Predictors Of Change In Function Research Articles

Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions.

Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population. We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up. The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores. 241patients were followed for a mean of 17.0 ± 7.5months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35points greater improvement in their MH score (p= 0.004) and a mean 3.54points greater improvement in PH score (p= 0.006). Fewer COPCs also predicted greater improvement in MH and PH. SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting.

74 Adherence to Behavioral Interventions is Associated with a Change in Participant Adjustment in a Sample of aMCI Patients

Objective:Behavioral interventions are a non-pharmacological treatment that shows improvement in the everyday functioning of people with Mild Cognitive Impairment (MCI). Multiple studies have focused on examining factors that can reduce or enhance adherence to behavioral interventions. However, few studies use adherence as a predictor of functional changes. The goal of this study was to analyze the association between adherence, age, and education in factor score changes of participant impairment, participant adjustment, and partner adjustment in a sample of participants with amnestic MCI (aMCI) and their study partners.Participants and Methods:We included fifty-two dyads of a person with aMCI and their study partner with intervention data at baseline and 24-week follow-up from the Physical Exercise and Cognitive Engagement Outcomes for Mild Neurocognitive Disorder (PEACEOFMND) study. At baseline, participants were randomized to one of three behavioral interventions: computerized cognitive training (BrainHQ; n=19), yoga (n=15), or wellness education (n=18). Factors were established from a larger clinical sample that used the same measures as PEACEOFMND. The three-factor latent structure was constructed as the following: 1) participant adjustment combined scores of the Center for Epidemiologic Studies Depression Scale (CES-D), Quality of Life in Alzheimer’s Disease (QoL-AD), and Self-Efficacy for managing MCI scales; 2) partner adjustment included study partner’s scores in CES-D, QoLAD and Caregiving Competence and Mastery Components (CCMC) of the Pearlin scales; 3) participant impairment included participant’s scores in E-Cog memory domain, and study partner’s scores in the Functional Activity Questionnaire (FAQ) and Zarit Burden Interview. We calculated factor changes by obtaining the difference between factor scores at follow-up and baseline. Bayesian correlation analysis was performed to investigate the association between age, education, adherence to the combined behavioral interventions, participant adjustment, participant impairment, and partner adjustment.Results:The Bayesian correlation results showed moderate evidence (BF10=6.8, Pearson’s r=0.38) supporting a positive correlation between adherence and change in participant adjustment. Additionally, there was moderate evidence (BF10=2.18, Pearson’s r=0.32) supporting a positive correlation between change in participant impairment and participant level of education as well as participant age and change in partner adjustment (BF10=2.8, Pearson’s r=0.33).Conclusions:Bayesian correlations replicated results from previous analysis using a traditional method, showing that increased adherence to combined behavioral interventions is associated with an increase in participant’s quality of life, self-efficacy, and better mood. Thus, commitment to behavioral intervention completion in aMCI participants is related to overall participant adjustment.

A Mathematical Method to Calculate Tumor Contact Surface Area: An Effective Parameter to Predict Renal Function after Partial Nephrectomy

We proposed a mathematical formula to calculate contact surface area between a tumor and renal parenchyma. We examined the applicability of using contact surface area to predict renal function after partial nephrectomy. We performed this retrospective study in patients who underwent partial nephrectomy between January 2012 and December 2014. Based on abdominopelvic computerized tomography or magnetic resonance imaging, we calculated the contact surface area using the formula (2*π*radius*depth) developed by integral calculus. We then evaluated the correlation between contact surface area and perioperative parameters, and compared contact surface area and R.E.N.A.L. (Radius/Exophytic/endophytic/Nearness to collecting system/Anterior/Location) score in predicting a reduction in renal function. Overall 35, 26 and 45 patients underwent partial nephrectomy with open, laparoscopic and robotic approaches, respectively. Mean ± SD contact surface area was 30.7±26.1 cm(2) and median (IQR) R.E.N.A.L. score was 7 (2.25). Spearman correlation analysis showed that contact surface area was significantly associated with estimated blood loss (p=0.04), operative time (p=0.04) and percent change in estimated glomerular filtration rate (p <0.001). On multivariate analysis contact surface area and R.E.N.A.L. score independently affected percent change in estimated glomerular filtration rate (p <0.001 and p=0.03, respectively). On ROC curve analysis contact surface area was a better independent predictor of a greater than 10% change in estimated glomerular filtration rate compared to R.E.N.A.L. score (AUC 0.86 vs 0.69). Using this simple mathematical method, contact surface area was associated with surgical outcomes. Compared to R.E.N.A.L. score, contact surface area was a better predictor of functional change after partial nephrectomy.

