical intra-group improvement for both groups in the BASFI, BASDAI, HAQ-s, and DAS-28. In the quality-of-life assessment, both groups showed statistical intra-group improvements for all domains except the “emotional aspect” domain in the resistance exercise group. In the muscle strength, there was a statistical improvement for all exercises in both groups, except for the “alternate biceps (bilateral)” exercise.ConclusionFunctional training and resistance exercise are similarly effective in improving functional capacity, functional status, disease activity, general quality of life, and muscle strength in patients with psoriatic arthritis.Trial registration: ClinicalTrials.gov: NCT04304326. Registered 11 March 2020, https://clinicaltrials.gov/ct2/show/NCT04304326?term=NCT04304326&draw=2&rank=1.

Digital Cognitive Assessment Leveraging the Boston Process Approach Can Flag Emergent Cognitive Decline in Individuals with Subtle and Mild Functional Disability

AbstractBackgroundEarly detection of Mild Cognitive Impairment (MCI) and Alzheimer’s Disease and Related Dementias (ADRD) is key to optimal management. Digital tests allow for the reliable capture of meaningful, process‐based neuropsychological test parameters that traditional paper/pencil measures fail to detect, thus enabling earlier detection. We assessed how subtle functional decline relates to process features extracted from the digital Clock Drawing Test (dCDT) and the digital Trail Making Test‐Part B (dTrB).Methods629 community dwelling participants (58.5% female) were assessed with the Functional Assessment Questionnaire (FAQ), the MMSE, the digital clock drawing test (dCDT) and the digital Trail Making Test‐Part B (dTrB). Three FAQ groups were constructed: FAQ = 0‐2 (minimal functional disability, n = 490); FAQ = 3‐5 (subtle functional disability, n = 90); FAQ = 6‐8 (mild functional disability, n = 49).ResultsParticipants with minimal functional disability were younger (p = 0.027) and scored better on the MMSE (p = 0.001) than other groups. Groups were equated for education. dCDT command/copy component placement was more accurate among participants with minimal functional disability compared to other groups (command dCDT p = 0.001 versus mild functional disability; copy dCDT p = 0.006 versus both subtle and mild functional disability). On the dTrB, participants with minimal disability drew faster than those with subtle or mild disability (mean stroke velocity, p = 0.001). Analyses for percent pen lift time found no difference between participants with minimal versus subtle disability; however, both groups differed from participants with mild disability (p = 0.001). Optimal group classification using stepwise nominal regression with the minimal functional disability group as the reference was achieved using dCDT copy component placement and dTrB mean stroke velocity (X 2 = 28.37, p = 0.001), where dTrB mean velocity entered first (X 2 = 17.73, p = 0.001) followed by dCDT copy component placement (X 2 = 11.19, p = 0.004). Both variables contributed comparably to group classification (Wald statistic range 5.82‐8.88, p = 0.012, respectively).ConclusionsThe digital assessment described above, targeting executive, scanning, visuoconstructional and motor domains, captures highly nuanced, discrete behaviors with precision/ operationalism heretofore unattainable. Consequently, it is reasonable to posit that digital cognitive assessments leveraging the Boston Process Approach can both objectively detect emergent cognitive impairment and infer its likely impact on functional activities, critical for practical assessment in clinical care.

