Multiple Outcome Measures Research Articles

A conceptual validation of transformative learning theory

ABSTRACTObjectivesThe aim of this study is to evaluate the integrated transformative learning theory and quantitative measurement model developed by Stuckey and colleagues in 2013.MethodsThe Transformative Leaning Survey (TLS) was administered as a cross‐sectional web survey to 467 respondents recruited from a variety of sources. The questionnaire includes four transformative learning outcome measures (acting differently, deeper self‐awareness, holding more open perspectives, experiencing a deep shift in worldview) and 14 transformative learning process measures in three domains (extra‐rational, rational, social critique).ResultsThe majority of respondents were female (73.7 percent), white (70.7 percent), with a graduate degree (57.2 percent), and professional employment (56.1 percent); the median age was 35–44. Reliabilities (alpha) of TLS scales ranged from 0.68 to 0.91 (median = 0.78). Multivariate regression identified two rational process factors (Action, Disorienting Dilemma) and two social critique process factors (Empowerment, Unveiling Oppression) that had significant (p < 0.05) positive independent associations with multiple transformative learning outcome measures; no extra‐rational process measures were significant.ConclusionsThis study replicates, validates, and extends the development of the Transformative Leaning Survey and advances transformative learning theory by identifying drivers of transformative learning outcomes. Further quantitative, qualitative, and mixed method research on transformative learning is needed.

Effectiveness of second language collocation instruction: a meta-analysis

Abstract This study reports a meta-analysis of studies that investigated the effectiveness of instruction on second language collocation learning. A total of 64 research projects in 17 primary studies (the number of participants = 3,859) were included in the meta-analysis. Aggregated results confirmed the effectiveness of collocation instruction for facilitating second language collocation learning (d = 1.415, 95% CI: 1.189, 1.641). The results of moderator analysis indicated that the intervention method was a significant predictor of intervention effectiveness. To be specific, 1) explicit interventions produced larger effect sizes than implicit interventions; 2) interventions with low session frequency did not produce larger effect sizes than those with high session frequency; 3) long interventions did not show larger effect sizes than short interventions; and 4) constrained-constructed responses, selected responses, and multiple outcome measures did not produce larger effect sizes than free-constructed responses. The study also offered explanations for the results, as well as implications for the teaching and research of collocations.

413 Fat Grafting as a Therapeutic Treatment for Frey's Syndrome: A Comprehensive Review of the Literature and Recommendations for Management

Abstract Aim With the reported incidence of Frey's syndrome as high as 59%, the significant morbidity experienced by patients post parotidectomy has resulted in a range of treatment options being proposed with variable outcomes. The lack of consensus has resulted in patients being offered a wide range of treatments with varying success. While fat grafting remains a treatment for contour deformity correction, there is emerging evidence to suggest its effectiveness as a treatment for Frey's syndrome, warranting further investigation. This systematic review aims to evaluate the efficacy of fat grafting as a treatment for Frey's syndrome post parotidectomy. Method A systematic review was conducted as per PRISMA guidelines, with all articles from MEDLINE, Embase, Web of Science, Ovid, Scopus, and Cochrane screened by two independent reviewers using discreet inclusion and exclusion criteria followed by in depth full-text reviews. Results 116 papers were screened with 16 meeting the inclusion criteria (13.8%) totalling 785 patients, with multiple outcome measures for assessing Frey's syndrome. Fat grafting was shown to significantly reduce the incidence of Frey's syndrome in patients having undergone both superficial and total parotidectomies, with 15 studies (93.8%) finding a significant reduction in its incidence post treatment. Conclusions With low donor site morbidity, biocompatibility, ease of use, low cost to perform and high patient satisfaction, the systematic review of the evidence supports the use of fat grafting post parotidectomy as an effective treatment for Frey's syndrome. Further research to determine the long-term outcome would inform its suitability as a first line treatment.

