Self-report Measures Of Function Research Articles

Psychosocial Factors Associated with Cognitive Function in Prostate Cancer Survivors on Hormonal Treatments: A Systematic Review.

Hormonal treatments (HT) for prostate cancer (e.g., androgen deprivation therapy) yield clinical and survival benefits, yet adverse cognitive changes may be a side effect. Since psychosocial factors are largely modifiable, interventions targeting these factors may help mitigate these adverse cognitive effects. This systematic review aimed to identify a range of psychosocial factors associated with cognitive function in individuals with prostate cancer undergoing HT and to determine whether these factors mitigate or exacerbate this effect. Applying PRISMA guidelines, a comprehensive search of relevant databases conducted in September 2023 using terms related to prostate cancer, hormone therapy, and cognitive outcomes was undertaken. The search yielded 694 unique abstracts, with 11 studies included for analysis examining the relationship between cognitive function and the following psychosocial factors: psychological distress, fatigue, insomnia, and coping processes. Findings were mixed with only two studies reporting significant associations between cognitive performance with fatigue and depression. Three studies that included measures of perceived cognitive function identified associations with depression, anxiety, fatigue, insomnia, illness threat appraisals, and coping styles. However, no studies found evidence for an association between self-reported and objective measures of cognitive functioning. Evidence regarding the association of interpersonal factors is lacking. Moreover, whether these factors mitigate or exacerbate the effect of HT on cognitive function still needs to be determined. Overall, the research exploring the association between psychosocial factors and cognitive function in prostate cancer survivors undergoing HT is still in its infancy. Further research is required to optimize the implementation of neuropsychological interventions for prostate cancer survivors.

Protective Factors in the Context of Childhood Bereavement: Youth Gratitude, Future Orientation, and Purpose in Life.

The objective of the study was to examine potential associations between positive youth development constructs (gratitude, future orientation, purpose in life) and psychological functioning (posttraumatic stress symptoms, depressive symptoms, maladaptive grief reactions) among bereaved youth and test whether these associations vary by age. A diverse sample of 197 clinic-referred bereaved youth (56.2% female; M = 12.36, SD = 3.18; 36.1% Hispanic, 23.7% White, 20.1% Black, 11.9% Multiracial, and 8.2% another race/ethnicity) completed self-report measures of psychological functioning and positive youth development constructs. Linear regression models indicated that gratitude and purpose were associated with lower posttraumatic stress and depressive symptoms among bereaved youth. Future orientation was associated with higher posttraumatic stress symptoms. Results were consistent across age. If replicated longitudinally, gratitude and purpose may be important protective factors against negative mental health outcomes in the aftermath of losing a loved one.

Self-reported Measures of Function Compared to Lower Limb Motor Performance in People With and Without Imaging Evidence of Unilateral Lumbar Nerve Root Compression: A Cross-sectional Study

ObjectiveThe primary objective of the present study was to determine if imaging findings of unilateral lumbar nerve root compression (ULNRC) impact performance on a coordinated motor performance task and to determine if there were correlations between motor performance and self-reported clinical measures. MethodsPeople with back pain (N = 45) were stratified into 3 groups based on combinations of: lumbar imaging; and clinical presentation for ULNRC. Group 1 included people with imaging of lumbar nerve root compression, who presented with neurological deficit. Group 2 people demonstrated imaging evidence of nerve compression, without motor, sensory or reflex change. Group 3 participants possessed only degenerative changes on lumbar imaging films, and were neurologically intact. Performance measures included behavioral and kinematic variables from an established lower limb Fitts’ Task requiring movements to targets of different difficulties. Self-reported measures of disability, function and pain were collected. Analysis of variance for between and within group variables were conducted, and Pearson correlation compared performance with self-reported measures. ResultsAll groups yielded main effects for movement time with increasing task difficulty as predicted by Fitts’ Law. A main effect revealed Group 1 participants performed less accurately than Group 3 participants. Positive correlations were predominantly found between self-report measures and motor performance for Group 2 and Group 3. ConclusionImaging, and self-reported measures alone did not predict function, however, Fitts’ task performance accuracy effectively differentiated groups.