Apathy and dysfunction in Lewy Body Disease

AbstractBackgroundStudies in Alzheimer’s disease and frontal temporal lobe dementia have shown high prevalence and persistence of apathy at different disease stages and its strong association with functional decline. Here we use well‐established methods to examine the relationship between apathy and function in a cohort of well‐characterized patients with Lewy Body Disease (LBD) who had regular assessments over time.MethodSample includes participants in the National Alzheimer’s Coordinating Center Uniform Data Set (NACC‐UDS, 9/2005‐12/2019) who had at baseline (1) cognitive status of mild cognitive impairment (MCI) or dementia, (2) presumed etiologic diagnosis of LBD, and (3) ≥1 follow‐up. Baseline diagnosis of Parkinson’s disease (PD) was assessed. Apathy was identified using clinician judgment. Participants’ function was measured using the Functional Assessment Questionnaire (FAQ). Multivariable linear mixed model (LMM) was used to estimate relationships between apathy, cognitive status (baseline MCI vs dementia), and function over time.ResultThe sample included 339 participants with MCI and 748 with dementia. Average age = 72.7±8.3, 74% male, 86% non‐Hispanic white, 15.4±3.4 years of education, baseline MMSE = 23.7±5.8, with 3.4±1.7 years of follow‐up. Proportion of participants who reported difficulty with function at baseline ranged according to task complexity from 48% (Heating water, making a cup of coffee, turning off stove after use) to 85% (Assembling tax records, business affairs, or papers); with total FAQ = 13.0±9.1. Presence of apathy increased from 52% at baseline to 60% at visit 4. Across all follow‐ups, 24% of the participants were never apathetic, 13.7% had apathy intermittently (&lt;50% of all visits), 28.3% persistently (≥50% of all visits), and 34.0% were apathetic at all visits. LMM estimation results showed that, compared to participants who were never apathetic, FAQ was 3.8±0.8 points higher, i.e., greater dysfunction, at baseline in participants who were always apathetic, and 3.3±0.7 points higher in those who had intermittent/persistent apathy (both p&lt;0.001). Rate of functional decline was 0.41±0.3 points faster each year in those always apathetic compared to never apathetic (p&lt;0.1).ConclusionApathy is highly prevalent in individuals with LBD. Independent of cognitive status, more persistent apathy was strongly associated with worse function.

Translation and adaptation of a questionnaire for assessing cognitive domains based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders ‐ DSM‐5 for neurocognitive disorders

AbstractBackgroundThe Cognitive Domains and Functional Assessment Questionnaire (QACDF) assesses cognitive and functional decline based on the DSM‐5 criteria for Neurocognitive Disorders¹. The QACDF has two versions, one for the patient and another for the informant. It is composed of 30 items, each assessed by a likert scale. This questionnaire has appropriate semantic characteristics for the Brazilian older adult population.MethodThe objective of this study was to translate, adapt and assess the semantic, idiomatic, experiential and conceptual equivalence of the QACDF. Firstly, the QADCF original version in Portuguese was translated to English by two Bilingual translators, a non‐specialist linguist and a specialist in the field. After this, the two translators (T1 and T2) together with a mediator translator synthesized the translations in a common version (T3). Then, the T3 version was back‐translated into Portuguese by a Bilingual translator, blind to the original version². The three versions (original, translated and back‐translated) were assessed by a committee of specialists. The committee was composed of the initial translators, an English native speaker, an expert in the methodology and the main researchers.ResultThe QACDF Items were adjusted to conceive equivalent expressions for the target language, as well as to assess cognitive domains and the functionality of daily living of English speakers. Semantic, idiomatic, experiential and conceptual equivalence were debated by the committee until consensus was reached.ConclusionThe translation of the instrument followed the proposed methodology by Beaton et col. However, while the Brazilian Portuguese versions have been assessed by two pilot studies, pilot studies are still needed to further adjust the questionnaires for English speakers.

The evaluation of translated neuropsychological assessments tools for the early detection of mild cognitive impairment (MCI) in low‐ and middle‐income countries (LMICs)

