Rating Scale Measures Research Articles

Accuracy of Self-Reported Sun Exposure and Sun Protection Behavior

The objective of this study was to compare the accuracy of self-reported skin cancer risk outcome measures proposed as standards by prevention experts to aggregated estimates of behavior from weekly diaries. Weekly electronic diaries of ultraviolet radiation (UVR) behaviors, initially validated by comparison with daily electronic diaries, were used to assess the accuracy of commonly used end-of-summer self-reported measures among 250 adults. Results revealed low biases, and good correspondence between simple open-ended self-reported estimates of days outside, hours outside, sunbathing days and hours, and days outside when not protected by either sunscreen, long-sleeved shirts, hats, or shade. Rating scale measures commonly used in the current literature and those recently recommended as standards by a workshop of experts showed evidence of being non-interval and lacking precision for more frequent behavior (e.g., >1 h sun exposure daily). These data indicated that open-ended frequency self-reports of skin cancer risk behaviors that follow procedures designed to increase accuracy were reliable over a summer-long period.

Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS): a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

BackgroundLumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis.MethodsWe will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone). Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention.Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization and costs to assess cost-effectiveness of epidural steroid injection.DiscussionThis study is the first multi-center, double-blind RCT to evaluate the effectiveness of epidural steroid injections in improving pain and function among older adults with lumbar spinal stenosis. The study will also yield data on the safety and cost-effectiveness of this procedure for older adults.Trial RegistrationClinicaltrials.gov NCT01238536

Aetiology for the covariation between combined type ADHD and reading difficulties in a family study: the role of IQ

Background: Twin studies using both clinical and population‐based samples suggest that the frequent co‐occurrence of attention deficit hyperactivity disorder (ADHD) and reading ability/disability (RD) is largely driven by shared genetic influences. While both disorders are associated with lower IQ, recent twin data suggest that the shared genetic variability between reading difficulties and ADHD inattention symptoms is largely independent from genetic influences contributing to general cognitive ability. The current study aimed to extend the previous findings that were based on rating scale measures in a population sample by examining the generalisability of the findings to a clinical population, and by measuring reading difficulties both with a rating scale and with an objective task. This study investigated the familial relationships between ADHD, reading difficulties and IQ in a sample of individuals diagnosed with ADHD combined type, their siblings and control sibling pairs.Methods: Multivariate familial models were run on data from 1,789 individuals at ages 6–19. Reading difficulties were measured with both rating scale and an objective task. IQ was obtained using the Wechsler Intelligence Scales (WISC–III/WAIS–III).Results: Significant phenotypic (.2–.4) and familial (.3–.5) correlations were observed among ADHD, reading difficulties and IQ. Yet, 53%–72% of the overlapping familial influences between ADHD and reading difficulties were not shared with IQ.Conclusions: Our finding that familial influences shared with general cognitive ability, although present, do not account for the majority of the overlapping familial influences on ADHD and reading difficulties extends previous findings from a population‐based study to a clinically ascertained sample with combined type ADHD.

Early antidepressant effect of memantine during augmentation of lamotrigine inadequate response in bipolar depression: a double‐blind, randomized, placebo‐controlled trial

Recent studies indicate that modulation of glutamate neurotransmission is associated with antidepressant response. Lamotrigine, an anticonvulsant which decreases presynaptic glutamate release, has been shown to be effective in the depressive phase of bipolar disorder (BD-D); however, only 40-50% of patients have a full response. This pilot study investigated whether memantine, a low-affinity N-methyl-D-aspartate (NMDA) receptor antagonist approved for Alzheimer's disease, can augment the effects of lamotrigine. BD-D outpatients in a major depressive episode on a stable dose of lamotrigine (100 mg or more) were randomized to either memantine (starting dose of 5 mg increased up to 20 mg over four weeks, then 20 mg stable dose from four to eight weeks) or matching pill placebo for eight weeks. Patients were rated on the 17-item Hamilton Depression Rating Scale (HDRS) and other behavioral measures weekly. The eight-week repeated-measures mixed-effect model for HDRS was not significant for memantine (n = 14) versus placebo (n = 15). Exploratory mixed-effect analyses for the first four weeks, while the memantine dose was being titrated up every week, revealed a significant decrease in HDRS scores from baseline (p = 0.007). This proof-of-concept study failed to show a statistically significant benefit of memantine augmentation of lamotrigine for patients with BD-D over eight weeks. However, memantine had an antidepressant effect early on in the treatment while its dose was being titrated up. Larger placebo-controlled studies are needed to ascertain optimal timing and dosing for memantine augmentation of lamotrigine in BD-D.