One leg testing in hip and knee osteoarthritis: A comparison with a two-leg oriented functional outcome measure and self-reported functional measures

ObjectiveTo compare the responsiveness of two unilateral lower-limb performance-based tests, the one-leg rise test and the maximal step-up test, with the bilateral 30-second chair-stand test and the self-reported measure of physical function (HOOS/KOOS). Specific aims were to evaluate responsiveness, floor/ceiling effect and association between the instruments. MethodData was included from 111 participants, mean age 61.3 years (8.3), with clinically verified hip or knee osteoarthritis, who reported less than 150 minutes/week of moderate or vigorous intensity physical activity. Responsiveness, how well the instruments captured improvements, was measured as Cohen’s standardised mean difference (SMD) for effect size, and was assessed from baseline to 12 months following a physical activity intervention. Other assessments were floor and ceiling effects, and correlations between tests. ResultsThe maximal step-up test had an effect size of 0.57 (95% CI 0.37, 0.77), the 30-second chair-stand 0.48 (95% CI 0.29, 0.68) and the one-leg rise test 0.12 (95% CI -0.60, 0.31). The one-leg rise test had a floor effect as 72% of the participants scored zero at baseline and 63% at 12 months. The correlation between performance-based tests and questionnaires was considered to be minor, (r= 0.188 to 0.226) (p=0.018 to 0.048). ConclusionThe unilateral maximal step-up test seems more responsive to change in physical function compared to the bilateral 30-second chair-stand test, although the tests did not differ statistically in effect size. The maximal step-up test provides specific information about each leg for the individual and allows for comparison between the legs.

Physical functioning in patients with end-stage knee osteoarthritis: A cross-sectional study in Jordan using self-reported questionnaire and performance-based tests.

Knee osteoarthritis (OA) is a debilitating condition that leads to functional limitations. Self-reported questionnaires and performance-based tests are tools commonly used for measuring physical function. (1) To evaluate the impact of end-stage knee OA on functional outcomes and examine the association between self-reported and performance-based measures of function in patients with end-stage knee osteoarthritis awaiting total knee arthroplasty (2) To explore the interrelationships among pain, strength, and overall physical function in this patient population. In this cross-sectional analysis, 33 patients with end-stage knee OA were recruited and completed the knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and executed performance-based tests including the Timed Up and Go, the 30-second chair stand test, and the Stair Climbing Test. Knee pain, and isometric hip and knee strength were evaluated. Patients perceived deficits in their physical functionwith a score of 35/100 on the KOS-ADLS and demonstrated functional limitations in all performed tasks. KOS-ADLs was weakly associated with TUG and 30s-CST (r=-0.301, p= 0.047, and r= 0.39, p= 0.014. respectively). Knee pain was linked with the KOS-ADL score and GRS score (r=-0.406, p= 0.010; r=-0.343, p= 0.027; respectively), while the strength of the affected side was correlated with the performed (p=< 0.001) and reported function outcomes (p= 0.007). Participants exhibit declines in both perceived and executed functional abilities. Self-reported and performance-based functional measures are weakly correlated within our study group, highlighting the importance of incorporating both measures in clinical practice for a comprehensive evaluation of physical function. Pain was linked to subjective aspect of physical function, while strength was connected to perceived and performed functional capacity. Implementing a tailored rehabilitation program targeting muscle weakness and pain holds the potential to mitigate functional decline in individuals awaiting total knee arthroplasty (TKA).