Predictors of Functional Changes in Italian Nursing Home Residents: The U.L.I.S.S.E. Study

ObjectivesTo identify independent predictors of the risk of functional decline in older nursing home (NH) residents. DesignA longitudinal observational study. SettingThirty-one NHs participating in the U.L.I.S.S.E. project, distributed throughout Italy. ParticipantsAll older (≥65 years) long-term NH residents without complete disability and with at least one follow-up evaluation during the 12-month study period (n = 1263). MeasurementsAll participants underwent a standardized comprehensive evaluation using the Italian version of the Minimum Data Set for NHs. The activities of daily living (ADLs) Long-Form scale was used to evaluate functional status. Facility characteristics were collected using an ad hoc designed questionnaire. ResultsOf the NH residents, 40.4% experienced a decline in the ADL during the follow-up. The mixed effect logistic regression model showed that depression (odds ratio [OR] 1.45, confidence interval [CI] 1.16–1.81, P = .005) and the use of antipsychotics (OR 1.30, CI 1.06–1.60, P = .016) were associated with a higher probability of ADL decline, whereas the presence of a geriatrician (OR 0.60, CI 0.41–0.88, P = .015) and a higher than median hour per resident per week of nursing care (OR 0.55, CI 0.37–0.80, P = .006) were associated with a lower risk. ConclusionsOur findings suggest that preventing functional decline in NH residents might be possible by optimizing the management of depression and by reducing the current high prescription rate of antipsychotics. Moreover, the presence of a geriatrician, associated with an adequate amount of nursing care, seem to be important facilities characteristics to achieve this goal. These findings should be tested in large-scale pragmatic clinical trials.

A new cognitive evaluation battery for Down syndrome and its relevance for clinical trials.

The recent prospect of pharmaceutical interventions for cognitive impairment of Down syndrome (DS) has boosted a number of clinical trials in this population. However, running the trials has raised some methodological challenges and questioned the prevailing methodology used to evaluate cognitive functioning of DS individuals. This is usually achieved by comparing DS individuals to matched healthy controls of the same mental age. We propose a new tool, the TESDAD Battery that uses comparison with age-matched typically developed adults. This is an advantageous method for probing the clinical efficacy of DS therapies, allowing the interpretation and prediction of functional outcomes in clinical trials. In our DS population the TESDAD battery permitted a quantitative assessment of cognitive defects, which indicated language dysfunction and deficits in executive function, as the most important contributors to other cognitive and adaptive behavior outcomes as predictors of functional change in DS. Concretely, auditory comprehension and functional academics showed the highest potential as end-point measures of therapeutic intervention for clinical trials: the former as a cognitive key target for therapeutic intervention, and the latter as a primary functional outcome measure of clinical efficacy. Our results also emphasize the need to explore the modulating effects of IQ, gender and age on cognitive enhancing treatments. Noticeably, women performed significantly better than men of the same age and IQ in most cognitive tests, with the most consistent differences occurring in memory and executive functioning and negative trends rarely emerged on quality of life linked to the effect of age after adjusting for IQ and gender. In sum, the TESDAD battery is a useful neurocognitive tool for probing the clinical efficacy of experimental therapies in interventional studies in the DS population suggesting that age-matched controls are advantageous for determining normalization of DS.

