Self-reported Functional Disability Research Articles

Associations between patient-reported functional disability and measures of physical ability in juvenile fibromyalgia.

Juvenile fibromyalgia (JFM) is a chronic condition characterized by symptoms of pain and fatigue and is associated with sedentary behavior and functional disability. Adults with fibromyalgia exhibit deficits in physical fitness as evidenced by lower aerobic capacity and physical endurance, but it is unknown whether these impairments are apparent in adolescents with JFM. Furthermore, the extent to which functional disability and pain interference relate to measures of physical fitness has not been investigated in a pediatric pain population. During a baseline assessment for a clinical trial, 321 adolescents with juvenile fibromyalgia (M age = 15.14, 85.2% female) completed measures of pain intensity, fatigue, JFM symptom severity, functional disability, and pain interference. They also completed 2 validated fitness tasks: (1) the Harvard step test, which assesses aerobic fitness, and (2) the 6-minute walk test, a simple submaximal test of endurance. We examined associations among self-report measures and fitness assessments using bivariate correlations. We then employed hierarchical regression analyses to determine the unique contributions of physical fitness assessments to self-reported functional disability and pain interference. Results indicated that youth with JFM exhibited deficits in aerobic capacity and physical endurance. However, physical fitness explained negligible variance in functional disability and pain interference beyond that accounted for by pain, fatigue, and JFM symptom severity. Scores on available functional disability measures may reflect perceived difficulties in coping with symptoms during physical tasks rather than actual physical capability. Rigorous and sensitive assessments of physical fitness and endurance are needed to determine whether rehabilitation interventions for pediatric pain improve physical functioning.

Neuropathic-like symptoms and central sensitization related signs and symptoms negatively affect the functional performance of patients with knee osteoarthritis – a cross-sectional study

ObjectiveThis study aimed to compare the functional performance among participants with a neuropathic-like symptoms (NS) and central sensitization related signs and symptoms (CS), and their knee osteoarthritis (OA) counterparts. MethodsA cross-sectional observational study was conducted with 125 participants with knee OA (94 females, mean age 63.1 ​± ​7.4 years). Participants completed a self-reported questionnaire with personal and clinical features and musculoskeletal pain characteristics, including NS (PainDETECT), CS (Central Sensitization Inventory, CSI), and conditioned pain modulation. Self-reported functional disability (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) and functional mobility (Timed Up and Go, TUG) were compared among patients with NS, CS, and their knee OA counterparts using the one-way analysis of variance (ANOVA). ResultsThirty-three (26.4%) participants had NS and CS, eighteen (14.4%) had NS, twenty-seven (21.6%) participants had CS, and 47 (37.6%) had knee OA with no NS or CS. A one-way ANOVA revealed greater functional limitation in the group with NS and CS (mean ​= ​67.5 ​± ​12.0) or NS (mean ​= ​56.7 ​± ​17.5) than the group without these symptoms (mean ​= ​32.0 ​± ​20.7) with a statistical significance difference [F(3, 121) ​= ​29.434, p ​< ​0.001] in the WOMAC Total score. The group with NS and CS (mean ​= ​19.2 ​± ​7.4) or NS (mean ​= ​16.3 ​± ​6.3) had slower velocity than the group without these symptoms (mean ​= ​11.6 ​± ​3.5) with a statistical significance difference [F(3,121) ​= ​10.045, p ​< ​0.001] in the TUG test. ConclusionParticipants with knee osteoarthritis and NS or CS pain phenotype have greater functional limitations than their counterparts.

Poorer Inhibitory Control Uniquely Contributes to Greater Functional Disability in Post-9/11 Veterans.

Post-9/11 Veterans endorse greater self-reported functional disability than 80% of the adult population. Previous studies of trauma-exposed populations have shown that increased post-traumatic stress disorder (PTSD) and depressive symptoms are consistently associated with greater disability. Additionally, poorer cognitive performance in the domain of executive functions, particularly inhibitory control, has been associated with disability, though it is unclear if this effect is independent of and/or interacts with PTSD and depression. Three overlapping samples of n= 582, 297, and 183 combat-deployed post-9/11 Veterans completed comprehensive assessments of executive functions, PTSD and depressive symptoms, and self-reported World Health Organization Disability Assessment Schedule-II (WHODAS II). Poorer performance on measures of inhibitory control (Delis-Kaplan Executive Functioning System Color-Word Interference-CWI Test and gradual-onset Continuous Performance Test-gradCPT), but not other executive functions, were significantly associated with greater disability on the WHODAS II (ρ's = -.13 and -.13, p= .002 and .026, respectively). CWI inhibitory control measures accounted for unique variance in disability after controlling for PTSD and depressive symptoms (R2 change = 0.02, p< .001). Further, CWI significantly moderated the effect of depressive symptoms on disability, such that better inhibitory control weakened the relationship between depression and disability. Inhibitory control deficits are uniquely associated with increased disability in combat-deployed post-9/11 Veterans, and better inhibitory control abilities may serve as a protective factor for depressive symptoms leading to increased disability.