Influence of psychological factors on the relationship between subjective and objective memory in adults with pharmacoresistant temporal lobe epilepsy

PurposeMany adults with temporal lobe epilepsy (TLE) report subjective cognitive impairment; however, prior studies have shown a discrepancy between these subjective complaints and objective cognitive deficits on neuropsychological measures. Mood disorders/symptoms are also common in TLE and have been linked to greater subjective cognitive difficulties. To further understand these relationships, this retrospective study sought to determine if symptoms of depression and anxiety moderate or mediate the relationship between subjective cognitive impairment and objective cognitive performance in adults with TLE. MethodParticipants were 345 adults (mean age = 40.7; 55 % female) with pharmacoresistant TLE who completed self-report screening measures of depression, anxiety, and subjective cognitive function along with objective memory measures as part of a pre-surgical clinical neuropsychological evaluation. A series of linear regression analyses was conducted to examine the potential moderating and mediating effects of mood on the relationship between subjective and objective memory function after adjusting for relevant covariates. ResultsConsistent with existing literature, self-reported depression and anxiety symptoms were significantly correlated with subjective memory difficulties across all scales (all p < .001). Subjective memory impairment was also significantly correlated with objective memory performance on neuropsychological measures, albeit with small effect sizes (estimate range 0.04-0.20). Contrary to our hypothesis, depression and anxiety did not moderate or mediate the relationship between subjective memory complaints and objective memory performance. ConclusionsWhile symptoms of depression and anxiety were associated with subjective memory ability in this cohort of adults with TLE, this study suggests that mood symptoms do not fully explain the relationship between subjective and objective memory function, likely reflecting the complex and multifactorial relationships among these variables. Nevertheless, our results highlight the importance of screening for depression and anxiety symptoms and assessing patients' subjective memory complaints as part of a neuropsychological evaluation as each of these factors tap into a different aspect of the patient functioning.

Exploring the Utility of the Rorschach Test in Predicting Weight Loss After Bariatric Surgery

Abstract: Bariatric surgery (BS) is an effective approach to treat severe obesity, which should include multidisciplinary care. Prior to surgery, candidates for BS usually undergo a psychological assessment based mostly on self-report of clinical symptoms. However, the results of this assessment are not always sufficient to predict outcomes. Therefore, this study examined the potential of a multimethod approach to assessing patients seeking BS using both self-report and performance-based measures of cognitive and affective functioning. A sample of 50 women who had applied for surgery at a public facility in Brazil were assessed with the Difficulties in Emotion Regulation Scale (DERS), the Rorschach Performance Assessment System (R-PAS), and the Trail Making Test (TMT). Patients who dropped out before treatment ( n = 27) had higher initial body mass index and poorer performance on cognitive flexibility at baseline. In the remaining 23 patients who underwent surgery, indicators of emotional and cognitive functioning from all measures were associated with weight loss (WL) at 6 and 12 months after surgery. However, only R-PAS variables regarding psychological resources were associated with WL 18 months after surgery. We discuss the usefulness of the Rorschach as a source of information for patients seeking BS and the implications for current assessment practices in the field.

An intergenerational service-learning approach to improve hand function in older adults

ABSTRACT Homebound older adults are at greater risk for functional impairments, social isolation, and loss of independence. Adequate hand function is needed to perform many daily activities, yet is understudied, particularly in the homebound population. The purpose of this study was to pilot test an intergenerational program in which pre-health college students were trained to deliver hand exercises to homebound older adults receiving Meals on Wheels (MOW) services. Eight MOW clients (mean age: 80.1 ± 12.9y) and 17 students completed the program. Students visited clients 2×/week for 6 weeks and engaged in hand exercises and meaningful conversations. Measures of hand strength, dexterity, self-reported function, self-efficacy, depression, and social isolation were taken before and after the program. Clients and students also completed a post-program experience survey. Significant improvements in pinch strength were observed, and 75% of clients reported better upper limb mobility after training. Survey feedback was positive with clients saying they enjoyed interacting with college students, while students praised the hands-on nature of the program and engagement with older adults. Results from this pilot study demonstrate an intergenerational approach to deliver hand training is feasible and underscores the value of using such models to increase access to care for homebound older adults.

