Observational Assessment Tools Research Articles

Performance Evaluation of a Supervised Machine Learning Pain Classification Model Developed by Neonatal Nurses.

Early-life pain is associated with adverse neurodevelopmental consequences; and current pain assessment practices are discontinuous, inconsistent, and highly dependent on nurses' availability. Furthermore, facial expressions in commonly used pain assessment tools are not associated with brain-based evidence of pain. To develop and validate a machine learning (ML) model to classify pain. In this retrospective validation study, using a human-centered design for Embedded Machine Learning Solutions approach and the Neonatal Facial Coding System (NFCS), 6 experienced neonatal intensive care unit (NICU) nurses labeled data from randomly assigned iCOPEvid (infant Classification Of Pain Expression video) sequences of 49 neonates undergoing heel lance. NFCS is the only observational pain assessment tool associated with brain-based evidence of pain. A standard 70% training and 30% testing split of the data was used to train and test several ML models. NICU nurses' interrater reliability was evaluated, and NICU nurses' area under the receiver operating characteristic curve (AUC) was compared with the ML models' AUC. Nurses weighted mean interrater reliability was 68% (63%-79%) for NFCS tasks, 77.7% (74%-83%) for pain intensity, and 48.6% (15%-59%) for frame and 78.4% (64%-100%) for video pain classification, with AUC of 0.68. The best performing ML model had 97.7% precision, 98% accuracy, 98.5% recall, and AUC of 0.98. The pain classification ML model AUC far exceeded that of NICU nurses for identifying neonatal pain. These findings will inform the development of a continuous, unbiased, brain-based, nurse-in-the-loop Pain Recognition Automated Monitoring System (PRAMS) for neonates and infants.

A78 VALIDITY EVIDENCE FOR OBSERVATIONAL EUS COMPETENCY ASSESSMENT: A SYSTEMATIC REVIEW

Abstract Background Endoscopic ultrasound (EUS) encompasses a range of diagnostic and therapeutic procedures that require technical, cognitive, and non-technical skills. The implementation of competency-based frameworks in endoscopic education has emphasized trainee assessment based on predefined milestones, rather than procedure volume. Observational assessment tools with strong validity evidence are needed to achieve this goal. Aims To systematically identify and evaluate observational competency assessment tools employed in EUS using an established validity framework. The secondary aim is to evaluate the educational utility of assessment tools. Methods We searched three databases (MEDLINE, EMBASE, and Evidence-Based Medicine Reviews) and the grey literature from inception to May 2023. Messick’s unified framework was used to evaluate validity evidence based on content, response process, internal structure, relations to other variables, and consequences. Each domain was scored from 0 to 3 with a maximum score of 15 points. Educational utility was evaluated using the Accreditation Council for Graduate Medical Education Standards considering ease of use, ease of interpretation, resources required, and educational impact. Study quality was assessed using the Medical Education Research Quality Instrument. Results Our search identified 2081 records. We screened 44 full texts and included 5 observational EUS assessment tools from 10 studies. All 5 tools are formative assessments, with 4 employed in clinical settings and one in a simulated setting. All tools use Likert rating scales and are rater-based, with 2 having additional self-assessment components. Validity evidence scores ranged from 3 to 13, with the EUS Assessment Tool (EUSAT), Global Assessment of Performance and Skills in EUS (GAPS-EUS), and The EUS and ERCP Skills Assessment Tool (TEESAT) scoring highest, with 10, 11, and 13 points, respectively. Overall educational utility was high across studies given ease of tool use. The TEESAT had the strongest educational impact considering its influence on credentialing and competence thresholds. Study quality was high overall, with scores ranging from 9.5 to 12 (maximum 13.5 points). Inter-rater agreement for validity evidence and educational utility scoring was substantial (k=0.73, raw agreement 80%) and almost perfect (k=0.92, raw agreement 96%), respectively. Conclusions The EUSAT, GAPS-EUS, and TEESAT demonstrate the strongest validity evidence for observational competency assessment of EUS and are easy to implement in educational settings. Future work should investigate barriers to implementation and evaluate utility of these tools for summative assessment. EUS Observational Competency Assessment Tool Validity Evidence Scores Funding Agencies None

