Optimal Cut-off Score Research Articles

Revision and Validation of the Hwa-Byung Scale

IntroductionHwa-Byung is a cultural-related mental syndrome that reflects the cultural characteristics of Korean in DSM-IV. This syndrome is caused by anger or resentment towards unreasonable social violence and trauma.ObjectivesThe purpose of this study is to revise and validate the ’Hwa-Byung scale’, which can be used to diagnose Hwa-Byung and evaluate the severity of its symptoms.Methods To begin with, the factors of the Hwa-Byung scale were set based on the previous studies. Additionally, the respective subfactors were generated by the semi-structured interviews with these patients. Based on these factors and previous studies, a 142-item pool was developed and verified by six Oriental Neuropsychiatrists. A pilot study was conducted on 50 patients with Hwa-Byung and the main study for the validation was conducted on 200 Hwa-Byung patients. Item analysis, internal consistency, and exploratory/confirmatory factor analysis were performed. Lastly, this study analyzed the ROC curve to present the diagnostic cut-off score of the scale.ResultsAs a result of analyzing the content validity of the item pool, we constructed a preliminary scale. We excluded the inadequate questions from the pilot study results. In the main study, The Hwa-Byung scale showed high internal consistency and its items were suitable for the factor structure. Finally, we suggest an optimal cut-off score of the symptoms sub-scale for screening Hwa-Byung.ConclusionsOverall, the results of this study indicated the reliability and validity of the Hwa-Byung Scale. Based on these results, we discussed several values and limitations of this study and provided suggestions for further research.DisclosureNo significant relationships.

Evaluation of the geriatric 8 (G8) screening tool in a multi-ethnic Asian population of older adults with cancer: Results from Geriatric Oncology Longitudinal End to eNd (GOLDEN) Study.

e24029 Background: The Geriatric 8 (G8) questionnaire has been validated predominantly in Western populations as a screening tool to identify vulnerable older adults with cancer who would benefit from comprehensive geriatric assessment (CGA). Given the paucity of evidence of the performance of this tool in a multi-ethnic Asian population, there is a need to determine whether the established cut-off score of 14 should be adjusted for improved performance in this population of older adults. Methods: Prospective cross-sectional study was done in older adults aged ≥ 65 years in the outpatient setting of an academic tertiary cancer center, the National University Cancer Institute, Singapore (NCIS). G8 questionnaire and CGA were conducted for eligible patients. The performance of the G8 screening tool in identifying patients who would benefit from a CGA was evaluated using receiver operating characteristic (ROC) curve analysis: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). Results: 180 participants (mean age 74 years) were included in the study. 40.5% were female. 90% were Chinese, 7% were Malay, 2% were Indian. 57.8% were pre-frail and 12.8% were frail. The top five cancers in our study population were colorectal (30%), lung (25%), head and neck (12%), upper gastrointestinal (10%) and gynecological (7.0%). ROC analysis showed an AUC of 0.73 (95% CI 0.65 – 0.80) with an optimal cut-off score of 13 (Sn 71.7%, Sp 74.0%). Conclusions: G8 performed well in identifying older adults with cancer who would benefit from a CGA, in a multi-ethnic Asian population. In our cohort, we found that a slightly lower cut-off score of 13 performed better, and should be taken into consideration as part of daily oncology practice in Asia. Future research efforts should go into examining the biological aspects of frailty in this population.

Validity of the Edinburgh Postnatal Depression Scale for screening pregnant and postpartum adolescents: a systematic review

