Monitor Patient Progress Research Articles

Development of Home Food Introduction Pathway Through Epic My Chart

Food allergy prevalence has been increasing in the United States to 7.6% of children. Many foods can safely be introduced at home, and do not require monitored challenges. We developed protocols for safe home introduction of peanut, milk, and egg products, via Epic MyChart ® patient portal. Our objectives were developing tools to support patients and families in the safe home introduction of foods and providing Allergists and PCP's with a mechanism to monitor patient progress.

ORTHO AI : The Dawn Of A New Era: Artificial Intelligence In Orthopaedics

ORTHO AI : The Dawn Of A New Era: Artificial Intelligence In Orthopaedics

Asthma management with the help of digital therapeutics: Review of clinical trials

Digital therapeutics has emerged as a promising approach to manage chronic health conditions, including asthma. With the help of digital inhalers, mobile apps, and monitoring devices, patients can track their symptoms in real time and access personalized treatment plans remotely. Telemedicine and telemonitoring asthma have enabled health-care providers to monitor patient progress continuously while reducing the need for frequent office visits. Digital inhalers are one such example, providing patients with a complex therapeutic modality to self-administer. One such example is Propeller's digital platform helps asthma patients and their health-care providers record and monitor medication usage, review symptoms, and receive personalized interventions. A literature review was conducted to identify clinical trials reporting the use of digital tools for improving asthma outcomes, which showed that there are only monitoring tools available to improve asthma management through digital therapeutics at present. For example monitoring of adherance, asthma outcomes measurement. However, advancements in technology hold great potential for providing more comprehensive care by integrating data from multiple sources such as wearable sensors or electronic medical records into a single platform that could support better decision-making regarding patient care. The field of digital therapeutics is still evolving, but it holds immense promise for revolutionizing how we manage complex health conditions like asthma by empowering patients with effective tools that allow them to take control of their condition proactively.

Adopting Information and Communication Technology (ICT) in Public Healthcare Facilities in Kogi State, Nigeria

The study focused on Information and Communication Technology and Healthcare Delivery in Kogi State, Nigeria. The study specifically ascertained the effects of risk tolerance and costs on the adoption of ICT in the public healthcare facilities in Kogi State; and investigated the extent at which ICT adoption can influence efficiency in the public healthcare facilities in Kogi State. Research survey design was employed. The study targeted 53 public healthcare facilities in Kogi State. 229 health personnel actively participated in the study. Data were collected; presented and analyzed using frequency distribution table. Descriptive statistics and regression analysis were applied. Finding showed that both risk tolerance and cost have significant predictive power over the adoption of ICT in the public healthcare facilities in Kogi State, and that ICT adoption has substantial influence on efficiency in the public healthcare facilities in Kogi State. The study concluded that ICT can increase patient safety by providing easy information to medical cases, allowing for online treatment reviews, monitoring patient progress, and foreseeing potential medical mishaps. The study recommended that the management and government should organize an intervention programme to promote risk tolerance among users, and that government should provide financial support to reduce the burden of cost in order to increase adoption of ICT in the public healthcare facilities in Kogi State.

Using personalized prognosis in the treatment of relapsing multiple sclerosis: A practical guide.

The clinical course of multiple sclerosis (MS) is highly variable among patients, thus creating important challenges for the neurologist to appropriately treat and monitor patient progress. Despite some patients having apparently similar symptom severity at MS disease onset, their prognoses may differ greatly. To this end, we believe that a proactive disposition on the part of the neurologist to identify prognostic “red flags” early in the disease course can lead to much better long-term outcomes for the patient in terms of reduced disability and improved quality of life. Here, we present a prognosis tool in the form of a checklist of clinical, imaging and biomarker parameters which, based on consensus in the literature and on our own clinical experiences, we have established to be associated with poorer or improved clinical outcomes. The neurologist is encouraged to use this tool to identify the presence or absence of specific variables in individual patients at disease onset and thereby implement sufficiently effective treatment strategies that appropriately address the likely prognosis for each patient.