Cold sensitivity and its association to functional disability following a major nerve trunk injury in the upper extremity-A national registry-based study.

AimsTo investigate self-reported cold sensitivity and functional disability after a repaired major nerve trunk injury in the upper extremity.MethodsWe identified 735 individuals with a major nerve trunk injury in the upper extremity, surgically treated with direct nerve repair or reconstructed with nerve autografts, in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity, and perceived disability were collected using two questionnaires (HQ-8 and QuickDASH) preoperatively, and at three and 12 months postoperatively.ResultsWe included 281 individuals, who had responded the questionnaires, where 197 (70%) were men (median age 34 [interquartile range 25–52] years) and 84 (30%) were women (median age 41 [25–55]). Cold sensitivity (scored 0–100) was the most prominent symptom 12 months postoperatively after an injured and repaired/reconstructed median (p<0.001) or ulnar (p<0.001) nerve, while individuals with a radial nerve injury showed milder symptoms. Concomitant injuries did not affect cold sensitivity scores. Individuals with ulnar nerve injuries scored higher in stiffness (p = 0.019), weakness (p<0.001) and ability to perform daily activities (p = 0.003) at 12 months postoperatively than median nerve injuries. Individuals with a median, ulnar or radial nerve injury with severe (>70) cold sensitivity had 25, 37 and 30 points higher QuickDASH scores, respectively (p<0.001), at 12 months postoperatively than individuals with mild (<30) cold sensitivity. There were no differences in QuickDASH score or cold sensitivity score at 12 months postoperatively between direct nerve repair or nerve reconstruction with nerve autografts. Neither age, nor sex, affected QuickDASH score at 12 months postoperatively.ConclusionCold sensitivity after surgery for a major nerve trunk injury in the upper extremity can be substantial with impaired ability to perform daily activities, where an ulnar nerve injury may have a worse outcome.

How Well Does Patient-reported Functional Disability Correspond to Measures of Physical Fitness in Adolescents with Fibromyalgia?

The Functional Disability Inventory (FDI) is one of the most commonly used patient-reported outcome measures in clinical trials of pediatric pain. In addition to self-reported impairment, studies using activity monitoring devices show that adolescents with widespread musculoskeletal pain often exhibit sedentary behavior. Little is known about how impairment in daily physical activities is reflected in objectively-assessed physical fitness among adolescents with widespread pain. During a baseline assessment for a clinical trial, adolescents with juvenile fibromyalgia (N=226, Mage=15.26, 85% female) completed questionnaires (FDI, PROMIS-Fatigue, pain intensity VAS) and two validated assessments of physical functioning (The Harvard Step Test [HST], a test of aerobic fitness; and the Six-Minute Walk Test [6MWT], the distance a participant is able to walk in 6 minutes). We hypothesized that measures of physical fitness would predict variance in self-reported physical functioning (FDI scores) after controlling for pain and fatigue. We computed bivariate correlations followed by a hierarchical linear regression analysis with pain intensity and fatigue entered in the first step, fitness assessments in the second step, and FDI scores as the dependent variable. FDI scores were strongly associated with fatigue and pain levels (r=.55, p<.001 and r=.47, p<.001, respectively), but only modestly associated with HST (r=-.29, p<.001) and 6MWT scores (r=-.16, p=.02). In the regression model, pain and fatigue together explained 59% of the variance in FDI scores, while fitness measures explained only 2% unique variance (∆r2=.02, p=.07). HST significantly predicted FDI scores (β=-.16, t=-2.21, p=.03), but 6MWT distance did not. After controlling for pain intensity and fatigue, only the HST showed a significant relationship to self-reported functional disability. Overall, fitness measures contributed negligibly to FDI scores. Results support the need to examine cognitive and emotional factors (e.g., fear of movement) which may contribute to physical impairment among youth with chronic pain. Grant support from NIAMS/NIH R01 AR070474 (PI: Kashikar-Zuck).