An Incomplete Model of Disability: Discrepancies Between Performance-Based and Self-Reported Measures of Functioning.

Appropriate conceptualization and measurement of disability are critical for population-focused resource allocation and policy development. Self-reported and performance-based measures of functioning have been used to represent disability. Variation in environmental context or self-perception of ability may influence self-reports; however, performance-based measures that attempt to control environmental context may not accurately capture real-world aspects of functioning. This study examined the agreement between self-report and performance-based measures of functioning within 4 domains among older adults. Cross-sectional data from the 2021 National Health and Aging Trends Study was used. Self-reported and performance-based measures of functioning were assessed for vision, hearing, mobility, and memory domains. We examined the diagnostic characteristics of performance-based versus self-reported measures using sensitivity, specificity, and receiver operating characteristics curves. Differences in the agreement of these measures across sociodemographic groups were investigated using logistic regression. Among 2442 respondents 71 years and older (mean 78.5±5.3, 56% female participants), performance measures of hearing and mobility had high sensitivity (89% and 91%, respectively) and low/moderate specificity (36% and 63%, respectively). The sensitivity and specificity of vision measures were 71%. Memory measures had high specificity (89%) and low sensitivity (28%). Performance-based discrimination ranged from 0.59 (memory) to 0.78 (mobility). Agreement varied across sociodemographic factors. Performance measures diverge from self-reported functioning among older adults. Discordance may reveal opportunities for environmental intervention where participants' performance does not capture the full extent of barriers in their daily lives. Additional research is needed to investigate individual and environmental factors which could explain the observed differences.

3 Neuropsychiatric Change and Childhood Adversity Levels in an Opioid Treatment Population

Objective:Early life adversity is strongly correlated with a number of negative health outcomes, with some of the highest risks are related to later illicit drug use and substance use disorders (SUDs). Specifically, it has been found that an ACEs score of &gt;4 confers a 7-10-fold risk of substance abuse. Subsequent research has identified a number of neurobiological effects of childhood trauma, including structural and functional disruptions of the LHPA axis, the brain's primary stress-response system. It has been hypothesized that various trauma-induced neurobiological changes may lead to later physical health, mental health, and psychosocial problems in persons with early life adversity. One area that such changes might affect is a person's ability to stop abusing substances, with factors such as trauma-related mood, self-efficacy, or cognitive functioning as considerations in early treatment success. This study followed a group of participants in a residential substance abuse treatment program across their first month of abstinence, to assess natural change in cognitive performance as well as potential effect of early life adversity on changes in neuropsychiatric outcomes.Participants and Methods:Participants were 37 adults (mean age=33.9 years, SD=6.7) who had completed detoxification and were first assessed during their first week of residential treatment. Follow-up assessment was completed 4 weeks later. Participants were primarily male (62%) and white (62%). They were all in treatment for opioid abuse, with a majority of participants reporting a history of polysubstance abuse. To measure adverse and protective factors, participants completed the Adverse Childhood Experiences scale and Protective And Compensatory Experiences Scale at baseline. Participants also completed the NIH Toolbox cognition battery and a set of self-report measures of cognitive functioning, mood, anxiety, and self-efficacy at baseline and follow up.Results:Results of paired samples t-test comparison between baseline and follow-up testing found a significant improvement in self-reported depression symptoms, anxiety symptoms, and self-efficacy (all p&lt;.001). Interestingly, participants overall reported an increase in cognitive problems between baseline and retest, even though on objective cognitive testing (NIH Toolbox cognition battery) there was significant improvement in cognitive performance. Participants generally had a high level of childhood adversity (mean ACE score of 4.5), with an average level of childhood compensatory experiences. Considering the specific effect for childhood adversity, ACE score was found to be predictive in amount of anxiety and self-reported cognitive change but not for objective cognitive performance or change in other factors.Conclusions:Consistent with previous research, these patients had a high level of past trauma, which interacted with a number of other neuropsychiatric measures and support the importance of assessing for trauma history and integrating trauma-focused treatment into substance abuse treatment programs.