Individual changes in stress, depression, anxiety, pathological worry, posttraumatic stress, and health anxiety from before to during the COVID-19 pandemic in adults from Southeastern Germany

BackgroundMany studies have previously compared the prevalence or sample means of distress and mental health problems from before to during the COVID-19 pandemic, while results on changes at the individual-level, and regarding multiple outcome measures are demanded.MethodsThis online study investigated individual changes in stress and mental health from before the COVID-19 pandemic to the first lockdown in adults from Southeastern Germany. This region was selected as it was where SARS-CoV-2 was first documented in Germany, and also due to the implementation of strict stay-at-home orders and social contact prohibitions. From April 10–27, 2020, we collected state measures and their clinical relevance for the subareas of perceived stress: worries, tension, joy, and demands. We also collected information regarding the following mental health problems: depression, anxiety, pathological worry, posttraumatic stress disorder (PTSD), and health anxiety; as well as retrospective measures of how participants felt they have changed in comparison to before the pandemic, ranging from worse to better.ResultsThe analytical sample comprised 396 adult participants. On average, participants experienced increases in worries, tension, and lack of joy, and increases in mental health problems, but a decrease in demands. Perceived increases in symptoms of depression (26.0%) and PTSD (25.5%) were significantly more frequent than in symptoms of anxiety (particularly acute fear and panic) (5.6%), pathological worry (9.8%), and health anxiety (7.3%) (ps<.001). One per 10 participants (10.4%) reported an increase in depressive symptoms, and nearly two per 10 (18.4%) an increase in PTSD symptoms and additionally showed a clinically relevant symptom strain during lockdown. Interestingly, mainly non-specific PTSD symptoms associated with a general stress reaction were experienced to be increased.ConclusionThe findings suggest a dissociation of perceived changes in subareas of stress and mental health with a particular experience of increases in depressive and general stress symptoms and a decrease in external demands. This points to a need for a more differentiated view on the impact of the COVID-19 pandemic on stress and mental health, and for targeted interventions for mental health problems arising frequently during the pandemic.

Pediatric to Adult Transition Literature: Scoping Review and Rheumatology Research Prioritization Survey Results.

The transition from pediatric to adult care is the focus of growing research. It is important to identify how to direct future research efforts for maximum effect. Our goals were to perform a scoping review of the transition literature, highlight gaps in transition research, and offer stakeholder guidance on the importance and feasibility of research questions designed to fill identified gaps. The transition literature on rheumatic diseases and other common pediatric-onset chronic diseases was grouped and summarized. Based on the findings, a survey was developed and disseminated to pediatric rheumatologists and young adults with rheumatic diseases as well as their caregivers. The transitional care needs of patients, healthcare teams, and caregivers is well described in the literature. While various transition readiness scales exist, no longitudinal posttransfer study confirms their predictive validity. Multiple outcome measures are used alone or in combination to define a successful transition or intervention. Multimodal interventions are most effective at improving transition-related outcomes. How broader health policy affects transition is poorly studied. Research questions that ranked highest for importance and feasibility included those related to identifying and tracking persons with psychosocial vulnerabilities or other risk factors for poor outcomes. Interventions surrounding improving self-efficacy and health literacy were also ranked highly. In contrast to healthcare teams (n = 107), young adults/caregivers (n = 23) prioritized research surrounding improved work, school, or social function. The relevant transition literature is summarized and future research questions prioritized, including the creation of processes to identify and support young adults vulnerable to poor outcomes.

Characteristics of anatomic and reverse total shoulder arthroplasty patients who achieve ceiling scores with 3 common patient-reported outcome measures.

Legacy shoulder outcome scores have postoperative ceiling scores effects when quantifying clinical outcomes for anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty patients. This study uses data from an international database of a single shoulder prosthesis using data from 30 different clinical sites to quantify and compare the percentage of aTSA and rTSA patients achieving postoperative ceiling scores with multiple outcome measures and defines the patient demographics, comorbidities, implant, and operative parameters associated with ceiling scores for each outcome measure. Clinical outcomes for 1817 aTSA and 2635 rTSA patients between 2007 and 2019 were quantified with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Simple Shoulder Test (SST), the University of California, Los Angeles (UCLA), Constant, and Shoulder Arthroplasty Smart (SAS) scores. The number of aTSA and rTSA patients with ceiling scores were calculated and sorted into those that achieved ceiling scores with the SST, ASES, and UCLA measures and compared to patients without ceiling scores. A univariate and multivariate analysis then identified the patient demographics, comorbidities, and implant and operative parameters associated with ceiling scores for each outcome measure. aTSA patients achieved ceiling scores at a significantly greater rate than rTSA patients for all outcome measures, except SAS. The SST score was the most susceptible to ceiling scores (aTSA = 43.4%, rTSA = 34.1%, P < .0001), followed by the ASES (aTSA = 23.7%, rTSA = 13.3%, P < .0001) and UCLA (aTSA = 22.2%, rTSA = 10.6%, P<.0001) scores. Ceiling scores were least likely with the Constant (aTSA = 0.4%, rTSA = 0%, P = .0060) and SAS (aTSA = 0.1%, rTSA = 0%, P = .0750) scores. Male patients had a significantly higher ceiling score rate than female patients using the SST and ASES scores, and no differences in ceiling score rates were observed with the UCLA, Constant, or SAS scores. Finally, we identified numerous patient demographic, comorbidity, implant, and operative parameters associated with SST, ASES, and UCLA ceiling scores for aTSA and rTSA patients. Postoperative ceiling scores occur at a high rate for aTSA and rTSA patients with the SST, ASES, and UCLA scores. Those most susceptible to ceiling scores are aTSA patients treated with cage glenoids, aTSA patients of lower body mass index, rTSA patients of male gender, rTSA patients with osteoarthritis diagnosis, and rTSA patients with subscapularis repair. Clinical researchers should consider using alternative scores, such as the SAS score, to ensure a more normalized distribution of data and more accurately quantify aTSA and rTSA outcomes.

