Functional Impairment In Individuals Research Articles

Reliability and validity of the online application of London Chest Activity of Daily Living scale in assessing dyspnea-related functional impairment in individuals after hospitalization for COVID-19

Purpose To investigate the test-retest reliability and construct validity of the LCADL scale applied via online form in individuals after hospitalization for COVID-19. Methods Methodological study. After hospitalization for COVID-19 individuals completed the LCADL via online form at two separate times. They also answered the post-COVID-19 Functional Status Scale (PCFS), dyspnea, fatigue, and health perception scales, modified Medical Research Council (MRCm), Short Form Health Survey 36 (SF-36). Hospitalization data were collected from the individual’s medical record. Results 104 individuals participated in the study (57 men, 45.2 ± 11.9 years). The LCADL showed moderately to high test-retest reliability (ICC: 0.73–0.86; p < 0.001), there was no difference in scores between test and retest (p > 0.05), the mean difference between the applications was smaller than the standard error of measurement and the internal consistency was adequate (Cronbach’s α = 0.70–0.94). In addition, it demonstrated adequate construct validity, showing correlations with PCFS, dyspnea perception, fatigue and health scales, mMRC, SF-36, and length of stay in the Intensive Care Unit (p < 0.05). The LCADL as percentage of the total score presented a significant floor effect (25%). Conclusion The LCADL applied online was reliable and valid for assessing limitations due to dyspnea in ADL in individuals after hospitalization for COVID-19.

The Digital Clock Drawing Test and Delayed Recall Predict Informant‐Rated Functional Impairment in Individuals with Cognitive Impairment

AbstractBackgroundNearly 6.7 million people aged 65 and older in the US are living with Alzheimer’s disease (AD). Early detection of dementia presents a difficult challenge, as the earliest signs of cognitive decline often go undetected. Thus, more sensitive and clinically meaningful cognitive screening tools are needed. Evaluating the patient’s dependence in activities of daily living is critical to detect progression toward dementia. The Linus Health DCTclock™ employs AI‐enabled analyses of the clock drawing process to evaluate cognitive and motor function. We evaluated the utility of four DCTclock composite scales including Spatial Reasoning, Drawing Efficiency, Information Processing, and Motor Skills, 22 DCTclock subscales, and the 3‐word Delayed Recall score from the Digital Clock and Recall (DCR™) to predict the informant‐rated functional activities questionnaire (FAQ) score in older adults ranging from cognitively unimpaired to individuals with mild cognitive impairment (MCI) and AD‐related dementia (ADRD).Method939 participants in a multisite study (age mean±SD = 72.1±6.7; 57.1% female; years of education mean±SD = 15.4±2.7; primary language English), classified as cognitively unimpaired (n = 406), MCI (n = 293), or ADRD (n = 238) were included. We conducted cross‐validated regularized logistic regressions with FAQ score ≥6 or ≥9 (mild or moderate functional impairment, respectively) as dependent variable and DCTclock composite scales, subscales, and Delayed Recall score as predictors, in addition to age, sex, and education.ResultCombination of DCTclock subscales and Delayed Recall predicted FAQ≥6 and ≥9 with AUCs = 0.79 and 0.81, respectively. DCTclock composite scales predicted FAQ≥ 6 and ≥9 with AUCs = 0.75 and 0.77, respectively. Combination of DCTclock composite scales and Delayed Recall predicted FAQ≥6 and ≥9 with AUCs = 0.77 and 0.79, respectively. DCTclock subscales by themselves predicted FAQ≥6 and ≥9 with AUCs = 0.77 and 0.79, respectively.ConclusionThe DCR, a brief digital cognitive assessment with automatic scoring that can be completed in primary‐care settings, can infer the effect of cognitive impairment on a patient’s functional activity with great accuracy and within a few minutes. This makes the DCR an empowering tool for primary‐care providers in practical evaluation of patients with cognitive impairment.