Objective: To examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) for screening depression in pregnant and postpartum adolescents. Background: The incidence of postpartum depression (PPD) in 15 to 19-year olds is double the rate reported among mothers older than 25 years. EPDS threshold scores that indicate possible depression among adolescents have not been established and may differ from those validated for adults. Study design and methods: A systematic review of the literature between 1987 and 2020 was conducted using five databases: CINAHL, EMBASE, MEDLINE, MIDIRS and PsycInfo. Studies that sampled adolescent mothers in the perinatal period, that screened for depressive symptoms using the EPDS, and which assessed the validity of the tool were included. The studies were grouped according to their methodology with results presented as a narrative synthesis. Two researchers independently reviewed search results, study selection and data extraction, and undertook quality appraisals using the Quality Assessment of Diagnostic Accuracy Studies checklist. Results: Five studies that sampled a total of 1,241 participants were included in the review: four validated the EPDS against diagnostic reference standards and one against other depression screening tools. The EPDS demonstrated high levels of sensitivity and specificity although optimal cut-off scores for possible depression were between 2 and 7 points lower than that recommended for adult samples. Overall performance of the EPDS was equivalent or better when compared to other screening tools. Discussion: The standard EPDS cut-off score (≥12) does not identify all adolescents at high risk of depression during the perinatal period. Scores of ≥9 may be more appropriate. However, different reference standards and sampling methods used in the studies compromise the review’s strength of evidence. Conclusion: Despite development of the EPDS more than 30 years ago, research into its validity among adolescents is still in its infancy. This review makes an important contribution to that body of evidence by revealing its limitations and highlighting trends upon which further research can build. Implications for research, policy and practice: Although Australian guidelines for perinatal depression screening are some of the most detailed in the world, limited guidance is offered for EPDS use among adolescents. The findings of this review raise important points for that guidance and for practitioners. Concerns for possible depression in adolescents should be triggered at an advisory EPDS cut-off score of ≥9. Further research is needed to confirm or refute these findings. What is already known about the topic? Postpartum depression (PPD) among adolescents is prevalent and a recognised public health concern due to its significant association with morbidity. Perinatal screening for depression using validated instruments, including the Edinburgh Postnatal Depression Scale (EPDS), is recommended in national and international guidance. There is no validated version of the EPDS for adolescents although there is evidence to suggest that cut-off scores indicative of possible depression may need to be lower than those recommended for adults. What this paper adds: The paper synthesises evidence that demonstrates the EPDS is a valid scale for perinatal screening of depression in adolescents. It identifies lower cut-off scores for suspected depression among adolescents compared to adults, and also highlights score differences in the pre and postnatal periods. The paper provides advisory screening guidance for practitioners and emphasises the importance of monitoring for depressive symptoms in perinatal adolescents at every healthcare encounter.

Validation of the Augmented Renal Clearance in Trauma Intensive Care scoring system for augmented renal clearance prediction in a trauma subgroup of a mixed ICU population

Augmented renal clearance is prevalent in trauma patients and leads to subtherapeutic levels of renally eliminated medications with potentially unfavourable clinical outcomes. The Augmented Renal Clearance of Trauma in Intensive Care (ARCTIC) score has been developed to predict augmented renal clearance in critically ill trauma patients. Our primary objective was to validate this score among the trauma subgroup of a mixed intensive care patient cohort. This single-centre, retrospective, observational cohort study assessed augmented renal clearance using a timed 24-h urine collection performed weekly. ARC was defined as a measured creatinine clearance of ≥130 ml/min/1.73 m2 . ARCTIC score performance was evaluated through a receiver operator characteristic curves and analysis of sensitivities and specificities for the trauma subgroup, the medical/surgical subgroup and the pooled cohort. Augmented renal clearance was observed in 33.9% (n=58) of trauma patients (n=171) and 15.7% (n=24) of medical/surgical patients (n=153). Examination of different cutoffs for the ARCTIC score in our trauma population confirmed that the optimal cutoff score was ≥6. Comparison between ROC curves for ARCTIC score and for regression model based upon our data in trauma patients indicated validation of the score in this subgroup. Comparison of sensitivities and specificities for ARCTIC score between trauma (93.1% and 41.6%, respectively) and medical/surgical subjects (87.5% and 49.6%, respectively) showed no clinical nor statistical difference, suggesting validation for the medical/surgical subgroup as well. In our mixed ICU population, the ARCTIC score was validated in the trauma subgroup. We also found that the score performed well in the medical/surgical population. Future studies should assess the performance of the ARCTIC score prospectively.

Accuracy and Cost-effectiveness of the Diabetic Foot Screen Proforma in Detection of Diabetic Peripheral Neuropathy in Myanmar.

