Self-reported Functional Ability Research Articles

Comparison of Proxy and Self-Reported Functional Ability in Heart Failure Patients with Cognitive Impairment

Background Heart failure (HF) patients often experience cognitive impairment that negatively impacts self-management ability, predisposing these individuals to worse post-hospitalization outcomes. Patient proxies may have more insight into a patient’s self-management capability especially in the context of patient cognitive impairment. Here, we incorporate proxy input to evaluate associations between patient- and proxy-reported capacity for instrumental activities of daily living (IADL) stratified along a patient’s cognitive function in an older hospitalized heart failure population. Methods We conducted a quality improvement study in older HF inpatients with cognitive impairment determined by Mini-Cog. Functional activity performance has been previously assessed using the Assessment of Living Skills and Resources Revision 2 (ALSAR), a validated index where higher numerical scores associate with increasing dependence in completing IADL and risk for needing a more structured living environment, nursing home placement, hospitalization, and death. We assessed ALSAR with patient self-report and proxy-report (range 0-44 lower scores equate to better performance) and calculated the absolute difference (ALSAR difference, lower scores show stronger agreement between patients and proxies). Patients’ Montreal Cognitive Assessment (MoCA) scores, among which scores less than 26 suggest clinically significant cognitive impairment, were correlated with ALSAR difference. Results Median patient age was 74 years. Forty-two percent were female among our sample of 30 hospitalized HF patients with cognitive impairment. Median patient ALSAR score of 4 (range 2-7) differed from median proxy ALSAR score of 7 (range 4-12) (p<0.01). Lower MoCA correlated with higher ALSAR difference (r=-0.58, p<0.01). Conclusions Assessing ALSAR difference in clinical practice is feasible and it correlates to MoCA score in hospitalized HF patients with cognitive impairment, consistent with prior work. These results support the notion that proxy-input of patient IADL assessment could improve patient needs detection among HF patients with cognitive impairment. This information may enhance risk assessment, disease management and discharge planning when targeting and proactively involving proxies. Prospective studies should evaluate this novel metric and its association with patient-centered outcomes.

Prognosis of patients with long COVID symptoms: a protocol for a longitudinal cohort study at a primary care referred outpatient clinic in Helsinki, Finland

IntroductionAfter COVID-19, many continue to experience persistent debilitating symptoms, that is, long COVID. Its most prevalent symptoms are chest pain, difficulties with breathing, painful muscles, ageusia or anosmia, tingling extremities...

Conditional Minimal Detectable Change for the Cochlear Implant Quality of Life-35 Profile Associated With Improved Functional Abilities 12 Months After Cochlear Implantation

It is essential to measure an individual patient's baseline and follow-up abilities to demonstrate changes in clinical outcomes over time. Inherent in this strategy is interpreting whether the measured change is clinically significant and beyond measurement error. Conditional minimal detectable change (cMDC) values are widely used in many disciplines but have rarely been established for outcome measures in otolaryngology or hearing research, and never in cochlear implantation. To determine cMDC values for the Cochlear Implant Quality of Life-35 (CIQOL-35) Profile instrument to enhance our understanding of the initial and ongoing changes in functional abilities from cochlear implants (CIs). Item response theory analyses of responses from a multi-institutional cohort of 705 CI users at a tertiary CI center were used to derive standard error (SE) values for each possible CIQOL-35 domain score. Using an iterative approach, these SE values were used to calculate cMDC values for every possible pre-CI and post-CI domain score combination. We then compared pre-CI to 12-month post-CI CIQOL-35 domains scores in an independent cohort of 65 adult CI users to determine whether the measured change exceeded error to be clinically significant. The analysis took place on December 14, 2022. The CIQOL-35 Profile instrument and cochlear implantation. The cMDC values were smaller for the communication domain, and global measure and cMDC values for all domains were larger at the extremes of the measurement scale. Overall, 60 CI users (92.3%) demonstrated improvement beyond cMDC at 12 months post-CI for at least 1 CIQOL-35 domain, and no patients' scores declined beyond cMDC for any domain. The percentage of CI users demonstrating improvement beyond cMDC varied by domain, with communication (53 [81.5%]) showing the largest number of CI users improving, followed by global (42 [64.6%]) and entertainment (40 [60.9%]). In general, CI users who demonstrated improvement in CIQOL-35 domains had greater improvement in speech recognition scores than patients who did not, but the strength and significance of these associations greatly varied by domain and speech material. This multistep cohort study found that cMDC values for the CIQOL-35 Profile provided personalized thresholds for detecting real changes in patient self-reported functional abilities over time across multiple domains, which may inform clinical decision-making. Moreover, these longitudinal results reveal the domains with more or less improvement, which may aid in patient counseling.

Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world

BackgroundThe older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh.MethodsThis cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox’s Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants’ sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants.ResultsThe overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability.ConclusionThe findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.

Self-Reported Questionnaire to Evaluate Functional Abilities in Middle Age: A Call for Delphi Expert Panel

Early detection of functional decline is important for promoting optimal aging. Self-reported questionnaires can efficiently assess functional abilities. Therefore, we aimed to highlight the lack of functional ability assessment questionnaires for the middle-aged population (MA, 45-65 years) and the need to develop such a questionnaire. An online search was performed to find questionnaires quantifying self-reported performance and functional abilities at MA. We also conducted an online survey of a group of the MA population and interviewed individuals who reported age-related functional decline. Eight potentially relevant questionnaires were found, and one hundred and twenty-three individuals responded to our survey, five of whom were interviewed. None of the questionnaires were specifically designed to assess functional capacity at MA, and most of the questionnaires are likely to have a ceiling effect in assessing the MA population. Furthermore, the questionnaires do not capture functions related to dynamic balance, flexibility, and maximum strength, which are reported as difficult by our respondents, making them less appropriate for assessing function at MA. There is a need to engage a Delphi expert panel of several relevant healthcare professionals to develop a functional capacity assessment questionnaire for MA.

Efficacy of therapeutic fasting and plant-based diet in patients with rheumatoid arthritis (NutriFast): study protocol for a randomised controlled clinical trial

BackgroundPrevious studies have shown beneficial effects of therapeutic fasting and plant-based dietary interventions on disease activity in patients with rheumatoid arthritis (RA) for a duration of up to 1 year....

Trends in Disability-Free Life Expectancy (DFLE) from 1995 to 2017 in the older Norwegian population by sex and education: The HUNT Study.

Understanding whether increasing Life Expectancy (LE) translates to improved health and function among older adults is essential, but results are inconclusive. We aimed to estimate trends in Disability-Free Life Expectancy (DFLE) in the older Norwegian population by sex and education from 1995 to 2017. National life table data were combined with cross-sectional data on functional ability for 70+ year-olds from the population-based Trøndelag Health Surveys 2-4 (1995-1997, 2006-2008 and 2017-2019) (n=24,733). Self-reported functional ability was assessed on a graded scale by a combination of Instrumental Activities of Daily Living (IADL) such as paying bills, going out or shopping (mild disability) and Personal Activities of Daily Living (PADL) such as washing, dressing or eating (severe disability). LE, DFLE, Mild-Disability LE and Severe-Disability LE at age 70 were estimated by the Sullivan method. From 1995 to 2017 DFLE at age 70 increased from 8.4 to 13.0 years in women, and from 8.0 to 12.1 years in men. DFLE increased in the basic and high educational groups, but more so in the high educational group among men. Educational inequalities in years spent with disability however, remained low. From the mid-1990s and over the past three decades both LE and DFLE at 70 years increased in the older Norwegian population, for both men and women, and across basic and high educational levels. Educational inequalities in DFLE increased, especially in men, but years spent with disability were similar across the three decades.