188 Patient-reported outcome measures for health-related quality of life in acne vulgaris: A systematic review of measure development and measurement properties

While multiple patient-reported outcome measures (PROMs) for health-related quality of life exist for patients with acne vulgaris, little is known about the validity of the development and measurement properties of these PROMs. A systematic review was conducted following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) framework. Data were extracted on PROM properties (target population, domains measured, recall period, development language, number of items), COSMIN-based development and pilot study grading, content validity score (relevance, comprehensiveness, comprehensibility, overall), and measurement properties (structural validity, internal consistency, reliability, construct validity, responsiveness, measurement error, and responsiveness).

Correlation of patient-reported outcome measures to performance-based function in critical care survivors: PREDICTABLE

BackgroundEstablishing sequela following critical illness is a public health priority; however, recruitment and retention of this cohort make assessing functional outcomes difficult. Completing patient-reported outcome measures (PROMs) via telephone may improve participant and researcher involvement; however, there is little evidence regarding the correlation of PROMs to performance-based outcome measures in critical care survivors. ObjectivesThe objective of this study was to assess the relationship between self-reported and performance-based measures of function in survivors of critical illness. MethodsThis was a nested cohort study of patients enrolled within a previously published study determining predictors of disability-free survival. Spearman's correlation (rs) was calculated between four performance-based outcomes (the Functional Independence Measure [FIM], 6-min walk distance [6MWD], Functional Reach Test [FRT], and grip strength) that were collected during a home visit 6 months following their intensive care unit admission, with two commonly used PROMs (World Health Organization Disability Assessment Scale 2.0 12 Level [WHODAS 2.0] and EuroQol-5 Dimension-5 Level [EQ-5D-5L]) obtained via phone interview (via the PREDICT study) at the same time point. ResultsThere were 38 PROMs obtained from 40 recruited patients (mean age = 59.8 ± 16 yrs, M:F = 24:16). All 40 completed the FIM and grip strength, 37 the 6MWD, and 39 the FRT. A strong correlation was found between the primary outcome of the WHODAS 2.0 with all performance-based outcomes apart from grip strength where a moderate correlation was identified. Although strong correlations were also established between the EQ-5D-5L utility score and the FIM, 6MWD, and FRT, it only correlated weakly with grip strength. The EQ-5D overall global health rating only had very weak to moderate correlations with the performance-based outcomes. ConclusionThe WHODAS 2.0 correlated stronger across multiple performance-based outcome measures of functional recovery and is recommended for use in survivors of critical illness.

Delivery of a Group Hypnosis Protocol for Managing Chronic Pain in Outpatient Integrative Medicine

ABSTRACT Although strong evidence exists for using individual hypnosis to treat pain, evidence regarding group applications is limited. This project evaluated changes in multiple outcome measures in persons with chronic pain treated with 8 weeks of group hypnosis. Eighty-five adults with diverse chronic pain etiologies completed an 8-session, structured group hypnosis treatment. Pain intensity, pain interference, and global health were evaluated at baseline, posttreatment, and 3- and 6-months posttreatment. Linear mixed effects models assessed changes in outcomes over time. In a model testing, all three outcome measures simultaneously, participants improved substantially from pre- to posttreatment and maintained improvement across follow-up. Analyses of individual outcomes showed significant pre- to posttreatment reductions in pain intensity and interference, which were maintained for pain intensity and continued to improve for pain interference across follow-up. The findings provide compelling preliminary evidence that a group format is an effective delivery system for teaching individual skills in using hypnosis for chronic pain management. Larger randomized controlled trials are warranted to demonstrate equivalence of outcomes between treatment modes.