Can Multidimensional Professional Development Improve Language and Literacy Instruction for Young Children?

This article addresses the impact of intensive, job-embedded mentor-coaching for 36 teachers and teaching assistants in relation to their language and literacy proficiency and the fidelity of their implementation of the Opening the World of Learning curriculum. The literacy scores for the majority of teachers in both the treatment and comparison conditions in the Early Childhood Educator Professional Development Promoting Education for Adults and Children Partnership Project, as measured by the Nelson-Denny Reading Test, were very low. Moderately high levels of implementation fidelity, on average, were achieved by the treatment teachers as they learned to use a literacy-rich curriculum. After 3 years of training and coaching, treatment teachers showed higher scores on the Teacher Behavior Rating Scale measure of language and literacy-related teaching behaviors than the comparison teachers, and these differences were large when examined as effect sizes.

Elements of Multidimensional Professional Development That Make a Difference

This article addresses the impact of intensive, job-embedded mentor-coaching for 36 teachers and teaching assistants in relation to their language and literacy proficiency and the fidelity of their implementation of the Opening the World of Literacy curriculum. The literacy scores for the majority of teachers in both the treatment and comparison conditions in the Early Childhood Educator Professional Development Promoting Education for Adults and Children Partnership Project, as measured by the Nelson-Denny Reading Test, were very low. Moderately high levels of implementation fidelity, on average, were achieved by the treatment teachers as they learned to use a literacy-rich curriculum. After 3 years of training and coaching, treatment teachers showed higher scores on the Teacher Behavior Rating Scale measure of language and literacy-related teaching behaviors than the comparison teachers, and these differences were large when examined as effect sizes.

Longitudinal tracking of gait and balance impairments in cerebellar disease

Cerebellar damage typically results in ataxia and can be caused by stroke, tumor, or one of many forms of degenerative disease. Since few pharmacological options are available, most treatments rely heavily on rehabilitation therapy. Little data exist on methods for tracking the progression of ataxia, which is critical for assessing the efficacy of current and newly developing treatments. Here, we tracked the severity of ataxia, with a particular emphasis on gait and balance dysfunction, in a group of individuals with cerebellar damage using the International Cooperative Ataxia Rating Scale (ICARS) and several instrumented laboratory measures of gait and balance impairments over 1 year. We found that the ICARS was able to distinguish between subjects with static lesions and those with degenerative disorders, was sensitive to increases in ataxia severity occurring over 1 year, and correlated well with specific instrumented measures of gait in persons with cerebellar degeneration. These results suggest the ICARS is a valuable tool for clinicians and investigators to document and track long-term changes in gait and balance performance in individuals with cerebellar degenerative disorders.

Perceived pain, fear of falling and physical function in women with osteoporosis

The aim of this cross-sectional study was to evaluate pain intensity-related differences in physical performance and fear of falling in elderly women with osteoporosis. A sample of 82 osteoporotic women (73.8 ± 8.1 years) with and without vertebral fractures was included. Numeric rating scale (NRS) measures (0 = no pain, 10 = unbearable) were applied to obtain actual pain intensity and to stratify between patients with mild (0–3), moderate (4–6) and severe (7–10) pain. Activity-related fear of falling was evaluated with the Falls Efficacy Scale-International Version (FES-I). Physical performance measures included maximum voluntary quadriceps strength, postural sway and gait speed measures. Controlling for age, fractures, and history of falls ANCOVA with Scheffe's post hoc test indicated significant slower walking velocities and greater postural sway for patients with severe pain. Furthermore, significant group differences could be detected for muscle strength and fear of falling. Patients with more intense pain (NRS ≥ 5) were 6.4 times (odds ratio; 95%CI: 1.5–26.7) more likely to score below average in fall-related self-efficacy and all physical performance tests. Among women with osteoporosis, heightened back pain intensity increases fear of falling and decreases physical performance irrespective of vertebral fractures and history of falls.