25 Biases in Informant Ratings of Functional Abilities in Mild Cognitive Impairment: Predictors of Caregiver-Rated Functional Abilities While Controlling for Patient Objective Cognitive Status

Objective:An understanding of factors that contribute to informant ratings of patients’ functional abilities is crucial, not only because these ratings are used to diagnose individuals with mild cognitive impairment (MCI) versus dementia, but also because these ratings are commonly used as outcome measures in clinical trials. While these ratings are assumed to be largely accurate, research shows they are subject to biases. Caregiver distress, higher caregiver educational attainment, and higher patient age are associated with a higher discrepancy between informant and patient reports of functional abilities. Studies on informant ratings of functional abilities that simultaneously control for patient objective cognitive abilities remain sparse. The current study aims to evaluate caregiver characteristics as predictors of informant-rated functional status while controlling for patient objective cognitive abilities in MCI.Participants and Methods:Individuals with a clinical diagnosis of MCI (Albert, 2011 criteria) were referred to the Cognitive Empowerment Program (CEP), a comprehensive lifestyle program addressing modifiable risk factors associated with progression. This study included cross-sectional data from 118 newly enrolled individuals and their caregivers who served as informants. Patient cognitive functioning was assessed with the Montreal Cognitive Assessment (MoCA). Predictors of interest included caregiver-rated functional abilities (Functional Activities Questionnaire; FAQ), caregiver burden (Zarit Burden Interview; ZBD), caregiver depressive symptoms (Center for Epidemiological Studies Depression scale; CES-D), caregiver stress (Perceived Stress Scale; PSS), and caregivers’ self-rated communicative effectiveness (Communicative Effectiveness Index; CETI). Hierarchical linear regression models were run to predict FAQ while controlling for patient MoCA scores. Separate models were run for the caregiver variables of interest including caregiver age, ZBD, CES-D, PSS, and CETI.Results:Caregivers were 75.6% spouses, 17.1% adult children, 3.3% unmarried partners/cohabitating partners, and 4.1% friends. The mean age of individuals with MCI was 74.7 years (SD: 6.96, mean education = 16.2±2.60 years; 47% female) and the mean age of caregivers was 66.4 (SD: 12.88, mean education = 16.3±2.34; 66% female). Worse ratings of functional abilities on the informant-rated FAQ were found for patients with lower MoCA scores (ß = .242, p = .008). Importantly, while controlling for MoCA scores, worse ratings of functional abilities on the FAQ were found for informants with lower age (ß = -0.269, p = .003), higher perceived stress (ß = 0.267, p = .003), higher caregiver burden (ß = 0.289, p &lt; 0.001), and lower self-rated communication effectiveness (ß = -0.324, p &lt; .001). Caregiver depression (ß = 0.089, p = .084) and education (ß = -0.137, p = .147) were not significant predictors of functional ability ratings while controlling for MoCA scores.Conclusions:Results of the current study highlight the potential for biases in informant ratings regarding functional abilities in MCI. Informant ratings were found to be significantly influenced by caregiver age, stress, burden, and communicative effectiveness. A key finding is that younger caregivers, such as adult children, may report greater functional impairment in individuals with MCI. The current findings have implications for the use of perceived functional ratings, both for diagnostic purposes and as outcome measures in clinical trials.

Does the slope and length of the plantar calcaneal spur affect the clinic?

Since some of the patients with plantar calcaneal spur (PCS) do not have pain, we aimed to investigate the effect of the slope and length of the spur on this situation. The length and slope of PCS were measured by examining the radiological images of 50 patients in this prospective study. VAS, AOFAS and FFI scores of the patients were determined. Patients were divided into groups according to PCS length and slope. According to the slope of the spur, the mean AOFAS, FFI and VAS scores were, respectively; 94, 38, 1.3 in below 20 degrees; 80.1, 86.8, 4.8 in 20-30 degrees; and 70.1, 106, 6.7 in above 30 degrees. According to the length of the spur, the mean AOFAS, FFI and VAS scores were respectively; 84.9, 68.2, 3.7 in those with length 0-5 mm; 81.1, 81.7, 4.5 in those with a length of 5-10 mm; and 71.7, 102.5, 6.4 in those with a length of >10 mm. A significant correlation was found between the angle and length of the PCS with the values of VAS, AOFAS and FFI (p<0.05). We observed that PCSs with a slope of less than 30 degrees and shorter than 10 mm do not create a serious clinical picture. If there is severe pain and functional impairment in individuals with this characteristic spur, investigation of other possible causes of heel pain must be considered.