Cold sensitivity, functional disability and predicting factors after a repaired digital nerve injury

To investigate self-reported cold sensitivity and functional disability after a repaired digital nerve injury. We identified 3204 individuals operated with digital nerve repair in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity and perceived disability, were examined using two questionnaires (HQ-8 and QuickDASH), three and 12 months postoperatively. Patients with diabetes (n = 48; 3%) were identified in the Swedish National Diabetes Register (NDR). Cold sensitivity (scored 0–100) was the most prominent symptom among 1553 included individuals (998 men, 555 women; median age 41 [IQR 27–54] years). In the regression analysis, flexor tendon injury, hand fracture and injury to multiple structures predicted worsened cold sensitivity (6.9, 15.5 and 25.0 points; p = 0.005, 0.046 and < 0.001) at 12 months. Individuals with moderate (30–70) and severe (> 70) cold sensitivity had higher QuickDASH scores at three and 12 months postoperatively than individuals with mild cold sensitivity (6.0 and 5.5; 19.8 and 21.0 points; p = 0.001). Flexor tendon injury, injuries to multiple structures and diabetes had significant effect on QuickDASH scores at three, but not at 12, months postoperatively. Cold sensitivity is common after a digital nerve repair and impacts self-reported disability. A concomitant injury, particularly multiple injuries, predicts postoperative cold sensitivity.

Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: a study protocol for a randomized controlled feasibility trial

BackgroundAbout 50% of women experience lumbopelvic pain (LBPP) during their pregnancy. LBPP has negative repercussions on sleep, social and sexual life, physical and work capacity, and psychological health and contributes to physical inactivity. The benefits of LBPP prevention or treatment in pregnant women through specific exercises should therefore be further investigated. This study protocol has been designed to establish the feasibility of implementing motor control exercise program with pregnant women presenting with a history of LBPP.Methods/designForty pregnant women with a history of LBPP will be recruited and randomly allocated to a control (20 participants) or intervention (20 participants) group. The control group will receive standard prenatal care, including basic information on what to do when suffering from LBPP. The intervention group will participate in three 40-min exercise sessions per week from < 20 weeks until 34–36 weeks of gestation: one supervised group session via the Zoom platform (once a month, this session will take place at the Université du Québec à Trois-Rivières) and two unsupervised sessions at home. A motor control exercise program will be developed to target strengthening of the lumbo-pelvic-hip core muscles and improve spinal and pelvic stabilization. Participants of this group will also receive standard prenatal care. Women of the control group will receive after 6 weeks postpartum an exercise program designed to reduce LBPP they may have developed during pregnancy and that may persist after delivery. Primary outcomes will be participants’ recruitment, retention and adherence rates, safety, and acceptability of the intervention. Secondary outcomes will include LBPP incidence, frequency, and intensity, as well as self-reported functional disability, physical activity levels, fear avoidance behavior, anxiety, and depression.DiscussionThis study will inform the feasibility of conducting a full-scale randomized controlled study to test the effectiveness of a motor control exercise program on the prevention and treatment of LBPP in women with a history of LBPP. Adequate prevention and treatment of pregnant women with a history of LBPP should help limit the recurrences of LBPP or the aggravation of its intensity during pregnancy.Trial registrationUS National Institutes of Health Clinical Trials registry NCT04253717 April 27, 2021.

From One Pain to Many: The Emergence of Overlapping Pains in Children and Adolescents.

The objective of this study was to compare children and adolescents with overlapping chronic pains (OCP) to those with single chronic pains (SCP) among youth presenting in specialized clinical settings, in an effort to identify potential risk factors for developing overlapping pains. A total of 1235 youth ages 8 to 18 seen in a tertiary care multidisciplinary pain clinic or a multidisciplinary headache clinic completed self-report measures of pain, disability, psychological functioning and clinical history and characteristics at the time of initial clinic visit. Information was captured in a chronic pain data repository and accessed for the current study. Subsequent pain symptoms developed on average 11.9 months (SD=24.5 mo) after onset of the first pain symptom. Compared with patients with SCP, patients with OCP report more medical comorbidity, more developmental issues, and poorer current sleep and school functioning. They also scored significantly higher than patients with SCP on self-reported functional disability, pain catastrophizing, fear of pain, depression, anxiety, and psychological stress and lower quality of life (all Ps<0.001). In multivariate analysis, variables most strongly associated with presenting with OCP were age (odds ratio [OR]: 1.1, P<0.001), having a clinically significant high functional disability (OR: 1.4, P=0.3), and low quality of life (OR: 2.5, P<0.001). Given their tendency toward more psychological and medical comorbidities, patients with OCP may require more intense and diverse treatment approaches. Some early life experiences may be a risk factor for development of OCP. Longitudinal studies are needed to fully evaluate the heightened risk for OCP associated with some of these factors.