Research interrupted: applying the CONSERVE 2021 Statement to a randomized trial of rehabilitation during critical illness affected by the COVID-19 pandemic

RationaleThe COVID-19 pandemic disrupted non-COVID critical care trials globally as intensive care units (ICUs) prioritized patient care and COVID-specific research. The international randomized controlled trial CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) was forced to halt recruitment at all sites in March 2020, creating immediate challenges. We applied the CONSERVE (CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstance) statement as a framework to report the impact of the pandemic on CYCLE and describe our mitigation approaches.MethodsOn March 23, 2020, the CYCLE Methods Centre distributed a standardized email to determine the number of patients still in-hospital and those requiring imminent 90-day endpoint assessments. We assessed protocol fidelity by documenting attempts to provide the in-hospital randomized intervention (cycling or routine physiotherapy) and collect the primary outcome (physical function 3-days post-ICU discharge) and 90-day outcomes. We advised sites to prioritize data for the study’s primary outcome. We sought feedback on pandemic barriers related to trial procedures.ResultsOur main Methods Centre mitigation strategies included identifying patients at risk for protocol deviations, communicating early and frequently with sites, developing standardized internal tools focused on high-risk points in the protocol for monitoring patient progress, data entry, and validation, and providing guidance to conduct some research activities remotely. For study sites, our strategies included determining how institutional pandemic research policies applied to CYCLE, communicating with the Methods Centre about capacity to continue any part of the research, and developing contingency plans to ensure the protocol was delivered as intended. From 15 active sites (12 Canada, 2 US, 1 Australia), 5 patients were still receiving the study intervention in ICUs, 6 required primary outcomes, and 17 required 90-day assessments. With these mitigation strategies, we attempted 100% of ICU interventions, 83% of primary outcomes, and 100% of 90-day assessments per our protocol.ConclusionsWe retained all enrolled patients with minimal missing data using several time-sensitive strategies. Although CONSERVE recommends reporting only major modifications incurred by extenuating circumstances, we suggest that it also provides a helpful framework for reporting mitigation strategies with the goal of improving research transparency and trial management.Trial registrationNCT03471247. Registered on March 20, 2018.

Investigation of the Kinematic Upper-Limb Movement Assessment (KUMA): A Pilot Study.

Purpose: Upper limb movement disorders are common after stroke and can severely impact activities of daily living. Available clinical measures of these disorders are subjective and may lack the sensitivity needed to track a patient's progress and to compare different therapies. Kinematic analyses can provide clinicians with more objective measures for evaluating the effects of rehabilitation. We present a novel method to assess the quality of upper limb movement: the Kinematic Upper-limb Movement Assessment (KUMA). This assessment uses motion capture to provide three kinematic measures of upper limb movement: active range of motion, speed, and compensatory trunk movement. The researchers sought to evaluate the ability of the KUMA to distinguish motion in the affected versus unaffected limb. Method: We used the KUMA with three participants with stroke to assess three single-joint movements in: wrist flexion and extension, elbow flexion and extension, and shoulder flexion/extension and abduction/adduction. Participants also completed the Modified Ashworth Scale and the Chedoke-McMaster Stroke Assessment, two clinical measures of functional ability. Results: The KUMA distinguished between affected and unaffected upper limb motion. Conclusions: The KUMA provides clinicians with supplementary objective information for motion characterization that is not available through clinical measures alone. The KUMA can complement existing clinical measures such as the MAS and CMSA and can be helpful for monitoring patient progress.

Accuracy and Validity of a Single Inertial Measurement Unit-Based System to Determine Upper Limb Kinematics for Medically Underserved Populations.

Stroke is one of the leading causes of death and disability worldwide, with a disproportionate burden represented by low- and middle-income countries (LMICs). To improve post-stroke outcomes in LMICs, researchers have sought to leverage emerging technologies that overcome traditional barriers associated with stroke management. One such technology, inertial measurement units (IMUs), exhibit great potential as a low-cost, portable means to evaluate and monitor patient progress during decentralized rehabilitation protocols. As such, the aim of the present study was to determine the ability of a low-cost single IMU sensor-based wearable system (named the T’ena sensor) to reliably and accurately assess movement quality and efficiency in physically and neurologically healthy adults. Upper limb movement kinematics measured by the T’ena sensor were compared to the gold standard reference system during three functional tasks, and root mean square errors, Pearson’s correlation coefficients, intraclass correlation coefficients, and the Bland Altman method were used to compare kinematic variables of interest between the two systems for absolute accuracy and equivalency. The T’ena sensor and the gold standard reference system were significantly correlated for all tasks and measures (r range = 0.648—0.947), although less so for the Finger to Nose task (r range = 0.648—0.894). Results demonstrate that single IMU systems are a valid, reliable, and objective method by which to measure movement kinematics during functional tasks. Context-appropriate enabling technologies specifically designed to address barriers to quality health services in LMICs can accelerate progress towards the United Nations Sustainable Development Goal 3.