Posttraumatic stress disorder and functional impairment among World Trade Center Health Registry enrollees 14-15 years after the September 11, 2001, terrorist attacks.

The September 11, 2001, terrorist attacks on the World Trade Center (WTC) in New York City (9/11) had health-related consequences, including posttraumatic stress disorder (PTSD). PTSD is associated with functional impairment, which varies by symptom severity and other factors. This study aimed to identify predictors of functional impairment in individuals with low versus high PTSD symptom severity levels. WTC Health Registry enrollees exposed to 9/11 were surveyed four times between 2003 and 2015; cumulated data for individuals who endorsed at least one symptom on the PTSD Checklist-Civilian Version (PCL-C) at Wave 4 (2015-2016) were included (N = 30,287) and examined cross-sectionally. Individuals were classified based on PCL-C scores as having low/no (2-29) or high levels of PTSD symptom severity (≥ 44). Functional impairment was defined as subsequent difficulties in daily living. Among low/no PTSD severity participants, adjusted odds ratios (aORs) for the associations between functional impairment and poor self-rated health (vs. good), low social support (vs. high), and no physical activity (vs. active) were 1.23-1.92. In the same group, low versus high household income was associated with more functional impairment, aOR = 1.34, 95% CI [1.13, 1.59]. Among participants with high-level PTSD symptoms, women, aOR = 1.70, 95% CI [1.31, 2.20], and Hispanic enrollees, aOR = 1.76, 95% CI [1.31, 2.36], were more likely to report an absence of impairment. Self-rated health, social support, and physical activity emerged as important predictors of PTSD-related functional impairment across PTSD symptom severity levels, supporting clinical interventions targeting these factors.

Influence of a Sacroiliac Belt on Pain and Functional Impairment in Patients With Low Back Pain: A Randomized Trial

ObjectiveThe purpose of this study was to assess the protective influence of the Serola Sacroiliac Belt on pain and functional impairment in individuals with low back pain (LBP) during 5 days of strenuous manual labor. MethodsThirty-three participants (mean ± standard deviation: age, 43.2 ± 11.4 years; height, 1.74 ± 0.11 m; body mass index, 88.3 ± 16.7 kg) with LBP were randomized to either condition A (wearing the Serola Sacroiliac Belt during a 10-minute daily repeated strenuous lifting task) during week 1 or condition B (not wearing a Serola Sacroiliac Belt during the same lifting task) in week 2 or vice versa. All 33 participants completed 1 week under condition A and 1 week under condition B for comparison. At the beginning and end of each week, the following dependent variables were measured: lumbar spine pain on a 0 to 10 Numeric Rating Scale (NRS), spine and thigh discomfort on a Nordic Musculoskeletal Questionnaire, and completion of a toe-touch surface electromyography flexion relaxation phenomenon test. ResultsDuring the week that participants used the Serola Sacroiliac Belt, spine pain increased 0.2 compared with 0.9 on the NRS for those who did not use the belt. No statistically significant difference was observed for Nordic Musculoskeletal Questionnaire data or the flexion relaxation phenomenon test in this study. ConclusionThe findings of this preliminary study suggest participants using the Serola Sacroiliac Belt while performing a daily repeated lifting task had less progression of their LBP. However, this protective value did not meet the recommended NRS for minimally clinically important difference, and there was no effect on functional impairment.