Who Dislikes Whom, and For Whom Does It Matter: Predicting Aggression in Middle Childhood.

This study investigated the role of mutual dislike dyads (MDDs) in the development of aggressive behavior across the middle childhood years. Of particular interest was whether involvement in MDDs predicted later aggression, and whether the magnitude of the association between MDDs and later aggression varied based on characteristics of target children and 'others' involved in their MDDs. Data were collected on a community sample of 453 children participating in an ongoing longitudinal study. Classroom peer nomination and rating-scale measures were collected in kindergarten through third grade; aggressive behavior problems were assessed via teacher ratings in the early elementary years (kindergarten and first grade) and late elementary years (fourth and fifth grade). MDD involvement in the middle elementary years (second and third grade) was associated with higher levels of aggression in the late elementary years among boys (but not girls), and these predictions held after controlling for group-level peer disliking in the middle elementary years, aggression in the early elementary years, and demographic variables. The association between MDD involvement and subsequent aggression was also qualified by the aggressiveness of others in children's MDDs: Having more MDDs predicted later aggression only among boys whose MDDs involved mostly non-aggressive others.

Trussed in Evidence? Ambiguities at the Interface between Clinical Evidence and Clinical Practice

This article considers the dominance that randomized controlled trials (RCTs) of psychotropic agents currently have in relation to the practice of psychiatry in mental health and primary care settings. In contemporary psychiatry, data of marginal significance based on rating scale measures are privileged as evidence that treatments are effective, while judgments of drug effects based on clinical practice are downgraded. The dominance of RCTs has also led to an increasing promotion of rating scales in clinical practice, described here as ;rating scale mongering.' The logical consequence of current interpretations of RCT data is that clinicians should adhere to guidelines which are based on a systematic assembly of such data, but the selective publication of trial data and ghostwriting of publications, lays the basis for guideline capture, and a corresponding capture of evidence-based clinical practice by pharmaceutical companies.

The Impact of a Changed Environment on Arousal Levels of Patients in a Secure Extended Rehabilitation Facility

This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility. Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility. Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit. The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.

Prevalence of sleep problems in individuals with multiple sclerosis

Background Sleep disturbance in multiple sclerosis has received little research attention despite the potential influence it may have on disease impact. Objective To estimate the prevalence of sleep disorders in a large community sample of individuals with multiple sclerosis. Methods A cross-sectional self-report survey of 1063 persons with multiple sclerosis. Sleep was assessed using the Women's Health Initiative Insomnia Rating Scale and Medical Outcomes Study Sleep measure. Results The prevalence of sleep problems in multiple sclerosis is significantly higher than in the general population or other chronic diseases and may affect women with multiple sclerosis more than men. Conclusion Sleep disturbance should routinely be evaluated in patients with multiple sclerosis and new interventions developed.

Repetitive Transcranial Magnetic Stimulation in the Treatment of Depression in Adolescents

This open-label pilot study examined repetitive transcranial magnetic stimulation as a possible treatment of adolescent resistant depression. Nine adolescents (aged 16-18 years) with severe resistant depression (determined by SCID) were recruited, and their depression, suicidality, and cognitive functions were evaluated before, during, and after a course of twenty 10-Hz, 2-second trains (intertrain intervals of 58 seconds) given over 20 min/d over 14 working days. Lower levels of depression with progression in therapy were recorded by both the Beck Depression Inventory and Child Depression Rating Scale measures (F1.7,14.01 = 4.52, P < 0.05; F4,32 = 6.645, P < 0.01, respectively). Three patients reached the primary outcome measure of less than 30% reduction in their Child Depression Rating Scale. The effect on suicidality was not significant. Side effects were considered mild. Repetitive transcranial magnetic stimulation might be a possible therapy for adolescent depression. Our preliminary findings warrant double-blind, controlled studies.