Factors associated with unsuccessful return-to-work following work-related upper extremity injury.

Returning to work following occupational injury is a key outcome for both workers' compensation boards and injured workers. Predictive factors for returning remain unclear. To describe factors associated with unsuccessful return-to-work (RTW) in a hand injury population to identify target areas through which occupational rehabilitation programmes can help injured workers achieve successful RTW outcomes. Demographic data, functional, pain and psychosocial scores were recorded for injured workers discharged between April 2011 and September 2015 from a multidisciplinary upper extremity treatment programme. The primary outcome of RTW status was assessed at programme discharge. Bivariate analyses and multivariable logistic regression were used to identify factors associated with being unable to RTW. Of 872 participants who met the inclusion criteria, 65% were male and the mean age was 46 (standard deviation [SD] 11) years. In unadjusted bivariate analyses, the group with an unsuccessful RTW outcome had higher mean baseline pain, catastrophizing and QuickDASH scores; a higher baseline prevalence of depression, and reported a high level of pain more frequently than those who were working at discharge. In the adjusted logistic regression model, not working at baseline, higher QuickDASH score and presence of depression at baseline were independently associated with unsuccessful work status outcome. Negative baseline work status, greater self-reported functional disability and presence of depression were associated with greater odds of unsuccessful RTW following a workplace upper extremity injury. Integrating mental healthcare provision with occupational rehabilitation is a potential programmatic approach to improve RTW.

A survey of falls in people with dystonia.

Dystonia is a chronic and sometimes progressive neurological disorder causing abnormalities in movement and function. We conducted a preliminary survey to investigate whether people with dystonia experience falls and to identify contributing factors to falls in this population. An online survey of people with dystonia was conducted in November 2015. Respondents were asked to complete demographic information, three questionnaires (the Falls Self-Efficacy Scale International [FES-I], the Activities-based Balance Confidence Scale [ABC] and the Functional Disability Questionnaire [FDQ]), and to report any falls sustained during the previous 6 months. Thirty-nine percent of the 122 respondents reported falling in the previous 6 months and 65% of fallers were diagnosed with dystonia not affecting the lower limbs. Fallers reported lower falls self-efficacy and balance confidence with higher functional disability. Both falling scales correlated with self-reported functional disability. Linear regression analysis for falls prediction revealed the variables FES-I and FDQ accounted for almost 30% of the falls in this dystonia population. This survey indicates that fear of falling and balance confidence are impaired in people with dystonia, possibly impacting on function and falls. Further investigation into balance, function and falls in this population is required.

Obesity and diabetes are jointly associated with functional disability in stroke survivors

BackgroundStroke is the most common cause of complex disability. Obesity and diabetes increase risk for functional disability in the general population, but their contribution to functional disability in stroke survivors is unknown. ObjectiveTo investigate the joint association of obesity and diabetes with functional disability in stroke survivors. MethodsCross-sectional data from 34,376 stroke survivors from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys were examined. Weighted and age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for sociodemographic characteristics) with 95% confidence intervals (CIs) were calculated to compare prevalence and odds for self-reported functional disability, stratified by obesity-diabetes status (i.e., neither condition, obesity only, diabetes only, both conditions). ResultsPrevalence of functional disability increased across obesity-diabetes categories in the total sample: neither condition (45.4%, 95% CI: 43.4%–47.4%), obesity only (55.3%, 95% CI: 52.7%–58.0%), diabetes only (60.8%, 95% CI: 57.5%–64.1%), and both conditions (70.3%, 95% CI: 67.7%–72.9%). Compared to respondents with neither condition, those with both obesity and diabetes had 2.62 (95% CI: 2.23–3.08) higher odds for functional disability; odds were also increased for respondents with obesity only (1.52, 95% CI: 1.32–1.76) and diabetes only (1.71, CI: 1.45–2.01). ConclusionsOur findings indicated a joint effect of obesity and diabetes on functional disability that exceeded either condition alone, placing stroke survivors with both health conditions at greatest risk for diminished functional capacity. Recognizing obesity and diabetes as modifiable risk factors may be useful for identifying stroke sub-populations that could benefit from lifestyle intervention.