P110 Sex differences in hand osteoarthritis symptoms and function

Abstract Background/Aims There is currently no consensus regarding sex-related differences in pain intensity and functional abilities among patients with hand osteoarthritis (OA). In this study we determine sex-related differences in pain intensity and functional ability among patients with hand OA, as assessed by a self-report questionnaire and by performance-based tests. Methods Using the AUSCAN tool for symptom and functional assessment of hand OA with dynamometry we prospectively accessed patients meeting the ACR criteria for hand osteoarthritis. Using this analysis, assessments of pain and function were compared in male and female patients. The outcome measures included self-reported pain measures, functional assessment and dynamometry measures. Results The study population included 106 patients (90 females and 16 males) with a mean age of males 48.44 (7.48) and females 52.67 (9.43). All patients with symptomatic hand osteoarthritis meeting ACR Criteria. When accessing difference between sexes, men were found to be significantly heavier (p = 0.003) and have greater grip and pinch strength.As part of function and pain assessments there was a significant correlation between difficulty with fine motor skills such as difficulty doing buttons, difficulty when doing jewellery, or peeling vegetables associated with pain when turning objects e.g. doorknobs, taps and faucets for men in comparison to women. Difficulty in these fine motor skills also correlated with stiffness on wakening and pain on lifting heavy objects regardless of sex. A Mann-Whitney U test was run on 106 participants to determine if there were differences in pain or functional scores between males and females. This reviled Median score for males () and females () was statistically significantly different,There were sex differences noted in the correlation associated with pain with rotational movements e.g. turning objects and functional difficulty with fine motor movements including difficulty when doing up buttons ( Males r(14) = -0.109, p = 0.698, Females r(88) =0.489, p = <0.01 value.= ), difficulty when doing jewellery ( Males r(14) =-0.265, p = 0.339.= Females r(88) = 0.570, p = <0.01) , difficulty peeling vegetables ( Males r(14) = -0.207, p = 0.458 Females r(88) = 0.519, <0.01 ) Conclusion The results demonstrate the presence of sex differences in patients suffering from hand osteoarthritis self-reported functional ability and pain scales. These differences indicate the need for further studies to explore the mechanisms of hand OA and to understanding the specific impact of gender on the development and progression of disease. With further understanding we can obtain the proper strategy to provide better individualised treatment. It also highlights that rehabilitation programs should consider these differences and each patients’ performance limitations in order to address the specific needs of each individual patient. In doing so, improved pain and functional status will improve morbidity in hand OA Disclosure B. Dinneen: None. D. Heath: None. M. Ghaffar: None. M. O'Sullivan: None. C. Silke: None. B. Whelan: None.

The night out task and scoring application: an ill-structured, open-ended clinic-based test representing cognitive capacities used in everyday situations

The night out task (NOT) was developed as a naturalistic, open-ended, multitasking measure that requires individuals to complete eight subtasks comparable to those encountered during real-world functioning (e.g., pack travel bag, prepare tea). We examined psychometric properties and administration feasibility of this direct observation measure within a clinic-like setting using a tablet-based coding application. A sample of 148 community-dwelling older adults (82% cognitively healthy; 18% mild cognitive impairment) and 57 younger adults completed the NOT along with other neurocognitive tests and questionnaires. Inter-rater reliability across NOT primary (i.e., time, accuracy, efficiency) and process-related (e.g., error-types, self-corrections) variables was mostly excellent. NOT primary measures showed expected patterns of convergent and discriminant validity with measures of cognition, demographics, and well-being. External validity was established by the NOT ability to distinguish between age and diagnostic (cognitively healthy vs. mild cognitive impairment) groups. Demonstrating incremental validity, the NOT primary variables (execution time in particular) were predictive of self-reported functional abilities and completion quality of in-home everyday tasks over and earlier variables such as demographics, cognition, and mobility. These findings suggest that the NOT and its app interface, which allows for continuous logging of observations, are a feasible in-clinic measure to assess cognitive capacities important for real-world functioning. With further validation, the NOT may allow for earlier detection of functional difficulties. Understanding errors and strategies used during NOT performance could also have implications for individualized interventions.