AbstractBackgroundThe incidence of mild cognitive impairment (MCI), particularly in low and middle‐income countries (LMICs) has been noticeably on the rise. With the high cost of dementia care, the need for tools that aid with the early detection of MCI is becoming of high importance, especially in LMICs. As a part of screening for MCI, many tests have been proposed evaluating for impairments in cognitive, behavioral, and functional domains, which are important for ruling out and evaluating for any reversible causes. While useful, most of these tests were developed in the west, limited works exist reporting the appropriateness and experience of using such tests for patients from LMICs.MethodIn this work, we aim to evaluate the use of translated digital assessment for detecting MCI in an Arabic‐speaking population in Palestine. For this purpose, we developed a digital test covering three cognitive, behavioral, and functional domains, where MMSE and the Neuropsychiatric Inventory ‐ Questionnaire (NPI‐Q) together with two functional assessment questionnaires were translated to Modern Standard Arabic (MSA) and presented in a digital interface. Upon the development and translation of the digital tests, field testing was conducted to check for use experience and appropriate patient comprehension of the questions to match their intended use.ResultFollowing the implementation of the digital assessment tools, quantitative and qualitative data was collected summarizing the user experience, where numerous limitations were noted. Despite being asked in their native language, several patients expressed the need for more clarifying questions. While all patients were Arabic speakers, some patients required the use of simpler terminology that matches their local dialects. Other patients reported the lack of relevance of certain questions, regarding the activities of daily living in the functional assessments. Overall, the patient’s experience and comprehension of questions varied with their age and literacy level.ConclusionDespite the high prevalence of dementia in LMICs, there are limited available neuropsychological assessment tools that are fit for the local cultural and linguistic. The findings suggest the need for the development of culturally and linguistically appropriate assessments to ensure appropriate patient comprehension, and avoid misdiagnosis of patients.

The hidden toll of war: a comprehensive study of orthopedic injuries in Yemen

BackgroundYemen has been experiencing a protracted civil war and humanitarian crisis since 2015, which has resulted in many war-related injuries. However, there is a lack of data on the epidemiology, characteristics, and outcomes of these injuries, especially the orthopedic ones. This study aimed to describe the war-related orthopedic injuries in Yemen and their impact on the patients’ health and function.MethodsThis was a retrospective study based on medical records and trauma registries of 3930 patients who were admitted to three major trauma centers in Sana’a city with war-related orthopedic injuries from January 2015 to December 2020. We collected data on demographics, injury mechanisms, injury types and locations, surgical procedures, complications, mortality, and functional outcomes using the Musculoskeletal Function Assessment questionnaire. We used descriptive and inferential statistics to analyze the data and performed a logistic regression analysis to identify the factors associated with mortality.ResultsMost of the patients were young males and civilians who suffered from complex and severe injuries involving multiple body regions, especially the lower extremities. The main mechanisms of injury were gunshot wounds, blast injuries, and landmine explosions. The patients required multiple surgical procedures and implants, and had high rates of complications and mortality. The most common complications were infection, nonunion, malunion, and amputation. The most common cause of death was sepsis. The functional outcomes were poor, as indicated by the high mean MFA score. The logistic regression analysis showed that older age, blast injuries, spine injuries, vascular injuries, and infection were significant predictors of mortality.ConclusionThis study provides valuable information on the war-related orthopedic injuries in Yemen and their impact on the patients’ health and function. It also identifies some areas for future research, such as exploring the risk factors for infection and nonunion/malunion, evaluating the effectiveness and cost-effectiveness of different surgical procedures and implants, assessing the long-term outcomes and quality of life of the patients, and developing novel strategies to enhance bone and soft-tissue healing.

50 Examining the Utility of a Performance-Based Test of Everyday Function for Assessing Cognition in Older Adults Who Speak English as a Second Language