The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation)

Objective Despite rising prevalence rates, no standard tool is available to identify individuals at risk of developing contractures. This study aimed to gain expert consensus on items for the development of the Observational Risk Assessment Tool for Contractures: Longitudinal Evaluation (ORACLE) for care home residents. Design A two-round, online modified Delphi study. Participants Panellists were qualified healthcare professionals with a background in physiotherapy, occupational therapy, nursing, and rehabilitation medicine. Main outcome measures In the first round, the experts were asked to rate the predesigned list of items on a Likert scale while in the second round, consensus was sought in the areas of disagreement identified in the previous round. Results The two rounds of the Delphi survey included 30 and 25 panellists, respectively. The average clinical and academic experience of the panellists was 22.2 years and 10.5 years, respectively. The panel demonstrated a high level of consensus regarding the clinical factors (10 out of 15 items); preventive care approaches (9 out of 10 items), and contextual factors (12 out of 13 items) ranging from 70% to 100%. Conclusion This Delphi study determined expert consensus on items to be included in a contracture risk assessment tool (ORACLE). The items were related to factors associated with joint contractures, appropriate preventive care interventions, and potentially relevant contextual factors associated with care home settings. The promise of a risk assessment tool that includes these items has the capacity to reduce the risk of contracture development or progression and to trigger timely and appropriate referrals to help prevent further loss of function and independence.

An examplary application of mathematics teaching based on formative assessment

Mathematics, by nature, has a spiral structure. The fact that the students fail to acquire an achievement in the mathematics course negatively affects other achievements. Therefore, students' mathematics failure continues exponentially. In this context, it is important to identify and eliminate students’ weaknesses, if any, with the formative assessments in the learning process. The present study aimed to improve the success level of the students with the formative assessment-based teaching practice about circle and circular region in secondary school seventh-grade mathematics teaching and implement an exemplary application for formative assessment-based teaching. Since the study sought to evaluate the learning process of the students and eliminate the weaknesses identified in the process, an action research design, one of the methods of qualitative research, was used. The study was carried out with 34 seventh-grade secondary school students. Data were collected and analyzed descriptively through observation, interview and various formative assessment tools used in the process. At the end of the three-week implementation period, substantial improvement was observed in the achievements of low and medium-achieving students, and the overall success of the students changed positively at the end of the process.

O.6.3-10 Investigating the impact of a school garden intervention on children’s school motivation, climate literacy, food literacy and physical activity: the FoodACT protocol

Abstract Background Globally, too many children are not sufficient physically active and have unhealthy food habits with the highest prevalence seen in families with low socio-economic-status (SES). Previous research has stated that schools are considered a key setting for promoting children physical activity (PA), food literacy (FL) and to improve their social health. School gardens is exactly such an intervention where teaching is relocated to an outdoor setting. Relocation of teaching, which is a central ingredient of school gardens, has shown to be positively related to increased PA in both boys and girls during the school day. School gardens aim towards practical experience and education in food and climate. PA is not I focus, but the school garden learning environment provides pupils opportunities to be active. Therefore, the FoodACT study aims to investigate how a school gardening intervention impact pupils school motivation, CL, FL and PA with a special attention on children with low SES. Methods The FoodACT study is designed in three sub-studies. An efficacy study, quantifying the effects of school gardens using a pre-post quasi-experimental design measuring the pupils’ FL, CL and SM. A within-subject-design association study, quantifying the influence of the school garden activities on pupils PA at two sessional periods during the intervention. An association study, investigating the contextual characteristics of the school garden activities using the systematic observations instrument, The Physical Activity Research and Assessment tool for Garden Observation (PARAGON), which can capture pupils’ movements and motions categorised in ‘overall PA-level’, ‘garden-related tasks’, ‘garden related motions’, ‘social associations’, and ‘interaction’. The observations is supplemented by pupil focus-group interviews about their experience of the school garden intervention. Results Study design, recruitment experience and pilot-study data on PA and garden activity observations will be presented. Funding The FoodACT study is funded by the Novo Nordisk Foundation (Grant no: 077522).