Patient Preferences for Surgical Treatment of Knee Osteoarthritis: A Discrete-Choice Experiment Evaluating Total and Unicompartmental Knee Arthroplasty.

Total knee arthroplasty (TKA) is a common treatment for end-stage knee osteoarthritis but is associated with increased complication rates compared with unicompartmental knee arthroplasty (UKA). UKA offers better functional outcomes but is associated with a higher risk of revision. The purpose of this study was to apply good-practice, stated-preference methods to quantify patient preferences for benefit-risk tradeoffs associated with arthroplasty treatments for end-stage knee osteoarthritis. A discrete-choice experiment was developed with the following attributes: chance of complications, functional ability, awareness of the knee implant, and chance of needing another operation within 10 years. Patients included those aged 40 to 80 years with knee osteoarthritis. A pivot design filtered respondents into 1 of 2 surveys on the basis of self-reported functional ability (good compared with fair or poor) as measured by the Oxford Knee Score. Treatment-preference data were collected, and relative attribute-importance weights were estimated. Two hundred and fifty-eight completed survey instruments from 92 males and 164 females were analyzed, with 72 respondents in the good-function cohort and 186 in the fair/poor-function cohort. Patients placed the greatest value or relative importance on serious complications and rates of revision in both cohorts. Preference weights did not vary between cohorts for any attribute. In the good-function cohort, 42% of respondents chose TKA and 58% chose UKA. In the fair/poor-function cohort, 54% chose TKA and 46% chose UKA. Patient preferences for various treatment attributes varied among patients in a knee osteoarthritis population. Complication and revision rates were the most important factors to patients, suggesting that physicians should focus on these areas when discussing treatments. The proportion of patients who chose UKA suggests that the current trend of increased UKA utilization is aligned with patient preferences. Systematic elicitation of patient preferences for knee arthroplasty procedures, which lays out evidence-based risks and benefits of different treatments, indicates a larger subset of the knee osteoarthritis population may prefer UKA than would be suggested by the current rates of utilization of the procedure. Arthroplasty treatment should align with patient preferences and eligibility criteria to better deliver patient-centered care.

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol

BackgroundTherapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA)-related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA.MethodsThe project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programs, self-management, and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up.DiscussionThis study will evaluate the effectiveness of a tele-rehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient’s status and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effects in patients with a chronic rheumatic disease could be feasible and easy to implement in daily life clinical practice and current musculoskeletal care.Trial registrationClinicalTrials.gov NCT04263974. Registered on 7 March 2020. Date of last update 15 April 2020. Ethics committee code: PI_RH_2018.

Adolescent psychological beliefs, but not parent beliefs, associated with pain and function in adolescents with patellofemoral pain

ObjectivesThe purpose of this study was to assess the association of adolescent and parent psychological beliefs with 1) self-reported functional ability, 2) pain and 3) objective measures of function. Study designCross-sectional study. SettingPediatric Outpatient Hospital. ParticipantsEighty-six adolescents with patellofemoral pain (PFP) (14.6 ± 1.7 years old, 62% female) and 72 parents. Main outcome measuresPatient questionnaires were used to describe pain, knee function, fear avoidance (Fear Avoidance Beliefs Questionnaire-Physical Activity; FABQ-PA), kinesiophobia (Tampa Scale for Kinesiophobia-11; TSK-11), and pain catastrophizing (Pain Catastrophizing Scale; PCS) in adolescents with PFP. Parents (n = 72) completed FABQ-PA, TSK-11, and PCS questionnaires. Hip and knee strength, quadriceps and dorsiflexion motion, the single-leg hop for distance and lateral-step down test measured physical performance. ResultsAdolescent psychological beliefs were significantly associated with pain (FABQ-PA r = 0.33, and PCS r = 0.34), function (FABQ-PA r = −0.59,TSK-11 r = −0.33), hip strength (FABQ-PA r = −0.41, TSK-11 r = −0.32), and single leg hop for distance (FABQ-PA r = −0.38). Parent psychological beliefs were not associated with the adolescent’s beliefs, pain or function. ConclusionsAdolescent, but not parent, psychological beliefs were associated with pain, self-reported function and objective measures of function.

