Self-reported Functional Assessment Research Articles

Prevalence and functions of non-suicidal self-injury in Spanish adolescents.

This study examined the prevalence, characteristics and functions of Non-suicidal Self-injury (NSSI) among Spanish adolescents. The sample consisted of 1,864 adolescents aged between 12 and 19 years (Mean Age = 15.32, SD = 1.97, 51.45% girls). The participants completed a modified version of the self-report scale Functional Assessment of Self-Mutilation (FASM; Lloyd, Kelley, & Hope, 1997) to assess rates and methods of NSSI used during the last 12 months. They also indicated the functions of NSSI. NSSI behaviors are common among Spanish adolescents. More than half of the sample showed such behavior in the past year, and 32.2% had carried out severe NSSI behaviors. The functions of NSSI were examined by using confirmatory factor analyses. Results supported a hierarchical model consisting of two second-order factors: automatic reinforcement, which explained both positive and negative automatic reinforcement, and social reinforcement, which explained both positive and negative social reinforcement. These dimensions are critical to understand the factors that maintain NSSI behavior and have implications for treatments.

Frailty is adversely associated with quality of life in patients with newly diagnosed pancreatic cancer

Introduction: Decreased quality of life in patients with pancreatic cancer has been associated with poor performance status and increased mortality risk. Patients with newly diagnosed pancreatic cancer often present with frailty but the prevalence of this clinical syndrome and the extent to which it is associated with oncologic outcomes in these patients is unknown. We hypothesized that frailty is associated with decreased quality of life and other predictors of poor survival in pancreatic cancer. Objectives: To determine whether the presence of frailty syndrome correlateswith diminishedquality of life in patientswith pancreatic cancer. Methods: We prospectively measured frailty on the basis of Fried’s criteria (3 or more of the following: low grip strength, slow gait speed, weight loss, low physical activity, and exhaustion) in adult patients with newly diagnosed pancreatic cancer who presented to MD Anderson Cancer Center between July 2012 and May 2013. Nonparametric bivariate methods were used to evaluate the associations between self-reported Functional Assessment of Cancer Therapy – Hepatobiliary (FACT-Hep) symptom and quality of life scores and frailty, performance status, anatomic stage, and ACE-27 comorbidity scores. A multivariable regression model was constructed to determine whether frailty was associated with overall quality of life based on the total FACT-Hep score, when controlling for performance status and stage. Results: Of 143 patients enrolled, 73 (51%) were 65 years and older and 68% were male; 62 (43%) had metastases. Thirty-seven (25.9%) were frail. Frailty was not associated with either age or anatomic stage. Frailty was associated with increased hepatobiliary-associated symptoms (p b 0.001) and adversely associated with overall quality of life (mean total FACT-Hep 104.9 vs. 135.1, p b 0.001) as well as physical (p b 0.001), functional (p b 0.001), and emotional (p= 0.02) FACT-Hep subscale scores. Performance status and disease stage were significantly associated with decreased overall quality of life, but comorbidity was not. In a multivariable regression model, frailty remained significantly associated with the total FACTHep score when controlling for performance status and anatomic stage. Conclusion: Over one quarter of patients with a new diagnosis of pancreatic cancer met criteria for frailty syndrome, and frailty was associated with decreased quality of life. The prognostic implications of frailty syndrome for pancreatic cancer patients is being explored in this longitudinal study.

Association between skeletal muscle inflammatory markers and walking pattern in people with knee osteoarthritis

Patients with knee osteoarthritis (OA) are characterized by increased muscle inflammation and altered gait. We investigated the association between proinflammatory mediators in the vastus lateralis and physical function and gait in patients with knee OA. Nineteen patients with knee OA underwent gait analysis, assessment of self-reported pain and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and a muscle biopsy that was taken during their knee replacement surgery. Muscle was analyzed for cellular protein inflammatory mediators, interleukin-6, monocyte chemotactic protein 1 (MCP-1), p65 NF-κB, signal transducer and activator of transcription 3 (STAT-3), and JNK-1. Sagittal plane knee function, including early stance knee range of motion (ROM) and knee sagittal plane impulse, was measured using a motion analysis system. Pearson's correlation was used to assess relationships between selected variables. Significant positive correlations were found between MCP-1 and self-perceived stiffness, physical function, and the total WOMAC score (P < 0.05). MCP-1 was also negatively correlated with early stance knee ROM (r = -0.52, P = 0.023). Reduced velocity was associated with elevated levels of p65 NF-κB and STAT-3 (P < 0.05). Knee sagittal plane impulse was negatively correlated with JNK-1 (P = 0.02), indicating reduction in knee impulse with an increased level of JNK-1. Increased levels of several proinflammatory mediators were correlated with altered knee function during walking as well as greater physical disability and slower gait velocity. Identification of the cellular and molecular mechanisms associated with muscle inflammation is important to better understand the underlying mechanism responsible for altered gait and function in patients with knee OA.