43 Mood and Everyday Function in Older Adults: Analyses of Self-report and Performance-based Measures of Everyday Function

Objective:The relation between depressed mood and functional difficulties in older adults has been demonstrated in studies using self-report measures and has been interpreted as evidence for low mood negatively impacting everyday functional abilities. However, few studies have directly examined the relation between mood and everyday function using performance-based tests. This study included a standardized, performance-based measure of everyday action (Naturalistic Action Task, NAT) to test the prediction that report of depression symptoms are associated with self-report and performance-based tests of everyday function. Associations with anxiety symptoms and motivation/grit and everyday function also were explored.Participants and Methods:68 older adults without dementia were screened and recruited (n = 55, M age = 74.21, SD= 6.80, age range = 65 to 98) from the community and completed self-report measures of depression symptoms (GDS), anxiety (GAI), motivation (Short Grit-S), and everyday functioning (FAQ). Participants also performed the NAT, which requires completion of a breakfast and lunch task and is scored for task accomplishment, errors (micro-errors, overt, motor), and total time. Additionally, an informant also reported on the participant’s everyday function. Spearman correlations were performed and results showing a medium effect size or greater are reported.Results:Participant mood (GDS) was associated with self-reported function (FAQ; r =.45) but not performance-based measures of everyday function (NAT). Self-reported anxiety and motivation were not meaningfully associated with either self-reported or performance-based everyday function. Participant self-report (FAQ) and informant report of participant’s function (IFAQ) supported the validity of performance-based assessment as both were meaningfully associated with NAT performance (FAQ x NAT overt errors r = .34; I-FAQ x NAT micro-errors r = .34; I-FAQ x NAT motor errors r = .49).Conclusions:Mood, but not anxiety or motivation, was associated with self-reported everyday function but not performance-based function. When considered alongside the meaningful relations between self/informant-report of function and everyday task performance, results suggest mood does not impact everyday function abilities in community-dwelling older adults without dementia. We suggest that frameworks to be reconceptualized to consider the potential for mild functional difficulties to negatively impact mood in older adults without dementia. Additionally, interventions and compensatory strategies designed to improve everyday function should examine the impact on mood outcomes.

Functional brain connectivity during social attention predicts individual differences insocial skill.

Social attention involves selectively attending to and encoding socially relevant information. We investigated the neural systems underlying the wide range of variability in both social attention ability and social experience in a neurotypical sample. Participants performed a selective social attention task, while undergoing fMRI and completed self-report measures of social functioning. Using connectome-based predictive modeling, we demonstrated that individual differences in whole-brain functional connectivity patterns during selective attention to faces predicted task performance. Individuals with more cerebellar-occipital connectivity performed better on the social attention task, suggesting more efficient social information processing. Then, we estimated latent communities of autistic and socially anxious traits using exploratory graph analysis to decompose heterogeneity in social functioning between individuals. Connectivity strength within the identified social attention network was associated with social skills, such that more temporal-parietal connectivity predicted fewer challenges with social communication and interaction. These findings demonstrate that individual differences in functional connectivity strength during a selective social attention task are related to varying levels of self-reported social skill.

Low household income, financial literacy, or financial health: Which is the strongest risk factor and outcome of depressive symptomatology?