ObjectiveProper foot assessment is important for early detection and treatment of diabetic peripheral neuropathy (DPN), the main cause of diabetic foot ulcers (DFUs). This study aimed to determine the accuracy and cost-effectiveness of the locally developed Diabetic Foot Screen (DFS) proforma in detecting DPN among diabetic patients at 10 selected clinics in Yangon, Myanmar.MethodologyThe study included 625 type 2 diabetics from 10 primary care clinics who participated in the diagnostic accuracy and cost-effectiveness analysis. They were assessed with DFS proforma and biothesiometry by two examiners independently. The cost-effectiveness analysis was conducted based on available data in the local primary care setting.ResultsThe overall accuracy of the DFS proforma assessment was 74.76% (95% CI: 70.46%- 79.06%). The optimal cut-off DFS score was ≥1.5 (sensitivity 62%; specificity 76%) in detecting DPN. Compared to biothesiometry, the cost-effectiveness of DFS proforma assessment in DPN detection was 41.79 USD per DPN case detected.ConclusionThis study supported the use of DFS proforma for DPN detection in primary care clinics. It also provided new information on the estimated costs per patient with DPN detected in Myanmar.

Correlation between Quality of Life and severity of Parkinson's Disease by assessing an optimal cut-off point on the Parkinson's Disease questionnaire (PDQ-39) as related to the Hoehn & Yahr (H&Y) scale.

Strong evidence shows that symptoms in individuals with Parkinson's Disease (PD) restrict both their independence and social participation, leading to a low Quality of Life (QoL). Conversely, a reduced QoL has a negative impact on symptoms. The aim is to evaluate the correlation between QoL and severity of PD by assessing the presence of an optimal cut-off point on the Parkinson's disease questionnaire (PDQ-39) as related to the Hoehn &Yahr (H&Y) scale in a cohort of Italian adults with PD. A multicenter, cross-sectional study was performed. This study was conducted on a cohort of consecutive individuals. All participants were evaluated with the PDQ-39, and the severity of PD was recorded according to the H&Y scale by a neurologist. Receiver op-erating characteristic (ROC) curves and coordinates, visually inspected, were used to find cut-off points with optimal sensitivity and specificity. These were in turn used to determine the optimal PDQ-39 cut-off score for identifying disease severity according to H&Y stages. 513 individuals were included in the study. The ROC curve analysis showed that QoL worsened with an increase in disease severity and age. Moreover, QoL was worse in females. The results of this study allowed for the correlation of QoL and disease severity in a cohort of individuals with PD. With this cut-off point, it is now possible to make a determination of QoL of an individual with PD at a certain stage of the disease, in a specific age range, and of a particular gender.

Usefulness of nutritional assessment using Geriatric Nutritional Risk Index as an independent predictor of 30-day mortality after hip fracture surgery

IntroductionThe Geriatric Nutritional Risk Index (GNRI) is an objective nutritional status assessment tool used for predicting mortality risk in hospitalized patients. However, it is unclear whether GNRI reflects short-term mortality for hip fracture patients after surgery. We examined the usefulness of the nutritional status assessed by the GNRI and identified cutoff scores that predict mortality risk. Does GNRI on admission predict the mortality after surgery for hip fracture? HypothesisEvaluation of GNRI could help identify patients at higher risk of 30-day mortality after hip fracture surgery. Materials and methodsThis retrospective study used data from 1040 patients who underwent hip fracture surgery. Fatalities within 30 days after hip fracture surgery were investigated. The GNRI was calculated on admission in all patients as follows: 14.89×serum albumin (g/dL)+41.7×body mass index/22. Receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) and the optimal cutoff score that could predict 30-day mortality after hip fracture surgery. This cutoff score was used for comparing the mortality rates between patient groups with a GNRI higher and lower than the cutoff score using Fisher's exact test. Logistic regression analysis was used to determine risk factors of 30-day mortality. ResultsThere were 17 fatalities (1.6%) in the cohort. The ROC-AUC value was 0.811, and the cutoff GNRI was 75.4. Mortality was significantly higher in the group with a GNRI<75.4 compared with the group with a GNRI≥75.4 (odds ratio [OR], 22.99; 95% confidence interval [95% CI], 7.55–78.05; p=0.00000004). A GNRI<75.4 was a significant predictor of mortality within 30-days after hip fracture surgery (OR, 27.1; 95% CI, 8.57–85.9; p≤0.0001). DiscussionOur results show that nutritional status assessment using GNRI can help predict 30-day mortality among geriatric patients undergoing surgery for hip fracture. The GNRI is a simple and accurate tool for predicting the risk of mortality after hip fracture surgery. Level of evidenceIV; case series study.

Clinical Outcome Discrimination in Pediatric ARDS by Chest Radiograph Severity Scoring.

