Prediction Of Functional Status Research Articles

Risk factors for functional state deterioration in patients with lymphatic malformation occuring in the neck region

Introduction. The improvement and prediction of functional status in patients with lymphatic malformations of the head and neck, particularly in neck masses, remains a pressing socio-economic concern. As of the publication of this article, no comprehensive scientific studies have explored the cause-and-effect relationships that impact the functional status of this specific patient demographic.Aim. To elucidate the cause-and-effect relationships impacting the functional status of patients with cervical lymphatic malformations and to develop a predictive model for their functional decline.Materials and methods. A retrospective cohort study was conducted, involving a detailed analysis of the functional status of 115 paediatric and adolescent patients aged 1 month to 17 years, treated for cervical lymphatic malformations at the Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology, and Immunology, from May 2012 to December 2022. The analysis utilised the Cologne Disease Score (CDS), varying according to the histological type of the lymphatic malformations (microcystic, macrocystic, or mixed) and the staging of the de Serres classification.Results and discussion. The study involved 115 patients with a median age of 2.1 years (ranging from 0.4 to 5.5 years). It was determined that the ‘Mixed lymphatic malformations type,’ ‘Stage V of the de Serres classification,’ and ‘Need for surgical treatment’ were clinically and statistically significant prognostic factors for the deterioration of functional status in these patients, reducing the CDS scores by 0.976 to 4.514 points, respectively. These findings supported the development of a predictive model for worsening functional status in this group.Conclusion. The predictive model formulated during this research accounts for the histological type, location, and treatment modality, and is recommended for clinical application within specialised medical institutions.

Prediction models for functional status in community dwelling older adults: a systematic review

BackgroundDisability poses a burden for older persons, and is associated with poor outcomes and high societal costs. Prediction models could potentially identify persons who are at risk for disability. An up to date review of such models is missing.ObjectiveTo identify models developed for the prediction of functional status in community dwelling older persons.MethodsA systematic review was performed including studies of older persons that developed and/or validated prediction models for the outcome functional status. Medline and EMBASE were searched, and reference lists and prospective citations were screened for additional references. Risk of bias was assessed using the PROBAST-tool. The performance of models was described and summarized, and the use of predictors was collated using the bag-of-words text mining procedure.ResultsForty-three studies were included and reported 167 evaluations of prediction models. The median c-statistic values for the multivariable development models ranged between 0.65 and 0.76 (minimum = 0.58, maximum = 0.90), and were consistently higher than the values of the validation models for which median c-statistic values ranged between 0.6 and 0.68 (minimum = 0.50, maximum = 0.81). A total of 559 predictors were used in the models. The five predictors most frequently used were gait speed (n = 47), age (n = 38), cognition (n = 27), frailty (n = 24), and gender (n = 22).ConclusionsNo model can be recommended for implementation in practice. However, frailty models appear to be the most promising, because frailty components (e.g. gait speed) and frailty indexes demonstrated good to excellent predictive performance. However, the risk of study bias was high. Substantial improvements can be made in the methodology.

The influence of the CRS-R score on functional outcome in patients with severe brain injury receiving early rehabilitation

BackgroundThe aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment.MethodsPatients consecutively admitted to intensive or intermediate care units of a neurological rehabilitation center were enrolled in the study. Consciousness and functional status were assessed with the Coma Recovery Scale-Revised (CRS-R) and the Early Rehabilitation Barthel Index (ERBI), respectively. Both assessments were carried out weekly within the first month and at the end of early rehabilitation. Patient and clinical data were entered into a binary logistic regression model to predict functional status at discharge.Results327 patients (112 females, 215 males) with a median age of 63 years (IQR = 53–75) and a median disease duration of 18 days (IQR = 12–28) were included. Most patients suffered from stroke (59 %), followed by traumatic brain injury (31 %), and hypoxic ischemic encephalopathy (10 %). Upon admission, 12 % were diagnosed as comatose, 31 % as unresponsive wakefulness syndrome (UWS), 35 % as minimally conscious state (MCS) and 22 % already emerged from MCS (eMCS). Of all patients undergoing complete early rehabilitative treatment (n = 180), 72 % showed improvements in level of consciousness (LOC). In this group, age, initial CRS-R score and gains in CRS-R score after four weeks independently predicted functional outcome at discharge.ConclusionsThe study confirms the relevance of the CRS-R score for functional outcome prediction. High CRS-R scores and young age facilitate functional improvements and increase the probability to continue treatment in subsequent rehabilitation phases. Moreover, results indicate that recovery might occur over a period of time that extends beyond acute care.