Assessment of Periodontal Examination and Diagnostic Skills through Objective Structured Clinical Examination: An Observational Assessment Tool

Assessment of Periodontal Examination and Diagnostic Skills through Objective Structured Clinical Examination: An Observational Assessment Tool

The development and design of the Musical Functional Assessment Profile (MFAP) in autism

The Musical Functional Assessment Profile (MFAP) in autism has been developed as a specific music therapy observational assessment tool to provide qualitative and descriptive information about the functionality of the child on the autism spectrum. It allows for assessing seven developmental functions: social interaction, communication and language, flexibility and anticipation, symbolisation, memory functions, motor functions and sensory functions. The MFAP tries to value the strengths, challenges, difficulties, and supports provided, considering current autism diagnostic criteria and treatment issues viewed from the perspective of neurodiversity. It may also allow the delineation of music therapy treatment goals and intervention planning related to a person-centred and a strength-based approach. The development and design of the tool is presented, and its practical advantages and disadvantages are discussed. Further research studies are required to determine the precise scope and accuracy of this tool; future directions are established for its validity and reliability process.

Families of patients with Alzheimer's disease dementia notice progression from symptoms of disorientation and visual memory disturbance.

Alzheimer's disease dementia (ADD) is the most common cognitive disease, but patients' families may notice some symptoms yet not recognise that they indicate ADD. This study investigated the symptoms that families notice as ADD as the disease progresses. New outpatients diagnosed with ADD (n = 315) at five memory clinics completed two cognitive assessments, the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). During an interview, family members completed the Functional Assessment Staging Test (FAST), an observational assessment tool that classifies ADD progression into seven stages. We then examined the relationship of the family-assessed FAST score with clinician-assessed HDS-R and MMSE domain scores by comparing between patients with FAST 1-3 and FAST 4-7. Next, we divided the FAST 4-7 group into the FAST 4-5 and FAST 6-7 subgroups and divided the FAST 1-3 group into the FAST 1-2 and FAST 3 subgroups. Surprisingly, half of the families did not recognise that the symptoms indicated ADD. Scores for orientation of time and place on the HDS-R and MMSE and for visual memory on the HDS-R were significantly related to family-assessed FAST score. Moreover, the orientation of time and place score on both scales and visual memory on the HDS-R were significantly worse in the FAST 4-7 group than in FAST 1-3 group. In the FAST 4-7 group, scores for age on the HDS-R and for reading and drawing on the MMSE were significantly worse in the FAST 6-7 subgroup. In the analysis of the FAST 1-3 group, there was no significant difference among the HDS-R and MMSE domains between the FAST 1-2 and FAST 3 subgroups. Family members of patients with ADD tend to notice the progression of ADD from the symptoms of disorientation and visual memory.

Validity evidence for observational ERCP competency assessment tools: a systematic review.

BACKGROUND : Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is critical for supporting learning and documenting attainment of skill. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. METHODS : We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. RESULTS : From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one for simulated ERCP, and one for simulated and clinical ERCP. Validity evidence scores ranged from 2 to 12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence, with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality (maximum score 13.5) was strong, with scores ranging from 10 to 12.5. CONCLUSIONS : The BESAT, ERCP DOPS, and TEESAT had strong validity evidence compared with other assessments. Integrating tools into training may help drive learners' development and support competency decision making.

The Association between Socio-Demographic Characteristics and Using Pain Assessment Tools among Critically Ill Patients.

Background and Objectives: Pain is still undertreated among ICU patients, especially cognitively impaired patients. Nurses play a crucial role in their management. However, previous studies found that nurses had insufficient knowledge about pain assessment and management. Some nurses' socio-demographic characteristics, such as being female; age; years of experience; type of unit, either medical or surgical; education level; years of nursing experience; qualification; position; and hospital level, were found to be associated with their practices of pain assessment and management. This study aimed to examine the association between nurses' socio-demographic characteristics and the use of pain assessment tools for critically ill patients. Materials and Methods: A convenience sample of 200 Jordanian nurses responded to the Pain Assessment and Management for the Critically Ill questionnaire to achieve the study's aim. Results: The type of hospital, academic qualification, years of experience as a critical care nurse, and hospital affiliation were significantly associated with increased use of self-report pain assessment tools for verbal patients, while the type of hospital and hospital affiliation was significantly associated with an increased use of observational pain assessment tools for nonverbal patients. Conclusion: Examining the association between socio-demographic characteristics and the use of pain assessment tools for critically ill patients is essential for quality pain practice.