Background There is no accurate radiological measurement to estimate the severity of pediatrics acute respiratory distress syndrome (PARDS). We validated the effectiveness of an adult radiographic assessment of lung edema (RALE) score in PARDS. Aim To assess the severity and prognosis of PARDS based on a chest radiograph (CXR) RALE scoring method. Methods Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria were used to diagnose PARDS. General demographics, pulmonary complications, and 28‐day mortality of the patients were recorded. Subgroups were compared by prognosis (survive and death) and etiology (infection and noninfection). Two observers calculated RALE independently. Each quadrant of CXR was scored by consolidation scores 0 (none alveolar opacity), 1 (extent <25%), 2 (extent 25%–50%), 3 (50%–75%), and 4 (>75%) and density scores 1 (hazy), 2 (moderate), and 3 (dense). Quadrant score equals consolidation score times density score. Total score equals to the sum of four quadrants scores. The ROC curve and survival curve were established, and the optimal cutoff score for discrimination prognosis was set. Results 116 PARDS (72 boys and 44 girls) and 463 CXRs were enrolled. The median age was 25 months (5 months, 60.8 months) and with a mortality of 37.9% (44/116). The agreement between two independent observers was excellent (ICC = 0.98, 95% CI: 0.97–0.99). Day 3 score was independently associated with better survival (p < 0.001). The area under the curve of ROC was 0.773 (95% CI: 0.709–0.838). The cutoff score was 21 (sensitivity 71.7%, specificity 76.5%), and the hazard ratio (HR) was 9.268 (95% CI: 1.257–68.320). The pulmonary complication showed an HR of 3.678 (95% CI: 1.174–11.521) for the discrimination. Conclusion CXR RALE score can be used in PARDS for discriminating the prognosis and has a better agreement among radiologist and pediatrician. PARDS with pulmonary complications, day 3 score whether greater than 21 points, have a better predictive effectiveness.

Mobility screening for fall prediction in the Canadian Longitudinal Study on Aging (CLSA): implications for fall prevention in the decade of healthy ageing.

BackgroundGuidelines for fall prevention in older adults recommend mobility screening for fall risk assessment; however, there is no consensus on which test to use and at what cutoff. This study aimed to determine the accuracy and optimal cut-off values of commonly used mobility tests for predicting falls in the Canadian Longitudinal Study on Aging (CLSA).MethodsMobility tests at baseline included the Timed Up and Go (TUG), Single Leg Stance (SLS), chair-rise and gait speed. Inclusion criteria were: age ≥ 65 years and meeting first-level fall screening criteria (i.e. history of a fall or mobility problem) at baseline. Accuracy of fall prediction at 18-months for each test was measured by the area under the receiver operating curve (AUC).ResultsOf 1,121 participants that met inclusion criteria (mean age 75.2 ± 5.9 years; 66.6% women), 218 (19.4%) reported ≥one fall at 18 months. None of the tests achieved acceptable accuracy for identifying individuals with ≥one fall at follow-up. Among women 65–74 and 75–85 years, the TUG identified recurrent fallers (≥two falls) with optimal cut-off scores of 14.1 and 12.9 s (both AUCs 0.70), respectively. Among men 65–74 years, only the SLS showed acceptable accuracy (AUC 0.85) for identifying recurrent fallers with an optimal cutoff of 3.6 s.ConclusionsOur findings indicate that commonly used mobility tests do not have sufficient discriminability to identify fallers in a population-based sample of community-dwelling older adults. The TUG and SLS can identify recurrent fallers; however, their accuracy and cut-off values vary by age and sex.

Association of Higher Body Mass Index and Diastolic Dysfunction in Patients Non-Hospitalized with COVID-19: A Post-COVID-19 Echocardiography Study