Anxiety and health-related quality of life after cardiac surgery.

IntroductionThe aim of this study was to investigate the effect of elective cardiac surgery on health-related quality of life (HRQoL).Material and methodsOne hundred and eight (35 women and 73 men, mean age 62.3 ±12.7 years) patients undergoing open heart surgery were enrolled in the study. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire, and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 108 patients filled out the SF-36 and STAI, and 102 patients at 6-month follow-up.ResultsIt was found that there was significant improvement in three out of eight health domains: physical functioning (p < 0.02), role physical (p < 0.01), and social functioning (p < 0.04), at 6-month follow-up. The two STAI sub-scores: the State Anxiety Inventory and the Trait Anxiety Inventory were found to be high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was not any statistically significant decrease in the levels of anxiety.ConclusionsThis study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status and HRQoL in patients after cardiovascular surgery. Furthermore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety.

Assessment of anxiety and health-related quality of life in patients with lower extremity peripheral arterial occlusive disease.

IntroductionThe aim of this study was to investigate the effect of chronic occlusive vascular disease on anxiety with adverse outcome with health-related quality of life (HRQoL).Material and methodsThree hundred and thirty-five patients who were treated for peripheral arterial occlusive disease were enrolled in this study. 187 patients who had undergone percutaneous transluminal angioplasty and 148 patients who had one or more surgical revascularizations enrolled in the study. Mean age of the patients was 62.6 ±10 years. Two hundred and eighty-nine patients were male, 46 patients were female. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 335 patients filled out the SF-36 and STAI, and 304 patients (90.7 % of the series) filled them out at 6-month follow-up.ResultsThere was no mortality and no significant morbidity after vascular interventions in the series. Significant improvement was found in two of eight health domains. The score of social functioning increased to 60.4 from 52.6 (p < 0.03) and general health perception increased to 75.1 from 60.5 (p < 0.04) at 6-month follow-up. The two STAI sub-scores, the State Anxiety Inventory (STAI-S) and the Trait Anxiety Inventory (STAI-T) were found high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was no significant decrease of the levels of anxiety.ConclusionsThis study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status in patients suffering from lower extremity peripheral arterial occlusive disease.

Combination of DXA and BIS body composition measurements is highly correlated with physical function-an approach to improve muscle mass assessment.

Fluid volume estimates may help predict functional status and thereby improve sarcopenia diagnosis. Bioimpedance-derived fluid volume, combined with DXA, improves identification of jump power over traditional measures. DXA-measured lean mass should be corrected for fluid distribution in older populations; this may be a surrogate of muscle quality. Sarcopenia, the age-related loss of muscle mass and function, negatively impacts functional status, quality of life, and mortality. We aimed to determine if bioimpedance spectroscopy (BIS)-derived estimates of body water compartments can be used in conjunction with dual-energy X-ray absorptiometry (DXA) measures to aid in the prediction of functional status and thereby, ultimately, improve the diagnosis of sarcopenia. Participants (≥ 70years) had physical and muscle function tests, DXA, and BIS performed. Using a BMI correction method, intracellular water (ICWc), extracellular water (ECWc), and ECWc to ICWc (E/Ic) ratio was estimated from standard BIS measures. Jump power was assessed using jump mechanography. The traditional measure used to diagnose sarcopenia, DXA-derived appendicular lean mass (ALM) corrected for height (ALM/ht2), was the least predictive measure explaining jump power variability (r2 = 0.31, p < 0.0001). The best measure for explaining jump power was a novel variable combining DXA ALM and BIS-derived E/Ic ratio (ALM/(E/Ic); r2 = 0.70, p < 0.0001). ALM/(E/Ic) and ICWc had the highest correlation with jump power and grip strength, specifically jump power (r = 0.84 and r = 0.80, respectively; p < 0.0001). The creation of a novel variable (ALM/(E/Ic)) improved the ability of DXA to predict jump power in an older population. ALM/(E/Ic) substantially outperformed traditional lean mass measures of sarcopenia and could well be an improved diagnostic approach to predict functional status. DXA-measured ALM should be corrected for fluid distribution, i.e., ALM/(E/Ic); this correction may be considered a surrogate of muscle quality.