Considering self-reported baseline function and cognition in predicting post-operative complications among older adults.

Older adults experience high rates of postoperative complications and poorer outcomes. Current perioperative risk assessments lack specific measures and are too time-consuming for busy surgeons. Using data from the Health and Retirement Study Survey linked with Medicare data, we performed a cross-sectional study, evaluating all adults ≥65 years old who underwent high-risk elective surgery between 1992-2012. Primary exposure variables included self-reported preoperative functional and cognitive abilities using activities of daily living (ADLs), instrumental activities of daily living (IADLs), and a 27-point self-administered test of memory and mental processing. Primary outcome was the development of a serious postoperative complication within 30-days following index operation. Overall, 42% (n=501) developed at least one serious postoperative complication. Patients with moderate (aOR 1.52, 95% CI: 1.14-2.04) and severe (aOR 1.55, 95% CI: 1.00-2.46) baseline functional limitations were at higher risk of serious postoperative complications compared to those with no functional limitation. Cognitive impairment was not associated with serious postoperative complications. Self-reported functional measures may help to quickly identify patients at high-risk for surgical complications and better inform pre-operative discussions including earlier initiation of palliative care services.

Subjective Cognitive Complaint in Parkinson's Disease Patients With Normal Cognition: Canary in the Coal Mine?

The objective of this study was to determine the frequency and impact of subjective cognitive complaint (SCC) in Parkinson's disease (PD) patients with normal cognition. Patients with PD with expert consensus-determined normal cognition at baseline were asked a single question regarding the presence of SCC. Baseline (N = 153) and longitudinal (up to 4 follow-up visits during a 5-year period; N = 121) between-group differences in patients with PD with (+SCC) and without (-SCC) cognitive complaint were examined, including cognitive test performance and self-rated and informant-rated functional abilities. A total of 81 (53%) participants reported a cognitive complaint. There were no between-group differences in global cognition at baseline. Longitudinally, the +SCC group declined more than the -SCC group on global cognition (Mattis Dementia Rating Scale-2 total score, F1,431 = 5.71, P = 0.02), processing speed (Symbol Digit Modalities Test, F1,425 = 7.52, P = 0.006), and executive function (Trail Making Test Part B, F1,419 = 4.48, P = 0.04), although the results were not significant after correction for multiple testing. In addition, the +SCC group was more likely to progress to a diagnosis of cognitive impairment over time (hazard ratio = 2.61, P = 0.02). The +SCC group also demonstrated significantly lower self-reported and knowledgeable informant-reported cognition-related functional abilities at baseline, and declined more on an assessment of global functional abilities longitudinally. Patients with PD with normal cognition, but with SCC, report poorer cognition-specific functional abilities, and are more likely to be diagnosed with cognitive impairment and experience global functional ability decline long term. These findings suggest that SCC and worse cognition-related functional abilities may be sensitive indicators of initial cognitive decline in PD. © 2020 International Parkinson and Movement Disorder Society.