BackgroundDepression's relations to psychosocial processes are complex, bidirectional, and include financial functioning. The current study compared the extent to which household income, financial literacy (knowledge and skill), and financial health (saving, spending, borrowing, and planning behavior) were risk factors and outcomes of depression. MethodsA United States national sample of working-aged adults (N = 6565) completed self-report measures of financial functioning and depression in years 2020 and 2022. Depression scales assessed both negative (depressive symptoms) and positive (life satisfaction) affective dimensions. ResultsLower income, less financial literacy, and especially poorer financial health correlated significantly with more depressive symptoms and lower life satisfaction. Poorer financial health demonstrated the strongest prospective relations with increasing depressive symptoms and decreasing life satisfaction over the two-year retest interval. In parallel, higher depressive symptoms and lower life satisfaction each predicted subsequent decreases in financial health. LimitationsResults from this longitudinal, observational study suggested but could not establish causal connections between depression and financial functioning. The study's novel results require replication before clinical application. ConclusionsMore so than low income or limited financial literacy, poor financial health is both a risk factor and potential outcome of depression, including more depressive symptoms and lower life satisfaction. If these findings are replicated, financial health may be an important research and clinical target for depression assessment, prevention, and treatment.

Lower-Socioeconomic Status Patients Have Extremely High-Risk Factor Profiles on Entry to Cardiac Rehabilitation.

Patients with lower socioeconomic status (SES) have higher rates of cardiovascular events, yet are less likely to engage in secondary prevention such as cardiac rehabilitation (CR). Given the low number of lower-SES patients entering CR, characterization of this population has been difficult. Our CR program specifically increased recruitment of lower-SES patients, allowing for careful comparison of medical, psychosocial, and behavioral risk factors between lower- and higher-SES patients eligible for secondary prevention. Demographic and clinical characteristics were prospectively gathered on consecutive individuals entering phase 2 CR from January 2014 to December 2022. Patients were classified as lower SES if they had Medicaid insurance. Statistical methods included chi-square and nonpaired t tests. A P value of <.01 was used to determine significance. The entire cohort consisted of 3131 individuals. Compared with higher-SES patients, lower-SES individuals (n = 405; 13%) were a decade younger (57.1 ± 10.4 vs 67.2 ± 11.2 yr), 5.8 times more likely to be current smokers (29 vs 5%), 1.7 times more likely to have elevated depressive symptoms, and significantly higher body mass index, waist circumference, and glycated hemoglobin A 1c , with more abnormal lipid profiles (all P s < .001). Despite being a decade younger, lower-SES patients had lower measures of cardiorespiratory fitness and self-reported physical function (both P s < .001). Lower-SES patients have a remarkably prominent high-risk cardiovascular disease profile, resulting in a substantially higher risk for a recurrent coronary event than higher-SES patients. Accordingly, efforts must be made to engage this high-risk population in CR. It is incumbent on CR programs to ensure that they are appropriately equipped to intervene on modifiable risk factors such as low cardiorespiratory fitness, obesity, depression, and smoking.

Religiosity does not prevent cognitive declines: Cross-sectional and longitudinal evidence from the Survey of Health, Aging and Retirement in Europe

Over the past hundred years, a plethora of studies on intelligence and religiosity associations predominantly yielded evidence for a meaningful negative relation between these two variables. However, effect strengths varied substantially between primary studies and it has been suggested that religiosity and intelligence associations change as people age, because religiosity may play a protective role for cognitive abilities in elderly individuals. Consequently, it has been suggested that negative intelligence and religiosity associations may decline in strength or even reverse signs as people age. Therefore, we examine here cross-sectional associations of self-reported religious behaviors and several measures of cognitive function (numeracy, verbal fluency, memory and a proxy of psychometric g) as well as their cross-temporal changes in respondents from 11 European countries and Israel aged 50+ years (N = 30,424) in three waves of the Survey of Health, Aging, and Retirement in Europe (SHARE). As expected, cognitive function scores were meaningfully negatively related to praying whilst associations with participation in religious services were trivial. Cross-lagged panel analyses yielded consistently negative, albeit small, effects of both intelligence on praying and of praying on intelligence. Multilevel random-intercept regressions showed tentative evidence for faster cognitive declines in more religious people for numeracy and g, but not for verbal fluency and memory. No conclusive evidence for a moderation by societal values of religiosity could be found. In all, our evidence shows a negative, non-trivial association between intelligence and religiosity in elderly participants which remains longitudinally robust. These findings corroborate the generality of the small negative intelligence and religiosity association.