A translatable RNAi-driven gene therapy silences PMP22/Pmp22 genes and improves neuropathy in CMT1A mice.

Charcot-Marie-Tooth disease type 1A (CMT1A), the most common inherited demyelinating peripheral neuropathy, is caused by PMP22 gene duplication. Overexpression of WT PMP22 in Schwann cells destabilizes the myelin sheath, leading to demyelination and ultimately to secondary axonal loss and disability. No treatments currently exist that modify the disease course. The most direct route to CMT1A therapy will involve reducing PMP22 to normal levels. To accomplish this, we developed a gene therapy strategy to reduce PMP22 using artificial miRNAs targeting human PMP22 and mouse Pmp22 mRNAs. Our lead therapeutic miRNA, miR871, was packaged into an adeno-associated virus 9 (AAV9) vector and delivered by lumbar intrathecal injection into C61-het mice, a model of CMT1A. AAV9-miR871 efficiently transduced Schwann cells in C61-het peripheral nerves and reduced human and mouse PMP22 mRNA and protein levels. Treatment at early and late stages of the disease significantly improved multiple functional outcome measures and nerve conduction velocities. Furthermore, myelin pathology in lumbar roots and femoral motor nerves was ameliorated. The treated mice also showed reductions in circulating biomarkers of CMT1A. Taken together, our data demonstrate that AAV9-miR871–driven silencing of PMP22 rescues a CMT1A model and provides proof of principle for treating CMT1A using a translatable gene therapy approach.

Trial-level characteristics associate with treatment effect estimates: a systematic review of meta-epidemiological studies

BackgroundTo summarize the up-to-date empirical evidence on trial-level characteristics of randomized controlled trials associated with treatment effect estimates.MethodsA systematic review searched three databases up to August 2020. Meta-epidemiological (ME) studies of randomized controlled trials on intervention effect were eligible. We assessed the methodological quality of ME studies using a self-developed criterion. Associations between treatment effect estimates and trial-level characteristics were presented using forest plots.ResultsEighty ME studies were included, with 25/80 (31%) being published after 2015. Less than one-third ME studies critically appraised the included studies (26/80, 33%), published a protocol (23/80, 29%), and provided a list of excluded studies with justifications (12/80, 15%). Trials with high or unclear (versus low) risk of bias on sequence generation (3/14 for binary outcome and 1/6 for continuous outcome), allocation concealment (11/18 and 1/6), double blinding (5/15 and 2/4) and smaller sample size (4/5 and 2/2) significantly associated with larger treatment effect estimates. Associations between high or unclear risk of bias on allocation concealment (5/6 for binary outcome and 1/3 for continuous outcome), double blinding (4/5 and 1/3) and larger treatment effect estimates were more frequently observed for subjective outcomes. The associations between treatment effect estimates and non-blinding of outcome assessors were removed in trials using multiple observers to reach consensus for both binary and continuous outcomes. Some trial characteristics in the Cochrane risk-of-bias (RoB2) tool have not been covered by the included ME studies, including using validated method for outcome measures and selection of the reported results from multiple outcome measures or multiple analysis based on results (e.g., significance of the results).ConclusionsConsistently significant associations between larger treatment effect estimates and high or unclear risk of bias on sequence generation, allocation concealment, double blinding and smaller sample size were found. The impact of allocation concealment and double blinding were more consistent for subjective outcomes. The methodological and reporting quality of included ME studies were dissatisfactory. Future ME studies should follow the corresponding reporting guideline. Specific guidelines for conducting and critically appraising ME studies are needed.