Objective:Accurate early detection of subtle cognitive difficulties is critical for optimizing treatment of neurodegenerative disease. Those who speak English as a second language (ESL) in the US may be at a disadvantage on Englishwritten neuropsychological tests, increasing the potential for error, particularly when cognitive difficulties are mild and/or when informants are not available/unreliable. This study examined the utility of a standardized, performance-based test of everyday function for the assessment of cognition in ESL older adults.Participants and Methods:Five ESL participants (Mage=83 years; range 65-84 years old) were recruited along with 43 cognitively healthy, native English speakers (controls) as part of a larger study of functional assessment in community-dwelling older adults. Participants were required to identify a study partner to answer questions about their cognitive abilities and everyday functioning. ESL participants reported diverse native languages: Cantonese, Mandarin, Gujarati/Hindi, Farsi, and Azeri. One of the 5 ESL participants reported a diagnosis of MCI. Participants completed the Mini-Mental Status Exam, Trail Making Tests, Digit Span, Boston Naming Test, Hopkins Verbal Learning Test, and Brief Visual Memory Test, resulting in 15 test scores. Participants also completed the Naturalistic Action Test (NAT), a performance-based tests that requires preparation of a breakfast and lunch using standardized objects presented on a table. Recordings of NAT performance were scored by two coders for time to completion, accomplishment of task steps, and errors (overt, micro-error, motor), resulting in 10 scores for the Breakfast and the Lunch tasks. Any discrepancies amongst the two coders were resolved by our lab. Informant-report questionnaires included the Functional Assessment Questionnaire (FAQ), Everyday Cognition Questionnaire (ECog) and IADL-C. Total scores from the cognitive tests, NAT, and informant reports for each ESL participant were compared against the scores of Controls by computing T-scores using the Control M and SD. Low/impaired test scores were defined as &lt;1.5 SD.Results:Informants reported intact everyday function (FAQ, IADL-C) for all ESL participants. Informant-reported ECog scores varied as expected; with mild decline reported for the participant with MCI. On traditional cognitive tests, ESL participants showed variable performance, such that low scores were obtained on up to 9 of the 15 scores. The ESL participant with MCI obtained low scores on 11/15 scores. On the NAT, all of the ESL participants without MCI showed scores on the Breakfast (accomplishment, errors) that were comparable to Controls. Completion time for both Breakfast and Lunch and Lunch scores (accomplishment, errors) were variable, with low across observed in ESL participants with healthy cognition.Conclusions:Older participants with ESL and healthy cognition showed highly variable scores on traditional, neuropsychological tests. However, on one item from a performance-based assessment of everyday function (NAT Breakfast), ESL participants with healthy cognition consistently performed well compared to healthy Controls. Performance was less consistent for completion time across both NAT tasks and on all measures from the Lunch task, for which the steps and objects may have been less familiar to ESL participants. Thus, performance-based testing holds promise for informing neuropsychological assessment of ESL older adults, but care should be taken in selecting test items that are highly familiar and outcome measures that are most meaningful across a range of cultures.

Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture.

The objective of the study was to evaluate the long-term strength and gait outcomes after intramedullary nailing of isolated tibial diaphyseal fractures. This retrospective cohort study was conducted at an academic Level I trauma center. Fifteen participants with isolated tibial diaphyseal fractures (OTA/AO 42) at least 2 years postoperative from intramedullary nailing (IMN) provided informed consent. The average age was 40 ± 14 (range, 24-69); there were nine men and six women. Knee flexion-extension strength data were collected. Temporal-spatial, kinematic, and kinetic gait parameters were measured and compared to historic control data. Participants completed the SF-36 and shortened musculoskeletal function assessment questionnaires. The mean length of follow-up between surgery and gait analysis was 6 ± 2 years. The fractured limb demonstrated deficits in quadriceps strength between 9.8% and 23.4% compared to the unaffected limb. Temporal-spatial parameters revealed slower walking speed, shorter stride length, decreased cadence, and shorter single-limb support time in the fractured limb. Altered kinematic and kinetic findings included a knee extension shift during stance, with an increased knee flexor moment demand and decreased total knee power during loading and midstance. These findings represent deficits in concentric and eccentric knee extensor activity. Additionally, the fractured limb demonstrated decreased ankle dorsiflexion during stance and diminished ankle push-off power. Long-term outcomes after IMN of tibial diaphyseal fractures demonstrate decreased quadriceps strength and altered gait parameters that may have implications to the high incidence of knee and ankle pain in the fractured limb.