EFFECT OF MIRROR THERAPY VERSUS REPETITIVE FACILITATION EXERCISE ON UPPER LIMB FUNCTION IN POST STROKE PATIENT

Objective: To compare the effects of task-based mirror therapy and Repetitive Facilitation Exercise on upper limb function in post stroke patient. Methodology: A randomized controlled trial was conducted in Pakistan Railway general hospital, Rawalpindi. The duration of this study was from 10th July to 31st December 2019. Non-probability purposive sampling technique was used with n=50 male and female subacute and chronic post-stroke patients between 40-50 years. The patients with Modified Ashworth Scale &lt;3 and the first-ever stroke was included. The participants were randomly divided by the sealed envelope method into mirror therapy group (n=25) and Repetitive Facilitation Exercise group (n=25). The Upper extremity functional index (UEFI) was used to assess the functional impairment in individuals with upper limb dysfunction, Fugl Meyer (FMA-UE) for assessment of activity in post stroke patients, “Wolf Motor Function Test (WMFT) for upper extremity performance and functional capability” and Brunnstrom recovery scale (BRS) for motor function of the upper limb was used in a post stroke patient. All the patients were assessed at baseline than after 3 weeks and again after 6week for interventional session of 30 min,3 days of the week. Data were analyzed through SPSS version 23. Results: The mean age of Group A (MT) was 50.97±6.741 and 49.76±12.66 of Group B (RFE). After 6 weeks of intervention between groups analysis of Task-based mirror therapy showed significant improvement in mirror therapy group as compare to Repetitive Facilitation Exercise group ,for upper extremity functional index scores(p&lt;0.001) but for motor assessment(FMA-UE), Wolf Motor Function Test (WMFT) and for stroke recovery (Brunnstrom) no statistically significant difference (p≥0.05) was found. Within-group analysis of both groups showed statistically significant results in all variables (p&lt;0.001). Conclusion: Mirror therapy and Repetitive facilitation Exercise both were found to be effective in improving upper limb motor functions of acute stroke patients. However, Mirror therapy has shown significant effects in upper extremity functional index. Keywords: Mirror therapy, Physical therapy, Repetitive Facilitation Exercise, Stroke, Upper extremity.

To Compare the Effectiveness of Muscle Energy Technique and Deep Neck Flexors Training on Pain, Range of Motion and Functional Disability in Patients with Mechanical Neck Pain

The goal of this study was to examine the effectiveness of muscular energy method with deep neck flexors training on pain, range of motion, and functional impairment in individuals with mechanical neck pain. This randomized controlled trial was carried out at the Mayo Hospital's OPD physiotherapy department in Lahore. In this study, 30 patients were chosen at random and divided into two groups: Group 1 was treated with deep neck flexors training, while Group 2 was treated with muscular energy method (post isometric relaxation). Every patient signed a Performa and gave their informed permission. The questioner used to collect data was based on the NDI, Visual analogue scale (VAS), and Ranges of motion (flexion, extension, rotation, and side bending at neck). Patients in group 1 showed marked improvement as compared to group 2. Both groups showed improvement but group 1 showed statistically more improvement (p value&lt;or =to 0.05). It is concluded from the study that, patients with mechanical neck pain, when treated by deep neck flexors training showed a significant treatment outcome when analyzed on VAS, NDI, and Goniometer for ROM. When Group 1 and 2 were compared, it was seen that Group 1 showed more significant results than group 2.

Functional and cognitive impairment in the first episode of depression: A systematic review.

To describe the cognitive and functional impairment in individuals with the first episode of major depressive disorder (MDD) as compared to controls and individuals with recurrent MDD. Also to describe the functional and cognitive trajectory after the first episode of MDD. A total of 52studies were included in our systematic review. 32studies compared the cognitive performance between first episode of depression (FED) and controls, 11studies compared the cognitive performance between recurrent depression (RD) and FED, 10 compared global functioning between RD and FED, fourstudies assessed cognition in FED over time, and twostudies assessed global functioning in FED over time. The majority of studies (n=22/32, 68.8%) found that FED subjects performed significantly worse than controls on cognitive tests, with processing speed (n=12) and executive/working memory (n=11) being the most commonly impaired domains. Seven out of 11studies (63.6%) found that RD performed significantly worse than FED, with verbal learning and memory being the most commonly impaired domain (n=4). Most studies (n=7/10, 70%) did not find a significant difference in global functioning between RD and FED. In three of fourlongitudinal studies assessing cognition, subgroup analyses were used instead of directly assessing cognition in FED over time while the remaining study found significant cognitive declines over time in FED when compared to controls. The two longitudinal studies assessing functional trajectory found that functioning significantly improved over time, possibly due to the improvement of depressive symptoms. There is strong evidence that cognitive impairment is present during the first episode of depression, and individuals with multiple episodes display greater cognitive impairment than individuals with a single episode. Future studies aimed at identifying predictors of cognitive and functional impairment after the first episode of depression are needed to describe the functional and cognitive trajectory of individuals with the first episode of MDD over time.