Self-reported symptoms of everyday executive dysfunction, daytime sleepiness, and fatigue and health status among adults with congenital aniridia: a descriptive study

ABSTRACT Background Congenital aniridia is a rare genetic disorder of the eye characterized by visual impairment and progressive vision loss. While prior research has focused on ocular manifestations in individuals with aniridia, there is a dearth of research on impacts on cognition and mental health. The aims of this study were to describe subjective symptoms of everyday executive functioning, fatigue and sleepiness in adults with aniridia and to compare self-reported health status with that of a normative reference group. Methods Twenty-nine adults (aged 18–79 years) with congenital aniridia were included in this online survey, of whom 52% were females. Participants completed self-report measures of executive functioning (The Behavior Rating Inventory of Executive Function–Adult Version), sleepiness, fatigue, and health status (EQ-5D-5L). Results Participants reported relatively few problems in everyday executive functioning, with only 14% experiencing impaired executive functioning. Scores on the five EQ-5D-5L domains (mobility, self-care, usual activities, pain, and anxiety/depression) did not differ from those of the normative reference group. The frequencies of excessive daytime sleepiness and severe fatigue were 17% and 38%, respectively. Ocular pain was experienced by 62% of participants. Conclusions The findings show that cognitive problems are related to and reflect self-reported health status and extent of fatigue. Moreover, those who suffered from ocular pain reported more difficulties with executive functioning, sleepiness and fatigue. These findings are important for understanding this disorder and supporting patients.

Effects of HiBalance training program on physical function of individuals with idiopathic Parkinson disease: a systematic review and meta-analysis.

The effectiveness of the HiBalance training program for individuals with Parkinson disease (PD) remains debated, prompting a systematic investigation. This study aims to assess whether the HiBalance training program yields favorable outcomes on physical function and self-reported function measures in PD individuals. A systematic search across PubMed, Cochrane Library, Ovid, Scopus, and PEDro databases identified studies exploring HiBalance training's impact on physical function in idiopathic PD. Publication date restrictions were not applied. Two independent reviewers evaluated bias risk using the Cochrane Risk of Bias tool and study quality using the PEDro scale. Effect size (standardized mean difference, SMD) and heterogeneity (Higgins I2) were determined. Six studies underwent qualitative analysis, with two randomized-controlled trials and one multi-center clinical trial being included in the meta-analysis. HiBalance training exhibited a significant impact on physical function (SMD = 0.49; P = 0.0003). The Mini-BESTest score and gait velocity displayed improvements with moderate-effect sizes. However, solely gait velocity showed clinical enhancement. Yet, these benefits did not remain at the 6- and 12-month follow-ups post-intervention. Self-reported function measures showed no alteration post-HiBalance training. Publication bias was absent. HiBalance training led to clinically significant improvements solely in gait velocity, though these gains waned over time. The findings suggest the necessity of refining the HiBalance program to sustain positive outcomes and ensure lasting enhancements. This underscores the importance of post-HiBalance training exercise programs to maintain benefits in the long term. The protocol of this review and meta-analysis was registered at PROSPERO (CRD42022325649). Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022325649 .

Predictors of performance and perceived fatigability in people with multiple sclerosis