Examination of the psychometric properties of the FORensic oUtcome Measure (FORUM): a new outcome measure for forensic mental health services

IntroductionForensic mental health services provide care to people in secure psychiatric hospitals and specialised community teams. Measuring outcomes is important to ensure such services perform optimally, however existing measures are not sufficiently comprehensive and are rarely patient reported.ObjectivesTo examine a novel instrument for measuring outcomes in forensic mental health services, the FORensic oUtsome Measure (FORUM), which consists of a complementary patient reported questionnaire (FORUM-P) and clinician reported questionnaire (FORUM-C).MethodsInpatients at a forensic psychiatric service based in a regional healthcare organization in the UK completed the FORUM-P, while members of their clinical teams completed the FORUM-C. Patients and clinicians also provided feedback on the questionnaires.ResultsSixty-two patients participated with a mean age of 41.0 years (standard deviation 11.3). For internal consistency, Cronbach’s alpha for the FORUM-P was 0.87 (95% confidence interval (CI) 0.80-0.93) and for the FORUM-C was 0.93 (95% CI 0.91-0.96). For test-retest reliability the weighted kappa for the FORUM-P was 0.44 (95% CI 0.24-0.63) and for the FORUM-C was 0.78 (95% CI 0.73-0.85). For interrater reliability of the FORUM-C the Spearman correlation coefficient was 0.47 (95% CI 0.18-0.69). The FORUM-P received an average rating of 4.0 out of 5 for comprehensiveness, 4.6 for ease of use and 3.9 for relevance, while the FORUM-C received 4.1 for comprehensiveness, 4.5 for ease of use and 4.3 for relevance.ConclusionsOutcome measures in forensic mental health can be developed with good measures of reliability and validity, and can be introduced into services to monitor patient progress.DisclosureNo significant relationships.

Impact of COVID-19 social distancing measures on routine mental health care provision and treatment outcome for common mental disorders in the Netherlands.

ObjectiveThe uptake of digital interventions in mental health care (MHC) has been slow, as many therapists and patients believe that in‐person contact is essential for establishing a good working relationship and good outcomes in treatment. The public health policies regarding social distancing during the coronavirus disease‐2019 (COVID‐19) pandemic forced an abrupt transformation of MHC provisions for outpatients: Since mid‐March 2020, nearly all in‐person contact was replaced with videoconferencing. The COVID‐19 crisis offered a unique opportunity to investigate whether MHC with videoconferencing yields inferior results as compared to in‐person interventions.MethodIn a large urban MHC facility in the Netherlands, measurement‐based care is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pretest and post‐test data were used to compare outcomes for three cohorts: treatments performed prior to, partially during and entirely during the COVID‐19 lockdown. Outcomes were compared in two large data sets: Basic MHC (N = 1392) and Specialized MHC (N = 1040).ResultsTherapeutic outcomes appeared robust for COVID‐19 conditions across the three cohorts: No differences in outcomes were found between treatments that were conducted during lockdown compared to in‐person treatments prior to COVID‐19, or treatments which started in‐person, but needed to be continued by means of videoconferencing.DiscussionVideoconferencing care during the COVID‐19 pandemic had similar outcomes compared to traditional in‐person care. These real‐world results corroborate findings of previous randomized controlled studies and meta‐analyses in which videoconferencing and in‐person care has been directly compared in terms of clinical effectiveness.