Background: The studies reported an association between body mass index (BMI) and diastolic function in metabolically healthy individuals. The relationship between the BMI and diastolic dysfunction (DD) of those who are metabolically healthy who recovered from COVID-19 without hospitalization and who have effort dyspnea has not been adequately studied yet. In this study, we aimed to characterize the association between BMI and diastolic function in an uncomplicated group with preserved ejection fraction. Materials and Methods: The study included 50 (17 males and 33 females) patients (PG) and 50 (20 males and 30 females) healthy control subjects (CG). Transthoracic echocardiogram was performed in all patients. Results: There was no significant difference between the groups in terms of age (p=0.101), gender (p=0.534), and BMI (p=0.070). C-reactive protein (CRP) (p=0.005) and D-dimer (p=0.009) were significantly higher in the PG. Grade 1 DD was significantly higher in PG (p&amp;lt;0.001). When controlling for the effect of age in the PG, a significant negative correlation was found between BMI and E/A ratio (r=-0.452; p=0.001), while this significance was not detected in the CG (r=0.122; p=0.404). The area under the ROC curve of BMI for the detection of DD was 0.806 (p&amp;lt;0.001; 95% CI (0.716-0.896)). The optimal cut-off score for BMI was 28.91, and its sensitivity and specificity for the diagnosis of DD were 39.3% and 93.1%, respectively. According to the binary logistic regression analysis, the sensitivity of BMI related to the diagnosis of DD was 50.0% and the specificity was 88.9%. Conclusions: These early abnormalities in cardiac function may have important implications for explaining the DD that is associated with increased cardiopulmonary morbidity caused by higher BMI.

Prevalence of bilateral vestibulopathy among older adults above 65 years on the indication of vestibular impairment and the association with Dynamic Gait Index and Dizziness Handicap Inventory

Purpose To estimate the prevalence of bilateral vestibulopathy (BV) and evaluate the association with, and concurrent validity of the Dynamic Gait Index (DGI) and the Dizziness Handicap Inventory (DHI) in diagnosing BV based on video head impulse test (vHIT) among older adults ≥65 years referred to a geriatric falls clinic on suspicion of vestibular impairment. Materials and methods The vHIT was applied as a reference standard of BV to estimate diagnostic parameters for optimal cut-off scores of DGI and DHI applied separately and in combination. Results Two-hundred medical records were reviewed (70% women, mean age 79.4 years). The prevalence of BV was 9%. DGI was weakly associated with BV: Odds Ratio (OR) 1.15 (95% confidence interval (CI): 1.01; 1.31), with a 93% sensitivity and 47% specificity of a cut-off score of 16. The total score of DHI showed no association with BV: OR 1.01 (95% CI: 0.98; 1.04). The concurrent validity for BV and DGI and/or DHI were found to be inadequate. Conclusions A prevalence of 9% underlines the relevance for assessment of BV. Only a weak association between DGI and/or DHI and BV was found. Thus, vHIT remains the preferred test for detecting BV in geriatric fall assessments. IMPLICATIONS FOR REHABILITATION Bilateral vestibulopathy (BV) has numerous negative consequences for older adults and the prevalence is high among older adults referred to a geriatric falls clinic on suspicion of vestibular impairment. The Dynamic Gait Index (DGI) and the Dizziness Handicap Inventory (DHI) are not valid alternatives to the Video Head Impulse Test (vHIT) when assessing BV among geriatric outpatients.

Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments.

ObjectiveViolence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED.MethodsA prospective cohort study was conducted among adult and pediatric patients aged ≥10 years visiting 3 emergency departments in Michigan between May 1, 2021, and June 30, 2021. Triage nurses completed the 16‐item checklist using electronic health records (EHRs), and the occurrence of violent incidents were collected before ED disposition. A multivariate logistic regression model was applied to select a parsimonious set of items.ResultsAmong 10,554 patients, 127 had ≥1 violent incidents (1.2%). The regression model resulted in a 7‐item ABRAT for EDs, including history of aggression and mental illness and reason for visit, as well as 4 violent behavior indicators. Receiver operating characteristics analysis showed that the area under the curve was 0.91 (95% confidence interval [CI], 0.87–0.95), with a sensitivity of 84.3% (95% CI, 76.5%–89.9%) and specificity of 95.3% (95% CI, 94.8%–95.7%) at the optimal cutoff score of 1. An alternative cutoff score of 4 for identifying patients at high risk for violence had a sensitivity and specificity of 70.1% and 98.9%, respectively.ConclusionThe ABRAT for EDs appears to be a simple yet comprehensive checklist with a high sensitivity and specificity for identifying potentially violent patients in EDs. The availability of such a screening checklist in the EHR may allow rapid identification of high‐risk patients and implementation of focused mitigation measures to protect emergency staff and patients.