A Multi-method Investigation of the Personality Correlates of Functional Ability in Older Adults

ABSTRACT Objectives This study evaluated the role of personality in predicting functional ability (FA) in older adults using self-report, collateral report, and performance-based measures of FA. Methods Participants included older adults (N = 131) who completed a personality measure (NEO-FFI), a self-report of FA (OARS ADL), and participated in a performance-based assessment of FA (DAFS-R). In addition, each participant had a collateral complete a collateral report of FA (OARS ADL). Bivariate correlations were computed to assess how Five Factor Model traits were related to self-report, collateral, and performance-based measures of FA. Results Neuroticism was negatively related to self-reported FA (r = − .27) and collateral-reported FA (r = − .18) and Conscientiousness was positively related to self-reported FA (r = .25). None of the traits were significantly related to the performance-based measure of FA. Conclusions These results suggest that personality traits can impact self-reported FA in older adults and underscore the importance of assessing FA in older adults using multiple methods, particularly performance-based measures. Clinical Implications Clinicians should consider how personality may impact FA in older adults and multiple methods of FA performance should be examined to better tailor recommendations.

Living Alone with Mild-To-Moderate Dementia: Findings from the IDEAL Cohort.

A significant proportion of people with dementia live alone, but little is known about their specific needs. To understand the profile of people living alone with mild-to-moderate dementia in the UK and identify any systematic differences associated with living situation. We analyzed cross-sectional data from 1,541 people with mild-to-moderate dementia and 1,277 caregivers participating in the IDEAL cohort at the first wave of assessment. There were 1,256 (81.5%) people with dementia living with others and 285 (18.5%) living alone, of whom 51 (3% of whole sample) reported little or no informal support. There were relatively few differences associated with living situation and odds ratios were generally small. People living alone were older on average, and more likely to be female, than those living with others. Those living alone were more likely to have higher cognitive ability and self-reported functional ability, and more social contact with those from other households. They were also lonelier, expressed less satisfaction with life, and used home care services and equipment more. There were no differences in symptoms, mood, quality of life, or well-being. The findings support the view that it is possible to 'live well' with mild-to-moderate dementia while living alone, given appropriate support, including home care and equipment. Nevertheless, it is important to consider how those living alone may be supported to have a more satisfactory experience, and how health and social care services can best respond to their needs.

Cumulative Dis/Advantage and Health Pattern in Late Life: A Comparison between Genders and Welfare State Regimes

ABSTRACTThis study provides a cross-national perspective to apply Cumulative Dis/Advantage (CDA) in explaining health inequality between developing and developed countries in the context of Welfare State Theory. Cross-sectional data from the international Health Retirement Study (United States, China, Mexico, and England) in 2013–2014 were used (n = 97,978). Four health indicators were included: self-reported health, depressive symptoms, functional ability, and memory. Regression models were fitted to examine the moderation roles of country and gender. Results indicated older Chinese and Mexican had poorer health status than their British and American counterparts consistently except for Mexicans’ memory. Cumulative health gaps between developing and developed countries existed only for functional ability. There is no evidence of a widening gap in health status between genders in late life. CDA explains the increasing gaps of functional ability across age groups between countries. General health and mental health, may however, depend more on individuals’ intrinsic capacity and human agency.

CUMULATIVE DIS/ADVANTAGE AND HEALTH TRAJECTORY IN LATE LIFE: A COMPARISON BETWEEN FOUR COUNTRIES

Cumulative Dis/Advantage (CDA) theory concerns how societal structure influences individual developmental and health trajectory across the life span, but few studies have applied CDA in the international setting with gender comparisons. This study provides a cross-national perspective to test CDA in explaining health inequality between developing and developed countries. Cross-sectional harmonized data from the international Health Retirement Study-series (United States, China, Mexico, and England) in 2013-2014 were used (n=97,978). Four health indicators were included: self-reported health, depressive symptoms, functional ability, and memory. Sociodemographic information and health behaviors were used as covariates. Regression models were fitted to examine the moderation roles of country and gender in health trajectory in later life. Results indicate self-reported health and mental health remained steady while functional ability and memory declined across late life span. Older Chinese and Mexican respondents had poorer health status than their British and American counterparts consistently except for memory in the Mexican data. Cumulative health gaps between developing and developed countries existed only for functional ability. Females in the four countries had poorer health than their male counterparts except their memory status. We conclude that CDA explains only the temporal decline of functional ability and its increasing gaps in later life between countries. Health inequality between countries could be attributed to the limited availability of healthcare and social resources in developing countries. However, other health status, including general health and mental health, depend more on individuals’ intrinsic capacity and human agency.