Internal consistency and construct validity of the Short Musculoskeletal Function Assessment (SMFA) in older adults

Objective The primary objectives of this study were to 1) investigate the internal consistency 2) and construct validity of the Short Musculoskeletal Function Assessment Questionnaire (SMFA) in older adults commencing physical rehabilitation in an outpatient setting. Methods This cross-sectional study recruited older adults who had commenced physical rehabilitation in an outpatient setting. The SMFA consists of two indices: 1) dysfunction capturing the impact of musculoskeletal disorders on physical limitations, and 2) bothering capturing how the individual is emotionally affected by their disorder. SMFA holds four categories: ‘mobility’, ‘daily activities’, ‘emotional status’, and ‘function of the arm and hand’. Participants answered the SMFA alongside other patient-reported questionnaires (such as the 36-Item Short Form Survey, SF-36) and similar) and objectively measured muscle strength for the upper and lower body and functional capacity. Results We included 115 older adults with a median age of 74 years (IQR 9). Adequate internal consistency was seen with Cronbach’s alpha values of 0.90–0.94 for the SMFA indices and 0.77–0.91 for the SMFA categories. The strongest correlations between the SMFA indices were observed with the SF-36 physical component summary (SMFA-Dysfunction r = 0.74, p < 0.05, SMFA-Bother r = 0.72, p < 0.05). Only fair correlations were found between SMFA index scores and clinical outcome measures. Discussion This study demonstrated that the SMFA has adequate internal consistency and construct validity for self-reported health status in older adults, especially when considering components covering physical health status. However, we only observed fair correlations between SMFA and clinical outcome measures, indicating that SMFA does not adequately capture muscle strength and functional capacity.

Association of frailty with cognitive impairment and functional disability in older adults with affective disorders: a brief research report.

The Clinical-Functional Vulnerability Index (IVCF-20) is a validated multidimensional instrument that has been used in Brazil to evaluate functional disability in frail older adults. The main aim of this study was to assess frailty using this novel screening tool. In addition, to investigate whether frailty was associated with cognitive impairment and functional disability in older adults with affective disorders. Participants included were over 60 years old, with affective disorders (depressive or anxiety disorders), from two specialized outpatient clinics. The sample was comprised of 46 patients (30% of a total from 153). The following instruments were applied: Clock Drawing Test (CDT), Mini Mental State Examination (MMSE); Verbal Fluency Test (VFT); Pfeffer Questionnaire or Functional Assessment Questionnaire (FAQ); Katz Index; Geriatric Depression Scale (GDS-15); Geriatric Anxiety Inventory (GAI), and IVCF-20 as well as sociodemographic and clinical questionnaires. The association between the variables of interest was estimated using Spearman correlation. This study found a negative correlation between frailty and cognitive decline (MMSE; rs = -0.58; p < 0.001); (VFT; rs = -0.60; p < 0.001); (CDT; rs = -0.47; p = 0.001) and a positive correlation between frailty and depressive symptoms (GDS-15; rs = 0.34; p = 0.019) as well as disability for IADLs (FAQ; rs = 0.69; p < 0.001). However, there was no statistical difference in the association between frailty and anxiety symptoms (GAI; rs = 0.24; p = 0.103) or disability for BADLs (Katz; rs = -0.02; p = 0.895). Our data support that the associations between frailty, cognitive and functional disability are prevalent issues in Psychogeriatrics. Assessing frailty in a multidimensional context is essential using a rapid assessment frailty tool in clinical practice.