Abstract CT550: Phase II study of acalabrutinib and an anti-CD20 monoclonal antibody in patients with anti-MAG mediated neuropathy

Abstract Background: Peripheral neuropathy occurs in 20-25% of patients with an IgM paraprotein and 40-50% of patients with an IgM monoclonal gammopathy have a detectable anti-myelin associated glycoprotein (MAG) antibody. The presence of an anti-MAG antibody is often associated with a chronic, progressive symmetric demyelinating polyneuropathy that can lead to sensory deficits and gait dysfunction, significantly altering a patient’s quality of life. Prior clinical trials have failed to demonstrate an effective long-term therapy for anti-MAG neuropathy. Additionally, the best manner to assess the evolution of this type of neuropathy has not been elucidated. We designed this clinical trial to evaluate a potential therapy for anti-MAG related neuropathy based on previous reports of subjective improvement in patients with anti-MAG neuropathy treated with rituximab or Bruton’s tyrosine kinase inhibitors. We included multiple neurologic outcome measures so their responsiveness and performance could be assessed in a clinical trial setting. Methods: This is a single-arm open-label phase II trial investigating the use of acalabrutinib and an anti-CD20 monoclonal antibody for the treatment of an IgM-associated anti-MAG mediated neuropathy. Eligible patients must have positive anti-MAG antibody titers with an IgM monoclonal gammopathy of undetermined significance (MGUS) or Waldenström macroglobulinemia (WM). Patients must have a predominantly sensory neuropathy characterized by demyelinating features in nerve conduction studies with a modified Rankin score of ≥1 with progressive symptoms or a modified Rankin score of ≥2. The ECOG performance status must be ≤2. Acceptable organ and marrow function are required. Prior exposure to chemotherapy, Bruton Tyrosine Kinase inhibitors, or other therapies for WM are not permitted except for steroids, IVIg, or an anti-CD20 monoclonal antibody given at least 90 days before study drug initiation. Approximately 33 patients will be enrolled in this study. Patients will be treated with acalabrutinib 100 mg orally twice daily on days 1-28 of each cycle and treatment will be administered until disease progression or unacceptable toxicity. Rituximab (or a biosimilar) will be administered on days 1, 8, 15, and 22 of cycles 1 and 4. The primary endpoint of this trial is to evaluate the overall hematologic response rate (defined as ≥25% reduction in serum IgM) associated with the treatment. The key secondary endpoint is to evaluate the proportion of patients that achieve improvement or stability in neuropathic symptoms based on the Inflammatory Rasch-built Overall Disability Scale (I-RODS) patient-reported disability scale. Additional secondary neurologic endpoints include the INCAT disability score, exam-based outcomes (the MRC distal sum score and INCAT-ISS), measures of function (10-meter walk test, 9-hole peg test), a pain scale, a fatigue scale (FSS), and a neuropathy-specific quality of life scale (IN-QOL). Additional secondary endpoints include time to next treatment, overall survival, hematologic response based on MYD88 and CXCR4 mutational status, change in bone marrow disease burden, and proportion of adverse events associated with treatment. This study is currently open and accruing patients. Clinical trial information: NCT05065554 Sponsor: AstraZeneca Citation Format: Shayna Sarosiek, Christopher T. Doughty, Andrew Branagan, Catherine A. Flynn, Kirsten Meid, Timothy P. White, Megan Little, Carly Leventoff, Steven P. Treon, Jorge J. Castillo. Phase II study of acalabrutinib and an anti-CD20 monoclonal antibody in patients with anti-MAG mediated neuropathy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT550.

Photobiomodulation: a cultural nursing intervention for physical and psychological adaptation

Background Wellbeing among postpartum women needs to be assessed. This article aimed to evaluate the effectiveness of photobiomodulation near infrared as a cultural nursing intervention for postpartum women in Indonesia. Methods A research and development study design was undertaken from 2018 to 2020 in three stages to evaluate the effectiveness of photobiomodulation near infrared: a phenomenological study (n=20), a pre-experimental study (n=80) and a quasi-experimental design (n=90). Data were analysed using one-way ANOVA and a Kruskal–Wallis test. Results Three themes emerged from the qualitative study that focused on development tools. Photobiomodulation near infrared was developed to cover postpartum women's needs. Significant statistical differences were found in multiple outcome measures after implementing photobiomodulation near infrared. Conclusions Photobiomodulation near infrared is a promising intervention for postpartum mothers.