Headache Characteristics and Psychological Factors Associated with Functional Impairment in Individuals with Persistent Posttraumatic Headache.

Persistent posttraumatic headache (PPTH), one of the most common symptoms following mild traumatic brain injury, is often associated with substantial functional disability. The objective of this study was to assess the contribution of demographics, headache characteristics, and psychological symptoms to disability associated with PPTH. Participants completed the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Pain Catastrophizing Scale (PCS), and the Migraine Disability Assessment (MIDAS) questionnaire. Two linear regression models were formulated to interrogate the relationships between 1) demographics and headache characteristics with the MIDAS questionnaire and 2) demographics, headache characteristics, and psychological symptoms with the MIDAS questionnaire. A two-way stepwise regression using the Akaike information criterion was performed to find a parsimonious model describing the relationships between demographics, headache characteristics, and psychological measures with the MIDAS questionnaire. Participants included 58 patients with PPTH and 39 healthy controls (HCs). The median MIDAS score among those with PPTH was 48.0 (first quartile [1Q] = 20.0, third quartile [3Q] = 92.0), indicative of severe disability. Compared with the HCs, those with PPTH had higher scores on the BDI, STAI, and PCS. Older age predicted lower MIDAS scores (age: B=-0.11, P<0.01), whereas higher headache frequency, greater headache intensity, and higher trait anxiety scores predicted higher MIDAS scores in individuals with PPTH (headache frequency: B=0.07, P<0.001; headache intensity: B=0.51, P=0.04; trait anxiety score: B=1.11, P=0.01). Individuals with PPTH had substantial psychological symptoms and headache-related disability. Disability was partially explained by age, headache frequency and intensity, and trait anxiety. Holistic management of patients with PPTH to address headaches and psychological symptoms might reduce headache-associated disability.

A multicenter, observational study of pain and functional impairment in individuals with major depressive disorder in partial remission: the DESIRE study

Background: The study explores the association between pain and functional impairment in patients with partially remitted MDD, considering both clinician and patient reported outcomes.Methods: Multicenter, observational, and cross-sectional study, with 583 outpatients with partially remitted MDD. Measures of pain intensity (VAS), functional impairment (SOFAS), depressive symptomatology (HAM-D6), and remission from MDD and functional status from a patient-centered perspective (RDQ) were collected. VAS scores (cut-off: 30) were used to divide the sample in two groups: no pain (n = 274) and pain (n = 309). Descriptive data, correlation and regression analyses were obtained.Results: Functional impairment (SOFAS) and pain (VAS) were negatively and significantly correlated in the total sample, and in the group with pain. Lower pain predicted higher functioning. The pain sub-sample was older, less educated, with higher medical comorbidities, higher HAM-D6 scores, and lower functionality (SOFAS). In the RDQ, the pain group showed significantly higher scores in the symptom-related subscales, and lower scores in the subscales related to positive mental health, functioning and wellbeing.Limitations: Correlational and observational design. The criteria and instruments used to measure pain and to define a threshold might limit the generalizability of findings.Conclusions: Pain and functionality should be assessed and treated in patients with MDD in partial remission. Our results indicate that functionality should be assessed with a broader perspective, that also considers positive mental health features.

Symptom Clusters and Functional Impairment in Individuals Treated for Lyme Borreliosis.