Functional turnover from lowland to montane forests: evidence from the Hyrcanian forest in northern Iran

Abstract: Plant functional traits and functional diversity play key roles in ecosystem functioning. Exploring patterns of functional diversity is of great importance in the management process of forest ecosystems. Altitudinal pattern of plant functional diversity is poorly investigated in Hyrcanian relict forest, N Iran. We explored differences in trait composition between lowland and montane forest types. Altitudinal variation of plant functional traits along 2400 m altitudinal gradient was examined. In order to collect species and vegetation data, 67 vegetation sampling plots were placed along the altitudinal gradient. Eight plant functional traits; related to plant physiognomy, competitive ability and dispersal, were selected for 174 recorded vascular plants and weighted by importance-value of taxa. We used generalized linear model, principal coordinate analysis along with functional diversity metrics to investigate functional changes along the gradient. The importance of different traits such as chamaephyte life form, tiny leaves, dry indehiscent fruits and small seeds increase with altitude. In contrast, other traits including large leaves, taller plants, fleshy fruits, anemophily as well as medium to large seeds decrease with increasing elevation. Functional difference between lowland and montane forest vegetation is strongly supported in our results. Trait associations, different environmental parameters, disturbance type and especially altitude were concluded to be important predictors of functional changes. Vegetation type is a key determinant of functional patterns in temperate forests. We strongly recommend exploring and considering functional diversity in forest management practices.

Relationships of age, cholecystectomy approach and timing with the surgical and functional outcomes of elderly patients with cholecystitis

Background Safety confirmation has led to calls for laparoscopic cholecystectomy (LC) to prevail in elderly patients, but the functional changes after LC have not been sufficiently compared with open cholecystectomy (OC). Using an administrative database, we reassessed the quality of cholecystectomy approach and timing of cholecystectomy for elderly patients with cholecystitis. Methods A total of 2552 patients aged ≥60 years who underwent cholecystectomy for cholecystitis were enrolled. Variables included demographics, comorbidities, complications, preoperative bile duct scrutiny, cholecystectomy timing (<48, 48–96, >96 h), functional status estimated by the Barthel index, teaching status, postoperative length of stay (LOS) and total charges (TC). The impacts of age, OC and timing on LOS, TC, complications and functional changes were assessed by mixed linear regression analyses using propensity score-matched cohorts for LC and OC. Results The patients comprised 1742 LC and 810 OC patients across 122 hospitals. The mean ages and octogenarian proportions were 70.1 years and 10.6% for LC and 72.9 years and 20.5% for OC. Advancing age, males and acute inflammation were more frequently associated with OC. Longer LOS, higher TC and more complications were observed for OC. Age was a predictor of functional changes but not complications. Octogenarians and complications were associated with longer LOS, higher TC and more functional deterioration. Earlier cholecystectomy was only associated with lower TC. Conclusions Octogenarians were likely to have OC and functional deterioration. Since OC was a predictor of resource use and complications, strategies to complete earlier LC and prevent complications are required for octogenarians.

Differential selection within the Drosophila retinal determination network and evidence for functional divergence between paralog pairs

The retinal determination (RD) network in Drosophila comprises 14 known nuclear proteins that include DNA-binding proteins, transcriptional coactivators, kinases, and phosphatases. The composition of the network varies considerably throughout the animal kingdom, with the network in several basal insects having fewer members and with vertebrates having potentially significantly higher numbers of RD genes. One important contributing factor for the variation in gene number within the network is gene duplication. For example, 10 members of the RD network in Drosophila are derived from duplication events. Here we present an analysis of the coding regions of the five pairs of duplicate genes from within the RD network of several different Drosophila species. We demonstrate that there is differential selection across the coding regions of all RD genes. Additionally, some of the most significant differences in ratios of non-silent-to-silent site substitutions (d(N)/d(S)) between paralog pairs are found within regions that have no ascribed function. Previous structure/function analyses of several duplicate genes have identified areas within one gene that contain novel activities when compared with its paralog. The evolutionary analysis presented here identifies these same areas in the paralogs as being under high levels of relaxed selection. We suggest that sequence divergence between paralogs and selection signatures can be used as a reasonable predictor of functional changes in rapidly evolving motifs.