Physicians’ and nurses’ experience of using the Abbey Pain Scale (APS) in people with advanced cancer: a qualitative content analysis

BackgroundThe Abbey Pain Scale (APS), an observational scale used to assess pain in people with end-stage dementia, is also widely used in Sweden to assess pain in patients with advanced cancer. It is unclear whether the APS is appropriate in this context. This study aims to explore physicians’ and nurses’ experiences of using a Swedish translation of the APS (the APS-SE) in people with advanced cancer.MethodsConventional qualitative content analysis was used to analyse interviews with physicians (n = 6) and nurses (n = 6) working in oncology and specialised palliative care about their experiences of using the APS-SE.ResultsThree categories were created: fills a need, not always on target, and does not fully suit the clinical situation. Participants reported that although the APS-SE provides support in a challenging situation, it sometimes misses the mark: it does not distinguish well between pain and other types of suffering and its pain score tends not to reflect professionals’ intuitive perceptions of patients’ suffering. Some parts of the APS-SE were not considered useful, and others were perceived as ethically questionable.ConclusionHealth professionals greatly need an observational pain assessment tool for people with advanced cancer. The APS-SE is helpful in this context, but participants did not perceive it as ideal. Its problems seem inherent to the original APS rather than related to its translation from English to Swedish. Further research is needed to provide a more suitable pain assessment tool for patients with advanced cancer.

A117 VALIDITY EVIDENCE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPETENCY ASSESSMENT TOOLS: A SYSTEMATIC REVIEW

Abstract Background Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is essential to ensure trainees possess the skills needed for independent practice. Traditionally, ERCP training has used the apprenticeship model, whereby novices learn skills under the supervision of an expert. A growing focus on procedural quality, however, has supported the implementation of competency-based medical education models which require documentation of a trainee’s competence for independent practice. Observational assessment tools with strong evidence of validity are critical to this process. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. Purpose To conduct a systematic review of ERCP assessment tools and identify tools with strong evidence of validity using a unified validity evidence framework Method We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. Result(s) From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5). Conclusion(s) The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared

The Clinical Suitability of an Artificial Intelligence-Enabled Pain Assessment Tool for Use in Infants: Feasibility and Usability Evaluation Study.

Infants are unable to self-report their pain, which, therefore, often goes underrecognized and undertreated. Adequate assessment of pain, including procedural pain, which has short- and long-term consequences, is critical for its management. The introduction of mobile health-based (mHealth) pain assessment tools could address current challenges and is an area requiring further research. The purpose of this study is to evaluate the accuracy and feasibility aspects of PainChek Infant and, therefore, assess its applicability in the intended setting. By observing infants just before, during, and after immunization, we evaluated the accuracy and precision at different cutoff scores of PainChek Infant, which is a point-of-care mHealth-based solution that uses artificial intelligence to detect pain and intensity based solely on facial expression. We used receiver operator characteristic analysis to assess interpretability and establish a cutoff score. Clinician comprehensibility was evaluated using a standardized questionnaire. Other feasibility aspects were evaluated based on comparison with currently available observational pain assessment tools for use in infants with procedural pain. Both PainChek Infant Standard and Adaptive modes demonstrated high accuracy (area under the curve 0.964 and 0.966, respectively). At a cutoff score of ≥2, accuracy and precision were 0.908 and 0.912 for Standard and 0.912 and 0.897 for Adaptive modes, respectively. Currently available data allowed evaluation of 16 of the 17 feasibility aspects, with only the cost of the outcome measurement instrument unable to be evaluated since it is yet to be determined. PainChek Infant performed well across feasibility aspects, including interpretability (cutoff score defined), ease of administration, completion time (3 seconds), and clinician comprehensibility. This work provides information on the feasibility of using PainChek Infant in clinical practice for procedural pain assessment and monitoring, and demonstrates the accuracy and precision of the tool at the defined cutoff score.