Context: Persistent fatigue, pain, and neurocognitive impairment are common in individuals following treatment for Lyme borreliosis (LB). Poor sleep, depression, visual disturbance, and sensory neuropathies have also been reported. The cause of these symptoms is unclear, and widely accepted effective treatment strategies are lacking.Objectives: To identify symptom clusters in people with persistent symptoms previously treated for LB and to examine the relationship between symptom severity and perceived disability.Methods: This was a retrospective chart review of individuals with a history of treatment of LB referred to The Dean Center for Tick-Borne Illness at Spaulding Rehabilitation Hospital between 2015 and 2018 (n = 270) because of persistent symptoms. Symptoms and functional impairment were collected using the General Symptom Questionnaire-30 (GSQ-30), and the Sheehan Disability Scale. Clinical tests were conducted to evaluate for tick-borne co-infections and to rule out medical disorders that could mimic LB symptomatology. Exploratory factor analysis was performed to identify symptom clusters.Results: Five symptom clusters were identified. Each cluster was assigned a name to reflect the possible underlying etiology and was based on the majority of the symptoms in the cluster: the neuropathy symptom cluster, sleep-fatigue symptom cluster, migraine symptom cluster, cognitive symptom cluster, and mood symptom cluster. Symptom severity for each symptom cluster was positively associated with global functional impairment (p < 0.001).Conclusion: Identifying the interrelationship between symptoms in post-treatment LB in a cluster can aid in the identification of the etiological basis of these symptoms and could lead to more effective symptom management strategies.Key Message: This article describes symptom clusters in individuals with a history of Lyme borreliosis. Five clusters were identified: sleep-fatigue, neuropathy, migraine-like, cognition, and mood clusters. Identifying the interrelationship between symptoms in each of the identified clusters could aid in more effective symptom management through identifying triggering symptoms or an underlying etiology.

Childhood Trauma and Psychosis: An Updated Review.

There is growing evidence to support the link between childhood trauma and psychosis. Childhood trauma increases the risk for psychosis and affects severity and type of psychotic symptoms, and frequency of comorbid conditions, including depression and substance use. Childhood trauma is linked to more severe functional impairment in individuals with psychosis. There is evidence to support gender differences in the influence of childhood trauma on the course of psychotic illnesses, appearing to be more profound in girls and women. Other biological markers that may explain the link between childhood trauma and psychosis include brain-derived neurotrophic factor and other inflammatory markers.

The Effect of Partial and Chronic Sleep Deprivation on Working Memory and Attention in Emergency Medicine Interns

Background: Sleep is an organized behavior that is repeated every day as a vital necessity based on the biological rhythm. Sleep deprivation is known as one of the major problems that can cause functional impairment in individuals. Therefore, it is expected that sleep deprivation in interns also causes problems in their performance. Objectives: According to the importance of cognitive health in health care workers, we decided to study the effects of partial and chronic sleep deprivation on attention and working memory in the emergency medicine interns in Yazd University of Medical Sciences. Methods: The number of 50 emergency medicine interns were randomly selected and their demographic information was entered the data collection form. The subjects were examined before and after the one-month period of the shift work. Working memory and attention in participants were compared with the application of working memory and attention tests in 2-time points. Finally, the collected data were entered the SPSS software version 16 and statistical tests were performed subsequently. Results: The results showed that there is no significant difference between the mean of direct and reverse auditory working memory, direct and reverse visual working memory, as well as the divided attention of participants before and after the one-month period of the shift work, but there was a significant difference between the average of selective attention of participants before and after the one-month period of the shift work (P value < 0.05). Also, this study showed that, regardless of the effect of sleep deprivation, the mean of divided attention and working memory are different between males and females. Conclusions: According to the results of the study, it can be concluded that the type of sleep deprivation in the emergency medicine interns only reduces the selective attention and this effect was not dependent on the gender.

Cognitive Impairment in Schizophrenia: Current Perspective

Impairments in a variety of cognitive functions are found in patients with schizophrenia. These impairments affect a wide array of different cognitive abilities and are often of moderate to severe degree. Cognitive impairments appear to present across lifespan, detectable at the time of first episode of illness, probably predate the illness and manifest a generally stable course over time.Though cognitive impairment does not form a part of diagnostic criteria, it has been included in DSM-V and proposed to be included in ICD-11 as a schizophrenia course specifier. This review attempts to provide a broad overview of the domains, onset, severity and course of cognitive impairments in schizophrenia, with a focus on functional relevance and treatment possibilities. There is strong evidence for a relationship between cognitive impairment and vocational and functional impairment in individuals with schizophrenia.

