Functional Outcomes In People Research Articles

Neural Basis for the Ability of Atypical Antipsychotic Drugs to Improve Cognition in Schizophrenia

Cognitive impairments are considered to largely affect functional outcome in patients with schizophrenia, other psychotic illnesses, or mood disorders. Specifically, there is much attention to the role of psychotropic compounds acting on serotonin (5-HT) receptors in ameliorating cognitive deficits of schizophrenia. It is noteworthy that atypical antipsychotic drugs (AAPDs), e.g., clozapine, melperone, risperidone, olanzapine, quetiapine, aripiprazole, perospirone, blonanserin, and lurasidone, have variable affinities for these receptors. Among the 5-HT receptor subtypes, the 5-HT1A receptor is attracting particular interests as a potential target for enhancing cognition, based on preclinical and clinical evidence. The neural network underlying the ability of 5-HT1A agonists to treat cognitive impairments of schizophrenia likely includes dopamine, glutamate, and gamma-aminobutyric acid neurons. A novel strategy for cognitive enhancement in psychosis may be benefited by focusing on energy metabolism in the brain. In this context, lactate plays a major role, and has been shown to protect neurons against oxidative and other stressors. In particular, our data indicate chronic treatment with tandospirone, a partial 5-HT1A agonist, recover stress-induced lactate production in the prefrontal cortex of a rat model of schizophrenia. Recent advances of electrophysiological measures, e.g., event-related potentials, and their imaging have provided insights into facilitative effects on cognition of some AAPDs acting directly or indirectly on 5-HT1A receptors. These findings are expected to promote the development of novel therapeutics for the improvement of functional outcome in people with schizophrenia.

Facilitative Effect of Serotonin1A Receptor Agonists on Cognition in Patients with Schizophrenia

Disturbances of cognitive function are considered to largely affect the outcome in patients with schizophrenia. There is much attention to the role of psychotropic compounds acting on serotonin (5-HT) receptors in ameliorating cognitive deficits of the disease. Among the 5-HT receptor subtypes, the 5-HT(1A) receptor is attracting particular interests as a potential target for enhancing cognition, based on preclinical and clinical evidence. The neural network underlying the ability of 5-HT(1A) agonists to treat cognitive impairments of schizophrenia likely includes dopamine, glutamate, and gamma-aminobutyric acid neurons. Recent advances of electrophysiological measures, such as event-related potentials, have provided insights into facilitative effects on cognition of some atypical antipsychotic drugs or related compounds acting directly or indirectly on 5-HT(1A) receptors. These considerations are expected to promote the development of novel therapeutics for the betterment of functional outcome in people suffering from schizophrenia.

Review: emotion identification deficits are associated with functional impairments in people with schizophrenia

QUESTION Question: What is the strength of the relationship between emotional perception and function in people with schizophrenia and what factors moderate this relationship? Outcomes: Strength of the association between...

The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis

Osteoarthritis (OA) is a leading cause of functional impairment and pain. Proprioceptive defects may be associated with the onset and progression of OA of the knee. The purpose of this study was to determine the effectiveness of proprioceptive exercises for knee OA using meta-analysis. A systematic review was conducted on 12th December 2011 using published (Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, PubMed, PEDro) and unpublished/trial registry (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials and the UK National Research Register Archive) databases. Studies were included if they were full publications of randomized or non-randomised controlled trials (RCT) comparing a proprioceptive exercise regime, against a non-proprioceptive exercise programme or non-treatment control for adults with knee OA. Methodological appraisal was performed using the PEDro checklist. Seven RCTs including 560 participants (203 males and 357 females) with a mean age of 63 years were eligible. The methodological quality of the evidence base was moderate. Compared to a non-treatment control, proprioceptive exercises significantly improved functional outcomes in people with knee OA during the first 8 weeks following commencement of their exercises (p < 0.02). When compared against a general non-proprioceptive exercise programme, proprioceptive exercises demonstrated similar outcomes, only providing superior results with respect to joint position sense-related measurements such as timed walk over uneven ground (p = 0.03) and joint position angulation error (p < 0.01). Proprioceptive exercises are efficacious in the treatment of knee OA. There is some evidence to indicate the effectiveness of proprioceptive exercises compared to general strengthening exercises in functional outcomes.

A Combined Early Cognitive and Physical Rehabilitation Program for People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial

In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown. The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units. This is a randomized controlled trial. The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center. The participants will be patients who are critically ill with respiratory failure or shock. Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter-number sequences, pattern recognition). Daily physical rehabilitation sessions will advance patients from passive range of motion exercises through ambulation. Patients with cognitive or physical impairment at discharge will undergo a 12-week, in-home cognitive rehabilitation program. A battery of neurocognitive and functional outcomes will be measured 3 and 12 months after hospital discharge. If feasible, these interventions will lay the groundwork for a larger, multicenter trial to determine their efficacy.