ABSTRACT Background and Objective Fatigability is a distinct construct from fatigue that has been reported to contribute to activity limitations in people with multiple sclerosis (PwMS). Identifying predictors of performance and perceived fatigability may guide the development of interventions to mitigate fatigability. This study investigated predictors of performance and perceived fatigability among PwMS. Methods PwMS (N = 51) completed self-report measures of demographics, clinical history, symptoms severity (Modified Fatigue Impact Scale), and functioning (PROMIS Physical Function and PROMIS Cognitive Function Abilities). Performance fatigability measures included Ambulatory Fatigue Index (AFI), Deceleration Index (DI), and Distance Walking Index (DWI). Perceived fatigability measures included Pittsburgh Fatigability Scale (PFS), Perceived Physical Exertion, and Perceived Fatigue Intensity. Performance and perceived fatigability measures were calculated based on the Timed 25-Foot Walk Test and the 6-Minute Walk Test. Results Multivariable linear regression analyses indicated that PROMIS Cognitive Function was a significant independent predictor of performance fatigability measured with AFI (β = -0.515, p = 0.007), DI (β = -0.511, p = 0.008), and DWI (β = -0.516, p = 0.007). Regarding perceived fatigability, PROMIS Pain Intensity predicted Perceived Fatigue Intensity (β = 0.325, p = 0.035). PROMIS Physical Function predicted PFS Mental fatigability (β = -0.503, p < 0.001). PROMIS Physical Function (β = -0.619, p < 0.001) and Cognitive Function (β = -0.249, p = 0.037) predicted PFS Physical fatigability. Conclusions Preliminary findings suggest that self-reported functioning levels, including physical and perceived cognitive function, are potential predictors of performance and perceived fatigability in MS. Notably, perceived fatigue impact showed no association with performance or perceived fatigability. Future studies are warranted to confirm and extend our findings.

Incremental Contribution of the Minnesota Multiphasic Personality Inventory - 3 to Predicting One-Year Postoperative Spinal Cord Surgery/Spinal Cord Stimulation Outcomes.

Pre-surgical psychological assessments are becoming common in the United States and are recommended or required prior to surgical/spinal cord stimulator intervention for chronic back pain. Psychological testing is often recommended for these evaluations and the various versions of the Minnesota Multiphasic Personality Inventory (MMPI) have demonstrated utility for predicting outcomes in this setting. This investigation sought to extend that literature with the newest version of the MMPI, the MMPI-3. The sample comprised of 909 patients (50.5% men, 49.5% women) who consented to participating in an outcome study and took the MMPI-3 along with other self-report measures of pain, functional disability, and emotional functioning prior to surgery as part of their pre-surgical psychological assessment. Self-report measures of pain, functional disability, and emotional functioning were administered again one-year following the intervention. MMPI-3 scale scores accounted for up to 9% of additional variance in the outcomes after controlling for pre-surgical measures. Measures of emotional/internalizing dysfunction, somatic dysfunction, and, to a lesser extent, behavioral/externalizing dysfunction contributed the most to the prediction of poorer outcomes.

How does change occur in psychotherapy? Innovative moments predict stronger therapeutic alliance and functional improvement in a psychodynamic case study

Innovative moments (IMs) in psychotherapy contradict or challenge clients’ maladaptive patterns of meaning associated with their suffering. IMs are receiving increased theoretical and empirical attention in psychotherapy research and are associated with symptomatic improvement. However, little is known about possible predictors of IMs and their impact beyond their association with outcomes. A therapeutic alliance (TA) that implies a collaborative bond between clients and therapists might set the stage for the occurrence of IMs. Additionally, the occurrence of IMs could serve as a relational experience within the session that strengthens the TA. Thus, in the present study, we examined the association over time between IMs and (i) TA, and (ii) functioning, in a time-limited case study with a good outcome. Furthermore, this study is one of the first to explore IMs in psychodynamic therapy (PDT). Transcriptions of ten randomly selected sessions of PDT of a 43-year-old male with dysthymia were coded using the innovative moment coding system. Self-report measures of function and TA were collected at each session. Data were analyzed using simulation modeling analysis. Consistent with good-outcome cases in other therapeutic approaches, high-level IMs (H-IMs) increased while low-level IMs (L-IMs) decreased throughout treatment. H-IMs predicted a change in functioning in the following session. Finally, H-IMs were associated with higher TA post-session, and specifically with agreement on treatment tasks. To conclude, moments of change in the client’s pattern of meaning are related to stronger TA and better treatment outcome. If replicated, these findings may provide important insights regarding the unfolding of therapeutic change.