Intervention Validity of Social Behavior Rating Scales

The term intervention validity refers to the extent to which assessment results can be used to guide the selection of interventions and evaluation of outcomes. In this article, the authors review the defining attributes of rating scales that distinguish them from other assessment tools, assumptions regarding the use of rating scales to measure children's social behaviors, and features of scale design that promote intervention validity. They argue that integration of a pragmatic theory for problem solution, assessment of socially valid content, and utilization of a reporting framework aligned to known and effective intervention options are essential to promoting intervention validity of rating scale measures. To illustrate, they describe the combined theoretical and empirical approach used to develop the Social Skills Rating System and its recent revision, the Social Skills Improvement System. Ongoing challenges in the integration and monitoring of social skills interventions are discussed, and possible strategies for linking assessment to intervention are described.

Validity, reliability, and clinical importance of change in a 0—10 numeric rating scale measure of spasticity: a post hoc analysis of a randomized, double-blind, placebo-controlled trial

Background: The measurement of spasticity as a symptom of neurologic disease is an area of growing interest. Clinician-rated measures of spasticity purport to be objective but do not measure the patient's experience and may not be sensitive to changes that are meaningful to the patient. In a patient with clinical spasticity, the best judge of the perceived severity of the symptom is the patient. Objectives: The aim of this study was to assess the validity and reliability, and determine the clinical importance, of change on a 0–10 numeric rating scale (NRS) as a patient-rated measure of the perceived severity of spasticity. Methods: Using data from a large,randomized,doubleblind, placebo-controlled study of an endocannabinoid system modulator in patients with multiple sclerosis-related spasticity, we evaluated the test-retest reliability and comparison-based validity of a patient-reported 0-10 NRS measure of spasticity severity with the Ashworth Scale and Spasm Frequency Scale. We estimated the level of change from baseline on the 0–10 NRS spasticity scale that constituted a clinically important difference (CID) and a minimal CID (MCID) as anchored to the patient's global impression of change (PGIC). Results: Data from a total of 189 patients were included in this assessment (114 women, 75 men; mean age, 49.1 years). The test-retest reliability analysis found an interclass correlation coefficient of 0.83 ( P < 0.001) between 2 measures of the 0–10 NRS spasticity scores recorded over a 7- to 14-day period before randomization. A significant correlation was found between change on 0–10 NRS and change in the Spasm Frequency Scale ( r = 0.63; P < 0.001), and a moderate correlation was found between the change on 0–10 NRS and the PGIC ( r = 0.47; P < 0.001). A reduction of ∼30% in the spasticity 0–10 NRS score best represented the CID and a change of 18% the MCID. Conclusions: The measurement of the symptom of spasticity using a patient-rated 0-10 NRS was found to be both reliable and valid. The definitions of CID and MCID will facilitate the use of appropriate responder analyses and help clinicians interpret the significance of future results.

Falls and gait disturbances in Huntington's disease

Falls are common in patients with Huntington's disease, but the incidence, falling circumstances and contributing factors have never been examined. We recorded falls in 45 early to midstage Huntington's disease patients, both retrospectively (12 months) and prospectively (3 months). Fall rates were related to relevant baseline measures, including the Unified Huntington's Disease Rating Scale (UHDRS) and quantitative measures of balance (using angular velocity sensors) and gait (using a pressure-sensitive walkway). Balance and gait measures were compared between patients and 27 healthy age-matched controls. Twenty-seven patients (60%) reported two or more falls in the previous year and were classified as fallers. During prospective follow-up 40% reported at least one fall. A high proportion of falls (72.5%) caused minor injuries. Compared to nonfallers, fallers showed significantly higher scores for chorea, bradykinesia and aggression, as well as lower cognitive scores. Compared to controls, Huntington patients had a decreased gait velocity (1.15 m/s versus 1.45 m/s, P < 0.001) and a decreased stride length (1.29 m versus 1.52 m, P < 0.001). These abnormalities were all significantly greater in fallers compared to nonfallers. In addition, fallers had an increased stride length variability and a significantly greater trunk sway in medio-lateral direction compared to nonfallers. We conclude that falls are common in Huntington's disease. Contributing factors include a combination of "motor" deficits (mainly gait bradykinesia, stride variability and chorea, leading to excessive trunk sway), as well as cognitive decline and perhaps behavioral changes. These factors should be considered as future targets for therapies that aim to reduce falls in Huntington's disease.