Effect of maitland mobilization in cervical and thoracic spine and therapeutic exercise on functional impairment in individuals with chronic neck pain.

[Purpose] This study evaluated joint mobilization and therapeutic exercise applied to the cervical spine and upper thoracic spine for functional impairment caused by chronic neck pain. [Subjects and Methods] Eighteen study subjects were randomly assigned to two groups of nine people each. Therapeutic exercise only was applied to the cervical and upper thoracic spine for Group I, while both therapeutic exercise and joint mobilization were applied to Group II. The visual analog scale, neck disability index, active cervical range of motion, static balance capacity, and muscle tone were assessed with a pre-test. The intervention was carried out for 60 minutes a day, three times a week, for two weeks for each group, followed by a post-test using the same protocol as the pre-test. [Results] The visual analog scale, neck disability index, and active cervical range of motion improved significantly in both groups. Group II improved significantly more on right lateral flexion and rightward rotation. Muscle tone improved significantly in the upper trapezius in both groups. [Conclusion] The joint mobilization and therapeutic exercise for functional impairments caused by chronic neck pain had a significant effect on several types of functional impairment.

Critical appraisal of questionnaires to assess functional impairment in individuals with mild cognitive impairment.

Mild deficits in instrumental activities of daily living (IADLs) have consistently been reported in the individuals with mild cognitive impairment (MCI). A variety of functional assessment tools, including self-and informant report questionnaires and performance-based measures, have been employed in MCI. Previously, a limited focus has been directed at appraising the quality of questionnaires. The goal of this study was to identify the questionnaires that have been validated in the MCI population. Additionally, the quality of validation studies and psychometric attributes of these questionnaires were appraised. Relevant articles were systematically searched in PsychINFO, Ovid MEDLINE, and CINAHL against specific eligibility criteria. To evaluate the methodology of the psychometric studies, the COSMIN checklist was employed. Also, the psychometric properties of the assessment tools were evaluated based upon Terwee's criteria. A total of five psychometric studies and questionnaires were critically evaluated. Varying psychometric properties were available for the chosen tools. None of the studies received the best possible rating for their methodological quality. It was found that questionnaires with high discriminative ability to distinguish MCI from other diagnostic groups were: Disability Assessment in Dementia-6 (DAD-6), Functional Activity Questionnaire (FAQ), and Alzheimer's Disease Cooperative Study/Activities of Daily Living scale adapted for MCI patients (ADCS-MCI-ADL-24). Psychometric studies with strong methodological rigor are required in the future. Considering the fact that IADL decline has been associated with dementia, early detection of functional difficulties in MCI needs to be encouraged as it will allow suitable and timely interventions to prolong functional independence of affected individuals.

Assessing functional impairment in individuals with mild cognitive impairment

To date, there is no consensus on how to assess functional impairment in individuals with mild cognitive impairment (MCI), and this lack of consensus is reflected in the clinical practice. Since the criterion used in the literature is very vague, clinicians are still left without much guidance in this area. Thus, the main goal of this study was to examine how functional impairment in individuals with MCI has been assessed in the literature. An electronic database search strategy was developed in consultation with an experienced librarian. Four databases (CINAHL, PsycINFO, PubMed, and MEDLINE) were searched from 2000 to May 2014 to provide a comprehensive coverage of the literature. The literature search yielded 14 tools that assessed functional impairment in MCI. Among those, nine tools were performance-based measures in which participants were observed while executing a task in a simulated environment using real life material. In terms of questionnaires (either informantor self-reports), five tools were found. Different functional domains have been assessed in each tool. According to this review, the characteristics of the instruments used in the literature to assess functional impairment in individuals with MCI vary greatly. Nonetheless, results of this study allow clinicians to make better-informed decisions when choosing a functional assessment for this population.

The relationship between neurocognitive and psychosocial functioning in major depressive disorder: a systematic review.