A Modified Lemaire Lateral Extra-Articular Tenodesis in High Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction: Two-Year Clinical Outcomes

Background:The incidence of anterior cruciate ligament reconstruction (ACLR) in patients aged 19 years or younger is increasing significantly and many patients possess risk factors that predispose to ACL re-tear. Lateral extra-articular tenodesis (LET) may be performed in conjunction with ACLR to reduce the risk of ACL re-tear.Purpose:To evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR.Methods:A consecutive series of patients who underwent ACLR and LET with a minimum of 2-year follow-up data was analyzed retrospectively. ACLR techniques included all-epiphyseal (AE) and complete transphyseal (CT) and were indicated based on skeletal age. Skeletally immature patients underwent a QUAD ACLR. Patients with closed or closing growth plates underwent a BTB ALCR. Outcome measures included participants’ return to sports, concomitant or subsequent surgical procedures and multiple patient-reported outcome measures, including Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores.Results:Sixty-seven consecutive patients (mean age 15.16 ±1.74 years, range 11-19 years, 64% female) were analyzed (Table 1). Sixty-five patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The median grade at the time of surgery was 9th grade. Eleven patients (16%) were revision ACLR procedures. Eight (12%) patients underwent AE and 59 (88%) underwent CT ACLR. Forty-six (69%) cases employed a QUAD autograft, while 21 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, median SANE score was 97, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 25. RTS rate was 93%. Fifteen patients had subsequent surgical procedures, including 3 hardware removal procedures for hemiepiphysiodesis, 4 contralateral ACLR, 5 meniscus surgeries, 1 lysis of adhesions, 1 hammertoe correction and 1 revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study.Conclusion:The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up.Table 1Patient Demographics and Surgical Characteristics

Rehabilitation in dementia: CST and Sonas group interventions for people with moderate cognitive impairment. A pilot study

Purpose Dementia is a complex, progressively degenerative condition. It results in loss of cognitive and functional capabilities, along with a significant increase in the level of dependency. A reduction in the use of pharmacological interventions correlates with an increased in good quality non-pharmacological interventions in dementia care. The purpose of this study is to examine the impact of 14-session face-to-face cognitive stimulation therapy (CST) and Sonas group interventions on individuals living with dementia with moderate cognitive impairment, from pre-intervention to post-intervention in terms of their cognition, communication, neuropsychiatric symptoms, activities of daily living and quality of life. Design/methodology/approach A pilot single blind prospective controlled trial evaluated two group intervention approaches, cognitive stimulation therapy (CST) and Sonas, with 28 participants with moderate dementia. Pseudorandomisation and single blinding were implemented. CST has a solid evidence base. Sonas is a widely used multi-sensory intervention in Ireland with an emerging evidence base. Participants were recruited from a mental health service. Participants who had a formal diagnosis of dementia, moderate cognitive impairment and some ability to communicate and understand communication were included. Findings Results supported CST to a greater extent than Sonas. The CST group showed significant changes in cognition (p = 0.032) and communication (p = 0.006). Both groups had significant changes in carer quality of life (CST, p = 0.019; Sonas, p = 0.035). Results support the recommendations for a future definitive trial. Research limitations/implications Rehabilitation potential of individuals living with moderate dementia was demonstrated. This study suggests that group interventions like these impact on the trajectory of dementia. Practical implications Rehabilitation interventions impact on the trajectory of dementia. CST and Sonas have no impact on activities of daily living. Future studies with larger sample sizes, 16 weeks intervention period and control groups are required. Social implications This pilot study supports CST over Sonas interventions for individuals living with moderate dementia. Multiple outcome measures demonstrated trends towards significance for both interventions. Future definitive trials may detect a significant effect of both interventions. Originality/value A dementia diagnosis is devastating and generally creates negative perceptions and associations (Alvira, 2014). In contrast, the outcomes of this study are positive. This study provides evidence that occupational therapist intervention can impact on the trajectory of the condition with people with dementia demonstrating that they do have rehabilitation potential by responding to treatment and improving and maintaining their abilities as they progress through the condition.

300 Patient Experience with Same Day Surgery for Artificial Urinary Sphincter Insertion - A Safe and Efficient Option

ABSTRACT Introduction Prior research has questioned the need for overnight observation (OBS) following artificial urinary sphincter (AUS) surgery. Objective We sought to analyze our institutional experience transitioning from OBS to same day surgery (SDS) for AUS surgery. Methods We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 03/2020. Medical records were reviewed for patient demographics, immediate postoperative complications, timing of postoperative discharge, need for readmission, emergency department (ED) visit, outpatient phone call, or non-routine clinic visit within 7 days of discharge, and need for device explant or revision within 90 days of discharge. Patients were grouped based on discharge status: OBS vs. SDS. Catheters were removed prior to discharge (OBS group) or self-removed at home (SDS group) on the morning of postoperative day 1 (POD1). Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients (09/2017 through 08/2020). Student's t and Chi-squared tests were used to compare groups. Results We identified 528 men who met inclusion criteria. Men in the SDS group (n = 308) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier (Table). Men in the OBS group (n = 220) were more likely to suffer an immediate postoperative complication and to be readmitted within 90 days of surgery. The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n = 39) had mean additional room and bed charges of $ 745 ± 302 vs. none for SDS patients (n = 183). Conclusions SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast

Cross-sectional and longitudinal correlations between the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and other outcome measures in multiple sclerosis

BackgroundThe Arm Function in Multiple Sclerosis Questionnaire (AMSQ) is the first validated disease specific patient-reported outcome measure (PROM) designed to assess upper extremity function in patients with multiple sclerosis (MS). ObjectiveTo determine correlations between the AMSQ and established physician- and performance based outcome measures. MethodsIn a cross-sectional cohort of 533 patients correlations between the AMSQ and the Expanded Disability Status Scale (EDSS), its functional systems, the 9-Hole Peg Test (9-HPT) and the Timed-25 Foot Walk (T25FW) were determined. Subgroup analyses were performed as well. Also, correlations were determined in 110 of 533 patients with available longitudinal data. ResultsStrongest correlations were found in the cross-sectional cohort between the AMSQ and the EDSS (β 0.60, p<.001), the 9-HPT dominant hand (β 0.52, p<.001) and 9-HPT non-dominant hand (β 0.46, p<.001), the Pyramidal (β 0.57 p<.001) and the Cerebellar functional system (β 0.54, p<.001) of the EDSS. ConclusionThe moderate correlations between the AMSQ and several established physician- and performance based outcome measures underline that the AMSQ, an easily at long-distance administrable PROM, could be considered as a reliable outcome measure for the monitoring of MS in daily practice. Additional research is needed to support these findings.

Information Communication Technology Use to Improve eHealth Literacy, Technophobia, and Social Connection among Community Dwelling Older Adults

ABSTRACT The Intergenerational Forum (IF), an innovative intervention, offers andragogic programs for community-dwelling older adults, enabling them to engage in youth-led tutorials to learn about Information Communication Technology (ICT). This study examines the outcome of a 12-week class focused on encouraging intergenerational exchange and mutual aid between college students and older adults. Fifty older adults in South Korea participated in the 12-week IF program. First, older adults’ Internet usage patterns were examined. Using a pretest-posttest nonequivalent control group design with multiple outcome measures, we compared older mentees’ e-health literacy, technophobia, feelings of social isolation, and social capital following the IF classes. Our findings suggest that older adults’ adoption and employment of ICT skills improved their overall eHealth literacy and perceived usefulness of the Internet. Consequently, older IF participants with technophobia saw a decrease in anxiety, and an improvement in their confidence in using computer technology throughout the study period. Study findings imply that developing educational programs specifically designed for community dwelling elders with restricted access to ICT and little digital literacy is both desirable and feasible.

Assessment of Different Middle Vault Reconstruction Techniques in Rhinoplasty from Multiple Patient-Reported Outcome Measures.

It is important to assess the patient satisfaction with shape and function by patient-reported outcome measures (PROMs) following structural or dorsal preservation rhinoplasty (DPR) techniques on the middle nasal vault. To analyze the results of different middle vault rhinoplasty techniques with multiple PROMs and compare their differences according to the findings of PROMs. Four different techniques were performed for the middle vault: spreader graft, L-strut graft, DPR with high strip (DPRwHS), DPR with low strip. The outcomes were evaluated preoperatively, 2 and 12 months postoperatively with the following PROMs: Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation, and Standardized Cosmesis and Health Nasal Outcomes Survey. This study included 129 patients. All techniques provided significant improvements in all PROMs (p < 0.001), except DPRwHS in NOSE. Between postoperative short- and longer-term, no significant differences were observed in DPR groups (p > 0.05), unlike structural techniques. In this comparative study of different middle nasal vault rhinoplasty techniques, we did not detect a difference in the improvement of the patient-reported outcomes of DPR techniques from as early as 2 months to 1 year postoperative.

A0878 - Evaluation of the learning curve for Thulium laser enucleation of the prostate using multiple outcome measures

A0878 - Evaluation of the learning curve for Thulium laser enucleation of the prostate using multiple outcome measures