Diagnostic Performance and Validity of the German Version of the BDI-II - A Secondary Analysis with Data from Clinical and Nonclinical Samples

Study of the diagnostic performance and validity of the German Beck Depression Inventory (BDI-II) in a large data set from multiple adult samples. The BDI-II was assessed together with the SCID-I as external criterion in 638 individuals (385 currently or remitted depressed individuals, 253 controls). The screening performance of the BDI-II was calculated for suggested cut-offs from the BDI-II manual and for optimal cut-offs derived from ROC-analyses. The internal consistency of the BDI-II was high (> 0,90) and it showed plausible associations with construct-related scales. Optimal cut-off scores of 16+ resulted for MDE (Youden's J = 0.838) and of 14+ for DD (J = 0.814). The German BDI-II is a reliable und valid screening tool for detecting depressive episodes and depressive disorders in the adult population. Depending on prioritized goals different cut-off-values can be used.

Usefulness of the acromioclavicular joint cross-sectional area as a diagnostic image parameter of acromioclavicular osteoarthritis.

BACKGROUNDAcromioclavicular joint (ACJ) space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis (ACJO). However, the morphology of the ACJ space is irregular because of osteophyte formation, subchondral irregularity, capsular distention, sclerosis, and erosion. Therefore, we created the ACJ cross-sectional area (ACJCSA) as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.AIMTo hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.METHODSACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance (S-MR) imaging that revealed no evidence of ACJO. Oblique coronal, T2-weighted, fat-suppressed S-MR images were acquired at the ACJ level from the two groups. We measured the ACJCSA and the ACJ space width (ACJSW) at the ACJ on the S-MR images using our imaging analysis program. The ACJCSA was measured as the cross-sectional area of the ACJ. The ACJSW was measured as the narrowest point between the acromion and the clavicle.RESULTSThe average ACJCSA was 39.88 ± 10.60 mm2 in the normal group and 18.80 ± 5.13 mm2 in the ACJO group. The mean ACJSW was 3.51 ± 0.58 mm in the normal group and 2.02 ± 0.48 mm in the ACJO group. ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals. Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm2, with 91.4% sensitivity and 90.0% specificity.CONCLUSIONThe optimal ACJSW cutoff score was 2.37 mm, with 88.6% sensitivity and 96.7% specificity. Even though both the ACJCSA and ACJSW were significantly associated with ACJO, the ACJCSA was a more sensitive diagnostic image parameter.

Validity and reproducibility of the PPLP score in the follow-up of anterior cruciate ligament reconstruction in athletes

Objectives:In a context where psychological scores appear to have an increasing influence on the resumption of sports, it would also appear to be essential to evaluate the relevance of global scores with multiple criteria. The PPLP score (Psychological Physical Ligament Predictive score) enables an analysis of subjective, clinical and isokinetic muscle assessment items.Methods:We prospectively followed anterior cruciate ligament (ACL) reconstructions in several series for which we analyzed the validity of the score (763 patients), the reproducibility, the sensitivity to change, the relevance in the follow-up of ligamentoplasty (3,296 ligamentoplasties followed postoperatively) as well as the predictive nature in the resumption of sports (258 patients). The PPLP score has two parts: one (PPLP1) based on 100 points for postoperative follow-up and the other also based on 100 points (PPLP2) which is added to the first score for follow-up at a certain period of time after surgery to determine a new score of 200 points. We also tried to identify correlations with other scores in the literature (OAK, Lysholm, Tegner, KOOS, Arpeggio, IKDC Subjective and the Psychovitality Test).Results:We demonstrated the distinction of the items (r coefficient of 0.20) for construct validity. Intra-examiner and extra-examiner reproducibility was excellent, ranging from 0.92 to 1. The PPLP score changed in a statistically significant way during hospitalization and according to the operating lead time with phases of higher variation. Complicated clinical changes manifested in a low score, in particular neuro-algodystrophies (1.9%) with a mean PPLP1 of 80.33 while changes without complications (80.8%) had a mean score of 94.28 with a significant difference (p < 0.0001). The PPLP2 score correlated significantly with the resumption of competition (p = 0.012). A high score was associated with faster recovery. The optimal cut-off score was 176 (sensitivity 79.7% and specificity 49.3%). The results of the PPLP score were correlated with the other scores.Conclusion:The PPLP score was validated in terms of construction, reproducibility, and sensitivity in the follow-up of ACL ligamentoplasties. It provides indications on the quality of change and the possibilities of resuming sports. It is the only score that incorporates isokinetic assessments.

Diagnostic Accuracy of the Telephone Interview for Cognitive Status for the Detection of Dementia in Primary Care.