P136: The prediction of functional status two years later with current subjective perspectives on their own health in aging people in Korea: a nationwide longitudinal survey

P136: The prediction of functional status two years later with current subjective perspectives on their own health in aging people in Korea: a nationwide longitudinal survey

Prediction of pulmonary function after lobectomy

Aim-Background Lung cancer is the most common cause of cancer death in both men and women in our country. It has been estimated that there will be 7,000 lung cancer deaths every year in Greece. However, many patients with bronchogenic carcinoma also have coexistent obstructive lung disease. In these patients, preoperative prediction of functional status after lung resection is mandatory. The aim of our study was to determine the effect of lobectomy on postoperative spirometric lung function.

Nurses' assessment of rehabilitation potential and prediction of functional status at discharge from inpatient rehabilitation

The goals of this study were to evaluate the accuracy of nurses' predictions of rehabilitation potential in older adults admitted to inpatient rehabilitation facilities and to ascertain whether the addition of a measure of executive cognitive function would enhance predictive accuracy. Secondary analysis was performed on prospective data collected for 362 Medicare beneficiaries enrolled in a national, multicenter study of rehabilitation outcomes. Ordinary least squares regression analysis was performed. Nurses' admission prognoses for rehabilitation potential predicted patients' functional status for observed activities of daily living upon discharge (r = 0.20, R = 0.04, P< 0.001). The addition of a measure of executive cognitive function, the Behavioral Dyscontrol Scale, significantly enhanced the variance explained by the model (r = 0.48, R = 0.23, P< 0.001). Nurses' prediction of functional outcome for hip fracture patients was significant (r = 0.26, R=0.07, P< 0.001). Predictions for patients with medical-surgical diagnoses did not achieve significance (r = 0.12, R = 0.02, P = 0.13). The findings show the independence of nursing prognoses and the level of executive cognitive function, and suggest that inclusion of this measurement of executive cognitive function may significantly enhance the accuracy of nursing prognoses. Development and implementation of related nursing education might be warranted. Further research is needed to ascertain the best method to introduce assessment of executive cognitive function into the rehabilitation environment.

Ispitivanje funkcionalnog statusa bolesnika posle hirurske revaskularizacije miokarda

Determination of patient's functional status in early postoperative period is a delicate task, because of its general health status. Measures that can be used for that purpose are walk tests and functional status questionnaires. To determine correlation of different functional tests administered preoperatively and two minute walk test (2MWT) done postoperatively. To detect predictors of early functional recovery measured with two minute walk test. We examined ninety eight patients hospitalized for an elective coronary artery bypass graft surgery in February and March 2008. Functional status was assessed preoperatively using Duke Activity Status Index questionnaire (DASI), generic health related quality of life questionnaire and two minute walk test. Prior to discharge from the hospital, two minute walk test was repeated along with VAS for intensity of pain. Statistical analyze was done using Pearson's correlation coefficient, T test and multivariate regression analysis. Distance walked in 2 minutes decreased significantly postoperatively (p < 0.001). There was significant correlation between DASI and SF -12 preoperatively (r = 0.6 p < 0.001) and DASI preoperatively with 2MWT postoperatively (r = 0.4 p < 0.001). 2MWT postoperatively showed good correlation with intensity of pain (r = -0.42 p < 0.001) and age (r = -0.35 p < 0.001). There were no significant correlation with comorbidity, number of bypasses or postoperative complications. Multivariate regression analysis showed that the age was the strongest independent predictor of functional recovery (beta = - 0.33 < 0.05p) and that values of DASI preoperatively had moderate importance in prediction of functional status(beta = 0.238 p < 0.06). 2MWT was sensitive to change postoperatively. Significant correlation of 2MWT postoperatively with DASI preoperatively, age and VAS, as well as prediction capacity of age and DASI, gives us possibility to utilize those parameters in early rehabilitation program in order to achieve maximal functional recovery of patients.

Prediction of functional status in older adults: The ecological validity of four Delis–Kaplan Executive Function System tests

This study tested the ecological validity of four Delis-Kaplan Executive Function System (D-KEFS) tests by examining how well performance on D-KEFS measures predicted observed daily functioning in community-dwelling older adults. Older adults ages 65 to 92 years completed four D-KEFS tests requiring planning and cognitive fluency. The four combined D-KEFS measures accounted for approximately 26% of the variance in observed functional ability, when controlling for education and depression, thus supporting the ecological validity of the D-KEFS (Pearson r = .66). However, in a multiple regression analysis, the D-KEFS Trail Making Test-4 was the only measure of executive functioning that accounted for unique, independent variance in observed functional ability.