MY SCD PROTOCOL - AN ONLINE, COMPREHENSIVE, REMOTELY-SUPERVISED PROTOCOL FOR IBD PATIENTS TO IMPLEMENT AN EFFECTIVE DIETARY INTERVENTION

Abstract Many IBD patients are keen to modify their diet to better manage their disease. However, little or no dietary guidance is offered to IBD patients or is not comprehensive and lacks practical resources to implement and sustain the modification. Up to 70% of IBD patients self-prescribe dietary restrictions with demonstrated risk of nutrient deficiencies. There is currently no comprehensive IBD dietary intervention presented in a customizable, easy-to-follow protocol format. To meet this need, we developed and tested a full-featured online version of an effective IBD dietary intervention. METHOD: ‘My SCD Protocol’ is a comprehensive, customizable protocol based on the specific carbohydrate diet (SCD). The online, self-paced protocol provides educational resources, self-assessment tools, and step-by-step instructions to start and advance through SCD. Ingredients are presented in 4 ordered Stages (Elimination, Reintroduction, Maintenance, Expansion) to help methodically expand tolerable ingredients. Stage-specific curated recipes support implementation and offer variety and personalization. Patients self-report symptoms, meals, and progress using a HIPAA-compliant mobile app. Entries are accessible in real-time by the patient’s care team. The protocol currently holds 304 SCD ingredients and 164 recipes. Patients (n=87) referred to Modulla Health IBD Nutrition Clinic, or seeking support directly, implemented My SCD Protocol based on preference and ingredient tolerance. Symptoms were self-reported using the accompanying app. Interim results are reported here. RESULTS: Patients successfully accessed and personalized My SCD Protocol. Table 1 summarizes patient profiles. Table 2 presents self-reported symptom changes, showing improvements in all categories except urgency and appearance of mucus. Additional outcomes, including fecal calprotectin, will be reported. DISCUSSION: SCD has been shown to induce clinical response and biochemical remission in adult and pediatric IBD patients. SCD is either self-implemented by patients using a trial-and-error approach, or is dietitian-supervised, primarily using the ‘legal’ SCD ingredient list and little else. SCD was implemented in a clinical trial setting using a predefined, prescriptive meal model with little room to personalize diet (DINE-CD). My SCD Protocol is the first comprehensive protocol to help implement, personalize, and safely advance through SCD. Patients reliably accessed the educational videos, staged ingredients, matching recipe libraries, and logging tools using mobile and web tools. We show self-reported symptom improvements during the first 21 days of the protocol leading to longer-term adherence to diet modification. Care teams who recommend My SCD Protocol to patients can conveniently and continuously monitor patient progress in real-time and supervise patients throughout the intervention.

Does grip strength correlate with rotator cuff strength in patients with atraumatic shoulder instability?

AimTo investigate if there is a correlation between grip strength (GS) and rotator cuff (RC) strength in patients with atraumatic shoulder instability (ASI) and to compare the relationship between these two measures with that previously published for a healthy population. Moreover, to determine if testing GS could be incorporated as a surrogate clinical assessment for RC strength in these patients.MethodsA total of 20 subjects with ASI were included. Out of the 20 patients, eight presented with bilateral instability, which constituted a total of 28 atraumatic unstable shoulders (N = 28). GS was measured using a Jamar hand-dynamometer. External rotation (ER) and internal rotation (IR) strength was tested in inner and outer ranges using a hand-held dynamometer (HHD). Pearson’s correlation test was computed to investigate the relationship. Multiple linear regression was conducted to predict GS based on RC strength.ResultsSignificant and strong positive correlations were found between GS and inner-range IR (r = 0.764, P < 0.001), inner-range ER (r = 0.611, P = 0.001), outer-range IR (r = 0.817, P < 0.001), and outer-range ER (r = 0.736, P < 0.001). A significant regression equation was found (F (4, 23) = 13.254, P < 0.001), with an R2 of 0.697 indicating that RC strength explained 69.7% of the variance in GS.ConclusionsThe results support the hypothesis showing that GS is strongly associated with RC strength in ASI patients. The simplicity of handgrip testing allows it to be used in clinical scenarios where sophisticated assessment tools are not available. GS is a convenient means to monitor patient progress during shoulder rehabilitation programs.

RANCANG BANGUN ALAT MONITORING PERKEMBANGAN PASIEN PASCA STROKE BERBASIS IoT (INTERNET of THINGS)

The design of this IoT (Internet of Things)-based post-stroke patient monitoring tool was built to monitor patient progress remotely. Flex sensor hardware was used to retrieve data from every movement of the patient's finger muscle strength, then processed by the NodeMCU ESP32 after that the data will be sent to the web server via the IoT platform using a local wireless network. The results of research on the development of post-stroke patients can be displayed to a web server in the form of a table plot of data values for the index finger, middle finger, and ring finger. The post-stroke patient monitoring system can be accessed on PC and Android devices. The results of the sample test from the device obtained the highest value of 3.26 MMT and the lowest value of 0.2 MMT so that the patient's finger muscle strength was declared unstable and frequent changes in muscle strength.