Prevalence and Risk Factors of Depression and Anxiety in Essential Tremor Patients: A Cross-Sectional Study in Southwest China.

Background: Essential tremor (ET) is one of the most common movement disorders, and it has been associated with anxiety and depression, but risk factors for these mental symptoms are unclear. This study aimed to evaluate the prevalence and potential risk factors of depression and anxiety in ET patients in China.Methods: This cross-sectional study involved 245 Han Chinese patients with ET. Depression was assessed using the Hamilton Depression Rating Scale-24 Items, and anxiety was assessed using the Hamilton Anxiety Rating Scale. Clinico-demographic characteristics were compared between patients with or without depression or anxiety.Results: We revealed that 63.3% of patients had at least mild anxiety and 54.3% had at least mild depression. Severity of anxiety or depression was correlated with lower Mini-Mental State Exam score (P = 0.028 and P = 0.002, respectively), higher self-report functional disability score (P = 0.027 and P = 0.003, respectively), as well as the presence of tremor in the neck (both P < 0.001), face (P = 0.025 and P < 0.001, respectively), or voice (both P < 0.001). Binary logistic regression identified female sex, presence with cranial tremor, and greater functional disability score as risk factors of anxiety; the last two factors were also the determinants of depression. Neither anxiety nor depression correlated with physician-assessed severity of arm or leg tremor.Conclusion: Chinese ET patients show high prevalence of depression and anxiety. ET patients should be screened for these mental symptoms, especially women and those with cranial tremor and self-reported functional disability.

Completion Rates and Clinical Changes of Patients Seeking Non-Invasive Treatment for Low Back Pain in 13 Centres of a Sports Medicine Institute in India

Background/Aim: Low back pain (LBP) is the major cause of disability worldwide. The existing treatments are expensive and associated with complications. The present study aimed to determine the proportion of patients completing therapy and rehabilitation phases and describe the changes in self-reported symptoms and functional disability among LBP patients enrolled in a private sports medicine institute. Methods: This is a cohort study involving review of case records. We studied 2 phases out of 3 of non-invasive treatment of LBP: therapy of around 10 days (myofascial trigger point release therapy, cryotherapy, aqua therapy and acupuncture) and rehabilitation of around 3 weeks (muscle strengthening exercises). Results: A total of 443 patients were enrolled; their mean (SD) age was 46 (15) years, 46% were male, and 193 (44%) presented with chronic (>6 months) pain. The numbers of patients who completed the therapy and rehabilitation phases were 327 (74%) and 115 (26%), respectively. The median (IQR) visual analogue scale pain scores were 7 (6–9) at entry, 2 (1–3) at completion of therapy and 1 (0–2) at completion of rehabilitation (p < 0.001). The median (IQR) functional disability scores were 32 (22–53) at entry, 15 (6–26) at completion of therapy and 4 (0–14) at completion of rehabilitation (p < 0.001). Conclusion: Low completion rates were observed. Patients who completed therapy reported reduction in pain and improved functionalities.

Prevalence, Factors, and Health Impacts of Chronic Pain Among Community-Dwelling Older Adults in China

BackgroundChronic pain (CP) is prevalent among older adults in many Western countries and its prevalence, factors, and self-reported or objective measured health impacts have been well documented. However, there is limited information on these aspects among Chinese community-dwelling older adults. AimsOur aim was to assess the prevalence of CP and identify its associated factors as well as health impacts among older adults in China. DesignCross-sectional design. SettingsCommunity settings. Participants/SubjectsA total of 1219 community-dwelling adults aged 60 years or older. MethodsData on CP, sociodemographic characteristics, comorbidity, cognitive function, and physical activity, as well as self-reported outcomes (functional disability, depression, quality of sleep, and undernutrition) and objective measured physical function, were obtained. ResultsAmong 1,219 participants, 41.1% reported CP, of whom 16.6% experienced moderate to severe pain. The risk of CP was higher among older women with comorbidity and with depression and lower among older adults with higher educational level as well as with adequate physical activity. CP had significant associations with inadequate physical activity, functional disability, depression, poorer quality of sleep, and undernutrition, as well as worsening physical performance, poorer standing balance, and chair stands. ConclusionsCP is a common problem among Chinese community-dwelling older adults, particularly among the most vulnerable subgroups, and has substantial impacts on self-reported functional disability, depression, poor quality of sleep, and undernutrition, as well as objective measured physical function. Therefore it is relevant for older adults to develop effective CP management programs.