IMPROVING CAREGIVER ASSESSMENT AND COMMUNICATION ABOUT PAIN IN RELATIVES WITH DEMENTIA

Abstract Pain is under-detected and poorly managed in persons with dementia (PWD). Family caregivers are well situated to detect and facilitate management of pain in PWD, but they receive little guidance and training in these tasks. Our group developed the Pain Identification and Communication Toolkit (PICT), a manualized, multicomponent intervention to help caregivers recognize pain in their care recipients and communicate their observations to healthcare providers. PICT includes a) training in administering an observational pain assessment tool, b) coaching in effective pain communication, and c) building caregivers’ skills through practice. To evaluate PICT’s acceptability, feasibility, and preliminary efficacy, we conducted a pilot randomized controlled trial of N=34 caregivers (n=18 randomized to PICT; n=16 randomized to a control condition). Participants were from diverse racial and ethnic backgrounds (14% Black; 15% Hispanic; 8% Asian; 8% multiracial). Of the caregivers enrolled in the intervention group, 66.7% reported that PICT improved their confidence in identifying pain symptoms, and 83.3% reported that PICT improved their confidence in communicating pain-related concerns to providers. Retention was excellent: 100% of caregivers in the PICT group completed all intervention sessions (4 total); only 5% prematurely terminated the study (did not complete the 12-week post-assessment questionnaire). Notably, caregivers in the PICT group showed a significant improvement in confidence communicating with healthcare providers from baseline to 12-week follow-up (M=3.9 vs. M=4.4; p<.01). Collectively, these findings suggest PICT’s potential as an intervention to help caregivers recognize and communicate about pain in PWD and that a full-scale efficacy trial with larger sample is warranted.

Development and Rasch Validation of an Observational Assessment Tool of Upper Limb Functional Impairment in Stroke Survivors: Functional Assessment Test for Upper Limb

ObjectiveTo develop and validate a quick observational clinical tool, the Functional ASsessment Test for Upper Limb (FAST-UL), for the evaluation of upper limb impairment in goal-directed functional-oriented motor tasks after stroke. DesignObservational, cross-sectional, psychometric study. SettingInpatient and outpatient rehabilitation clinic. ParticipantsA total of 188 post-stroke survivors (mean age 65.2±17.7 years, 61% men, 48% with ischemic stroke and 66% in the sub-acute phase; N=188). InterventionsNot applicable. Main Outcome MeasuresPrincipal component analysis and Rasch analysis through a Partial Credit Model were used to assess the structure and psychometric properties of the 5 items of the FAST-UL (Hand to Mouth [HtM], Reach to Target, Prono-Supination, Grasp and Release, and Pinch and Release [PaR]). ResultsThe Cronbach's α equal to 0.96 was indicative of an acceptable internal consistency; the reliability, as measured through the Person Separation Reliability equal to 0.87, was good. The FAST-UL tool was unidimensional. All the FAST-UL items were found to fit well the Rasch measurement model. The easiest to perform FAST-UL item was the HtM movement while the most difficult was the PaR movement. ConclusionsThe FAST-UL is a quick, easy-to-administer observational assessment tool of upper limb motor impairment in post-stroke survivors with good item-level psychometric properties.

Reliability Analysis of Observation-Based Exposure Assessment Tools for the Upper Extremities: A Systematic Review.

(1) Background: The objectives of this systematic review were to (i) summarize the results of studies evaluating the reliability of observational ergonomics exposure assessment tools addressing exposure to physical risk factors associated with upper extremity musculoskeletal disorders (MSDs), and (ii) identify best practices for assessing the reliability of new observational exposure assessment tools. (2) Methods: A broad search was conducted in March 2020 of four academic databases: PubMed, Science Direct, Ergonomic s, and Web of Science. Articles were systematically excluded by removing redundant articles, examining titles and abstracts, assessing relevance to physical ergonomics and the upper extremities, and article type. (3) Results: Eleven articles were included in the review. The results indicated no singular best practice; instead, there were multiple methodological approaches researchers chose to use. Some of the significant variations in methodologies include the selection of reliability coefficients, rater and participant selection, and direct vs. digital observation. (4) Conclusion: The findings serve as a resource summarizing the reliability of existing observational risk assessment tools and identify common methods for assessing the reliability of new observational risk assessment tools. Limitations of this review include the number of databases searched, the removal of truncation symbols, and the selection of keywords used for the initial search.