Medial augmentation plating of aseptic distal femoral nonunions

BackgroundDistal femur nonunions are well-recognized contributors to persistent functional disability, with limited data regarding their treatment options. In the current study, we asked whether additional medial augmentation plating is a feasible treatment option for patients with aseptic distal femoral nonunion and intact lateral implants.MethodsWe conducted a single-center, retrospective study including 20 patients treated for aseptic distal femoral nonunion between 2002 and 2017. The treatment procedure included a medial approach to the distal femur, debridement of the nonunion site, bone grafting and medial augmentation plating utilizing a large-fragment titanium plate. Outcome measures were bone-related and functional results, measured by the Hospital for Special Surgery Knee Rating Scale (HSS) and the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D).ResultsEighteen of 20 nonunions showed osseous healing at 8.16 ± 5.23 (range: 3–21) months after augmentation plating. Regarding functional results, the mean HSS score was 74.17 ± 11.12 (range: 57–87). The mean SMFA-D functional index was 47.38 ± 16.78 (range 25.74–71.32) at the last follow-up. Index procedure-associated complications included two cases of persistent nonunion and one case of infection.ConclusionsAccording to the assessed outcome measures, augmentation plating is a feasible treatment option, with a high proportion of patients achieving bony union and good functional outcomes and a few patients experiencing complications.

Psychometric properties of the Edinburgh Visual Gait Score in children with spastic cerebral palsy

BackgroundTo our knowledge, no other studies investigated the internal consistency of the Edinburgh Visual Gait Score (EVGS). The aim of our study was to determine the reliability and construct validity of the EVGS in children with cerebral palsy (CP).ResultsA total of fifty children with CP were enrolled in the study. Participants were evaluated with Gross Motor Function Classification System (GMFCS), Wisconsin Gait Scale (WGS), Gillette Functional Assessment Questionnaire (Gillette FAQ), Timed Up and Go Test (TUG), and EVGS (Rater-A and Rater-B). Slow-motion video analysis was used for the visual gait analysis. The inter-rater reliability, internal consistency, and construct validity of the EVGS were analyzed. The intraclass correlation coefficient (ICC) of the EVGS total score was 0.947 (CI: 0.90–0.97). Inter-rater reliability was excellent (ICC>0.80). The Cronbach’s alpha value was 0.936, within the acceptable range (0.70<α<0.95). In addition, the standard error of measurement (SEM95) and minimal detectable change (MDC95) scores of EVGS were 1.72 and 4.78, respectively. The correlation values of EVGS (Rater-A) and GMFCS, TUG, GFAQ, and WGS were 0.494, 0.661, −0.663, and 0.611, respectively. On the other hand, the correlation values of EVGS (Rater-B) and GMFCS, TUG, GFAQ, and WGS were 0.492, 0.664, −0.714, and 0.757, respectively. Except for comparison with GMFC, EVGS was highly valid in all other correlational analyzes (r>0.50). EVGS had moderate validity with GMFCS for both raters.ConclusionThe EVGS was reliable and valid. Internal consistency of the EVGS is high, indicating a consistent structure to assess gait in children with CP.

Apathy and dysfunction early in the course of behavioral variant frontotemporal dementia