Gender differences in four-year incidence of self-reported and performance-based functional disability: The International Mobility in Aging Study

ObjectivesTo examine differences in incidence of functional disability between older women and men. Methods2002 participants (65–74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016. ResultsIn 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL disability, while 105 (19.2%) developed mobility disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL disability, 117 (26.5%) developed mobility disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL disability (IRR 1.4; 95% CI 1.04–1.88) and mobility disability (IRR 1.4; 95% CI 1.06–1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88–1.32). ConclusionsAlthough women have a higher self-reported incidence of ADL and mobility disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.

Relationships Among Perceived Functional Capacity, Self-Efficacy, and Disability After Dysvascular Amputation

BackgroundProsthesis rehabilitation after dysvascular transtibial amputation (TTA) is focused on optimizing functional capacity with limited emphasis on promoting health self-efficacy. Self-efficacy interventions decrease disability for people living with chronic disease, but the influence of self-efficacy on disability is unknown for people with dysvascular TTA. ObjectivesTo identify if self-efficacy mediates the relationship between self-reported functional capacity and disability after dysvascular TTA. DesignCross-sectional, secondary data analysis. SettingOutpatient rehabilitation facilities. ParticipantsThirty-eight men (63.6 ± 9.1 years old) with dysvascular TTA. MethodsParticipants had been living with an amputation for less than 6 months and using walking as their primary form of locomotion using a prosthesis. The independent variable, functional capacity, was measured using the Prosthesis Evaluation Questionnaire–Mobility Scale (PEQ-MS). The proposed mediator, self-efficacy, was measured with the Self-Efficacy of Managing Chronic Disease questionnaire (SEMCD). Main Outcome MeasureDisability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. ResultsThe relationship between self-reported functional capacity and disability is partially mediated by self-efficacy. Relationships between WHODAS 2.0 and PEQ-MS (r = –0.61), WHODAS 2.0 and SEMCD (r = –0.51), and PEQ-MS and SEMCD (r = 0.44) were significant (P < .01). Controlling for SEMCD (P = .04), the relationship between PEQ-MS and WHODAS 2.0 remained significant (P < .01). Statistically significant mediation was determined by a bootstrap method for the product of coefficients (95% confidence interval: –2.23, –7.39). ConclusionsThis study provides initial evidence that the relationship between self-reported functional capacity and disability is partially mediated by self-efficacy after dysvascular TTA. The longitudinal effect of self-efficacy should be further examined to identify causal pathways of disability after dysvascular amputation. Furthermore, additional factors contributing to the relationship between self-reported functional capacity and disability need to be identified. Level of EvidenceIII

Effect of obesity on self-reported pain and functional disability in patients with knee osteoarthritis in Zaria, North Western Nigeria

Introduction: Osteoarthritis (OA) is the most common causes of arthritis in human, with the knee joint being the most commonly affected. Knee OA patients often present with knee pain and varying degree of functional limitation in activities of daily living. The incidence and prevalence of knee OA increases with age and is poised to increase even further in tandem with an expected increase in life expectancy, rise in population age, and increased prevalence of obesity. Obesity is associated with the occurrence and severity of knee OA, and it is perhaps the most amenable of all knee OA risk factors. The contribution of obesity to pain and functional limitation in Nigerian knee OA patients is not well elucidated. This study aims at ascertaining the burden of obesity in Nigerian knee OA patients with regards to its prevalence, effects on pain, and functional disability. Materials and Methods: Between January 2010 and February 2011, 140 consenting knee OA patients were recruited consecutively, as they presented to the Rheumatology Clinic of Ahmadu Bello University Teaching Hospital, Zaria. Knee OA was diagnosed in patients using American College of Rheumatology clinicoradiographic criteria. Information was collected from patient using a pretested interviewer-administered structured question. Pain, stiffness, and functional disability were determined using Likert version of Western Ontario McMaster Universities Osteoarthritis index (WOMAC). Patients were grouped based on body mass index (BMI) into obese (BMI > 30 kg/m2) and nonobese (BMI

Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage.