The Dementia Coding System (DeCS): Development and initial evaluation of a coding system to assess positive, challenging, and music-related behaviors of people with dementia

ABSTRACT Introduction The Dementia Coding System (DeCS), an observational assessment tool to measure positive, challenging, and music-related behaviors in people with dementia, was developed and psychometrically evaluated to assess effects of non-pharmacological interventions (for example, individualized music interventions). Method Data from N = 114 people with dementia were analyzed for factorial validity, internal consistencies, and test-retest reliability. Factorial validity was analyzed using explorative factor analysis (EFA). Results The results indicate a single factor including nine items that represent “Positive Behaviors”. Internal consistency and test-retest reliability were also acceptable for this single factor. Two exploratory factors (“Challenging Behaviors”, “Musical Engagement”) were proposed for behaviors that could not be included in the EFA due to insufficient variability. Here again, internal consistency and test-retest reliability were calculated with acceptable results. Discussion In conclusion, DeCS is a useful coding system to assess effects of non-pharmacological interventions, especially music-based interventions for people with dementia, across a variety of behavioral indicators of negative and positive aspects of quality of life.

The context and development of the early relational health screen.

Early relational experiences are key drivers for developing social emotional capacities, educational achievement, mental health, physical health, and overall wellbeing. The child health sectors are committed to promotion, prevention, and early intervention that optimize children's health and development, often employing evidence-based screening as foundational practices. Despite a variety of validated parent-infant observational assessment tools, few are practical within busy practice settings, acceptable with all racial and ethnic groups and ready for universal adoption. In response to this need, a team of clinicians, early childhood educators, researchers and infant mental health specialists collaborated to develop and test a novel video-based, dyadic relational screening and monitoring tool, the Early Relational Health Screen (ERHS). This tool uniquely focuses on the early parent-child relationship (6-24 months), within the construct of early relational health (ERH). Initial testing demonstrated that the ERHS is a valid, reliable, feasible, and useful screening and monitoring tool for clinical applications. The ERHS was further developed within a population-based, prospective research study and adapted with brief video feedback for parents in the home visiting and child health sectors. The ERHS and its adaptations appear to advance ERH and equity within the transforming child health and public health care systems of today.

Can Observational Gait Assessment Tools be used to Assess Independent Walking in Stroke Patients?

Can Observational Gait Assessment Tools be used to Assess Independent Walking in Stroke Patients?

Observational assessment of communication to empower patients with dementia to make legally effective decisions – revalidation of CODEMamb

Objectives: Communication enables humans to exercise their rights. Dementia research consistently shows that communication skills decrease as the disease progresses. Nonverbal communication abilities decline more slowly than verbal skills and often become more important as the disease advances. However, resources and deficits in nonverbal and verbal communication behavior differ between persons with dementia and contexts. Knebel et al. proposed the observational assessment tool CODEMamb that we believe to be the first standardized instrument to differentiate between content-related and relationship aspects of nonverbal communication behavior. Until now, evaluations of CODEMamb have been exploratory and used small samples. Method: We therefore retested the psychometric criteria of CODEMamb in persons with a suspected dementia in an ambulatory setting. Data was drawn from 326 older adults (aged 52 − 91) during routine screening in Germany. Results: Our findings support the three-factorial structure of CODEMamb. Internal consistency of the overall scale and the three subscales of CODEMamb was high. Correlations with CERAD-NP subscales revealed similarities to CODEMamb, indicating sufficient convergent validity. Finally, CODEMamb was able to differentiate between persons according to the stage of their disease. Conclusion: CODEMamb is a theoretically based, reliable and valid observational assessment tool and its use in ambulatory settings can help foster individual, person-centered communication by identifying the resources of people with dementia, thereby empowering them in rights-exercising situations.