Prospective Study of Associations Among Positive Emotion and Functional Status in Older Patients With Coronary Artery Disease

We examined associations between positive emotion (PE) and functional status (Duke Activity Status Inventory) in 948 coronary artery disease (CAD) patients (35.1% women; age M = 70.1 years, SD = 6.3). Emotion and function measures were gathered during hospitalization and annually for 3 years. We used random coefficient models to examine PE during hospitalization and follow-up, as a predictor of change in function. Analyses adjusted for baseline functional status, negative emotion, social support, marital status, and disease severity. Sex was examined as a moderator of effects. PE assessed during hospitalization was a significant predictor of change in function such that lower levels of PE were associated with accelerated decline in function. Lower levels of PE during follow-up were also related to increasing decline in function but only in men. Thus, our findings indicate that PE is associated with less decline in functional status following hospitalization for CAD.

Keitel Functional Test for Patients With Rheumatoid Arthritis: Translation, Reliability, Validity, and Responsiveness

The purpose of this study was to translate the German Keitel Functional Test (KFT) into Danish and test it for reliability, concurrent and predictive validity, and responsiveness in patients with rheumatoid arthritis (RA). Translation of the KFT was performed according to international recommendations, and the translated version was tested twice by 2 observers for intraobserver and interobserver reliability, with a 1-week interval between assessments, in 20 patients with RA with stable disease activity. Validity was investigated by studying 2 patient groups: (1) 15 patients with long-lasting (median=6 years) active RA, tested before and after 2, 6, and 14 weeks of anti-tumor necrosis factor alpha (TNF-alpha) inhibitor therapy, and (2) 35 patients with early (median=0.25 year) RA, tested at years 0, 0.5, 1, and 2. Twenty-three patients in the early RA group also were tested at year 7. KFT, conventional clinical and biochemical markers of disease activity, and Health Assessment Questionnaire (HAQ) were used. The translated KFT showed good intraobserver reliability (intraclass correlation coefficients [ICC]=.90 and .95, coefficient of variation [CV]=3.5%) and interobserver reliability (ICC=.99 and .92, CV=3.5%), and the KFT correlated with several measures of disease activity and, most closely, with the HAQ. The KFT was, in contrast to clinical disease activity measures, not sensitive to changes over time. Only baseline KFT data were significantly related to functional changes over a long period of time as measured by the KFT, and only in the early RA group. The Danish translation of the KFT showed good reliability, acceptable concurrent validity, very poor responsiveness, and inconclusive results concerning predictive validity. The results of this study do not support the use of the KFT for monitoring function in clinical practice, as an outcome measure in clinical trials, or as a predictor of functional changes.

Examining the consequences of rehabilitation interventions on disease progression and functional decline: Is function really the only thing that matters?