Maximising adherence to study protocol within pharmaco-rehabilitation clinical trials

Background The Dopamine Augmented Rehabilitation in Stroke (DARS) trial is a double-blind placebo controlled trial investigating impact of co-careldopa/placebo in combination with routine NHS occupational/physical therapy on functional outcome in people with acute stroke. The trial involves participants taking Investigational Medicinal Product (IMP)/placebo prior to therapy sessions while in the acute stroke unit and following hospital discharge Stroke survivors may have significant residual impairments such as weakness, aphasia, visual disturbance, cognitive problems and mood disorders which may affect their ability to comply with DARS medication/ therapy schedule.

Outcome in early-onset schizophrenia revisited: Findings from the Early Psychosis Prevention and Intervention Centre long-term follow-up study

Objective To compare the long-term outcome in individuals with early-onset (before age 18) and adult-onset schizophrenia spectrum disorder who were initially diagnosed and treated in the same clinical center. Method A prospective follow-up study of 723 consecutive first-episode psychosis patients (age range 14 to 30 years) on average 7.4 years after initial presentation to an early psychosis service, the Early Psychosis Prevention and Intervention Centre in Melbourne, Australia. The outcome measures included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Negative Symptoms, the Beck Depression Inventory, the Global Assessment of Functioning Scale, the Social and Occupational Functioning Assessment Scale, and the Quality of Life Scale. Results Follow-up interviews were conducted on 66.9% (484/723) individuals, of whom 75.6% (366/484) received a schizophrenia spectrum disorder diagnosis at baseline. Early-onset schizophrenia spectrum disorder was observed in 11.2% (41/366). At follow-up, individuals with early-onset reported significantly fewer positive symptoms and were characterised by significantly superior functioning on measures assessing global functioning, social-occupational functioning, and community functioning than individuals with adult-onset. The early-onset group also achieved significantly better vocational outcomes and had a more favourable course of illness with fewer psychotic episodes over the last two years prior to follow-up. Finally, when investigated as a continuous variable, younger age at onset significantly correlated with better symptomatic and functional outcomes. Conclusions These results question the assumption that early-onset schizophrenia typically has a poor outcome. Early detection and specialised treatment for the first psychotic episode appear to be more effective at improving long-term functional outcomes in people with early-onset schizophrenia as in those with adult-onset schizophrenia. This possibility and the reasons for it need further investigation.

Physical Fitness Training for Patients With Stroke

Physical Fitness Training for Patients With Stroke

The influence of temperament on symptoms and functional outcome in people with psychosis in the Northern Finland 1966 Birth Cohort

Objective To describe symptom expression and functional outcome in psychotic disorders in relation with temperament traits assessed with the Temperament and Character Inventory (TCI) in a population-based sample. Method As part of the 31-year follow-up survey of the Northern Finland 1966 Birth Cohort, TCI temperament items were filled in by 4349 members of the cohort. In individuals with psychotic disorders, also positive and negative symptoms and outcome variables were assessed in a 35-year follow-up. Information of TCI and outcomes were available for altogether 41 individuals with psychosis. Result Reward dependence (RD) (rho = −0.45) and Persistence (P) (rho = −0.52) were significantly correlated with Positive and Negative Syndrome Scale (PANSS) negative symptoms. Higher P scores predicted higher social and occupational functioning (as measured by Social and Occupational Functioning Assessment Scale [SOFAS]), and higher Harm avoidance (HA) predicted a higher likelihood of being on a disability pension. Conclusion Results indicate that understanding of personality dimensions support better understanding of outcome and symptom expressions in psychotic disorders.

Spinal Cord Injury: Promise, Progress, and Priorities

Spinal Cord Injury: Promise, Progress, and Priorities from the National Academies' Institute of Medicine proposes a comprehensive research program to enhance neurologic and functional outcomes for people with spinal cord injury (SCI). With funding from the New York State Spinal Cord Injury Board, the Institute of Medicine impanelled a 13-member committee of SCI researchers and advocates that also solicited recommendations from other well-known SCI researchers. The book posits potential for clinical breakthroughs based on recent animal SCI research and outlines a proposal for greater study of basic SCI neurobiology and of neuroplasticity treatment options, coordinated translational trials, and strengthened infrastructure for SCI research. The book most successfully targets persons with SCI, advocates for SCI research, and policy makers. For SCI researchers and SCI clinicians, much of the material is basic review, although the overview may be useful for those new to the field. The chapter on design of clinical trials argues for a traditional “big science” approach with several Centers of Excellence and a National SCI Research Network to be established to facilitate large-scale, multicenter trials. An alternate viewpoint, that exploratory research is often most rapidly and most cost-effectively accomplished on a small scale by many individual basic science researchers and clinician-investigators, is not represented. Many potential therapeutic interventions are addressed, such as preventing secondary neurologic injury, controlling inflammation, promoting axon regrowth, using gene therapy, bridging gaps with transplantation, and restoring impulse conduction. Concerns are raised about the premature clinical use of these new therapies before safety has been fully evaluated (eg, oligodendrocyte-ensheathing glia transplants into the spinal cord of patients with paraplegia). Some areas of SCI research with therapeutic potential are minimally discussed (eg, treatment of incomplete spinal cord injury, neurotransmitters and neurotrophins and their respective receptor changes, plateau potentials, ion-channel alterations, robotics, and brain-computer interfaces). Figures are sparse. The final chapter on state-funded SCI research programs nicely summarizes this less well-known information.