Routine Outcome Monitoring in Psychotherapy Treatment Using Sentiment-Topic Modelling Approach

Despite the importance of emphasizing the right psychotherapy treatment for an individual patient, assessing the outcome of the therapy session is equally crucial. Evidence showed that continuous monitoring of patient's progress could significantly improve the therapy outcomes to an expected change. The patient's progress can be tracked closely to help clinicians identify not progressing in the treatment by monitoring the outcome. This monitoring can help the clinician consider any necessary actions for the patient's treatment as early as possible, e.g., recommend different types of treatment or adjust the style of approach. Currently, the evaluation system is based on the clinical-rated and self-report questionnaires that measure patients' progress pre-and post-treatment. While outcome monitoring tends to improve therapy outcomes, there are many challenges in the current method, e.g., time and financial burden for administering questionnaires, scoring, and analyzing the results. Therefore, a computational method for measuring and monitoring patient progress throughout treatment is needed to enhance the likelihood of positive treatment outcomes. This paper focuses on developing a computational method using a Dynamic Joint-Sentiment-Topic model (dJST) to measure and monitor the patient treatment outcome by tracking patient’s current and recurrent views of topic and sentiment. We identified the sentiment and topic trend evolved throughout treatments for each therapy session on the author's level. Our results show that this computational method could potentially lead to an inexpensive clinical monitoring tool to evaluate patients' progress during psychotherapy.

Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study.

BackgroundDespite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities.ObjectiveThis study assessed providers’ views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings.MethodsParticipating providers included BH and physical health (PH) providers from a women’s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach.ResultsA total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities.ConclusionsDigital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow.

Cardiac autonomic functioning and clinical outcome in adolescent borderline personality disorder over two years

The present study aimed to expand on previous findings that pre-treatment autonomic nervous system (ANS) functioning serves as a predictor of clinical outcome in adolescent borderline personality disorder (BPD), while examining whether the relationship between ANS functioning and treatment outcome may vary as a function of early life maltreatment (ELM). ANS stress response was examined considering changes in heart rate (HR) and vagally-mediated heart rate variability (vmHRV) over different conditions of the Montreal Imaging Stress Task (MIST) in a clinical sample of N = 27 adolescents across the spectrum of BPD severity. Participants received in- and/or outpatient treatment, while clinical data was assessed at routine follow-ups. Clinical outcome was defined by change in the number of fulfilled BPD criteria (as measured using the SCID-II), severity of psychopathology (CGI-S), and global level of functioning (GAF), measured 12 and 24 months after baseline assessments. Mixed-effects (random-intercept/random slope) linear regression models were calculated to examine markers of ANS function as potential predictors of clinical outcome. Irrespective of the presence of ELM exposure, both vmHRV resting-state and stress recovery measures were identified as significant predictors of clinical outcome over time. This study adds to the existing literature by replicating and expanding on preliminary findings, considering also physiological reactivity and recovery in addition to resting-state measures of ANS functioning. The present results further highlight the potential of markers of ANS functioning to serve as objective measures in the process of monitoring patient progress and to make predictions regarding treatment outcome in psychiatry research.

The hand therapist's role in the prevention and management of upper extemity injuries in the modern mass production industrial setting