Neurocognitive deficits are demonstrated in major depressive disorder (MDD) and most likely contribute to the functional impairment experienced by affected individuals. We systematically reviewed the evidence on neurocognitive deficits and their relationship(s) to psychosocial functioning in MDD. English-language literature was searched in MEDLINE, EMBASE, Science Direct, and PsycInfo databases for the years 1980-October 15, 2013, with the following terms: (depressive disorder or depressive disorder, major) and permutations of (cognitive, neurocognitive, neuropsych*) with (impairment, deficit, performance, test) and (quality of life; functional outcomes; outcome assessment, health care) or (assessment, outcomes; assessment, patient outcomes; outcomes assessment; outcomes assessments, patient). Inclusion criteria were (1) nongeriatric adults (< 60 years) with a primary diagnosis of MDD by DSM-IV, ICD-9, or ICD-10 criteria; (2) use of neuropsychological tests; and (3) use of a specific measure of social, occupational, or daily functioning. Of 488 articles identified in the initial search, 10 met the inclusion criteria. Two independent appraisers assessed eligibility of the studies. Substantial heterogeneity in the samples and methods precluded a quantitative meta-analysis, so we performed a narrative descriptive review. The included studies employed a variety of neurocognitive tests and assessments of psychosocial functioning. Overall, depressed samples had neurocognitive deficits in various domains that were associated with different measures of psychosocial functioning. However, these findings were constrained by methodological limitations of studies. The limited evidence base suggests that neurocognitive functioning appears to be broadly associated with functional impairment in individuals with MDD, but the quality of evidence is weak. Further studies to clarify the relationship(s) between neurocognitive and psychosocial functioning in MDD will benefit from larger and more homogeneous samples, prospective designs with multivariate analyses, and use of comprehensive assessments of psychosocial functioning that are validated in depressed populations.

Hand Function in Adults with Radial Longitudinal Deficiency

Functional impairment in individuals with radial longitudinal deficiency can be influenced by several factors, including a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited finger motion, and impaired grip strength, but their relationship with activity and participation in adults with radial deficiency is not known. Twenty individuals, eighteen to sixty years of age, who had Bayne type-II to V radial longitudinal deficiency, were examined in the context of the International Classification of Functioning, Disability and Health. Body function and structure were evaluated by measures of range of motion, grip strength, key pinch, sensibility, and radiographic parameters. Activity was evaluated by the Box and Block Test and the Sollerman test, and participation was evaluated by QuickDASH (the short form of the Disabilities of Arm, Shoulder and Hand outcome measure) and by the Medical Outcomes Study 12-Item Short Form Health Survey. Statistical correlations among assessments of body function and structure, activity, and participation were examined. The mean total active motion of the wrist (43°) and mean total active motion of the digits (377°) were less than the norms. The mean radial deviation of the wrist was 31°. The mean grip strength (4.0 kg), key pinch (1.4 kg), and scores for the Box and Block Test (55 blocks per minute) and the Sollerman test on hand function (56 points) were considerably lower than the norms. The mean scores were 18 points for QuickDASH, 51 points for Short Form-12 physical component summary, and 53 points for Short Form-12 mental component summary. Significant relationships were found between the Box and Block Test and grip strength (p = 0.012), key pinch (p < 0.001), and total active motion of digits (p < 0.001); between the Sollerman test and the total active motion of elbow (p < 0.001) and the total active motion of digits (p < 0.001); between the QuickDASH and forearm length (p < 0.001), the total active motion of elbow (p = 0.001), and the total active motion of digits (p < 0.001); between the Short Form-12 physical component summary and grip strength (p = 0.016), forearm length (p < 0.001), total active elbow motion (p < 0.001), and total active digit motion (p < 0.001); and between the Short-Form-12 mental component summary and radial deviation of the wrist (p = 0.019). No significant correlations were found between the radiographic measurement of the radial deviation of the wrist (total forearm angle) and the Box and Block Test (p = 0.244), the Sollerman test (p = 0.775), QuickDASH (p = 0.156), Short Form-12 physical component summary (p = 0.107), or Short Form-12 mental component summary (p = 0.129). In individuals with radial longitudinal deficiency, grip strength, key pinch, forearm length, and elbow and digital motion seem to be more important for the individual's activity and participation than the radial angulation of the wrist. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.