AbstractBackgroundApathy is highly prevalent in frontotemporal dementia (FTLD) but its impact on function is less understood. This study (1) examined the natural history of apathy in a large, national sample of well‐characterized patients clinically diagnosed with FTLD who had regular assessments over time, and (2) estimated the impact of apathy on function longitudinally across spectrum of disease severity.MethodSample includes individuals enrolled in the National Alzheimer’s Coordinating Center Uniform Data Set (NACC‐UDS, 9/2005‐12/2019) who had a primary clinical diagnosis of FTLD at baseline with suspected underlying etiology of behavioral variant of FTLD (bvFTLD) with at least one follow‐up visit (N = 888). Apathy was identified using clinician judgment. Prevalence, incidence, and persistence of apathy at each visit and cumulatively over time were assessed. Participants’ function was measured using the Functional Assessment Questionnaire (FAQ). Dementia severity as measured by baseline CDR. Linear mixed model (LMM) was used to estimate relationships between apathy, baseline CDR, and function over time.ResultAverage age of the sample = 63.4±9.1, 61% male, 92% non‐Hispanic white, average education = 15.4±3.1. Average MMSE = 23.0±6.7, GDS = 3.2±3.1 NPIQ = 8.4±5.9, CDR Sum of Boxes = 5.6±4.2, FAQ = 14.5±9.4. Presence of apathy fluctuated between 52‐65% for those with baseline CDR = 0.5, 73‐83% for CDR = 1, and 82‐87% for CDR = 2. Cumulative prevalence of apathy, i.e., proportion of participants with an endorsement of apathy in at least one visit over participant’s entire follow‐up, was 81.4% in CDR = 0.5, 93% in CDR = 1, and 94% in CDR≥2. LMM estimation results showed that independent of dementia severity and other participant characteristics, FAQ was 3.3±0.8 points higher at baseline in participants with persistent apathy and 2.1±0.8 points higher in those who always had apathy compared to (those without apathy or with intermittent apathy. Interaction terms between apathy and time were not statistically significant.ConclusionResults confirm apathy is highly prevalent across the range of dementia severity in bvFTLD. Independent of dementia severity, more persistent apathy was strongly associated with worse function. However, apathy was not associated with the rate of decline in function over time, likely because function was already highly impaired by CDR = 1. Interventions to support function may be needed early in the course of bvFTLD.

Relative importance of multimodal risk factors to discriminate memory trajectories: Similarities and differences across ethnoracial groups in cognitively normal older adults

AbstractBackgroundInequalities in dementia incidence and heterogeneities observed on memory decline are present across ethnic/racial groups. Research suggests that inequities in risk/protective factors contribute towards these differences. We examine risk factors across multiple domains to identify those that best discriminate differences in memory trajectories across ethnoracial groups.MethodWe used an ethnoracially diverse longitudinal cohort of cognitively normal older adults (n = 299; mean age = 73.47 (6.90) years; 63.9% female) from the University of California, Davis‐Alzheimer’s Disease Research Center. First, we applied latent class growth analysis to objectively classify memory trajectories into distinct latent groups across a maximum of 10 follow‐ups. Second, we used random forest analyses (RFA) to examine relative importance of 22 risk/protective factors from seven domains (demographic, genetic, brain morphometry, plasma and functional biomarkers, psychological and lifestyle factors) to discriminate low/high memory performers as stratified by three ethnoracial groups (African Americans [AA; n = 111]; Hispanics [n = 108], Whites [n = 66]).ResultFirst, we observed that four latent classes (low, intermediate, high, very high) best represented memory trajectories (Figure 1). Second, for our RFA analyses, we collapsed low and intermediate groups to a low group (n = 136; 40.4% AA, 25.6% Hispanics, 28.8% Whites), and high and very high to a high performing group (n = 148; 34.6% AA, 50% Hispanics, 15.4% Whites). High memory class was predicted (Figure 2) in AA by lower smoking years, lower Functional Assessment Questionnaire (FAQ), younger age, higher education, lower neurofilament light (NfL), Apolipoprotein E non‐carriers, low neuropsychiatric inventory (NPI) severity, men, and higher hippocampal volume (AUC = 0.73); in Hispanics with men, lower FAQ, lower Geriatric Depression Scale (GDS), smaller third ventricle, larger hippocampal volume, lower NPI severity, smaller lateral ventricle, and lower NfL (AUC = 0.86); and in Whites, with lower FAQ, higher education, higher alcohol use frequency, lower NfL, lower GDS, smaller lateral ventricles, and low white matter hyperintensities (AUC = 0.82).ConclusionWe observed similarities and differences in predictors to discriminate low versus high memory performers in three ethnoracial groups. Identifying relative importance of risk factors will promote the integration of multimodal risk factors across ethnoracial groups to develop novel and complex risk profiles leading to early detection and identification of asymptomatic or preclinical older adults.