While reading the articles by Mikesky et al (1) and van Dijk et al (2) which appear elsewhere in this issue of Arthritis Care & Research, I was reminded of the ongoing debate concerning whether measurement of radiographic progression of osteoarthritis (OA) or the progression of symptoms and functional decline is more relevant in reflecting the status of patients with knee OA. Mikesky et al examined the effects of strength training on the incidence and progression of knee OA over a 30-month period. This area of study is important because although there have been a number of studies addressing the relationship between strength and physical function (3–6) and the effects of strength training on pain and function (6–9), to my knowledge there have been no clinical trials examining the effects of strength training on the incidence or progression of radiographic knee OA. However, based on the results of the Mikesky et al study (1), the actual training program did not appear to induce a significant amount of muscle strengthening in the short term, and there was actually a decrease in strength over the long term. Despite concerted efforts by the investigators to encourage adherence to the exercise programs, significant problems with subject adherence occurred during the course of the study, which may explain the limited effects of the program on muscle strength. Nevertheless, it is difficult to make any definitive conclusions about the effects of strength training on the incidence or progression of knee OA based on the results of the study by Mikesky et al, when it is not clear that meaningful increases in strength actually occurred. Further work is still needed to determine whether inducing and maintaining significant gains in muscle strength can have either a protective or adverse effect on the progression of knee OA. The article by van Dijk et al (2) is a systematic review of the literature concerning the changes in functional status over time and the identification of predictors of functional change in patients with knee and hip OA. This area of work is also very important because improved understanding of factors that may either contribute to or protect against functional decline can provide insight for developing interventions that might enhance the effectiveness of preventing or minimizing disability. Although van Dijk et al identified a number of factors in the current literature that can either contribute to or protect against functional decline, they correctly point out that the evidence is limited and there is much more room for work in this area. However, van Dijk et al made one statement that caught my attention: “Previous results from cross-sectional studies suggested there was no or only a weak association between radiologic changes and functioning. In this review, this ambiguous relationship was confirmed by the results of longitudinal studies, emphasizing the need to focus on functional rather than radiologic consequences. Such functional focus is furthermore important, because knowledge of functional consequences is essential for the development of optimal rehabilitation programs in patients with OA.” For me, this statement served as the impetus for the topic of this editorial. Although I am in agreement with a significant focus on function (because this has been a very large element in my own work), I am concerned that it is premature to suggest we completely shift the direction of focus away from radiologic consequences, or progression of disease, and direct our efforts mainly on function when evaluating the consequences of rehabilitation interventions for knee OA. It is true that both cross-sectional and longitudinal studies have not demonstrated that radiographic severity correlates with measures of pain and function (10–13). For this reason, it has been suggested that efforts may be better placed in developing interventions that reduce the burden of illness related to OA with respect to pain, limitation of G. Kelley Fitzgerald, PhD, PT: University of Pittsburgh, Pittsburgh, Pennsylvania. Address correspondence to G. Kelley Fitzgerald, PhD, PT, Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260. E-mail: kfitzger@ pitt.edu. Submitted for publication June 19, 2006; accepted July 13, 2006. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 55, No. 5, October 15, 2006, pp 687–689 DOI 10.1002/art.22243 © 2006, American College of Rheumatology

Five years after traumatic brain injury: A study of individual outcomes and predictors of change in function

Study functional changes between one and five years after traumatic brain injury (TBI). Prospective cohort. TBI Model Systems National Database subjects using cohort with complete one and five year data (n = 301). Disability Rating Scale (DRS) Level of Functioning and Employability Items. On Level of Functioning, 53 (18%) individuals improved, 228 (76%) stayed the same, and 20 (7%) worsened by more than one point from Year 1 to Year 5. On Employability, 50 (17%) individuals improved, 237 (79%) stayed the same, and 14 (5%) worsened by greater than one point. Level of Functioning improvement was predicted by FIM-Motor, FIM-Cognitive, Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test (written and oral), and Wechsler Adult Intelligence Scale-Revised Block Design, and worsening predicted by Symbol Digit Modalities Test (written and oral). Improvement in Employability was predicted by race, while Glasgow Coma Scale Eye Opening was predictive of worsening. Although the majority did not demonstrate meaningful change on the DRS items from year 1 to 5, some individuals made dramatic gains and a minority declined. There are demographic and functional indicators present at one-year post-injury that may be predictive of subsequent change.

Predictors of functional change and length of hospitalization in acute rehabilitation

Predictors of functional change and length of hospitalization in acute rehabilitation

Predictors of functional change and length of hospitalization in acute rehabilitation

Predictors of functional change and length of hospitalization in acute rehabilitation