Cognitive diagnostic work-up in primary care is not always physically feasible, owing to chronic disabilities and/or travel restrictions. The identification of dementia might be facilitated with diagnostic instruments that are time efficient and easy to perform, as well as useful in the remote setting. We assessed whether the Telephone Interview for Cognitive Status (TICS) might be a simple and accurate alternative for remote diagnostic cognitive screening in primary care. We administered the TICS (range, 0-41) for 810 of 1,473 older people aged 84.5 (SD, 2.4) years. We scrutinized electronic health records for participants with TICS scores ≤30 and for a random sample of participants with TICS scores >30 for a dementia diagnosis using all data from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial for 8-12 years of follow-up. We used multiple imputation to correct for verification bias. Of the 810 participants, 155 (19.1%) had a TICS score ≤30, and 655 (80.9%) had a TICS score >30. Electronic health records yielded 8.4% (13/154) dementia diagnoses for participants with TICS ≤30 vs none with TICS >30. Multiple imputation for TICS >30 yielded a median of 7/655 (1.1%; interquartile range, 5-8) estimated dementia cases. After multiple imputation, the optimal cutoff score was ≤29, with mean sensitivity 65.4%, specificity 87.8%, positive predictive value 11.9%, negative predictive value 99.0%, and area under the curve 77.4% (95% CI, 56.3%-90.0%). In the present older population, the TICS performed well as a diagnostic screening instrument for excluding dementia and might be particularly useful when face-to-face diagnostic screening is not feasible in family practice or research settings. The potential reach to large numbers of people at low cost could contribute to more efficient medical management in primary care.

Transcultural validation of a French-European version of the Prescription Opioid Misuse Index Scale (POMI-5F).

The Prescription Opioid Misuse Index scale (POMI) is a brief questionnaire used to assess opioid prescription misuse. In view of the increase in the prescription of opioid analgesics for chronic noncancer pain (CNCP), this tool is particularly useful during medical consultations to screen opioid misuse in patients using opioids. We sought to generate and validate a French-European translation of the POMI. We conducted an observational, longitudinal, and multicenter psychometric study with crosscultural validation. All adult CNCP patients who were treated with opioids for at least three months, were followed in pain clinics, and spoke French were eligible. From September 2015 to November 2017, we included 163 patients and analyzed 154. We performed a pretest on a sample of representative patients to evaluate acceptability and understanding of translation. Study patients completed the POMI scale at a pain clinic (test phase), and we assessed test-retest reliability after two to four weeks by a second completion of the POMI scale at home by patients (retest phase). We subsequently explored psychometric properties of the POMI (acceptability, internal consistency, reproducibility, and external validity). Due to poor internal consistency and reproducibility, items 4, 7, and 8 of the original POMI scale were removed, and we proposed a five-question French-European version (POMI-5F). The internal consistency of POMI-5F was good (Cronbach's α = 0.71), as was test-retest reliability (r = 0.65 [0.55-0.67]). The external validity of POMI-5F, compared with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was moderate but significant (r = 0.45; P < 0.001). The optimal POMI-5F cut-off score to indicate misuse was 2/5 (sensitivity = 0.95 and specificity = 0.54). We generated and validated a French-European translation of the POMI scale, POMI-5F, for use by French researchers and physicians to identify opioid misuse in CNCP patients.

Psychometric properties of CAST for early detection of problematic cannabis use in Spanish adolescents

The high prevalence rates of cannabis use in adolescents and its early onset constitutes a major public health problem, raising the need for its early detection. The availability of validated tools to analyze early cannabis use is essential to detect problematic use at an early age. The Cannabis Abuse Screening Test (CAST) (Legleye et al., 2007) is widely applied in Europe; however, the CAST cut-off scores vary according to the setting, the screening objective, and the correction version (CAST-f or CAST-b), creating therefore confusion in its application. Moreover, the psychometric properties of the CAST as a tool for detecting problematic cannabis use are understudied. To fill this gap, such psychometric properties have been analyzed in a sample of Spanish adolescents while using different cut-off scores for CAST-f and CAST-b. Based on our findings, the optimal cut-off scores are 2 points for CAST-b and 4 points for CAST-f. The internal reliability of CAST-f (α = 0.83) and CAST-b (KR-20 = 0.80) are satisfactory. Factorial analysis suggested the assumption of a one-dimension model. The CAST seems to be a valid and reliable tool for early screening of problematic cannabis use in Spanish adolescents.