BackgroundAnterior cervical discectomy and fusion (ACDF) with a polyetheretherketone (PEEK) cage is considered as the gold standard for patients with cervical disc disease. However, there are limited in vivo data on the impact of ACDF on the cervical kinematics and its association with patient-reported clinical outcomes. The purpose of this study was to investigate the impact of altered cervical sagittal alignment (cervical lordosis) and sagittal range of motion (ROM) on patients’ self-reported pain and functional disability, after ACDF with a PEEK cage.MethodsWe prospectively studied 74 patients, who underwent single-, or consecutive two-level ACDF with a PEEK interbody cage. The clinical outcomes were assessed by using the pain numeric rating scale (NRS) and the neck disability index (NDI). Radiological outcomes included cervical lordosis and C2-C7 sagittal ROM. The outcome measures were collected preoperatively, at the day of patients’ hospital discharge, and also at 6 and 12 months postoperatively.ResultsThere was a statistically significant reduction of the NRS and NDI scores postoperatively at each time point (P < 0.005). Cervical lordosis and also ROM significantly reduced until the last follow-up (P < 0.005). There was significant positive correlation between NRS and NDI preoperatively, as well as at 6 and 12 months postoperatively (P < 0.005). In regard to the ROM and the NDI scores, there was no correlation preoperatively (P = 0.199) or postoperatively (6 months, P = 0.322; 12 months, P = 0.476). Additionally, there was no preoperative (P = 0.134) or postoperative (6 months, P = 0.772; 12 months, P = 0.335) correlation between the NDI scores and cervical lordosis.ConclusionsIn our study, reduction of cervical lordosis and sagittal ROM did not appear to significantly influence on patients’ self-reported disability. Such findings further highlight the greater role of pain level over the mechanical limitations of ACDF with a PEEK cage on patients’ own perceived recovery.

The vulnerability of self-reported disability measures to malingering: a simulated ADHD study

Objective: Making diagnostic and accommodation decisions for potential Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is difficult, as the assessor often relies more on self-reported symptoms and functional disability than in childhood evaluations. Malingering of ADHD occurs frequently in the educational setting and for a variety of reasons, including the potential benefits of access to stimulant medications and academic accommodations. Method: The present study utilized a simulation design to examine the potential for malingering of self-reported functional disability on the World Health Organization Disability Schedule 2.0 (WHODAS). Participants were 167 students from two Midwestern universities. Thirty-six self-reported a previous diagnosis of ADHD, and the remaining 131 students were randomly assigned to one of three conditions: best effort, malingering for the purpose of receiving stimulant medication, or malingering for the purpose of receiving extra time accommodations. Results: Individuals in both malingering groups reported higher levels of disability on all domains of the WHODAS compared to healthy controls and individuals with ADHD. There were no significant differences between malingering groups. Conclusions: Results suggest the WHODAS is susceptible to non-credible responses and should not be relied upon solely as a measure of disability in the context of ADHD evaluations.

Effects of Pilates and trunk strengthening exercises on health-related quality of life in women with chronic low back pain.

Pilates programs are widely used as a form of regular exercise in a broad range of populations investigating their effectiveness for chronic low back pain (CLBP) treatment. The aim of this study was to compare the effects of a Pilates program and a trunk strengthening exercise program on functional disability and health-related quality of life (HRQOL) in women with nonspecific CLBP. A total of 101 volunteer women with CLBP provided data with a 3-month follow-up. They were randomized to either a Pilates (n= 37), trunk strengthening exercise (n= 36) or a control group (n= 28), exercising for a period of 8 weeks, three times a week. Data were collected on HRQOL using the Short-Form 36 Health Survey (SF-36v2), and functional disability using the Roland Morris Disability Questionnaire prior to program initiation, mid-intervention, immediately after program termination, and three months post-intervention. The Pilates participants reported greater improvements on self-reported functional disability and HRQOL compared with participants in the trunk strengthening exercise and control groups (p < 0.05). The effects were retained for a period of three months after program termination for the Pilates group and to a lesser extent for the trunk strengthening exercise group. An 8-week Pilates program improved HRQOL and reduced functional disability more than either a trunk strengthening exercise program or controls among women with CLBP.