BackgroundThis case study presents the role of an onsite hand therapist (Certified Hand Therapist, Occupational Therapist, Physical Therapist) in an industrial setting and the services that can be provided in this comprehensive care model. Onsite hand therapists can impact on Occupational Safety and Health Administration (OSHA) first aid programs and can provide state of the art treatment for the injured worker in both a direct and indirect capacity. PurposeThe purpose of this case study article is to review the many potential services the hand therapist can offer to facilitate the return-to-work of injured employees and provide employers with a proactive case management and state-of-the-art ergonomic prevention, improving profit margins and facilitating safe work environments. Study DesignA Case Study design demonstrating the diverse and positive impact of hand therapy on the mass production industrial setting. MethodsNovel to this approach is a description of outcome instruments (QuickDASH) administered in a periodic manner to understand the trajectory of change in patient-level disability throughout the rehabilitation process. The Optimal Screening for Prediction of Referral and Outcome (OSPRO-YF) is utilized to help predict the functional outcome for the injured worker. Case studies on common upper extremity pathologies will be discussed, demonstrating the benefits of onsite hand therapy with enhanced treatment and case management. ResultsThe utilization of the QuickDASH and the OSPRO-YF creates a process to determine the progression of injured workers in therapy, the trajectory of change in patient-level disability and to observe when changes occurred. An example of the periodic assessment approach is described in a case study to identify when the most significant change occurred and creating a mechanism to determine if patients were progressing as expected. ConclusionsInherent in this case study process is a fluidity in which the therapist can monitor patient progress and adjust the rehabilitation process that benefits both the patient and the industrial setting. A hierarchical functional level system is presented to describe an appropriate intervention strategy to coincide with a patient's progression of wound healing which can be provided by a hand therapist with specialized knowledge.

A Mobility Measure for Inpatient Rehabilitation Using Multigroup, Multidimensional Methods.

Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation. For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills. Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI. The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).

A Fay-Herriot Model for Estimating Subjective Cognitive Decline among Military Veterans.

Although studies have examined the geographic distribution of dementia among the general population in order to develop geographically targeted interventions, no studies have examined the geographic distribution of subjective cognitive decline (SCD) among military veterans specifically. To map the geographic distribution of subjective cognitive decline from 2011-2019 in the United States among military veterans. Cross-sectional. United States. Individuals reporting previous service in the United States Armed Forces. Using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data, which is last year for which geocoded SCD data is publicly available, we estimated the survey-weighted county-level prevalence of veteran SCD for counties with >30 veterans (43 counties in 7 states). We then developed a Fay-Herriot small area estimation linear model using auxiliary data from the Census, with county-level veteran-specific covariates including % >65 years old, % female, % college educated, and median income. Following model validation, we created beta-weighted predictions of veteran SCD for all USA counties for 2011-2019 using relevant time-specific Census auxiliary data. We provide choropleth maps of our predictions. Results of our model on 43 counties showed that county-level rates of SCD were significantly associated with all auxiliary variables except annual income (F = 1.49, df = 4, 38). Direct survey-weighted rates were correlated with model-predicted rates in 43 counties (Pearson r = 0.32). Regarding predicted rates for the entire USA, the average county-level prevalence rate of veteran SCD in 2011 was 13.83% (SD = 7.35), but 29.13% in 2019 (SD = 14.71) - although variation in these rates were evident across counties. SCD has increased since 2011 among veterans. Veterans Affairs hospitals should implement plans that include cognitive assessments, referral to resources, and monitoring patient progress, especially in rural areas.

The Reliability and Validity of Wearable Inertial Sensors Coupled with the Microsoft Kinect to Measure Shoulder Range-of-Motion.

Background: Objective assessment of shoulder joint active range of motion (AROM) is critical to monitor patient progress after conservative or surgical intervention. Advancements in miniature devices have led researchers to validate inertial sensors to capture human movement. This study investigated the construct validity as well as intra- and inter-rater reliability of active shoulder mobility measurements using a coupled system of inertial sensors and the Microsoft Kinect (HumanTrak). Methods: 50 healthy participants with no history of shoulder pathology were tested bilaterally for fixed and free ROM: (1) shoulder flexion, and (2) abduction using HumanTrak and goniometry. The repeat testing of the standardised protocol was completed after seven days by two physiotherapists. Results: All HumanTrak shoulder movements demonstrated adequate reliability (intra-class correlation (ICC) ≥ 0.70). HumanTrak demonstrated higher intra-rater reliability (ICCs: 0.93 and 0.85) than goniometry (ICCs: 0.75 and 0.53) for measuring free shoulder flexion and abduction AROM, respectively. Similarly, HumanTrak demonstrated higher intra-rater reliability (ICCs: 0.81 and 0.94) than goniometry (ICCs: 0.70 and 0.93) for fixed flexion and abduction AROM, respectively. Construct validity between HumanTrak and goniometry was adequate except for free abduction. The differences between raters were predominately acceptable and below ±10°. Conclusions: These results indicated that the HumanTrak system is an objective, valid and reliable way to assess and track shoulder ROM.