Cut-off score of the modified Ashworth scale corresponding to walking ability and functional mobility in individuals with chronic stroke

Purpose To determine the optimal cut-off score for the Modified Ashworth Scale (MAS) corresponding to unfavorable outcomes for mobility and walking ability. Methods The level of plantar flexor muscle spasticity and the 10-meter walking test (10mWT), timed up and go (TUG), and five time sit-to-stand (FTSTS) outcomes were evaluated in individuals after stroke. The correlation between MAS and the tests was investigated, and the optimal cut-off score, sensitivity, and specificity were evaluated through receiver operating characteristic (ROC) curve. Results Twenty-one participants with chronic stroke and plantar flexors spasticity (11 men; 10 women; mean age = 57.6 ± 12.5 years) participated in the study. Significant correlations between MAS and 10mWT (r= −0.45; p < 0.05), MAS and TUG (r = 0.48; p < 0.05) were found. The optimal cut-off scores were MAS > 2 for unfavorable 10mWT (sensitivity = 100%; specificity = 54.5%; ROC = 0.782) and MAS ≤ 2 for favorable TUG outcomes (sensitivity = 55.5%; specificity = 91.6%; ROC = 0.782). Conclusions This study revealed that moderate level of plantar flexors spasticity results in the highest sensitivity to predict poor gait speed performance and the highest specificity to predict good mobility performance in individuals after stroke. These findings will help clinicians in their evidence-based decision making on the role of spasticity for mobility and walking ability. Implications for rehabilitation Moderate level of spasticity (MAS <2) is the optimal cut-off score for 10mWT and TUG tests. Reducing the level of spasticity of plantar flexors below this cut-off point might be associated with an increased walking speed in this population. MAS <2 might not limit walking and mobility in individuals after stroke. Calf muscles spasticity might not compromise five time sit-to-stand (FTSTS) performances and might be related to a smaller influence on the sit to stand task.

Functional Independence and Disability Evaluation in Stroke Patients: Optimal Cutoff Scores for a Pictorial-Based Longshi Scale, Barthel Index, and Modified Rankin Scale.

IntroductionThe modified Rankin Scale (mRS) and Barthel Index (BI) are widely used to measure functional outcomes worldwide. The Longshi Scale (LS), a novel pictorial-based instrument, was designed to improve the simplicity and convenience of measuring functional outcomes in the Chinese context. However, the disagreements in functional outcomes assessed by the mRS, BI, and LS are misleading, particularly in stroke patients. This study aimed to identify the optimal cutoff scores of LS and BI according to the mRS in Chinese stroke patients with different levels of functional disability.MethodsThe mRS, BI, and LS were applied to evaluate functional independence and disability in 7364 stroke patients in a multi-center cross-sectional study. Stroke patients were categorized into bedridden, domestic, and community groups in advance using the LS, indicating severe, moderate, and mild functional disability, respectively. The optimal cut-off scores of the LS and BI according to the mRS were identified via sensitivity, specificity, and Youden's index and stratified by different levels of functional disability determined by LS. We also plotted the receiver operator characteristic (ROC) curves of sensitivity and specificity and determined the area under the curve (AUC).ResultsIn the bedridden group, LS and BI cutoff scores with the highest Youden's index were 5 and 10 for mRS 4, and the AUCs for the ROC curve were 0.848 and 0.863 for mRS 4. In the domestic group, LS and BI cutoff scores with the highest Youden's index were 5 and 65 for mRS 3, and the AUCs for the ROC curve were 0.796 and 0.826 for mRS 3. In the community group, LS cutoff scores with the highest sum of sensitivity and specificity were 9, 9, and 8 for mRS grades 0, 1, and 2, respectively, while the BI cutoff scores with the highest sum of sensitivity and specificity were 100, 100, and 95, respectively, while the AUCs for the ROC curve were 0.697 and 0.735 for mRS 2, 0.694 and 0.716 for mRS 1, and 0.628, and 0.660 for mRS 0.ConclusionsThe mRS is more precise to determine mild functional disability, whereas BI can provide more specific information on moderate and severe levels in stroke patients. Although LS was a less precise was to determine moderate and severe levels than BI, it is much simpler and more convenient to be applied to a large-scale population.