Accuracy of brief and full forms of the child mania rating scale

This study assesses the sensitivity of full and brief forms of a parent-rated mania scale to variations in diagnoses. Parents of a sample of 150 subjects either diagnosed with bipolar disorder (BD) or attention deficit hyperactivity disorder (ADHD), or healthy controls (HC), completed the full Child Mania Rating Scale and other measures. We used single-parameter item-response theory models to produce a brief parent mania rating scale from the full version. The 10-item, brief Child Mania Rating Scale -- Parent (CMRS-P) version correlated .93 with 11 items from the full CMRS-P that were not used in constructing the brief version, and showed accuracy comparable to the full scale in differentiating BD from ADHD, and in discriminating among bipolar subtypes.

Antidepressant response to partial sleep deprivation in unipolar depression is not related to state anxiety

One night of total or partial sleep deprivation (SD) produces a temporary remission in up to 60% of patients with major depression, yet mechanisms remain unclear. We investigated whether the antidepressant effects of SD are caused, even partially, by an improvement in anxiety. As part of a functional magnetic resonance imaging study, 19 unmedicated major depression patients and eight controls completed the Spielberger State/Trait Anxiety Inventory (STAI) (state version) at baseline and sleep-deprived scanning sessions. We found (1) greater anxiety in patients than controls; (2) no baseline or SD STAI difference between responders and nonresponders; (3) no STAI change with SD in any subject group; and (4) no significant correlation between any STAI and Hamilton Depression Rating Scale measures. Our findings did not provide support for an anxiolytic process associated with the antidepressant effects of SD.

Neurofeedback Treatment for Pain Associated with Complex Regional Pain Syndrome Type I

ABSTRACT Introduction. Complex Regional Pain Syndrome Type I (CRPS-I) is a devastating pain condition that is refractory to standard care. Preliminary evidence suggests the possibility that neurofeedback training might benefit patients with chronic pain, including patients with CRPS-I. The current study sought to address the need for more information about the effects of neurofeedback on pain in persons with chronic pain by (1) determining the average decrease in pain in patients with CRPS-I following neurofeedback training, (2) identifying the percent of patients reporting pain decreases that are clinically meaningful, and (3) documenting other benefits of neurofeedback training. Method. Eighteen individuals with CRPS-I participating in a multidisciplinary treatment program were administered 0–10 numerical rating scale measures of pain intensity at their primary pain site, as well as pain at other sites and other symptoms, before and after a 30 minute neurofeedback training session. A series of t-tests w...

Surgery for Parkinson's disease improves disability but not impairment components of the UPDRS-II

The Unified Parkinson's Disease Rating Scale (UPDRS) activities of daily living (ADL) items have been described as reflecting both disability (true ADL items) and impairment (rather than ADLs). As a result of combining these scores, UPDRS part II scores may not accurately reflect the impact of surgery on ADLs [Hariz G.M., Lindberg M., Hariz M.I., Bergenheim A.T. Does the ADL part of the unified Parkinson's disease rating scale measure ADL? An evaluation in patients after pallidotomy and thalamic deep brain stimulation. Mov Disord 2003;18:373–81.]. The goal of the present study was to assess the metric properties of the ADL section of the UPDRS in terms of its ability to measure surgical change. We tested the effects of unilateral pallidotomy ( N=14) and bilateral subthalamic nucleus (STN) DBS ( N=11) on both disability and impairment components of the UPDRS-II at uniform follow-up assessment periods of 6 months and 1 year, with a subset of pallidotomy patients ( N=9) re-assessed at 2 years. Across the follow-up periods in both patient groups, items identified as best reflecting disability showed significant improvement from pre-surgical levels, whereas items representing impairment showed no overall change. Consistent with this, change in total ADL scores was tempered by the inclusion of the impairment items. Because the measurement of a patient's functional status is important in determining the effectiveness of an intervention, analysis of appropriate items from the UPDRS ADL section is imperative.