Body structure versus body function in haemophilia: the case of haemophilic ankle arthropathy

Imaging and clinical scores are the main tools used to evaluate the progression of haemophilic arthropathy (HA). Based on haemophilic ankle arthropathy, this study aimed to explore the concordances between structural and clinical alterations, determined by standard radiological and clinical scores, and functional alterations assessed by three-dimensional gait analysis (3DGA). In total, 21 adult haemophilia patients underwent extensive ankle evaluation using the physical examination part of the World Federation of Haemophilia joint score, the Arnold-Hilgartner and the Pettersson radiological scores, and self-reported ankle function assessment using the revised Foot Function Index. Significant associations were found between self-reported ankle function assessment and the three 3DGA variables representative of joint function (range of motion, peak plantar flexion moment, and peak power generated at the push-off phase). Radiological and clinical scores were compared with ankle muscle peak power measurement, the most reliable 3DGA gait variable for ankle function. No significant associations were found between both clinical and functional scores and the 3DGA functional assessment. This discordance may be explained by the lack of a direct relationship between functional alterations detected by 3DGA and the structural changes assessed using X-ray or clinical scoring. Another explanation may be the limitation of clinical and radiological scoring systems in properly determining the severity of HA. Functional assessments such as 3DGA should be used more frequently when monitoring the progression of ankle arthropathy or the effects of therapeutic interventions in adult haemophilia patients.

Menopausal symptoms in women undergoing chemotherapy-induced and natural menopause: a prospective controlled study

Background: Women with breast cancer frequently undergo menopause following adjuvant chemotherapy. Here, we investigated whether they have more severe symptoms than women undergoing natural menopause.Patients and methods: Forty-one women who had undergone menopause as a result of chemotherapy and 57 healthy women who had undergone recent natural menopause were evaluated on two occasions 1 year apart. The primary end point was the summed score of the self-report Functional Assessment of Cancer Therapy, endocrine symptoms (FACT-ES) scale. Quality of life was evaluated by the FACT-G questionnaire and fatigue by the FACT-F subscale.Results: There was a strong trend for patients to report worse FACT-ES scores than controls at the first (P = 0.05) and second (P = 0.04) time points. More patients had moderate/severe hot flashes than controls undergoing natural menopause (51% versus 19%, P = 0.003). Patients reported worse fatigue than controls at the first assessment (P = 0.04), with no difference at the second. Menopausal symptoms were associated with fatigue for both groups. There was no difference between patients and controls in the quality-of-life scale, although assessment of patients is likely subject to adaptation and response-shift bias.Conclusions: Women undergoing chemotherapy-induced menopause may experience worse symptoms than women undergoing natural menopause.

The Uses of Disease Activity Scoring and the Physician Global Assessment of Disease Activity for Managing Rheumatoid Arthritis in Rheumatology Practice

To evaluate the uses of quantitative disease activity scoring and a physician global assessment of disease activity for managing rheumatoid arthritis (RA) in rheumatology practice. The Global Arthritis Score (GAS) and a physician global assessment (Physician Global) were determined during each office visit for a community practice RA population. The GAS was calculated from patients' self-reported pain, functional assessment, and tender joint count. The Physician Global was recorded on a 10-point visual analog scale. The correlation of these 2 disease activity measures was determined for the most recent office visit of 185 patients with RA, and the reasons for discordant results were identified by chart review. The GAS and Physician Global were concordant for active or inactive disease in 126 of 185 patients (68%) and were discordant in 59 (32%). Forty-five of these discordant patients had a high GAS while their Physician Global indicated inactive disease. Their GAS values were high because of osteoarthritis, back pain, soft tissue rheumatism, and/or prior joint damage rather than active RA. The other 14 patients had a low GAS with an uncontrolled Physician Global for a variety of reasons. (1) An RA disease activity score and a quantitative Physician Global can be measured during rheumatology office visits to document patients' disease status. (2) Disease activity scoring contributes valuable information, but should not replace the Physician Global in guiding RA patient management or reimbursement decisions.

Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial

Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Objective To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee. Design Randomized, single-blind, before-after trial. Setting Physiotherapy gymnasium and hydrotherapy pool. Participants Patients awaiting elective hip or knee joint replacement surgery. Interventions Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment. Main Outcome Measures Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale. Results Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes. Conclusions While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.

Performance-Based Functional Assessment in Older Hospitalized Patients: Feasibility and Clinical Correlates

Functional evaluation is a cornerstone of multidimensional geriatric assessment; however, little is known of the clinical value of standardized performance-based assessment in the acute care setting. The aim of this study was to evaluate the clinical correlates and short-term predictive value of the Short Physical Performance Battery (SPPB) in older patients admitted to the hospital for an acute medical event. We enrolled 92 women and men 65 years old or older who were able to walk, who had a Mini-Mental State Examination (MMSE) score > or =18, and who were admitted to the hospital with a clinical diagnosis of congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), or minor stroke. The SPPB was assessed at hospital admission and discharge. Self-report functional assessment included basic activities of daily living (ADL) and instrumental activities of daily living (IADL). Spearman's rank correlation coefficients and multivariable linear regression analyses were used to study the association of SPPB score and functional and clinical characteristics, including length of hospital stay. The mean age was 77.7 years (range 65-94 years), 49% were female, 64.1% had congestive heart failure, 16% COPD, 13.1% pneumonia, and 6.5% minor stroke. At hospital admission the mean SPPB score was 6.0 +/- 2.7. SPPB scores were inversely correlated with age, the severity of the index disease, and IADL and ADL difficulty 2 weeks before hospital admission (p <.01), and were directly correlated with MMSE score (p =.002). On average, SPPB score increased 1 point (+0.97, standard error of the mean = 0.2; p for paired t test <.001) from baseline to hospital discharge assessment. After adjustment for potential confounders, baseline SPPB score was significantly associated with the length of hospital stay (p <.007). In older acute care inpatients, SPPB is a valid indicator of functional and clinical status. SPPB score at hospital admission is an independent predictor of the length of hospital stay.

A randomised, placebo-controlled, double-blind trial of the effects of d-methylphenidate on fatigue and cognitive dysfunction in women undergoing adjuvant chemotherapy for breast cancer

Women who receive adjuvant chemotherapy for breast cancer develop fatigue, and a subset reports cognitive impairment. Methylphenidate is reported to improve fatigue and to decrease cognitive impairment in other populations. Women were randomised early during their chemotherapy to receive d-methylphenidate (d-MPH), a form of methylphenidate, or an identical appearing placebo. All participants took placebo for one cycle to ensure compliance and then study medication until completion of chemotherapy. Subjects were assessed at baseline, end of chemotherapy and at approximately 6 months follow-up with the High Sensitivity Cognitive Screen (HSCS) and the Hopkins Verbal Learning Test-Revised (HVLT-R). They also completed the self-report Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-F (F = fatigue) questionnaires, evaluating quality of life and fatigue. A total of 57 evaluable women were randomised: 29 to d-MPH and 28 to placebo; the study did not meet its accrual goal of 170 patients, mainly because women were reluctant to take additional medication in general and methylphenidate in particular. Groups were well matched for age (median, 50 years) and education. d-MPH and placebo were well tolerated. There were no significant differences between the randomised groups in classification of cognitive function by HSCS or in summed FACT-F fatigue scores (the primary endpoints of the study) at any of the assessments. There were also no differences in HLTV-R scores or quality of life. This study is underpowered, but there are no trends to suggest that d-MPH, taken concurrently with adjuvant chemotherapy, improves quality of life or fatigue.

Spinal Mechanisms of Pain Control

To demonstrate initial results using Khan Kinetic Treatment (KKT) as a chronic neck pain treatment and to present pain control mechanistic theory on which the treatment is based. A self-reported functional assessment, neck pain questionnaire, and pain medication dose were used as outcome measures for 44 matched patients randomly split into 2 groups ("treatment" and "control"). The treatment group underwent a treatment period consisting of several individual KKT treatments, whereas the control group continued conventional therapy. Compared with a control group, the treatment group lowered both their self-recorded neck pain scores (P=0.012) and pain medication dose (P=0.048), although current functional assessment questionnaires (range of motion, overall activity, and recreation/work activities) did not detect changes (P=0.233, 0.311, and 0.472, respectively). We address the theory of the pain control mechanisms of the device in detail. Although we await randomized placebo controlled trials and additional results from ongoing mechanistic studies, initial results show that KKT is potentially an effective treatment for chronic neck pain and may contribute to the reduction of pain relieving medication.