Improvements in Objectively Measured Activity Behaviors Do Not Correlate With Improvements in Patient-Reported Outcome Measures Following Total Knee Arthroplasty

BackgroundActivity monitors have added a new dimension to our ability to objectively measure physical activity in patients undergoing total knee arthroplasty (TKA). The aim of the study is to assess whether changes in the time spent sitting, standing, and stepping were associated with changes in patient-reported outcome measures (PROMs) before and after TKA. MethodsValid activPAL data (>3 days) and PROMs were obtained from 49 men and women (mean [SD] age, 62.8 [8.6] years; body mass index, 33.8 [7.1] kg/m2) who underwent primary TKA, before and at 6 weeks or 6 months after surgery. Patient-reported symptoms of pain, stiffness, and knee function were obtained using the Knee injury and Osteoarthritis Outcome Score and Oxford Knee Score questionnaires. ResultsMean (SD) Knee injury and Osteoarthritis Outcome Score (80.1 [16.3] to 41.6 [6.5], P < .001) and Oxford Knee Score (12.0 [9.8] to 17.7 [22.8], P < .001) scores improved 6 months after TKA. Walking time (mean [95% confidence interval]; min/d) increased from before (79 [67-91]) to 6 months after TKA (101 [88-114], P = .006). Standing time (318 [276-360] to 321 [291-352], P = .782) and sitting time (545 [491-599] to 509.0 [459.7-558.3], P = .285) did not change from before to 6 months after TKA. Participants took more steps (2559 [2128-2991] to 3515 [2983-4048] steps/day, P = .001) and accumulated more steps (31 [30-34] to 34 [33-35] steps/min, P < .001) after TKA compared to before. There were no associations between changes in activity behaviors and changes in PROMs (P > .05). ConclusionDespite improvements in self-reported knee pain and functional ability, these changes do not correlate with improvements in objectively measured light-intensity and sedentary activity behaviors.

Cross-cultural adaptation and psychometric properties of the Dutch version of the Hand Function Sort in patients with complaints of hand and/or wrist

BackgroundMusculoskeletal complaints of arm, neck, and shoulder (CANS) can lead to loss of work productivity. To assess the functional consequences of impairments in work, patient-reported outcomes can be important. The Hand Function Sort (HFS) is a 62-item pictorial questionnaire that focuses on work task performance. The aims of this study were the cross-cultural adaptation of HFS into HFS-Dutch Language Version (HFS-DLV) (Part I) and determining construct validity, internal consistency, test-retest reliability, responsiveness and floor/ceiling effects of HFS-DLV (Part II).MethodsI: Translation into Dutch using international guidelines. II: Construct validity was assessed with Spearman’s correlation coefficients between the HFS-DLV and the Dutch version of the QuickDASH, PRWHE, PDI, RAND-36, NRS-pain, and work ability score. Internal consistency was assessed using Cronbach’s α and reliability by a test-retest procedure. A global rating scale of change was used after 4–8 weeks of hand therapy to determine responsiveness.ResultsI: Forty patients were included, and no items were changed. II: 126 patients with hand, wrist, and/or forearm disorders classified as specific or nonspecific CANS. Six predefined hypotheses (50%) were confirmed. Cronbach’s α: 0.98. Test-retest reliability: ICC of 0.922. AUC of 0.752. There were no floor/ceiling effects.ConclusionsI: Translation process into the HFS-DLV went according to plan. II: For construct validity, the presumed direction of correlations was correct, but less than 75% of hypotheses were confirmed. Internal consistency was high, suggesting redundancy. Reliability and responsiveness of the HFS-DLV were good. HFS-DLV can be used in research or clinical practice for Dutch patients with CANS, to evaluate self-reported functional work ability.