Physical Therapy for Central Vestibular Dysfunction

Brown KE, Whitney SL, Marchetti GF, Wrisley DM, Furman JM. Physical therapy for central vestibular dysfunction. Objective To determine if vestibular physical therapy (PT) leads to improved functional outcomes in people with central vestibular dysfunction. Design Retrospective case series. Setting Outpatient PT clinic. Participants Forty-eight patients with central vestibular dysfunction met the criteria for inclusion in this retrospective chart review. The 48 patients were divided into various subgroups including central vestibulopathy, cerebellar dysfunction, stroke, mixed central and peripheral vestibulopathy, and posttraumatic central disorders. Intervention Patients were treated with a custom-designed PT program for a mean of 5 visits over an average of 5 months. Main Outcome Measures Patients completed the Activities-Specific Balance Confidence Scale, the Dizziness Handicap Inventory (DHI), the Dynamic Gait Index, the Timed Up & Go test, and the Five Times Sit-to-Stand (FTSTS) Test. Results Significant differences were demonstrated between initial evaluation and discharge in each of the assessment measures for the entire group. Post hoc tests were performed to determine if there was a significant difference in any of the assessment measures by diagnosis. Central vestibular diagnostic subgroup was shown to affect pre- to postintervention differences in the functional and disability measures ( P≤.05). With the exception of the FTSTS, effect sizes of change due to PT intervention were greater in those persons with severe disability at baseline as determined by a DHI score of more than 60. Conclusions Patients with central vestibular dysfunctions improved in both subjective and objective measures of balance after PT intervention. Persons with cerebellar dysfunction improved the least.

Review: cholinesterase inhibitors have a modest effect on neuropsychiatric and functional outcomes in Alzheimer’s disease

Trinh NH, Hoblyn J, Mohanty S, Yaffe K. Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis. JAMA2003 Jan; 280 :...

A conceptual review of functioning: implications for the development of consumer outcome measures.

Australia's National Mental Health Strategy aims to achieve improved consumer outcomes. The development and refinement of consumer outcome measures is targeted within the Second National Mental Health Plan. The National Standards for Mental Health Services identify measures of functioning, quality of life and satisfaction with services as relevant to assessing and monitoring consumer outcome. Consumers have described gauging their own recovery through the achievement of functional goals in everyday life. This paper reviews how functioning is viewed within the mental health field, and implications for developing better functional outcome measures. Literature describing the development of measures of functioning, principles of outcome measurement, and functional outcomes for people with severe mental illness was identified, using PsycLIT. A review yielded themes reflecting a number of assumptions about the concept of functioning. Functioning is inadequately defined, raising issues about what is focused on, and from whose viewpoint, each of which has implications for using measures of functioning to monitor consumer outcome. Conflation of dissimilar functional domains, and flawed assumptions about the importance of symptomatology in influencing functional outcome limit the sensitivity to meaningful change of functional measures. Consumer perspectives are relatively neglected in functional tool development. A conceptual framework that recognizes lived experience and the interaction between persons and their environment is much needed to guide the development of functional outcome measures. Qualitative and quantitative research methodologies should be used to advance understanding of functioning and to address limitations of current approaches to functional outcome measurement.

Late component ERPs are associated with three syndromes in schizophrenia

Positive, negative, and cognitive symptoms of schizophrenia may affect functional outcomes. However, these factors alone do not account for a large percentage of variance in outcomes. We investigated demographic, cognitive, symptom, and functional capacity predictors of current functional status in 280 outpatients with schizophrenia or schizoaffective disorder. Functional decline over the lifespan was also examined in a subset of participants. Stepwise regressions modeled predictors of current functional status and functional decline as measured by the Assessment of Lifespan Functioning Attainment (ALFA). ALFA functional domains included paid employment, independence in living situation, romantic relationships, close friendships, and recreational engagement. More severe depressive symptoms were consistently associated with worse current community integration (lower levels of close friendships and recreational engagement). Better working memory performance was associated with higher rates of current paid employment. There were no consistent modifiable predictors of decline in functioning, but women reported less functional decline in the domains of employment and close friendships than men. Better cognitive performance was associated with less decline in living independence and romantic relationships, but more decline in paid employment and recreational engagement. Increased assessment and treatment of comorbid depressive symptoms may improve functional outcomes in people with schizophrenia.