Initial Results Using Khan Kinetic Treatment™ as a Low Back Pain Treatment Option

Objectives: Demonstrate initial results using Khan Kinetic Treatment [KKT™] as a low back pain [LBP] treatment option.Methods: A self-reported functional assessment, LBP questionnaire, and pain medication dose were used as the outcome measures for 48 matched subjects randomly split into two groups [treatment and control]. The treatment group underwent a treatment period consisting of several individual KKT™ treatments over a few weeks period, while the control group continued conventional treatment. A paired t-test analyzed the functional assessment scores and a two group by two LBP score [positive or non-positive] McNemar's test was used for the LBP questionnaires. Pain medication dose analysis consisted of a two group by two pain medication dose outcome [same or reduced] McNemar's test.Results: Compared to a control group, the treatment group lowered both their self-recorded LBP scores [P < 0.001] and showed a strong positive trend to lower their pain medication dose [P = 0.054]. Only the range of motion assessment questionnaire [range of motion, overall activity, and recreation/work activities] detected changes in these measurements [P = 0.046, P = 0.061, P = 0.052, respectively].Conclusions: Although we await blinded and randomized placebo controlled trials, initial results suggest thatKKT™may be an effective treatment for LBP, may increase the range of motion, and may decrease the need for pain relieving medication.

Impact of Androgen Deprivation Therapy on Physical and Cognitive Function, as Well as Quality of Life of Patients With Nonmetastatic Prostate Cancer

Many patients with prostate cancer receive androgen deprivation therapy for long periods. We compared physical and cognitive function, and quality of life in a cross-sectional study of 57 patients receiving androgen deprivation therapy for nonmetastatic prostate cancer and 51 healthy age matched controls. Physical and daily function were measured by the 6-minute walk test, grip strength, the timed up and go test, and activities of daily living measures. Cognitive function was evaluated by the High Sensitivity Cognitive Screen and by a self-report prototype Functional Assessment of Cancer Therapy cognitive function subscale. Quality of life was assessed by the Functional Assessment of Cancer Therapy-General with the subscale for fatigue and by the Patient-Oriented Prostate Utility Scale. Androgen deprivation therapy was given for a median of 1.8 years (range 0.4 to 7.4). Patients had lower median hemoglobin than controls (134 vs 148 gm/l, p <0.0001). Performance on physical tests was similar in the 2 groups. Moderate or severe cognitive impairment by the High Sensitivity Cognitive Screen was similar for patients (23%) and controls (35%, p = 0.2). Self-reported cognitive dysfunction was also similar. Scores for the Functional Assessment of Cancer Therapy-General were similar but the Patient Oriented Prostate Utility Scale summary score was worse for patients (median 71 vs 86, p <0.001). More patients reported severe fatigue (Functional Assessment of Cancer Therapy-Fatigue score less than 35, p = 0.03). Low energy, poor bladder control and loss of sexual function were reported in 36%, 47% and 95% of patients, and in 16%, 34% and 33% of controls, respectively. Patients treated with androgen deprivation therapy experience more symptoms and have worse fatigue than controls, but this study did not detect any effect on physical or cognitive function.

The A-B-C's of smoking cessation: Using behavioral strategies to help undergraduates stop smoking.

Despite reports claiming cigarette smoking remains the most preventable cause of premature death in the United States, cigarette use by college students is increasing on campuses nationwide. We investigated the effectiveness of a brief multicomponent smoking cessation program provided for a 21year-old female (Sue) and an 18-year-old male (Tom) undergraduate student from a midwestern university. The treatment program consisted of self-report functional assessment methodology, schedule-reduced smoking, and functionally derived self-management strategies. The use of a functional assessment device provided descriptions of antecedent-behavior-consequence relationships, thereby engendering idiographic self-management cessation strategies, and a schedule-reduced smoking component was included in order to facilitate the programmed reduction in nicotine intake. Dependent measures included self-report of daily smoking frequency and alveolar carbon monoxide levels. Treatment included four weekly sessions lasting approximately 45 minutes. Though neither participant achieved complete cessation, Sue achieved a 70% reduction in smoking at 6-months followup. Tom achieved a 60% reduction in smoking at 14-day follow-up, but reported returning to above pre-treatment smoking frequency at 6-months follow-up. Treating college smokers with a rapid multicomponent program targeting the both the behavioral and pharmacological aspects of smoking behavior may offer reductions in smoking. Approximately one quarter of U.S.