Prediction of Functional Status from Neuropsychological Tests in Community-Dwelling Elderly Individuals

Age-related dysfunction of frontal systems can result in deficits in planning, organization, self-control, and awareness of problems, which are likely to affect the ability to care for one's self. The purpose of this study was to determine the relationship between age-related frontal/executive deficits and impairment in instrumental activities of daily living (IADLs) in elderly individuals. Twenty-seven community-dwelling individuals were administered a comprehensive battery of neuropsychological tests and a performance-based evaluation of IADLs. Multiple regression analyses indicated that executive function and depression severity accounted for a significant proportion of variance in IADLs, with executive function making the greatest contribution. Tests measuring other cognitive functions, such as memory, language, and spatial skills, did not contribute significantly to the prediction of functional status. Furthermore, executive measures accounted for more variance than other demographic characteristics such as general health status, age, and educational level. The results of this study indicate that executive dysfunction in normal aging may be the best predictor of functional decline. A better understanding of the mechanisms that underlie IADL skills will ultimately aid in the development of compensatory and intervention strategies designed to delay the onset of assisted living and nursing home placement.

380. Functional deficit in schizophrenia: course, correlates, and etiological factors

Functional deficit has been a central feature of conceptions of sohizophrenia since the time of Kraepelin. Only recently, however, has it again become understood that functional deficit is not an epiphenomenon of the episodic features of the illness, such as positive symptoms. It is now more widely known to be a feature of the illness that is stable over time and more strongly determined by the cognitive and deficit features of the illness than by psychotic symptoms. This workshop focuses on the importance of functional deficit, including its temporal course and its relationship with cognitive impairment. Two of the presentations highlight the importance of cognitive deficit in the prediction of functional status. The first demonstrates that the causal path from poor premorbid functioning to current functional deficit is through current cognitive functioning, while the second shows that functional decline in schizophrenia is accompanied by cognitive decline as well. In addition, the workshop addresses key issues in the assessment of functional deficit. Like other areas of assessment in psychopathology, self-report and unsystematic retrospective evaluation of functional impairment is likely to give poor information about functional deficit. Two of the presentations in the workshop address the issue of direct assessment of functional deficit, including the introduction of a new method for behavioral assessment of functioning and critical information about the factors that may enhance or interfere with remediation of functional deficit.

The Predictive Validity of the Newcastle Independence Assessment Form Research (NIAF-R): Further Development of an Alternative Measure

Earlier papers have detailed the conceptualization, development, and testing of the Newcastle Independence Assessment Form (NIAF-R), an alternative global outcome measure. This article establishes the predictive validity of the measure. Predictive validity was examined by applying two different prediction models, using functional status and return to work (RTW) as the two outcome variables. Multiple linear and logistic regression analyses indicated that the NIAF-R, when incorporated in equations with age and injury severity, the latter determined by length of coma, was consistently predicting functional status from as early as 8 weeks and return to work from as early as 12 weeks post-injury. Prediction of functional status was especially significant, with the NIAF-R accounting for up to 90 percent of the variance. Prediction of return to work, although consistent, was less powerful. Implications for the validity of the NIAF-R, with particular reference to prognosis and rehabilitation planning, are presented.

Prognosis of rehabilitation outcome in head injury using the Disability Rating Scale

In this correlational study, we investigated the prediction of functional status on discharge from head injury rehabilitation in 64 adults with traumatic closed head injury. Subjects were rated on Rappaport's Disability Rating Scale during rehabilitation to obtain the Disability Rating Score on admission to rehabilitation, recovery rate during the first month of rehabilitation, and discharge Disability Rating Score. Potential prognostic variables included demographic and social characteristics, severity of injury indicators, head injury deficits present on admission to rehabilitation, and initial Disability Rating Score, and recovery rate. Multiple regression analyses were performed to determine if discharge Disability Rating Score could be predicted from subsets of the potential prognostic variables. Significant contributions were made to the regression equations by initial Disability Rating Score, recovery rate, post-traumatic amnesia and cognitive deficits. A single multiple regression containing the four significant predictors retained initial Disability Rating Score and recovery rate as significant. The findings were cross-validated on a new sample of 30 head injury patients. Initial Disability Rating Score on admission to rehabilitation emerged as a useful predictor of rehabilitation outcome.